Health Bill

Baroness Shawcross-Wolfson Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

Moved by

[Baroness Shawcross-Wolfson]

28: Clause 7, page 4, line 31 at end insert—
“(1A) The Secretary of State must publish an independently verified long-term assessment of the workforce needs of the health service and a ten year education and training plan to deliver on those needs.(1B) The first assessment and plan under subsection (1A) must be published within one month of the day on which this Act is passed. (1C) The Secretary of State must keep the assessment and plan under review and revise both at least once every five years.”Member’s explanatory statement
This amendment would require the Secretary of State to publish an independently verified assessment of the long-term workforce needs of the health service and a ten-year education and training plan to meet those needs, with the first assessment and plan published within one month of Royal Assent.

[Baroness Shawcross-Wolfson (Con)]

My Lords, I am grateful to the noble Lord, Lord Patel, and the noble Baronesses, Lady Harding of Winscombe and Lady Cass, for their support for this amendment. In moving Amendment 28, I want to make a very simple argument. The Bill gives Ministers direct responsibility for training and educating the NHS workforce. I believe that it should also make Ministers responsible for setting out what workforce they believe the NHS requires and for developing a training and education plan to deliver that workforce.

This is not a controversial proposal—Amendments 92, 252 and 253 in this group make a very similar case—nor is it a new proposal. In 2022, your Lordships’ House passed a very similar amendment to the Health and Care Bill, not once but twice, with support from the Labour Benches, the Liberal Democrat Benches and the Cross Benches. In 2023, the Conservative Government published a long-term workforce plan and asked the National Audit Office to scrutinise the modelling behind it. In 2024, the Labour Party manifesto promised “regular, independent workforce planning”, and Ministers subsequently committed to producing a new workforce plan with independent scrutiny.

Therefore, in theory, we all agree. But in practice, we are now more than two years after the election and Ministers have set aside the Conservative Government’s 2023 plan, understandably, but have still not published their own. In June, Ministers said it was coming imminently. We are now told that it will arrive in due course.

An insufficient NHS workforce is a problem that has been many years in the making. At the end of June, the NHS in England had more than 100,000 vacancies. But vacancies are not the whole story. Since 2015, the number of patients registered with GP practices has risen by more than 10%, but the number of fully qualified full-time GPs has gone down. Others in this House can describe far better than I can what workforce shortages mean on the front line, so I will not talk about how hard it is to plan services when you have insufficient staff to deliver them or the toll on healthcare professionals when we constantly ask them to cover gaps or the impact on patient care. But I hope that others in this debate will do.

Instead, I want to talk about how we ended up here. I believe that all Governments understand the importance of NHS workforce planning. But experience shows that very few are able to develop and deliver a comprehensive plan. That comes down to the very simple fact that training must be paid for today and the benefits of training are realised only in the future. It takes three years to train a nurse, around 10 years to train a GP and up to 15 years to train a consultant. So Ministers constantly face a choice between the pressures of today and the prospect of a better NHS in three, 10 or 15 years’ time. Every £1 spent on a GP for 2035 is £1 not spent this winter or on this year’s political priorities. At any one moment, choosing to prioritise today makes sense. But, repeated year after year, that choice leaves us with a workforce that cannot possibly meet the demands it faces.

Of course, politicians can and sometimes do take long-term decisions. As chair of the Health and Social Care Committee, Sir Jeremy Hunt championed independent workforce forecasts. As Chancellor, he was in a position to fund an NHS workforce plan and did so. That 2023 plan was backed by over £2.4 billion. It set out ambitions to double medical school places, increase GP training places by half and almost double adult nursing training places. It was not a perfect forecast, and the NAO kindly pointed that out when it was asked to scrutinise it, but it was a baseline and it showed that, when the political will exists, it is possible to plan for and invest in the future. However, hoping for sufficient political will is not a strategy. We will not often have a Chancellor who was previously Health Secretary.

This amendment would make long-term workforce planning a duty and not a matter of personal commitment. It would require independently verified assessments of what staff the NHS needs and a 10-year plan to train and educate the staff needed. The first assessment and plan would have to be published within one month of Royal Assent to the Bill. Both the plan and assessment would be kept under review and would have to be revised at least every five years.

In 2022, the noble Baroness, Lady Merron, told the House that

“without mandated forecasts of staff numbers, meaningful workforce planning—something that every other efficient organisation undertakes—cannot take place”.—[Official Report, 26/4/22; col. 223.]

