Health and Social Care Workforce

Steve Brine Excerpts

Thursday 13th July 2023 Commons Chamber

[Steve Brine (Winchester) (Con)]

I beg to move,

That this House has considered the Third Report of the Health and Social Care Committee, Workforce: recruitment, training and retention in health and social care, HC 115, published on 25 July 2022, and the Government response, HC 1289, published on 24 April 2023.

Today’s debate could not come at a more timely moment, although when I wrote that line, I did not realise that it would be at an even more timely moment, given the news that we had this lunchtime about the Government accepting the pay review bodies’ recommendations across the public sector. As I said earlier in the House, I welcome that very much and think it is a fair and proportionate response on behalf of the whole economy and all taxpayers. The Government, of course, have to see things in the round. I hope that all unions in the health space will show the same response that we have seen initially from the main teaching unions. I urge them to do that.

Last week we marked the 75th anniversary of the NHS, and the week before that the Government published the much anticipated “NHS Long Term Workforce Plan”. It was very much welcomed. Some 46 organisations posted messages of support for it, so I think it landed well. In the context of the last fortnight, this is therefore a good moment to look back at what the Health and Social Care Committee, which I chair, recommended in our major report last year on workforce issues, and to look forward to see how many of those recommendations have been taken up in the new workforce plan, and what remains to be done.

This follows hot on the heels of our topical evidence session yesterday, where we heard some initial views about the plan from stakeholders; we put some of the already emerging questions to them and to the medical director of NHS England, Professor Stephen Powis. We are particularly grateful to the former doctor and author Adam Kay for coming and speaking to us, and to Alex Whitfield, chief executive of Hampshire Hospitals NHS Foundation Trust, which runs the Royal Hampshire County Hospital in my constituency. I thank them for coming in. The Committee’s workforce report was published nearly 12 months ago, at the end of July 2022. It was the result of a wide-ranging and in-depth inquiry looking at workforce issues, including recruitment, training and retention across the health and social care sectors. I pay tribute to my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the current Chancellor of the Exchequer, for his work then chairing the Committee and since.

As ever, we are as one, and I endorse every one of our report’s findings. That is because it was the result of more than 150 written submissions and an extensive range of oral evidence witnesses from across the health and care sector, who put together the report. Its main conclusions were stark. The report found that the NHS and social care sector is facing the greatest workforce crisis in its history. It noted that, in September 2021, the NHS was advertising just over 99,000 vacant posts and for social care the figure was 105,000.

[Daisy Cooper (St Albans) (LD)]

rose—

--- Later in debate ---

[Steve Brine]

Such a choice. I give way to the hon. Member for Hornsey and Wood Green (Catherine West).

[Catherine West]

I thank the hon. Gentleman for securing this debate at such an important moment, when waiting lists are at record levels, if the press are to be believed. Does he agree that we need urgent improvements in the way the workforce from abroad are employed? Some really exploitative practices are going on out there in certain care homes. Does he agree that that needs to be tackled urgently?

[Steve Brine]

Anybody employed in health and care should be treated properly and with respect, and they should be welcomed to this country with thanks for the work they are doing. If the hon. Lady has specific examples of something—I am guessing she may have from her intervention—I ask her to please speak in the debate and put them on the record.

[Daisy Cooper]

I thank the hon. Gentleman for securing this debate, and I thank him and the Committee for doing the work on the report. He notes that the issues in social care are regrettably much worse than they have been before. He will know that, on 30 June, nine NHS leaders wrote to the Prime Minister calling for a workforce plan for social care. The Royal College of Nursing and others have called for it, too, including my party, the Liberal Democrats. Does he as the Chair of the Committee or the Committee as a whole have a view on that? I know that the Health Secretary has said that the work- forces are different, but I wonder whether the Committee has a view.

[Steve Brine]

We very much do. I will come on to that, but I am happy to address the point straightaway. In getting the NHS workforce plan out, there were four people in that marriage: No. 10, No. 11, the Department and NHS England. The idea of producing another workforce plan for social care causes some degree of deep sigh. That said, it has to be done. When I was at NHSConfedExpo in Manchester last month talking about our integrated care systems inquiry, Patricia Hewitt, the former Labour Health Secretary, and I were talking about all these issues and there is no question: there was a huge response from the room in wanting to see a care plan alongside an NHS plan. The Minister for Social Care is on the Treasury Bench, so she will have heard this exchange. A care plan is even more difficult than the NHS workforce plan, because the vast majority of services in that sector are not delivered by the state. However, just because something is difficult—I could mention the five priorities—it does not mean they do not need doing.

I was just touching on the vacant posts, and both figures have got worse since the report was published. We think there were some 112,000 or so vacant NHS posts in England in March this year. The inquiry that led to our report found that almost every healthcare profession was facing shortages. The impact of that work- force crisis was also clear to see. The report cited, for example, that the waiting list for hospital treatment had risen to nearly 6.5 million in April last year. That waiting list stood at 7.4 million by April this year, and I dare say the strike action in recent months has not helped. I say, “I dare say”, but I know it has not helped, and the figures speak for themselves, which is why I reiterate my call for them, in the Prime Minister’s words this lunchtime, to

“know when to say yes”

to the pay offer that has been made as a final offer today.

The Committee’s report was critical of the Government’s reluctance to act decisively and noted that a workforce plan promised in spring 2022 still had not materialised. It recommended in no uncertain terms that the Government produce

“objective, transparent and independently audited”

plans with workforce projections covering the short, medium and long terms. The reason I stress “audited” is that the House will remember that the now Chancellor and I were among those who voted in favour of an independently audited workforce plan when the Health and Care Act 2022 went through this House. It is credit to the Chancellor that he has driven that agenda through in government. It was announced a couple of weeks ago that the National Audit Office would now do that assessment. We look forward to that and we as a Select Committee will offer the NAO any help we can. It is what we called for.

I am delighted that the NHS long-term workforce plan was published at the end of last month and is here. It is no coincidence that that happened once my predecessor as Chair entered the Treasury as Chancellor. It is a huge moment for the NHS, a big moment for patients and a good moment for patient safety. Patients lie at the heart of the Chancellor wishing to drive it through.

There are caveats, of course, as there always are with me. For example, the Committee called for workforce plans for public health and for social care, as was raised in my exchange with the hon. Member for St Albans (Daisy Cooper). For what it is worth, as I have said in the House before, I think the Government were right to resist the constant tedious calls from people—including me—to get on and publish the plan, because in fact the most important thing was to get it right. I have spoken about the four organisations in that marriage, and I do not underestimate how difficult it was to get the workforce plan out. Now that it is out, we can scrutinise it—of course, that is part of what we are doing today. I know that it takes time to get these things done and it was right that the Government took their time.

The plan is a real sign of hope for patients and for families. There is also hope for the staff who work in the NHS. Our report noted that the pressures on the workforce were having a “real human impact” on the people working in the service, and they still are. It pointed to the fact that

“In August 2021 alone, the NHS lost two million full-time equivalent days to sickness, including more than 560,000 days to anxiety, stress, depression”

and other mental disorders. Adam Kay, who has written movingly about his decision to leave medicine, spoke powerfully about that to the Select Committee yesterday. I refer the House to the transcript of that, if people are interested.

The talk of burnout has become commonplace. Aside from the obvious human impact, the result is a massive impact on retention. That is a vicious circle, which increases the pressure on those who remain working in the service. People can now see the hope part of what I am saying: the cavalry is coming over the hill and there is a plan. That in itself can make a difference. The pay settlement today along with the pension announcement in the Budget and the long-term workforce plan should be seen as a package of measures that I hope gives the workforce some hope that there are better times ahead.

