NHS Workforce: England

Stephen Hammond Excerpts

Wednesday 17th July 2019 Westminster Hall

[The Minister for Health (Stephen Hammond)]

It is a pleasure to see you in the Chair, Mrs Moon. I look forward to responding to the debate, which has been interesting, and I congratulate the hon. Member for Wolverhampton South West (Eleanor Smith) on securing it.

I listened carefully to my hon. Friend the Member for St Ives (Derek Thomas). He will be pleased to know that I will be happy to write to him about podiatry; there are some interesting issues about new plans that are being put in place. He will recognise that there are more applicants for university nurse training places this year than in the previous year.

I was pleased to hear the contributions from the hon. Members for Lincoln (Karen Lee) and for Westmorland and Lonsdale (Tim Farron). I have responded to the hon. Gentleman about ambulances. He will know that there are eight posted in the Cumbria and Morecambe Bay areas, but I am looking with him at procurement there and will be looking to see where the North West Ambulance Service places those ambulances. He questioned whether promises are being fulfilled. I guide him to the implementation framework. He also talked about planning and investment. That is why there is a long-term plan and a people plan, and why moneys are going in to back them up. I also listened carefully to the hon. Member for Hartlepool (Mike Hill).

I say to the hon. Member for Washington and Sunderland West (Mrs Hodgson), let us start by agreeing with each other. I think both of us, and everybody in the Chamber and across the House, would recognise and praise the work of everybody who works in the NHS—I have been pleased to do that on every occasion I have responded to a debate in Westminster Hall or on the Floor of the House. The hon. Lady rightly mentioned that the interim people plan recognises the pressures that are being put on staff. What she failed to say, of course, is that not only do we recognise that but there is a whole chapter on addressing those issues and making the NHS the best place to work. She talked a little about junior doctors and nurses in training, failing to recognise that we have just done a deal with the junior doctors that includes a four-year pay deal and resolution of the number of issues they had with the contract review. There are now more applicants for nurse training places than there were in the previous year.

Like many other Members, I attended the RCN member-led event yesterday and heard at first hand about the aims of the campaign from many nurses working in the NHS. I met again a number of the people I met at an event for nurses in training back in November. At the heart of the campaign, as everybody recognises, is the RCN’s intention to ensure that the needs and requirements of the NHS workforce are prioritised. I fully support the RCN’s focus on the importance of the NHS workforce—recruitment and retention—but I am not convinced that legislation is always the answer, and I am not convinced that changing legislation will necessarily bring about the changes and focus the RCN seeks.

However, given that the hon. Member for Wolverhampton South West secured the debate in recognition of the Secretary of State’s legislative duties in relation to workforce, it is probably right that I set out exactly what the legal position is. Through the Care Act 2014, the Secretary of State delegated to Health Education England powers to support the delivery of excellent healthcare and health improvement for patients and the public in England by ensuring that the current and future NHS workforce has the right number of staff with the right skills, values and behaviours at the right time and in the right place to meet patients’ needs.

The Care Act 2014 sets out in detail Health Education England’s remit and range of responsibilities, including its duty to ensure an effective system of education and training for the NHS and public health. Beyond the detail of the legislation, HEE provides leadership for the education and training system, and ensures that the workforce have the right skills to be able to deliver excellent healthcare in the right numbers. HEE was established to deliver a better healthcare workforce for England and is already accountable for ensuring that there is a secure workforce supply for the future. It has responsibility for promoting high-quality education and training that is responsive to the changing needs of patients and local communities.

The full range of HEE’s responsibilities, deliverables and accountabilities are described in its annual mandate, which the Secretary of State is required to approve. The most recent edition of that mandate and HEE’s latest annual business plan summarise what it is doing and its achievements. I am pleased to say that, as those who have had the chance to read it will have noted, the mandate for 2019-20 was published last week.

The hon. Member for Washington and Sunderland West made a point about legislation for safe staffing, but there is already a commitment to safe staffing and to ensuring that the NHS aims to be the safest healthcare system in the world, as it should be. Part of that must come from transparency in staffing levels, which is why the care hours per day data were introduced in 2016. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 require hospitals to have the right staff in the right place at the right time, and appropriate staffing levels are a core element of the Care Quality Commission’s registration regime. As the hon. Lady will know, all providers of regulated activities must be registered with the Care Quality Commission and meet the registration requirements. The safe staffing requirement is therefore already there, and accountability mechanisms are in place.

[Mrs Hodgson]

The Minister says that accountability is already in place. Staffing levels may be required and desirable, but what happens when they cannot be met because the staff are not there? Where is the accountability?

[Stephen Hammond]

The hon. Lady will know that the CQC regime puts directives in place if staffing levels are not there. The local providers are then forced to address those issues. The accountability is there.

Beyond this issue, several hon. Members talked about exactly what we are doing now. There was recognition that the Government have put in place the long-term plan and the people plan. Any reading of those will see that our overarching plan for the health service looking forward recognises explicitly that getting the workforce supply right is key. That is therefore an important part of the long-term plan, which sets out the vital strategic framework to ensure that in the next 10 years the NHS will have the staff it needs. Nurses and doctors will have the time they need to care, work in a supportive culture and allow them to provide the expert, compassionate care to which they are committed.

