Interim NHS People Plan

Debate between Jonathan Ashworth and Stephen Hammond

Wednesday 5th June 2019 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op) (Urgent Question)]

To ask the Secretary of State for Health and Social Care to make a statement on the interim NHS people plan.

[The Minister for Health (Stephen Hammond)]

The NHS published its interim people plan on Monday, and I laid a written ministerial statement at the earliest opportunity yesterday.

The plan is a first, but critically important, step in ensuring that the NHS has the people, leadership and culture it needs to deliver the NHS long-term plan. The interim people plan has been developed by Baroness Dido Harding, the chair of NHS Improvement, in partnership with frontline staff, NHS employers and a wider range of other representative groups and stakeholders. It takes a tough look at the challenges facing people working across the NHS. It sets out how leaders will be supported to create cultures that empower staff and make sure that every member of staff, regardless of their background, will be able to progress.

Critically, the plan calls for all NHS organisations to set out how they will ensure that the NHS is the best place to work. The recently appointed chief people officer for the NHS will play a vital role in supporting the NHS to do this. The interim people plan sets out a number of practical steps to increase the supply of clinical staff. This includes an extra 5,000 additional clinical placements for nurse training places by September 2019 and a commitment to further expansion of medical school places.

Ultimately, the plan will ensure that the NHS is best able to retain the highly skilled and dedicated staff who choose a career in healthcare, including the most senior clinicians. Therefore, we have listened to their concerns that pension tax changes are discouraging them from doing extra work for patients. That is why Government will consult on how to introduce new flexibilities for this critically important staff group.

But we are not complacent. We know there is more work to do to secure the people, leadership and culture that the NHS needs. My right hon. Friend the Secretary of State has asked Baroness Harding to lead further work over the summer to prepare the final people plan. As has always been intended, the final people plan will be published soon after the conclusion of the spending review, when there will be further clarity on education and training budgets.

I would like to take this opportunity once again to place on record my thanks, and the thanks, I am sure, of everybody across the whole House, to all the NHS staff who do a wonderful job in ensuring that our constituents—their patients—get excellent care.

[Jonathan Ashworth]

It is a pleasure, as always, to see the Minister of State, but the Secretary of State should be doing his day job and be here answering questions about the health service, not playing his Tory leadership games.

Our NHS is struggling with vacancies of 100,000. Our NHS staff are the very best in the world—and none of them wants to be part of a trade deal with the Americans, of course—but they are working under immense pressure because of these chronic shortages. Shortages put patient care at risk, and that means that standards of care are falling. This means that our constituents wait longer to get a GP appointment because we have lost 1,000 GPs. It means that women are turned away from maternity units because we are short of 3,500 midwives. It means that cancer diagnosis is delayed because of shortages in the cancer workforce. As Dido Harding’s report shows, we are short of 40,000 nurses in the workforce, and that is now critical. It means that at a time when mental health problems are increasing—The Lancet reports today on an increase in non-suicidal self-harm—we have actually lost 5,000 mental health nurses since 2010. We have problems in the learning disability sector. Health Education England today warns that because of the shortages in learning disability nursing, we are set to

“hit critical levels in the next five years”,

with vacancies of 30%. We have an ageing population. Adult social care is short of 110,000 staff, and yet district nursing has been cut by 50%. We do not have enough nurses on our children’s wards. Health visitors and school nurses in our communities have been cut.

This NHS workforce crisis is linked to decisions of this Government. As Dido Harding’s report says,

“applications for nursing and midwifery courses have fallen since the education funding reforms”.

Those education funding reforms include the abolition of the bursary. Is not that therefore a damning indictment of the decision by this Government to abolish the bursary, and will the Minister now commit to bringing it back?

The report also references continuing professional development, where budgets have again been cut, by a third. It says:

“Employers have…been investing less in their people, as pressures on NHS finances have grown.”

Is that not an admission that Tory austerity, with nine years of underfunding in the NHS, has contributed to the workforce crisis of today?

The Health Secretary has said that he wants “a new Windrush Generation” of overseas nurses to fill the staffing gap, so can the Minister explain why a commitment to recruit 5,000 extra nurses a year internationally was dropped from the Dido Harding report? Did the Government put pressure on Baroness Harding? On international recruitment, can he guarantee that no one offered a job in the NHS or care sector will be restricted by the £30,000 salary cap, as the chair of Health Education England called for yesterday at the Health and Social Care Committee?

Finally, the Minister referenced the spending review. He will have seen that the Chief Secretary said yesterday at a Select Committee that the spending review is now unlikely to be ready for 2020-21. That means that new funding for training, for Health Education England and for capital investment in public health and social care will not come on stream until 2021—two years away. Does the Minister think that that is an acceptable way to deal with the NHS crisis we are facing? I urge the Minister, for whom I have a lot of respect, to accept that we cannot keep delaying this situation further. The Health Secretary needs to abandon his leadership games, focus on his day job and get a grip.

