Health and Care Bill (Nineteeth sitting)

Debate between Philippa Whitford and Chris Skidmore

Committee stage
Wednesday 27th October 2021 Public Bill Committees

[Dr Whitford]

I spent a few years in cancer research while doing my doctorate. Does the Minister recognise that when there is that hand-to-mouth need to get a publication so as to get another grant, researchers are taken away from what we might call blue-sky or imaginative research that may not work out? People end up researching something they virtually already know the answer to, because that way they will get a publication and then get another grant. It is not just about their personal insecurity—it skews the type of research that gets done.

[Chris Skidmore]

Absolutely. I thank the hon. Member for making that point. When I was Science Minister, we recognised the need to look again at some of the processes that underpin research applications for UK Research and Innovation, for instance. We have the bureaucracy review that is currently being chaired by Adam Tickell, current vice-chancellor of the University of Sussex who is moving on to the University of Birmingham. We need to end this cyclical process of time—which is ultimately the greatest commodity that anyone has to offer—being taken away from researchers whose expertise is far better spent focusing on their research in the laboratory or performing clinical trials, and ensure that they can get on with what they do best rather than having to worry about the administrative burden of applying and form-filling every year.

--- Later in debate ---

[Chris Skidmore]

Thank you for allowing me to speak to these two new clauses together, Mr McCabe. They are essentially interrelated and were the product of a roundtable that I put together and hosted with Universities UK and the deans of medical colleges in my role as co-chair of the all-party university group. These were the two asks that the universities and medical colleges had for the Bill. I offer these new clauses as part of that consultative approach, so I will not be pushing them to a vote.

Basically, we are at a crux. I raised this question on clause 33 of the Bill, but when it comes to workforce planning and training, we take a siloed approach, focusing on what the Department of Health and Social Care, NHS England and Health Education England set out as their vision, and the funding flows from that. Not included in that vision, although clearly there are consultative opportunities, is a recognised role and responsibility in legislation for healthcare education providers, the universities and the deans of the colleges in providing the clinicians, doctors and nurses of tomorrow. Nor is there recognition that the workforce is changing. While we have the Government’s commitment to the retention of nurses and doctors, that retention can take place only if there is continuous professional development.

When I was a Health Minister, I was very concerned to ensure an uplift in the budget of Health Education England to 3.4% to match that of NHS England. It had always been thought of as the poorer relation; the money would always flow later, and it took a great deal of lobbying from the relevant organisations to make the point that we needed to put that workforce training money aside, particularly for continuous professional development.

New clause 27, in summary, reflects the fact that if we are to have an integrated care system, and if the new White Paper is to look at how to integrate social care with healthcare, we will need to provide huge retraining opportunities for both NHS and social care staff to enable them to work across whatever that new landscape may be. I do not think it is practical to send everyone back to university, or even always to have physical in-work training opportunities, important though those may be. We will clearly need to have digital opportunities, online courses and a whole technological revolution in how we deliver those retraining opportunities.

Those opportunities are out there. If we look at the universities and the role of EdTech, it is important that the health service grips that opportunity with both hands while it has the chance to do so, because it will be coming down the tracks. If we want to implement reform via the integration of services, it will only be as good as the people working in those services, as we all know, and those people will be as good as they can be only if they are given the appropriate opportunities to train and retrain during their career.

The need for new clause 28 has become more pressing as a result of recent developments. It sets out a duty for education placement capacity; I will not go into the detail of the new clause, but effectively it is about place planning and ensuring that the universities and royal colleges are involved with that at the very outset. In the debate on clause 33, I talked about the paradox of our having a cap on places, which is causing a bottleneck in post-18 education—those pupils who are desperate to become doctors or nurses, but who find a cap on their aspiration.

That cap is there, as we know, because medical places are expensive; they cost not £9,250 a year, but more like £70,000 over the course of a medical student’s training lifetime. At the same time, however, we have a cap on places for those 18-year-olds entering the system and then—surprise, surprise—we find we do not have enough doctors and nurses in the system, and we have to start retraining from abroad.

[Dr Whitford]

Obviously, there has been a drive to expand medical student places in universities right across the UK, but one part of the system that is controlled centrally is foundation places, which a medical graduate has to spend their first two years in. This year, for the first time, there was a shortfall of about 400 places. Hopefully all those graduates have now got a foundation doctor place, but they cannot practise outwith a foundation place, which lasts two years, so they simply cannot work as doctors, nor can they work as doctors until they complete that two-year foundation role. There is no point in expanding medical school places if those at the end of the production line get turfed out to be unemployed or go and work as something else. It is not just about university places; there is also the issue of placements as foundation doctors for the first two years of their career.

