Doctor Training

Will Quince Excerpts

Tuesday 17th January 2023 Westminster Hall

[The Minister of State, Department of Health and Social Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Sir George, and I am hugely grateful to my hon. Friend the Member for South Cambridgeshire (Anthony Browne) for raising this important issue and for his hugely constructive proposals and suggestions.

The workforce are the beating heart of everything our NHS does and stands for, and doctors make up an important part of the workforce and are invaluable to our NHS. I am hugely grateful for the incredible work they do day in, day out. I also thank all those who have contributed to the debate. I will try my best to respond to as many of the themes raised as possible in the time available to me.

Let me turn first to workforce pressures, which were raised by a number of hon. Members. We know, and I certainly recognise, that the workforce remain under sustained pressure having worked tirelessly through the covid pandemic to provide high-quality care to those who need it. I recognise, too, the huge and important role that doctors play in supporting our NHS. That role is as important as it ever was, which is why I am passionate about supporting our doctors, particularly in challenging times.

As the hon. Member for Strangford (Jim Shannon) rightly said, it is vital that we support the workforce not just now, but in the future. I recently met with the British Medical Association, the Hospital Consultants and Specialists Association and other unions to discuss, among other things, what we can do to ensure that NHS staff continue to feel valued in their work, but also how we can improve such things as their working environment and working conditions, which are really important. I look forward to continuing those discussions.

The crux of the debate is growing the workforce. What have we seen in the past year? We have seen record numbers of staff, including record numbers of doctors working in our NHS—since October 2021, 4,700 more doctors, representing a 3.7% increase—but I recognise that demand for NHS services continues to grow, which is why we have done a significant amount already to invest in training additional doctors and our future workforce.

As my hon. Friend the Member for South Cambridgeshire said, the Government have created and funded 1,500 more medical school places each year for domestic students in England. That is a 25% increase over three years, and the expansion was completed in September 2020. It has delivered five new medical schools for England. My hon. Friend mentioned levelling up, which of course was part of the motivation behind that expansion, hence the new medical schools in Tyne and Wear, west Lancashire, mid-Essex, Lincolnshire and Kent.

My hon. Friends the Members for Gloucester (Richard Graham) and for Redditch (Rachel Maclean) mentioned the Three Counties Medical School. I know some of the issues around that, some of which I think are specific. I would be happy to meet my hon. Friends, and my hon. Friend the Member for Worcester (Mr Walker), who has also raised the matter with me, to discuss this further.

In addition—I am conscious of the fact that we are talking about medical places—we temporarily lifted the cap on medical places for students completing A-levels during the pandemic, in 2020 and 2021. That resulted in an intake of nearly 8,500 in each year, which was significantly above the planned figure of 7,500.

My hon. Friend the Member for Newton Abbot (Anne Marie Morris) asked what we are doing to look at new routes into medicine. That is an important point: yes, we have the traditional routes, but what are we doing to consider other ways in? I am delighted that, only last week, Health Education England announced funding for the first 200 apprentices to begin training as doctors over the next two years. That marks an important step in making a career in medicine more accessible. My hon. Friend the Member for Wantage (David Johnston) made a similar point: we have to make medicine more accessible. I am really excited about those apprenticeships and what can be done in that space.

Turning to the long-term workforce plan, I heard what my hon. Friend the Member for South Cambridgeshire and others said in calling for us to be bolder and more ambitious, and I know that we need to do more to ensure that the NHS has the workforce that it needs for the future. I heard my hon. Friend’s call for a feasibility study on doubling the number of places, and I will take that away and look at it. I also heard his call for an increase of circa 1,000 places next year. That would have a significant financial implication, which would not sit within our spending review allocation. Again, I will have to take that away and look at it, and have those conversations with the Chancellor.

We have commissioned NHS England to develop a long-term plan for the NHS workforce for the next 15 years. That high-level, long-term NHS workforce plan will look at the mix and number of staff required across all parts of our country, and it will set out the actions and reforms needed to reduce supply gaps and improve retention. My hon. Friends the Members for Bolsover (Mark Fletcher) and for Torbay (Kevin Foster) eloquently set out why we need a workforce that will reflect the changing nature of medicine and technology, and demographic changes. That is vital, and those will be key parts of the NHS long-term plan.

My hon. Friend the Member for Wantage rightly said that those going into medicine understandably want a portfolio career. General practice is still an attractive option and we have more people wanting to be GPs, which is a great thing, but I wonder how many people would want to be Members of Parliament if they were just doing surgeries, which is part of the role, all day every day. In medicine, a portfolio mix involves some time in the hospital and some time in general practice. It is really important that people have the ability to develop their skills and have a specialism, but they should not lose their generalist skills. I think we will see more people wanting to be GPs but also to spend time in hospitals and other settings, and our NHS long-term plan must reflect that.