Government Mandate for the NHS

Debate between Jonathan Ashworth and Stephen Hammond

Thursday 25th April 2019 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the Government’s failure to lay before Parliament the NHS mandate for the current financial year.

[The Minister for Health (Stephen Hammond)]

I am grateful to have the opportunity to set out the Government’s approach to setting a mandate for NHS England for 2019-20. The Government’s annual mandate to NHS England for 2019-20 will, for the first time, be a joint document with the annual NHS Improvement remit letter, called an accountability framework. This signals the importance of these two arm’s-length bodies working increasingly closely to maximise their collective impact. It will set one-year transitional objectives to allow the NHS time to implement the long-term plan, and it has been developed to meet the needs of patients, families and staff.

We are committed to the NHS and are funding its long-term plan to ensure that it is fit for the future for patients, their families and NHS staff. The accountability framework sets the expectations that will make that long-term plan a reality. The Government have continued to prioritise funding the NHS, with a five-year budget settlement for the NHS announced in summer 2018 that will see the NHS budget rise by £33.9 billion a year by 2023-24.

The funding settlement and the implementation of the long-term plan are not affected in any way by the short delay in the publication of the accountability framework. We are all engaged to ensure that the accountability framework is published and laid as soon as possible, and I and my ministerial colleagues and officials are working closely with NHS England and Healthwatch England, as statutory consultees, to ensure accountability, improvement and progress to deliver world- class care for patients.

[Jonathan Ashworth]

It is a pleasure to see the Minister of State, as always, but the Secretary of State should be here to defend his failure to produce the NHS mandate. In every previous year, in accordance with section 23 of the Health and Social Care Act 2012—an Act that he supported and voted for despite everyone telling the Government not to support it—the Government have published the NHS mandate before the beginning of the financial year. This mandate outlines the Secretary of State’s priorities for the NHS given the financial settlement, yet this is the first time a Secretary of State has failed to lay before Parliament the Government’s mandate to the NHS for the forthcoming financial year. Is this a failure of leadership or the latest piece of stealth dismantling of the Health and Social Care Act? If it is the latter, why not just take our advice and bin the whole thing and so end the wasteful contracting, tendering and marketisation it ushered in?

The Minister talks of the 10-year long-term plan, but it is no good his telling us he endorses Simon Steven’s vision of the NHS in a decade’s time, when Ministers cannot even tell us what they expect the NHS to achieve in a year’s time. He boasts of the new revenue funding settlement for the NHS but seemingly has not got a clue what he wants the NHS to spend it on in the next 12 months, and at the same time he does not talk about the cuts to public health budgets, training budgets and capital investment.

Will the new accountability framework deliver for patients in the next 12 months? Last year’s mandate pledged that A&E aggregate performance in England would hit 95% in 2018. That pledge was broken, so can the Minister tell us whether, for those A&E departments not trialling the new access standard, the four-hour A&E standard will be met this year, or will the target not be met for the fourth year running?

Or how about the 18-week referral to treatment target? More than half a million people are now waiting more than 18 weeks for treatment. The target that 92% of people on the waiting list should be waiting less than 18 weeks has not been met since 2016. Will that target be met in the next 12 months, or has it also been abandoned? What about cancer waits? Some 28,000 patients are now waiting beyond two months for treatment. The target for 85% of cancer patients to be seen within two months for their first cancer treatment after an urgent referral has been missed in every month but one since April 2014. Will that target be met this year, or will cancer patients be expected to wait longer and longer?

On staffing and pay, will funding be made available in the next 12 months, as it was last year, for a pay rise for health staff employed on agenda for change terms and conditions working in the public health sector for local authorities and social enterprises?

We have no NHS mandate, even though it is mandatory. We have no social care Green Paper, even though it has been promised five times. The big issue has been ducked again. We have no workforce plan, even though we have 100,000 vacancies across the NHS, and the interim plan, which should have been published today, has been delayed again. The Secretary of State parades his leadership credentials around right-wing think-tanks, yet on this record he could not run a whelk stall, never mind the Tory party. It is clearer than ever that only Labour will fully fund our NHS and deliver the quality of care patients deserve.

[Stephen Hammond]

Anyone listening to that will have realised that the hon. Gentleman is more concerned with political points scoring and process than with the substance and funding of the NHS. [Interruption.] The hon. Member for Dewsbury (Paula Sherriff) shouts at me, but she will want to remember that the shadow Secretary of State welcomed the long-term plan—or much of it—back in January.

It is absolutely clear—evidence was provided to the Public Accounts Select Committee yesterday by the permanent secretary and the chief executive of NHS England—that while obviously it would be better to publish by the deadline, it is more important that the mandate be right than published on a particular day. It is more important that we get this document on the long-term strategy of the NHS correct. As Simon Stevens, the chief executive of the NHS, said, there is no problem with this short delay to the mandate. It is an important document, but it is causing him no problems. It is causing no problems.

