Clause 35 - Report on assessing and meeting workforce needs

Health and Care Bill – in the House of Commons at 5:11 pm on 30th March 2022.

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Votes in this debate

Photo of Eleanor Laing Eleanor Laing Deputy Speaker and Chairman of Ways and Means, Chair, Standing Orders Committee (Commons), Chair, Standing Orders Committee (Commons)

With this it will be convenient to discuss the following:

Lords amendment 30, and Government motion to disagree.

Lords amendment 48, Government motion to disagree, Government amendment (a) in lieu, and amendment (b) in lieu.

Lords amendment 57, and Government motion to disagree.

Lords amendment 89, Government motion to disagree, and Government amendment (a) in lieu.

Lords amendment 108, and Government motion to disagree.

Lords amendments 42 to 47, 55, 56 and 58 to 64.

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

It is a pleasure in discussing this set of amendments to be facing the shadow Secretary of State, Wes Streeting, although I might not say that after he has made his contribution or challenged me. I am grateful for the opportunity to speak to this important set of amendments, and I again put on record my gratitude to their lordships for the work they have done in scrutinising this Bill. This group is about accountability and makes it clearer that the Government are committed to ensuring that the NHS is transparent, accountable and effective.

Lords amendments 42 to 47 ensure that the procurement regulations will have to include provision for procurement processes and objectives; for steps to be taken when competitively tendering; and for transparency, fairness, the verification of compliance and the management of conflicts of interest. They also require NHS England to issue guidance on the regulations. It behoves me to pay tribute to the shadow Minister, Karin Smyth, who served on the Bill Committee throughout. Although we did not always agree, she brought her expertise and forensic skills with issues such as this to that Committee. Even if she did not always agree with the conclusions, she made sure we were well informed in the conclusions we reached.

We recognise those key aspects as vital. While it was always our intention to include them in the new provider selection regime, the amendments add clarity and clearly signal our intentions. Furthermore, Lords amendment 47 makes the regulations subject to the affirmative procedure. We are grateful for the input of the Delegated Powers and Regulatory Reform Committee in advising that, and we have listened.

Lords amendment 55, supported by the Scottish Government, makes it clear that any powers or duties conferred on Scottish Ministers in relation to their role in collecting information for medicine information systems can be treated in the same way as other NHS powers or duties in Scotland and be delegated to health boards in Scotland.

Lords amendments 56 and 58 to 64 relate to the power to transfer the functions of arm’s length bodies. Following constructive engagement with the devolved Governments, these amendments enable us to proceed on a UK-wide basis. Lords amendment 56 clarifies that the powers in part 3 of the Bill in respect of special health authorities apply in relation only to England and cross-border special health authorities, and not Wales-only special health authorities. Lords amendments 58 and 59 remove devolved Ministers and Welsh NHS trusts from the list of appropriate persons to whom property, rights and liabilities can be transferred through a transfer scheme following a transfer of functions.

Lords amendment 60 creates a requirement for the Government to obtain the consent of the devolved Governments for any transfer of functions within the competence of their legislatures or which modify functions exercised by the Welsh Ministers, Scottish Ministers or a Northern Ireland Department. Finally, Lords amendments 61 to 64 are consequential upon the changes made by Lords amendment 60.

I am also asking the House to disagree with several amendments made in the other place. First, Lords amendment 29 relates to the workforce, and I reassure the House that the Government are committed to improving workforce planning. We recognise the importance of having a properly trained workforce in sufficient numbers and in the right places. We are already taking the steps we need to ensure we have record numbers of staff working in the NHS. While we recognise the strength of feeling behind the amendment, we simply do not think it is necessary in its current form, and we urge the House to reject it.

Photo of Peter Aldous Peter Aldous Conservative, Waveney

I am aware that the Government have put in place their own plans for NHS workforce planning, but can my hon. Friend address the concerns that framework 15 has inadequacies in terms of data collection, does not provide an assessment of workforce numbers and is not responsive to societal shifts?

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care) 5:45 pm, 30th March 2022

My hon. Friend puts his finger on a key issue, which is the dynamic nature of workforce trends, whether in terms of demand or supply, which is one of the challenges of a long-term projection—it would need to be a dynamic process. That is why we believe that the right approach is the one set out by my right hon. Friend the Secretary of State. His predecessor commissioned that framework review from Health Education England in July last year, and the Secretary of State has subsequently asked for further work to be done in a further commission that looks at a workforce framework over 15 years. That is the first time that has been done, as I heard him say at the Dispatch Box earlier today when talking about the Ockenden review, and it will be a hugely valuable tool for the NHS and for us when we make decisions in this place about priorities and prioritisation in healthcare. As always, I am grateful to my hon. Friend Peter Aldous.

Before I go into more detail, I will make a point on which I suspect the shadow Secretary of State and I are in complete agreement. Although there may not be many things in this group of amendments that we agree on, I am sure that he will join me in recognising the amazing work done by our health and care workforce over the past two years, and not just in the past two years, which were exceptional circumstances, but every day of the year—day in, day out—whichever year it is. I put that on record because it is important.

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

The hon. Gentleman nods; as I say, I suspect that may be a rare moment of agreement on this group of amendments.

We continue to be committed to growing and investing in the workforce. This year we have seen record numbers of staff working in NHS trusts and clinical commissioning groups, including record numbers of doctors and nurses. The monthly workforce statistics for December 2021 show that there are more than 1.2 million full-time equivalent staff. Those workforce numbers come on the back of our record investment in the NHS, which is helping to deliver our manifesto commitments, including to have 50,000 more nurses by the end of the Parliament. We are currently on target to meet that manifesto commitment, as the number of nurses was a little over 27,000 higher in December 2021 than in September 2019.

The spending review settlement will also underpin funding the training of some of the biggest undergraduate intakes of medical students and nurses ever. In that context, I highlight the decision made, I believe, under one of my predecessors to expand the number of medical school places from 6,000 to 7,500, which has come on stream. Of course there is a lead time before those going through medical schools will be active in the workforce, but it is an important step forward.

Photo of Janet Daby Janet Daby Labour, Lewisham East

I draw the Minister’s attention to the 2 million Uyghurs who have been detained in concentration camps. They are making slave-made goods that have infiltrated our NHS, which puts health workers at risk of wearing products made by modern slavery. Will he recognise the importance of accepting Lords amendment 48 so that the NHS is not dependent on slave-made goods?

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

I hope the hon. Lady will forgive me, because I will finish discussing the workforce amendments before I turn to the so-called genocide amendments and the organ sales amendments. I will come to her point, but I hope she will allow me to do it in that way; I have heard what she has said.

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

I will make a little progress, then I will give way to the hon. Lady, as I tend to do. She is a regular participant in health debates.

We are already committed to improving workforce planning. In July 2021, as I said, we commissioned that important work with partners to review long-term strategic trends. It is also important to note in that context that my right hon. Friend the Secretary of State announced that we are merging NHS England and Health Education England, which is a hugely important move that brings together the workforce planning and the provision of places and of new members of the workforce with the funding available for that and the understanding of what is needed in the workforce. It brings supply and demand considerations together.

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

I will make a little more progress, then I will give way to Rachael Maskell and then, if I have time, I will give way to her. I want to address the points of Janet Daby in good time and I am conscious that the votes took up a chunk of the time allowed for this group of amendments.

We are also committed to increasing transparency and accountability. The unamended clause already increases transparency and accountability on the roles of the various actors within the NHS workforce planning system.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Digital, Culture, Media and Sport)

When looking at workforce planning, it is really important not only that the Government depend on NHS professionals trained overseas, but that they look at commissioning more training places here. In particular, I would point to the dentistry profession, as the Government are currently waiting for 700 dentists to pass their exams. It really does highlight the shortage of training for our own dentists when one in three dentists practising has trained overseas. Will the Government look at the commissioning of more training places so that we can grow our own workforce?

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

The hon. Lady will be pleased to know, or will I hope be reassured to a degree to know, that underpinning our strategy to grow the workforce—for example, the nursing workforce or other specialisms—is the fact that we have multiple strands to the strategy. Those coming from overseas who wish to work in the NHS are always going to be an important and valued part of our NHS workforce, but of course we are also committed to growing the number, for want of a better way of putting it, that we grow at home through training places and medical schools. Crucially, however, a key element here is retention of our existing staff, so that we are not simply recruiting and training lots more staff to replace those who are leaving. All of those factors are important.

