NHS Workforce Expansion

– in the House of Commons at 1:47 pm on 28 February 2023.

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Photo of Roger Gale Roger Gale Deputy Speaker and Chairman of Ways and Means, Deputy Speaker 1:47, 28 February 2023

We now come to the first Opposition day motion, on the subject of expanding the NHS workforce. I have to inform the House that Mr Speaker has not selected the amendment.

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care 1:57, 28 February 2023

I beg to move,

That this House
condemns the Government’s failure to train enough staff to tackle the worst workforce crisis in the history of the National Health Service with a current shortage of 9,000 hospital doctors and 47,000 nurses;
notes reports that the draft NHS England workforce plan calls for a doubling of medical school places to address this crisis;
calls on the Chancellor of the Exchequer to use the upcoming Spring Budget to end the 200-year-old non-domiciled tax status regime;
and further calls on the Government to use revenue generated by ending that regime to adopt Labour’s plan to expand the NHS workforce by doubling the number of medical training places, delivering 10,000 more nursing and midwifery clinical placements, training twice the number of district nurses each year and delivering 5,000 more health visitors.

To anyone who has needed medical care in recent months, it is blindingly obvious that the NHS is desperately in need of more staff. Doctors and nurses are overworked, hospitals are understaffed and the staff are burnt out. Patients are waiting longer than ever before, and 13 years of the Conservatives’ failure to train enough staff has broken the NHS, leaving patients to pay the price. In the words of Sir Edward Leigh, Labour has a plan; where is the Government’s?

Photo of Edward Leigh Edward Leigh Conservative, Gainsborough

The point I have been trying to make in recent months is that we should try to learn from the experience of Europe, where they have very effective social insurance systems and much more effective outcomes, so when the hon. Gentleman says he has a plan, I think we would all like to know what the plan is. Is it radical reform, or is it just more and more taxpayers’ money thrown into the NHS?

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

I am grateful beyond words for that intervention. I will outline Labour’s plans immediately and return to the right hon. Gentleman’s challenge—proposing a social insurance system—a little later in my remarks.

The point of this debate is that there is a serious shortage of staff. Labour has a plan to address that shortage, whether that is measures for retention of the staff we have or our plan for the biggest expansion of the NHS’s staff in history. The Conservatives have no plan, so let me outline what Labour’s plan is. We will double the number of medical school places so that we train 15,000 doctors a year. We will train 10,000 new nurses and midwives every year. We will double the number of district nurses qualifying each year and train 5,000 more health visitors. In a formula that will become familiar in the run-up to the next general election, we are clear about how we would pay for it, too. We will pay for it by abolishing the non-dom tax status, because patients need doctors and nurses more than a wealthy few need a tax loophole.

Photo of Catherine West Catherine West Shadow Minister (Foreign and Commonwealth Affairs)

Does the shadow Secretary of State agree that it is not just about cash; it is also about the huge recruitment issues? For example, the North Middlesex University Hospital has 800 patients a day into accident and emergency, and it is suffering because even if there is the budget, there simply are not the staff to employ to put on the frontline?

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

My hon. Friend is absolutely right, and it is why current staff in the NHS are right to say that retention is urgent and that we need measures from the Government immediately to deal with retention. By definition, if we have a shortage of staff, retention is not enough, and that is why Labour has put forward a fully costed, fully funded plan for the biggest expansion of NHS staff in history.

Photo of Yasmin Qureshi Yasmin Qureshi Shadow Minister (Equalities Office)

Does my hon. Friend agree that the £1.3 billion that the NHS spent on agency staff last year could have been used to recruit proper, full-time NHS staff?

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

I wholeheartedly agree. It is why we are in the worst of all situations: the shortage of staff means not only that patients are receiving poorer care, but that we are paying over the odds as taxpayers for the Conservatives’ failure to recruit and retain the staff we need.

We are not alone in thinking that the biggest expansion of NHS staff in history and doubling the number of medical school places is the right solution. Amanda Pritchard, the chief executive of NHS England, has rightly said that we need greater investment in training to stop excellent British students being turned away. The Royal College of Physicians has called for medical school places to be doubled, and now the NHS is formally asking the Government to fund it. Why are the Government refusing to fund a doubling of medical school places, which the NHS and the Royal College of Physicians say is necessary, and which patients can see through experience is desperately necessary?

Photo of Luke Evans Luke Evans Conservative, Bosworth

I am grateful to the shadow Secretary of State for bringing me in on this point. Training is really important. As someone who has been a medical student, I know that one of the most important things to look at is how many people will be on one’s firms. We do not want 12, 15 or 20 people all coming into a cubicle to see a patient. Although I welcome the idea of expansion, can he talk me through what the ratio will be on ward rounds for medical students being trained?

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

I am glad that finally Government Members have noticed that Labour has got a plan and are asking how it will work; I wish that Government Ministers would join in. The proposal we set forward to double the number of medical school places is based on modelling put forward by the Royal College of Physicians, which understands perfectly well the points the hon. Member makes. I have had excellent meetings with university vice-chancellors, who are keen to roll up their sleeves and help. The reason we set out a plan this far from a general election was for two reasons. First, we want to give medical schools and NHS employers time to prepare for the expansion. Secondly, we hope that the Government adopt this plan to give the next Labour Government a head start. I very much hope, as this motion says, that the Chancellor will take our plan and incorporate it into his Budget, and I will cheer him if he does so.

I will tell the House how ludicrous the situation is today. There are medical schools in England today that are exclusively training international students, many of whom will leave upon graduating, while at the same time we are turning away thousands of straight-A students from our own country who want to help the NHS. Brunel University is training 100 new doctors, with not a single UK student. Chester University has deferred the launch of its medical degree by a year because the Treasury will not give it a penny. Local NHS trusts and charities have chipped in to fund 20 UK medical student places at Three Counties Medical School at Worcester University, because the Government are refusing to fund a single domestic student. Despite pleas from the NHS, the Minister for Skills, Apprenticeships and Higher Education, Robert Halfon, has threatened to fine medical schools if they increase their offers to applicants next term.

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

I am almost certain that Mr Bone will not agree with his universities Minister.

Photo of Peter Bone Peter Bone Conservative, Wellingborough

The hon. Member is making an interesting speech. On the point about retaining people from overseas going into medical training, who he said will then qualify and leave, does he think there is an argument for having an arrangement of the sort they have in the airline industry, whereby someone who is trained here then has to work here for a certain number of years, or otherwise repay the cost? Does he think that would help the situation?

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

There are a couple of challenges with that approach. First—I want to be clear about this—having international students come to study at UK universities is a wonderful thing. It is wonderful for British students who mix with cohorts drawn from across the world, and it is wonderful because they contribute to the cultural and intellectual life of our universities, and of the towns and cities in which they live while studying here. It is a wonderful thing because they often return to their countries with fond memories of Britain, which is an extension of our soft power and diplomatic influence. Those are all great reasons why we should cherish, embrace and welcome international students, and it is why I hope the Home Secretary does not win the argument inside Government to restrict further access to international students. Finally, I should say that international students also pay an enormous amount to come and study here in the UK, and they subsidise home students.

I want to be clear about how much I welcome international students, but it is an absurdity that people are coming to this country to study in medical schools that have no British students. It is an absurdity, when we have a chronic shortage of doctors, nurses, midwives and allied health professionals, that we see straight-A students from our own country being turned away, while university medical schools are being told they can only recruit international students. That is the depths of stupidity that this Government are plumbing.

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

I commend the shadow Minister for his thoughts. The poaching of junior doctors by Australia, for example, for better pay and working conditions, as opposed to fractured shift patterns here, is a major issue. It is not just about expanding the workforce, to which he has referred; it is also about having a careful and concerted campaign to retain staff here. Does he agree that has to be part of the thrust of this debate?