Hon. Members rightly said that that will not be for this Government; it may well be for the Government beyond. However, the long-term plan rightly recognises by its very nature that what we need to put in place today must continue through the next 10 years to ensure that we have the staffing levels we need.

[Karen Lee]

A number of us mentioned the nursing bursary. The long-term plan talks about extra places for nurses, but if nurses are not being trained—the evidence shows that numbers have dropped by about 25% to 30% —clearly we cannot have them in place. I seek the Minister’s comments on reinstating a nursing bursary so that mature students and other students can afford to train.

[Stephen Hammond]

I will come to the number of nurses in training and related issues in a moment, to address the hon. Lady’s comments.

Associated with the long-term plan is the people plan, which clearly recognises, to reference what I said about Health Education England, the significant role of that organisation in securing the NHS workforce for the future. That is why my right hon. Friend the Secretary of State for Health and Social Care commissioned Baroness Harding, the chair of NHS Improvement, to work alongside and closely with Sir David Behan, the chair of HEE, to develop the workforce implementation plan. The interim people plan published in June set out the actions needed to change positively the culture and leadership of the NHS, making it the best place to work, which addresses the issues rightly raised about recruitment and retention.

The people plan commits to developing a new operating model for the workforce that ensures that activities happen at the optimal level, whether in individual organisations, local healthcare systems, regionally or nationally, with roles and responsibilities being clear.

On NHS workforce supply, hon. Members talked about demand for nursing and midwifery courses. The latest available evidence shows that we are starting to see a substantial rise. Data published only last week showed a 4.5% increase in applicants compared to 2018, with that being the second increase in as many years. To build on that, to ensure that we increase the pipeline of nurses coming into the profession, the Department has worked with NHS England to ensure that funding is available for up to 5,000 additional clinical placements for nursing degrees in England. The chief nursing officer for England has led work to identify and accelerate the availability of such clinical placements. It is vital that universities ensure that they take up offers and provide placements to ensure that places are filled at the end of this year’s recruitment cycle. That can happen.

[Mrs Hodgson]

I acknowledge the 4% increase—it is a small increase—but figures show that the numbers are still down 29% from 51,830 in 2016, when the bursary that covered training was removed. Even with that small increase, we are still 15,000 short of the figure when the bursary was axed.

[Stephen Hammond]

The figures show an increase in applicants this year. The hon. Lady will know that there are 1.4 applications for each place, and she will have heard me say that we are creating additional clinical placements to ensure that more nursing places are available. I recognise that there has been a drop, but I hope that she applauds the 4.5% increase in applicants this year. That is key.

A number of Members rightly talked about additional nursing roles and support. Health Education England is leading a national nursing associates programme with a commitment for 7,500 nursing associate apprentices to enter training this year. That builds on a programme that has already seen thousands start training in 2017 and 2018.

The RCN is leading work focused on the legislative framework for all professional groups. I should set out that work on the people plan also included examining options for growing the medical and allied health work- force, including the possibility of further medical school expansion, increasing part-time study, expanding the number of accelerated degree programmes and greater contestability in allocating the 7,500 medical training places each year to drive improvements in the curriculum.

For allied health professionals, the long-term plan sets out a commitment to completing a programme of actions to develop further the national strategy, focusing on implementation of the plan. There will be a workforce group to support that work and make recommendations, including on professions in short supply, which would address the podiatry point made by my hon. Friend the Member for St Ives. That is essential.

I do not think that anyone should be in any way complacent, and the Government are clearly not complacent. Many hon. Members will have heard me say that, as well as training the workforce for the future, it is important that we support and retain the current workforce. The interim people plan is committed to reviewing how to make increases in a number of factors. One such factor is national and local investment in professional development and workforce development.

There are examples of good practice in this area across the NHS, and I was particularly pleased when I visited Leeds Teaching Hospitals NHS Trust to see how a group of band 6 nurses had created their own in-house training programme, boosting management skills and leading to greater collaborative ways of working. That example of best practice makes the case for national investment in such programmes and for national funding for continuing professional development.

Everyone recognises the need to recruit more staff, but it is also fair to put on the record the fact that the number of staff working in the NHS today is at an all-time high—it is the highest it has been in the NHS’s 70-year history. Since 2010 there has been a significant growth in qualified staff. [Interruption.] I hear a sigh from Opposition Members, but it is worth making the point that there are now 51,900 more professionally qualified staff, including 17,000 more nurses working on wards. That is a simple fact; it is a piece of data, and we cannot get away from it. I do not suggest that one should be complacent in any way, but we should recognise that there are more nurses and doctors, and the Government are committed to delivering on our promise to ensure that the NHS has the right staff with the right skills in the right place at the right time to deliver the hugely valuable, excellent care that patients deserve.

Question put and agreed to.

Resolved,

That this House has considered the legal duties of the Secretary of State for Health and Social Care for NHS workforce planning and supply.