NHS Staff: Oxfordshire

Anneliese Dodds Excerpts

Tuesday 20th February 2018 Westminster Hall

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

It is a real pleasure to see you in the Chair, Mr Hollobone, and to be among my fellow Oxfordshire MPs. I wish that we could always take the same friendly approach as this county group to different policy issues. It is a pleasure to participate in this debate and to follow the hon. Member for Banbury (Victoria Prentis) and the hon. Member for Oxford West and Abingdon (Layla Moran), to whom I am very grateful for calling it.

In common with my colleagues, I receive a huge amount of case work from patients, members of the public and NHS staff who are concerned about the local NHS. I want to share one very recent example that offers some very telling lessons. A local nurse who came to one of my surgeries had talked to other nurses in her department and put a notice on the staffroom noticeboard asking for people to add their comments about issues that they wanted raised with their local MP. Low pay and understaffing came right at the top of that list. She was absolutely dedicated to helping her patients, but she felt under extreme pressure. She said to me that the recent negligence claim that was brought against a doctor, which many of us will have seen, could have happened anywhere in the NHS, and that she was enormously concerned. I was very impressed by her dedication and concern to make sure that these issues were dealt with at political level. She did not believe that they were being dealt with and I do not believe that they have been either.

The Library briefing rightly indicates that recruitment and retention are largely the responsibility of individual trusts, yet they are undertaken within a framework of national policy. This is a particular problem for the local NHS—colleagues have already mentioned that. The pay cap in particular is a big issue in Oxford—we have no uplift compared with London, which is a competitor in staffing terms—as is the large number of EU staff in the local NHS. I will briefly run through each of those three matters before turning to some of the positive moves that are ameliorating the situation but are being countered by those strong headwinds from national-level factors.

The seven-year pay cap has been a particular problem for NHS staff in Oxford because of the gap between wages and our high living costs. It is the No. 1 issue whenever I talk to NHS staff. Yes, there will be local concerns too, but so many staff say to me that they feel they are being forced either to leave the profession or to work as an agency or bank member of staff, because the pay is not keeping pace with the costs that they face. That is a much more expensive way of staffing the healthcare system, because it is much more expensive to fill those gaps through bank or agency staff than by using the permanent workforce. The hon. Member for Oxford West and Abingdon mentioned that the Government have maintained that they will lift the pay cap, but that is contingent upon an “Agenda for Change” process. A lot of the NHS staff I have talked to have said they are worried that that could be used as an excuse to screw down terms and conditions.

More than one nurse has said to me on the doorstep that they are concerned about the impact of the removal of the nurse training bursary and pointed out that nurses who are in training cannot do other jobs to keep themselves afloat. They are expected, in effect, to live on thin air. That might be possible at times in some low-cost areas, but it is just not possible in Oxford, and it leads to a lot of potential recruits abandoning their dream of entering nursing. That really is a dream for a lot of people, and they are very motivated to do it, but it is becoming very hard to achieve.

Colleagues have already referred to Oxfordshire’s particular problems with mental healthcare. Mental healthcare funding generally is low in Oxfordshire compared with other clinical commissioning group areas, but that is compounded by the issues with recruitment. Again, there have been positive developments, such as the reinvigoration of the child and adolescent mental health service, but we still have many issues with recruitment.

That is of course compounded by the lack of Oxford weighting, which is a particular problem for us because we are so close to London. If we were not, we might be in a different situation, but there is a natural process whereby staff look to London and see what they would be able to afford there, where their housing costs would be the same, if not lower. Colleagues will know that local NHS staff began a petition calling for some kind of Oxford weighting to be introduced. That petition now has more than 7,000 signatures.

Such a weighting must not be used as an excuse to move away from collective bargaining. I am a bit disappointed that some Government Members have said to me, “Yes, this is why we need to abandon collective bargaining.” That is not what NHS staff have told me they want. A weighting introduced specifically to cover housing costs—we could call it a levy, a special payment or whatever—could be part of a system that recognised the abnormally high costs in Oxford, which is the most expensive place in the UK to buy a home and one of the most expensive in which to rent.

We need to ensure that outsourced staff are covered by any uplift. I was appalled to hear that some outsourced staff have been living in a corridor in a shared house because they cannot afford a room. This is not about people being able to afford their own flat or house; it is much worse. I recently came across a couple living with their children in Blackbird Leys, which is a relatively low-cost area of Oxford, who both work in the NHS. They were unable to afford their rent and thought they would have to move out of the city. That is not uncommon.