[John Redwood (Wokingham) (Con)]

I am alarmed, as my hon. Friend is, about the 9.1% annual loss of staff, which is a high loss rate by any standard and implies that something is wrong with the jobs or leadership. Do he and the Committee think that a lot more work needs to be done on job descriptions, job feasibility and support for people in their roles so that these jobs are perceived to be of greater value by people and they do not want to leave? Otherwise, we have the extra costs of training somebody new.

[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.

[John Redwood]

I see why there may be difficulties speeding up between 2022 and 2025, although, like the other contributors, I urge the Government to do all that they can. It is also the case that much faster progress is expected between 2028 and 2031 than between 2025 and 2028. I would have thought it possible to bring some of that forward, which would be welcome for future managers of the NHS.

[Steve Brine]

I see no reason why not. I am always open to argument from Government Members, but in so many parts of our workforce economy, there is a shortage of people wanting to do certain roles. That is not the case for people wanting to go to medical school. I am constantly contacted by people from around the country, and certainly in my area of Winchester and Chandler’s Ford. Many children—often those of serving medics—who are straight A students want to go to medical school but cannot because there are no places. We have made the mental leap to put the places there, and bringing them forward must be possible. The Minister knows that we are on the case, and I place that challenge before her.

On medical degrees, the plan also talks about NHS England working with the GMC. We heard from its chief executive Charlie Massey yesterday about consulting on the introduction of four-year medical degrees. The Committee explored the idea of shortening training periods in its original report; principally that was in the context of postgraduate training, but I fully support it. We currently take international graduates from all over the world where there are much shorter undergraduate training programmes than in the UK. As long as the GMC standards are met, I am very supportive of shortening the medical degree. I have spoken directly and on the record to the chief executive of the GMC about it. Obviously, quality and safety must be paramount, but as long as it is satisfied with the medical licensing certificates that it will issue, we should embrace that, and I am pleased to see it in the report.

I am also encouraged by the emphasis that the plan places on apprenticeships, with a commitment to providing 22% of all training for clinical staff through apprenticeship routes by 2031-32. That is up from just 7% today. In our related report on the future of general practice—because everything comes back to workforce—we called for the Government to provide the funding necessary to create 1,000 additional GP training places each year. The plan pledges to increase the number GP training places by 50%, to 6,000, by 2031-32. Box ticked, win—thank you.

Our workforce report called for reforms to the NHS pension scheme to prevent senior staff from reducing their hours and retiring early—again, a win. The Government have listened to the Committee. Obviously, that was announced in the spring Budget this year and is incredibly welcome. It was the No. 1 ask of the British Medical Association and we responded—something I hope it will remember over the coming days. I also hope the Opposition will come around to supporting it as well. Maybe when the Opposition spokesman has her say today she might reflect on the changes to pensions in the Budget, because they have been welcomed across the health sector.

The plan makes it clear that NHS England will work with the Government to deliver actions to modernise the NHS pension scheme—there is a specific section on that—and that the Department will introduce reforms to the legacy pension scheme, so that staff can partially retire or return to work more easily. That will make a big difference to some staff, including the consultant reconstructive surgeon who gave evidence to our original inquiry. He described his retirement happening “almost against his will” as a result of pension taxes. He said the NHS was “haemorrhaging senior staff” over pension concerns. I am therefore really pleased that the issue is being addressed.

I meet two or three times a year with the presidents of all the royal colleges in my role as Chair of the Select Committee. I wondered whether it might take a while for the announcement in the spring Budget to feed through, but within weeks of the announcement being made, a number of them were reporting to me—I had asked them directly about this—that it had already moved the dial in terms of people making different decisions about leaving the service, so I think that is a good one.

I think the training bit of the plan is incredibly strong—I have given some examples—but on retention, I think the report is “could do better”, as it said in my school reports. We recommended that there should be a review of flexible working arrangements in all trusts, with a view to ensuring that all NHS staff have similar flexibilities in their working arrangements to those employed as locum or agency staff. The plan talks about a renewed focus on retention with improved flexible working options. Although there is clearly a lot of detail still to come, I was pleased to see that on this point, the Government are listening to the Committee. However, we still need more detail on that and on how it ties in with the childcare changes, for instance, that were announced recently in the Budget.

[Daisy Cooper]

I am grateful to the hon. Member for giving way again. I could not agree with him more on the point about retention. We hear a lot about recruitment, but fundamentally we cannot recruit our way out of a retention crisis, which is what we have right across the NHS workforce. Does he agree that we need measures for retention very urgently in the sphere of general practice? The Government rightly say that they are recruiting more GPs than ever before, but we have a bit of a “one in, one out” situation, where the bucket is very leaky and for every GP we are recruiting, another one leaves. We need retention measures right across the board, but very specifically in general practice if we are to recruit more GPs to fix the front door to the NHS.

[Steve Brine]

Yes. One witness at our session yesterday said that the tap is well and truly on but the plug is still half out, which is a very good way of putting it. The recovery plan for primary care published a few months ago is really strong. It is really positive: it talks about wider primary care roles and it has been created in conjunction with the Royal College of General Practitioners. We need to see a fast-paced roll-out of that plan. We need the extra money for community pharmacies to move through the contract fast, so that it moves the dial even faster, because that is critical to the retention of general practice staff, and it is also critical to this winter being better than last. So, yes—point taken.

Another important point to note about the workforce plan is that it is iterative, so it will be refreshed every two years. I guess there are two ways of looking at that and I would appreciate the Minister’s comments. I understand it is at the Treasury’s insistence that it is looked at every two years, which is fine. We can look at it two ways: either the Treasury wants to make sure the plan is ambitious enough and, if necessary, that it is more ambitious so it can put more funding behind its next iteration, or—to look at it the half-empty way—the Treasury may wish to trim back. It is very important that the Department, Ministers and the House make sure that it is the former. The iterative side of the plan is important, and while we are still in the early stages, it is also important that the plan starts to deliver quickly in a practical way for people on the ground. That is why I said what I did about working with the primary care plan.

One of the possible risks to delivery—there are a few, because the plan contains big assumptions and models of numbers—is that the plan is based on a pretty ambitious labour productivity assumption of 1.5% to 2%. During the statement when the plan was put forward, somebody in the Opposition—it may have been the Opposition Front Bencher, the hon. Member for Bristol South (Karin Smyth)—said that the NHS has struggled to achieve that kind of productivity gear change in the past, so achieving it now will be a challenge. That does not mean that it is not the right thing to do, but I would like to understand from the Government what will happen to the projections in the plan—not necessarily today, but as we go forward—if the productivity assessment is not achieved.

[Catherine West]

What assessment have the hon. Member and the Committee made of the iterative process and the Treasury’s assumptions, building in the ageing workforce and the acute nature of mental health needs among the younger population?

[Steve Brine]

We have not done that yet, but I merely put down a marker today that I hope there will be a review process, so that we can be even more ambitious. If we were to write a risk register for the plan, I would suggest that one part of that register could be the productivity challenge, which the NHS has long struggled with.

Let me turn to social care. In many ways, the picture there is more challenging. The Committee’s report notes Care England’s finding that in December 2021,

“95% of care providers were struggling to recruit staff, and 75% were struggling to retain their existing staff.”

The report concluded:

“Care workers often find themselves in under-paid roles which do not reflect the value to society of the service they provide. Without the creation of meaningful professional development structures, and better contracts with improved pay and training, social care will remain a career of limited attraction”—

not poor attraction, because many people want to do it—

“even when it is desperately needed.”

I know that the Minister is passionate about this issue and that she will give a passionate response today. We noted, however, that health and social care services are obviously interdependent, and if efforts in the plan to tackle the challenges in the NHS are to be successful, capacity needs to increase across both health and care. The Minister knows that, but I feel that I have to say it. That point is crucial, and with the welcome focus on the NHS workforce, it is vital that the issues affecting the care workforce are not forgotten. The NHS workforce plan cannot succeed if the challenges facing the social care workforce are not tackled.