[Chris Skidmore]

The hon. Member is absolutely right. When it comes to the foundation year, I was interested in looking at what future reform might come in the workforce. We would need to work with the royal colleges and vested interests on a replacement, or at least on what could make the foundation process more flexible so as to allow in-work training on that foundation year pathway. That is a huge opportunity, and, if I was still a Minister, I would be pressing for a White Paper to look at how we could deliver workforce innovation, because I do not think we can continue to sustain our trajectory using infrastructure and systems designed in the early to mid-20th century. There is a balance to strike, in that we need to ensure that the safety of patients is accounted for, but technology and training has moved on to a different space. We do not see this constriction in other countries, which can offer fast-track routes through medical training processes, particularly post degree and into the foundation stage.

The issue of placement has become incredibly pressing—it is actually a real-time issue. During the pandemic, because the grade threshold was lowered and teacher assessment was used, an additional 1,900 students were accepted to take up medical places in September 2021. Whatever we think about that, those students were all given a place because they had achieved the right threshold, but to train them, an additional £60 million is needed. However, the Government have capped the training budget at £30 million, so although students have been accepted on to courses, universities are finding that they must make a loss of £2,460 per student in the academic years 2020-21 and 2021-22, and the Government are not opening their books to change that cap on finances.

The cap is therefore returning from this coming year, and as a result 1,000 fewer students will be trained each year. In effect, we will see a reduction in the number of students coming on board to be trained. There is currently this one-off moment that universities are taking forward, but as a result we will go backwards when we know that we need more doctors. The demographic changes that I spoke about in debate on clause 33 are coming down the tracks, but we will end up just recruiting from abroad. It is not that there is necessarily anything wrong with those qualifications; I would just prefer a sustainable and, in effect, sovereign pathway.

The post-Brexit narrative is that global Britain will ensure that we can stand on our own two feet and have a sustainable skilled workforce. That could be recognised if we had a placement strategy for medical students. However, we can do that only if we involve the universities and the education sector. The problem is that the Department for Education controls the purse strings for that budget, and I do not think that it realises the long-term consequences on our healthcare system.

The new clause would close a loophole that is kneecapping the Minister and the Department of Health by placing artificial caps on aspiration and—worryingly —on the future number of doctors entering the healthcare system. I will not press my new clauses to a vote, but the issue is extremely pressing. We will see 1,000 fewer students enter medical places next year than did so this year; and students going through the system have no funding for their places, despite having been given those places. That is a real-time issue that has resulted from the wider policy issue not being resolved. The new clauses would help resolve it, but I will not push them to a vote.

Oral Answers to Questions

Debate between Philippa Whitford and Chris Skidmore

Monday 29th April 2019 Commons Chamber

[Chris Skidmore]

I am always happy to meet the hon. Gentleman. I am sure he remembers that when I was a Cabinet Office I happily worked with him on an amendment he tabled to the Higher Education and Research Act 2017 regarding student registration. However, since 2017, the figures show a rise in EU and non-EU students. He mentions market share. He is absolutely right that we want to do more and that we need to do more. That is why we published our international education strategy, which has the ambition not just of raising the complete value of international education from £30 billion to £35 billion by 2030, but of putting in the figure of 600,000 students. It is not just about having a system that works around visas, but the whole student experience and ensuring the UK is the best place to study globally.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

6. What assessment he has made of the potential effect on tertiary education of the UK leaving the EU without an agreement.

[John Mc Nally (Falkirk) (SNP)]

8. What assessment he has made of the potential effect on tertiary education of the UK leaving the EU without an agreement.

[The Minister for Universities, Science, Research and Innovation (Chris Skidmore)]

The Government remain focused on securing a deal that will ensure an orderly exit from the EU. We are considering all aspects of how exiting the EU might affect education, including the delivery of the Government guarantee, attracting international students and staff, and access to student finance.

[Dr Whitford]

In contrast to Scotland, the Secretary of State proposes to remove home fee status from EU students after Brexit. This has created such concern that the Norwegian higher education Minister is advising students to avoid the UK. Is the Secretary of State proud that his plans are causing European students to avoid our universities?