Photo of Debbie Abrahams Debbie Abrahams Labour, Oldham East and Saddleworth

Does the Minister want to comment on the fact that 100-plus organisations—and not just those 100 organisations, including the BMA, but former chief executives of NHS England—are still very concerned that the Government’s measures on workforce planning do not go far enough?

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

I am grateful to the hon. Lady, and she and I have worked together on a number of issues in the past. We always engage—and the since the inception of the Bill and throughout its passage, we have engaged collaboratively—with a whole range of organisations, such as professional bodies and trade unions, including some of those she mentioned. We believe that the approach we have adopted in the commissions from the Secretary of State, coupled with the merger with Health Education England, will be a significant step forward, and we believe it is the right approach to take. I suspect that the hon. Lady may disagree, and I always respect her opinion, although I may not always agree with it.

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

I wanted to make a little progress, but I will give way to the Chair of the Select Committee.

Photo of Jeremy Hunt Jeremy Hunt Chair, Health and Social Care Committee, Chair, Health and Social Care Committee

Could the Minister possibly just tell me whether there is a single NHS organisation that is not supporting Lords amendment 29, which the Government are planning to reject?

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

I may regret giving way to my right hon. Friend. I do not often say that, but perhaps I do now. I believe that this is about striking an appropriate balance in workforce planning and understanding supply and demand. I believe that the approach we have adopted as a Government, with the commission and the subsequent commission from the Secretary of State, is the right one. We are working closely with all NHS organisations from NHS England down, and I am sure that we will continue that collaborative work and that they will recognise the value being added by these commissions.

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

I will make a little progress if I may, but if the hon. Gentleman can shoehorn his way in a little later, I will, assuming I am making good progress, try to find a way to come back to that point for him.

On Lords amendments 30 and 108, while we recognise the concerns of the other place, we think it is important to enable the Secretary of State to intervene in reconfigurations with greater flexibility where such an intervention is warranted. While the Secretary of State already has powers over reconfigurations, our proposals will allow them to better support effective change and respond in a more timely way to the views of the public, health oversight and scrutiny committees and, indeed, parliamentarians in this House. It will reduce wasted time and effort, and it will allow Ministers to become involved at the right stage, not simply at the end stage of the process. For that reason, we urge the House to reinstate clause 40 and schedule 6.

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

I think the hon. Gentleman is seeking to intervene. I find it difficult to say no to him, so I will give way.

Photo of Tim Farron Tim Farron Liberal Democrat Spokesperson (Environment, Food and Rural Affairs), Liberal Democrat Lords Spokesperson (Communities and Local Government), Liberal Democrat Spokesperson (Housing, Communities and Local Government)

The Minister is a thoroughly good man, and I am very grateful. He will be aware of the National Audit Office’s projection that there are probably 100,000 undiagnosed cancer cases since the pandemic. Tragically, clinicians reckon that probably 20,000 of those people have already passed away. Will he agree and commit to a specific workforce strand when it comes to cancer? We desperately need cancer specialists, nurses, oncologists, radiotherapists and so on if we are going to be able to tackle this problem, but also make sure that we are not overburdened in the future, so that we can save lives?

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

I am pleased I took the hon. Gentleman’s intervention on an issue that I know he has long taken an interest in. As well as the overall macro-trends of supply and demand, I expect the work being undertaken to look at the specialisms sitting beneath. He and I have discussed the significant increase in percentage terms in the number of radiographers, radiologists and others since 2010, but I acknowledge his underlying point that there is more to do if we are to achieve the ambitions set out in our consultation on the 10-year cancer plan and our broader ambitions for cancer care and treatment. We continue to look at that, and those specialisms will form a part of that work.

The hon. Member for Lewisham East raised a subject that I suspect will come up in contributions to the debate, including from my right hon. Friend Jeremy Hunt. Regarding Lords amendment 48, we have heard the strength of feeling in the other place about the gravity of this issue, and I know that no one in this House would support the use of forced labour in creating NHS goods or their coming from areas where genocide may be taking place. We are fully committed to ensuring that that does not happen and we are now proposing further measures to tackle the use of forced labour, but we do not believe that this is the right legislative vehicle for introducing those changes, especially those made in the other place relating to genocide.

The Government will bring forward new rules for transforming public procurement in the forthcoming procurement Bill, which will cover all Government procurement and further strengthen the ability of public sector bodies to exclude from bidding for contracts suppliers that have a history of misconduct, including forced labour. We believe that that is the right vehicle for such provisions. The review of the 2014 modern slavery strategy will be published in spring this year, and will provide an opportunity to build on the progress we have made and to adapt our approach to take account of the evolving nature of these terrible crimes. We know that the NHS is one of the biggest procurers in this country, and it is for that reason that we are introducing measures in this Bill to ensure that NHS procurement works for the good of all.

NHS England and NHS Improvement agreed a new slavery and human trafficking statement for 2022-23 on 24 March, with new modern slavery countermeasures in the NHS supplier road map, updates to the NHS standard contracts to strengthen our position on modern slavery, and the development of a new strategy to eradicate modern slavery across the NHS supply chain. We are going to go further than that, though. In amendment (a) in lieu of amendment 48, we propose to introduce a duty on the Secretary of State to carry out a review into the risk of slavery and human trafficking taking place in NHS supply chains, and to lay before Parliament a report on its outcomes. That review will focus on Supply Chain Coordination Ltd, which manages the sourcing, delivery and supply of healthcare products, service and food for NHS trusts and healthcare organisations across England. As well as supporting the NHS to identify and mitigate risk with a view to resolving issues, the review will send a signal to suppliers that the NHS will not tolerate human rights abuses in its supply chains and will create a significant incentive for suppliers to revise their practices. I will listen to my right hon. Friend the Member for South West Surrey when he makes his contribution and endeavour to respond when I wind up this debate. I know he has strong views on this subject, as do other hon. Members

Photo of Janet Daby Janet Daby Labour, Lewisham East

I thank the Minister for his response. My concern is the level of urgency. If the Government allow the problem to continue in the NHS, they are inadvertently allowing slavery to continue, which is not helpful.

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

As ever, the hon. Lady makes her point courteously but clearly. As I said, depending on the time available at the end of the debate, I will endeavour to respond more fully to the points that she and my right hon. Friend make.

Photo of Iain Duncan Smith Iain Duncan Smith Conservative, Chingford and Woodford Green

I hope to speak on this subject if I catch your eye, Madam Deputy Speaker, but I want to make the point that right now, even though it is not meant to be allowed, the NHS is using products made by slave labour. Only two days ago, The Spectator demonstrated that products being used in King’s College Hospital actually came from providers in Xinjiang, so it is happening now. Like the hon. Member for Lewisham East, I want to emphasise the urgency of this issue, so I intend to bring it up with my hon. Friend the Minister during the debate.

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

I should say at this point that I was grateful for the opportunity to talk to my right hon. Friend about this subject a week or two ago, and I suspect that our conversations will continue.

I want to cover the rest of this group of amendments. Lords amendment 57 would exclude statutory functions of NHS Digital from the transfer of powers in the Bill. I urge the House to reject that amendment. I have assured Members of this House and in the other place that the proposed transfer of functions of NHS Digital to NHS England would not in any way weaken the safeguards we have in place for the safe and appropriate use of patient data. NHS Digital’s current obligations in terms of its data functions, and particularly the safeguards that apply to patient data, will become obligations on NHS England. The merger, which has been announced as Government policy, is in response to the recommendation of the Wade-Gery review. It is essential to simplify a complex picture of national responsibilities for digital and data services in the NHS, bringing them together in a single organisation that leads on delivery and the data needed to support it.

Finally, I turn to amendment 89, on organ tourism. While the Government are sympathetic to its aim of ensuring that the law would capture anyone with a close connection to this country who purchases an organ overseas, we have significant concerns about the adverse impact that such an approach could have on transplant patients and NHS staff. We therefore tabled an amendment in lieu, which would achieve a similar effect without creating a disproportionate impact on vulnerable recipients and NHS staff. In effect, it would mean that wherever in the world their actions take place, most UK nationals—and all residents of England, Wales and Scotland—could be prosecuted for existing offences that cover the trade in human organs. The amendment would encompass paying for the supply of an organ, seeking to find someone willing to supply an organ for payment or initiating or negotiating any commercial arrangement for an organ to be supplied. Such things are already illegal, and we are extending the territoriality of that for English, Welsh and Scottish residents.

