NHS: Staff Numbers

Lord Markham Excerpts

Tuesday 12th September 2023 Lords Chamber

[Lord Clark of Windermere]

To ask His Majesty’s Government what plans they have to increase the number of staff working in the NHS.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

A record number of staff are working in the NHS, including more than 6,000 more doctors and more than 16,400 more nurses than last year. We have backed the NHS long-term workforce plan with more than £2.4 billion over five years. This will put us on course to double the number of medical school training places, almost double the number of adult nursing training places and increase the number of GP training places by 50% by 2031. It will also ensure that the NHS workforce is put on a sustainable footing for the future.

[Lord Clark of Windermere (Lab)]

I thank the Minister for his Answer, but he knows that there is a dire shortage of staff right across the NHS, with 47,000 nursing vacancies. The recruitment of nurses to training places is down 13% this year. Some 170,000 workers in the NHS left their jobs last year, mainly under stress. Today, we have the news that a survey found that 32% of students who are currently in medical school have said that they intend to emigrate on completing their studies. I repeat what I asked in my Question: what plans do the Government have to increase the number of staff working in the NHS?

[Lord Markham (Con)]

The whole House will, I think, recognise that we have extensive plans that are, as I said, backed by £2.4 billion. That is what the long-term workforce plan was all about. There were many requests for us to put it in place and that is what we have delivered. All of this comes in the context of 63,000 more members of staff over the past year—actually, around 280,000 more members of staff since 2010. Those are substantial increases. Do we need to do more? Yes. Is that what the long-term workforce plan is all about? Yes.

[Lord Dobbs (Con)]

My Lords, those within the NHS must be allowed to work safely. Has my noble friend seen the reports today? A third of female surgeons have been sexually assaulted by other doctors within their workplaces, sometimes while they are actually operating on people. It is as unbelievable as it is appalling. What plans does my noble friend have for getting to the bottom of this, finding out the truth of these allegations and holding responsible those who are responsible for the safety of working practices within the NHS? In its recent dealings with him, did the British Medical Association mention this terrible issue—or have its interests been concentrated solely on money?

[Lord Markham (Con)]

I thank my noble friend. Like all of us, I am sure, I was appalled to hear about that study. The most fundamental purpose of any employer is the safety and well-being of their staff, obviously, and I am afraid that the hospitals that allowed that to happen and allowed that culture to take place clearly failed. Clearly, we need to get to the bottom of that. As I often say, it starts with the leadership in each hospital and the culture that is built up within each college. Those are the people who need to be looking at themselves in the mirror and asking whether they have the right culture to make sure that everyone feels safe in the workplace.

[Lord Allan of Hallam (LD)]

My Lords, we know that the Minister is a big fan of data dashboards for tracking such things as the flow of patients through hospitals. Does he agree that such a dashboard would be an excellent way for us to track the Government’s progress against all the various targets that they have put into their workforce plan? Will he commit to producing one?

[Lord Markham (Con)]

I believe that the whole point of the workforce plan is that every couple of years there is a review of our progress against it and how it needs to be adapted, since it is a moving feast. So, absolutely, it is vital and something we are working on. Overall, the things that we said that we would do we are on course for. We said that we would increase the number of nurses by 50,000 over the course of this Parliament. It is currently 47,000. We said that we would increase doctors’ appointments by 50 million. That is currently on track. So a lot of good work has already happened. A lot of targets have been hit. Yes, there is more to be done and we are happy to track it.

[Lord Patel (CB)]

My Lords, it is currently predicted that there will be a shortage of about 4,000 fully trained anaesthetists by 2025. The Government’s plan to expand anaesthesia associate training will also need anaesthetists to supervise the trainees in the workplace. However, currently there is a bottleneck at a certain level of the training of anaesthetists. That bottleneck can be resolved by increasing the number of training slots. Why do we not do that?

[Lord Markham (Con)]

In every area, anaesthetists being a very good example, we need to be looking at where the bottlenecks are and moving to free up those situations. I think we would all agree that with practitioners such as anaesthetists and in other areas, it is a very sensible approach to make sure that the most highly skilled are focused on the most highly skilled jobs and that they can have people underneath them who can be trained to work within that. So hearing that there is a certain amount of opposition from certain colleges and the BMA to those sorts of roles is quite disappointing. I hope they would accept that this is a key way of addressing the issue.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, can I take the Minister back to the original Question from my noble friend Lord Clark? He put before the House some quite startling statistics about the number of medical staff—particularly but not exclusively doctors —who are leaving following or shortly after the completion of their training, either for other countries or for private practice? What view does he take of that drain away from the National Health Service and the effective loss of the investment that the country makes in the very expensive training of clinicians?

[Lord Markham (Con)]

My first point on that is to ask what the real facts are. Five years on from qualification, around 95% of doctors are still registered with the General Medical Council and still practising in the UK. So the fact is that retention is very high. That notwithstanding, we want to do everything that we can to retain people, and professional development is what the long-term workforce plan is all about. Also, we all know that pensions were a big reason for a lot of the brain drain and doctors leaving the profession, and that was something we were quite radical in supporting and changing. We are going through this bit by bit, asking what key things we need to do to retain our staff and resolve this.

[Lord Forsyth of Drumlean (Con)]

My Lords, I have seen press reports that suggest, from future projections, that one in 11 people in the workforce will end up being employed by the NHS. Does the Minister really believe that this is sustainable? What plans does he have to avoid what would be a completely impossible situation for the economy?

[Lord Markham (Con)]

Yes, I am aware of this. Health spending equates to roughly 11% of the GDP of our country. Not surprisingly, the number of people in the workforce reflect that. It is absolutely mind-blowing; the amount of investment going into this space is bigger than the economy of Greece. Without a doubt, we have to make productivity improvements and look to technology, AI and all the things we can do to improve output and make sure that that total is not just ever-increasing.

[Baroness Merron (Lab)]

My Lords, the Government’s workforce plan is silent on having enough properly maintained treatment facilities, buildings and equipment, all of which have become increasingly inadequate. Could the Minister confirm what assessment has been made of the physical capacity requirements to deliver the NHS workforce plan? How will he ensure that staff have what they need to do their job?

[Lord Markham (Con)]

The noble Baroness is absolutely correct: a workforce plan needs to be backed up with the physical real estate to deliver it. As noble Lords are aware, I am responsible for the new hospitals programme, which is part of that. In primary care, much of the long-term workforce plan is all about getting upstream of the problem in terms of prevention, and clearly we need to make sure that the physical real estate is there to support that. So the next steps will be to make sure that the capital meets the long-term workforce plan.

[Baroness Jolly (LD)]

My Lords, the NHS needs more recruits, but can the Minister tell the House where there are pressing shortages that adversely affect patient care and when he anticipates that the problem will be sorted?

[Lord Markham (Con)]

As I say, the long-term workforce plan puts this on the right footing, going forward. There are big increases in the number of staff, so it is not like we have not been working hard on this area already. By any definition, 63,000 more staff over the last year is a prime example of that. So we are addressing this, but I am not going to pretend to the House that this can be done once, lightly and quickly; it is part of a long-term programme, which the long-term workforce plan is all about.