I visited the HC-One care home in my constituency last month during Care Home Open Week, and I met a very interesting lady from the Prince’s Trust, who is working with the care home group on the pipeline of social care staff. I recommend that the Government get in touch with the Prince’s Trust, which is doing good work in trying to inspire young people to go into a career in care. I accept that the social care workforce is a different kind of workforce and that not all the levers are under the Government’s control, as I said, but the Government know that there is much to do on this issue.

To conclude, the 75th anniversary is a huge milestone for the NHS. Millions of people still have huge affection for the organisation, but to misplace that and take it for granted would be to do the opposite of serving the NHS faithfully. The anniversary cannot be an exercise in nostalgia. It must be an opportunity to look forward and to make sure that we have an NHS that works for our constituents now and in the decades to come; that is a prevention service as much as it is a sickness service; and that is among the best organisations in the country, in the public or private sector, for the way it looks after its staff. I am very optimistic about the workforce plan. It is a big step in the right direction. The fact that it is out there is a big moment, but there is plenty still to be done, and the Minister knows that my Committee will be right there scrutinising that work as it is taken forward. The plan is just the start.

[John Redwood (Wokingham) (Con)]

Like others, I warmly welcome the workforce plan. I am grateful to my hon. Friend the Member for Winchester (Steve Brine) and his Committee for producing a detailed and interesting report that highlights many of the things we need to study.

I suspect most of us in this Chamber, of whatever political party, accept the broad principles that we need to train more medical staff in this country and that we need to expect to recruit more people to deal with the rising workloads and rising population in the years ahead and to clear the current backlogs. And who would not want progress on better working conditions and decent levels of remuneration, so that many more people are proud to remain in these jobs?

It is not as if we have not had these issues before, and it is not as if the workforce has not been expanding. As the report reveals, the number of full-time equivalent staff in NHS England has expanded by 263,000 since 2010, which is a very substantial increase. It is rather more than 263,000 people, because it includes part-time arrangements too. Of those, some 55,000 are nurses and 42,000 are doctors, which means that more than 160,000 are not in those two leading medical professions. NHS managers, who have increased substantially in number during that time, need to demonstrate that they are recruiting the right kinds of support staff, administrative back-up and IT help so that medical professionals are better able to concentrate on treating people and doing a good job.

In the past, I have led a couple of large industrial groups, and in the days before we had an elected Assembly to run the Government of Wales, I was responsible for the very substantial public sector workforce in Wales, including the NHS workforce, as Secretary of State, so I have some experience of the complexities and difficulties of helping to supervise or run large workforces. I freely confess that none of those workforces was on the scale of NHS England, which is another degree larger, with a workforce of 1.5 million. None the less, whether it was tens of thousands or hundreds of thousands, I understand the complexities of dealing with large workforces.

I have reflected on what worked and on my experiences. My first reflection reinforces the point we have heard from the Committee. If I had experienced a 9.1% rate of turnover each year, I would have been quite alarmed. Had that been added to by a 6% or 7% absence rate, as is reported in some professions and areas of NHS England, I would have been even more alarmed. Although I had lesser problems with absence and loss of talent, I regarded them as a challenge that the leadership and management teams had to take on. To deal with the frictions, there were nearly always things that could be done to improve conditions of employment and to improve the understanding between management and those trying to execute policy.

The frictions were not always about pay. Of course, increasing pay is greatly helpful, and I welcome the results of the independent review—I was one of the many voices saying the independent review had to be implemented—but we now need something for something. We need to complement pay by making good decisions so that people feel they have a worthwhile, feasible job.

The one thing on which I disagree with my hon. Friend the Member for Winchester is his point that, with an organisation this big, it might be rather difficult to do the right kind of mentoring and individual treatment. The NHS is a series of small organisations under a general umbrella. There have been endless arguments, not particularly on party lines, about how much should be decided by experts and well-paid people at the centre and how much should be decided in the hospitals and surgeries—about how much delegated power there should be.

There is certainly management at all levels. As my hon. Friend reminded us, there are chief executives and other senior staff in hospitals, and there are practice managers and others in GP surgeries. Quite a lot of the mentoring, understanding, and evolution of a person’s role or job must occur in those local places, where one of the local management’s main tasks must surely be ensuring that their staff are looked after and well motivated. This service is a great example of a people-led service. It has millions of potential patients and a million and a half staff, and it is the interaction between them that matters. The quality of service is almost entirely dependent upon the skills, attitudes and approach of the medical professionals and their support workers in delivering a good quality of service to those who turn up as patients.

We need to say to the 36,000 managers of the NHS England system that they have an important task; that surely they know their staff and what some of their staff’s problems are; and that it is in their hands, not in the hands of Ministers, how the jobs are described and made into realistic jobs, with tasks that people want to do and can do. It is for those managers to work out how staff are rostered and how people become eligible for a promotion. Good staff management is about managing all those things.

[Steve Brine]

Let me further the debate on this. We talked to the trust chief executive about this yesterday. She said that she does good exit interviews with people who leave her trust. They leave for varying reasons, but often it is because they have got a different job in a different part of the country, and their family circumstances have changed—they are not always off to Sydney. So this comes down to leadership. The Secretary of State would talk about the Messenger review—I assume the Minister would concur—which talks about leadership in trusts and integrated care systems. That is not as good everywhere as it might be.

[John Redwood]

That is right. I hasten to add that there are many examples of good practice in the NHS. In the hundreds of trusts, units and management commands in the NHS, there are some very fine examples. In a large organisation such as this, part of the skill lies in spreading the best practice from the places that know how to do things and are doing them well to those that need help or support. They may not be aware of what is feasible, given the resource to which they are committed. I have found whenever I have been involved with something that was not working well that bad management have often made a mistake and appointed some good people but not in the positions of influence and power where they can really make things happen. Where someone is trying to recover something that is not running well, it is often about identifying the people who are good but who may be sidelined, frustrated or not being used properly, and then transferring them into different roles, to give the idea to the others that the organisation can be a good one.

My hon. Friend was hinting at where someone wants to get to if they are leading any organisation. They want success, because success breeds success; people want to work for a successful and happy organisation. If morale is allowed to sink, performance starts to get poorer. If performance sinks, really good people perhaps do not want to be associated with it or they are frustrated that they are not given the power to sort it out. The organisation could then get into a downward spiral, which it needs to avoid.

Let me move on to a slightly tougher message and spoil the party. I take as my text the work that the Chancellor of the Exchequer and his team have been doing and his recent big speech at the Guildhall on productivity. His research revealed that productivity in crucial public services, particularly the NHS, is considerably below its 2019 levels. We are all sympathetic to the fact that there was a major disruption of the NHS’s work for the period 2020-21, and probably we would also expect there to have been difficulties in in 2022 after the impact of a major diversion of effort and activity into tackling the pandemic. We are all very grateful to those brave and talented staff who did what they needed to do to see people through. However, over that period a large additional amount of money was provided, not just for the pandemic, but now on a continuing basis, along with some additional staff, as we have been commenting on, yet we are still not back to the productivity levels we were at in 2019.

As the managers of the NHS go about creating a more contented and happier workforce, in the way I have been describing, they need to say to people, “You are going to be better paid, but we can also look at your promotion, grading and job specifications,” because the good ones should be able to get additional pay and go up the scale into more important jobs. There has to be something for something. The managers have to help the staff to deliver more treatments, consultations and diagnoses, which must be possible because we are not even at the levels we were at in 2019.

[John Redwood]

I agree with all that. I have been very careful not to criticise the staff; I am talking about a management problem. If there are too many agency staff, then time has to be spent explaining to them how that particular hospital or department works, which would not be necessary if the regular staff had turned up. If there are gaps because of staff absences or people having resigned, that puts more strain on people and the system does not work efficiently.