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

I wholeheartedly agree with the hon. Member. I will talk about this later in my speech, but it is why the Government have to resolve this pay dispute with existing NHS staff. The danger is not that they walk out for another day of strike action, but that they walk out of the NHS altogether for countries that treat them better. What an absurd position to be in. It is also absurd, by the way, that we still have doctors retiring early for no other reason than that the pensions rules create an active financial disincentive to work up to normal retirement age, as many of them would like to do. It is completely absurd.

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

I am happy to give way to the hon. Member again, but may I gently suggest that he would be better off lobbying current rather than future Ministers?

Photo of Luke Evans Luke Evans Conservative, Bosworth

As the hon. Gentleman sees himself as a future Minister, what is his solution for the pensions position for consultants?

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

I am delighted that the hon. Member asks. I had a good meeting with the British Medical Association pensions committee recently. There are a number of ways in which this matter could be resolved, one of which might be a tax-unregistered scheme, which we have seen used successfully in the judiciary. [Interruption.] I am perfectly fine with having a tax-unregistered scheme. I think the difference between the Opposition and the Government is that the Government have an army of civil servants to do the modelling. That is what I would like the Government to do. I say to the hon. Member again that it is no use lobbying the next Government—lobby the current Government.

Turning again to the international picture, the NHS is having to recruit from countries on the World Health Organisation’s red list—countries that desperately need the few doctors and nurses they have—because our Government cannot be bothered to train their own. I think that is unethical, immoral, a disgrace and a kick in the teeth for the UK students who desperately want to be the doctors, nurses, midwives and allied health professionals that our country needs.

The Chancellor is refusing to budge, I believe, on cost grounds, but Labour’s plan before the House today would cost £1.6 billion a year. We have shown how we would pay for it: scrapping non-doms would raise more than £3 billion. If the Chancellor needs any tips about the non-doms system, or if perhaps he is worried that non-doms might flee the country, he need only knock on his next-door neighbour’s door to see a case in point. He will find out how the system works, and that when people are asked politely to pay their taxes here, they do not flee the country.

Inaction also has costs. The NHS spent an eye-watering £3 billion on agency staff last year. One hospital was so desperate that it paid £5,200 for a doctor to work a single shift. Does that not sum up the approach of this Government: penny wise and pound foolish?

Photo of Alex Sobel Alex Sobel Shadow Minister (Environment, Food and Rural Affairs)

My hon. Friend is making a remarkable speech. My constituent Marjorie Dunn spent seven weeks and a day in Harrogate Hospital last year, and in that time she saw NHS nurses leave the service and she was treated predominantly by agency staff—mistreated, I have to say, by agency staff. It is a disgrace. When she was eventually moved to a recovery hub run by Leeds City Council, she got excellent treatment there. She had broken her pelvis and been told she would never walk again, but it was the council physiotherapist who got her up and walking again. Is it not right that we should be supporting local authorities such as Labour-run Leeds to get such facilities as well as the NHS?

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

My hon. Friend is absolutely right. I very much enjoyed my visit to Leeds with the shadow Chancellor to look at the work the acute trust is doing with Leeds City Council to speed up delayed discharges. He is absolutely right about the impact of the churn of staff on a ward—because they are not regular staff on a contract of employment at a particular hospital or medical facility—and it can be quite distressing for patients to see the faces and names change every day and to constantly be explaining once again what their experience in the hospital has been, if indeed the staff have time to stop and talk.

I am really struck by the fact that one of the biggest issues that staff raise with me is the moral injury. The fact is that they are busting a gut and working their socks off, and they go home at the end of the day deeply demoralised, distressed and depressed because they know that, despite their very best efforts, they are not providing the quality of care that patients deserve, through no fault of their own. That is why, even above the issues of pay and of terms and conditions, which I think many of us would understand in and of themselves, I think the straw that is breaking the camel’s back is the moral injury. Unless we address that, we are going to lose the brilliant staff we have, before we even start to think about recruiting the staff we need.

Photo of Grahame Morris Grahame Morris Labour, Easington

I am very grateful to my hon. Friend for giving way before my knee does. Clearly, he is a man with a plan. Is it not incredible that we do not have a plan for dealing with cancer—the Government have dropped the 10-year cancer plan—particularly at a time when 50,000 patients a month are having to wait more than two weeks between diagnosis and seeing a specialist? We need a plan that incorporates workforce recruitment and retention.

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

I apologise for keeping my hon. Friend bobbing—the last thing the NHS needs is another patient, so I hope the exercise has been good for his joints rather than the straw that breaks that camel’s back.

My hon. Friend is absolutely right. I think cancer treatment is in many respects the canary in the coalmine, because it is an area where speed really does matter and where early detection can make a huge difference to the success of the outcomes. It is why, when we were in government, we had a cancer guarantee. By pursuing that cancer guarantee and making sure that patients received timely access to both diagnosis and treatment, the rising tide for cancer patients lifted all ships, and we saw a general improvement in the NHS, so that by the time we left government we had the lowest waiting times in history.

I am deeply anxious that within those waiting lists, which stand at a record in excess of 7 million now, will be a huge amount of undiagnosed cancer. As I know from personal experience of going to accident and emergency with something else, it is often in A&E departments that cancer is detected. I worry how many cancer patients like me will arrive at A&E, see the waiting times and walk away with a cancer undiagnosed. It certainly keeps me awake at night, and it should keep Ministers awake at night too.

Photo of Bambos Charalambous Bambos Charalambous Shadow Minister (Foreign, Commonwealth and Development Affairs)

I congratulate my hon. Friend on an excellent speech. Is he aware that Macmillan Cancer Support has today published research showing that 2022 was the year in which all national cancer targets were missed in at least one month? That is truly shocking, and it is why we need an NHS workforce plan urgently. Does he agree that it is about time the Government came forward and produced such a plan?

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

I wholeheartedly agree with my hon. Friend. Unless the NHS has the staff it needs, patients will not get the timely care they deserve. It really is as simple as that. We have a plan; the Government do not, and they are very welcome to take ours.

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

The shadow Secretary of State is making a very good speech. On the issue of cancer, around half of cancer patients need radiotherapy, but barely a quarter get it. One reason is that the workforce in radiotherapy is small— 6,400 people. At the moment, the number of posts vacant in radiotherapy centres is 30% higher than the number of new graduates leaving college and coming into the professions that make up that workforce. We also found in the Radiotherapy UK survey that 80% of the workforce in radiotherapy centres reported that either they or a colleague had considered leaving. Does he think that the cancer workforce is essential to a cancer plan that will actually save lives?

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

The hon. Gentleman is absolutely right, and I have been following his work and that of the all-party parliamentary group on radiotherapy in this area, because he raises issues that ought to be taken very seriously. I was very grateful to my hon. Friend Grahame Morris for coming to meet me about these challenges in particular. Of course, this has to be at the heart of a serious plan to improve cancer outcomes.

There is no doubt but that Labour’s workforce plan—supported by the NHS, supported by the professions, supported by so many members of the public—would make a difference. In fact, our inboxes have been filling with people welcoming the plan. It was a particular surprise to me to see one piece of fan mail that said:

“Despite my obvious political allegiances it would be remiss of me not mention the fact that Labour has pledged to double the number of medical school places and recruit additional health visitors and district nurses.”

It goes on to say that it

“is something I very much hope the government also adopts on the basis that smart governments always nick the best ideas of their opponents.”

Well, what luck that this particular fan of Labour’s policy joined the Government just two weeks after he sent the email. It is, of course, the Chancellor of the Exchequer, who I must say I thought was an excellent Chair of the Health Committee. It is almost as if he had learned from all his mistakes when he was the Secretary of State for Health.