I do not want to stress the point too much, but I do not think the answer is to stop Oxford’s economy growing. Instead, we must ensure that we pay NHS staff properly. My party set out in our grey book how we would do that by removing the pay cap, which, given the issues with recruitment and retention, may end up saving the NHS money in the long run. NHS staff have told me that they believe it would save the NHS in particular on filling gaps with agency staff that are not filled by permanent staff.

The hon. Member for Oxford West and Abingdon mentioned the reliance of our local NHS on EU staff. Oxfordshire has about double the national average of EU staff. It does not give me any joy to say that—although I expressed concerns just before the referendum and afterwards about the danger that a new immigration system for EU staff similar to that for non-EU staff would end up costing the NHS money and result in it losing staff—all those chickens seem to be coming home to roost. I have experienced the same kinds of issues as the hon. Member for Banbury, who mentioned NHS trusts’ problems with recruiting staff from outside the EU, and particularly with getting them on to their books. It will be an enormous problem if we end up taking the same approach to staff from the EU, because the system is already very costly, bureaucratic and unclear.

Given those circumstances and all the problems, local measures can have only limited impact, but I will mention a few of them, because they demonstrate that solving the current problems with recruitment and retention requires national commitment. First, Members have already mentioned that one of the major problems for our local NHS is social care, which is under enormous pressure in Oxfordshire. Social care is the responsibility of Oxfordshire County Council, which has struggled to deliver adequate services since its budget was cut by about one third due to reductions in central Government grant. However, there are positive developments in Oxfordshire. The home assessment reablement team—HART—has brought together social care and NHS staff and delivered a big acceleration in the provision of the social care that people need when they are able to go home. That ultimately has not been enough, but it has helped.

Secondly, it has been good to see Oxford Brookes University develop its own nursing and midwifery school in an innovative attempt to bring together research, education and training, which does not happen anywhere else in the country, and to persuade local people that nursing and midwifery may be for them. Again, though, that is a big challenge, because people still have to be able to afford to live in Oxford while they undertake that world-class training.

Thirdly, we have spoken quite a bit about housing. Oxford’s housing plans include a commitment from the city council to enable the NHS to meet employee needs by exempting staff housing schemes on land owned by the NHS from social rent requirements. However, it is important that we ensure that any housing that results from that exemption is permanently provided on a favourable basis, for affordable rent, to those who need it. If it is only later going to be sold and returned to the free market, it is not going to deal with the problems. Applying a 50% affordable housing requirement to new developments in Oxford will also help the situation. Constituents I speak to, including people who work in the NHS, say that schemes such as Help to Buy and the stamp duty holiday are not having an impact, because even contemplating buying a house is far too much of a jump. Genuinely affordable housing would help.

The removal of restrictions on land acquisition, new rules on viability and enabling local authorities to borrow to build would help improve the situation further, especially when it comes to the provision of key worker housing. In Oxford, that has to involve co-operation with neighbouring councils. I am pleased that we have had such co-operation on the Oxford to Cambridge corridor, but that needs to come to fruition. Independent assessments indicate that Oxford needs about 30,000 new homes, but there would be space for only about 8,000 within Oxford’s boundaries even if occupancy levels in the city were intensified. The Oxford to Cambridge corridor plan has to focus on delivering housing for key workers and people on low incomes; otherwise it will not deliver the change that we need.

The leader of the city council and I wrote to the Housing Minister last week to detail some of the areas where we desperately need change. Oxford probably has the biggest housing crisis of just about any city. Unfortunately, we see that right in front of us every day from the number of people on the streets, but there is also a hidden problem of people struggling in overcrowded or unsuitable accommodation.

The local NHS trust is working hard on recruitment and retention, and it has done some innovative things. The hon. Member for Oxford West and Abingdon mentioned the golden handshake people get when they start, which is obviously necessary. A lot of work has been done on advertising, recruitment fairs and so on, and there is an attractive on-the-job training offer, although we always need more funding for that. However, all that has been done in the context of the almost perfect storm of factors that affect us in Oxford—particularly the pay cap and uncertainty for EU staff.

