Health and Care Bill

Peter Aldous Excerpts

Consideration of Lords amendments
Monday 25th April 2022 Commons Chamber

[Daisy Cooper (St Albans) (LD)]

I will speak to the workforce amendment and the amendment on the social care cap.

The Lords have compromised on the workforce amendment—they have now asked for projections every three years instead of every two, and they no longer require independent verification of the projections—so it is deeply disappointing that the Government have not moved to meet them halfway, especially when outside the Government there is so much cross-party consensus that the amendment is badly needed. I know from my constituency of St Albans, as I am sure many Members know from theirs, that our NHS and care staff are burnt out. They are understaffed and overworked. Those people, who continue to turn up every single day, need to know that the cavalry is coming, and without this workforce amendment, they simply will not.

There have been worrying reports that NHS trusts have been silenced when they have tried to talk about the numbers of staff that they need to recruit, so will the Minister address this question in his response: if the Government will not produce workforce planning numbers, will they at least commit to not interfere with or silence any part of the NHS or care sector that decides that it wants to produce its own workforce projections? I look forward to hearing the Minister’s assurances on that point.

When it comes to the social care cap, Ministers have stated time and again that their changes would save the Treasury £900 million a year by 2027-28, but that saving comes at the expense of people with fewer assets and savings, including those who will have been paying five years of increased national insurance contributions, which were put in place partly to fund these care reforms. The Government continue to say that that improves on the current situation, but they conveniently ignore that it is much worse than their original proposal. The social care cap provision does nothing to generate more care; it does nothing to give protections to unpaid carers, who are often on lower incomes but save the Government millions of pounds; and it does nothing to help the social care workforce. I know from my constituency that hospitality, the NHS and social care are all fighting for the same people, and nothing in the Bill will help to improve that situation.

[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.