This is Lent, a period for atonement and a time for forgiveness, so I make this pledge today: if the Chancellor realises the errors of his ways and comes to this House to double the number of medical school places in the Budget and adopt Labour’s NHS expansion to deliver the biggest expansion of the NHS workforce in history, I will cheer him on from the Opposition Front Bench during the Budget. I will cheer him on—

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

Well, I need the help of the hon. Gentleman and Conservative Members, because my pleas seem to be falling on deaf ears. That is why I have taken the trouble to circulate this email to every Conservative Member, so that they can collar the Chancellor in the voting Lobby this evening—no doubt when he is voting with us, because he agrees with us—and I look forward to their assistance in helping him to see the error of his ways. In all seriousness, it is time that the Chancellor put his money where his mouth is, abolished non-doms and used the proceeds to train the doctors and nurses that the NHS needs.

We know the consequences of the current NHS crisis. Earlier this month, I met Samina and Minnie Rahman, who lost their loving husband and father on Christmas eve after calling for an ambulance three times. The family were initially told a nurse or paramedic would call them back, as it was deemed Iqbal did not require an ambulance. Forty minutes later, when his condition worsened and his family were unable to lift him into their car to drive him to hospital, they phoned 999 again. This time an ambulance was sent, but was then diverted to a higher-priority call. When Iqbal stopped breathing an hour after the first call, his family called 999 a third time, and an ambulance eventually arrived 24 minutes later. The paramedics spent 90 minutes attempting to revive Iqbal in front of his family, but they were unable to. That story is tragic and awful for the family who lost a husband, a father, and a grandfather. Perhaps most depressing is that this case is no longer surprising. The hour and a half that Iqbal waited for an ambulance was the average amount of time that patients with conditions such as heart attacks and strokes waited in December.

The West Midlands Ambulance Service has apologised to Mr Rahman’s family, but they want the Government to take action. They are calling for change to ensure that no other family must endure what they have been through, and they have three asks. First, they want an independent review to establish the number of deaths and serious harms caused by ambulance delays. The Government have rejected figures from the Royal College of Emergency Medicine that claimed that up to 500 people a week were losing their lives this winter due to long waits for emergency care. They also rejected figures from the Office for National Statistics on the number of excess deaths suffered in the past year. Well, Mr Deputy Speaker, “ignorance is bliss” is not a responsible approach to the crisis in emergency care. Sunlight is the best disinfectant, so I hope the Minister will commit to establishing the true scale of the harm caused by the crisis in the NHS.

Secondly, Minnie and Samina ask the Government to instigate Cobra-style meetings to deal with the public health emergency of ambulance delays. That is already happening to deal with the fallout from industrial action, but we need the same level of action for non-strike days. Thirdly, Minnie and Samina have asked to meet the Health and Social Care Secretary, so that he can hear at first hand about their experience, and see the trauma it has caused. The Secretary of State is not able to be here this afternoon, but I hope the Minister will convey that request to him. I gently remind her that I passed on Zaheer Ahmed’s request to meet the Secretary of State after his five-year-old nephew passed away following multiple failings by the health service, but that meeting is yet to be arranged. I think the least we can do as public servants is listen to those we serve, especially those who have suffered in the most unimaginable way. I hope the Secretary of State will meet those families, and that they are able to spur the Government into taking the action we need.

One promise of the NHS is that it is there for us when we need it. That has been completely fundamental in this country for as long as many in the Chamber can remember, but that promise is now broken. People are frightened that the NHS will not be there for them in an emergency. It is not hard to understand why. Look at the news today that more than 1.5 million patients waited for more than 12 hours in A&E last year, which is estimated by the Royal College of Emergency Medicine to have seen 23,000 people lose their lives.

This is not just about emergency care. Patients in need of an operation or even a GP appointment do not know whether the NHS will be there for them when they need it. That is why so many people are voting with their feet, and with their wallets, and going private. Of course most people in this country cannot afford to pay, so they have no choice but to wait and worry. Restoring that promise of an NHS that is there for us when we need it should be a basic task for any Government, but this Government do not even have the ambition, let alone a plan to get there. Instead, the Health and Social Care Secretary said last month that a world where patients are seen within four hours at A&E is “too ambitious” and “not achievable”. But it was achieved until 2015. It was certainly achieved under the last Labour Government.

The target for ambulances reaching patients with strokes or heart attacks has almost doubled to half an hour. If someone wants to see a GP, there is an “expectation”, not a guarantee, that they will be able to do that in two weeks. Two weeks! I remember Tony Blair being attacked because people were forced to see a GP within two days—what people wouldn’t give to be in that position now. Millions wait longer than a month. The Government missed the goal so they moved the goalposts. They have accepted that the NHS will not be there for all of us when we need it. That is what managed decline looks like. That is what brings about the end of the NHS. It is not calls for a different model from the right hon. Member for Gainsborough and others; it is this: slow, irreversible decline. That is what the end of the NHS will look like, and that is why we desperately need a change in Government.

Photo of Catherine West Catherine West Shadow Minister (Foreign and Commonwealth Affairs)

Does my hon. Friend remember when the NHS had an 80% approval rate among UK citizens back in 2008? Now look at it—approval is under 50%, perhaps 38%.

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

I wholeheartedly agree with my hon. Friend. We delivered the highest levels of patient satisfaction in the history of the national health service. Now patient satisfaction is at its lowest level since at least 1997. There is a second basic promise of the NHS which, if it is not broken, is under attack today like it has not been for years. When I went through my treatment for kidney cancer I had lots to think and worry about—every cancer patient does—but the one thing I never had to worry about was the bill. That is the thing that people love most about the national health service, but those who have never believed that healthcare should be provided to all, regardless of their means, are using this crisis to attack that principle. The right hon. Member for Gainsborough called the NHS the

“the last example of collective planning and socialist central control”—[Official Report, 22 September 2022;
Vol. 719, c. 840.]

and even today called on the Health and Social Care Secretary to look at insurance based systems instead.

Sir Christopher Chope has a Bill before the House this week that would extend user charging. The Prime Minister himself pledged last summer to charge patients who miss GP appointments, although he has since ditched that pledge—indeed, he has ditched an awful lot since he became Prime Minister. Two former Health Secretaries have joined in. Matt Hancock has proposed charging for missed GP appointments. Sajid Javid went further and suggested charging patients to see a GP, or even to attend A&E. If he were here, I would happily give way to hear an explanation as to how that would work. The most deeply cynical thing about this, is that the right hon. Members for West Suffolk and for Bromsgrove are the people who bear much of the responsibility for the mess we are in today. They ran down the NHS. They refused to train the staff needed to treat patients on time. Now they say that timely care, free at the point of use, as we enjoyed 13 years ago, and as we have enjoyed for much of the past 75 years, is no longer possible—that we cannot afford it any more, that it is not achievable. That regressive, miserabilist argument cannot be allowed to win. Not only is it unjust, but it is wrong, so let us take it on in its own terms.

Why do patients who are ill enough to need to see a doctor miss appointments? Very often it is because the appointment clashes with work, they are unable to travel, they did not receive the letter, or it arrived too late. The answer is to change the archaic and maddening way that patients are forced to book appointments, and build a new system around patient convenience. If patients could choose whether to have an appointment face-to-face or over the phone, if they did not have to wait on hold at 8 am to book an appointment, then wait for a call back that can come at any time of the day, fewer appointments would be missed. Why is it that those who attack NHS managers as being wasteful bureaucrats want to install far more of them? Because that is what an insurance-based system would mean. One-third of US healthcare costs go to insurance company overheads and providers billing patients. Is that really what the proponents of an insurance system want—more administration, more bureaucracy, and less money spent on delivering healthcare?

What would happen if we charged patients to see a GP? People would stay away. In some cases, yes, that would mean people who did not need to see a GP would not take up an appointment. But it would also mean that many people who needed to see a GP but could not afford the price stayed away. More conditions would go undiagnosed, and left to become more serious until the patient had to go to hospital instead. It would mean worse outcomes for patients, a less healthy society, and greater cost to the taxpayer. While we might save £39 on a GP appointment, it costs far more for patients to go to A&E, which costs £359 on average. Not only are those proposals unfair, but they would mean more bureaucracy, more late diagnosis, more expensive and less effective hospital treatment—exactly the opposite of what the NHS needs. Such proposals are wrong on fairness, wrong on efficiency, and wrong on health outcomes. Those in government have no plan for the NHS, and there are even worse ideas sitting on their Back Benches.

