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?

Budget Resolutions and Economic Situation

Karin Smyth Excerpts

Wednesday 15th March 2023 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

I am on the optimistic side of the spectrum that the Chancellor was talking about today. I would welcome measures on prepayment meters and some support for suicide prevention, but the most sensible thing he said today was about the contribution that those of us in our mid-50s can make to the economy. Overall, however, it is truly astonishing, knowing how many thousands of pounds worse off people are after 13 years of this Government, that the further low growth we are anticipating will now continue for another two years.

This Government completely lack ambition for the country, but they particularly lack ambition for young people. There was nothing in this Budget for young people, particularly on housing help. There was a failure to reform the apprentice levy as promised, and they are still not doing enough for people from disadvantaged backgrounds.

The Government have broken their promise to fix social care. The stark reality is that more than 150,000 people have died waiting for state social care, and 57,000 people would have received support and they now will not. The Chancellor has promised far less funding for adult social care than he recommended when he was Chair of the Health and Social Care Committee.

I welcome the fact that people who are facing the cost of living crisis will have the fuel duty cut, but the Chancellor has made some clear choices. That £6 billion initiative, plus the additional £1 billion for the pension rise—so £7 billion—would have gone some way towards meeting that social care commitment that he wants to see. What happened to the health and care workforce plan that was so widely trailed? Clearly the Chancellor did not get the thing that he has already committed to past himself in the Treasury—we are expecting it sometime soon.

Childcare providers are at risk of collapse, leaving parents not only struggling with the cost of childcare but unable to find childcare in the first place. Extending hours is simply not enough. Childcare provision is not just about babysitting services; it is about children’s wider education. President Biden has put forward a family support package in America, and the Labor party leadership in Australia have looked at childcare completely differently, saying that it is

“an economic reform which promotes inclusion and growth—not a babysitting service. An economic reform that delivers benefits to two generations of Australians…The best start in life for our children…Flexible support for modern families…And a…boost to productivity and participation”.

What we have had today does not meet those challenges and it looks as though it does not even meet the basics that were being asked for.

At the weekend, I was pleased to join the Bristol Women’s Commission at its event on the caring economy and how it can add to our productivity. We looked at the infrastructure for carers, improving working conditions, and pay and skills for low-paid care workers. That is what this Government need to be doing. I commend the work of the BWC. Unfortunately, it looks as though the Green party in Bristol will not be supporting the BWC in the future. I hope it changes its mind about that, because the BWC is doing some fantastic work.

The apprenticeship levy is a massive failure. Starts are falling backwards; the cohort is made up mainly of people in senior positions; and only 13% of degree-level apprentices come from neighbourhoods in the bottom fifth of deprivation, with twice as many coming from the most advantaged backgrounds. That is not good enough. As for the new traineeship—or “returnee-ship”—the shiny new thing we have seen today, the Department for Education has been a dreadful failure on apprenticeships and the idea that it can help people come back is not one we can believe.

Overall, there is nothing in the Budget for the west and the south-west. Again, we have been completely ignored by this Government. Transport is a crucial issue for us in Bristol South. We can support tackling the climate crisis and moving towards net zero only if we have a functioning transport system, and this Government simply do not care about that. Many of my constituents rely on buses; the elderly and young people going to education need a bus service. With the end of the bus recovery grant, my constituents would like to know what on earth the Government are going to do to support them.

It looks as though the only mention of the west country in the Red Book is in the section about Devon, which says we are going to get some money to deal with potholes. That is literally the only mention of the west and the south-west that I can find in this entire shiny document—[Interruption.] The chuntering from those on the Government Benches is about their MPs. If that is the best that that wall of Tory MPs across the west country can come up with, I look forward to them disappearing. Much more could have happened on this, as we are a good, functioning economy. The Red Book has 116 pages, but there is nothing in it for Swindon, Bristol, Filton, Plymouth, Stroud, Truro or Falmouth. It is a complete waste of our time for the south-west, and the sooner the Tories go, the better.

Scotland Act 1998: Section 35 Power

Karin Smyth Excerpts

Tuesday 17th January 2023 Commons Chamber

[Mr Jack]

Yes.

