Health and Care Bill

Margaret Greenwood Excerpts

Consideration of Lords amendments
Monday 25th April 2022 Commons Chamber

[Peter Aldous (Waveney) (Con)]

I am grateful to have a few minutes to say a few words on the cap on care costs and on workforce planning.

With regard to the care cap, it is important to congratulate the Government on tackling a problem—or attempting to defuse a ticking time bomb—that all their predecessors shied away from. However, there is concern that the proposals are a rushed tag-on to a Bill that was designed for a different purpose: the integration of health and social care and the setting up of integrated care systems. I accept that there is a clear correlation, but the legislation that addresses the problem of people being forced to sell their homes to pay for their care should have been considered and scrutinised separately and carefully, with the objective of putting in place a system that has political consensus and will stand the test of time. That is what the Dilnot proposals and the Care Act 2014 achieved, and they should be the foundation stone on which we build this new system.

My concerns are twofold. First, clause 140 is extremely unfair to those with limited assets and modest incomes. The changes may save the Government hundreds of millions of pounds, but they do so at the expense of those on low incomes and those who live in parts of the country where house values are lower, such as Lowestoft in my constituency. Secondly, there is a worry that working-age adults with disabilities will be unfairly penalised, hence the introduction by the other place of a provision to address it. I acknowledge the Government’s worries about the cost implication of that additional provision, but that iniquity needs to be addressed.

On workforce planning, there is a staffing crisis both in the NHS, where there are 110,000 full-time equivalent vacancies, and in social care, where there are another 100,000 vacancies, high staff turnover and very limited respite for unpaid and family carers. Those deficiencies cascade through the health and care system, creating bed-blocking in hospitals and impeding the efforts made to reduce waiting lists. There is an urgent need for strategic planning to address this crisis. There is concern that framework 15 is not working because of inadequacies in the collection of data, lack of assessment of workforce numbers, and unresponsiveness to societal shifts.

Since we last considered the issue last month, the other place has sought to address the Government’s concerns and, as we have heard, has made reasonable concessions. There is a crisis that must be addressed, and I hope that at this very late stage the Government will accept this reasonable amendment, so that we can get on with this much-needed work.

[Margaret Greenwood (Wirral West) (Lab)]

Amendment 29B goes much further than the Bill’s current provisions on workforce reporting, which are extremely weak. It would require the Government, at least once every three years, to lay a report before Parliament describing the system in place for assessing and meeting the workforce needs of health, social care, and public health services in England. What could be more reasonable? One has to wonder why the Government do not support amendment 29B. Surely any Government who were committed to running the NHS as a public service would see these provisions as crucial.

The Royal College of Physicians has pointed out that clause 35

“will not set out how many health and social care staff are needed to meet demand”

and has stated that, without long-term projections, which amendment 29B would provide, there is no way to assess how changes in workforce trends, such as retirements or working part time, will impact the delivery of healthcare. The Royal College of General Practitioners has spoken of unsustainable pressures driving GPs out of the workforce and threatening to destabilise general practice.

Just a few weeks ago, the Royal College of Nursing said that nursing staff are exhausted and that staff shortages are undermining their efforts to give safe and effective care—a sentiment reflected by a nurse I met on bank holiday Monday. That is hugely concerning. As the RCN has said, there is a clear evidence base showing that staffing levels have a direct impact on the safety and quality of patient care. When I met members of the RCN last year, they made clear to me the increased stress levels that nurses are experiencing as a result of staff shortages and the impact that is having on the care they so desperately want to deliver.

According to the Health Foundation:

“In the next 25 years, the number of people older than 85 will double to 2.6 million”

in England, so demand for social care is increasing and we need to know that there will be enough doctors, nurses and social care workers to meet people’s needs. The “Strength in Numbers” campaign, a coalition of more than 100 health and care organisations, says that we must put

“measures to adopt a sustainable long-term approach to workforce planning on a statutory footing.”

Without credible, up-to-date numbers, the system cannot plan.

I support Lords amendment 29B. I urge the Government to think about those NHS staff who are working so hard and are so stretched by the amount of stress they are under because they do not have enough colleagues around them, and to listen to the clinicians who are calling on the Government in this regard.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests as a practising NHS doctor. I welcome the Government’s concessions on modern slavery and procurement and on the reconfiguration of NHS services. However, I remain concerned about two issues: the care cap and independence in the staffing assessment process.

To touch briefly on the issue of the care cap, a number of years ago I took through this House the Care Act 2014, as a Minister in the coalition Government. We based that Act and the care cap on the Dilnot proposals. I continue to be concerned that the current proposals deviate from the Dilnot proposals, in that those with lower or more moderate net assets will be asked to pay disproportionately more than those with greater assets. That is something I find very difficult to accept. It deviates from the principles of the 2014 Act and the Dilnot proposals, and I hope that even at this late hour the Government will reconsider their position on it.

I rise in particular to speak in support of Lords amendment 29B and the comments by my right hon. Friend the Member for South West Surrey (Jeremy Hunt). It is undoubtedly the case that we cannot have safe staffing in the NHS if we do not have the right number of staff. We cannot meet the increasingly complex care needs of patients with not just one, two or three but sometimes four comorbid conditions if we do not have staff with the right skills and in the right numbers to meet those care needs.

We talk often of building new hospitals and of our programme of capital investment in hospitals, but unless we have the right numbers to staff those hospitals, we will not be able to deliver safe care. In every constituency represented in this Chamber, we recognise that there are staff shortages in the local NHS. We recognise particular challenges in the medical workforce among fully qualified GPs—over the past seven years the number of full-time equivalent GPs has fallen. We recognise challenges in the midwifery workforce, which were brought tragically to our attention by the Ockenden report, and we recognise challenges in areas such as intensive care and paediatrics and throughout the health service.

The problem with health workforce planning is that Governments see the NHS in electoral cycles, but workforce is much more complicated than that. From starting medical school to becoming a consultant it takes perhaps 15 years, and to become a fully qualified GP takes about 10 or 11 years. It is important that we have a genuine independence to the process of workforce planning. I have great faith in Health Education England and I am sure it will produce a good report and assessment, but unfortunately it will be doing so with one hand tied behind its back, because it must do so within the confines of the financial envelope in which it is working, and it lacks the genuine independence to say what the NHS really needs.

If we care about patients and about the future of the NHS and its needs, true independence in a report on workforce is required. That is in the best interests of patients, of the health and care workforce and of the future of our health service. I hope the Minister will reconsider.