Photo of Chi Onwurah Chi Onwurah Shadow Minister (Business, Energy and Industrial Strategy), Shadow Minister (Science, Research and Innovation)

My hon. Friend is making an excellent speech. Does he agree that the lack of support for a workforce plan, and the deliberate running down of the NHS, will prevent it from being able to take on and take up changes in technology, innovation, processes and treatment that could ensure better healthcare with less cost, enabling the NHS of the future to provide the support and treatment that the British people deserve?

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

I wholeheartedly agree with my hon. Friend. This really is the crux of it after 13 years of Conservative Government: either the NHS is in the mess it is in today through deliberate policy choice, deliberately running down the NHS because they do not believe in it, or the NHS is in this state through negligence and incompetence. [Interruption.] Perhaps the Minister would like to tell us whether it is negligence and incompetence, or deliberate policy choice. [Interruption.] Apparently, it is the pandemic. I wondered how long it would be before we ticked that box on the health debate bingo card.

If the NHS was in its worst crisis in history and we had the longest waiting times in the history of the NHS because of the pandemic, why were NHS waiting lists at their longest historic level before the pandemic? Why were there 100,000 staff shortages before the pandemic? Why were there 112,000 vacancies in social care before the pandemic? I will tell you why, Mr Deputy Speaker. For the entire time they have been in government, whether pre-pandemic or post-pandemic, the Tories have not had the first clue what to do with the NHS. They took a golden inheritance of the shortest waiting times and the highest patient satisfaction in history, and they have squandered it over the last 13 years to the extent that people dial 999 and an ambulance does not come, people ask to see a GP and there are not enough appointments, and cancer outcomes and cancer waiting time targets are not met—not a single one. That is their record. It is the consequence of their choices and it is one of many reasons why this country needs a change and a Labour Government.

The right hon. Member for Gainsborough asked what reform under a Labour Government looks like. I say to him that it is not the model of funding that is broken, but the model of care. The NHS diagnoses too late, by which stage treatment is less effective and more expensive. We focus too much of our spending on hospital care and not enough on primary care, social care and prevention. The reform our health service needs is shifting that focus out of the hospital and into the community, because if we can reach people sooner we can catch illness earlier and even prevent it in the first place—better for patients and better value for money for the taxpayer. That is what a real reform argument looks like.

Of course, we need to retain the necessary NHS staff. There are 133,000 vacant posts in the NHS today. The number of fully qualified GPs is falling, with an extra 140 patients per doctor compared with five years ago, and midwives are leaving faster than they can be recruited. There is no NHS without the people to staff it, so that is the great gamble the Government have taken on the industrial action in the NHS. It is not just that staff walk out for a day on strike; it is that they walk out of the health service altogether. By ignoring the nurses and the ambulance workers for months, the Government have allowed 140,000 appointments and operations to be cancelled, and risk putting off thousands of staff from continuing their careers in the health service.

Have the Government learnt their lesson? Of course they have not. In two weeks’ time, junior doctors are set to walk out on strike for 72 hours. It will mean huge disruption to patient care, yet there has not been a single meeting or minute of negotiation between Ministers and junior doctors. Why on earth are they not trying to stop yet more disruption to NHS care? Instead of ignoring staff, the Government ought to be doing everything they can to retain them in the health service. That means getting around the negotiation table and resolving the dispute on pay; it means getting around the table and fixing the pensions dispute; and it means listening to staff about their everyday experiences and making sure that, finally, they can see some light at the end of this miserable tunnel.

Photo of Afzal Khan Afzal Khan Shadow Minister (Justice)

My hon. Friend is making an excellent speech. On the lack of workforce, does he agree that another area is the mental health service, which is getting worse across the board? Individuals and families are suffering, but there also is a knock-on effect on the police. A fifth of their time is spent helping people with mental illness. The economy loses £100 billion every year through mental illness.

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

I am really grateful to my hon. Friend. He is absolutely right to talk about the mental health workforce. Labour is committed to an extra 8,500 mental health workers, which would mean dedicated mental health support in every school, and community mental health hubs that would reduce pressure on GPs and ensure people get seen sooner. It would ensure support for young people in school before they reach crises in mental health. We would pay for it by abolishing the carried profits loophole, a tax loophole that benefits private equity fund managers. It is not on the Order Paper this afternoon, Mr Deputy Speaker, but if the Government want to adopt that plan in the Budget too, they are very welcome to do so.

Whether it is more mental health staff, more doctors, more nurses, more midwives or more health professionals, the NHS is in crisis and only Labour has a plan to fix it. The Chancellor knows it is the right thing to do—he said so himself. The NHS backs it. Medical schools have the capacity to train more doctors. Thousands of straight-A students want to help the NHS and the NHS needs their help more than ever. The only thing standing in their way is this Government. I challenge them today: double the number of medical schools places, so that we train 15,000 doctors a year; train 10,000 new nurses and midwives every year; double the number of district nurses qualifying every year; train 5,000 more health visitors; and pay for it by abolishing the non-dom tax status, because patients need doctors and nurses more than a wealthy few need a tax loophole. That is the choice the Conservatives face in the Budget. We have a plan; they do not. They are welcome to nick it. Patients across the country would thank them and us if they do.

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care) 2:35, 28 February 2023

I am grateful for this chance to come to the House and talk about the NHS workforce. I am happy to begin with something that I expect is a point of agreement with those on the Opposition Benches: praising our fantastic NHS workforce and all they have done through the pandemic and are doing now as we recover from covid. Hon. Members will not be surprised to learn that my colleagues the Secretary of State for Health and Social Care and the Minister for Health and Secondary Care, who has responsibility for workforce, are today focused on discussions with the Royal College of Nursing, so it is my particular honour to speak on behalf of the Government today and to take a moment to re-set the tone, and indeed raise the bar, in this debate.

I am very happy to talk about our NHS workforce at a time when we have record numbers of doctors and nurses working in our health service. I am equally happy to talk about our social care workforce, the very people Wes Streeting seems to forget time and time again. I note that they are forgotten in his motion again today. In contrast, the Government are working with our whole health and social care workforce, not only training record numbers of doctors and nurses, and recruiting a whole host of healthcare professionals into the NHS, but bringing historic reforms for the social care workforce—all that despite the global pandemic, which created the most challenging backdrop any Government have faced for decades.

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care)

I will make a bit of progress, so that there is the opportunity for Back Benchers to speak.

We have heard and will no doubt continue to hear about how we have been in power for 13 years so far, so it is only right to look at some of the figures since 2010. Since 2010, we have 35,000 more hospital doctors and 46,000 more nurses and health visitors, not to mention a nearly 50% increase in medical consultants and a near 60% increase in paramedics. That is what we have done.

Photo of Aaron Bell Aaron Bell Conservative, Newcastle-under-Lyme

I am very grateful to the Minister for giving way. In addition to the excellent point she made about the absence of social care in the motion, does she agree that the figures the Opposition have chosen to use in the motion do not give the whole picture at all? They do not include vacancies filled by bank staff, very often from the same hospital.

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care)

My hon. Friend makes a very good point about the selective use of figures by Opposition Members.

Photo of Karin Smyth Karin Smyth Labour, Bristol South

I want to pick up the point about social care, on which, as the Minister knows, I am very keen to see progress. Her Government shelved their social care plans. The former Prime Minister said he had fixed social care, leading the entire country through that dance. He promised people that it was fixed and that people in their older age or with disabilities could be secure, so it is rather shameful for her to raise that point without then saying—maybe she will go on to do so—when we will actually see any progress on social care. Why have her Government shelved their plans?