I really agree with her and hope that she will support this principle from the Government Benches as she did from the Opposition Benches, and back this amendment or one along similar lines.

I would be grateful if the Minister could also answer two questions. First, when will the Government publish their own workforce plan? Secondly, who will undertake the independent scrutiny of that plan?

Every Government must have the right to set their own spending priorities. But every Government should be transparent about the workforce they believe the NHS needs and what the decisions they are making today about education and training will mean for tomorrow’s workforce. I hope the Committee will agree. I beg to move.

[Baroness Hollins (CB)]

My Lords, I am grateful to the noble Baroness, Lady Tyler, and the noble Lord, Lord Singh of Solihull, for co-signing my amendments in this group.

I will start with Amendment 252 because it relates to the points made by the previous speaker. It would place a duty on the Government to publish a follow-up mental health workforce plan within 12 months of the highly anticipated publication of the next 10-year NHS workforce plan. It would require detail on how the mental health workforce will be effectively retained and recruited to meet the scale of the mental health demand. Retention and recruitment measures, combined with a clear commitment to the resources required, would help to assure many patients and people across the mental health sector about how the Government’s ambitions in this area will be matched by a strategic approach to delivery. The sector is looking for tangible outcomes for patients, particularly those who live with a serious mental illness.

Mental health and well-being support for NHS mental health staff is integral to the plan, including developing occupational mental health capacity and investing in staff mental health and well-being hubs nationwide. Staff sickness figures reveal that anxiety, stress, depression and other psychiatric illnesses continue to be the most reported reasons for sickness absence among the NHS workforce. In the 12 months up to and including May 2026, those conditions accounted for more than 8.3 million days of sickness absence, equivalent to 29% of total sickness absence over that period. So, while I welcome the commitment in the 10-year health plan to introduce staff treatment hubs for NHS staff, I am keen to understand how the hubs will interact with existing NHS staff mental health and well-being hubs. A dedicated NHS mental health workforce plan would help to ensure that the hubs are as effective as possible.

Amendment 92 would require ICBs to assess and report on mental health workforce efficiency for their local area every two years and propose measures to address the challenges faced by their workforces in delivering services for the communities that they serve. This takes me back to the discussions during the passage of the Mental Health Bill about the need for sufficient community services for people with learning disabilities, and autistic people, to avoid unnecessary and lengthy admissions to hospitals.

Localised focus is vital. Organisations across the mental health sector are concerned that the NHS 10-year plan is too vague about how ICBs are expected to both successfully manage system pressures and, at the same time, meet the ever-growing need for an expanded mental health workforce. Does the Minister agree that requiring ICB-led assessments would be an effective way to ensure that the Government’s programmes of national reform can be matched with local plans so that the ambitions of the 10-year health plan can be delivered?

--- Later in debate ---

I will be pleased to pick up some of the points in writing. I can say to the noble Lords, Lord Patel and Lord Kamall, that we have an NHS Digital Academy in place to support the workforce to develop digital data and AI skills and to give them the confidence to use them, which is absolutely going to be needed for a future NHS.

[Baroness Shawcross-Wolfson (Con)]

My Lords, I am grateful to everyone who has taken part in this debate. In the interests of time, I will keep my remarks as short as possible. I am grateful to the Minister for answering so many questions and setting out so comprehensively what the Government are already doing in this space.

The Minister mentioned external scrutiny of the Government’s workforce plan. It was not totally clear to me whether that meant published scrutiny. I would be grateful if she could pick that up in writing to explain what independent scrutiny has been and will be done, and what is going to be published.

I am taking a leaf out of the book of the noble Lord, Lord Stevens, in that I would like to quote the noble Baroness, Lady Merron, of 2022—she put it better than I could:

“This powerful debate has focused on two simple truths. First, without the full team of people in place at the right time, it will not be possible to provide the health, social care and public health services we need. The second simple truth is that this will not just happen on its own”.—[Official Report, 3/3/22; col. 987.]


I am afraid that everything I have heard this evening suggests it is even more important that we put this amendment in the Bill. I am very glad that this Government remain committed to producing a workforce plan in due course. I would like to ensure that all Governments are committed to producing workforce plans in a timely manner and with the independent scrutiny that is required. For the moment I beg leave to withdraw the amendment, but I would like to return to this on Report if the Government do not produce their own recommendations, which I hope they will do.

Amendment 28 withdrawn.