All my remarks are made in the context of what I said at the beginning about trying to make these jobs more worthwhile and feasible. We need to look at how that can be done, and managers have to answer questions about whether some of them are imposing too many requirements on people that are not directly related to them performing their tasks better. There have to be limits on how much other general management information or other management themes they want to pursue, when the main task is to clear the backlogs and to treat the patients. The patients should come first, second and third, and that is not always possible if managers are making many other demands. So that is where the management teams need to take the organisations.

I was coming to the other good point that the hon. Member for St Albans (Daisy Cooper) makes, which is also well made the workforce plan. We are living through an extremely exciting digital revolution. It may even be speeding up with the developments in artificial intelligence, which could be dramatically helpful. There is a continuing task in the NHS, which sometimes thwarts those attempting it, to make sure technology is applied in the right way and is understood and friendly to use, so that hard-pressed and busy medics can find it a support, rather than a tribulation or a barrier.

Given the NHS’s huge range of data and experience, artificial intelligence should be an extremely valuable support, aiding diagnosis and decisions on treatment. I am not one of those who think that computers can do these things on their own or are about to take over the world. In the model we are talking about, the computer is an extremely important assistant that can do research and produce first drafts—that kind of thing—in a way that speeds up the work and effectiveness of the professional. However, it has to be controlled and guided by the medical professionals, who have the judgment, wider experience and expertise. The quality and speed of what they do could be greatly enhanced with the right kind of AI backup. For example, if they are facing a condition they do not know much about because it is rare, the computer would be able to give them immediate access, one assumes, to the details of what has happened in similar cases, what it looks like and how it might be treated.

[Steve Brine]

We have the time, so let us explore that briefly. My right hon. Friend is right to talk about technology and AI in particular. We produced a report a couple of weeks ago on digital NHS. We are struggling with first base on digital. Medics talk to us about having to log in to multiple systems in order to do one very simple task. I worry that, while we are talking about 21st or 22nd century technology on assistive AI, we are struggling with first base. We were at the Crick Institute yesterday. Teams there were talking to us about the challenges of bringing together all the datasets that exist across the NHS to assist in their research, and they cannot even do that. This should be an assistive help to the workforce, but we have a long way to go on that. I know the Secretary of State is very seized of this opportunity, but my right hon. Friend knows that there are problems.

[John Redwood]

Yes, indeed. Wishing to be optimistic, I was pointing out, as many will do, that there is huge opportunity in this area. None the less, my hon. Friend is quite right that there are all sorts of issues and questions, such as: what the existing technology delivers; whether the systems talk to each other sufficiently; and whether it has data in a format that can easily be transferred to a more common and modern system. We are obviously back into arguments on—I do not have a strong view on this, but experts should—how much has to be laid down centrally, so that there is an England-wide, or NHS-wide, system that is freely interoperable, and how much is best determined by local units, which know their own needs and will be organising the training and will want things that their own staff find helpful to them and fit into the sometimes differentiated approach that an individual hospital or a GP surgery may have.

It is good news that we are taking future manpower requirements seriously. It is good news that we are having an informed conversation about what might be possible. It is good news that most people, I think, agree that technology is part of the answer. Having better motivated and happier staff is clearly fundamental to the answer. I hope that, when the Minister sums up, she will have a few thoughts for me on what actions the senior management of the NHS and its various trusts are taking so that they can get those absence rates down, so that they can get the loss of staff substantially reduced, so that they have fewer staff saying, “This is not feasible,” or, “I am burned out,” and more staff saying, “I am really proud to work here,” or, “This is going extremely well; we cut our backlog last week,” and, “Did you know that many people are now getting over this condition because of our treatments?”

That is clearly what we want. We want high-morale organisations. That takes money and the right number of staff. It also requires great leadership, but it is not just leadership from the political top; it must be, above all, leadership from the very senior managers at the top of NHS England percolating down to the very important senior managers that we have in every trust and every major health institution under the framework of NHS England.

--- Later in debate ---

[Steve Brine]

I will close by thanking the Minister, my right hon. Friend the Member for Wokingham (John Redwood), my hon. Friend the Member for Worcester (Mr Walker) and the hon. Member for Bristol South (Karin Smyth) for their contributions, as well as my Clerks, my predecessor and the many members of the Committee who produced the report.

The Minister is right that many boxes have been ticked, but she also knows me well enough to know that I am always creating new boxes. We have not discussed NHS dentistry today. That is mentioned in the report, but it requires a great deal more exploration. Indeed, tomorrow we will produce the Committee’s report on NHS dentistry services—I know the Government are looking forward to that. The long-term workforce plan is a big moment, but there are boxes that are not ticked around the volunteer workforce, which I know the NHS cares greatly about, and around sexual health services, which I do not see any mention of in the plan. We will return to some of those themes.

The thing about health and the NHS is that it is never done. As I said in my remarks, we have to see the workforce plan as part of the context of the recovery plan for primary care, the urgent emergency care plan, the choice agenda in tackling waiting lists and the pension reforms—it is part of the ecosystem. The longest serving Health Secretary, who is now the Chancellor, and I have been very honest in saying that when we were at the Department, we wished we had pursued the workforce plan. There were other plans such as the NHS people plan that were shorter term, but we regret not doing this then. That is why it is so important that from the learning we have all done, we have this plan in place.

It is, I think, typically honest of the Prime Minister to produce a 15-year plan. I sincerely hope that he is re-elected next year, but of course that might not happen. The Conservative party could be out of office and back in office before the 15-year plan is complete. This is about doing the right thing for the health service, for patients and for our constituents, and doing the right thing for the country. I hope that whoever stands at that Dispatch Box next will continue this plan and build on it, because there is no alternative. The NHS is precious and we cherish it, and this plan proves that.

Question put and agreed to.

Resolved,

That this House has considered the Third Report of the Health and Social Care Committee, Workforce: recruitment, training and retention in health and social care, HC 115, published on 25 July 2022, and the Government response, HC 1289, published on 24 April 2023.

Childcare and Early Years

Steve Brine Excerpts

Wednesday 8th March 2023 Commons Chamber

[Mr Robin Walker (Worcester) (Con)]

It is great to see you back in your place, Madam Deputy Speaker. Both you and the late Baroness Boothroyd have demonstrated amply, on International Women’s Day, that a woman’s place is in the Chamber and preferably in the Chair of the Chamber.

I am very grateful to the Backbench Business Committee for approving this very important and timely debate, and to all colleagues across all parties and across the House who supported my bid for it. I would also like to pass on my thanks to the Liaison Committee, under whose auspices these estimates day debates take place. I pay tribute to the work that the Petitions Committee has done in this area. I have come hot foot to this Chamber from a meeting of the Petitions Committee, as has my hon. Friend the Member for Winchester (Steve Brine) and the all-party parliamentary group for childcare and early education which he chairs.

The departmental estimates briefing from the House of Commons Library shows education as the second-biggest winner after health in absolute terms when it comes to changes in day-to-day spending—the so-called resource departmental expenditure limits line in estimates—and a minor loser on capital DEL. The welcome increase in the former, however, is dominated by the impact of the revaluation of the student loan book.

As a former schools Minister, I cannot begrudge the fact that the largest proportion of the £3.9 billion increase in the education resource budget is going to schools, and I am in no doubt that the extra funding of £2 billion in each year of the next two years announced in the spending review is needed in the schools system. Nor do I in any way regret that the second-biggest winner in the education space is high needs. As we heard on Monday, the Government have overseen a 50% increase in spending on high needs since the 2019 election, which I very much welcome and support.

However, I am concerned. As the House has heard many times, early intervention is money well spent and the case for early intervention, early identification of need and early education is stronger than ever. In that context, it is deeply concerning that the only line in the departmental estimates that is clearly focused on childcare or the early years is a £52 million increase in resource DEL. That increase in spending on the early years is tiny in comparison to the overall increase in the Department’s budget, a rate of increase across the piece of just 1.4% when compared to the same line in the 2022-23 main estimate. That breaks down into an increase in early years funding for schools of £35 million, a rate of increase of just 1% and an increase of £17 million for early years funding through the families budget, a slightly more reassuring 14% annual increase.