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care)

On the contrary, we have already made progress on some things in our social care White Paper published just over a year ago. We will soon publish next steps, particularly focused on workforce reforms. I have been talking to several stakeholders involved in exactly that area over the last few weeks. If the hon. Lady is patient she will see some of that coming forward.

I was talking about some of the things that we have done to vastly increase the number of healthcare professionals in the NHS. As part of our ambitions for the future, more than 26,000 students were accepted on to nursing and midwifery courses in England last year—a 28% increase on 2019.[This section has been corrected on 14 March 2023, column 3MC — read correction] We are on track to meet our manifesto commitment of 50,000 more nurses by 2024. Much as we continue to strive to go further and faster, those are the figures as they stand. We might wish to make a comparison with Labour-controlled Wales, though it is sometimes hard to do so because it does not collect crucial data such as vacancy rates. One has to wonder why. That is the same Labour-run Wales where patients are twice as likely to be waiting for treatment as in England. Some 50,000 people are currently waiting over two years, while here in England we eliminated two-year waits last year.

I will move on from the situation in Wales, as I am sure Opposition Members will be glad to do so. The Leader of the Opposition has said that he thinks we are hiring too many people from overseas in health and care. The same gentleman spent several years campaigning for a second referendum on freedom of movement. Whatever his views this week, it is the work of a responsible Government to look at every available option to give this country the health and care workforce that it needs. Alongside training more doctors and nurses, recruiting from overseas and giving people from other countries a chance to work in the NHS is the right thing to do.

Photo of Chi Onwurah Chi Onwurah Shadow Minister (Business, Energy and Industrial Strategy), Shadow Minister (Science, Research and Innovation)

I am pleased to hear the Minister say that it is the Government’s duty to look at every available option. During the pandemic, I take it that she clapped on her doorstep for the NHS workforce who did so much to get us through it, so why will she not look at the option of abolishing the non-dom tax loophole, to fund more nurses and doctors and a better NHS in future?

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care)

A responsible Government take a responsible approach to funding our public services, including the NHS. Later I will come to exactly the point about the Opposition’s proposals to use that funding pot again and again for the health service.

Coming to social care and international recruitment, we have put care workers on the shortage occupation list. As a result, social care employers have already been able to offer care worker visas to more than 34,000 people. I welcome international nurses joining our nursing and midwifery register, and I make no apology for continuing to encourage bright and talented international doctors to come and work in the NHS. In fact, that is the very idea of the points-based immigration system that we have so successfully implemented.

As well as recruiting the best and the brightest, it is vital that we retain them. Ultimately, our goal is to make sure that the NHS is one of the very best places to work in the world; both my parents were NHS doctors and, believe me, I have had plenty of conversations about why sometimes it is not. What is most frustrating is when the system prevents them from giving people the very best care.

It is not simply all about pay, as Opposition Members might have us believe. The hon. Member for Ilford North talked about nursing pay, but he will understand that we are currently in talks and now is not the moment to play politics with this issue. We are pleased that the Royal College of Nursing has paused strike action. We have no doubt that both sides are committed to finding a fair and reasonable settlement—one that recognises the vital role that nurses and nursing play in the health service, the wider economic pressure facing the United Kingdom and the Prime Minister’s priority to halve inflation.

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care)

I will not, as the hon. Gentleman had a long time at the Dispatch Box.

Our talks are focused on pay, terms and conditions and enhancing productivity. We are hopeful that we will find a pragmatic way forward. We also know that pensions and the interaction between pension, pay and taxes matter. In general practice, we are consulting on changes to the pension scheme so that clinicians who want to stay in the NHS will not have to worry that they might lose out financially. Going beyond pay, from my conversations with staff I know the importance of their day-to-day experience at work, and of having the resources and the support that they need. We will continue to press ahead with supporting the mental health and wellbeing of NHS staff.

As we work to support our workforce, we must move beyond discussion just about numbers and pay. In the NHS we have one of the largest workforces in the world, with many hundreds of organisations within it. It is an entire ecosystem. We have an incredible opportunity to do things differently at real scale, with bold new ways of working. Take our surgical hubs, which are getting hundreds of thousands more patients quicker access to procedures. Community diagnostics centres are bringing diagnostic care nearer to home without the need even to visit acute hospital sites.

We are empowering our community pharmacists to do more. We have already introduced a range of new clinical services in community pharmacy, including blood pressure checks and minor illness referrals from GPs and NHS 111. This year we will introduce more services, including a pharmacy contraception service. Just as these innovations are good for patients, they are good for the workforce too, freeing up more time for colleagues to do what they do best.

On training, the Opposition motion calls for an expansion of medical school places. I will not pre-empt the upcoming NHS workforce plan, but I can say that it will set a clear direction for our workforce, making sure that we have the right people with the right skills in the right places over the next 15 years. It was this Government—through the Chancellor when he was Health Secretary—that expanded medical school places from around 6,000 each year to more than 7,500—a 25% increase in just three years. In fact, that was such a substantial expansion that it saw the creation of five new medical schools in England, one of which in east Kent I visited earlier this month. There, they are not only training more future doctors but innovating in how they do so, preparing medical students to work in the NHS of the future.

Equally, it is not for me to tell the House what will be in the spring Budget. In the current fiscal environment there are far fewer public spending elements that can be traded off against health and care spending compared with previous decades. Yet even when faced with tough choices in the autumn, including very real pressure on public finances, this Government made a deliberate choice to prioritise health and social care, including investment of an additional £14 billion over the next two years.

When it comes to the spring budget, I can guarantee to the House that our sums will add up, unlike those of the hon. Member for Ilford North, who seems to be banking on what he believes will be an inexhaustible pot of non-dom taxation, including for his uncosted and unfunded reorganisation of primary care. He did not mention that much earlier—a policy so roundly mocked by the sector that we woke up to it on the “Today” programme and found it had been put to bed by “Newsnight”.

Since the business investment relief scheme, introduced in 2012, non-doms have invested more than £6 billion in the UK. They play their part in supporting the vital public services that we all depend on. Even a former Labour shadow Chancellor has said that scrapping non-doms would probably end up costing Britain money—to be fair, that seems to be the Labour party’s main objective, with £90 billion of unfunded spending commitments to date, and counting.

Photo of Grahame Morris Grahame Morris Labour, Easington

It is not correct that Labour’s spending plans are unfunded, and I hope that the Minister will put the record right. On the cancer plan, there is information out there that the incidence of cancer is increasing. To get value for money, would it not be sensible for the Government to invest in precision radiotherapy, as a treatment that improves patient outcomes in a cost-effective manner? That would get the best value for money for the taxpayer.

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care)

I know that the hon. Gentleman feels very strongly about the issue; we have talked about radiotherapy. He will know that we have invested more than £160 million in improving radiotherapy equipment. This year, we are investing an extra £50 million in the cancer and diagnosis workforce. We are continuing to work hard with the NHS on reducing the backlogs that we have seen since the pandemic, when people did not come forward for cancer treatment as they would have in normal times.

Photo of Aaron Bell Aaron Bell Conservative, Newcastle-under-Lyme

The Minister mentioned non-dom status under the previous Labour Government, and what they said about it. Is she aware that Alistair Darling said that

“such a charge could discourage men and women—doctors and nurses, business men and women—from coming to this country…and we do not want to turn them away”?—[Official Report, 9 October 2007;
Vol. 464, c. 171.]

Gordon Brown considered a five-year cap and abandoned it. Ed Balls said that it would end up “costing Britain money”. The supposed heir to Blair is sitting at the Opposition Dispatch Box, opposite the Minister. Is it not surprising that he has not learned more lessons from new Labour?

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care)

My hon. Friend makes an excellent point. We hear about this source of funding again and again—we hear that non-doms will provide all this money—but plenty of the shadow Health Secretary’s predecessors in Labour have said that they do not think the policy he suggests would generate any more income whatsoever.

