Midwives in the NHS

Rachael Maskell Excerpts

Monday 17th January 2022 Commons Chamber

[Siobhan Baillie]

I could not agree more with both interventions. I think we are going to hear more from other Members about continuity of care, which is the way to manage pregnancy and how most midwives want to work. But that can be achieved in many hospitals and many midwife teams only if we have the staffing. Given the numbers at the moment, this is a key issue.

[Rachael Maskell (York Central) (Lab/Co-op)]

I am grateful to the hon. Member for securing today’s debate and also wish her well with her pregnancy.

I have spoken to midwives in York and visited maternity services. Many women find that they are diverted from York to other maternity services at the time of delivery—clearly, very stressful for them—because we just do not have adequate staffing. Does the hon. Member not agree that we need a proper workforce plan to ensure that women have the safety that they require through their pregnancy and particularly at the time of birth?

[Siobhan Baillie]

I think what we will hear from the Government is that there is a plan for recruitment, but we need more details. The Royal College of Midwives is certainly asking questions. My right hon. Friend the Member for South West Surrey (Jeremy Hunt) knows from the work of the Health and Social Care Committee that when the current Culture Secretary was maternity services Minister last year, she was incredibly passionate about this issue. She accepted that the NHS was short of the equivalent of 1,932 full-time midwives—but since then, sadly, the number has fallen by a further 222, leaving the shortage at over 2,000. Since records began in 2009, the number of NHS midwives has fallen in England year on year. We are in a really difficult situation at the moment.

To put this into perspective, there were more than 613,000 births in England and Wales in 2020. At the last count of midwives in 2021, there were 26,901 in England, but that drops to 22,301 if we look at part-time figures. By looking at the birth rate and the number of midwives, we can see just how stretched midwives are.

The Association for Improvements in Maternity Services says that

“urgent action is certainly needed to shore up what seems to be a maternity service that is losing staff at a catastrophic rate.”

Over half of midwives surveyed by the Royal College of Midwives say they are considering leaving their job. I know personally a wonderful midwife, Stevie, who has chosen to retire this year, and I wonder how many midwives are making the same choice. My mother, who is a nurse, not a midwife, is choosing to retire as well. They have had a pretty tough two years in the NHS, as we know, but the most worrying feature of the RCM survey, which the hon. Member for Strangford (Jim Shannon) mentioned, is that the highest levels of dissatisfaction are among newer midwives—those who have spent five years or less working in the NHS. So we have a pipeline problem, a new intake problem and a problem with retention of experienced staff.

Vaccination Strategy

Rachael Maskell Excerpts

Wednesday 12th January 2022 Commons Chamber

[Maggie Throup]

It is important to go back to some of the stats I set out earlier. Those who are unvaccinated are eight times more likely to be hospitalised, and more than 60% of people in intensive care units are unvaccinated. If we can stop people getting the virus in the first place, it will not be transmitted and people will not catch the disease and be hospitalised. It is important to note that it was the will of the House to introduce that policy in December. As I have said repeatedly, the JCVI keeps all the data under constant review, which obviously has an impact on Government policy.

[Rachael Maskell (York Central) (Lab/Co-op)]

I wish to follow the question raised by the right hon. Member for South West Wiltshire (Dr Murrison), because the reality is that the facts have changed, and depleting efficacy, as well as transmissibility, is presenting a challenge for the Government and their longer term management of covid. Rather than forcing NHS staff to have their first vaccine by 3 February, which will present a massive risk to the NHS—the Government’s own assessment is that between 64,000 and 115,000 NHS and healthcare staff will be sacked—will the Government go back and review the issue, and ask the JCVI what the best strategy is for managing the pandemic from this point forward?

[Maggie Throup]

We have our plans in place. We have our vaccination programme, our testing, and our antivirals. Part of the purpose of the vaccination programme is to ensure that some of the most vulnerable in our society are protected. As I said earlier, having the vaccine as a condition of employment is about patient safety and ensuring that people who are in hospital or care homes are protected from this deadly virus.

