Health and Care Bill

Lord Stevens of Birmingham Excerpts

Lords Hansard - Part 1 & Report stage
Thursday 3rd March 2022 Lords Chamber

[Baroness Jones of Moulsecoomb (GP)]

I shall speak to Amendment 82 in the name of my noble friend Lady Bennett of Manor Castle. I attended Second Reading and made my views felt then, but I have not been able to join the deliberations on the Bill since then because of the pressure of other Bills in your Lordships’ House.

Even I, as someone who does not know very much about medicine, know that the most urgent challenge currently facing our health service is a shortage of nurses. I have been lobbied very heavily by the Royal College of Nursing, because Amendment 82 is its number one priority. It feels that, without a co-ordinated work plan, a coherent forward view and knowledge of exactly how the situation is at the moment, it cannot possibly achieve the sorts of numbers that are needed. There were almost 50,000 vacancies before Covid, and you can imagine the pressure that Covid has put on to the NHS—extreme pressure at completely unsustainable levels, and with staff numbers that are actually unsafe. We all know this, yet Boris Johnson and the Conservatives made big promises at the last election—their manifesto made a promise of 50,000 more nurses—and instantly that number began to unravel, as it included existing nurses who do not quit. That is unclever and unsophisticated number crunching.

I do not understand why this Government will not live up to their manifesto commitments. One reason why I have not been able to speak on this Bill since Second Reading is because of all the other Bills coming through, on which the Conservatives have said that they are aiming to achieve their manifesto commitments. They are actually going rather beyond their manifesto commitments in lots of areas—but the fact is that they are picking and choosing as if from a box of sweets the ones that they prefer.

The Royal College of Nursing represents over 480,000 nurses in health and social care. These are people whose pay requests are constantly ignored—and who constantly have their pay cut; in real terms, it has reduced. Just at the point when MPs are getting very welcome extra pay, nurses hang on by their fingertips. We know that vacancies are also a huge problem, with retirement age approaching for a lot of nurses. Nurses need the certainty of planning, and I do not hear those plans coming from the Government, although this is really their job—to manage the economy and manage society in a way that benefits everybody. Clearly, if the NHS fails in any area, that does not benefit anybody at all.

I argue very strongly for Amendment 82, and I just hope that the Government wake up in time to see how necessary it is.

[Lord Stevens of Birmingham (CB)]

My Lords, I am very pleased to co-sponsor the amendment proposed by the noble Baroness, Lady Cumberlege, Amendment 80, and to speak in support of a number of the other amendments in this group. I declare my honorary fellowship of the Royal College of Physicians and the Royal College of GPs, and thank them and the 100 other organisations across the health and social care sector that have joined in the cross-party support that this amendment is likely to generate.

In considering how to vote on this amendment, I think it really boils down to two very straightforward questions. First, do we need regular, rigorous and independent workforce planning for health, social care and public health? The social care point, as the noble and learned Lord, Lord Mackay of Clashfern, has just reminded us, is so crucial here. The second question is: if so, will we get it, with appropriate rigour and independence, without this amendment? I suggest that the answer to that question is, unfortunately, no.

The first question is self-evident to most people. We discussed it throughout Committee: workforce pressures mean that it is obvious that we need regular workforce planning. The very long lead times make it critical. Earlier this week, your Lordships were debating pressures in young people’s mental health services and eating disorder services. It is worth reminding ourselves that a new consultant psychiatrist specialising in eating disorders, starting work in NHS mental health services this morning, will have entered medical school 15 years ago. It is worth reminding ourselves, too, at a time when the NHS is confronting long waits for routine operations and needs to deal with a backlog of care, that the new medical student starting undergraduate medicine in September will report for duty as a consultant orthopaedic surgeon in 2037.

So the lead times are clear, yet we have a paradox: more young people and, indeed, mid-career people, would like to join this great campaign, this social movement—the health service, social care and public health—but we are turning them away. In 1945, Nye Bevan said:

“This island is made mainly of coal and surrounded by fish. Only an organising genius could produce a shortage of coal and fish at the same time.”


I suggest that, if Bevan were recasting his aphorism for today, he would say that, at a time when the NHS and social care have such a clear need for more staff, only a workforce planning system of organisational genius could turn away bright and committed young people from undergraduate medicine and other oversubscribed university places for health and other professions.