There is an enormous amount that we, as Members who represent Oxfordshire constituencies, should be proud of, and I am sure that we all are. We have world-class services and incredible opportunities because of the proximity of Oxford University, Oxford Brookes University and other research centres, and the incredible diversity of innovative companies and others in our area. However, those world-class services are under pressure like never before. If we want to continue providing the kind of excellent care that I am grateful to have received when I gave birth to both my children in the John Radcliffe Hospital, we need to deal with these issues very quickly.

--- Later in debate ---

[Mr Vaizey]

I am happy to work with my hon. Friend, particularly considering her back-handed compliment. She has heard hundreds of speeches from me, so for this to be the best she has heard—

[Anneliese Dodds]

I agree that it is a marvellous speech, and I thank the right hon. Gentleman for that. On the point he was making, we must be sanguine, of course, and I am sure that colleagues will be. There is a tension that I have discussed many times with the trust, and with others; it wants a green and pleasant environment for patients and staff, but intensifying car parking, as many want, might go against that. There could also be planning implications. To be fair, the trust is actively looking at the issues.

As to innovation, the new district heating system that has just been put in is pretty unique. We should give credit where it is due, sometimes: it will ultimately save the trust hundreds of thousands of pounds.

[Mr Vaizey]

I thank the hon. Lady for a course correction in my so-called brilliant speech. I have perhaps been too hard on the NHS management locally to make that point. I am sure that there are hundreds of examples of great innovations that they have introduced. I want to re-emphasise what I said at the beginning of my speech about my huge admiration for nurses, doctors, consultants, surgeons and indeed NHS managers, who do a difficult job. However, I hope that there is appreciation of the frustration that I feel as Wantage Community Hospital’s closure comes up to its second anniversary and there appears to have been no movement.

I do not have time to discuss pay but I noted what my hon. Friend the Member for Henley said. He is a bold and brave advocate for pay locally, and if he thinks that an Oxfordshire weighting is a good idea I am happy to support that, because of his venerable experience in the area. I would be delighted for us to get together as all the MPs of Oxfordshire and with key stakeholders. Personally, I would leave the Minister out of it, because the key message for me in this debate is that Oxfordshire has its issues, but a lot of them can be solved locally.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Evans. I congratulate the hon. Member for Oxford West and Abingdon (Layla Moran) on securing the debate and on the powerful arguments she made about the recruitment and retention crisis affecting NHS services in her area and across the country.

As the hon. Lady said, the NHS has been a frequently raised issue in recent times, certainly since her election. I join her and the other right hon. and hon. Members who have spoken today in praise of the dedication and commitment of the staff who work in our health service. She said that we are close to a crisis in the NHS. I believe that only the dedication and commitment of staff prevent a crisis from turning into a complete catastrophe. She was also right to say that the good will of staff is propping up services at the moment. That is something that, I am sad to say, I have to keep repeating every time we have a debate: it is the good will of staff that keeps the show on the road.

I was concerned to hear that some staff had approached the hon. Lady to say that some of the levels of experience in particular wards were raising concerns about patient safety. She highlighted in particular the shortage of mental health specialists. She is right to say that the good intention to try to achieve parity of esteem will be extremely difficult to meet when there are so many shortages.

The hon. Lady diagnosed a number of issues that have contributed to causing the crisis. Uncertainty around Brexit has certainly accelerated some of the staffing challenges already in place. The abolition of the nursing bursary has also created issues, and I will come back to that later on. I agree with her that reliance on agency staff is unsustainable, and we can talk about that in a little more detail later. She mentioned the pay cap, as I think every hon. Member did; that is something else I will come back to later, but I remind her that when her party was in government it enacted that policy for a full five years.

The hon. Lady also mentioned staffing shortages in social care. It is sad to hear that those doing one of the most valuable jobs in society feel that they have a better prospect of earning a decent living in retail. That brings home the challenge we face. The issues she raised about training and professional development are also particularly relevant.

The hon. Lady was right to mention that behind all of that is the funding challenge we currently face. We are in the longest and most sustained financial squeeze in the history of the NHS, and it is inevitable that those kinds of issues will come up until we reach a sustainable funding settlement. She also raised the question of housing and the cost of living in Oxfordshire. I think most hon. Members touched on that point. She said she was concerned that unless the issues are tackled in a comprehensive way, services will be rationed. I am afraid to say that services up and down the country are already being rationed, as we have discussed here on a number of occasions.