Such numbers without context might sound very significant, but the context, as we are often reminded by the Front Bench, is that the Government spent nearly £20 billion on childcare and the early years over the last five years, and are currently spending around £5 billion a year across the various different Government Departments that support it. I do not claim to be an accountant. I do not claim to be the greatest living authority on the departmental estimates process and—pace the Prime Minister—I did not complete an A-level in mathematics, but I do know that an increase of £52 million on a budget of billions is not a big deal. In fact, the House of Commons Library’s very helpful briefing for this debate confirms that the Department for Education’s resource DEL for early years is being increased by just 1.4% from £3,781 million to £3,833 million. At a time when inflation is running at around 10%—even if we hit the Prime Minister’s laudable ambition of halving it we will be running above 5%—that does not feel like anything close to a real-terms increase.

In evidence to the Education Committee, the Institute for Fiscal Studies highlighted the problem. It submitted written evidence in November 2022, headed:

“Funding for the early years is likely to fall by 8% up to 2024 as a result of faster-than-expected cost rises”.

It set out that

“The early years sector in England received a significant uplift to its budget at the last Spending Review in 2021…but higher-than-expected inflation means even that increase will not compensate for rising costs. We estimate that childcare providers’ costs are likely to rise by 9% in total between this year (2022-23) and 2024-25. Judged against these rising costs, total funding for the free entitlement will be 8% lower in real terms in 2024-25 than it is this year.”

[Steve Brine (Winchester) (Con)]

I welcome my hon. Friend’s speech and I welcome his Select Committee conducting an inquiry into childcare and early education. We can talk about entitlement as much as we like, but if the settings are not there, we have a problem. The private voluntary independent sector is losing numbers. I have seen two closed in my constituency in the past six months. This is a problem. We have a supply side problem. Does he agree that achieving parity on business rates between the PVI sector and the maintained sector where an early years setting is in a school would help significantly with its in-year budget problem?

[Mr Walker]

My hon. Friend demonstrates his considerable knowledge and expertise in this space, and his all-party parliamentary group has gathered evidence from across the sector. I will come back to that point, because it is one of the many things we could be doing to help.

In fairness to Ministers in the Department, I know very well that they have been doing hand-to-hand combat with the Treasury year in, year out for more investment in every phase of education. In recent years, those battles have borne fruit, particularly for schools and for the high needs pupils in them. I also recall starting this year at the launch of the IFS’s very interesting report into education spending, which confirmed that over the last decade the early years has been the fastest growing area of Government spending in education and, unlike in the schools space where current increases in funding are making up for previous years of real-terms cuts, the early years budget has grown faster than any other phase of education in real terms under the Conservative Government.

By contrast, and before we hear too many speeches on Labour’s proposals for an all-singing, all-dancing £20 billion childcare offer, we should remember that it left a system with a single 15-hour offer and Department for Education spending on childcare and the early years at roughly a third of what it is today. That is the backdrop to the disappointing departmental estimate that underpins the debate.

The House will be aware, and as my hon. Friend the Member for Winchester mentioned, that I started my term as chair of the Education Committee with a call for an inquiry into childcare and the early years. I am very grateful to all the people, across parties, who elected me to that position and to all the members of the Committee who unanimously accepted that call. The inquiry is now well under way. We have heard loud and clear from the nurseries, childminders and the wider early years sector about the challenges they currently face—challenges my hon. Friend alluded to—the pressures they are feeling, and, as the IFS confirmed, the very real inflationary pressures being felt by the sector. We have heard time and again the case for more investment in this crucial sector. Although it is too early for me to pre-empt the findings or recommendations of our inquiry, I believe passionately that there is a strong case for more Government investment in this space.

[Mr Walker]

I want the Government to listen to many groups across the whole sector and see the case for investment. I will come later to the different elements of the case for investment, to which the hon. Lady rightly refers.

Childcare affordability is a crucial part of the argument. To date, our inquiry has heard about a perfect storm facing the nurseries and childminding sector, of parents struggling to pay the costs required to make the so-called “free hours” work, of rising employment costs and greater than ever competition for staff, and a high burden of bureaucracy. For the vast majority of providers run by the independent and voluntary sector, there is also the challenge of business rates, as my hon. Friend the Member for Winchester mentioned, which are increasing at an alarming rate, and of having to pay VAT on their investments when neither of those costs is felt by their direct competitors in school-based provision.

The National Day Nurseries Association has published figures that suggest that despite the very welcome increase in funded hours for parents, the Department—perhaps more accurately the Treasury—has knowingly underfunded the free hours so that there is a clear and increasing burden on parents and on settings themselves to cross-subsidise the two-year-old and 15 and 30 hours offers. The Sutton Trust has pointed out that 75% of childcare providers said that funding provided per hour for the 30 hours entitlement did not meet their costs, forcing them to apply charges to better-off families, including extras such as nappies, sunscreen and lunch. They say that that undermines the intention of the 30-hour policy as a free entitlement.

We have heard concerns from parents that the myriad different offers and support systems across early years are confusing, and from providers that the use of “free hours” terminology causes conflict with their customers. The reality is that these are subsidised hours, for which the state bears only a share of the cost burden. We have heard concerning statistics about the underspend in both the Department for Work and Pensions and the Treasury schemes to support childcare, because the need for up-front payments out of net income deter both parents on universal credit and those who should be benefiting from tax-free childcare from using the Government schemes. That is both part of the problem and, in my view, part of the solution. There is money that the Treasury has already approved to support childcare in the early years that is not getting spent. That money needs to be put to work to support the very real needs of parents and children.

That brings me to the fundamental point about the case for investment. The Prime Minister rightly said that education is the closest thing to a magic bullet that we have. Investing in education is a good thing and something that I have dedicated most of my time on the Back Benches to supporting. Early intervention usually pays dividends, and that is especially true of education. Many Members across the House, mostly notably my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), have repeatedly made the case for investment in the first 1,000 days of children’s lives. They have pointed to the strong scientific evidence that investment in this period has more impact on the way minds develop than any other.

The Nuffield Foundation has said that there is a strong case for additional investment in the early years, as a “foundational stage” of early development. It states:

“Given that lifelong inequalities have their roots in early childhood, this would be investment in social and individual well-being in the long term.”

An interesting research summary of “The Lifecycle Benefits of an Influential Early Childhood Program” by the Heckman Equation, states:

“Every dollar spent on high-quality, birth-to-five programs for disadvantaged children delivers a 13% per annum return on investment.”

Others have pointed to the huge productivity gains to be made from providing childcare that supports parents, particularly mothers, to continue in or return to work.

On International Women’s Day we should recognise the substantial benefits of closing the gender pay gap and allowing more women to realise their full potential, focusing not only on participation levels but on the quality of participation in the workforce. According to a PwC report published in March 2021 on women in work:

“There are large economic benefits to increasing the number of women in work.”

It estimated that the UK could gain £48 billion per annum from

“increasing female labour force participation rates to match those of the South West – consistent top regional performer for female participation in the UK index.”

A report by CBI Economics and the Recruitment & Employment Confederation from July 2022 entitled “Overcoming shortages - How to create a sustainable labour market” stated that if unaddressed, labour and skills shortages could see the economy lose £30 billion to £39 billion annually. Gingerbread has said:

“Successive research that we have undertaken pinpoints the cost of childcare as the biggest barrier to single parents in finding and staying in work as well as in progressing in their careers.”