Public Health

Rachael Maskell Excerpts

Tuesday 14th December 2021 Commons Chamber

[Sajid Javid]

We all want to relax. I wish I was more relaxed now than I already am. My hon. Friend is absolutely right on that, and I agree with him.

[Rachael Maskell (York Central) (Lab/Co-op)]

I appreciate that this is an escalating situation which needs urgent attention, but the fact is that if we are enabling social mixing, that is the very context in which we will see transmission, as we did with delta last December. Will the Secretary of State review these measures, as it seems that the statutory instruments before us today are already out of date?

[Sajid Javid]

It is of course important that we keep measures under review, but, for the reasons I gave earlier, I will continue to present this set of measures to the House. They strike the right balance and are a proportionate response.

--- Later in debate ---

[Rachael Maskell (York Central) (Lab/Co-op)]

I rise to express my serious concerns about the principle of mandatory vaccination, not for any ideological reasons but because it will have the contrary effect to that intended and therefore is wrong.

My concerns are first and foremost for public safety and also patient safety. That is the analysis I bring; having worked in the NHS for 20 years as a clinician, that is drilled into us from day one. The Government’s lack of strategy in managing this pandemic is astounding and they must understand that we need to get ahead of the virus in order to lock it down, as opposed to locking people, and their futures, down. A lack of consistency also continually comes through their policies. They cannot have it both ways; there must be one approach that carries that thread of containing the virus. They cannot say to one venue that they are are going to lock it down but tell another venue it has all the freedoms it needs, because that simply does not work; in fact, it is dangerous, and therefore the Government need to get a grip.

The very people we revered—who just a year ago we were clapping and calling our heroes—are the very people who are now exhausted, traumatised and frightened, and the legislation before us will sack them. For two decades I was their colleague and I know the dedication, compassion and care they give to their patients; I was their trade union leader and I know their professionalism and the sacrifice they give for the people they care for. I will not undermine that trusted relationship, which is absolutely essential in delivering healthcare in our country, and I will not ride roughshod over Labour’s NHS constitution, which pledges to assist people to participate fully in their own healthcare decisions and to support them in decision making. I will not turn my back on working people, and I will never forget my roots and those I served alongside. While the Prime Minister partied, NHS workers put on layers of personal protective equipment and fought for lives. That is what those in the NHS do: you make sacrifices and while traumatised you just keep going.

[Jeremy Corbyn (Islington North) (Ind)]

My Friend’s excellent work as a trade union leader in the NHS is well understood. She is speaking on behalf of NHS workers; has she any idea how many will be affected by this totally wrong attempt to force vaccinations and passports on people?

[Rachael Maskell]

I am grateful to my hon. Friend for making that intervention and he makes a point I wanted to make myself. The Government’s estimate on that in their impact assessment is 123,000, and even in the best-case scenario 62,000 will lose their jobs, which the NHS simply cannot afford.

[Ms Rimmer]

My hon. Friend knows about health and care workers—

[Ms Rimmer]

I apologise. I know my hon. Friend knows about care and health workers so she knows how dedicated they are; they have a vocation. Does my hon. Friend agree that the Government can and should stop going too far? Let us not break the trust between patient and worker and between Government. Let us go down the route, which has been proven to work, of persuasion and education, and ask them and work with them to distil the fear.

[Rachael Maskell]

I thank my hon. Friend, who represents her constituents so well. There is an alternative path and we can take it today. We know that the Prime Minister is allowing people to go to pubs and clubs unmasked, while he is sacking NHS staff who are wearing full PPE and testing. Some 93% of NHS staff are vaccinated; figures from the Office for National Statistics show that 4% of people are vaccine-hesitant, which rises to 21% among minoritised communities. As 22.1% of NHS staff are from minoritised communities, the regulations will target black workers. In fact, 26.8% of workers of mixed race are not vaccinated; that is in the Government’s impact assessment, which also gives the figures for black workers. The regulations therefore indirectly discriminate against black workers.