It was a pleasure, as always, to hear from the hon. Member for Banbury (Victoria Prentis). She always speaks strongly and passionately about NHS services in her area. She said that staffing issues were a major factor in the proposals to downgrade the maternity unit at Horton. It is a sad fact that half of all maternity units up and down the country have had to turn expectant mothers away at some point in the last year, often due to staffing shortages. We currently have a national shortage of about 3,500 midwives. It was interesting to hear some of the possible initiatives to attract new obstetricians in particular. Certainly, the prospect of free beer is something that works for me, but I do not know whether the hon. Lady can wait quite as long as it will take for me to train in that profession. I think we will have to do without my particular skills in that area.

The hon. Lady raised the issue of transparency and openness. It is disappointing to hear the difficulties she has had with her local trust on that issue, but it is clear from what she has said today that she has a lot to contribute to the wider health economy in her area. She is not alone on that issue. The Government have been pushing through policies on sustainability and transformation plans, accountable care organisations and the capital expenditure processes, which are all done under a veil of secrecy. There are wider issues in play there.

My hon. Friend the Member for Oxford East (Anneliese Dodds) described the current situation as a perfect storm—an apt description. I am impressed at the way in which she has engaged with staff in the health service in her constituency to get to the real meat and bones of the issues. It was sad to hear that staff feel they are forced to leave the profession and go to work for an agency; she was absolutely right to say that forcing staff to go and work for an agency to make ends meet costs us more in the long term. There are ways in which that could be a saving for us if the pay cap was lifted.

The problems with the nursing bursary were again highlighted, particularly how they are exacerbated in the Oxfordshire area by the cost of living. Has the Minister done any analysis of the cost of living in different parts of the country and the income streams available to those undertaking nursing degrees, who, because of the way the degree is structured, do not have the option of supplemental employment?

My hon. Friend explained very well how the proximity to London creates recruitment difficulties. The stark image of staff living in a corridor highlighted to me the impact of eight years of pay restraint. She also highlighted the bureaucratic nature of recruiting overseas staff. I know immigration policy is outside the Minister’s remit, but I hope he is making representations to the Home Office about how we tackle those issues in future. My hon. Friend highlighted how, despite the Government’s various initiatives for getting people on to the housing ladder, it is still too big a leap for many. We need much more genuinely affordable housing to be built.

We also heard from the hon. Member for Henley (John Howell). I agree with him that the problem did not start in the last year. He raised the question of challenges in GP practices, particularly younger GPs not feeling able to make the financial commitments to buy into practices, but also the restrictions on operations. He was right to mention that GPs need to move with the times on technology. A number of interesting initiatives are doing that up and down the country, although we have concerns about some of them and how they may exclude patients.

Finally, we heard from the right hon. Member for Wantage (Mr Vaizey). He painted an impressive picture of how healthy the Oxfordshire area is, but a report by the Oxfordshire clinical commissioning group shows a gap in life expectancy of nine years between different parts of the county—something about which the Opposition feel passionately.

It is fair to say, from the right hon. Gentleman’s comments, that the local NHS leadership are not on his Christmas card list. He gave a pretty damning assessment of their ability to engage, but of course the structures we are currently working under were brought in under the Health and Social Care Act 2012, which led to the removal of the Secretary of State’s responsibility for much of the system and to the fragmentation with which we are all grappling. I applaud the right hon. Gentleman for his efforts to try to bring everyone together, but he should consider whether the legislative framework we currently work under is fit for purpose. The way in which he has brought people in the NHS together is important and we should be doing more of that. In this particular area, that should be not just on the health economy, but on the wider issues, particularly those relating to cost of living and housing.

As we have heard, the potential impact of the recruitment and retention crisis was brought into stark focus by the issue that sparked the debate: the leaked email from the head of chemotherapy at the Oxford University Hospital’s NHS Foundation Trust that found its way on to the front page of The Times. That memo confirmed to staff that the trust was down on nurses at the day treatment unit by approximately 40%, and as a consequence that the hospital was having to delay chemotherapy patients’ starting times to four weeks. It also stated that there was no prospect of an improvement in the situation for 18 months to two years.

More worrying was a proposal to reduce the number of chemotherapy cycles available to dying patients, which is totally contrary to National Institute for Health and Care Excellence guidelines, as well as the national cancer strategy. We were therefore relieved to hear that the trust has now backed down from those suggestions.