Sometimes, including in the evidence provided to our inquiry, it has been suggested that there is some conflict between the two objectives. In reality, investment in the early years and in childcare should be a win-win. It should be good for the children, who are better stimulated, supported and prepared for education, and better for parents, who know that they can engage in work with confidence, knowing that their children are getting that stimulation in a safe setting that meets their needs. A recent report by the Centre for Progressive Policy think-tank has suggested that the economy stands to gain a staggering £38 billion, or 1% of GDP, if a fully effective childcare system could support more women to continue in careers and reap the benefits of returning to work. Others, such as Onward, have pointed to the clear desire of parents to have access to affordable and flexible childcare, and the benefits of both parents being able to deploy help from the Government effectively.

As Schools Minister, I often heard concerns from primary schools about the challenges of children arriving in schools less school-ready than they had been previously, and the greater range of measures and extra support needed to prepare them for life at school. Having children stimulated by excellent early years provision would address that challenge far more effectively and in a more timely manner than interventions or catch-up funding spent in the school years. In the noble quest of ensuring that more children leave primary school able to read, write and do maths, investment in the early years when they learn basic communication—their letters and numbers—should be a no-brainer.

Laura Barbour of the Sutton Trust told the Select Committee:

“In primary schools, 93% said that they recognised that time spent in an early years setting prior to attending primary school made a significant difference when they arrived in school, particularly for children from more disadvantaged families.”

[Steve Brine]

My hon. Friend is making such an important point, which is one of the reasons why the all-party group that I lead is called “on childcare and early education.” It is important that we flatten the distinction in taxation terms between early years settings and early years carried out in school. The people who run those settings—I declare an interest because my wife works in one—are early years educators. All too often society does not see them as that. I know that the Minister does, as have all previous Ministers, but all too often the discourse is about just childcare. It is not—it is early education.

[Mr Walker]

My hon. Friend is absolutely right, and I am glad that he has declared his family connection in that respect. We should all value the contribution of the early years and the people who work in what we might describe as childcare but is early education, early simulation and support of children. The steps that the Princess of Wales has taken to draw attention to the importance of the sector are very welcome.

--- Later in debate ---

[Dame Andrea Leadsom (South Northamptonshire) (Con)]

May I say what a huge pleasure it is to see you back in the Chair, Madam Deputy Speaker—and what better day to be discussing this topic than International Women’s Day? I wish all the women—and men—in the Chamber a happy International Women’s Day. Is it not wonderful that there are so many of us now? It is indeed wonderful to see so many women in politics, making a contribution and debating these issues. On behalf of all of us, I want to encourage every young woman, of whatever party, who has political interests and ambitions to get stuck in. We will help you. Come and join us; you will be most welcome.

Let me begin by paying tribute to my hon. Friend the Minister, who has been such an advocate for what, as I think everyone in the House knows, I am so passionate about: giving every baby the best start in life. The lovely thing about that is that I am, so far, not alone. Every Member I talk to, in every party, is incredibly supportive, because we all know from bitter experience of constituency cases, from what we have read, and from what we have learned as politicians and in our own lives, how critical it is for every single baby to have a chance of the best start in life.

Let me give the House some statistics. We know from a study conducted by the Early Intervention Foundation in 2016 that the cost to our economy of late intervention is about £17 billion a year. Almost a third of that is the cost of looked-after children. The children who have some of the worst outcomes in the country are those who are removed from their families and taken into care, and it is shocking that so much money is spent on achieving such poor outcomes. Huge parts of that £17 billion are spent on dealing with domestic violence, and young people who are not in employment, training or education and whose life chances have been hampered by their not being given the best start.

My hon. Friend the Member for Worcester (Mr Walker) has already mentioned the work of Professor James Heckman in analysing the rates of return on human capital investment. It says very clearly, “If you do not care about human happiness, just look at the money—follow the money!” A pound, or a dollar in the professor’s case, invested during the antenatal period will pay exponentially more, in terms of the return, to the human potential of the child—and will lower the later cost to society—than a pound, or a dollar, spent further down the line, when that child is already in the realms of youth crime or perhaps mental illness. Financially, prevention is not much kinder but so much cheaper than cure. Across our United Kingdom, and indeed across the world, there is a growing wealth of evidence for that.

I pay tribute to the Princess of Wales for her amazing work through the Royal Foundation Centre for Early Childhood, observing the struggles of parents and the number of parents who do not feel confident about knowing what their baby needs. I have talked to consultant paediatricians as part of my work as the Government’s early years healthy development adviser, and one of them said to me, “I am supposedly an expert in this field, but when my wife and I had our baby, we were like, ‘Aargh! What do we do with this?’” That is the challenge. It is not about the nanny state, or about interfering; this can happen to any us. I had three babies, and by the third time I thought I had it sussed, but my 19-year-old still gives me hell!

When you first have a child, you do think, “What am I supposed to do with this?” You take that beautiful, squeaky new baby home, and once you have got over the stitches and the other horrific unspeakable things that befall women in these circumstances, you find yourself trying to focus on the fact that you have had no sleep, which is an effective torture, is it not, Madam Deputy Speaker? We all know what it is like if we have had no sleep, and your baby, like my first, does not sleep for more than two hours at a time. In the one antenatal class that I just vaguely recalled, I was asked, “What is your 24-hour clock like now?” We all said things like, “Between 11 pm and about 7 am, I am fast asleep.” Then we were asked, “What do you think it will be like once you have had the baby?” We all said, “Well, I don’t really know, actually.”

It is so difficult, having a baby. You can be as rich as Croesus, you can be happily married, you can have all the support and the nannies in the world, you can have maternity nurses, and it is still difficult. Actually, I pay tribute to the Netherlands, where 95% of babies are born at home and you get a free maternity nurse, on the state. I would do that trade any day of the week—hands up those who would not! To have someone who will take the baby off you so that you can get a few hours’ sleep—that is extraordinary. However, I hope I am not freaking out anyone who is thinking of having a baby: it is the most glorious thing we ever do, and I welcome the fact that so many of our colleagues in the House have young children. I was proud as Leader of the Commons to introduce proxy voting for baby leave, because, oh my goodness, we cannot just sit at home and watch everyone voting and hope that our slip is going to be adhered to. We need to continue our lives.

So, for many women, and men, this is the most difficult thing they ever do, but what is so appalling is that we are really not allowed to say that. When I had my first child I was working at Barclays and I had just been appointed senior executive—one of only eight women; it was an absolute badge of honour—and they said, “We will do this appointment if you will come back after 10 weeks.” I know that seems extraordinary. They could not legally do that now, but in those days they could. And I said yes, which was really stupid. In hindsight, why on earth did I say yes? Anyway, there ensued two miscarriages, postnatal depression and awful trauma, and I left. It was not a happy experience. I say that because we are never allowed to say when things are difficult and we are really struggling, but we really want to keep our career. We do want to have it all, and that is understandable, but at the moment we really cannot.

We absolutely have to focus on the incredible investment in the early years. Again, I pay tribute to the Under-Secretary of State for Education, my hon. Friend the Member for East Surrey (Claire Coutinho); to the Prime Minister who, as Chancellor, funded this incredible project; and to the Chancellor, who as a Back Bencher and Chair of the Health and Social Care Committee was absolutely supportive of the best start for life. I also pay tribute to Opposition colleagues. One of my earliest friends in this place was the wonderful Lord Frank Field—if I may use his name since he is no longer an MP—and the even more wonderful, if that is possible, Dame Tessa Jowell, both of whom have been such advocates for giving every baby the best start in life.

What the Government are seeking to do is to provide support. My hon. Friend the Member for North Dorset (Simon Hoare), who is no longer in his place, talked about the importance of early years settings to build families’ capacity to be parents. In those settings, parents can chat to others and ask, “What size nappies are you using? Have you weaned yet? What are you feeding your baby?” We do not get a manual, do we? We should, but we do not. Another thing we do not get, which we should, is an on/off button. Don’t you agree, Madam Deputy Speaker? I am sure Matthew would agree. When Madam Deputy Speaker’s son used to sit in his sitting room opposite mine and play my music in my flat from his Bluetooth, I wanted an on/off button then. He was a bit older.