The Government’s amendments strengthen account-ability and improve the Bill. However, several of the amendments from the other place are either unnecessary or have unintended consequences, so we ask the House to reject them.

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care 6:00 pm, 30th March 2022

It was a great pleasure to see the Minister at the Dispatch Box, but I must warn him and the Minister for Care and Mental Health, Gillian Keegan, that the Government will not convince us that their position on workforce is right even by sending out the most charming members of their Health team. I will go into the reasons for that. I start with enormous thanks to Members of the House of Lords for the enormous amount of work that they put into making the Bill much better than it was when it left the House of Commons. In particular, I thank my noble Friends Baroness Thornton, Baroness Merron and Baroness Wheeler who showed great wisdom and stamina in forging huge alliances in the other place to get the consensus needed to make the improvements that we are discussing. I also thank Liz Cronin and Richard Bourne for supporting the shadow Lords team.

The NHS is facing the greatest crisis in its history. Covid has not gone away, and the covid pressures on the NHS certainly have not gone away. Instead, it is in the unenviable position of having to deal with those ongoing challenges at the same time as trying to address the significant backlog that existed before we went into the pandemic, when a record 4.5 million people were already on NHS waiting lists.

Today, we see that there is a staff shortage of 110,000 across the NHS as well as 105,000 vacancies in social care. Six million people are now waiting for NHS treatment—the longest waiting lists on record—and they are waiting longer than ever before. Cancer patients are not being seen by specialists on time; they are waiting too long for diagnosis when every day matters. Stroke victims are being left to wait hours for an ambulance—except in the north-east, where over the winter heart attack patients were told to phone a friend or call a cab. It is therefore no surprise to learn today that public satisfaction with the NHS is at its lowest level in 25 years, since 1997. Of course, that was the year when Tony Blair led Labour to victory at the general election and delivered shorter waiting times and the highest patient satisfaction in the history of the NHS. The Government could do a great deal of good by learning from the example left by the last Labour Government and trying to rebuild the legacy that they have trashed over the last 12 years.

It is not just patients who are dissatisfied with the NHS. I know from speaking to frontline staff and NHS leaders across the country that they are exhausted after their heroic efforts of the past two years. They are burned out, they are overstretched, and there are simply not enough of them. They are proud of the NHS and proud to work for the NHS, but, in too many cases, people are going home at the end of a long shift and agonising about whether they did the right thing, agonising about whether they made the right decisions for their patients and agonising about whether they had forgotten a crucial detail. It is getting worse, not better. Some 27,000 NHS workers voluntarily left the health service in just three months last year, the highest on record. The Health Secretary has admitted that the Government will not meet their manifesto commitment to recruit the 6,000 GPs we need to get people seen on time and we know that many cases will simply present in overstretched accident and emergency departments. Today, we heard about the consequences of the failure to safely staff our health service.

On that note, I want to place on record my thanks to the Secretary of State for Health for his response to the Ockenden review—and to his predecessor, the Chairman of the Health and Social Care Committee, Jeremy Hunt for commissioning the review in the first place—and the commitment to implement in full not its recommendations, because Donna Ockenden has not made recommendations, but the must-dos she has set out. I cannot imagine the trauma of losing a child and we owe it to mothers who have been through that suffering to ensure that they are never let down again. This is not a party political point. The review spans two decades under Labour and Conservative Governments. I want to acknowledge that and be honest about that. The clear finding is that we must safely staff our maternity wards. Today, midwives are leaving the NHS in greater numbers than it is able to recruit them. That is just one of the reasons why we need a workforce plan for the NHS.

Photo of Geraint Davies Geraint Davies Labour, Swansea West

I have just returned from Lithuania, where I was speaking to the head of migration in a refugee centre who said that they are welcoming their neighbours not just because they should but because they are providing a very valuable addition to their workforce. They are taking tens of thousands of people. Given that 1.4 million EU citizens who are registered to work in Britain have decided to stay in Europe, should we not be opening our hearts and homes and recognise the benefits some of them would bring by working in the NHS?

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

I thank my hon. Friend for his intervention. It is certainly the case that refugees fleeing Ukraine—indeed, other conflict zones around the world—bring enormous skills to our country. For as long as they are here and living with us, we should enable them to make whatever contribution they wish. If some of the people from Ukraine or elsewhere want to work in the NHS, we should absolutely welcome them with open arms.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Digital, Culture, Media and Sport)

I am grateful to my hon. Friend, who is making an excellent speech. This debate is concentrated on physical health, but if we look at workforce planning on mental health we know we are at a significant deficit. If we are talking about parity of esteem, surely Lords amendment 29 is absolutely imperative, so that we can start investing in the future of our mental health services?

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

My hon. Friend is absolutely right and she will know of our party’s ambitious commitments, outlined by my hon. Friend Dr Allin-Khan, to ensure that patients receive guaranteed mental health treatment within a month. That would be revolutionary. It will require investment and require recruiting the people we need to help provide that care, but this country is living through a mental health crisis on top of everything else. This has been a deeply difficult two years for our country during the pandemic. Many people bear not just the physical scars and ongoing physical health consequences of long covid, but the grief, the loss and the injury to their mental health and wellbeing caused by this deadly pandemic. Many of those people who are suffering mental health crises are the very people who are still turning up for their shifts in the hospitals, still turning up for their shifts in the GP surgeries, and still turning up at work to help care for others even though they are in need of care themselves.

Lords amendment 29 does not commit the Government to hire thousands more doctors and nurses, although they should. It does not commit to new funding for the NHS, although it desperately needs that. It does not even commit the Government to finally publish the workforce strategy the NHS is crying out for, despite the fact that the NHS has not had a comprehensive workforce strategy since the Labour Government’s plan was published in 2003. All we are talking about today is an independent review of how many doctors, nurses and other staff the NHS needs for the future. That is not just a view put across by Labour Members: it is supported by many Members right across the House, including the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey, who is a former Health Secretary. It is not the first time that he has helped to unite the sector, although I remember the days when it was sometimes united in opposition to, rather than in support of, his proposals.

I will say this, actually: when the right hon. Member for South West Surrey took over as Chair of the Health and Social Care Committee, I was really nervous about the prospect of a former Health Secretary effectively marking his own homework, but on this issue, he has shown a degree of honest reflection and has genuinely contributed his experience to the debate about the future of health and social care in this country. Not only has he been honest about where he fell short, and where other Conservative Ministers may have fallen short, but he is determined to make sure that we improve the quality of the health and social care debate in this House. I very much welcome his contribution to the debate about the NHS workforce challenge.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

The shadow Minister is always kind in giving way. I want to back up his comments about Jeremy Hunt. On Lords amendment 29, does the shadow Minister acknowledge that Macmillan Cancer Support said that it needs an additional 3,371 cancer nurse specialists? That would double the nurses by 2030, and it gives us a reason why we need to support Lords amendment 29 and why workforce safety is critical.

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

The hon. Gentleman is absolutely right. If I am honest, I suspect that the Minister and the Secretary of State for Health and Social Care also agree that Lords amendment 29 is needed. I suspect the truth is that they are not the ones blocking it. They are in a Treasury-imposed straitjacket from the Chancellor, preventing them from doing what they know to be necessary for the NHS, because the Treasury would rather stick its head in the sand and not acknowledge the scale of the challenge or the reality of the cost. It hopes that ignorance is bliss and that we can carry on as we are, and perhaps nobody will notice—even the 6 million people on NHS waiting lists.

Photo of Matt Rodda Matt Rodda Shadow Minister (Work and Pensions) (Pensions)

I wholeheartedly agree with my hon. Friend’s speech; he is addressing absolutely the issues that the sector faces. All of us support the NHS and want to see it thriving. Does he agree, however, that the challenge is about the Treasury and the Prime Minister and the lack of support and understanding from the Prime Minister and the Chancellor at this crucial time, when the NHS has gone through such a difficult period?