It will imminently be time to give Back Benchers an opportunity to speak, so let me end by saying that it has been an honour to open this debate on behalf of the Government and to respond to the array of misrepresentations from Labour Front Benchers. The NHS exists to care for patients, and they should always be our first priority, but the NHS’s greatest asset is its workforce.

From a lifetime of talking to staff, I know that what they want is to care for patients in a way they feel proud of. They can do that only if they themselves are cared for, feel valued, are looked after and have enough colleagues to support them. The Government are working flat out on every one of those areas. We are hiring more staff, harnessing new technology, joining up health and social care, and building bridges between parts of the system like never before. I know how tough it has been and, on too many days, how tough it still is on the frontline. I am determined that we will continue to do what is right by health and social care staff, for them and for the people they look after.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Scotland) 2:51, 28 February 2023

May I start by expressing my thanks to all health and care staff across the UK? I pay tribute to them for the work they do year in, year out—especially during the pandemic, when they literally risked their lives to care for us and our loved ones. Sadly, some of them paid the ultimate price. Others who are suffering with long covid face losing their pay or their job, and we should be ashamed of that.

The covid pandemic had a massive impact on all four health services across the UK. The two biggest challenges are the backlog and the workforce we need to deal with it. However, there were underlying problems before covid. We had 10 years of Tory austerity: up to 2010, the annual average uplift in NHS funding was usually between 3.5% and 4%, but for most of the 2010s it was less than half that.

Scotland spends more than 6% more per head on health than England. That money covers things like free prescriptions. The shadow Health Secretary, Wes Streeting, talked about not charging for GP appointments. Free prescriptions, in the same way, ensure that people take their medication, so that we do not let diseases get out of control and they do not end up costing more in hospital later.

We also spend a massive extra 43% on social care. That allowed us to provide free personal care, valued at £86,000, when we heard about the potential care cap in England. Providing free personal care, which in Scotland includes people younger than 65 if they have a need for it, allows people to live independent, high-quality lives in their own home for as long as possible. I am sure that there is not a person in this Chamber who will not want that when their turn comes.

Scotland has the highest number of nurses, care staff, GPs and consultants per head of population in any of the UK nations, but all the national health services are facing staff shortages in both NHS care and social care. Even where staff numbers appear to have increased, the problem is that demand is growing quicker. That is because we are an ageing population—and, sadly, we are not ageing well. From the age of about 50, we start collecting diseases. The NHS gets us through and helps us to manage, but many people, particularly in deprived communities, can spend 20 years or more in ill health. The NHS is struggling to cope. We need to invest in a wellbeing approach to every person who lives in the UK—every child born—so that they do not end up a bunch of old crocks like many of us in this Chamber.

Safe staffing is vital. It is not hospitals or machines, but people, who deliver treatment and care when we are ill. The staffing issues have multiple causes. The decade of austerity meant many public sector pay freezes and caps, which made jobs seem unattractive. Caps on public pay and benefits take money out of local economies—many of us know of dead high streets. It is a pointless approach, because less tax goes back to the Government and it strangles the economy. Giving people enough to live on, with decent benefits and decent public sector pay, injects money into local economies and stimulates growth, which we keep hearing is the big thing that this Government believe in.

Another cause is Brexit. There was a 90% fall in EU nurses coming to the UK after the vote in 2016—not even the loss of freedom of movement in 2021, but the vote. Since the formal loss of freedom of movement, care providers have suddenly had to deal with the Home Office. Many MPs in this Chamber will know just how difficult that is, with the cost of visas, the administrative burden and the general shortage of workers because of Brexit. Health and social care is having to compete with almost every other sector in the economy, so paying people badly simply will not wash.

Of course, there was also the pandemic. I was back in the NHS in the first wave in 2020, and I know that staff were incredible. They felt empowered. We were able to sit around a table, whether it was physical or virtual, work out what needed to be done, make a decision and move on in a way that staff on the frontline are rarely empowered to do. The problem is that this has gone on for three years now. Staff are suffering from exhaustion and burnout, but instead of having people clap for them, they get negative media complaining about staff and GPs and suggesting that GP practices are shut or that a phone appointment does not count.

I became quite ill and ended up in the hospital across the road in autumn 2021. When I finally got back to where I live, I had three GP consultations, two specialist consultations and just one day in a hospital, going through tests, before my medication was organised. Frankly, with my lifestyle, that suited me down to the ground. I did not need to hang around in a clinic, risking infection with covid. The job got done. Let us stop denigrating phone appointments. GPs are not stupid. If they speak to a patient on the phone and need to examine them, they will arrange that.

We have to realise that it is not just about the media; as politicians we have a duty, too. I have to gently point out to the shadow Health Secretary—particularly as my own husband was a GP—that GPs are not just gatekeepers for the NHS. They provide long-term continuity of care, they examine the patient, they are advocates and they guide the patient to the right service. Imagine someone with back pain. Were they digging the garden? Do they need to see a physio? Do they have a slipped disc, do they have a kidney stone, do they have a leaking aneurysm—or do they have metastatic cancer? How is a patient meant to disentangle that without a GP?

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

Let us be clear about this: I have never disputed GPs’ expertise or the important role that they play in diagnosis. But if the hon. Member thinks GPs are so fantastic, why are there so many fewer now under the SNP in Scotland?

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Scotland)

That is not true—and 99% of our trainee posts last year have already been filled. Perhaps the hon. Gentleman should look at the statistics. We have more GPs per head of population than any of the other nations in the UK, including Wales, which his party runs.

So what do we need to do about this? Clearly we need to train more staff, but we must also not only increase the number of both nursing and medical student places, but look at the cost of studying and the student debt that those people will be left with. We do not have tuition fees in Scotland and our nurses receive a bursary of £10,000 a year, which means that we are investing £20,000 in every student nurse in Scotland.

Photo of Karin Smyth Karin Smyth Labour, Bristol South

The hon. Lady talks a great deal about the inputs of the SNP Government in Scotland, but very little about the outcomes there. Does she not agree that, rather than carping about the contrast between how good things are in the rosy land of Scotland that she portrays—which is not a true picture, as we know from what is happening with the SNP leadership election—and how bad they are in Wales, England and indeed Northern Ireland, we should start learning from the different ways in which the different Governments are providing services and working people? We need to stop carping about those differences, learn from each other and recognise that outcomes are different, rather than just talking about the inputs. Is that something on which she might want to work with other people?

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Scotland)

I think I have spent the last eight years demonstrating the different approaches that Scotland takes. The Minister talked about community pharmacies, which have been providing minor ailment care in Scotland since 2005. Our optometrists are allowed to refer people with cataracts directly to hospital, whereas in England, they are often made to go through a GP. So I am sharing and have shared ideas in that way. However, there has been a 5.8% increase in the uptake of nursing jobs in Scotland, so we also have more nurses per head of population.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Scotland)

I should like to make some progress. The hon. Gentleman had a very long time at the Dispatch Box and I think there should be more than just the three of us.

It is important to recognise the impact of the loss of the nursing bursary in 2016. The number of nursing student applications fell in England after the bursary was cut, so perhaps this is one of the ideas that I am sharing. The numbers recovered to some extent in 2019, when the bursary was brought back, but it is only £5,000, and tuition fees are more than £9,000 a year. Nurses in England are graduating with debt of about £50,000, and they need to begin paying it back immediately, which means that the money is coming out of their salaries. Perhaps that could be looked into.

If the number of medical students is increased, it is necessary not only to ensure that there are places on the ward where they can learn—this was mentioned by Dr Evans, who is no longer in the Chamber—but to expand and fund the training places in hospital they will occupy after they graduate. There was a real problem last year when the extra medical students who were graduating could not find foundation jobs until the last minute. If graduates do not go through the foundation scheme, they cannot practise as doctors. We also need to invest in middle-grade specialist training in order to create consultants.

