NHS Workforce Expansion

Karin Smyth Excerpts

Tuesday 28th February 2023 Commons Chamber

[The Minister for Social Care (Helen Whately)]

I am grateful for this chance to come to the House and talk about the NHS workforce. I am happy to begin with something that I expect is a point of agreement with those on the Opposition Benches: praising our fantastic NHS workforce and all they have done through the pandemic and are doing now as we recover from covid. Hon. Members will not be surprised to learn that my colleagues the Secretary of State for Health and Social Care and the Minister for Health and Secondary Care, who has responsibility for workforce, are today focused on discussions with the Royal College of Nursing, so it is my particular honour to speak on behalf of the Government today and to take a moment to re-set the tone, and indeed raise the bar, in this debate.

I am very happy to talk about our NHS workforce at a time when we have record numbers of doctors and nurses working in our health service. I am equally happy to talk about our social care workforce, the very people the hon. Member for Ilford North (Wes Streeting) seems to forget time and time again. I note that they are forgotten in his motion again today. In contrast, the Government are working with our whole health and social care workforce, not only training record numbers of doctors and nurses, and recruiting a whole host of healthcare professionals into the NHS, but bringing historic reforms for the social care workforce—all that despite the global pandemic, which created the most challenging backdrop any Government have faced for decades.

[Karin Smyth (Bristol South) (Lab)]

Will the Minister give way?

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[Helen Whately]

My hon. Friend makes a very good point about the selective use of figures by Opposition Members.

[Karin Smyth]

I want to pick up the point about social care, on which, as the Minister knows, I am very keen to see progress. Her Government shelved their social care plans. The former Prime Minister said he had fixed social care, leading the entire country through that dance. He promised people that it was fixed and that people in their older age or with disabilities could be secure, so it is rather shameful for her to raise that point without then saying—maybe she will go on to do so—when we will actually see any progress on social care. Why have her Government shelved their plans?

[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.

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[Dr Whitford]

That is not true—and 99% of our trainee posts last year have already been filled. Perhaps the hon. Gentleman should look at the statistics. We have more GPs per head of population than any of the other nations in the UK, including Wales, which his party runs.

So what do we need to do about this? Clearly we need to train more staff, but we must also not only increase the number of both nursing and medical student places, but look at the cost of studying and the student debt that those people will be left with. We do not have tuition fees in Scotland and our nurses receive a bursary of £10,000 a year, which means that we are investing £20,000 in every student nurse in Scotland.

[Karin Smyth]

The hon. Lady talks a great deal about the inputs of the SNP Government in Scotland, but very little about the outcomes there. Does she not agree that, rather than carping about the contrast between how good things are in the rosy land of Scotland that she portrays—which is not a true picture, as we know from what is happening with the SNP leadership election—and how bad they are in Wales, England and indeed Northern Ireland, we should start learning from the different ways in which the different Governments are providing services and working people? We need to stop carping about those differences, learn from each other and recognise that outcomes are different, rather than just talking about the inputs. Is that something on which she might want to work with other people?

[Dr Whitford]

I think I have spent the last eight years demonstrating the different approaches that Scotland takes. The Minister talked about community pharmacies, which have been providing minor ailment care in Scotland since 2005. Our optometrists are allowed to refer people with cataracts directly to hospital, whereas in England, they are often made to go through a GP. So I am sharing and have shared ideas in that way. However, there has been a 5.8% increase in the uptake of nursing jobs in Scotland, so we also have more nurses per head of population.

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[Karin Smyth (Bristol South) (Lab)]

Having spent most of my career in NHS management roles before becoming an MP, I often reflect on my own motivation for choosing two such unpopular careers—ones that, like the England manager job, virtually everyone can do better. One of our colleagues said recently that NHS managers are utterly useless and overpaid, which is what many of our constituents might say about us. As someone who has always been a manager and active in the Labour party, I was often told rather gently by my colleagues that I was too political to be a manager in the NHS, and my colleagues in the party often say that I am a bit too managerial to be an MP, so I think I am somewhere just about right.

The truth is that the NHS is an intensely political construct. NHS managers do not have the neutrality cloak of civil servants or the freedom of many business leaders. The lack of clarity around the role of NHS management is, I think, problematic, and it often leaves managers isolated and less able to do the job that we crucially need them to do. The Secretary of State’s pledge to cull managers yet again comes at a time when the challenges faced by the system are the greatest that we have ever seen, even without taking the pandemic into account. Industrial relations are at an all-time low, capacity and demand are massively out of kilter, the physical estate is crumbling, with £10 billion-worth of backlogs, and morale is at dangerously low levels.

We need much better management, but managers need to be clear with us. Ten years on from the Francis report and the introduction of a duty of candour, we—the public, Members of Parliament and patients—have to know where and when our system is and is not safe. We have to be informed about the trade-offs between cost and quality, and we should be active parts of the discussion about the future of technology and big data in healthcare. I am disappointed that the Minister has again trotted out the figures of inputs but has not addressed the crucial issues. We did not do that before the pandemic, and it is quite extraordinary that the Government are still not receiving the messages from the frontline.

The increased recruitment to NHS unions, more support for strikes and the reality of people’s experiences all tell us the same message. The Government’s current response is all about getting rid of the current crisis: the money that they are putting in is too little and too late to be of real value, and instead of collaborating with local authorities, which are now worrying about the pick-up rates, they are fragmenting many local relationships. The uncertainty about payment by results and the faltering steps towards better collaboration mean that the deckchairs are still moving, and for our constituents, things are not improving.

Our focus in government, of which I am enormously proud to have been a part in an NHS trust and then as a manager, was on patient choice. That was not because we think that the NHS is a market, as is often said, but because we think that the NHS needs a stronger patient voice to co-produce individual care, and because we are asking people to pay more in this age of long-term conditions and co-morbidity, so we have to ensure that they have more local accountability in the system. The system is not accountable locally.

I repeat my comments about Scotland and Wales. The Welsh waiting lists are not acceptable. The Scottish waiting lists are not acceptable. None of this is acceptable. As politicians, we all need to start addressing some of the underlying issues we share and start learning from one another.

I am proud of my time in the NHS and fully aware of the scale of the task ahead, but with good clinicians, good managers and, dare I say it, good politicians, we can develop a longer-term plan and turn this around, should we choose to. The workforce is the right focus to start with, but other improvements in quality of care can happen if we trust the local. Let us build improvements where we can and work with the willing. Let us rejoin the dots destroyed by the disastrous Lansley reforms.

I recently received an updated join strategic needs assessment from my local authority—the plan for my constituency. These are all things I worked on over 10 years ago, and it is utterly heartbreaking to see. Cervical screening coverage for all women in Bristol is lower than average. Bristol is below the national average for HPV vaccination in boys and girls. Breast cancer rates are 16% higher in Bristol than the England average, and the prevalence of osteoporosis is rising much faster in Bristol than in England. One in four attendances at A&E for falls is a resident of my constituency. I remember the old falls service 10 years ago. This is not a new disease to be eradicated; we do not need a new cure. These are all entirely, and fairly cheaply, preventable problems of public health.

The local NHS priorities are now excess weight management, harmful use of alcohol and falls in old age—all public health preventive work—but with child and adult social care taking up more than 60% of local authority revenue budgets, public health has been hollowed out and is entirely reliant on the voluntary sector. People living with profound disability and ill health are dying earlier and in worse condition. The next debate is about employment. Let us get those people back to better health and back to work. Let us help them care for the older people and people with disabilities they need to care for, but crucially, let us give them their life back. The Government need to join the dots. Instead of bad-mouthing and culling more management, let us give local government and the NHS the tools they need to do the job.