Health and Social Care Workforce

Karin Smyth Excerpts

Thursday 13th July 2023 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

I thank the Backbench Business Committee for scheduling this debate and the hon. Member for Winchester (Steve Brine) for his opening comments. I also thank the right hon. Member for Wokingham (John Redwood) and the hon. Member for Worcester (Mr Walker) for their speeches.

It is good that the Chair of the Education Committee, the hon. Member for Worcester, has joined up with the Health and Social Care Committee to line up discussions, particularly on apprenticeships. I hope that that progresses because there are a great many problems in the assumptions that the plan makes on apprenticeships. I think that he will highlight that to the Committee.

The report and the work done by the Health and Social Care Committee were hugely important in shining a light on the problems facing our health services at a time when the Government were still denying the scale of those problems. I thank all members of the Committee for their dedication in producing the original report. Indeed, they had another good session yesterday. They have rigorously pursued this issue across parties for a number of years.

As the hon. Member for Winchester said, since the Government’s response in April, we have had a further response, which I think is helpful for this debate, in the long-term workforce plan. I cast my mind back to Committee stage of the Health and Care Bill and to the many debates held in this place and the Lords. I, among others, including the hon. Member, tried every which way to get the Government to agree to an independent review process. In those heady days, many of us were on the WhatsApp broadcast list of the right hon. Member for South West Surrey (Jeremy Hunt). I find that those messages do not come as frequently now as they did then.

Workforce problems were the primary issue facing our health and social care services then and they still are now. My Labour colleagues and I have been warning about that for many years. When we were in government in 2000, we produced a 10-year plan of investment and reform—a plan that delivered not only 44,000 more doctors and 75,000 more nurses, but the lowest ever waiting times and the highest ever patient satisfaction rates in the history of the NHS. It has taken this Government some 13 years to even attempt something similar.

We must not forget why the workforce plan is so crucial. Thousands of patients are waiting for surgery, families are trying to get support for care in the community, and people are struggling to get through to their GPs. They are all being denied the quality care that we all deserve. It is the health and care staff who are left to pick up the pieces of a system that the Government have allowed to fall apart around our ears—sometimes quite literally in the case of the estates.

The hon. Member for Winchester spoke very well—his usual style—about the burnout issue that his Committee has heard about, which is very real. As a former NHS manager, I take issue slightly with what the right hon. Member for Wokingham (John Redwood) said. This cannot be laid at the door of management, because we are also losing managers from the system.

The scale of the problem is massive. I thought that I had a pretty good grasp of the problem, but as I read the Government’s long-term workforce plan, my jaw dropped further and further towards the floor. How on earth did things get quite so bad? Nothing now says what 13 years of the Tory party’s mismanagement has done to our country better than the evidence in the plan. The gap between the current state of the workforce and what we need to prepare for the future is huge. The Government’s failure to get to grips with that sooner means that the work needed to bridge that gap, and the costs, will, sadly, be much greater.

We have talked of hope this afternoon. In the long-term workforce plan, we have a clear statement of how bad things are—we look forward to the National Audit Office looking at it independently—but we also need to try looking forward, which I will try to do with some hope. However, the plan is largely based on the system today; it is not really based on the system of tomorrow. Personalised medicine, genome therapy, new dementia and obesity drugs and artificial intelligence will all transform service delivery—we talk about that a lot in this place—and will therefore transform the necessary job roles. The 15-year plan does not account for those imminent changes. Although I recognise that, in the foreword to the plan, the chief executive acknowledges that, of course, we cannot predict everything over the next 15 years, and we hear talk, although I am not entirely sure it has been confirmed, of the plan being reviewed every two years—perhaps the Minister can confirm that—the Government have missed the opportunity to indicate in that long-heralded document what the future might look like for those delivering and receiving care.

Crucially, we do not really have a plan for how things will get better—there is no plan for delivery. On the promised figure of £2.4 billion, there is no indication of where that money will come from, how it will be disbursed or what costs are actually covered in that figure. Has the Minister considered the downstream implications for the workforce who will support our clinicians—for example, the porters, caterers, cleaners and the wider workforce—rather than those who are mentioned?

While the work to model current and future requirements is admirable, we do not know much about the assumptions that underpin the plan, but we have some hints. Page 23 says:

“Beyond core terms and conditions, which are outside the scope of this Plan, we will need government to support this Plan by providing the necessary continued and sustained investment in infrastructure, reforming education funding and strengthening social care provision on which the success of this Plan depends.”

The question for the Minister is, will the Government do that?

In my long experience of reading NHS documents, much like a sports fan reading the newspapers, I go straight to the back pages. That is where the key risks to this plan are identified. Paragraphs 14 and 15 of chapter 5, on page 109, state:

“the modelling recognises the balance of risk around productivity”—

an issue that was discussed by the right hon. Member for Wokingham and the hon. Member for St Albans (Daisy Cooper). It goes on:

“Achieving the productivity improvements assumed in the Plan is dependent on two key factors. First, it requires a sustained increase in capital investment in the ageing NHS estate, including in primary care, to replace equipment that has passed its recommended lifespan… This would enable staff to function more efficiently, and shorten diagnosis and treatment times in areas such as cancer”,

which is surely something the Government want to see. It continues:

“Second, it requires investment in digital infrastructure throughout the NHS, including appropriate training and support”.

The next paragraph says:

“The modelling for this Plan assumes that the balance of care between the NHS and social care will remain broadly the same. However, an increase in the capacity of and access to social care would likely contribute to reducing the assumed growth in demand for NHS services”.

The Minister’s response to those paragraphs would be very useful. We do not know the cost or the delivery route for any of these factors, even though they are in the plan.

However, we do have a workforce plan published. There is hope—it was in my speech before Members raised it today—that at least the Government will start to tackle the crisis that they have created. Integrated care systems bring us an opportunity to ensure local delivery and some accountability. Will the Minster confirm that ICSs will have the resources and support needed to implement strategies to recruit and retain staff?

Finally, Labour will introduce plans only when we can show how they will be paid for, because that is what taxpayers deserve. The Government are welcome to borrow our plan to fund it by scrapping the non-dom tax status. The Government have a lot of form in making grand announcements and promises of money, only for us to see that money disappear or, worse, the funding reduce in another part of the system, adding to the burnout problem. Can the Minister assure those in the NHS and our constituents that that will not happen?