We need to recruit more from overseas, because progressing from student to consultant or GP takes nine or 10 years, while progressing from student to consultant surgeon takes about 15 or 16 years. Adding more student places will not solve the problem in the short term. We must, however, avoid recruiting from low and middle- income countries on the World Health Organisation red list. That is simply unethical, and is being reported as direct recruitment from trusts in England. We should be ruling that out. It should not be allowed and I think the Government could tackle the matter.

We have, unfortunately, lost freedom of movement, and it is clear from what Labour is saying that it will not return. That is a challenge for us in Scotland, because we need people: we are facing a huge demographic challenge. The Government should put all health and social care roles on the shortage occupation list, and reduce visa costs and hassle. Forty-nine per cent. of overseas GP trainees in the UK report these issues, and 17% of those say that they may leave. The obstructive process of dealing with the Home Office is driving doctors away. The Government should perhaps also waive the NHS charge for staff who work in health and social care.

However, I agree with all the Opposition Members who have said that what is most important is retaining staff, because otherwise we will lose experience. Some decent pay would be a start, and after the pay freezes and after covid, those staff certainly deserve it. The Government are keen to rave about the independent pay review body when it suits them, but to ignore it when it does not. Nurses in Scotland were already being paid between £1,300 and £2,500 more than those in the rest of the UK, and to catch up with what is being paid to Agenda for Change staff in Scotland, the UK Government will need to provide a 14% pay rise for the coming year. If they did give a decent pay rise to the incredible staff who work in the NHS, devolved nations would also be able to fund a decent pay rise for their staff. Both Scotland and Wales are limited by having no real borrowing powers.

We need a review of the pay, terms and conditions and support for junior doctors, of how their rotas are managed and of their quality of life, because we need to understand why they are leaving the UK—part of that is wanting the adventure and experience of working overseas, so perhaps we should consider building that into our training schemes, giving junior doctors a flexible year in which to do research, work as a volunteer or work in another country—and, of course, we need reform of the mess that is the NHS pension. The lifetime and annual tax allowance system is penalising senior staff who do extra work. Many are refusing extra roles such as that of clinical director or educational supervisor. They are turning down the overtime that is critical to clearing the backlog, going part time, or even retiring earlier.

The Scottish Government and, I am sure, the Welsh Government are offering pension recycling and “retire and return”, but that is all the devolved Governments can do. The problem lies in the Treasury. This system was introduced in 2015, supposedly to deal with tax evasion and avoidance. It is nonsensical to apply it to a public sector defined benefit scheme. Pensions cannot be played with that way. The problem is that increases in the pension pot are being counted as income. Staff have no way to predict that, and end up being faced with vast bills simply for being able to work some extra weekends.

We also need to maintain the wellbeing projects that were started during the pandemic. All NHS staff are still facing a huge amount of stress this winter, which is made worse by the staff shortages and the increased demand resulting from covid, influenza and other respiratory infections. The covid data from 2022 shows that there was no respite. Unlike in 2020 and 2021, hospital admissions stayed relatively high, even between the peaks, which means that staff have literally been running non-stop for nearly a year and a half. As has been said, staff are willing to work hard—they have always worked hard—but the problem is that when they go home at night feeling they did not do a good job and when they feel that their ward is not safe, that undermines both their commitment and their ability to do the job. The General Medical Council reports that burnout and dissatisfaction are the two main factors driving senior staff out of the NHS.

However, we must not forget social care staff. I was surprised that they were not mentioned in Labour’s motion. The standard measure of NHS performance in all four health services is the four-hour A&E target because it assesses the flow through a hospital from admission to discharge. It started to deteriorate in England in 2013, following the changes introduced in the Health and Social Care Act 2012, but it fell in all four health services in the later phases of the pandemic as hospitals tried to restart elective work. NHS Scotland is also struggling after covid, but let me gently point out, notwithstanding the snide comments from Tory and Labour Members, that Scotland is still the best-performing of the four nations in this regard.

Struggling A&E performance is driven not by A&E issues but by the back-pressure of patients who are waiting for beds—in other words, by delayed discharges. The lack of care workers to deliver home care is what is actually driving the A&E issue, and this should be the thermometer to test the temperature of the entire acute system. There are currently more than 160,000 vacancies for social care in the UK. We cannot fix the NHS without fixing social care, so we need a workforce plan for NHS and social care. As in Scotland, we need to respect care staff: pay them a minimum of the real living wage, not the pretendy living wage; pay sleepovers when they carry them out; and pay travel time. To have them doing all these things unpaid is undermining their take-home pay.

In Scotland, care staff are now registered and getting access to professional training and development. This is part of our plan for a national care system, but care staff need decent pay. They also need recognition and respect for the very tough job of looking after our loved ones. I cannot imagine anyone in this Chamber who could do the job. They need a career path so that good staff who enjoy delivering care can remain in the care sector and not just use it as a stopgap until they can get a better paid job on the till in a supermarket.

Several hon. Members:

rose—

Photo of Roger Gale Roger Gale Deputy Speaker and Chairman of Ways and Means, Deputy Speaker

The Front Benchers have taken an hour and a quarter out of the time available for this debate. The Opposition have indicated that they would like to wind up at 4.30, meaning that the wind-up speeches should start at around 4.05. I think there are 11 Members standing. I am not going to set a time limit, but doing the maths, if all colleagues wish to get in, we are down to five minutes. It is up to you. If you choose not to allow your colleagues to speak, you can take longer.

Photo of Aaron Bell Aaron Bell Conservative, Newcastle-under-Lyme 3:11, 28 February 2023

Thank you, Mr Deputy Speaker. It is a pleasure to catch your eye a little earlier than I did yesterday evening.

I welcome the speech from the SNP Front Bench. It is good to see Scotland is having its say in this debate. I disagree with a lot of what Dr Whitford said, but it is good to see that she is standing up for her Government. At the start of this debate, there were no Welsh Labour MPs in here at all. I see that a couple have popped in now. It is interesting, given what Labour claims it is going to do for the NHS in England, that no Welsh Labour MPs have put in to speak in this debate to defend their record in Wales.

I also note that the hon. Lady, in praising how things work in Scotland, did not refer to the recent report by Audit Scotland that said that the plans to hire GPs in Scotland were not on track, the target for more mental health staff was at risk and the number of operations was still 25% below pre-pandemic levels. It was described as an ever-increasing crisis in the Scottish NHS, with the double whammy of nursing vacancies going up at the same time as staff are leaving, yet the man responsible for the NHS in Scotland, Humza Yousaf, is standing to be the next leader of the SNP. Wikipedia does not inform me as to the hon. Lady’s preference in that election—perhaps she has not endorsed anybody yet—but I find it extraordinary that the man responsible for presiding over the state of the NHS in Scotland is putting himself forward to be the next leader of the SNP. It is an astonishing succession failure from Nicola Sturgeon to have such a weak field vying to be First Minister of Scotland, which is a very important job. But as I say, I respect the fact that the hon. Lady is here standing up for what she believes in and standing up for her Government in Holyrood.

Turning to the motion, as I said in my intervention on the Minister—I congratulate her on her speech—I reject some of the premises of the motion and some of the statistics involved. It is pretty rich to be lectured by the Opposition, given the backlogs they left in 2010 when they had no covid to contend with. There is no mention of covid in the motion. They left a 20,000 backlog in elective surgery that successive Governments got down to 1,000—a 95% fall—before the pandemic. [Interruption.] If Wes Streeting does not think the pandemic is relevant in the context of backlogs, I don’t know what to tell him. Under the Labour Government there was also a lack of productivity growth in the NHS—it was at less than 1% a year—which we have got back up to 1.7% since 2010. The hon. Gentleman spoke about IT, and I agree with him on that—I used to work in IT—but the Labour Government wasted £12.8 billion on IT for the NHS, which was a complete disaster and exposed as such by the Audit Commission.

Photo of Alex Cunningham Alex Cunningham Shadow Minister (Justice)

I do not quite understand this backlog the hon. Gentleman is talking about. I remember when it took three years for somebody to get a knee replacement or a hip replacement. Under the Labour Government it took six to eight weeks. Not 68 weeks; six to eight weeks. Across all elective surgery, we put those lists well and truly through the floor. Surely he can acknowledge that.

