Health and Care Bill

Baroness Harding of Winscombe Excerpts

Lords Hansard - Part 1 & Report stage
Thursday 3rd March 2022 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I will be exceptionally brief and make two very quick points, but first I need to apologise for, when I spoke earlier, omitting to mention my registered interest as a non-executive director of the Royal Free London NHS Foundation Trust.

I very strongly support Amendment 80, moved so ably by the noble Baroness, Lady Cumberlege, and pressed so very cogently by the noble Lord, Lord Stevens, and others. It is absolutely fundamental to everything that the Bill is designed to achieve, and we will not achieve those things unless the workforce is addressed.

In relation to Amendment 111 in the name of the noble Lord, Lord Hunt, I say that it is so important that we have a review into the distribution of GPs in England. I was very concerned when we debated in Committee the huge variation in list numbers in different parts of the country. The biggest lists were in the most deprived areas. If you track that back to the debate we were having on health inequalities, where there was a huge consensus across the House, it is clear that we are never going to fundamentally tackle health inequalities unless we have far greater equality in things like the size of GPs’ lists.

[Baroness Harding of Winscombe (Con)]

My Lords, I also support my noble friend Lady Cumberlege and Amendment 80. The noble Lord, Lord Stevens, made two points: I would just like to add a third to his argument. He argued that workforce planning needs to happen. There is no large employer of people that does not plan its workforce other than the NHS. We need to do it, and I do not think anyone in this Chamber is going to disagree. He also said that this would not happen without legislation. I will not repeat the points I made at Second Reading or in Committee, or those that he just made so eloquently.

My third point, which I would like to add, is very much addressed to my noble friend the Minister. It is that this amendment will not bring the downsize that the Treasury truly fears. This is actually an amendment of sound management that enables the NHS to manage finances and people better. While there will be more money spent on training, this is actually the way to control the costs of the ever-growing demand for health and social care. If you do not plan, you cannot control the costs. This is actually the way to do the very thing that the Treasury is most concerned about.

Far from locking in old, established ways of working, this is also the way to drive transformation because, unless we are honest about the ever-growing demand for clinicians of every profession, we will not face the fact that we will need to change the way those clinicians work together as medicine and science evolve and all of us age. This is a way to deliver the very thing that the Treasury most wants: control of the finances and transformation of our healthcare services.

With that, I add one final point, and I hope noble Lords will forgive me for repeating what I said in Committee. There is another reason why we need to do this now. Our NHS people are exhausted, and they have lost hope that we understand what it is really like on the ground for them. By passing this amendment, we will give them hope; we will show them that, collectively and cross-party, we really understand that it is they who make our wonderful, precious health and care system work, and we are committed to helping them going forward.

[Baroness Finlay of Llandaff (CB)]

My Lords, I must declare my interests: I am a fellow of the Royal College of Physicians, the Royal College of General Practitioners, the Academy of Medical Sciences, and the Royal College of Physicians of Edinburgh, which is affected by Amendment 168. I am an honorary fellow of the Royal College of Emergency Medicine, president of the Chartered Society of Physiotherapy and an observer on the Medical Schools Council. All those organisations have a vested interest in this amendment.

Very simply, this amendment just makes sense for the future. Without it, the cost of healthcare to the nation will rack up and never come under control. The talk about people working in the NHS is a fallacy. What matters is whole-time equivalents and the competencies of those people with whole-time equivalents. While it is absolutely right to say that it might take 15 years for somebody to come through training as a specialist, what is not understood is that, as soon as people qualify, having left their undergraduate training, they are then on the job. They are learning on the job, working incredibly hard and contributing, but they do not have the competencies developed. That is what takes a long time. The modern techniques that get things done much more quickly and that deal with more patients—laparoscopic surgery having been an example—are highly skilled, but highly efficient.

We have a shortage of 1,400 anaesthetists. Without anaesthetists, you cannot have good maternity services, you cannot operate and you cannot have good emergency services. They are absolutely essential to the whole running of secondary care. Then, of course, in primary care, we have the gaps as well, so the specialist training is really important.

As well as that, this cannot be handed over to algorithms on a computer and left to IT, because of the need for personal interaction between the clinician and the patient and their family. I do not believe that this will be replaced by AI. However, many jobs performed currently will be taken over by AI, freeing up clinicians to become even more specialist competent.

Building on the comments of the noble Baroness, Lady Harding, I remind the House that poor care overall is more expensive than good care in the long term. It is a very short-term view to think that you can provide poor care; in the long term, you really do stack up debt. Stopping workforce planning will not avoid costs at all; all it will do is move the costs from one year further into the future and create bigger problems. Although I hesitate to say it, I think it will also fuel the whole litigation culture.

Amendment 80 is absolutely essential. If it is accepted by the Government, or passed by this House, then Amendments 81 and 82 would fit very neatly into the criteria against which such reports are to be written on the workforce. I remind noble Lords who might be unaware of this that the royal colleges already collect workforce data. Verification of data collected from integrated care boards and areas will not be difficult, because you will simply see how the figures match up. The figures will be reported centrally, and planning can take place. The amendment of the noble Lord, Lord Hunt, is so straightforward; I cannot see why we want to rack up costs further by not putting it through. Vacant posts cost money, they do not save money. By putting that through, we will have more efficient appointment procedures. This is an historical anomaly which could be corrected easily.

Relying on bank staff is really dangerous. Mistakes happen much more often when staff come in who do not know the place, the team or who to call. You would never field a sports team consisting of a bunch of people brought together to play at a high level who had never played before. Yet, what we are doing in our NHS is bringing in bank staff who often do not know the hospital or the team. They do not know the strengths of the other people in the team, so they do not know to whom they can delegate. I hope that the House will approve Amendment 80 if the Government are too short-sighted to just accept it.