NHS in London

Debate between Mike Gapes and Meg Hillier

Thursday 24th March 2016 Westminster Hall

[Meg Hillier]

I am sure the Minister will do that, but I am happy to share anything I receive from her. I am sure she will not be writing me secret letters, and even if she told me that she was I would ignore her, so I hope she provides information that is fully public.

There is a real concern about health workers being unable to afford to buy homes. When a group of local MPs met officials from the Barts trust after one of the trust’s more recent crises—it was around the time of, or just before, the general election—we asked them about the release of land for health workers. We got the distinct impression that those running the trust at the time—we have had new management in since—did not think that it was their responsibility to provide housing; the process was just about disposing of the land to fill the black hole in the trust’s budget. However, we know that health workers cannot afford to live in London and work locally; that is often true of doctors on good salaries, let alone anyone on a lower salary. There will be a real crisis if we cannot recruit health workers, and I will touch on that issue in a moment.

NHS England is keen to lay the blame for the financial crisis in acute trusts at the door of agency staff costs. The Secretary of State announced a cap on the pay rate in October, but the National Audit Office found that that is not the underlying problem. We also touched on the matter in a Public Accounts Committee hearing. It is the volume of agency working, rather than the rate paid, that is the bigger problem—the vacancy rate, requiring backfilling with agency workers, rather than the amount that they are paid. No doubt there is an problem there and the NHS should begin—I hope that it is beginning—to use its purchasing power to tackle that, but the foundation staffing model for hospitals, which is designed to fit the budget allocated by the Department, often has too few staff to deliver the required health outcomes. The NAO has uncovered the fact that 61% of temporary staffing requests in 2014-15 were to cover vacancies, not emergency cover.

[Mike Gapes]

Is my hon. Friend aware that the NHS employers and London NHS partnership have this week sent out information stating that nursing vacancies in London are running at 17%, which is 10,000 nurses? The NHS and local trusts are going all over the world to recruit, but the Home Office is bringing in a requirement for people to earn £35,000 before letting them in. Does not that contradict what the NHS is trying to do?

[Meg Hillier]

My hon. Friend anticipates what I was going to say—or perhaps it is just that we are all dealing with the same problems. Will the Minister outline what conversations her Department and NHS England have been having with the Home Office about the issue? We have seen many changes in the immigration rules, and they affect what happens. We should be recruiting and training British citizens and enabling them to earn a living, although I have no problem with other people working in the NHS. When we have problems with recruitment, of course it is right to look overseas, and many of our hospitals are well staffed by people from all round the world; but if those people cannot meet the threshold, they will not be allowed in, and that will cause a problem. I know that it is also causing concern to NHS England. No doubt the Minister is being lobbied; perhaps she can advise us. The cost to hospital trusts of the agency staff who fill in the gaps—they could be full-time workers from overseas or from the UK—has risen from £2.2 billion in 2009-10 to £3.3 billion in 2014-15.

I do not have much time to discuss GPs, but we know that that is a big issue, given the demand on the health service at primary care level in particular. On national figures, recruitment of new GPs is slow and early retirement is a looming crisis. If the Minister has not been alerted to that problem, I hope she will look into it. It is not a new phenomenon, but it is getting worse. Between 2005 and 2014 the proportion of GPs aged between 55 and 64 who left approximately doubled. In addition, there is an increasing proportion of unfilled training places—the figure was 12% in 2014-15—and an increasing number of younger GPs are leaving because the job is becoming untenable, with 12-hour days typical. Many GPs just do not want to do that. We need good access and support in primary care to make it work.

The Public Accounts Committee has recently looked at another issue that is worth highlighting, which is the management and supply of NHS clinical staff. We would acknowledge, although our report is not yet out, that in an organisation the size of the national health service, getting things exactly right will always be complex. The figures and the available data about who is needed, together with the problems that I have mentioned to do with GPs and recruitment of hospital and other health workers, could have been predicted. That is something on which I want the Minister to respond: surely, if there is a prediction, there is a need to be able to react quickly, so that training places are available and people are encouraged to take them up. That way, we would ensure that there were enough health workers.

To return to the issue of housing, it is at crisis point in my constituency. Someone on quite a good income cannot afford to buy or to rent in the private sector and will not have a hope of getting social housing, so we have a vast turnover of people. Young people come and live like students, but when they want a home of their own, a spare bedroom for a child, or just a lifestyle that they think befits their status and age, they move out. We have a crisis across the board, but particularly for the NHS. I hope that the Minister will answer some of my questions about how housing can become a key concern for her Department as well as the Department for Communities and Local Government, which delivers housing. My worry is that if the Minister and her colleagues do not lobby hard, the problem will be forgotten in the overall housing crisis and will become a major crisis for public health and health and wellbeing in London.