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

I wholeheartedly agree with my hon. Friend. To be honest, I do not know whether No. 10 or No. 11 is running the show. We hear that the Chancellor also blocks the Prime Minister from time to time. I can think of a few occasions during lockdown where that would have been good, if the Chancellor had bolted the door to the back garden, but we will not dwell on that now, Madam Deputy Speaker, because you will tick me off—

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

As you already are, Madam Deputy Speaker, but I could not resist.

The problem is that unless we face up to the scale of the workforce challenge, the Government simply will not deliver the shorter waiting times that patients need until they break out of their straitjacket. They should start today; otherwise, patients will be left wondering why they are paying more in taxes but waiting longer for care.

Government Members may argue that we do not need Lords amendment 29, because there is a planned update to “Framework 15”, Health Education England’s 15-year strategic framework for workforce planning—[Interruption.] My hon. Friend Karin Smyth cannot wait; she is watching her inbox daily, waiting for it to arrive. The truth is that this is inadequate. Previous iterations of the framework have not quantified the staffing numbers needed. The Secretary of State was recently unable to confirm when he appeared before the Health and Social Care Committee that the revised framework will set out the required numbers of staff. The truth is that the recent past is littered with promises of workforce strategies and frameworks that have either not materialised or failed to deliver the action needed.

Let me turn to the Minister’s claim that we have record numbers of doctors and nurses—it is today’s equivalent of, “You’ve never had it so good.” We all know—he knows this very well—that the population is growing and ageing, and as it does so, we need the numbers of nurses, doctors and carers to keep up. This is a question not just of recruitment, but of retention. When I ask frontline staff, “What would make the single biggest difference to your morale? What would be the thing that keeps you going even though you are exhausted, stressed and burned out?”, their answer is very simple: they just want to know that the cavalry is coming and that significant numbers of staff will be recruited to help provide the support they need. Their greatest fear is that the people who have slogged their guts out to get us through the pandemic will be left alone as they try to help the NHS to recover from the pandemic and from the problems that existed before it. If we are not careful, we will risk losing those staff, creating even greater pressures—a greater cost to patient care, a greater cost to patient safety and a greater cost in recruiting and training new doctors and nurses. With the best will in the world, and with the best training available at our brilliant medical schools, doctors and nurses take years to develop the skills and experience to make them outstanding clinicians. Those are the people we risk losing at this very moment.

While I have the opportunity, may I say to the Minister that I cannot understand why there are 791 medical school graduates who still do not have a junior doctor post? These people are qualified, they are ready and there is a shortage—get them to work!

Lords amendment 30 is a power grab, pure and simple. Does the Secretary of State really believe that he knows better than those who are working on the ground in our NHS? The Bill includes a requirement that Ministers be informed of every single service change and every single reconfiguration, and the Secretary of State will then decide whether each should go ahead. They should be careful what they wish for.

As the right hon. Member for South West Surrey knows, when I was first elected to this House and he was Secretary of State, I would not stop badgering him about the future of King George A&E. Every time I did, he batted it back to the local NHS trust and said that it was a local decision driven by clinical need. In the end, we won and we did not need him, but imagine the political pain that I would have inflicted on him if I had known that he was the one who held the pen and held the power. I say to the current Secretary of State: be very careful what you wish for.

The new powers, I am afraid, are part of a theme running through the Bill of more powers being placed in the hands of Government—a theme that the Delegated Powers and Regulatory Reform Committee has described as “disturbing”. The Government have gone from wanting to be the great liberators of the NHS under the right hon. Lord Lansley—who has gone through a rather entertaining damascene conversion in the other place—to wanting to rule with an iron fist under Comrades Javid and Argar.

The powers are completely unnecessary. They risk causing a decision-making logjam and dragging national politics into local decisions about services. For reforms intended to reduce bureaucracy, they could create a significant new bureaucratic burden.

Photo of Katherine Fletcher Katherine Fletcher Conservative, South Ribble 6:15 pm, 30th March 2022

Along with Mr Speaker and Mr Deputy Speaker, I have been in a similar position in Lancashire with the A&E unit under threat at Chorley and South Ribble Hospital. Contrary to the hon. Gentleman’s point, I have found that even with a meeting with the Speaker and Deputy Speaker of the House and the Health Secretary, and with a very compelling case as to why the local trust has made the wrong decision, there is nothing in law to allow them to do anything about it. I therefore very much welcome the amendments to ensure that local bureaucrats are not too tied in.

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

I really do understand the hon. Member’s point. She would like to be able to save her services and lobby her colleagues in Government to make those decisions, but—speaking from experience—saving our accident and emergency department was not about using politics or political pressure to change the decision. Public support was really important and we did our fair share of parliamentary petitions, marches and everything we could to keep the pressure up, but in the end it was about the evidence base that we put together to save the department.

When it comes to matters of clinical provision and of providing the best services for patients, clinical factors have to be paramount. I worry about how decisions turn into a political football either side of a general election and become a party political knockabout, when the primary consideration should be patients’ safety and concerns. Although I have cited an example in which saving our A&E was the right decision, I can think of cases right across the country in which communities feel very strongly, and we understand why, but passion, emotion and sentimental attachment to particular services do not always align with the clinical interests of local populations. Patient safety and evidence must come first. I really worry about the introduction of a party political knockabout in that context.

Ministers have argued that the new powers are necessary to ensure democratic oversight of health service decisions, but the existing system allows appropriate democratic oversight and allows contentious service change decisions to be resolved. I do not believe that the wholesale upheaval of the system and the introduction of sweeping new powers for the Secretary of State are justified.

Let me now deal with some of the other amendments— very briefly, as I am conscious of time. We support Lords amendment 48, which requires the Secretary of State to ensure that health service procurement does not violate the UK’s international genocide obligations. The amendment is consistent with the UK’s obligations under the convention on the prevention and punishment of the crime of genocide.

Lords amendment 89 deals with a related issue, prohibiting organ tourism involving both forced organ harvesting and black market organ trafficking. We welcome this change in the Bill, which amends the Human Tissue Act 2004 to prohibit UK citizens from travelling to countries such as China—although the wording of the amendment is not country-specific—for the purpose of organ transplantation. The restrictions are based on ensuring that there is appropriate consent, no coercion, and no financial gain. In some parts of the world, organs are not given freely but are taken by force, and we must bear that in mind in the drafting our legislation.

Lords amendment 57 is intended to retain the current safe haven for patient data within NHS Digital, and to prevent NHS England from taking on responsibility for it. Keeping patient data safe is important. It can be powerful when it is used well, and has enormous potential for better population health and better clinical outcomes in individual cases, if data is used wisely, safely and ethically. The amendment will keep statutory protections in place for a patient data “safe haven” across health and social care, required for national statistics and for commissioning, regulatory and research purposes. It also ensures that NHS England does not take on this responsibility, because of a potential conflict of interest in its role.

Lords amendments 42 to 46 deal with procurement. We welcome these changes. The years of the pandemic have also been years of crony contracting. After the scandal of billions in taxpayers’ money being handed out to mates for duff PPE and testing contracts, and PPE literally going up in smoke—along with taxpayers’ money—we hope that this is the start of Ministers’ looking again at where they went wrong during the pandemic.

This afternoon the House faces a simple choice. We must decide whether we are going to be honest with ourselves, with the NHS and with the country about the genuine staffing challenge in health and social care—and whether we are going to have a more responsible and grown-up political debate about how we meet that challenge—or whether we prefer to be the ostriches of the Treasury, with our head in the sand, pretending that these issues will go away, hoping for the best, hoping to squeeze a bit more efficiency out of the NHS through new efficiency targets. That really will not cut it. The recruitment of staff already announced by the Government really will not cut it.

For as long as we allow this situation to continue, patients will wait longer. They wait in agony. Their health outcomes are worse, and they lose confidence in the national health service. It is the greatest institution that this country has ever built, and it is going through the greatest crisis in our history. Let us be honest about that—with ourselves, with the NHS, and with the country—and support their lordships in their amendment.

Photo of Iain Duncan Smith Iain Duncan Smith Conservative, Chingford and Woodford Green

I shall try to be brief. I rise to speak to amendments (a) and (b) in lieu of Lords amendment 48, which refers to genocide. Along with 19 colleagues, some of whom are present, I tabled amendment (b) to recognise first a problem for the Government, and secondly an absolute imperative for all of us here.