Unvaccinated staff are frightened. On Friday, I spoke to someone in my constituency who has worked for the NHS for 16 years. Her father had a vaccine. His heart stopped. Miraculously, NHS workers brought him back to life; he is now in a critical condition. She is frightened. She tests; she wears PPE; she has sacrificed everything. She will be sacked.

I want all NHS and care staff to have vaccine counselling and education with a qualified practitioner who holds the right competencies so that concerns can be explored, not with line managers, who just do not have the competencies. I want everyone to be vaccinated—I cannot stress that enough—but I want to win the trust of staff, not push them further away, as the Government’s approach will. In York, where we have focused on those trusted conversations, we have seen 99% of our social care staff vaccinated. It just shows what works and what makes the difference.

We do not want to push people further away. We want to bring them in, win their trust and win their confidence, because we will have to ask more from our health and care staff as things get harder—we certainly will if there are fewer people to deliver the service. Let us do what works—enforcement never does. The regulations are vaccine-illiterate.

If 123,000 people lose their job in the midst of a health and care crisis, it will be catastrophic, not least as people are starting to hand in their notice now. Why go through another tough winter of trauma when we do not have to? The regulations will make it worse. We know that two vaccines, or even three, will reduce transmission of the virus, so get your jabs! But they will not stop transmission, so let us move to better PPE, FFP3 masks, daily testing and better biosecurity. Rather than pushing the regulations today, I urge the Government to go away and come back to the House with a plan for us to vote on in January. That is good governance and the way forward.

As a trade unionist, I am not prepared to be complicit in the sacking of our NHS and care staff. Trade unionists fight for working people; we are never complicit in writing their P45. As a trade unionist, I came to this place to fight for working people. I therefore urge that we change course and put staff and the care that they have for their patients first.

Covid-19 Update

Rachael Maskell Excerpts

Monday 13th December 2021 Commons Chamber

[Sajid Javid]

We will debate the SI in the House, and I shall be happy to talk more about it then, but I think that the number to which my hon. Friend referred is the number of people whom the NHS estimated to remain unvaccinated at the time when the Government said they were going ahead with the SI. I am pleased to inform her that since then the number has fallen. Tomorrow I will come to the House with the latest figure that we have, but it is improving all the time. When we introduced a similar measure in the residential care home sector, we saw the number of unvaccinated people fall day by day as more and more of them had positive engagement and took up the offer of a vaccine.

[Rachael Maskell (York Central) (Lab/Co-op)]

When the transmission rate of omicron is twice that of delta and we are asking people to work from home, why are we also telling them that they can go out and socialise in venues unmasked, although the contact tracing data from last December shows that it is in those social spaces that there are high levels of transmission?

[Sajid Javid]

This is about having a balanced and proportionate response, and that is the approach that the Government have taken. It is about recognising that while these restrictions help to slow the rate of spread, they also have a real impact on people’s lives.

Covid-19 Update

Rachael Maskell Excerpts

Monday 6th December 2021 Commons Chamber

[Sajid Javid]

Yes, I am happy to give that commitment to my right hon. Friend, for all the excellent reasons he gives. We were absolutely right, back at the start of the summer, to open up our country, including removing travel restrictions. That is one of the reasons, with regard to the dominant delta variant, why the UK is in a much better position than many other European countries today.

[Rachael Maskell (York Central) (Lab/Co-op)]

When it comes to public health compliance, consistency and clarity of message is important. The variant does not understand the difference between an indoor setting on transport or another indoor sitting, so why can the Secretary of State not ensure that all indoor sittings have the same rules applied to them?

[Sajid Javid]

I believe that the response we have had is balanced and proportionate.

Public Health

Rachael Maskell Excerpts

Tuesday 30th November 2021 Commons Chamber

[Maggie Throup]

As my right hon. Friend said, the Prime Minister said that we are putting these measures in place, about which I will speak more. I cannot speak for any other person who goes on the airwaves.