[Anneliese Dodds]

To be clear, as other Members have mentioned, those were not live proposals. The problem was that the trust had to scope out the full range of potential action, given the challenge it was facing. However, the proposals were not something that it wanted to do—quite the opposite. I just wanted to underline that.

[Justin Madders]

I thank my hon. Friend for that point. I was not trying to imply that the proposals were live, but the fact they were being considered is of huge concern, which Members have rightly raised. It will be helpful if the Minister could look at what caused the proposals to even be discussed, because they are contrary to so many of the principles and guidelines that we want in our NHS. I hope he will be able to assure us that those kinds of dramatic measures are not being considered in other areas.

The impact of recruitment and retention issues at the trust extends far beyond chemotherapy. In January, 2,159 patients waited for longer than four hours to be seen in A&E, falling well below the 95% target—a measure that the Health Secretary described as “critical for patient safety”. Even more worryingly, since December eight cancer operations and 26 heart operations were cancelled either the day before or on the day itself. Although that is at the upper end of operation cancellations, it is sadly a story that we now hear up and down the country. Cancelling an appointment at short notice causes immense frustration. It is sometimes unavoidable, but we know that it can have devastating consequences and put patients at unnecessary risk, not to mention the emotional impact. On the practical side, cover has to be arranged, spouses and family members have to arrange their own time off, and sometimes even national or international travel is required.

Staffing shortages are not behind every cancellation, but they will be a factor in many, and the vacancy rate at the trust tells us that it is an increasing problem. As we heard, vacancies at the trust for nurses, midwives and nursing support workers have almost doubled in the past year, from 5.99% in October 2016 to 10.8% in October last year, leaving about 400 whole-time equivalent vacancies. As we have heard from hon. Members, local factors have undoubtedly contributed to that. A 2017 study by Lloyds bank listed Oxford as the most expensive city in the UK, with average house prices 10.7 times average annual earnings. As we have heard, there is some support for the introduction of an Oxford weighting-type arrangement.

There is also a national context to look at, with housing costs being exacerbated by the pay cap. It is clear that, although that is probably at the sharper end of the pressures, Oxford’s issues are being repeated up and down the country. We now know that, after eight years of this Government, more nurses are leaving the NHS than joining. That position is particularly sharp in the Thames valley area, where there were 39% more leavers than joiners between September 2016 and September 2017.

While almost all trusts up and down the country have been unable to fill vacancies, Oxford’s is probably one of the more acute situations. However, much of it was completely predictable. One of the first decisions the Government took in 2010 was to cut the number of nurse training places by 3,000, which has led to about 8,000 fewer nurses nationally. We then had the Health Secretary’s farcical decision to take on the junior doctors, which has led to a demoralised workforce.

Then, to cap it all, as Members have said, came the decision to scrap nurse bursaries, which is possibly the most ill-conceived decision the Government have made—and there is plenty of competition for that particular award. We warned at the time that, far from providing more nursing places, the move would lead to a drop in the number of applications, with the biggest impact being on mature students, who bring a huge amount of experience from outside the profession.

As we have heard, statistics show that there was not only an 18% drop in applications in 2017, but a 2.6% decline in England in the number of students accepted on to courses. Among mature students, 13% fewer of those aged between 21 and 25 were accepted. That decision is discriminatory and stands in stark contrast to the Government’s aims on social mobility. Those are not just my words—they are in the equality assessment undertaken by the Department for Education. However, instead of learning from that lesson, Ministers have decided to scrap NHS bursaries for postgraduate students as well.

Alongside that disastrous decision, we have had the counterproductive capping of pay, which has led to hard-working NHS staff losing money in real terms at the same time as their workload has increased. We have heard encouraging noises from the Government recently, but we have seen no firm action. Perhaps the Minister can provide some clarity when he responds. The Nursing Times reported this week that the Treasury apparently still needs convincing that a rise in wages should be “meaningful”. Will the Minister send his Treasury colleagues a transcript of the debate, to persuade them that a strong case is being made for an increase?

Across Oxfordshire and the whole of our NHS, a recruitment and retention crisis is exacerbating a situation that has already reached crisis point. The Government need to act, realise their mistakes and urgently give hard-working NHS staff the belief that their work is valued and the confidence that their concerns are being listened to.

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

It is a pleasure to see you in the Chair, Mr Evans. I congratulate the hon. Member for Oxford West and Abingdon (Layla Moran) on securing the debate. We have met a number of times and I have responded to a number of her written questions, so I know that she is working hard on this subject.