The problem for the Government with Lords amendment 48 is, I understand, the inclusion of genocide. There is a reason for that. I disagree with the Government about this, but that is where they are. The Government talk of a “competent court” having to decide questions of genocide. We have been through this again and again recently, but the fact is that we will never get a decision from a competent court when it comes to countries of the scale and dimension of China, either because they veto it in the Permanent Assembly or because they are not members of the International Criminal Court, so we cannot get them that way.

I recognise that the purpose of this is really more to do—quite rightly—with slave labour, so the title of my amendment alludes to slave labour. That is much more focused, and makes clear what I should like to think we are all after. I abhor the genocide that I absolutely believe to be taking place in Xinjiang, and I think we need to take much greater action on that, but in the context of the Bill, the purpose of the amendment was to make clear to the Government that a significant number of Members—and more would have signed it had I bothered to ask them—are very keen to see such a measure included. I say those words carefully, because I have read what the Government have written down and I have discussed this at length with the Minister and the Secretary of State, and I fully accept what they are trying to do here with this amendment on review, but that amendment on review cannot tighten up the time because it can only be post hoc, as it were, after the Bill goes through. My determination is that, by the time this Bill comes back from the Lords, we will have an amendment specific to modern slavery in it.

The reason I say that is that this is clear, with a reference even in the last two days to the use of equipment made by slave labour in Xinjiang in at least one of our hospitals. That equipment has been tested, so there is no excuse for not knowing. There is a company called Oritain—there are others—that now has the digital and genetic fingerprints of all the products from these areas. It has spent 10 years getting this information, and it can test a product and tell us not only where in rough terms it comes from but even which factory made it. There is no excuse now. This is being used in the United States, which has declared genocide, for testing these products.

The NHS is a phenomenal purchaser and has huge capability to change people’s direction. I say to the Minister that I understand that behind closed doors—if any closed doors exist in Government generally, but these ones—some members of the Government have asked the Secretary of State to do an impact assessment. We love impact assessments in Government. Most times they mean absolutely nothing because they tell us what happened before, but not what will happen in the future. That is because almost every time the Government try to forecast the future, we get it wrong. Even the Office for Budget Responsibility manages that quite regularly.

What difference would an impact assessment make to this amendment in my name and that of 19 other Members? For example, an impact assessment might tell us that we should no longer buy from a particular area because we are certain it provides through slave labour, but that the procurement would be, say, £20 million more expensive as a result. Does that impact assessment then mean we cannot do that because we do not want to lose £20 million—or £20 billion or whatever it happens to be—because that is too expensive, and that we will on balance therefore purchase from a known slave labour provider? Is that what we are saying? Is that what the impact assessment will say to us? I say to those who call for an impact assessment: be careful what you call for. There is a simple impact here: are we to purchase equipment made by slave labour?

I have also heard that someone else in the Government has said that the balance is between provision for those who need it here in the UK and our use of a product that comes from a place using slave labour. I say: be careful of that comment. It is not a choice we have to make. Our choice is to care for those here in the UK, but also to care for those who are being brutalised and beaten into product production and often losing their lives; we have to have a care for them as well. There is no choice here. It is simple: do we or do we not wish to have products in circulation in our NHS, of which we are all very proud, that were made by slave labour? This is the single point.

I understand the problem with Lords amendment 48; it is that the Government will never recognise genocide, so that amendment would never have a bearing or an effect because they would simply say, “We do not recognise that genocide has taken place in that area and therefore we are let out.” It is let-out for them. This amendment of ours is very specific. It deals with slave labour, and we can prove slave labour. So I say to my hon. and right hon. Friends: this unites the whole House. If this comes back amended either by the Government or by somebody in the House of Lords, I give a little warning—not a threat—to my Government that the choice when this comes back will be: do you support the use of slave labour or do you not support the use of slave labour? There is no other choice. It is not a moderated choice. It is very simple for us. I will vote against slave labour for an amendment coming back from House of Lords, and I believe that many of my colleagues here—all of them, I hope—will do the same. I am certain that that will be the case for those on the Opposition Benches.

I have huge regard for my hon. Friend the Minister, and very much so for the Secretary of State. I have spoken to them at length, and I believe them to be completely onside with my argument. I ask a wider group in the Government to stop it. This is more important than moderated impact assessments, which mean nothing; this is about human lives. When it comes to human lives, the best impact we can have is ending brutality, intolerance and slave labour. If we can bring that to an end, it would be the biggest impact we ever have, and we could be proud of it.

Several hon. Members:


Photo of Eleanor Laing Eleanor Laing Deputy Speaker and Chairman of Ways and Means, Chair, Standing Orders Committee (Commons), Chair, Standing Orders Committee (Commons)

Order. It has only just become obvious to me that so many people wish to speak on this group of amendments. I will have to set an immediate time limit of four minutes, which might be reduced to three minutes. People who intervened on the Front Benchers will be considered to have already made their contribution.

Photo of Geraint Davies Geraint Davies Labour, Swansea West 6:30 pm, 30th March 2022

It is, of course, 125 years since the birth of Aneurin Bevan, who famously said:

“Illness is…a misfortune the cost of which should be shared by the community”.

That cost, as Sir Iain Duncan Smith said, should not be borne by the victims of genocide, abuse or slavery, so I support amendment 48 and, indeed, amendments (a) and (b).

I am the trade rapporteur of the Council of Europe in respect of safeguarding human rights, democracy and the rule of law. I very much hope that where there is abuse or slave labour, we pursue filtering out such imports from procurement in general. Curing illness should not be at the cost of creating illness and harm abroad.

Obviously we need security of supply. We have seen China use embargoes and trade sanctions against Australian wine and Lithuanian products, or whatever, so we need a safe supply, much of it home-grown, for when we face such a problem or a pandemic. I put it to the Minister that we need to look much more at generating production and procurement in the public sector. It is no good going to the pub landlord of Matt Hancock to get expensive PPE. We need both value for money and ethical sourcing.

Some of the proposals for integrated care boards involve corporations that have a vested interest. If we remove competitive tendering, waiting lists and costs would both go up. It is critical that we get value for money.

Looking at what happened in Wales during the pandemic, we find that the cost of PPE was, in fact, half the cost of PPE in England. The £1.1 billion given to Wales for test and trace was a Barnett consequential, but we spent only half of that, £533 million, because we used public sector procurement and production effectively.

Through a combination of ethical procurement and public sector provision, we can keep the light of the health service shining, we can keep the faith and we can build a stronger, more successful and cost-effective health service.

Photo of Jeremy Hunt Jeremy Hunt Chair, Health and Social Care Committee, Chair, Health and Social Care Committee

Like the shadow Health Secretary, I rise to speak in support of amendment 29, which the Government plan to vote down. This wholly innocuous amendment simply asks them to publish, every two years, independent projections of the number of doctors and nurses we should be training. The Government are rejecting the amendment because they think it would compel them to train more doctors, which is true, but it ignores the fact that this is the best way to reduce the £6.2 billion locum bill that is currently devastating the NHS budget.

The shadow Health Secretary was very generous to me, and I return the compliment by saying that I think he is doing an excellent job. I hope he remains shadow Health Secretary for many years.

I ask the House, in the nicest possible way, to reject the compromises proposed by the excellent Minister. The Government are publishing a 15-year framework, but he knows and we know that it will simply detail the number of doctors that the Government think they can afford, not the number of doctors we actually need. In the past—even last year—when the NHS has tried to publish the number of doctors it thinks it needs, it has been stopped by the Government. Why is there this reluctance to publish the number of doctors we are going to need in 15 years’ time, given that 97% of hospital bosses say that staff shortages are having an impact on the quality of care they are giving and there are 110,000 vacancies? The answer is simple: it is because the Government know we are not training enough right now. What message does it send to young doctors, newly qualified midwives and newly qualified nurses, who are incredibly stressed and pressured by the situation on the frontline, if we are saying to them, “Look, it is really tough now, but we are not even prepared to train enough doctors, nurses and midwives for the future to relieve that stress and pressure later on in your career”?

