NHS Staffing Levels

Margaret Greenwood Excerpts

Tuesday 22nd November 2022 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

I beg to move,

That this House has considered NHS staffing levels.

It is a pleasure to serve under your chairmanship this afternoon, Mr Hollobone. I pay tribute to all the nurses, doctors and other medical professionals—indeed, everybody who works in the NHS—for the work they do to look after patients and keep us all safe.

I have been overwhelmed by the number of organisations that have shown interest in this debate and have shared details of how the NHS staffing crisis is impacting on the people they represent. They are too numerous to mention here, but they include the Royal College of Nursing, the Royal College of General Practitioners, Versus Arthritis, Cancer Research UK, Unite the union, Parkinson’s UK, the Royal College of Midwives and many others. It is clear that there is insufficient capacity in the NHS in England to meet the needs of patients.

The NHS staffing crisis is a direct result of the failure of Conservative Governments to plan and deliver the workforce that we need. The crisis is not just about the impact of the pandemic; it predates that. In June this year, there were more than 132,000 vacancies in the NHS in England, which is up from around 98,000 the previous year and from around 105,000 in March. When we look specifically at registered nursing staff, as of June there were over 46,000 vacancies. Alarmingly, that is almost 8,000 more than in March. For medical staff, there were over 10,500 vacancies in June, which is around 2,500 more than in March.

By way of comparison, in December 2019 there were around 38,000 nursing vacancies and more than 8,800 medical staff vacancies. What was already an extremely serious situation before the pandemic has become worse. Staffing shortages create stress for NHS workers, and delays and deteriorating quality and safety for patients. As well as vacancies, waiting times for treatment and emergency services have continued to soar. Last month, of the nearly 1.4 million people who visited major A&E departments, more than 550,000 waited more than four hours from arrival to admission, transfer or discharge. That is 45.2% of attendees, which is way short of the target of 95% to be seen in four hours. In December 2019, 31.4% waited for more than four hours. Again, an already serious situation before covid has got worse.

As of last month, a total of 7.1 million people in England were waiting to start routine hospital treatment. More than 400,000 people had been waiting more than 52 weeks, and more than 2,000 longer than two years. Behind those statistics are huge numbers of people waiting in pain and anxiety. Cancer Research UK points out that, in September of this year, only 60.5% of patients started treatment within 62 days of an urgent referral, against a target of 85%. That means that, in September alone, around 6,000 people waited for more than 62 days for their cancer treatment to start. Even before the pandemic, cancer patients were waiting too long for diagnosis and treatment. The 62-day target has not been met since 2015.

On the Conservatives’ watch, millions of patients are being deprived of the timely treatment that they desperately need. Because of the unacceptable delays, some are paying for expensive private healthcare, and many are distressed to do so, because they believe in a publicly owned, universal, comprehensive national health service. They have been failed by Conservative Governments.

The staffing crisis is having a devastating impact on retention. Last month, the Health Service Journal reported that a record number of NHS workers voluntarily resigned from their jobs during the first quarter of this financial year. Almost 35,000 resigned voluntarily, which is up from around 28,000 during the same period in 2021 and around 19,000 in 2020. The most common reason for leaving during quarter 1 of 2021-22 was work-life balance, which almost 7,000 NHS workers cited as their reason for leaving.

A few months ago, I met with members of the Royal College of Nursing. They told me about the incredible amount of pressure that they are under because of staff shortages. They also told me of nurses suffering financial hardship. Some are going to food banks, some are unable to afford to drive to work, and some are leaving the profession to work in chain stores for better pay. However, it is not just about pay. The nurses told me that they often simply do not have enough colleagues to work alongside them. That is extremely stressful for them, and dangerous and deeply unfair for patients.

I turn now to industrial action. NHS staff care deeply about their patients, but they can also see that the NHS is at breaking point. Earlier this month, the Royal College of Nursing voted to take strike action in its fight for fair pay and safe staffing. That is unprecedented and has not been done lightly. The RCN has been clear: its members have voted for fair pay for nursing, safe patient care and to protect patients.

Numerous other organisations, representing thousands of workers, are also balloting for industrial action, including Unite the Union, Unison, the Royal College of Midwives and the GMB union. The Conservative Government’s failure to address the NHS staffing crisis is putting those working in the service under immense pressure and, in some instances, putting patients at risk. It is notable that, in a poll of 6,000 adults, carried out on behalf of Unite, 73% of respondents supported NHS and careworkers receiving pay rises that keep up with the cost of living. The Government should take note.