It is always great to hear Members speak personally about their experiences—maybe none more so that my hon. Friend the Member for Banbury (Victoria Prentis)—and how passionately they speak about the national health service. Members from the county of Oxfordshire have spoken well; I do not know how they play in private, but in public they seem like a very good team. That may not be the case in Hampshire; maybe there are too many of us on the Front Bench. We are only a two-party state in Hampshire; perhaps that is why.

The debate is not only important but timely. I had the pleasure of visiting the Churchill Hospital, which is part of the Oxford University Hospitals NHS Foundation Trust, last Tuesday during our half-term recess. I saw the superb and innovative cancer care provided by the dedicated staff—I obviously echo all the praise for the staff—and had the opportunity to discuss workforce issues for a little time with the chief executive, Dr Bruno Holthof, who is a very nice man, and his senior team. I therefore hope I can provide some well-informed replies to the hon. Member for Oxford West and Abingdon and Members from across the county. The NHS in Oxford is working hard to ensure it has the doctors and nurses to continue to provide excellent care to Members’ constituents.

We met in Maggie’s Oxford cancer centre. As Members will know, I am the cancer Minister—it is the thing that gets me out of bed in the morning—and I was blown away by Maggie’s cancer centre. I know there are a lot of them across the country, but this was in a beautiful building, was brilliantly designed and had incredible, passionate staff. I met a number of patients who described Maggie’s as a haven for them while they are going through their cancer treatment. It was great, as always, to talk to patients.

My hon. Friend the Member for Banbury spoke about the recent story in The Times—the front-page splash on changes to patient cancer treatment plans at the Churchill—which a number of hon. Members mentioned and which I suppose was the spur for the debate, although it seems to have broadened out into everything, covering about four different Government Departments. I, too, was obviously concerned when I saw the story. I called the chief executive of the trust, and he was very clear that, although it would have been a great story, there was only one small problem: it was not true.

The leaked emails—whoever leaked them can examine their own conscience and motives—set out hypothetical challenges and invited suggestions from clinical staff, ahead of a meeting taking place this month. There has been no change to formal policy on chemotherapy treatment at the trust, and any such decision would be a matter requiring clearance at board level anyway. As we discussed, the chief executive’s first consideration was, rightly, the obvious and needless worry caused to cancer patients across Oxford and the wider area. I am pleased, although obviously disappointed it was necessary, that he quickly put in place plans to communicate to his patients that there were absolutely no changes, as the hon. Member for Oxford East (Anneliese Dodds) said, to chemotherapy treatment.

The trust continues to meet two of the three main cancer waiting time standards and is working hard to meet the third. We discussed that last week, too, and the trust should be very proud of it. I was able to congratulate some of the team personally last week. The trust is considering how best to deliver chemotherapy services going forward, and I am confident that it will do that in the correct way, through the correct channels, and of course in compliance with NICE guidance.

When I was on site at the Churchill, I was able to pop in to the ACE wave 2 pilot. ACE stands for accelerate, co-ordinate and evaluate—I know that my right hon. Friend the Member for Wantage (Mr Vaizey) enjoys these acronyms. I met Fergus Gleeson, Sara Bainbridge, Shelley Hayles, a local GP in Oxford who leads on cancer, and Julie-Ann Phillips, who is the navigator—a great title—and seems to make it all happen there. I, as a cancer Minister, and we as a Government are very excited about ACE. It is about taking patients with suspected cancer from the GP and into the accelerated diagnostic centre and getting them a diagnosis or clearance quickly. I met patients and saw how much it means to them.

I asked patients about stories on the front pages of national newspapers, which of course are trying to sell national newspapers. I noted, in relation to the story, which was gleefully run by the BBC that morning once it had read The Times, that by the end of the day the coverage had slightly changed as it realised that it had been reporting fake news all day. I asked patients what they thought about seeing that sort of thing on the front page of The Times while they were receiving world-class cancer treatment in Oxford, and I will not repeat the exact words that they used, but they were very clear about how disappointed they were to see that, and that they did not feel that it represented the professionalism that constituents of hon. Members across this Chamber see. I think that hon. Members can get a sense of what I thought about that story, and I do not take The Times anyway.

