NHS Staffing Levels

Peter Dowd Excerpts

Tuesday 22nd November 2022 Westminster Hall

[Peter Dowd (Bootle) (Lab)]

It is a pleasure to speak under your stewardship, Mr Hollobone. I thank my hon. Friend the Member for Wirral West (Margaret Greenwood) for initiating the debate.

Where do I begin on this subject? It is difficult to know because Members have brought forward a plethora of information, but I will start with the House of Commons Library briefing, which is always a good source of information, and its research is based on independent sources. It says that the Health and Social Care Committee has said:

“The National Health Service and the social care sector are facing the greatest workforce crisis in their history.”

The NHS, which is the best part of 80 years old, is facing the worst crisis in its history, with a vacancy rate of 9.7%, which is 132,139 members of staff.

There is significant shortfall in staff across the piece. The hon. Member for Westmorland and Lonsdale (Tim Farron) talked about vacancies in pharmacy, dentistry, radiology, podiatry, ambulance staff, back-office staff—as those people who are at the heart of the service and keep it going are disparagingly called—cleaners and porters. Everybody says the whole NHS is under huge stress.

[Rachael Maskell]

I want to highlight the neuroradiology profession and the reality that staff shortages have an impact on clinical outcomes. Hardly any of our NHS trusts have neuroradiologists, but they could save 9,000 lives lost to strokes by being able to advance new techniques. Does my hon. Friend agree that it is important to look at the clinical outcomes that health professionals could bring?

[Peter Dowd]

My hon. Friend is right: it is crucial that we do that. A whole range of issues are beginning to affect staffing. For example, there is a £9 billion maintenance backlog in the NHS. Patients are being treated in hospitals that are not, in certain situations, fit for purpose and, importantly, staff have to work in those environments. In many cases, radiology equipment is not up to date, so staff and patients are either working or being treated in an environment in which the conditions and the equipment are not good. That goes to the heart of the staffing crisis as well.

There are lots of suggestions about how the Government could get to grips with the situation. Community Pharmacy England has plans to “resolve the funding squeeze”, which seems pretty straightforward, to

“tackle regulatory and other burdens”

that are affecting staffing, to

“help pharmacies to expand their role in primary care”

and to

“commission a Pharmacy First service”.

All those things go to the heart of enabling staff to feel wanted and that they are working in an environment where they are treated properly.

Of course, we then get people leaving in droves because of pay. I looked at some of the figures in relation to the pay restraint that we have had for the past few years: since the Government came to power in 2010, for all intents and purposes there has been either no pay increase or an increase of 1% here and 2% there.

[Clive Lewis (Norwich South) (Lab)]

I thank my hon. Friend for making such an excellent speech. Will he comment on the fact that at the University of East Anglia medical school we saw a fifth of new nurses, or training nurses, drop out of the course after the Government cut the nursing bursary? With the low pay, crisis of staffing and pressure that is going on, we expect those nurses to work in the NHS as they are training and rack up debt at the same time. If we are going to get the numbers back up, we must surely reintroduce the bursary.

[Peter Dowd]

Yes, we must. When these professionals come into the NHS and work their socks off, for all the hours that God sends, they do not even get a decent pay rise. They have had to pay to do the job, then they pay to do the job again because we are not giving them enough money. My hon. Friend is absolutely right. The amount of funding the NHS gets falls well short of our international competitors in terms of revenue and current and capital expenditure. We spend about £3,055 per person on health; in our competitor countries, which are similar economies with similarly sized populations—such as France and Germany—the figure is £3,600. That difference, of the best part of £600 per person, is absolutely significant. We are falling further behind as the years go by.

The Government say, “Well, this year we have accepted the independent NHS pay review body’s recommendation.” I suspect that this is the first time in many years that they have accepted, championed and blown the bugle for it. Let us look at the detail and analyse it. The terms of reference include

“the need to recruit, retain and motivate suitably able and qualified staff”.

That is not happening, is it? That is nowhere to be seen. They also mention

“regional/local variations in labour markets and their effects on the recruitment and retention of staff”.

That is not working either, is it?

The terms of reference mention:

“The funds available to the Health Departments, as set out in the Government’s Departmental Expenditure Limits”.

In effect, the Government tell the pay review body what it can do, because of the amount the Department has, and then, when the body agrees with what the Government say, they say it has been an independent assessment. It is not as simple as that.

Here is another one: “the Government’s inflation target” is a factor. We all know where that is—whose fault is that? It is not the Government’s fault; it is the Bank of England’s fault.

The terms of reference mention:

“The principle of equal pay for work of equal value in the NHS”—

which was referred to earlier and is not happening. They talk about:

“The overall strategy that the NHS should place patients at the heart of all it does”—

but it is far from putting them at the heart of the service. In conclusion, staff need a pay rise and better working conditions; the only way they will get that is with a Labour Government in two years’ time.