We cannot discuss the NHS staffing crisis without highlighting the Conservatives’ privatisation agenda, because it does impact on people working in the service. The Health and Care Act 2022 split the NHS in England into 42 statutory integrated care systems, each comprising an integrated care board and integrated care partnership.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I thank the hon. Lady for making such a poignant and important speech, and for securing this debate, because we are all grappling with the issue. Does she agree that the staff in the NHS do their very best, but the future planning of the workforce is also an issue? We do not have enough staff for the future workforce plan. That is particularly the case in mental health and learning disabilities. I read that 215 young people took their lives in 2021, the highest figure since records began. Is that a concern to her, because I think it is for most of us in the House? I am sure that, in the excellent speech is making, she will want to highlight that.

--- Later in debate ---

[Margaret Greenwood]

The hon. Lady makes an incredibly important point. There can be no more poignant and devastating example of what this crisis is leading to.

The Health and Care Act is a privatising piece of legislation that opens the door to private companies having a greater say in the delivery of health care. Guidance by NHS England, while the Act was going through Parliament, stated that it would enable integrated care boards to delegate functions to providers, including devolving budgets to provider collaboratives. Provider collaboratives are partnership arrangements involving at least two trusts, and they can include representation from the private or independent sector.

As we now know, the delegation of commissioning from ICBs to provider collaboratives will definitely go ahead. That represents not only the opportunity for the privatisation of the NHS, but clearly has implications for NHS staff. I am concerned that a situation may well arise where a provider collaborative decides to commission services from the private sector, instead of from the NHS provider that is currently delivering the service. In that instance, NHS staff may well find that their jobs are lost from the NHS, and that equivalent work is available only in the private sector, on poorer pay and conditions of service.

The Health and Care Act, which was passed by the Conservative Government earlier this year, has the potential to undermine national collective bargaining, and the pay and terms and conditions of NHS staff. It also undermines the concept of the NHS as a publicly owned organisation that has served us so well since 1948. The Act prohibits the chair of an ICB from approving or appointing someone as a member of any committee or sub-committee that exercises commissioning functions, if the chair considers that the appointment could reasonably be regarded as undermining the independence of the health service, because of the candidate’s involvement with the private healthcare sector or otherwise. However, that is clearly open to interpretation. It by no means rules out people with interests in private healthcare from sitting on those sub-committees.

If we are serious about providing governance that rules out the possibility of the private sector influencing the expenditure of public money, an organisation carrying out the functions of an ICB on its behalf should be a statutory NHS body. It is a great pity that the Government did not legislate for that, despite an amendment in my name calling for it, which had cross-party support.

Private companies can also have influence through integrated care partnerships, which are required to prepare a strategy setting out how the assessed needs of its area are to be met. ICBs must have regard to a strategy drawn up by an ICP, which I am concerned might be influenced by private companies. Of course, the responsibility of a private company is to make money for shareholders; it is not to support a publicly owned, publicly run national health service.

Other provisions in the Act also have serious implications for staff. The Act allows for a profession that is currently regulated to be removed from statutory regulation. That is deeply concerning. Once a profession is deregulated, we can expect the level of expertise in that field to decline over time, alongside the status and pay of those carrying out those important roles. Deregulation also brings with it serious long-term implications for the health and safety of patients.

The Act also provides for the revoking of the national tariff and its replacement with a new NHS payment scheme. Engagement on the NHS payment scheme is still under way, with a statutory consultation due to begin shortly. I have long been concerned that, given the requirement in the Act for NHS England to consult with each relevant provider before publishing the NHS payment scheme, including private providers, this may well be a mechanism through which the Government will give private health companies the opportunity to undercut the NHS. If that happens, I believe that one of the inevitable outcomes would be an erosion of the scope of “Agenda for Change”, as healthcare that should be provided by the NHS is increasingly delivered by the private sector.

