NHS Workforce Expansion

Chi Onwurah Excerpts

Tuesday 28th February 2023 Commons Chamber

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. We delivered the highest levels of patient satisfaction in the history of the national health service. Now patient satisfaction is at its lowest level since at least 1997. There is a second basic promise of the NHS which, if it is not broken, is under attack today like it has not been for years. When I went through my treatment for kidney cancer I had lots to think and worry about—every cancer patient does—but the one thing I never had to worry about was the bill. That is the thing that people love most about the national health service, but those who have never believed that healthcare should be provided to all, regardless of their means, are using this crisis to attack that principle. The right hon. Member for Gainsborough called the NHS the

“the last example of collective planning and socialist central control”—[Official Report, 22 September 2022; Vol. 719, c. 840.]

and even today called on the Health and Social Care Secretary to look at insurance based systems instead.

The hon. Member for Christchurch (Sir Christopher Chope) has a Bill before the House this week that would extend user charging. The Prime Minister himself pledged last summer to charge patients who miss GP appointments, although he has since ditched that pledge—indeed, he has ditched an awful lot since he became Prime Minister. Two former Health Secretaries have joined in. The right hon. Member for West Suffolk (Matt Hancock) has proposed charging for missed GP appointments. The right hon. Member for Bromsgrove (Sajid Javid) went further and suggested charging patients to see a GP, or even to attend A&E. If he were here, I would happily give way to hear an explanation as to how that would work. The most deeply cynical thing about this, is that the right hon. Members for West Suffolk and for Bromsgrove are the people who bear much of the responsibility for the mess we are in today. They ran down the NHS. They refused to train the staff needed to treat patients on time. Now they say that timely care, free at the point of use, as we enjoyed 13 years ago, and as we have enjoyed for much of the past 75 years, is no longer possible—that we cannot afford it any more, that it is not achievable. That regressive, miserabilist argument cannot be allowed to win. Not only is it unjust, but it is wrong, so let us take it on in its own terms.

Why do patients who are ill enough to need to see a doctor miss appointments? Very often it is because the appointment clashes with work, they are unable to travel, they did not receive the letter, or it arrived too late. The answer is to change the archaic and maddening way that patients are forced to book appointments, and build a new system around patient convenience. If patients could choose whether to have an appointment face-to-face or over the phone, if they did not have to wait on hold at 8 am to book an appointment, then wait for a call back that can come at any time of the day, fewer appointments would be missed. Why is it that those who attack NHS managers as being wasteful bureaucrats want to install far more of them? Because that is what an insurance-based system would mean. One-third of US healthcare costs go to insurance company overheads and providers billing patients. Is that really what the proponents of an insurance system want—more administration, more bureaucracy, and less money spent on delivering healthcare?

What would happen if we charged patients to see a GP? People would stay away. In some cases, yes, that would mean people who did not need to see a GP would not take up an appointment. But it would also mean that many people who needed to see a GP but could not afford the price stayed away. More conditions would go undiagnosed, and left to become more serious until the patient had to go to hospital instead. It would mean worse outcomes for patients, a less healthy society, and greater cost to the taxpayer. While we might save £39 on a GP appointment, it costs far more for patients to go to A&E, which costs £359 on average. Not only are those proposals unfair, but they would mean more bureaucracy, more late diagnosis, more expensive and less effective hospital treatment—exactly the opposite of what the NHS needs. Such proposals are wrong on fairness, wrong on efficiency, and wrong on health outcomes. Those in government have no plan for the NHS, and there are even worse ideas sitting on their Back Benches.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

My hon. Friend is making an excellent speech. Does he agree that the lack of support for a workforce plan, and the deliberate running down of the NHS, will prevent it from being able to take on and take up changes in technology, innovation, processes and treatment that could ensure better healthcare with less cost, enabling the NHS of the future to provide the support and treatment that the British people deserve?

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. This really is the crux of it after 13 years of Conservative Government: either the NHS is in the mess it is in today through deliberate policy choice, deliberately running down the NHS because they do not believe in it, or the NHS is in this state through negligence and incompetence. [Interruption.] Perhaps the Minister would like to tell us whether it is negligence and incompetence, or deliberate policy choice. [Interruption.] Apparently, it is the pandemic. I wondered how long it would be before we ticked that box on the health debate bingo card.

If the NHS was in its worst crisis in history and we had the longest waiting times in the history of the NHS because of the pandemic, why were NHS waiting lists at their longest historic level before the pandemic? Why were there 100,000 staff shortages before the pandemic? Why were there 112,000 vacancies in social care before the pandemic? I will tell you why, Mr Deputy Speaker. For the entire time they have been in government, whether pre-pandemic or post-pandemic, the Tories have not had the first clue what to do with the NHS. They took a golden inheritance of the shortest waiting times and the highest patient satisfaction in history, and they have squandered it over the last 13 years to the extent that people dial 999 and an ambulance does not come, people ask to see a GP and there are not enough appointments, and cancer outcomes and cancer waiting time targets are not met—not a single one. That is their record. It is the consequence of their choices and it is one of many reasons why this country needs a change and a Labour Government.