--- Later in debate ---

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I pay tribute to my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing this important debate, and praise all the Members who have spoken this afternoon for their brilliant contributions.

The NHS is a cornerstone of communities up and down our country. It is the biggest employer in Europe and one of the biggest in the world, supporting the livelihoods of millions of British families. A publicly funded healthcare service that is free at the point of need is a lifeline for so many, and the people of this country are overwhelmingly proud of it. The pride and respect we have for the NHS means that it will always have people to stand up and defend it when things are going wrong.

However, the reality is that patients are finding it impossible to get a GP appointment due to chronic shortages of doctors, as we heard from my hon. Friend the Member for Birmingham, Erdington (Mrs Hamilton). Stroke and heart attack victims are waiting an hour for an ambulance, and over 400,000 patients have been waiting more than a year for an operation. We have gone from an NHS that treated people well and on time to not just a winter crisis, but a year-round crisis, and an NHS that is understaffed and unable to deliver timely care.

The NHS is facing the greatest workforce crisis in its history. Right now, there are 132,000 vacancies across the NHS, and 165,000 in social care. We are short of 40,000 nurses, and we are losing midwives faster than we can recruit them. We are short of 12,000 hospital doctors, yet this summer, medical school places were cut by 30%, turning away thousands of straight-A students from training to become doctors when we need them more than ever. As we have heard again and again this afternoon, the consistent failure to train and retain the nurses and doctors our NHS needs has left staff overworked, overstretched and struggling to cope.

[Peter Dowd]

The Royal College of Physicians produced a short, medium and long-term plan for the NHS, specifically in relation to staffing. I was shocked to read that the measures to increase satisfaction and retention of current staff—getting the basics right—included access to hot food and drink, and rest facilities, at all hours of the day. The Royal College of Physicians putting that into a document shows how poor the situation is. Would my hon. Friend agree that the Government have to listen to that?

[Feryal Clark]

I wholehearted agree with my hon. Friend. With nurses already doing an average of £2,000 a year in overtime to make up shortages, the Government cannot rely on good will to get us through this crisis. They cannot afford to play politics and refuse to get around the negotiating table to avoid strike action.

It would be far too simplistic to suggest that pay is the sole cause of this crisis, as we have heard in this debate. Members who have spoken with NHS staff in their communities will know that the problems run far deeper than that. In this debate we have heard how staff are demoralised, burnt out and undervalued, and are working in poor conditions. Staff members are working harder than ever, but are unable to deliver the level of service they want for patients.

When I speak to NHS staff in my constituency of Enfield North, their passion and dedication is in no doubt whatsoever. One of the clear themes that came through in a local healthcare survey run over the summer was an appreciation in our community for the efforts of NHS staff. On a recent visit to Chase Farm urgent care centre, I saw at first hand the pride that staff had for the work they did, and their desire to deliver the best for patients, despite chronic shortages of staff and the most trying of circumstances. They are going above and beyond the call of duty.

We cannot keep relying on the good will of staff. We need to see their attitude matched by action from the Government. Staff need to know that they will not be hung out to dry and that help is there for them. What reassurance can the Minister give to staff, at places such as Chase Farm, that their cries for help will be heard? If the Minister believes that what we heard from the Chancellor is sufficient, then he is very much mistaken. I am pleased that, after long calls from the Back Benchers, the Chancellor has dragged his party into agreeing to an independent assessment of our NHS workforce needs, but does the Minister really expect that assessment to say that the NHS has the people it needs to deliver a safe standard of care for patients?

Talking will not cut it for NHS staff. We need a plan of action. I was pleased to hear from my hon. Friends the Members for Bradford West (Naz Shah) and for Barnsley East (Stephanie Peacock), who set out Labour’s plan so well. Labour’s plan will deliver the biggest expansion of medical school places in history, doubling the number to give the NHS the doctors it needs to get patients seen on time. It will also include an extra 10,000 nursing and midwifery places, helping to close the gap caused by the loss of 800 midwives in the NHS since the last election. Labour would double the number of district nurses qualifying each year and train 5,000 more health visitors. That would be funded by abolishing non-dom status, a move that brings in double the £1.6 billion investment that our NHS workforce needs. The Chancellor has described our plan as something that

“I very much hope the government adopts on the basis that smart governments always nick the best ideas of their opponents.”

Given that statement, I look forward the Minister bringing the plan forward as the Government’s own, sooner rather than later.

We know that getting more staff into the system will not, on its own, solve the problem. Our NHS has brilliant staff working in it already, and we must do more to give them the confidence to stay. The Government are simply not doing enough, and unless we improve retention, extra recruitment will not deliver the numbers we need. As we have heard, staff are leaving faster than we are recruiting. The scale of the crisis means that we cannot simply wait things out and hope it blows over. We need a plan and some action from the Government now. I look forward to the Minister telling us how they will deliver that.