NHS Workforce Expansion

Ben Bradley Excerpts

Tuesday 28th February 2023 Commons Chamber

[Ben Bradley (Mansfield) (Con)]

It is a pleasure to speak in this debate. I will try to skip the partisan rhetoric and get to the crux of some of the issues.

I start by thanking my hon. Friend the Member for Newcastle-under-Lyme (Aaron Bell) for mentioning PFI, because I also represent a hospital that, the last time I checked, spends 14% of its annual budget on repaying Labour’s PFI deal. That is incredible and a detriment to all my constituents, although it is a lovely building.

The workforce question is important, and we all want happy, healthy staff in our NHS and our wider health services. We all understand that they are under untold pressure from covid, the cost of living challenge and short staffing, but my message to the shadow Minister is that saying that, and saying that we want things to be better, is not a plan. It is nice to talk about, but it does not fix anything.

The motion is a little misleading, because it does not mention that we have 37,000 more doctors, 45,000 more nurses, record levels of recruitment and record staff numbers in our NHS. Truth be told, we have shortages in everything in our economy. We will debate the economy a little later, and we could discuss many of these things in that debate because we have a wider challenge of economic inactivity and getting people into work. This is a much bigger systems and process question than just chucking in more resources and adding more training courses. That will not fix this issue.

We have record funding and record staffing in our NHS, and this Government have taken a lot of action to try to increase them. People often talk about a reduction in the number of applications, but they miss or neglect to mention that Government action, including the nursing bursaries, has led to an increase in the number of actual people doing actual nursing courses because it removed the targets, enabled more funding to flow into the system and created more spaces on nursing courses, which has led, in part, to a 25% increase in the number of people studying nursing. We can all talk rhetoric and point fingers, but the Government action was, in many ways, effective. The truth is that the issue is more fundamental than just staffing, and the shadow Minister, probably deliberately, misses that point.

I want to raise two things. First, we should not forget care. I do not understand how we can discuss this issue without talking about care. The Government’s proposal on integration is essential. The NHS, even in one county, is not one organisation—it is all sorts of different organisations trying to work together, including a care system that does not share the same data or the same processes. So much of the burden and the pressure on staff comes down to the fact that these things do not work together properly.

Ambulances are taking elderly patients with care issues to A&E. Hospitals are discharging to care homes and increasing the likelihood of people ending up back in hospital, which is also a care issue for the most part. These things are interconnected, so I am aghast that the Opposition neglected to talk about care in their motion.

Where I agree with the Opposition is that we need a joint workforce plan across health and care, not least to try to overcome some of the stereotypes of working in care, so that, when people consider a career in care, they can clearly and overtly see the pathways through the system into a health service that provides a wide range and scale of opportunities. It would be a huge step forward if we could jointly recruit across health and care into a wide-ranging and exciting set of careers.

Discharge funding has been helpful, and the Government have improved care capacity in Nottinghamshire and the ability to get people out of hospital into care. However, there is still a whole-system issue: data and process need reform, as much as anything else. I agree with the shadow Minister on community-based care but, again, saying we would like more of it is not, in itself, a plan.

Secondly, no amount of money or reform will fix the system. Demand, and public expectations of our health service, have gone through the roof. Capacity has increased, but it is never enough because we expect our health service to provide, for free, everything we want in an increasing range of services. That is not possible or feasible when we have increasingly complex and expensive needs, an older population, more working-age disabled people, more lifelong and chronic illness and more mental ill health. The NHS was never set up to deal with that or the range and complexity of services, which were never envisaged.

Most of us agree that basic healthcare, free at the point of use on and through our NHS, is absolutely right and is fundamental to what many of us feel and believe about Britain, but it cannot grow forever at the expense of services, education and infrastructure. At some point we will need to have a conversation—it will be a brave Government who have that conversation—that draws a line around a basic set of services and expectations that people can access for free, and we will need to have a proper conversation about how we do the rest, because it is not sustainable to keep chucking more money into a pot and to keep expecting hard-pressed NHS staff to offer and deliver more and more when we know they will never catch up with increasing public demands and expectations. Staffing and funding are at record highs, yet the gap grows and waiting times grow. At some stage, we will need to have a proper discussion about what the NHS is for and whether our expectations are realistic, because the NHS does many things that are perhaps not what it is for.

I know you are keen for us to wrap up quickly, Mr Deputy Speaker, so I will finish with a few points. I have touched on some big, long-term questions, but we could quite quickly change some smaller things that seem like simple common sense to most people. We still deliver paracetamol on prescription, but it costs 30p at Boots. It costs £35 to go through all the different appointments and all the different systems to get paracetamol on prescription from the NHS, at the cost of tens of millions of pounds a year. Why do we do that? Why do we add that burden to our health system?

The 111 service was set up as an advice service to help people to figure out where in the system they needed to go, but now it calls ambulances. A few weeks ago, an ambulance technician told me a story about ambulance staff being sent out on a category 2 “stroke-level emergency” because a 111 call handler had ticked the wrong box on the decision tree—the caller had actually rung to say they had been picking up ice and had cold fingers. And we wonder why there is not the capacity and the space in the system! We need to reform the 111 service so that it follows the same decision tree as the 999 service or directs people back into 999. We need to give ambulance staff the ability to say no to people who call every day and to people who are not having emergency, critical conditions or problems and live near a hospital and are sat next to somebody who has a car and could drive them there. People have this impression that they can jump the queue. All those things would relieve pressure on A&E and on NHS staff, and they seem like simple and obvious things to do.

My final point is on the need to have an honest conversation. I agree that staffing and the need for more capacity and support to tackle waiting lists are huge priorities, and the Government are working on them, but we cannot continue to grow the health service forever. Everybody knows that—my constituents certainly do. This is a much more wide-ranging systems and process issue and a much more wide-ranging issue about our expectation of what a health service can realistically deliver. That is not something we are going to tackle today, but it is a conversation I have no doubt we will have to return to in the very near future.

[Several hon. Members rose—]