Doctor Training

Martyn Day Excerpts

Tuesday 17th January 2023 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I am grateful to the hon. Member for South Cambridgeshire (Anthony Browne) for securing this debate, which provides me with the opportunity to make a number of political points, but, with your indulgence, Sir George, I will start with a personal one. I put on the record my gratitude and thanks to all the staff of the Scottish NHS. This happens to be my first debate back since being taken ill at the end of last year and undergoing emergency surgery. I am pleased to say that, from every angle—from the local GP right through to the Royal Infirmary in Edinburgh—I was treated fantastically, despite which I hope that I do not have to avail myself of those services again any time soon.

In opening the debate, the hon. Member for South Cambridgeshire said much with which I agree. In fact, we have heard much on which there is probably a great degree of consensus. For years now, across the UK, there have been various issues with finding qualified staff to fill vacancies in our NHS, especially in a number of specialities. When combined with the aftermath of covid, that has resulted in a backlog that is putting immense pressure on frontline services and those who bravely staff the wards.

Staff shortages lead to delays in the whole system, which can mean longer waits for appointments, operations and getting home from hospital. It is vital that each of our nations is fully able to further recruit both domestic and international professionals. We should not ignore the fact that Brexit is exacerbating difficulties in recruitment. In addition, we have the related issue of staff retention.

As Members will know, health is a devolved area, but many of the levers affecting staffing levels, such as pensions and immigration, remain reserved to Westminster. Along with many others, the Scottish Government warned the UK Government of Brexit’s effect on the health and social care workforce, the supply of medicines and medical devices, and the economic impacts that would inevitably harm health outcomes.

Research by the Nuffield Trust in June, based on data relating to May 2021, suggests that NHS England could be short of 12,000 permanent hospital doctors and over 50,000 permanent nurses and midwives. The Nuffield Trust also recently produced research marking six years since Brexit, which demonstrated that

“Across medicine, nursing and social care, there has been a decline in EU recruitment and registration since the EU referendum in 2016.”

The Nuffield Trust also found:

“There is clear evidence that Brexit is likely to be reducing the incomes of people in the UK relative to a counterfactual of continued membership, through its impact on GDP, investment, and trade. The current economic situation means that this is likely to be an additional reduction on already falling real incomes, rather than slower growth. The link between health and income is well documented, and this is likely to lead to worse health outcomes and higher demands of the NHS.”

I share those concerns, and anti-immigration rhetoric around Brexit should have no place in our NHS or anywhere else in our society. Scotland needs people. Perhaps the Minister can tell us whether his Government will devolve control of immigration powers, so that Scotland can get labour force that it wants and needs—or is that a level that we will only benefit from with independence? Where Scotland does currently have powers, it has seen the number of doctors in training rise by 24.3% under the SNP. Scotland already trains more doctors per head than elsewhere in the UK. Scotland’s share of the UK intake in undergraduate medicine has grown to 13%.

While it is right that we discuss recruitment, we must also consider staff retention. That is why pay and terms and conditions are so important. I implore the UK Government to get around the negotiating table with health unions, just as the Scottish Government are doing, to mitigate the risk of strikes.

The number of staff leaving the profession is also of concern. NHS figures show that in the last year there has been the highest turnover rate in a decade. Between March 2021 and March 2022, although 19,309 staff joined the NHS, 15,389 left. The Scottish Government published their workforce strategy for health and social care in March. The target is to grow the NHS workforce by 1% over the next five years. It is no surprise that winter plans also include aims to recruit additional staff, including some from overseas. As part of Scotland’s recovery plan, the Scottish Government launched a new national recruitment campaign and established a national centre for workforce supply.

The Scottish Government have sought to retain junior doctors by preventing them from working seven full night shifts in a row and more than seven days or shifts in a row, as well as implementing a rest period of 46 hours off following a run of full shift nights. The Scottish Government agreed with the British Medical Association last year that by February this year, no junior doctor rota will contain more than four long shifts in a row, and we are already 99% compliant with that target. However, internationally and within the UK, there is competition to recruit staff. With record high vacancies, it will take a major drive to plug the workforce gap.

The Scottish Government have introduced new national guidelines, making it easier for retiring NHS staff to return to the NHS to support it as it continues to recover from the pandemic while also drawing their pension. However, there is a substantive issue of pension tax rules encouraging senior clinicians to reduce their commitments or retire early, and pension taxation is a wholly reserved matter. The UK Government need to provide a permanent solution that will help efforts to retain senior NHS staff.

There is little doubt that training of more doctors is required to attain the adequate levels of staffing that we all need, but people should be under no illusion that with fiscal and immigration powers reserved to this place, Scotland has to achieve that with one hand tied behind its back. Given yesterday’s unprecedented use of a section 35 order to strike down devolved legislation, even devolved powers may now be under attack, such that the days of devolution are numbered. All of this demonstrates the need for Scottish independence.