[Karin Smyth (Bristol South) (Lab)]

In my role on the Public Administration and Constitutional Affairs Committee, I have, with others, been around the UK looking into scrutiny and the operation of devolution, of which I am a strong supporter. The state of relationships between the Tories and the SNP is deleterious and it is damaging all our rights. The SNP went to court to argue that sex was a legal construct, not a biological one. Therefore, the SNP has landed us in this position and it is trading on people’s rights—it is outrageous. The SNP is disregarding sex-based rights, which is exactly—[Interruption.] It is not acceptable for people who are standing up to talk about women’s sex-based rights to be constantly badgered—[Interruption.] Equally, I do not accept barracking from the men in the corner on the Conservative Benches. What we need to know now—it would be helpful to have the reasons before going forward—is what exactly the UK Government, who have not discussed this in advance of this coming here before us and have behaved outrageously, are expecting the SNP Scottish Government to do to help the rights of transgender people and women.

[Mr Jack]

I will not go into the details of Lady Haldane’s judgment in December, but the hon. Lady is right to say that that has created part of the conflict. Again, that will be laid out in the statement of reasons. We would like the Scottish Government to address the concerns we have as to sufficient protections and safeguards for women and children across UK-wide legislation and for that to be reflected in the Bill.

Scottish Referendum Legislation: Supreme Court Decision

Karin Smyth Excerpts

Wednesday 23rd November 2022 Commons Chamber

[Mr Jack]

I refer the hon. Gentleman to the remarks I made earlier. Polling shows the Scottish people do not want another referendum. There is not massive dissatisfaction with the Union. It is very low on the Scottish people’s list of priorities. What they want is our two Governments to start working together to deliver their priorities. That is what they want us to do.

[Karin Smyth (Bristol South) (Lab)]

On the Public Administration and Constitutional Affairs Committee, we have been meeting our parallel scrutiny committees in the devolved legislatures. Some 20 years on, it is clear that devolution, parliamentary scrutiny functions and the inter-Union functions are not working and need improving. Our Union was forced and often violently formed, but it has for centuries successfully built, through consent and citizen recognition that unity is strength. The hallmark of this Government is ignorance of our history, disrespect for those institutions across the devolution settlement and a failure to engage across all Departments with the committees and bodies that have been formed to enhance the political Union. What the Secretary of State needs to take from this ruling is a need to force the Government to treat those institutions with the respect they deserve to keep our Union.

[Mr Jack]

We put in place the intergovernmental relations recommendations from the Dunlop review. Those were put in place.

Northern Ireland (Executive Formation etc) Act 2019 Section 5

Karin Smyth Excerpts

Monday 30th September 2019 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

I, too, welcome the Minister to his new post. He and I have previously met and talked in our respective roles in the British-Irish Parliamentary Assembly. He is a great loss to the Brexit team but a great addition to the Northern Ireland Office team, given his knowledge.

This is a cruel subject and there are many victims. I was recently involved in the police parliamentary scheme, as many other hon. Members have been, and I spent a day with the trafficking team here in London before going out on one of their investigations. Anyone who has seen up close the work that they do could only be massively impressed. It is very difficult work, and meeting and talking with victims is hugely emotional. I pay tribute to the work that they are doing here in London and to support teams across the United Kingdom and Europe.

It is very valuable to have this discussion about victims in Northern Ireland. The European Commission’s recent report “Together Against Trafficking in Human Beings” highlights that:

“Northern Ireland is the only part of the United Kingdom to have a land border and traffickers and enslavers exploit this. We therefore have strong links and effective partnerships in place to ensure that law enforcement organisations from both jurisdictions work together to tackle modern slavery.”

That is a core part of the United Kingdom’s work in this area. I therefore have a few questions for the Minister. First, in the context of the discussions that are now happening, and not just on the European arrest warrant but in relation to our joint north-south arrangements on human trafficking, which are a core part of the UK’s defence in this area, what discussions are taking place to ensure that traffickers and enslavers are not allowed to exploit the situation at the border.

Secondly, as has been mentioned already, support for victims really does rely on policing. We have heard about some good success this weekend, but the chief constable of the PSNI has said that he will require an extra 800 police officers over the next few months, so resourcing in this area is a massive problem. Having seen up close the level of resource needed by police forces in the rest of the United Kingdom—I have not been to Northern Ireland to see the work being done there—I know that it is a massive problem, and they will have to make decisions about those competing priorities. Again, we need an assurance from the Minister that the Government will be cognisant of those priority decisions that the chief constable is having to make now with regard to policing over the next few months, to ensure that the situation is not further exploited by traffickers.