The hon. Gentleman mentioned access to treatment and treatment times. This winter, more than 7 million patients were seen in under four hours. That is an increase of nearly 6% in attendances. I would have hoped that the Opposition Front Bench might have praised the NHS and its hard-working staff—

[Stephen Hammond]

Rather than shouting political points across the Dispatch Box.

The hon. Gentleman says there are no targets. He is of course wrong.

[Jonathan Ashworth]

I said you were not meeting them.

[Stephen Hammond]

No, the hon. Gentleman said there were no targets likely to be set for the NHS this year. The accountability framework will include detailed and specific annual deliverables and set out in detail a process for delivering future implementation as well as some of the early delivery goals for 2019-20. He is wrong therefore to say that the framework will not have deliverables attached to it. It will. He also mentioned the Green Paper—

[Jonathan Ashworth]

Where is it?

[Stephen Hammond]

I have said, as the hon. Gentleman has heard many times, that we are finalising that. Again, it is more important to get it right. On the long-term plan for workforce implementation, a draft plan is being produced and I expect that plan to be published in the very near future—[Interruption.]

Oral Answers to Questions

Debate between Jonathan Ashworth and Stephen Hammond

Tuesday 26th March 2019 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

May I just take a moment, on behalf of the Opposition Front Bench team, to thank the hon. Member for Winchester (Steve Brine) for all his work? We found him a decent, fair-minded Minister, and I wish to pass on my personal thanks for the work that he did on the children of alcoholics agenda.

We have 100,000 vacancies across the NHS. The Brexit mess means that we have fewer EU nurses and health visitors. Across the NHS, voluntary resignations are up 55% since 2011, and the professional development budgets have been cut by £250 million. Does the Minister agree that for Dido Harding’s review to be taken seriously, those cuts to continuing professional development must be reversed?

[Stephen Hammond]

As the hon. Gentleman heard me say earlier, Baroness Harding is developing the implementation plan, which will then feed into the final implementation plan published after the comprehensive spending review. The cuts, as he describes them, are not cuts. He knows that we are increasing the budget for the NHS in real terms and in cash terms up to 2023-24.

[Jonathan Ashworth]

The Minister is responsible for workforce, but does not seem to understand that training budgets have been cut. Baroness Harding’s review will only be taken seriously if it is backed up by real investment.

Outsourcing and transferring of staff, whether to wholly owned subsidiaries or the privatisation of clinical services, further undermines staff morale and creates a more fragmented workforce. The Secretary of State went to the Health and Social Care Committee and said no more privatisations on his watch, yet cancer scanning services in Oxford are being privatised. Will the Minister reverse those privatisations, or can we simply not believe a word the Secretary of State says?

[Stephen Hammond]

The hon. Gentleman can believe everything my right hon. Friend the Secretary of State says. He has delivered on his promise to work with the NHS to deliver a long-term plan, to deliver the funding that will make it possible, and to deliver the workforce that will ensure the plan is not undermined.

Integrated Care Regulations

Debate between Jonathan Ashworth and Stephen Hammond

Monday 18th March 2019 Commons Chamber

[Jonathan Ashworth]

Will the Minister confirm that, because of the competition and procurement rules and the regime brought in by the Andrew Lansley Act, he cannot rule out the possibility of an independent provider winning a contract? He might say it is unlikely, but he cannot rule out the possibility, so why does he not introduce a measure—a simple one-clause Bill, perhaps—to give the assurances that many campaigners want?

[Stephen Hammond]

The hon. Gentleman is right: it is highly unlikely. More than that, it is stated and restated in the long-term plan that NHS England has the clear expectation that the ICP contracts will be held by public statutory providers. He knows that, and others who have discussed this point have made it clear.

NHS 10-Year Plan

Debate between Jonathan Ashworth and Stephen Hammond

Tuesday 19th February 2019 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

Very good question.

[Stephen Hammond]

I am sure that there will be a number of excellent questions and interventions, but it was a good question. The plan sets out that all local health systems will be expected to outline this year how they will reduce health inequalities by 2023-24, and the intention is that that process will consider exactly the health inequalities that the hon. Member for Sheffield, Heeley (Louise Haigh) mentions.

Additional money for the primary sector will ensure that funding for primary medical and community health services, such as GPs, nurses and physiotherapists, increases by £4.5 billion in real terms in the next five years. That will mean up to 20,000 extra health professionals working in GP practices, with more trained social prescribing link workers within primary care networks. By 2021, all patients will be offered a digital-first option when accessing primary care. The plan also considers the future of the health system, and the new proposals for integration are the deepest and most sophisticated ever proposed by the NHS.