Health and Social Care Workforce

Robin Walker Excerpts

Thursday 13th July 2023 Commons Chamber

[Steve Brine]

Yes. There is a part of the workforce plan, which the Select Committee discussed a little yesterday, which talks about how, every year, every member of staff should have a conversation with their employers about their pension arrangements and mental health and wellbeing. That is fantastic. I am sceptical as to how it is remotely possible in an organisation of this size. That does not mean that I do not think the ambition is right—I think that it is right—but it would be helpful to the House if the Minister touched on that in her wind-up.

The other point I make to my right hon. Friend, which I will also make later in my speech, is that we must remember that there are NHS employers, and ultimately the Government are the employer in the widest possible sense, but the direct employer when it comes to hospitals is the trusts, and they have a big role to play in retention and in workforce health and wellbeing. We sometimes duck away from saying that, but I say that here in the House as well as privately to the chief executive of my trust.

I am encouraged by the emphasis that the workforce plan places on prevention, which everybody knows is one of my great passions in life and politics. That will clearly be crucial, given the supply and demand challenges facing the health service at the moment. Prevention is, as colleagues know, a subject dear and close to the work of the Select Committee: we have launched a major inquiry into the prevention of ill health, with 10 work- streams. We have already done the vaccination workstream and have moved on to the healthy places—home and work—workstream. Details of that are available on the Health and Social Care Committee’s website.

Let me turn to some of the specifics in the Committee’s report and what action the Government have taken. One of our key recommendations was that

“the number of medical school places in the UK should be increased by 5,000 from around 9,500 per year to 14,500.”

The plan does that: it doubles medical school training places in England to 15,000 by 2031-32, which is extremely welcome. As I said to the Prime Minister last week at the Liaison Committee, I hope it is possible to make some of those new places available before September 2025, as it says in the plan. However, with a UCAS deadline of mid-October for a September 2024 start, that looks extremely challenging. We discussed that yesterday at the Select Committee. An update from the Minister on that would be welcome.

[Mr Robin Walker (Worcester) (Con)]

I congratulate my hon. Friend on his report. On the issue of making places available, the report talks about the 2018 to 2020 university cohort and the great success of those new university medical schools. The Government’s response echoes that. The university medical schools approved by the GMC since currently have no funded places, though they are open and are receiving students. Does he agree that it would be very welcome if there were some funded places available in those three new medical schools by the earlier deadline that he has suggested?

[Steve Brine]

I thank the Chair of the Education Committee for being a guest at yesterday’s session with the medical director of NHS England in our workforce special. He is right. The Prime Minister told me at the Liaison Committee, and the medical director said yesterday, that it will take time to scale up. Yesterday, the GMC chief executive talked about training capacity in scaling up the medical places. That is right and needs to be done. However, where the medical schools are ready—even with fairly modest numbers—for September ’24, it would be an incredibly good signal of intent from the Government to allow them to start then. The money is front-loaded, so the fiscal cycle should allow that to happen. Knowing my hon. Friend, he will not let this one go. I thank him for raising it.

--- Later in debate ---

[Mr Robin Walker (Worcester) (Con)]

It is a pleasure to speak in such a very well-informed debate. I thank my hon. Friend the Member for Winchester (Steve Brine), who chairs the Health Committee, for inviting me to guest with the Committee on the issues of the long-term workforce plan. I think in this, as in many other areas, there is a great deal of crossover between the work that we do on the Education Committee and the work that he does in the health space.

I join my hon. Friend in welcoming today’s announcement about the public service pay negotiations. It is very welcome news that the education unions have suspended strikes. I join him in urging the health unions to look very carefully at the offer on the table to try to do the same.

I want to raise a few points in this debate, and the first is not related to the meeting we had yesterday, nor necessarily to the main theme of the workforce plan, but it has come up through my work on the Education Committee: the pressing and urgent need to ensure that when we look at workforce, we include child and adolescent mental health services, and the resources and people available in that space. I have spoken to people at my health and care trust in Worcestershire, who interestingly told me that they feel that they are quite well resourced and have the relevant people to meet adult mental health needs, but that there is further work to be done to make sure they can adequately meet child and adolescent mental health needs. Everything I see from the school sector—including some pressures we are looking at as part of our inquiry into recruitment and retention for the teaching workforce—makes it clear that the pressing mental health pressure on schools is a big part of the challenge. Anything the Minister and the workforce plan can do to address that would be extremely welcome.

Let me turn to the very interesting Committee meeting I attended yesterday, which demonstrated the great achievement of the Health Committee, under its previous and current Chairs, in pressing for a long-term workforce plan. That is something to be celebrated, and its shows the role of this House and its cross-party Select Committees, including when it came to the weightiness of the document we were scrutinising. We heard some interesting and useful evidence about the recruitment challenge and the retention piece. I share the concerns of my hon. Friend the Member for Winchester, echoing the evidence that was given to the Committee, that there is more work to do on retention and that it will require a great determination from the NHS and Ministers to address those issues in the long run.