Photo of Steve Brine Steve Brine Conservative, Winchester

I will support my right hon. Friend in standing up for Lords amendment 29, because when I look back to our time together at the Department, when we published the long-term plan and when I published the cancer plan, I know that the thing that undermined us most of all was when the stakeholders came back and said, “Where’s the people plan that goes alongside it?” Because we could not answer that, we were always playing catch-up. This Lords amendment sets that train back on the right track.

Photo of Jeremy Hunt Jeremy Hunt Chair, Health and Social Care Committee, Chair, Health and Social Care Committee

I thank my hon. Friend for that comment. He was an excellent cancer Minister. In our time, the biggest pressure was funding, but now people say that the biggest pressure is workforce. It is devastating for morale to refuse to address this issue at a time such as this. Any Government who care about the long-term future of the NHS have an absolute responsibility to make sure that we are training enough doctors and nurses for the future. Any Government who care about value for money for taxpayers should welcome a measure that will help us control a locum and agency budget that has got massively out of control. That is why opposing Lords amendment 29 makes no sense either for the Department of Health and Social Care or for the Treasury. This is why it is supported by more than 100 health organisations; every royal college and every health think tank; people in all parts of this House; many peers in the other place, including Lord Stevens, who used to run the NHS; and—this is the point I wish to conclude with—by thousands of thousands of doctors and nurses on the frontline.

Photo of Roger Gale Roger Gale Conservative, North Thanet

Is it not the case that what my right hon. Friend is proposing is custom and practice in very many developed countries already?

Photo of Jeremy Hunt Jeremy Hunt Chair, Health and Social Care Committee, Chair, Health and Social Care Committee

It is absolutely the case. We need something like this because, as I know—I will do my self-reflection now—when a Health Secretary negotiates a spending settlement with the Chancellor, the number of doctors they are going to have in 10 or 15 years’ time is quite low down their list of priorities because they are thinking about immediate pressures. So we need something that deals with that market failure. I did set up five new medical schools and was proud to do so, but I do not know whether that was enough. That is why we need something to make sure that we never have to worry, whoever the Government and the Health Secretary are, that this fundamental thing that is vital for the future of the NHS for all of us is always properly looked after.

Let me conclude by remembering what we were discussing this morning in the Ockenden review. We talked about the agonies faced by families. We did not talk enough about the agonies faced by doctors, midwives and nurses who find themselves responsible for the death of a child—it is psychologically incredibly devastating for them. We need to be able to look them in the eye and say, “The No. 1 thing in the Ockenden review that came out was that staffing shortfalls can make a difference. We understand that.” They know and we know that there is no silver bullet; this cannot be solved overnight. It takes seven years to train a doctor, 10 years to train a GP and three or four years to train a nurse or a midwife. No one is expecting a solution tomorrow, but we do at least have a responsibility to look each and every one of those people, who worked so hard for us in the pandemic, in the eye and say, “We do not have a solution right away but we really and truly are training enough for the future.”

Photo of Daisy Cooper Daisy Cooper Liberal Democrat Spokesperson (Health and Social Care)

The Minister made a valiant effort to dissuade some of us from supporting Lords amendment 29—the workforce amendment—but I suspect he knows he is not kidding anybody.

We have learned today that public satisfaction with the NHS is at its lowest level since 1997. We should not underestimate the blow that that news will deliver to the health and care workers who turn up, do an amazing job, and go above and beyond every single day. To say that that news is dispiriting is an understatement. It is important that those workers know that the public, and every Member of this House, loves our NHS; it is just that we want it to work a bit better. It is hardly surprising that people’s biggest frustrations are waiting times, a lack of proper funding and staff shortages. Those things are the fault not of health and care workers but of this Tory Government, who are driving our health and care services into the ground.

Cancer Research UK says that without the workforce amendment the Bill will fail to address the biggest barrier to the achievement of world-class cancer outcomes in the UK: the staffing shortages and pressures. The King’s Fund has said that the health and care workforce crisis will be the key rate-limiting factor in the reduction of the NHS elective care backlog. The workforce amendment may not be a silver bullet, but it is the closest thing to one, which makes it all the more frustrating that the Government will not accept it. As I suspect the Minister knows, the Government’s objections just do not stand up to scrutiny.

As Jeremy Hunt said, framework 15 simply sets out the number of staff the Government think they can afford, rather than the number of staff we actually need. I urge the Minister to think about what message that sends to my constituent, who is a newly qualified midwife. She wrote to me just a couple of months ago and said:

“I am extremely concerned about the crisis in maternity care. This isn’t caused by Covid-19—the systemic failings have been crippling the service for a generation—but the pandemic has made a bad situation worse.”

She said:

“I am being harmed, my clients are being harmed. Staff are being harmed. For every 30 newly qualified midwives, 29 are leaving. Parents are reporting bullying and coercion. Threats are being used to ensure compliance. Unnecessary medical interventions are at epidemic levels. Trauma—amongst parents and midwives—is rife.”

She said that “concerns are being missed” and interventions “made too late”, and that the reason was “staffing problems.” If that is not a wake-up call, I do not know what is.

I wish briefly to express my concern about the powers the Bill will give the Secretary of State. At best, the change will create a bureaucratic nightmare; at worst, it will lead to meddling and the politicisation of the day-to-day running of the NHS. The Government have tried to argue that the pandemic showed the need for Ministers to have more powers, but we know that during the pandemic the Secretary of State had powers over PPE and test and trace, both of which issues were handled extremely badly. The NHS’s operational independence is critical, but it will be undone by the introduction of the Henry VIII powers in the Bill, so Liberal Democrats will oppose them.

Finally, I congratulate Sir Iain Duncan Smith on his impassioned speech. I agree with him wholeheartedly that we have a duty as a nation and as a society to ensure that the goods used in our publicly owned NHS are not tainted by modern slavery or linked to the behaviours that may lead to genocide.

Photo of Derek Thomas Derek Thomas Conservative, St Ives

I rise to speak in support of Lords amendment 29, in the context of those who suffer brain tumours. I wish to take a moment to reflect on the fact that Tom Parker, a member of The Wanted who had done so much work to raise awareness of brain tumours and who worked with the all-party parliamentary group on brain tumours, which I chair, died today of his brain tumour. I wish to take a moment to remember him, his family and the two young ones he has left behind.

As I say, I chair the APPG on brain tumours, so I wish to discuss the need for Lords amendment 29 in that context. As we have heard, there is currently no data on how many healthcare staff the country needs, but we know that staff are overstretched. As we heard from my right hon. Friend Jeremy Hunt, £6.2 billion was spent on locums in the financial year 2019-20 to plug the gaps. The NHS and social care will never be able to keep up with demand without regular assessment of the numbers needed. As we know, the Government have so far dismissed this workforce planning amendment on the basis that the Department of Health and Social Care has commissioned a long-term strategic framework. We have heard already this evening why that is not good enough, although I am extremely aware of how much the Minister is engaged in, and concerned about, this workforce subject, and he has been generous with his time in talking to colleagues about what the Government hope to do.

Lords amendment 29 puts measures to adopt a sustainable long-term approach to workforce planning on a statutory footing. Regular, independent public workforce projection data will not solve the workforce crisis. However, a collective national picture of the health and care staff numbers needed now and in future to meet demand will provide the strongest foundations for taking long-term strategic decisions about funding, regional and specialty shortages, and skill mix. The regionality issue is very important for an MP who represents west Cornwall and the Isles of Scilly, as we have enormous problems in getting the skills that we need.

Let me turn to the issue of brain tumours. The National Institute for Health and Care Excellence recommends that both cancer and brain tumour sufferers have access to a clinical nurse specialist. A CNS plays a vital role in providing high-quality cancer care, and in supporting people diagnosed with a brain tumour, including by requesting scans, accompanying patients to clinics, co-ordinating their care, and signposting to available support services. For those diagnosed with a brain tumour, access to a clinical nurse specialist is crucial due to the challenges associated with co-ordinating their care. There are often multiple clinical professionals involved in their care, making the role that the CNS plays as an anchor and a central point of call for the patient incredibly important. That is why every brain tumour patient, whether living with a high or low-grade brain tumour, should have access to a CNS or a keyworker, as recommended by NICE. However, the workforce is incredibly stretched, and despite doing everything possible to deliver high-quality care, there are not enough staff to give every patient the support they need.