[Rachael Maskell (York Central) (Lab/Co-op)]

Dr Harries is a public health professional who therefore understands what public health measures need to be taken to secure our wellbeing against the pandemic. Why are the Government not listening to what public health professionals are advising?

[Maggie Throup]

I reassure the hon. Lady that we listen to the advice of health professionals all the time, but today we are debating statutory instruments on face coverings and self-isolation following travel.

--- Later in debate ---

[Maggie Throup]

I must make progress.

Given the potential severity of the consequences of not responding swiftly to this new variant, the Government have taken decisive action to bring back compulsory face-covering wearing in an array of settings. Face coverings are again compulsory in shops and on public transport, unless an individual has a medical exemption or a reasonable excuse.

[Rachael Maskell]

On that point—

[Maggie Throup]

I will continue.

The requirement to wear face coverings is not new. We have asked people to do their bit to stop the spread of the virus before, so we are again asking people to play their part, this time to help slow down any transmission of this new variant of concern.

--- Later in debate ---

[Alex Norris]

The hon. Gentleman’s question makes me think he has some plans to book; if he is trying to book a weekend away, he should not let me set those dates for him.

Turning to the regulations, and starting with the Health Protection (Coronavirus, Wearing of Face Coverings) (England) Regulations 2021 (S.I., 2021, No. 1340), it is right to reintroduce masks on public transport, in shops and other settings including banks, hairdressers and post offices for those who are not exempt. This measure should never have been abandoned. While mask wearing in public spaces forms part of the Government’s plan B, it was always part of the Opposition’s plan A rather than an emergency measure, as was encouraging working from home where possible.

[Rachael Maskell]

I am slightly confused by these measures, because the risks are the same in any indoor setting; whether on public transport, in a shop or in some other indoor space, the risks still exist. Can my hon. Friend tease out why there is an inconsistency in these regulations?

[Alex Norris]

My hon. Friend makes a good point that I will cover shortly. Of course the measure should apply to public transport and shops—and also to the House of Commons Chamber, but I will get to that shortly.

Covid-19 Update

Rachael Maskell Excerpts

Monday 29th November 2021 Commons Chamber

[Rachael Maskell (York Central) (Lab/Co-op)]

Without in-country manufacturing of the vaccine in the global south, we will never get the protection that we need against this pandemic, and no matter how many donations the Government make, supplies will never meet the demand. Will the Secretary of State therefore look again at the issue of in-country manufacturing, whether that involves release of the patent or other mechanisms, so that we can see a proper scaling up of the delivery of the vaccine in the global south?

[Sajid Javid]

The hon. Lady is right to talk about the importance of in-country manufacturing in the developing world. She will know that India, for example, is one of the largest manufacturers of vaccines, including the covid-19 vaccine, but she rightly points out that this capacity needs to grow and become available in other countries, and it is right to look to see how we can support that.

Covid-19 Update

Rachael Maskell Excerpts

Friday 26th November 2021 Commons Chamber

[Sajid Javid]

As always, the analysis provided by my right hon. Friend is absolutely correct. On the severity of the new variant, I am afraid we do not know enough yet. From what we can tell from what we might call a desktop analysis, the number of mutations that have been identified—double those for the Delta variant—does indicate that there is a possibility that it might have a different impact on an individual, should they get infected. But as I said earlier, there is a lot we do not know about it and we are working with our international partners to find out more.

[Rachael Maskell (York Central) (Lab/Co-op)]

I thank the Secretary of State for his statement and for emphasising the importance of vaccination. However, his statement makes it clear that we are seeing new variants and the risks still remain. Therefore, taking further public health measures is really important. I ask him again to give clear leadership on ensuring that face coverings, social distancing and high levels of hygiene are instituted, as well as better ventilation. Those measures make a difference, as we have seen throughout the past two years.