We also heard plenty of evidence—this has also been made clear to me on a local level—that recruitment, training and upskilling the workforce can play a key role in inspiring senior doctors to stay in and play their part in bringing forward the next generation. It was interesting to hear evidence from the General Medical Council and GPs about the benefits of those doctors being able to play a part in training the next generation. I have heard the same from many doctors within the Worcestershire Acute Hospitals NHS Trust and in our local primary care services in Worcestershire. It is one reason why we have a unanimous view from all the trusts across Worcestershire, Herefordshire, Gloucestershire and Dudley that they want to see a medical school up and running, training local students in Worcester, where we have a university that the Department values and recognises, to the extent that it has been the fastest growing nurse training university in the country over a number of years, and which the GMC has now approved to have a medical school—so far, so good; that is extremely welcome. I am grateful to the NHS and to Ministers for all the work that has gone into getting to that stage. We do, however, face a challenge.

My medical school, the Three Counties Medical School at Worcester, which serves a very large area of the country, is opening in September. It is bringing in students and has uniquely managed to find funding to support domestic students to start their medical training without funded places allocated by what used to be Health Education England and is now part of NHS England. The challenge is that the funding is finite. It has enough funding—which has been raised locally from local health trusts and charitable donations—to support a cohort of 20 students to start this September and to take them all the way through their training at the university, and hopefully onwards into the NHS.

Clearly, 20 students is not a large enough cohort to sustain a medical school, so alongside those 20 students in the first intake, there will be 28 international students. The evidence we heard yesterday was interesting on this point. I think we all recognise, and the report that the Select Committee published recognises, the benefit of international recruitment to the NHS. We absolutely want to attract talent, but we also need to recognise—as per the many arguments I have as Chair of the Education Committee when it comes to international students in general—that the majority of international students do leave; they do not necessarily stay and work long term in the NHS.

If we want to solve the recruitment and retention problem in the long run, we need to train more of our own doctors. We need to train those doctors locally. In health, just as in teaching, many people who train in a particular area are likely to stay in that area and pursue their careers there. That is also something that has been put to me over many years by my local trust and my local GPs as a reason to have a three counties medical school in Worcestershire.

I am very grateful for the support that the NHS and colleagues on the Front Bench have provided over the years in marching us up the hill to a position where the building is there, the university will be opening that medical school this year and the first students will be starting. That is fantastic.

My concern, and it is a concern shared by many colleagues—six Worcestershire MPs wrote to the Health Secretary last week about it—is that where the long-term plan, which is extremely welcome in most respects, sets out the plan to double medical training places, it carries the line:

“The first new medical school places will be available from September 2025.”

The three universities that have been given the go-ahead to host a medical school—Worcester, Brunel and Chester—have not yet had the opportunity to bid for funding places, so that date is frustrating. It means that, after the first year’s intake of locally trained domestic students at the Three Counties Medical School, we have the slightly bizarre potential for the following year’s intake to be entirely international students. I hope the NHS and Ministers can avert that, because it does not make sense from either a value for money or a long-term workforce planning perspective.

I appreciate that I did not give my hon. Friend the Minister advance notice of my intention to speak in this debate, so I do not expect her to be able to answer all my questions. However, I ask her to take this issue away and ensure that the Health Secretary looks very carefully at the letter he has received from all the Worcestershire MPs. I understand that the University of Worcester will also be writing to NHS England to make the case for additional funded places this year—that would be wonderful, but I appreciate that it would be very difficult—and for an allocation of funded places next year.

That is certainly something worth considering. It would help with recruitment, with retention and with some of the challenges that our local health service in Worcestershire has wrestled with for a long time—challenges that I am well aware of, having spoken to trust leaders and doctors in all areas of the NHS. Not only would it benefit us in Worcestershire, but it has the support and the placements are already there. That is crucial, because I understand the reasoning given in the NHS workforce plan is that the Government and the NHS need time to work out where the placements are and where they are required.

It is already clear that there are well over 100 placements available across Worcestershire, Gloucestershire, Dudley and Herefordshire for the medics when they come out of that training, so that problem is solved. It is already a four-year, graduate entry course, so the problem of long courses and things taking too long is also solved. I encourage colleagues on the Front Bench to engage with the request and see whether we can make the workforce plan even better by getting those funded places going at the universities that the General Medical Council has already determined are ready to go, to help meet the workforce challenge.

One other thing I would say, having listened to my hon. Friend the Member for Winchester and some of the debate yesterday on the Select Committee, is that no single Department has a monopoly on wisdom. As Select Committees, we are there not only to challenge and to criticise, but to welcome things when they go right. I was quite struck by the discussion of the importance of retaining trainers and the pressures currently facing them in the NHS, which the GMC raised concerns about.

We face a similar challenge in the education space, and the early career framework, designed to support teachers starting their careers in schools, is a very interesting model to look at—particularly when we look at the importance of mentoring and, for teachers, off-timetable hours to get that mentoring. There may be similar things that could be designed into the NHS; I would not claim to be any kind of an expert on that, but it is worth looking to see whether there are elements of that model that could even further strengthen the very welcome NHS long-term workforce plan.