[Chris Skidmore]

I recently met the Norwegian Minister the hon. Lady mentions, Iselin Nybø, to reassure her of the UK Government’s commitment to student programmes such as Erasmus and scientific programmes such as Horizon 2020. What I am not happy with is Members talking down our higher education system when the Government want to ensure that we bring more students here. We are looking at how to do that as part of our education strategy.

Tuition Fees: EU Students

Debate between Philippa Whitford and Chris Skidmore

Monday 29th April 2019 Commons Chamber

[Chris Skidmore]

I thank my hon. Friend for his comments. When it comes to tropical diseases, future scientific research on climate change or the opportunities that agri-tech might present to developing countries, it is absolutely right that we look at what we can do to play our part to help the poorest countries across the globe in those endeavours. I will be happy to discuss with him, and the Liverpool School of Tropical Medicine when I am next up in Liverpool, any potential policy initiatives that he might have in this sphere.

On the point about a transition period, the deal is a transition. We will be able then to get round the table and open up the square brackets around our future relationship, which are currently closed because of Members’ indecision and failure to back this EU deal—the EU helped to put it together and backs it also—so that we can move forwards together, safeguarding scientific partnerships and working on education partnerships.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

In many of his responses, the Minister has seemed to imply that being a member of the EU was stopping the UK having people from elsewhere in the world, but that is up to the Home Office here. He must recognise that the workforce is the biggest problem for all four UK health services. Medical and dental degrees take five years. Does he seriously think people will come here, pay enormous fees and then at three years roll the dice on whether they get a continuing visa?

[Chris Skidmore]

It is important to reflect that leaving the EU provides us with an opportunity to decide our own immigration policy—we are beginning that work for 2021 onwards, which is why we have the immigration White Paper and consultation—and the freedom to decide our own immigration policy. On the future position of fees, obviously we have been in the EU and have reciprocal fee requirements, but we also want to make sure that international students are not discriminated against, as they currently are—the hon. Lady cannot deny that international student fees are significantly more than those for EU students. It is important that we listen to universities about what future schemes for immigration and student exchange should look like.

Oral Answers to Questions

Debate between Philippa Whitford and Chris Skidmore

Monday 4th February 2019 Commons Chamber

[Chris Skidmore]

I should also like to congratulate the hon. Gentleman on his birthday. I was there not too long ago. Life comes at us fast, but we have to start somewhere. I would be happy to meet him to discuss the problem he has raised. The Government are committed to supporting STEM teaching in schools, and we have seen £7.2 million-worth of funding annually going into our network of 35 maths hubs. We are also determined to improve science teaching with a national network of 46 science learning partnerships, but let us sit down, perhaps with a celebratory cup of tea, and discuss the issue that he has raised.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Having started surgery when there were hardly any women surgeons and having been told that it was not possible for me to be a surgeon, I have been delighted to speak at Ayrshire College at the #ThisAyrshireGirlCan and Girls with Grit events. Has the Minister read the report by the Royal Society of Edinburgh, “Tapping all our Talents”, which is about getting more women into STEM, and if so, has he considered any of its recommendations?

[Chris Skidmore]

The hon. Lady is absolutely right to raise the importance of increasing female participation in STEM. Since 2010, we have seen about 26% more women entering STEM A-levels in England, and our efforts to increase skills participation include the Stimulating Physics Network, which delivers on a series of innovative gender-balanced interventions. I would be happy to read the report that she mentions and to discuss it with her. We are determined to ensure that we work together with the science community to raise participation in these crucial subjects.

European Union (Withdrawal) Bill

Debate between Philippa Whitford and Chris Skidmore

Committee: 4th sitting: House of Commons
Monday 4th December 2017 Commons Chamber

[Chris Skidmore]

No, only once for each person. I will give way to the hon. Member for Central Ayrshire (Dr Whitford).

[Dr Whitford]

Why will having a Brexit date give certainty and clarity, yet having a date on which the powers would move to the devolved Governments is considered unacceptable?

[Chris Skidmore]

We will be discussing the clause 10 powers to which the hon. Lady refers on a separate day—on the morning of day five. Clause 11 is about ensuring that the statute book is prepared for exit day. In a way, exit day provides that temporary limit. We know that we need to make changes to the common framework, but beyond that, we do not yet know what the negotiation period will look like when it comes to ensuring that we need an implementation period. That is why we cannot necessarily provide that certainty.