In a survey run by the Brain Tumour Charity, nearly one in six respondents with a brain tumour said that they were not given any access to a clinical nurse specialist, and 59% of respondents were able to speak to a keyworker, but that was all. In addition, the 10-year plan recommended holistic needs assessment provision, but for that, time and staff are needed. Ultimately, this challenge comes down to the NHS workforce. In the 2021 spending review, the Government announced funding specifically for the NHS workforce, but we recognise this afternoon that Lords amendment 21 is the only way for the independent assessments to deliver current and future workforce needs.

Photo of Peter Dowd Peter Dowd Labour, Bootle 6:45 pm, 30th March 2022

I concur with the comments made by every hon. and right hon. Member today, with the exception of the Minister. There is no question but that the NHS workforce is in crisis; that is what so many organisations say. The Government response has been limited to stopgap measures, so I am grateful to the Lords for their hard work on this Bill, which has been much improved since it left the Commons. The Lords are clearly on the side of the NHS. I hope that, even at this late stage, the Government will recognise that Lords amendment 29, which I support, is perfectly reasonable, and will welcome it with open arms. If they do not, the question is: why not?

I have had many emails from nurses and other healthcare professionals who are calling for such a measure to be supported. The amendment refers to a report on workforce needs, and says that it must include independently verified assessments of current and future workforce numbers required to deliver care to the population of England. What is wrong with that? It seems perfectly sensible. Planning the NHS workforce is central to the smooth operation of the service. The Lords amendment seeks to ensure that.

In north-west England, NHS vacancy rates have increased over the past year; they are reaching 13,500. That puts huge strain on the remaining workforce. There is a chronic workforce shortage in the NHS, driven by years of insufficient investment, and that needs to change. Mental health issues, alongside covid-related absences, are having a lasting effect on the mental health of NHS staff. British Medical Association surveys have consistently shown that the pandemic has, since its start, left staff reeling, and they are increasingly burned out as a result of the lack of support.

The number of people in the general practice workforce has lagged behind demand in recent years, as people have said time after time, and the pressure is becoming unsustainable. It is driving GPs out of the workforce and threatening to destabilise general practice. That is also the case for many other allied professionals across the whole spectrum. To address that, it is vital that the Government develop and implement a detailed plan to fill workforce shortages, but they have not yet seized that opportunity. The granularity of the assessment of the workforce situation sets the scene for the bigger picture. The chronic lack of resources and support has been keenly felt in the Liverpool city region. Hospital trusts in Liverpool plan to reintroduce car parking charges for NHS workers from 1 April. After everything those workers have done during the pandemic, it is dreadful that, in the midst of a cost of living crisis, they are being asked to cough up substantial resources just to get to work.

Workers are working two, three or four extra shifts per week. That is dangerous. NHS healthcare workers in Southport and Ormskirk Hospital NHS Trust and St Helens and Knowsley NHS Trust are campaigning to be re-banded because they are doing work that they should not have to do, and that they are not necessarily trained for. That is why I support Lords amendment 29, which is sensible and proportionate. As for the Chair of the Health and Social Care Committee, I say: there are 100 healthcare and related organisations saying, “This amendment is the right thing to do.” If those on the frontline think it is the right thing to do, why do the Government not also think it is the best thing to do?

Photo of Mike Wood Mike Wood Conservative, Dudley South

At its best, our national health service provides truly world-class care. That is down to the skill, passion and professionalism of its workforce. As hon. Members will know, I have personal reason to forever be grateful to the NHS, and particularly the staff at Russells Hall Hospital in Dudley. While new hospitals, equipment and technology are all crucial, they are nothing without the health and social care staff who are the beating heart of our health service.

However, I am concerned that Lords amendment 29 does little more than add to an already onerous level of bureaucracy in our NHS. Providing a report every two years instead of every five does not improve the record number of doctors and nurses. The Government are already committed to reviewing the long-term strategic trends in the health and social care workforce, and to developing a workforce strategy, and clause 35 of the Bill already commits to a workforce review every five years. That in itself will be quite an arduous task.

Huge steps have been taken in investing in the future of the NHS workforce, including by funding a 25% increase in places since 2016-17. That means 7,500 more medical schools training places in England over the past six years. The shadow Health Secretary is obviously right to say that the population has grown in recent decades, but I think it has grown by 8% since 2010, while the number of doctors working in our NHS is up by about one third. Clause 35 allows for medium and long-term workforce plans, and offers a sensible balance between the need for such work and the need to minimise unnecessary bureaucracy. That is why I will not support the amendment.

Turning to Lords amendment 30, while I recognise the arguments made by Opposition Members, I do not agree with them or believe that clause 40 should be removed from the Bill. I believe it contains sensible powers. We expect the Secretary of State to be responsible for our national health service—for the services provided in every part of the country. There was much opposition and controversy when provisions reducing that responsibility were introduced in previous legislation. If he is to exercise that responsibility, he must have the powers to do so.

Voters and Members of Parliament expect the Secretary of State to be able to take action where health services have been reduced. On 11 November, a few weeks before the by-election in North Shropshire, the leader of the Liberal Democrats, Ed Davey, questioned the Prime Minister at Prime Minister’s questions about the closure of Oswestry ambulance service. If we are to question the Prime Minister or the Health Secretary on the closure of services such as ambulance stations or hospitals, then it is only right that the Secretary of State should, in extreme circumstances, have the power prevent those closures. Our voters expect that, and frankly so do the Opposition.

Photo of Justin Madders Justin Madders Shadow Minister (Future of Work), Shadow Minister (Business and Industrial Strategy)

I wish to speak to Lords amendment 29 on the workforce. The most important thing I learned during my five years as a shadow Health Minister is that everything comes back to the workforce. We can have the grandest plans, strategy documents, reorganisations, integrations and configurations—all of which are probably in this Bill, in various forms—but it will all count for very little if the fundamental cog in the machine, the workforce, is not a central part of those plans. The consistent failure to invest in, and provide a plan for, the workforce, so that it can meet demand over a sustained period is at the root of the challenges that the NHS and social care face today. We now have a chance to correct that.

Let us look at some of the challenges. There are 93,000 NHS staff vacancies; £6 billion-plus has been spent on temporary staff to fill gaps; and more than half of staff are working unpaid extra hours each week, with 44% saying that they have felt ill with work-related issues—little wonder, given that retention remains a huge issue. We need a plan, and we need to give staff some semblance of hope that we are listening—that the claps on a Thursday were not just an empty gesture; that the tributes that we rightly pay here to their dedication are not meaningless platitudes; and that there is a determination to do something about the persistent rota gaps that mean that staff are both exhausted and demoralised.

The Health and Social Care Committee report on staff burnout says:

“It is clear that workforce planning has been led by the funding envelope available to health and social care rather than by demand and the capacity required to service that demand.”

That is rather the nub of it. Health and social care are both demand-led systems, yet the funding and therefore the workforce capacity are not linked to demand. Until that central issue is addressed, we will keep coming back to the many varied and unfortunate consequences of an overstretched and under-resourced workforce.

I suspect that the Minister—who I have a lot of time for, even though he is often wrong on these things—might privately think that a long-term workforce plan might be a good idea, not just to ensure that the NHS can plan properly and to move forward on a sustainable footing, but because that might help his Department when it goes into negotiations on the spending round with the Treasury, as it will be able to point to an independently verified assessment of workforce need. If the amendment has a weakness, it is that it does not ensure that any plan is actually feasible, because there is no requirement in it that any plan be fully funded. However, a plan that shows, for all the world to see, a clear funding gap would be helpful to the Minister, because it would allow him to go to the Treasury with a clear and objective demand. As he knows, I like to be helpful to him, so I hope that on this occasion he can support the amendment.

This debate is timely because it comes on a day when two surveys have been released that lay bare the crisis that we face. One survey shows that public satisfaction ratings with the NHS are reported to be at a 25-year low—a quarter of a century of surveys there—and another shows that the number of NHS staff who would recommend their trust as a place to work has plummeted. Those two facts are intertwined and symptomatic of the workforce crisis that the amendment is trying to address.

The question we must ask ourselves, if we choose not to support the Lords amendment, is whether the Government’s existing plans create sufficient accountability and rigour to deliver the transformative approach that the amendment would. In my view, it introduces a level of robustness to workforce planning that is currently missing. For the reasons I have set out, we owe it to the workforce, to patients and to those in receipt of social care to put workforce planning on the strong footing that the amendment would deliver.