Let me start with the global picture, and then I will localise. The dedicated men and women who work in our NHS are of course its greatest asset. The Government have backed the NHS. We have made significant investments in frontline services and are now taking bold steps to plan for future generations. We do, however, recognise the workforce challenges that the NHS faces in its 70th year. That is why the entire system embarked on a national conversation, with the publication by Health Education England in December of “Facing the Facts, Shaping the Future: A draft health and care workforce strategy for England to 2027”, which is designed to stimulate debates such as the one that we are having today. I know that HEE will read the record of this debate.

The strategy sets out the current workforce supply and retention, and the challenges that we face, but also the significant achievements made from work already under way. It is the first step towards a proper plan that stretches beyond any electoral cycle—we must get away from working in that way—and secures the supply of staff for future generations in our health service. The strategy posed a number of questions that will inform a comprehensive strategy for the workforce over the next decade, to be published in July this year. We need to think innovatively about how we can make the NHS workforce fit for the future, and as always in debates about our NHS, we have heard a number of excellent suggestions today. I encourage hon. Members to engage with the consultation, and from what I have heard today, I do not doubt that they will.

We have heard a lot today about recruitment. Of course, that is not the only way to ensure that the NHS has the workforce that it needs to deliver the safe and high-quality care in which I, the Secretary of State and all hon. Members are so interested. We need to ensure that our excellent doctors and nurses want, and are supported, to stay in the national health service, and we have a clear plan to ensure that the NHS remains a rewarding and attractive place to work.

Let me list a few of the things that the plan covers. It includes arrangements for more flexible working—we know that many health professionals are married to other health professionals, and quality of life matters as much as quality of pay—and a system of staff banks for flexible workers across the NHS, increasing opportunities for staff to work on NHS terms and to reduce agency costs for employers. Something else that we discussed last week is a scheme to offer the right of first refusal to NHS employees on any affordable housing built on NHS land, to increase NHS workers’ access to affordable housing, with an ambition of benefiting up to 3,000 families. When I got lost while trying to find Maggie’s cancer centre on the Churchill site, I noticed that there is a lot of surplus NHS land on that site, and I know that it is looking at that. In addition, since September 2014, more than 2,700 nurses have successfully completed the nursing return to practice programme and are ready for employment.

Let me localise to the recruitment and retention of NHS staff in Oxford, which I also discussed last week. It is important to note from the outset that although there are workforce challenges, Oxford University Hospitals NHS Foundation Trust has 388 more hospital doctors and 591 more nurses than it did eight years ago. It is also successfully seeing 11,500 more patients—a 120% increase—with suspected cancers than it was in 2010. One of the key challenges that we discussed is that Oxford, much like London, is a very expensive area to live and work in, as hon. Members have mentioned, and unemployment is very low. Those conditions present a recruitment challenge that other, less affluent areas do not have.

The hon. Member for Oxford West and Abingdon mentioned continuous professional development, and I promised to mention that. It is a matter for employers; any agreements, such as for protected study time, would need to be negotiated between employer and employees. However, it is always in the best interests of employers to encourage and support the learning and development of their employees. HEE provides national funding to support development of the NHS workforce and invests up to £300 million every year in supporting NHS employees to achieve registered qualifications, and that will continue.

We are increasing the number of nurse training places by 25%. That means 5,000 additional nurse training places every year from September 2018. It is one of the biggest increases in NHS history, and I was glad that the hon. Lady welcomed that in her opening remarks. She also mentioned Brexit, as my right hon. Friend the Member for Wantage did. The Secretary of State and the Prime Minister could not have been clearer: the Government hugely value the contribution of EU staff working in our NHS and understand the need to give them certainty. The Secretary of State has made it clear that after Brexit, we will have an immigration system that means that the NHS is able to get the staff that it needs, not just from the EU but from all over the world.

The hon. Lady asked about career progression; I think that she was referring to scale points earned in the NHS and whether they would transfer. I will get back to her on that; I will get a note to her and copy it to other hon Members in the debate, as I know they will be interested.

Pretty much everyone mentioned the idea of pay weighting for Oxford, as with London, given the proximity of the county. There are a number of mechanisms in the NHS funding and pay system to compensate for higher costs in particular areas. It is open to the independent NHS Pay Review Body to make recommendations on the future geographical coverage and value of such supplements. Additionally, there is flexibility for local NHS employers to award recruitment and retention premiums where recruitment is difficult at standard rates of pay, so when they are having their team get-together—

[Anneliese Dodds]

Will the Minister give way?