NHS Pensions and Staffing

Debate between Dan Poulter and Philippa Whitford

Wednesday 13th July 2022 Commons Chamber

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I draw the House’s attention to my entry in the Register of Members’ Financial Interests as a practising NHS hospital doctor, although I am not personally affected by the issues I am about to raise.

I think we would all agree that following the pandemic, the NHS is facing unprecedented challenges in delivering patient care. The current demands on the system are too high to be met by the existing workforce and resources alone, and while the Government rightly seek to increase the NHS workforce by training more doctors, nurses and other frontline clinical staff, it is equally vital that we retain the existing workforce. Simply put, losing senior and experienced staff at this time would be an unmitigated disaster for the NHS and the patients it serves.

One of the biggest threats to the retention of the most senior and experienced NHS staff is the punitive and unfair interplay between long-standing Government pension taxation policies and the NHS pension scheme. Those policies, and the punitive financial penalties that result from them, will cause many senior NHS workers to take drastic steps such as reducing hours, leaving leadership roles or taking early retirement. These pension penalties will result in senior and long-serving NHS workers aged 59 or 60 potentially losing over £100,000 from their pension pot if they delay retirement by one year, rather than retiring this year. That is resulting in senior and experienced NHS workers being advised by actuaries and accountants to reduce their working hours in order to avoid being hit by huge pension tax bills that will see them working for little pay, or in some cases no pay at all.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Obviously, I too was a doctor until recent years.

This is an issue for all four health services across the UK, and is taking away people with the knowledge, skills and experience to not just look after patients but teach. Is the underlying problem not that when this policy was introduced in 2015, the talk was about preventing tax avoidance? It is not possible to play games with a final salary scheme. It was never open to doctors to play games with their pension, and therefore it is simply the wrong policy for the wrong group of people.

[Dr Poulter]

The hon. Lady is absolutely right. There were some further unintended consequences of the Finance Act 2004, which I will come to in a moment, but doctors, nurses and healthcare professionals cannot chose the rate at which they contribute to their pensions—they have to contribute at a fixed rate. There is no choice, so unintentionally, we find ourselves in a situation where senior healthcare professionals are facing punitive, eye-watering annual charges on their pensions worth tens of thousands of pounds. That cannot be right.

NHS: Staffing Levels

Debate between Dan Poulter and Philippa Whitford

Tuesday 11th December 2018 Westminster Hall

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

It is an honour to serve under your chairmanship, Mr Hollobone. I, too, declare an interest as a longstanding NHS worker of more than 30 years.

Healthcare is not delivered by machines or buildings; it is delivered by people. People are the core of the NHS. The problem relates to workforce, and it is hitting all four nations. Although Scotland has the highest ratio of every group of healthcare staff per head of population, we too face challenges. We have a 4.8% nurse vacancy rate in Scotland, but in England it is more than 11.5%. The Royal College of Nursing says that there are 41,000 nurse vacancies at the moment, and if action is not taken, that will rise to 48,000.

As other Members mentioned, since the introduction of the bursary in 2015, there has been a one third drop in applications. Acceptances in England have gone down by almost 4%, whereas in Scotland they have gone up by almost 14.5% over the same period. The bursary is having a huge impact, particularly on mature students, who might already have a degree and have therefore also been hit by the removal of the post graduate bursary that allows a nurse to be trained in just two years.

There has been a 15% drop in mature students, which is hitting those with mental health issues and learning disabilities in particular, as those specialities tend to attract the more mature nurse student. There has been a 13% drop in mental health nursing staff and a 40% drop in nurses looking after those with learning disabilities. That makes those services unsustainable.

Brexit is affecting the workforce, as it is every other aspect of life. There has been a 90% drop in European nurses registering to come and work in the UK, and a trebling of EU nurses who are leaving the UK register. That does not help to solve the problem, and those nurses cannot be totally replaced by UK staff in enough time. It does not matter that the Government come out with warm words if the Home Office’s actions make people feel insecure. Friends of ours who have been GPs for more than 20 years in Scotland applied for citizenship for their children. The eldest and youngest children were granted it; the middle child was refused. What are they now talking about? “Maybe we should go back to Germany where we’d be safe.”

From every angle, the Government are taking actions that are making staffing levels worse. The former Secretary of State for Health, the right hon. Member for South West Surrey (Mr Hunt), used to go on about the lack of junior doctors and consultants as a cause of excess deaths among those admitted at weekends. Actually, the only staffing impact proven through research is on the ratio of registered nurses to patients—not healthcare assistants or others.

[Dr Poulter]

I am sure that most of us had great concerns about the previous Secretary of State’s use of statistics, but a mental health study was carried out and the highest morbidity rates were in the middle of the week, not at weekends, which rather disproved the assertions that he was making.

[Dr Whitford]

We pointed that out repeatedly at the time. It has been shown time and again that quality, well-trained, experienced nurses—not so much agency nurses or healthcare assistants—who know a ward are the bedrock of every single service in healthcare.

Brexit is having an impact. Even though in Scotland our Government have promised to pay settled status fees for all those working in public services, we have already lost, according to the British Medical Association survey, 14% of our doctors. England has lost almost 20%. We cannot reach a point where England has 50,000 nurse vacancies. That would be unsafe. The Government need to take action and, like the Scottish Government, put the bursary back, get rid of tuition fees, and make it sustainable for people to train to become nurses. If they do not do that, the sustainability and safety of the NHS in England will deteriorate further.