We have to accept that there will be extra costs from getting this right. The noble Baroness, Lady Cumberlege, was quite right to draw attention to the fact that there will be savings, including from the £6.2 billion spent in 2019-20 on agency and bank staffing across the health service. But there will be extra costs: the Royal College of Physicians has estimated that doubling undergraduate medicine places would cost perhaps £1.85 billion, which is about one-seventh of the amount that the House of Commons Public Accounts Committee identified last week as being likely to be lost from fraud and waste through the various furlough and other schemes introduced during Covid. So I think we need to put these costs in perspective.

The fact that there will be those costs gives us the answer to our second question. Of course, we need workforce planning, but are we going to get it without this amendment? I am afraid that I do not think we are. In Committee—although I shall not rehearse it—using publicly available materials, I set out the sorry history of what I described as the “wilful blindness” that has been inflicted on the health and social care sector and, indeed, on health Ministers and the Department of Health and Social Care itself, as they have sought to go about this task down the years.

The question before your Lordships is: has the leopard changed its spots? I suspect—and I genuinely sympathise with the Minister’s predicament—that he will tell us that the baton has now been passed from the Department of Health and Social Care to NHS England, so that for the first time it has the responsibility for undertaking this task, and we should be reassured by that fact. In that case, I ask him to give clear guarantees at the Dispatch Box that the proposed new powers of direction for the Secretary of State will never be used to veto or censor any independent estimates that NHS England itself puts forward, including those with a financial consequence. Indeed, I ask that he goes further than that and gives us a Dispatch Box guarantee that NHS England will be entirely free to publish, every two years, without approval, veto or censorship from either the Department of Health or the Treasury, the workforce need, demand and supply models implied in Amendment 80. If those guarantees are not forthcoming from the Dispatch Box, I think your Lordships will be entitled to draw your own conclusions.

[Lord Hunt of Kings Heath (Lab)]

My Lords, would the noble Lord be surprised to hear the rumours that the Treasury has prevented the Minister from responding in a positive way to this amendment?

[Lord Stevens of Birmingham (CB)]

We await insight from the Minister himself on that point; it is indeed, of course, what the chairman of the cross-party Health and Social Care Committee, Jeremy Hunt, suggested in the House of Commons. We have an immediate litmus test before us, which should help us answer the question posed by the noble Lord, Lord Hunt. As your Lordships will remember, we noted in Committee the fact that, just 10 weeks before the start of the financial year, when it should have been planning 10 years out, Health Education England still did not have its operating budget for the year ahead. My understanding—I hope to be corrected by the Minister—is that, certainly, as of 10 am, Health Education England still does not have its workforce operating budget for just 29 days’ time. That is precisely because of a set of behind-the-scenes discussions—no doubt courteous, but nevertheless fervent—between the Department of Health and Social Care on the one hand and the Treasury on the other.

Health Ministers are more sinned against than sinning on this, frankly, and in that sense this amendment will strengthen their hand. I suspect that, privately, they will welcome the mobilisation of your Lordships to support their negotiating case. The very fact that Her Majesty’s Government oppose this amendment is proof positive that it is needed. We need it because we need to look beyond the end of our noses. To vote against this amendment would be to cut off our noses to spite our faces.

[Baroness Whitaker (Lab)]

My Lords, this whole group is worthy of government action, and I support Amendments 80 and 81 in respect of speech and language therapists. The NHS Long Term Plan itself states that speech and language therapists are a profession in short supply. The Department of Health and Social Care, in its submission to the Migration Advisory Committee’s review of the shortage occupation lists, argues that speech and language therapists should be added to them because of the pressures facing these professions, particularly in relation to mental health.

The Royal College of Speech and Language Therapists, for whose advice I am grateful, suggests that a minimum increase in the skilled workforce is required in the region of 15%. In recent years, the profession has grown by 1.7% in a year. The Government themselves recognise that they are clearly not delivering the speech and language therapy workforce that we need. No national assessment has been undertaken of the demand and the unmet need for speech and language therapy, which, I remind noble Lords, is essential for people to be able to communicate. Will the Government accept Amendments 80 and 81 or explain otherwise how they plan to improve workforce planning so that speech and language therapy is no longer a profession in too short supply?