[Sajid Javid]

The hon. Lady makes a good point about the need to follow guidance and the rules currently in place. The plan A policies that we put in place remain the policies we need at this time, but she will not be surprised to know that we keep them under review and, if we need to go further, we will.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Sajid Javid]

My right hon. Friend has raised this issue with me before, but he is right to raise it again, because proper use of data is important to the future of the NHS. He may have noted our announcement yesterday that we are merging NHS Digital and NHSX with NHS England, which will enable us to do a much better job with data. I will of course look carefully at that report, and I should be happy to meet him to discuss it further.

[Rachael Maskell (York Central) (Lab/Co-op)]

Poppy is just eight. She has severe epilepsy, with ever more frequent and enduring episodes. Her specialist consultant has said that surgery is her only hope, but Sheffield and Leeds have refused to assess her for capacity and administration reasons, not clinical reasons. Will the Minister work with me to ensure that Poppy receives the treatment that she needs?

[Sajid Javid]

I am sorry to hear about the hon. Lady’s constituent, and of course a Minister will meet her.

Health and Care Bill

Rachael Maskell Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Rachael Maskell (York Central) (Lab/Co-op)]

Fifteen years is a long time in workforce planning. The make-up of the workforce could change significantly over that time, not least as we are trying to address some real workforce crises now. Will the Minister put in place a road map to fill those vacancies over that time, and interim reports so that we can review progress?

[Edward Argar]

I set out the commissioning of the 15-year framework to look at need. Within that, the House will be regularly updated, as happens now—not least in oral questions, as we saw in the session preceding this debate—with plenty of opportunities for Members to challenge the Government and to see updates. There is also the regular publication of figures and workforce statistics, which will continue. Once we have that 15-year framework back and see what HEE says, we will be able to look at how best that might be interrogated by Members of the House and the wider public. I am hopeful that it will report back in the spring, and I suspect that that may well occasion a debate in this House. If not, I suspect that it may well occasion an urgent question from the hon. Lady or the hon. Member for Ellesmere Port and Neston.

Let me turn to new clause 29, which also addresses the issue of workforce planning. This new clause would place a duty on the Secretary of State to report on workforce planning and safe staffing. I have just elaborated at some length on the substantial work that my Department is doing to improve workforce planning. It remains the responsibility of local clinical and other leaders to ensure safe staffing, supported by guidance and regulated by the Care Quality Commission. The ultimate outcome of good-quality care is influenced by a far greater range of issues than how many of each particular staff group are on any particular shift at any one time, even though that is clearly important, which is why the Government are committed to growing the health workforce. It is also important that local clinical leads can make decisions based on the circumstances in their own particular clinical setting, utilising their expertise and knowledge.

The amendment would also require the report to contain a review of lessons learnt. In the last decade, the Government have introduced significant measures to support the NHS to learn from things that go wrong, reduce patient harm and improve the response to harmed patients, such as: a regulated duty of candour that requires trusts to tell patients if their safety has been compromised and apologise; protections for whistleblowers when they raise safety concerns; the Healthcare Safety Investigation Branch, which we are building on and establishing as a separate statutory body through the Bill; and the first-ever NHS patient safety strategy, with substantial programmes planned and under way to create a safety and learning culture in the NHS.

I hope I have given the House some reassurance that we are doing substantive work to improve safe staffing and workforce planning. Again, I encourage the shadow Minister—perhaps it will be unsuccessful, but it is always worth trying—to consider withdrawing his amendment.

--- Later in debate ---

[Justin Madders]

New clause 29 and amendment 10 are the starting point, not the whole answer. They are a framework for getting this right in the future and offering the workforce, which, as the Minister said, has given so much in recent times, some hope that there will be better times along the way. I will refer later to the report by the Health and Social Care Committee on workforce burnout, which brought home just how demoralised the workforce have become and why they need to be given some positive news today.

[Rachael Maskell]

Anyone who on Sunday was on the March with Midwives will understand the real crisis now facing that profession—a particularly acute once since it is also about women’s health. Is there not a need to ensure that plans are not just on paper, but expedited, so that we are sure of seeing real delivery of those much-needed staff?