Thirdly, as has already been said today, these are victims, and even if we find them, which itself is a massive “if”, they require an awful lot of support and resource, particularly in housing and health provision, and especially mental health support and counselling. We know that mental health services in Northern Ireland are already heavily stretched, with high levels of mental health need. It is important, when looking at these reports and the work coming forward, that the Minister and his Department work with colleagues across Northern Ireland to really understand what we mean by aftercare. The fact that it has been raised here shows that people here feel very strongly about that. We know that these public services are already under huge strain and cannot cope with the levels of care needed. I do not have much confidence that they are able to provide that aftercare. The Government need to take that very seriously, support those victims and provide the rehabilitation services that they so desperately need.

Northern Ireland (Executive Formation etc) Act 2019 Section 4

Karin Smyth Excerpts

Monday 30th September 2019 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to follow the hon. Member for Congleton (Fiona Bruce) and my hon. Friend the Member for Swansea East (Carolyn Harris), who have both spoken with great knowledge and experience of this area through their work in the Chamber.

Whatever people’s views about the purview of the reports and the appropriateness of talking about them within this particular piece of legislation, I think they have really shone a light on some situations in Northern Ireland that have shocked many people in the House. People who have worked in this area for some time have been asking some very valid questions on behalf of people and families in Northern Ireland, and that must be a good thing. We would also like the Assembly up and running to take this work and legislation forward. In an outpouring of unanimity around some of these issues, I agree with the Minister; the situation is clearly outdated and there is a real lack of specific services.

It is estimated that problem gambling in Northern Ireland may be up to four times that in England. That really is quite an extraordinary figure. It is really important to shine a light on that and to understand the real impact on individuals, families and communities. The other thing that has struck many of us who have looked at the report is the hard work addressing this issue will involve and the pressure on local authorities, which are already heavily overstretched. They try to do great work, but are they really in a position to be able to manage this level of workload on top of everything else? That needs to be taken into consideration.

The report repeatedly mentions the need for the Health and Social Care Board to provide mental health services, but those of us who spend time in Northern Ireland know that its ability to provide additional mental health services is compromised in an area that is already so heavily stretched and in a community where the demand for mental health services is so much greater than in Great Britain, owing to Northern Ireland’s recent history. I would question the board’s ability suitably to provide the services needed by individuals, families and—as the hon. Member for Congleton mentioned—children. We are only just beginning to understand the impact of addictive behaviours on children, and we really need to be able to have that learning read across from England, Scotland and Wales into Northern Ireland somehow, with or without the Assembly.

The reports we are discussing really highlight the need for—dare I say—some greater harmonisation with Great Britain in some areas where people’s wellbeing is so starkly affected. I agree that the report we see today is limited in scope, but maybe the work will continue, given that the issue has now been so starkly highlighted. The system is obviously desperately in need of reform.

Scotland Bill

Karin Smyth Excerpts

Monday 8th June 2015 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

I am grateful for the opportunity to make my maiden speech after the excellent maiden speech by the hon. Member for Aberdeen South (Callum McCaig) and the speech by the hon. Member for Blaydon (Mr Anderson).

I am pleased to make a speech in a debate about matters that have important implications for my constituents, even though they cannot take part in it. We are at an important point in the history of these islands. As a southern English MP, daughter of recent Irish immigrants, and a proud European, I hope to play my part in shaping the future constitutional arrangements of these islands on behalf of the people I now serve. The people of Scotland have debated these issues for many years, and in the past year they have sent two strong messages. They wish to be part of the United Kingdom, but they wish to see something very different. The people of Bristol have also sent strong messages, and we all need to be mindful and find our own inner Gladstone. We need to understand those messages, be mindful of our shared history and proffer a way forward.

It is a great honour to serve as the Member for Bristol South. Dawn Primarolo, my predecessor, served as an MP for 28 years, and in paying tribute to her I should like to say what big shoes she has left for me to fill. In Parliament, Dawn took on shadow Health and Treasury roles, and in government she served the Treasury as Financial Secretary and Paymaster General before subsequent ministerial roles at the Department of Health, and at Children, Schools and Families. As Mr Speaker said, Dawn served with distinction as Deputy Speaker from 2010 until she stood down this year. When first elected in 1997, she was the only Labour MP in the south-west. Now we are four—that is progress. She was one of only 41 women, but now we are 191, which is perhaps better progress. I owe her, and the women who have come before me, a great deal. It is a debt that I intend to repay to the women who will follow.