Photo of Eleanor Laing Eleanor Laing Deputy Speaker and Chairman of Ways and Means, Chair, Standing Orders Committee (Commons), Chair, Standing Orders Committee (Commons)

I am surprised that Jim Shannon does not wish to speak. [Interruption.] Oh, he does. I hope he will be brief, so that the Minister will have time to answer the debate.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I certainly will make my points quickly. My first is on the organ transplant amendment, to which the Minister referred. I fully support the measure and have been asking for it for a number of years in the House, so I am pleased to see it moved tonight. Secondly, I am not sure whether Sir Iain Duncan Smith is going to push his amendment to a vote—[Interruption.] He is not, but if he did, he would have my support and probably that of my party, too.

Thirdly, I am pleased to lend my support to Lords amendment 29. It would create a national independent view of how many health, social care and public health staff are needed to keep pace with projected patient demand over the next five, 10 and 20 years. I wholeheartedly agree with Macmillan Cancer Support that the Bill will fail to address the biggest challenge facing the NHS and social care right now: staffing shortages and pressures. The Government need to take Lords amendment 29 seriously. Justin Madders referred to it, too. We recognise that we need to address staff shortages as soon as possible. I have referred to Macmillan and their request for an additional 3,371 cancer nurse specialists to help address that issue.

I will conclude with this point. I understand that the Government may come back with all the justifications as to why this is not the right amendment—the Minister is a real good man; we all know that, and he responds well to all our requests—but I am content that it would begin to address the issue that our NHS workforce is disintegrating. One of my constituents is in a prestigious medical school here on the mainland. She went to do her rotation with a GP as part of the work she does. He told her, “Do any job but this.” I thought that was disappointing. He said, “It will consume your life. You will work long hospital shifts and you will not have a personal life.” This is a seasoned GP who simply cannot cope, so we must do something, and this amendment is a way forward. I therefore will support it whenever it comes to a vote.

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care) 7:00 pm, 30th March 2022

As ever, I thank hon. and right hon. Members from all parts of the House for all their contributions to this important debate on an important set of amendments. Even if I do not always agree with everything he says, I welcome in particular the contribution from Justin Madders. He and I spent a productive period—I was going to say happy—sitting opposite one another for two days a week over many weeks in Bill Committee, taking this legislation through. While I miss him from his previous role as effectively my shadow, I wish him well in his current shadow ministerial role. I also put on record my gratitude, although he cannot be here today, to Alex Norris for his work on the Bill.

I gently tease, and this is no reflection on the current shadow Minister, that in Committee it took two shadow Ministers to try to keep me on my toes. It appears today that it takes three, but in saying that I cast no aspersions on the shadow Secretary of State, Wes Streeting, who I am fond of, even when he is gently or less so gently pushing me on certain issues.

I turn first to the organ tourism amendment, and I am grateful to the shadow Secretary of State for his approach on this issue. We have a shared objective here, and I assure Members that our approach would target not only transplant tourists, but anyone involved in making the arrangements for the purchase of the organ who may be a British national. The Government amendment, paired with our commitment to work with NHS Blood and Transplant to make more patients aware of the legal, health, and ethical ramifications of purchasing an organ, will send an unambiguous signal that complicity in the abuses associated with the overseas organ trade will not be tolerated.

Turning to reconfigurations, I strongly believe that the public rightly expect Ministers to be accountable for the health service, which includes the reconfigurations of NHS services. This House rightly voted to retain these clauses on Report. The reconfiguration power will ensure that decisions made in the NHS that affect all our constituents are subject to democratic oversight. Without it, the Secretary of State’s ability to intervene and take decisions will remain limited, and usually be at a very late stage in the process. Although I hear what hon. Members have said, I note that many hon. Members from both sides of the House none the less seek to persuade the Secretary of State and seek to raise issues relating to their local services with the Secretary of State with a particular outcome in mind.

As now, the Secretary of State would not be alerted to a potential change in services until the change had become a relevant issue and would not be able to intervene without that formal referral. We have retained the independent reconfiguration panel. The shadow Secretary of State raised the issue of the clinical appropriateness of the changes. Nothing that is proposed here alters the fact that clinical appropriateness and clinical and patient safety remain central to any decisions and remain an obligation on the Secretary of State in any decisions that he or she makes in that context.

Briefly, on the remarks of the shadow Secretary of State about waiting lists, he will be aware that we published a comprehensive and ambitious but realistic elective recovery plan that is backed by record funding and resources for the NHS to tackle those waiting lists, which have grown as a result of the pandemic. I am straight enough with him to recognise that there were waiting lists before the pandemic. He always makes that point and I highlight that we have a plan to fix that, which is exactly what we are doing.

The shadow Secretary of State also highlighted several other factors relating to the workforce and the workforce clause, as did my right hon. Friend Jeremy Hunt, the shadow Secretary of State—sorry, the Chair of the Health and Social Care Committee; I do not think we will be fielding shadow Secretaries of State from the Conservative Benches for some time yet. I entirely understand where my right hon. Friend is coming from on this issue, but I believe the approach that the Government have adopted, with the framework 15 commission and review and the broader commission that the Secretary of State has set out to look at drivers of workforce supply and demand, absolutely reflects our recognition of the centrality and importance of the workforce, and the right workforce, to the delivery of all our ambitions for constituents and for recovering waiting lists and waiting times.

We have not waited for any projections to get on with that; we are already investing in increasing our workforce and we are seeing record numbers of people working in our NHS. I have already highlighted that we are well on target to meet the commitment of 50,000 more nurses, with a current increase in the number of nurses of 27,000. Daisy Cooper highlighted the same issues in her remarks.

I am particularly grateful to my right hon. Friend Sir Iain Duncan Smith for his contribution on a challenging issue. There is a considerable degree of consensus on both sides of the House about the abhorrence of modern slavery, slavery or anything linked to it. We remain of the view that this is not the right legislation for the proposed changes.

As I set out in my previous remarks, new rules for transforming public procurement will further strengthen the ability of public sector bodies to exclude suppliers from bidding for contracts where they have a history of misconduct—or extreme misconduct in the case of slavery, forced labour or similar. In developing the modern slavery strategy review, it will continue to be important to engage across Government and civil society, nationally and internationally, to collect the necessary evidence to agree an ambitious set of objectives. It is right that the Government take action on the crime of modern slavery and it is right that the NHS is in step with all public bodies in doing so.

From listening to my right hon. Friend, I expect the issue to reappear when their lordships consider our amendments. In that context, I hope that he and other hon. Members are willing to continue to engage with the Government and my Department on this hugely important issue. As he rightly said, it is important not just in this House but outside this House to those we represent. I look forward to continued engagement with him.

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

I have literally 30 seconds left, so if my right hon. Friend’s intervention can be in five seconds, I will give way.

Photo of Iain Duncan Smith Iain Duncan Smith Conservative, Chingford and Woodford Green

Can the Minister tell his colleagues in the Government that there is never a good time? Now is the right time, and let us get on with it.

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

I think that was exactly five seconds, and I am grateful to my right hon. Friend. I suspect that colleagues across Government will have heard what he said and will pay very careful attention to it, as I know Ministers across Government do to all that my right hon. Friend says in this House.

With that in mind, I ask the House to accept the motions in my name on the amendment paper.

Photo of Eleanor Laing Eleanor Laing Deputy Speaker and Chairman of Ways and Means, Chair, Standing Orders Committee (Commons), Chair, Standing Orders Committee (Commons)

I congratulate the Minister on his perfect timing. That is very rarely done with such precision.

Question put, That this House disagrees with Lords amendment 29.

Division number 238 Health and Care Bill — Clause 35 - Report on assessing and meeting workforce needs

Aye: 243 MPs

No: 165 MPs

Ayes: A-Z by last name


Nos: A-Z by last name


The House divided: Ayes 249, Noes 167.

Question accordingly agreed to.

Lords amendment 29 disagreed to.

More than four hours having elapsed since the commencement of proceedings on Lords amendments, the debate was interrupted (Programme Order, this day).

The Deputy Speaker then put forthwith the Questions necessary for the disposal of the business to be concluded at that time (Standing Order No. 83F).