We have committed to publishing the plan this year. As the Chancellor set out in the autumn statement, it will include independently verified forecasts for the number of doctors, nurses and other professionals needed in five, 10 and 15 years’ time, taking full account of the improvements that we need in retention and productivity. The plan will ensure that we have the right people with the right skills to transform and deliver high-quality services fit for the future.

The hon. Member for Strangford asked about Northern Ireland. He is absolutely right to do so, because a plan cannot work in isolation. NHS England is looking at the NHS long-term plan, but it could not do so without having those all-important discussions with the devolved Administrations around our United Kingdom. There are a number of plans, but there is commonality of interest because of the nature of our United Kingdom, and inevitable join-up. I know that NHS England is having those conversations, and I will ensure that we have them at ministerial level too.

We have touched on international recruitment. As we grow the domestic workforce, ethical international recruitment remains a key element of achieving our workforce commitments, and we are ramping up efforts through targeted support for NHS trusts with recruiting from overseas. My hon. Friend the Member for South Cambridgeshire mentioned our code of practice for international recruitment, which aligns with the latest advice from the World Health Organisation. It guarantees stringent ethical standards when recruiting health and social care staff from overseas, and ensures that we can work collaboratively with other Governments around the world. Although it restricts active recruitment from particular countries, which my hon. Friend correctly referred to as the red list, he rightly pointed out that an individual still has the right to migrate. Therefore, we will still see individuals applying independently for vacancies in our NHS in the UK, which is known as direct recruitment. We are not actively recruiting, but people can nevertheless apply.

Our long-term NHS workforce plan is about ensuring that we get the balance right between international recruitment and domestic training places. As health systems develop around the world, we have to build our domestic resilience to ensure that we are training enough doctors here in the UK. Having said that, internationally trained staff have been a key part of our NHS since its inception in 1948, and they continue to play a vital role. Let me put on the record that we value hugely their contribution to providing excellent care.

Retention was another issue raised. I do not underestimate the importance of staff retention, which is as important as recruitment. As well as training more staff, which is vital, we have to ensure that we keep those highly qualified, experienced clinicians. We have to ensure that they feel supported and valued within in our NHS, not just at a national level, but at a local, individual trust level. We have the actions set out in the 2020 NHS people plan, which are helping us to build that culture and will help support us to ensure we get it right. They include a much greater focus on health and wellbeing, strengthening leadership and increasing opportunities for flexible working, which I know is important in a modern workforce.

A number of hon. Members mentioned pensions, and I understand that challenge. I meet the senior clinicians we need to retain in our NHS. We announced a package as part of our plan for patients in the summer, continuing the temporary retirement-return easements. We also announced the intention to introduce a number of permanent retirement flexibilities from 1 April this year. I know the Chancellor and the Secretary of State for Health and Social Care are acutely aware of the issue and are exploring what more can be done.

In the short time I have, I will cover specialty training. My hon. Friend the Member for South West Bedfordshire (Andrew Selous) rightly raised the important issue of GP training places. One challenge with more funding for medical schools is to ensure that there are specialty places for people to go into. It pains me when I hear that people want to train as GPs but there is not the space in GP practices for those specialty places. I know my hon. Friend has met my fellow Minister, my hon. Friend the Member for Harborough (Neil O’Brien). I am also happy to meet him to discuss this issue from a workforce perspective.

I was pleased when, only last week, Health Education England announced the creation of nearly 900 more specialty placements. That is hugely important, especially because there is a focus on areas such as mental health and cancer, where we know we have shortages. It pains me to hear of anyone wanting to be a GP but not having access to specialty training, because I know we need more of them.

Conscious of the fact that I intend to leave a little time for my hon. Friend the Member for South Cambridgeshire to respond, I thank all hon. Members for their constructive contributions to this morning’s debate. It has given me, the Department and, dare I say it, the Treasury some food for thought about the long-term future of medical training places.

Through the programme of work that I outlined and the long-term planning that NHS England has under way, which will be published this year, we are ensuring that the NHS has the robust and resilient workforce that we know it needs for the future. Doctors are, of course, an integral part of that. We are working to ensure that we have the right people with the right skills in the right places. We are working to ensure that they are well supported and looked after so that they, in turn, can look after those who need our great NHS services, and so that they can keep delivering that great standard of care that people need now and in the future.