Dawn’s dedication and commitment was evident for all to see, and her record is closely linked to that of the Labour Government in improving the lives of local people. There are too many examples to give, so I shall just touch on a couple. The building of a community hospital after a 70-year campaign is one, but I shall really pick up on education. All the secondary schools in Bristol were rebuilt under Labour’s Building Schools for the Future programme. The sun shone and the roofs were not just fixed, they were rebuilt, and the infrastructure and standards were improved. Thanks to teachers, support staff and governors, all Bristol South secondary schools are now rated good or better by Ofsted. However, attainment in some of our most economically challenged communities is still far below where it should be, and today in Bristol South new opportunities are needed to offer hope and aspiration for all, whatever path young people seek to pursue. It is a constituency whose people, down the years, have played a vital part in our country’s prosperity.

Bedminster in my constituency was home to more than a dozen coal mines. Well into the 20th century, many local people spent their working lives underground in dark and dangerous conditions, paid only for the coal that they cut. Hartcliffe formerly hosted what was Europe’s largest cigarette-manufacturing factory when it opened in 1974. Bristol South has a proud industrial heritage but, despite being manufacturers of growth, its people were rarely rewarded or permitted to share in its fruits. In fact, many paid a high cost—from lives lost in the Dean Lane pit disaster to industrial illnesses and the health problems caused by tobacco, in the manufacture of which the city played a pivotal role.

There is a special warmth and generosity among South Bristol people. They are, to use a well-known local phrase, “gert lush”. They are forward-looking, ready to seize chances to help to shape a future for themselves, their families and their communities. Those communities are strong, and a great variety of community groups and enterprises have grown up to provide help and support. Having powered economic growth in the past, residents are eager to play their part in doing so again. Equipping the people of Bristol South with the skills and knowledge that they need to be part of that growth for the changes that lie ahead is the biggest challenge for my constituency.

In many ways, Bristol’s story is a tale of two cities. It has thriving universities and booming finance, high-tech and creative sectors, but it also has areas of severe economic disadvantage. My constituency has immense talent in its workforce, young and old, but too often people’s potential lies dormant, latent and untapped, waiting to be triggered by local leadership and economic opportunities. This is where the Government’s grand design on devolution puzzles my constituents, prompting the question: where does Bristol—indeed where do Swindon, Exeter, Plymouth and the rest of the south-west—fit in the emerging narrative dominated by Scotland, Wales and the north?

The Government say that they are intent on devolving power to English regions but only where there is an elected mayor—a depressingly familiar, unadventurous, command-and-control approach to power sharing from central Government. The proposal invests all power in one individual. There is no compunction on that individual, perhaps other than having an eye on an election every few years, to consult, co-operate and negotiate solutions with other elected and civic leaders, or with communities, however they are represented.

Bristol was the only city to vote in favour of an elected mayor when given an opportunity. Bristol’s Mayor was elected by 9% of Bristolians on a turnout of 27%. Three years on, what is the lesson from this experiment to other English cities? Bristolians are still waiting for improvements to transport, housing, skills and jobs. Bristol should be at the forefront of the devolution debate, not lagging behind. The west of England is already an economic powerhouse with an economy worth £26 billion a year, and a net contributor to the Treasury.

The sensible strategic way ahead for my constituents is for communities’ real needs to be shaped not by distant legislators with a one-size-fits-all proposal or individual mayors with pet projects, but by the people and communities affected. I have spoken about the need for us to understand messages received from the people of Scotland about our shared history. One of the key lessons to emerge in recent years from Scotland and from Bristol is that power needs to be shared with communities and with individuals, not just with town halls and professional local politicians.

In recent years my constituents have heard much discussion about Scottish devolution, and in recent months about the so-called northern powerhouse. I know that collectively Bristol South’s residents have the skills, energy and potential to create a western powerhouse if only they are empowered to do so, and I look forward to supporting them all to make it happen.

[Several hon. Members]

rose—