That is one of the challenges that we have as parents: there is no manual. So how do we get that information? We have the Government’s programme of rolling out family hubs across England. I wish we could roll them out across the UK, and we will be working with our colleagues in the devolved Administrations to make that the case. In Scotland, they have got parenting mental health absolutely sorted but they do not have family hubs. Talking to some colleagues who are Scottish parliamentarians, I know that they would be keen to follow what we are doing here. I think we can learn from each other all around the world. In Chile they have the most wonderful support for new mums that we do not currently have here, but we are starting to roll out the family hubs across England.

Most importantly, we are rolling out the best start for life, which involves six universal services. People who go to a family hub will be able to get antenatal midwifery checks, to chat to a health visitor, to seek support for their mental health issues or those of their partner or any member of their family, or for their relationship with their baby. They will also be able to get breastfeeding support. This is another ridiculous thing: we are all expected to know how to do that, aren’t we? How on earth do you breastfeed a baby? Who knows? Hands up, any of the men? No. We do not get a manual for that either, and actually women need a lot of support. You would not give your five-year-old a two-wheel bicycle and say, “Right, off you go, darling.” You hold the back of the seat until they have got the hang of pedalling. Our breastfeeding rates are among the worst in western Europe and that is because no one gets any help—

[Steve Brine]

On that point, will my right hon. Friend take an unlikely intervention?

[Dame Andrea Leadsom]

My colleague is going to tell us how to breastfeed, ladies!

--- Later in debate ---

[Steve Brine]

I have never name-checked them in this House, but Auntie Jane and Auntie Jenni ran the BABIES breastfeeding support group at Lanterns nursery, which still exists in Winchester, and I remember going to them one morning after we had had a dreadful night with our first, Emily—who is 15 now and still a challenge—and we were just desperate. The only thing that got us through to daylight was knowing that we were seeing Auntie Jane and Auntie Jenni in the morning. I remember taking my wife and Emily down to see them, and they provided amazing support, as do support groups all over this country. So, Auntie Jane and Auntie Jenni, thank you.

[Dame Andrea Leadsom]

That is lovely, and I pay tribute to the thousands of volunteers who provide breastfeeding support. My hon. Friend highlights perfectly one of the great challenges of becoming a new parent. When we are really struggling, there is a high correlation with mental health issues. When there is not enough support for women who want to breastfeed their babies but find they cannot do so, they suffer from feelings of guilt and feeling that they have failed and they are not good enough, and that lends itself to the problems of postnatal depression that are only too prevalent right across England.

So, to recap: midwifery, health visiting, mental health support, breastfeeding support, safeguarding support and disability support will be universally available in family hubs to help every family to give their baby the best start in life. Not only that, there will be universal-plus support for the most tricky and challenging issues such as the prospect of domestic violence. We know that up to 30% of domestic violence starts in pregnancy because of the partner’s feeling, “This person is going to love the baby more than they love me.” All these challenges that are brought out by pregnancy are quite desperate to be solved. We know that if we can get the hang of giving every baby the best start for life, that will transform our society.

I mentioned that the cost to our economy of late intervention is about £17 billion a year. The Maternal Mental Health Alliance’s study has shown a cost of around £8 billion a year for every new cohort of births as a direct result of the cost of poor maternal mental health in the perinatal period. The all-party parliamentary group on conception to age two—the 1,001 critical days—has demonstrated that school readiness results in a reduction in later problems such as the propensity of children to get into gangs, to have poor mental health and to fail to learn and do well at school. The 1970 cohort study showed, significantly later on, that only 18% of children in the bottom 25% academically at age five get one or more A-levels, compared with 60% of those in the top 25% at age five. What happens to a child in their earliest years follows them throughout their life, and the more we can do in that earliest period, the better, so the Government are totally on the right lines.

Autism and ADHD Assessments

Steve Brine Excerpts

Monday 6th February 2023 Westminster Hall

[Elliot Colburn]

My hon. Friend is absolutely right. I am glad that he used the word neurodiversity because I think that that will be a common theme of many of our speeches, along with an understanding of diversity in autism and ADHD diagnoses, which is very important.

[Steve Brine (Winchester) (Con)]

My hon. Friend will know that the Health and Social Care Committee, which I chair, is undertaking a major inquiry into the prevention of ill health. Given the rather shocking statistics about the harm that adults with ADHD can come to—attempting suicide, for example—does he agree that answering the petition positively is a key prevention issue in healthcare?

[Elliot Colburn]

The Chair of the Health and Social Care Committee is absolutely right and I commend the work that the Committee has done in this area. I look forward to reading its report. Later in my speech, I will cover the wider health effects that waiting times can have on parents and adults waiting for assessments, so I am grateful to him for making us aware of that.

When I first agreed to open the debate, I initially took a personal view from my constituency. I have stood in this Chamber many times to talk about the poor experiences of parents in Carshalton and Wallington in attempting to secure education, health and care plans, or EHCPs, for their children due to the poor management of Sutton Council’s arm’s length organisation, Cognus, which was recently the subject of a BBC “Panorama” exposé. Barely a week goes by without a parent coming to talk to me at my surgeries about the poor experiences they have had when waiting for assessments or the inadequate assessments they have had—and this is the case not just for children, but for adults as well. Over recent weeks, in preparing for the debate, it became to me that assessment times are simply not fit for purpose.

Early Years Childcare: Staff-Child Ratios

Steve Brine Excerpts

Monday 14th November 2022 Westminster Hall

[Steve Brine (Winchester) (Con)]

It is a pleasure to see you and your pink hair in the Chair, Ms Harris. It is not often that is said in this Chamber. I thank the petitioners, including a number of my constituents, for signing the e-petition. I thank those in the Public Gallery who have come to watch, and, of course, Zoe and Lewis for being here today. They are very brave.

I speak as constituency MP for Winchester, and in my capacity as chair of the all-party parliamentary group for childcare and early education. I will start with what I always say in these debates: early years education should be thought of and seen in terms of quality, not in terms of quantity. Investment early in a child’s life pays dividends later on as they move through the system. The impact upon a child’s future is priceless. Internationally, the UK has the second lowest level of Government investment in the early years, but the highest level of investment from parents. Thus, parents have every right to ask for the very best. I know that is what the early education professionals, whom I speak to all the time, seek to provide. I declare my interest in that I am married to an early years worker—so I had better be good.

My view is that increasing ratios would have an adverse effect on that quality. Seeing as the ratios are where they are now, it is incumbent on those who propose to change them to explain why I am wrong in that thesis. The stated intention of the last Prime Minister and the Prime Minister before last to change the ratios—potentially abolishing them altogether—would not, as hoped for, improve flexibility or reduce the cost of childcare. Research from Coram suggests that a full-time nursery for children under the age of two costs almost 66%—two thirds—of a parent’s weekly take-home pay in England.

As the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) set out in her excellent opening remarks, if the proposed reforms are to save money for parents in the cost of living crisis—a perfectly sensible and laudable aim—the evidence to back that up has to be laid before us and the Government have to show their workings out. I am not deaf to those arguments; I am perfectly willing to hear them and happy to see those figures—but see those figures, I must.

Early years settings have expressed concerns to me, and to those of us on the all-party group, that the relaxation of staffing ratios raises the risk of accidents for young children due to fewer staff needing to provide the same quality of care to a greater number of children.