In that event, NHS staff may then find themselves forced out of jobs that are currently on “Agenda for Change” rates of pay, pensions and other terms and conditions, with only private-sector jobs with potentially lesser pay and conditions available for them to apply for if they wish to continue working in the health service. Just like the provision around provider collaboratives, that would appear to hold risk for NHS staff and their pay and conditions. As such, I would be grateful if the Minister will guarantee that the pay rates of “Agenda for Change”, pensions, and other terms and conditions of all eligible current NHS staff will not be undermined as a result of the adoption of the NHS payment scheme. Can he also confirm that trade unions, staff representative bodies and all the royal colleges will be consulted before the NHS payment scheme is published, as Ministers in the other place assured us during the passage of the Act?

I understand that the Government are to publish a comprehensive NHS workforce plan next year, including independently verified workforce forecasts of the number of doctors, nurses and other professionals we will need in five, 10 and 15 years’ time. Such a plan is long overdue, so can the Minister provide some further details about when we will see it? Will that plan also include details of the numbers of staff we will need in the social care sector, where there is also a workforce crisis that is intricately linked to that in the NHS? Will the Minister set out what measures he is taking to address the staffing crisis this winter?

[Rachael Maskell (York Central) (Lab/Co-op)]

The reality is that today, we are training NHS professionals in the same professional silos as we did 100 years ago. Medicine has moved on massively, so in light of the fact that a new workforce plan is being drawn up, is it not right that those professions are revisited to ensure we have a workforce fit for the future, as opposed to doing things just because we have done them for so many years?

[Margaret Greenwood]

As ever, my hon. Friend makes an interesting and detailed point born of her experience. The Minister should take note.

To conclude, since 2010, Conservative Governments have let the crisis in NHS staffing develop. Instead of doing the important business of Government and bringing forward a timely workforce plan and a properly funded training regime, they have focused their energy on not one, but two, major reorganisations of the national health service designed to open it up to privatisation. Instead of tending to the needs of the workforce and the needs of patients, they have been priming the pump for shareholders. The NHS must remain a comprehensive universal service, publicly owned, paid for through direct taxation and free at the point of use for all who need it. That very concept is under threat: it has been reported this week that NHS leaders in Scotland have discussed abandoning the founding principles of the NHS by having the wealthy pay for treatment, thus creating a two-tier system. Not only would that be a betrayal of its founding principles, but it would also bring in costly administrative processes that are not currently needed, as patients would need to be means-tested.

The NHS is also under threat from this Conservative Government’s failure to get a grip on the staffing crisis, and from their privatisation agenda. This attack on the fundamental principles of a comprehensive, universal, publicly owned national health service, free to all who need it and paid for through direct taxation, has left patients neglected and staff overworked and underpaid. Patients, the NHS, and all who work in the service deserve better. The Government must come forward as a matter of urgency with a credible plan to put things right for NHS staff and set out how they are going to deal with the crisis this winter, and Ministers must give NHS workers a fair pay rise, protect NHS services, and ensure staff safety.

[Several hon. Members rose—]

--- Later in debate ---

[Margaret Greenwood]

This has been such an important debate, and I thank every Member who contributed to it. My hon. Friend the Member for Batley and Spen (Kim Leadbeater) spoke of the dejected and run-down state of mind of many NHS staff. My hon. Friend the Member for Edmonton (Kate Osamor) spoke powerfully about how racism affects black and ethnic minority staff and how they are under-represented at senior management level—an issue that needs desperate attention.

My hon. Friend the Member for Birmingham, Erdington (Mrs Hamilton) spoke about her experience as a nurse for 25 years and the disastrous impact that staffing shortages have on her colleagues. We also had contributions from my hon. Friends the Members for Coventry North West (Taiwo Owatemi), for Bradford West (Naz Shah) and for Bootle (Peter Dowd), and the hon. Members for Strangford (Jim Shannon) and for Westmorland and Lonsdale (Tim Farron). I thank them all for their contributions.

We have heard powerful testimonies about the impact of the NHS staffing crisis on both staff and patients. We need the Government to come forward with a credible plan to show how they will address the crisis with a fair pay rise for NHS staff, and an urgent plan to deliver the colleagues that those staff so desperately need working alongside them. We also need the Government to call a halt to their privatisation agenda and to reinstate the service as a publicly owned, universal and comprehensive national health service that is free to all when they need it and paid for through direct taxation.

The NHS is one of this country’s proudest achievements, but it is clearly in crisis. NHS workers should not be pushed into industrial action through Government negligence. They deserve our support, and they deserve a pay rise.

Question put and agreed to.

Resolved,

That this House has considered NHS staffing levels.