[Justin Madders]

Like just about every profession and sector in the NHS, midwives are under tremendous pressure and are understaffed. We need a clear plan, and a plan that is delivered. Of course, having a plan is not the whole answer, which is why it is important that we hear regular reports back from the Secretary of State on progress. That is why we hope amendment 10 will be supported.

--- Later in debate ---

[Justin Madders]

I accept what the right hon. Member has said. There has been a gap in investment in IT and other things that make people’s jobs easier and more efficient, and that has been a characteristic of NHS spending over the last decade.

With your permission, Madam Deputy Speaker, I will try to make some progress, but it is important, as we have talked about the staff, that we pay tribute to all those who make the NHS what it is today. On Nursing Support Worker Day, I pay tribute to all those who work in wards, clinics and community settings to support our nurses and provide that essential hands-on care to patients.

Our care system does indeed face a crisis—over waiting times, over recovery—but as with all other crises, the root cause is inadequate funding. The most visible and significant symptom is an inadequate workforce, plus the scandal of social care provision. There is no plan at the moment; it is just a plan for a plan. When we talk about a workforce crisis, that cannot be in any way a reflection on the huge value and contribution of the workforce we have now.

There are particular positive aspects to amendment 10 to which I would like to draw attention. Explicit recognition of the need to consult with the workforce through trade unions is very welcome. The planning covers health and social care, which is also absolutely essential. Given the scope of the review, the timescale is about right—every two years is demanding, but not too onerous—but a regular update each year might be preferable. However, the main point, which I have made already, is to compel a regular report and review of demand. The central role is that the Secretary of State has a duty to get planning done, and we hope that will be a crucial lever for the change we need to see.

If the amendment has a weakness, it is probably the one we have touched on already, which is that it does not ensure that the plan is feasible or delivered. A plan that shows the gap is not a plan unless it has a credible funding solution alongside it. Even if that is not explicit in the amendment, we assume that funding would follow any such assessment and plan that is set out. Our suggestion would be that any such financial projections in a plan are subject to the same level of independent expert verification as we see with the Office for Budget Responsibility. Since all the various think-tanks are going to do an assessment anyway, we may as well have a built-in process for verification.

[Rachael Maskell]

Does my hon. Friend agree with me that many of the recruitment challenges often sit in outsourced services in the private sector, and as a result it is really difficult to find the complement of staff required because people want to work in the NHS? That needs to be taken into consideration in any workplace plan.

[Justin Madders]

I thank my hon. Friend for her intervention and I will later talk a little about outsourcing and the role it has to play. We believe that plans should be built from the bottom up, not from the top, and that implies the involvement of ICBs, NHS trusts and foundation trusts. ICBs and their strategic arms, integrated care providers, will not be functional for some time. That is a shame, but it does not mean we should not proceed with the amendment.

The scale of the workforce challenge is well established: high rates of vacancy, inadequate levels of retention, and much more. It goes far deeper than numbers and structures, to issues of workforce terms and conditions, particularly in social care. It must also cover cultural issues, as there is a clear indication that all is not well in the NHS in terms of diversity. There is also whistleblowing, and aspects of how staff are nurtured and supported. At its very best, the NHS is very good, but unfortunately that is not the story across the board. It should be good in every part.

On that theme, let me mention the continuing disgrace in the way that some members of the NHS workforce are treated. I find it unacceptable that cleaners, porters, catering and IT staff are still being outsourced by trusts that are trying to make tax savings or outsource services to the lowest bidder. Perhaps the Minister can look into the current dispute at South Warwickshire in that regard, as we do not think that is a template to follow. Workforce planning is not a problem that can be solved quickly, although increased funding in social care could help that. For the NHS, the long term is indeed a long time—for example, the time needed to develop and train GPs and consultants. More money is not the only answer; technology and reform of the way we work must all be part of the mix. However, the labour-intensive nature of care will not fundamentally change, so we must look at workforce numbers as the priority. It is often said that failing to plan is the same as planning to fail. Some colleagues believe that a failure to plan is exactly that—a route to ending the NHS as we know it by showing that it fails. However, the Bill suggests an acceptance that a plan is needed, and work is under way. Hopefully that work is not being handed out to more consultants, of whom we see enough already.