[Vicky Ford (Chelmsford) (Con)]

I thank my hon. Friend for everything he does for the early years sector. I also give my condolences to Zoe and Lewis for their tragic loss. In my constituency of Chelmsford, people want to have outstanding childcare, and, like others across the country, they care about the safety of their children. As a mother who once had three under four, I know what tight ratios mean. But people are also concerned about the affordability of childcare. Does my hon. Friend agree with me that when looking at the issue of international comparisons on ratios, one should try to compare apples with apples? We have to look at not just the staffing numbers but the investment in qualifications. Does he agree with me that the Minister is right to look at rations, but needs to ensure that those comparisons are done on a level playing field, taking into account those other considerations too?

[Steve Brine]

I absolutely agree with my right hon. Friend, the former Minister. As set out in the opening speech, the situation is very different in Scotland; there are different qualification levels. Also, in Scotland practitioners have to register with the Scottish Social Services Council in order to work in early years, and they have to commit to continuing professional development qualification levels to do that. The hourly rate is also higher. I do think it is different. My right hon. Friend referred to having had three children—I only have two. Yes, it is about the qualification, but it is also simply a numbers game and about having eyes on the child. Our two children are 12 and 15 next week—it is a busy month—but when they were small, my wife and I would divide and rule. We had a 1:1 ratio. When we were looking after their cousins, the ratio went up and it was more challenging. Clearly, I am not suggesting a 1:1 ratio in early years education, but why on earth would we want to go the other way in a setting where children potentially spend seven or eight hours a day for five days a week? I question it but, as I say, show me the money. Show me the evidence, show me the workings out and show me the savings, and then we can make an informed judgment.

There are concerns among providers and parents about settings having the capacity to support children with any additional needs, such as children with SEND, who may need more, rather than less, time with educators. I know the Minister will touch on this issue in her remarks. My fear, and that of providers and parents, is that a further ratio reduction would reduce the capacity and parental confidence even further, potentially driving more exclusion in early years education.

Another point is that current staffing ratios reflect the requirements for facilities and space set out in the Ofsted framework, which is very clear. It would therefore be troubling if the Department contradicted the guidance of the official regulator. If we were to proceed with reducing staff to child ratios, do Ministers intend to consult on changing the Ofsted framework? Of course, that would require a statutory consultation.

I have said that good early years education is vital to supporting our young people to develop, and Ofsted has identified children aged two to three as needing a particular focus on speech and language in order to build necessary communication skills for later in life. More children per staff member can only mean less time per child. Why is that particularly acute right now? Because of the pandemic, young children who started nursery in September do not have the socialisation skills that my children had in the years before they started in early years education, so I would suggest that that is even more important than ever right now.

Let me give some figures. Some 52% of early years staff say their workload and a lack of work-life balance are a cause of stress or unhappiness for them. With the existing ratios, staff are under pressure—I hear that every night at home—and they tell me they are worried about the time they are able to give each child in their care. We face a staffing challenge in the early years sector, and staff are leaving the sector, with many choosing careers in retail with fewer hours but similar, or even greater, levels of pay. Data from the University of Leeds shows a post-pandemic net loss of workers from the sector above and beyond the usual churn of staff, and I often make the point that dog-sitters in my area are often paid more than the people who look after our most precious asset. Dogs are precious too, but they are not our children.

On Saturday I was out in my constituency, talking to constituents. I spoke to a lady in Winchester who said that she was very worried about the nursery round the corner—I will not identify it, for obvious reasons—because it is losing the key worker who looks after her young daughter. It is really disruptive for her young daughter, and she is very worried about it. The nursery is losing that key worker because she is going to work in an office job, as she can get paid better and probably have a lot less stress. This is the reality of life. As the new Minister—obviously, she is a constituency MP as well—gets out and about, I dare to say that she will hear that more and more from the people she meets in the sector.

I would suggest that increasing the number of children each member of staff is working with or responsible for will only increase the pressure and stress within the workforce, and more of these vital workers will leave the sector, which already faces a recruitment and retention crisis. That will drive up costs for parents and exacerbate the financial problems in the sector, with over 84% of providers telling the APPG on childcare and early education that they expect to operate at a loss or merely break even this year—up from just over half in 2018. Nursery and early education providers said it is more difficult to recruit, and some 20% of childminders told us that they did not think they would be working in the sector in six months’ time. Many of those people are concerned about working with new ratios, in what they regard as potentially unsafe conditions.

One nursery worker wrote to me to say that the changes to ratios gave her “nightmares”; she said that the situation was like an episode of “Crimewatch”. Another said that she was “extremely concerned” about the additional pressure on staff, “both physically and emotionally”. I have seen figures that suggest that almost two thirds of practitioners could leave the sector if ratios went in the wrong direction. That is not just a figure; parents across the country will be unable to find good childcare and early education for their children to enable them to go to work and feed the workforce—a challenge in many other parts of the economy. This is not just a childcare story. Childcare is to the economy what social care is to the NHS. If we do not get this right, the economy will slow down, and heaven knows that right now we need the economy to speed up. We need growth.

Staff are referencing workload, stress and burnout as key concerns. I am not defending the current way of working as being perfect—far from it. The all-party group that I chair has for a while been calling for a wholesale review of childcare and early education, and we will write to the new Chair of the Education Committee when they are elected on Wednesday to request that review. I have already spoken to some of those standing for that position, two of whom are in this room.

In conclusion, we do not need a change in ratios. We need a wholesale, fact-based review of childcare and early education that focuses on the workforce, parents and, ultimately—the most important stakeholder—children. Our children deserve nothing less. I have already spoken to the new Minister, the Under-Secretary of State for Education, my hon. Friend the Member for East Surrey (Claire Coutinho), about the issue. I congratulate her on her position. She is a thinker and a serious person, and I really look forward to working with her. I respectfully ask her to meet my all-party group as soon as possible; we look forward to that conversation.

Oral Answers to Questions

Steve Brine Excerpts

Wednesday 7th May 2014 Commons Chamber

[The Prime Minister]

We want to build more houses so we have a better rental sector with more affordable rents. But as I said in my very first answer, if this is about finding new tenancies that give long-term security on a voluntary basis, yes. If it is about mandating rent controls from the centre and destroying the housing market, no. The problem I have with so many of the right hon. Gentleman’s policies is that they all come from the same place—

[Steve Brine (Winchester) (Con)]

Len.

[The Prime Minister]

Thank you very much. Len—they come from the Unite union. Unite said, “Renationalise the railways.” The right hon. Gentleman wants to renationalise the railways. Unite says, “Let’s have old-style rent controls.” He wants old-style rent controls. The problem with rent controls is their policies are for rent, their candidates are for rent and their leader is for rent. That is the problem.

Oral Answers to Questions

Steve Brine Excerpts

Wednesday 9th March 2011 Commons Chamber

[The Prime Minister]

The hon. Gentleman has raised this matter with me before. He speaks very powerfully on behalf of people who have that addiction, which is an extreme problem in our country.

We published a drugs strategy which set out an ambition to reduce drug use, including the use of prescription and over-the-counter medicines. That should include programmes to help people to withdraw from and come off those drugs. However, as I have said to the hon. Gentleman before, I think that we must deal with the problem at source. That is part of the purpose of our health reforms, which is to ensure that the national health service is genuinely concerned with the health of the whole person rather than being a national drugs service in which there can sometimes be too much prescribing of drugs.

[Mr Steve Brine (Winchester) (Con)]

The German company Storck UK, which owns and makes Bendicks chocolates in my constituency, has announced that it is consulting on plans that could involve production being moved to Germany. In the area that I represent, 115 jobs depend on that factory. Will the Prime Minister ask one of his Ministers in the relevant Department to meet me and representatives from the company as soon as possible to establish whether we can help?

[The Prime Minister]

I will certainly do that. My hon. Friend is right to speak up for his constituency and for that business. Through the growth review—we will confirm this in the Budget—we are taking steps to ensure that this country is the best place in Europe in which to do business. We have set out plans for the lowest rate of corporation tax anywhere in the G7, but we will also take further steps to ensure that we encourage companies to stay here, come here and invest here.