Health and Social Care Workforce
Debate between Steve Brine and Robin Walker(9 months, 3 weeks ago)
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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.
Childcare and Early Years
Debate between Steve Brine and Robin Walker(1 year, 1 month ago)
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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.
Oral Answers to Questions
Debate between Steve Brine and Robin Walker(2 years, 3 months ago)
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Steve Brine (Winchester) (Con)