Labour will support the amendment tabled by the Chair of the Health and Social Care Committee, which we hope will be pushed to a vote. I hope I have not been too effusive in my comments about him—I have a reputation to maintain after all—but I will refer to the excellent report done by his Committee on workforce burnout, which in many ways is the cornerstone of what we are debating. In its conclusion, the Committee said:

“The emergency that workforce burnout has become will not be solved without a total overhaul of the way the NHS does workforce planning. After the pandemic, which revealed so many critical staff shortages, the least we can do for staff is to show there is a long term solution to those shortages, ultimately the biggest driver of burnout. We may not be able to solve the issues around burnout overnight but we can at least give staff confidence that a long term solution is in place.

The way that the NHS does workforce planning is at best opaque and at worst responsible for the unacceptable pressure on the current workforce which existed even before the pandemic.

It is clear that workforce planning has been led by the funding envelope available to health and social care rather than by demand and the capacity required to service that demand. Furthermore, there is no accurate, public projection of what health and social care require in the workforce for the next five to ten years in each specialism. Without that level of detail, the shortages in the health and care workforce will endure, to the detriment of both the service provision and the staff who currently work in the sector. Annual, independent workforce projections would provide the NHS, social care and Government with the clarity required for long-term workforce planning.”

That conclusion shows what we are trying to achieve today. That is the nub of it: if not now, when? When will the Government finally accept the obvious that has been staring them in the face for years?

New clause 29 would require the Secretary of State to lay before Parliament a fully funded health and care workforce strategy to ensure that the numbers, skill and mix of healthcare staff are sufficient for the safe and effective delivery of services. It builds on other amendments, and seeks further assurances by putting patient safety and safe staffing levels at the heart of workforce planning, by setting out how the Government will be required to act to assess and rectify shortages. It seeks to ensure that the workforce will be on a sustainable footing in future. Patient safety should be our primary concern. We have the evidence base: when there are not enough registered nurses, mortality rates change and health outcomes are worse. I accept that the level of detail in the new clause is significant, but we consider that necessary to underscore the importance of setting out how this will be delivered.

--- Later in debate ---

[Jeremy Hunt]

My right hon. Friend speaks about these issues with a great deal of knowledge, given his former ministerial and Select Committee roles, and he is absolutely right. I think that the big lesson from the pandemic, and indeed an issue that emerged in the report that our Committees jointly produced, is the way in which science can add value to clinical practice and clinical practice can add value to science.

[Rachael Maskell]

One of the key workforces is, of course, in public health, where the aim is to shift the balance by increasing prevention so that we do not need all the doctors and nurses and other health professionals further down the road. The health visitor delivery programme led to a heavy stream of new health visitors, but it had other consequences. That is another reason why the right hon. Gentleman’s amendment is so important: we see rapid changes in the workforce which could have other consequences.

[Jeremy Hunt]

I thank the hon. Lady, who before entering this place spent her time campaigning to support NHS and care staff. She speaks with great experience, and I think that the fundamental point she makes is very important. Unless there is long-term strategic planning, when we have a priority such as the one we have at the moment of tackling the backlog, we will often make progress on that priority by sucking in staff from other areas, which then suffer. That is an unintended consequence which happened when I was Health Secretary, and I fear that it will happen again without a long-term strategic framework.

Amendment 10 has wide support. It is supported by 50 NHS organisations, including every royal college and the British Medical Association—an organisation which, to be honest, is not famous for supporting initiatives from me—and by six Select Committee Chairs and all the main political parties in this place. I am sure that the Government will ultimately accept it, because it is the right thing to do, but if they are intending to vote it down today, I would say to them that every month in which we delay putting this structure in place is a month when we are failing to give hope to NHS staff on the front line.

Let me end by quoting the Israeli politician Abba Eban, who said that

“men and nations behave wisely when they have exhausted all other alternatives.”

Let us prove him wrong today by supporting amendment 10.