Hepatitis C

Debate between Dan Poulter and Philippa Whitford

Tuesday 12th June 2018 Westminster Hall

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Streeter. Hepatitis C was identified about 25 years ago. When I was a young doctor, it was simply known as non-A, non-B hepatitis, because no one had any idea what it was. As the hon. Member for Southend West (Sir David Amess) said, we are talking about something that many people simply do not know they have. That is a key, underlying problem. Patients may only be aware that they have hepatitis C when they start to have liver symptoms, which is the start of cirrhosis or malignancy.

With any condition, we first want to prevent it. As was mentioned, at needle exchanges we already have blood screening to ensure that it is not coming from transfusion. We have to remember those in this country who previously suffered from contaminated blood that was iatrogenic—caused by doctors and the health service.

I agree with the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) that we need a more medical approach to the issue of drugs. If we drive problems underground, there is no possibility of detecting and treating people, to achieve the elimination that the World Health Organisation is aspiring to.

In Scotland we are recognised as world leaders, in the sense that we had a strategy in 2005, 2008, 2011 and then our elimination strategy, which was introduced in 2015. The 2011 strategy fed into what became the World Health Organisation strategy, as one of our senior leaders was seconded to it. The big change is sofosbuvir and ledipasvir—the new antivirals that are well tolerated and able to clear the viral load in 90% of all patients. Of course we would prefer a vaccine, as the hon. Member for Strangford (Jim Shannon) mentioned; that is how we eliminated smallpox and how we are trying to eliminate polio. However, the problem with hepatitis C is that, as he said, there are six genotypes, but 50 subtypes, and it mutates regularly. It is one of those viruses with a coating that is very hard to get a handle on with the immune system and therefore to develop a vaccine for, so we need to use the drugs until a vaccine is available.

The Scottish Medicines Consortium passed sofosbuvir in 2014 and NICE passed it in 2015. Unfortunately, NHS England took the approach of trying to slow things down because the drugs are very expensive. However, dealing with liver failure and having to consider liver transplantation is even more expensive. A cap of 10,000 patients with cirrhosis and the most severe conditions from hepatitis C was set.

In Scotland in 2015, we took the opposite approach—a public health approach—to try to reduce the virus in the community and prevent it from occurring.

[Dr Poulter]

The hon. Lady is making very good points. I am sure she will correct me if I am wrong, but the other point to make is that in Scotland there has been a much more joined-up approach in tackling heroin addiction. Scotland is much further forward than England in addressing such issues, in having a co-ordinated strategy and in recognising how addiction leads to prisons and the criminal justice system. Indeed, there is not the fragmented commissioning of services that we see in this country. Does she agree with me that that is something that England can learn from in addressing the lack of joined-up working and commissioning?

[Dr Whitford]

I thank the hon. Gentleman for his comments. As NHS Scotland is still a single public body, we do not have the issue around commissioning. We are also trying to take a much more health-based approach to addiction. As happens in England as well, we have multiple needle exchange programmes. This place has held us back from trying to introduce safe injection in Glasgow, which has one of our highest drug-addicted populations and highest incidence of drug-related deaths. However, that initiative comes under the Home Office and we have not been granted permission to try to take it forward. Always taking a criminal justice approach gets in the way of achieving the medical outcomes that we want.

It is really important to recognise the breakthrough of the drugs. With an eight or 12-week course, expensive as it is, more than 90% of patients will achieve a sustained virological response. That means they remain with undetectable levels of virus 12 to 24 weeks after the end of their treatment. The problem with rationing treatment to those who are actually ill is that it is the people who are not ill with hepatitis who spread it to other people, because they are out and active. If they are drug users, they are still using drugs. Someone who is so ill that they are confined to bed is not spreading it. That is why we took a public health approach to eliminating hepatitis C over the coming years. We certainly aim to achieve that before the World Health Organisation target date.

As the hon. Member for Southend West said, one of the key issues is people not knowing that they have the virus, so, in Scotland, part of our approach has been to create opt-out screening at various points of blood being taken. That will be from general practice in areas of high prevalence. It already includes bloods taken in accident and emergency. It includes screening at other times such as when we screen for HIV. Obviously, we screen for HIV when a woman has her booking appointment at the time of her pregnancy. We need to use all the opportunities that we can. Of course a patient always has a right to opt out, but when we make something the norm it becomes easier for people to agree.

The prison population obviously has a big problem with drugs, including IV drugs—either in the present or the past, before the prisoners were incarcerated. It is important that we get the tests taken up by such populations.

We also offer testing in more social settings, where there have been education events around hepatitis and HIV and where peer-to-peer work has been done. It is important that we raise awareness and try to reduce the stigma. There is a problem with always talking about HIV drug users, as opposed to recognising that someone might have been contaminated by blood in this country, while undergoing maternity care or surgery overseas, or, as was mentioned, in a tattoo parlour: it means that people do not care. We end up with, “Well, it’s their own fault”, which maintains the risk to everyone else and hampers elimination. As well as raising awareness, we absolutely have to reduce the stigma.

It is important to take a public health approach, as we have done in Scotland. I commend that to NHS England, which should remove the cap and do as we are doing: try to set a minimum target for new people to be found and treated as soon as possible. We have seen the new cases reduce from 1,500 in 2007 to 700 in 2013, but it is the chronic cases that have been out there for years that we have to find because they still carry the virus and can spread it to other people.

Of course, NHS England should try to get the price down. There is no right for drug companies to profiteer as opposed to having a fair return, but the issue must be taken in the round. We must recognise that eliminating the virus by using drug treatments while we wait for a vaccine will overall be an huge benefit to society.