The right hon. Member for Gainsborough asked what reform under a Labour Government looks like. I say to him that it is not the model of funding that is broken, but the model of care. The NHS diagnoses too late, by which stage treatment is less effective and more expensive. We focus too much of our spending on hospital care and not enough on primary care, social care and prevention. The reform our health service needs is shifting that focus out of the hospital and into the community, because if we can reach people sooner we can catch illness earlier and even prevent it in the first place—better for patients and better value for money for the taxpayer. That is what a real reform argument looks like.

Of course, we need to retain the necessary NHS staff. There are 133,000 vacant posts in the NHS today. The number of fully qualified GPs is falling, with an extra 140 patients per doctor compared with five years ago, and midwives are leaving faster than they can be recruited. There is no NHS without the people to staff it, so that is the great gamble the Government have taken on the industrial action in the NHS. It is not just that staff walk out for a day on strike; it is that they walk out of the health service altogether. By ignoring the nurses and the ambulance workers for months, the Government have allowed 140,000 appointments and operations to be cancelled, and risk putting off thousands of staff from continuing their careers in the health service.

Have the Government learnt their lesson? Of course they have not. In two weeks’ time, junior doctors are set to walk out on strike for 72 hours. It will mean huge disruption to patient care, yet there has not been a single meeting or minute of negotiation between Ministers and junior doctors. Why on earth are they not trying to stop yet more disruption to NHS care? Instead of ignoring staff, the Government ought to be doing everything they can to retain them in the health service. That means getting around the negotiation table and resolving the dispute on pay; it means getting around the table and fixing the pensions dispute; and it means listening to staff about their everyday experiences and making sure that, finally, they can see some light at the end of this miserable tunnel.

--- Later in debate ---

[Helen Whately]

On the contrary, we have already made progress on some things in our social care White Paper published just over a year ago. We will soon publish next steps, particularly focused on workforce reforms. I have been talking to several stakeholders involved in exactly that area over the last few weeks. If the hon. Lady is patient she will see some of that coming forward.

I was talking about some of the things that we have done to vastly increase the number of healthcare professionals in the NHS. As part of our ambitions for the future, more than 26,000 students were accepted on to nursing and midwifery courses in England last year—a 28% increase on 2019. We are on track to meet our manifesto commitment of 50,000 more nurses by 2024. Much as we continue to strive to go further and faster, those are the figures as they stand. We might wish to make a comparison with Labour-controlled Wales, though it is sometimes hard to do so because it does not collect crucial data such as vacancy rates. One has to wonder why. That is the same Labour-run Wales where patients are twice as likely to be waiting for treatment as in England. Some 50,000 people are currently waiting over two years, while here in England we eliminated two-year waits last year.

I will move on from the situation in Wales, as I am sure Opposition Members will be glad to do so. The Leader of the Opposition has said that he thinks we are hiring too many people from overseas in health and care. The same gentleman spent several years campaigning for a second referendum on freedom of movement. Whatever his views this week, it is the work of a responsible Government to look at every available option to give this country the health and care workforce that it needs. Alongside training more doctors and nurses, recruiting from overseas and giving people from other countries a chance to work in the NHS is the right thing to do.

[Chi Onwurah]

I am pleased to hear the Minister say that it is the Government’s duty to look at every available option. During the pandemic, I take it that she clapped on her doorstep for the NHS workforce who did so much to get us through it, so why will she not look at the option of abolishing the non-dom tax loophole, to fund more nurses and doctors and a better NHS in future?

[Helen Whately]

A responsible Government take a responsible approach to funding our public services, including the NHS. Later I will come to exactly the point about the Opposition’s proposals to use that funding pot again and again for the health service.

Coming to social care and international recruitment, we have put care workers on the shortage occupation list. As a result, social care employers have already been able to offer care worker visas to more than 34,000 people. I welcome international nurses joining our nursing and midwifery register, and I make no apology for continuing to encourage bright and talented international doctors to come and work in the NHS. In fact, that is the very idea of the points-based immigration system that we have so successfully implemented.

As well as recruiting the best and the brightest, it is vital that we retain them. Ultimately, our goal is to make sure that the NHS is one of the very best places to work in the world; both my parents were NHS doctors and, believe me, I have had plenty of conversations about why sometimes it is not. What is most frustrating is when the system prevents them from giving people the very best care.

It is not simply all about pay, as Opposition Members might have us believe. The hon. Member for Ilford North talked about nursing pay, but he will understand that we are currently in talks and now is not the moment to play politics with this issue. We are pleased that the Royal College of Nursing has paused strike action. We have no doubt that both sides are committed to finding a fair and reasonable settlement—one that recognises the vital role that nurses and nursing play in the health service, the wider economic pressure facing the United Kingdom and the Prime Minister’s priority to halve inflation.