Photo of Aaron Bell Aaron Bell Conservative, Newcastle-under-Lyme

When Labour left office, more than 20,000 people were waiting over a year for elective treatment. Before the pandemic—this was not acknowledged properly—the number of people waiting more than 52 weeks for elective treatment had fallen by 95% in England, to just over 1,000. Those are the statistics. The hon. Gentleman can argue with them if he likes, but they are there in black and white.

As I said, it is interesting to see the lack of contrition about the state of the NHS in Wales, which is a complete mess. I will refer to that in detail later, but only yesterday the NHS Board in North Wales was put into special measures for a second time. I accept that there are challenges everywhere—in Scotland, Wales and England. Indeed, if we look at the comparisons across the continent, we can see that these challenges are international in nature, because everybody is recovering from covid, but I believe that this Government are tackling the challenges, and the workforce challenges, head on.

Photo of Ashley Dalton Ashley Dalton Labour, West Lancashire

I am really glad that you have consistently raised the issue of covid. Could you suggest why it is that services such as the overnight children’s A&E at Southport and Ormskirk Hospital in my constituency, which was closed, allegedly due to covid restrictions, still remains closed to this day?

Photo of Roger Gale Roger Gale Deputy Speaker and Chairman of Ways and Means, Deputy Speaker

Order. I gently say to the hon. Lady that expression is through the Chair. This is a mistake that even those who have been here quite a while make. It is “the hon. Member”, not “you”.

Photo of Aaron Bell Aaron Bell Conservative, Newcastle-under-Lyme

I welcome the hon. Lady to her place and congratulate her on her recent election. I believe that her predecessor, Rosie Cooper, is now responsible for the issue that she has just raised, so perhaps she will have some luck if she speaks to her about that—[Interruption.] Have I got that wrong? I do apologise. By the way, I would like to pay tribute to Rosie Cooper, because I did not have the chance to do so when she left. She handled herself with great dignity in the face of some very unacceptable circumstances, and I pay tribute to her. I see several by-election victors on the Opposition Benches and I congratulate them all. I cannot speak exactly to the hon. Lady’s NHS trust. I am sure that if she writes the Minister or speaks to the NHS trust directly, she might get some answers as to what is going on in Southport, but if she will forgive me, I represent North Staffordshire.

Before I detail the work that the Government are doing, I would like to praise the work of everybody in the NHS—as the Opposition Front Benchers did—and particularly those in North Staffordshire who working in our hospitals and GP surgeries, our health visitors and clinical staff, and those who support those people. It has been a difficult winter—after a difficult few years—with covid and flu peaking simultaneously in December. I am pleased to report that the most recent figures from the integrated care board for Stoke and Staffordshire show that ambulance handovers hugely improved in February, compared with where they were in January, which was unacceptable, as I said in the House at the time. There has been an 8% increase in primary care appointments, compared with a year ago, with 73% delivered face to face—higher than the national average—and waiting times for surgery are falling, including for cancer treatment at the Royal Stoke Hospital. I pay tribute to everybody working at the coalface in the NHS, because I know what difficult work it is and we are all extremely grateful.

Turning to NHS workforce expansion, this Conservative Government are strengthening the NHS workforce. In hospitals we have 5,000 more doctors and 10,500 more nurses compared with October 2021. Compared with 2010, when the last Labour Government left office, we have 37,000 more doctors and 45,000 more nurses in our hospitals. We are also building up the workforce in primary care, recruiting 26,000 more primary care staff by March 2024—a target that is on track, unlike the target in Scotland. In Newcastle-under-Lyme, the number of doctors, nurses and other clinical staff based in GP surgeries has increased by 46% since September 2019. That is 55 additional full-time equivalent people. So we are seeing a growth in Newcastle-under-Lyme as well.

Workforce expansion is also about retention, as the Minister said. Times are tough for everybody, given what Putin’s war in Ukraine has done to inflation, but we have always prioritised NHS workers, especially those earning the least. A million workers received at least an additional £1,400 in their pay packets in the last year, and we accepted the independent pay review in full. During covid in 2021, we protected healthcare workers, giving them a pay rise during a wider public sector pay freeze and when private sector wages were falling. The full-time basic salary of a newly qualified junior nurse at the bottom of band 5 is now over £27,000, and experienced nurses or midwives at the top of band 6 are earning £40,588. On top of that, they get excellent pension provision, so we are looking after our NHS staff by paying them and retaining them.

More generally, we are also increasing the number of beds across the hospital estate. A new ward with 28 beds recently opened at the Royal Stoke University Hospital, but I know Tracy Bullock wants more, and I will speak to the Minister about that. We will need more beds for next winter, because the Royal Stoke is under incredible pressure, not least because of the burden of the New Labour private finance initiative contract that costs them a fortune to maintain. A previous Health Secretary ranked the worst 10 PFI contracts, and I believe that we were 11th or 12th at the time. The hospital has to live with that burden, and I raise it again with the Minister today; we want what went wrong before to be put right.

Photo of Gareth Thomas Gareth Thomas Shadow Minister (International Trade)

I hope the hon. Gentleman will not mind my encouraging the Minister to look, in addition to the case for more investment in his local hospital, at investing more in Northwick Park Hospital, which serves my constituents. It needs a 60-bed intensive care unit to improve the quality of critical care and, crucially, to help attract more critical care nurses and other medical staff.

Photo of Aaron Bell Aaron Bell Conservative, Newcastle-under-Lyme

I thank the hon. Gentleman for his point; I am sure the Minister has heard it. I will not say any more about that specific case, because I do not know his constituency that well—although I did work in Harrow once upon a time.

We had 120,000 more GP appointments every day in January ’23 compared with January ’22, and we are delivering the biggest ever catch-up—it is a necessary catch-up—over the next three years, with an extra £45.6 billion in funding to help us recover from covid. That will mean 9 million more scans, 9 million more checks and 9 million more procedures for the people who need them.

We know what Labour would do. It claims to have a plan funded through non-dom status, but I doubt that would raise the money, not only for the reasons I gave in the Opposition day debate at the end of January, but because it has already committed that money to breakfast clubs and various other things. There is a never-ending magic money tree that pays for all Labour’s commitments —[Interruption.] I know that the shadow Health Secretary and others have made many unfunded spending commitments. Labour’s answer is always more money, and the answer to how that will be funded is always a non-dom tax, which would not even raise the money Labour claims, as Ed Balls said, as Alastair Darling said, and as Gordon Brown found out for himself.

Photo of Aaron Bell Aaron Bell Conservative, Newcastle-under-Lyme

No, I have already spoken for 11 minutes, so I must get to the end—I have heard your strictures, Mr Deputy Speaker.

The NHS in Labour-run Wales has a shocking record of failure. As I said earlier, the health board in north Wales is once again under special measures. Since 2009, the Welsh Labour Government have consistently failed to meet the 95% four-hour target. England and Scotland, as the hon. Member for Central Ayrshire said, do a lot better on that measure. Patients in Wales are twice as likely to wait for hospital treatment, with 21.3% waiting after a referral by a consultant compared with only 12.8% in England. Perhaps the shadow Minister will explain, when summing up, whether he approves of Labour’s record in running the NHS in Wales or condemns it, as we do.

We also know about Labour’s record in government here in Westminster. As I said earlier, the elective surgery figure is a fact. Instead, we are investing record sums in our NHS. We are investing in its buildings and equipment but most of all in its staff. Having delivered for this country throughout covid, having vaccinated us and got us out of lockdown—which I recall the shadow Health Secretary opposing before Christmas 2021—and back to work, we are now helping the NHS to recover. I am proud to support this Government.

Several hon. Members:

rose—

Photo of Roger Gale Roger Gale Deputy Speaker and Chairman of Ways and Means, Deputy Speaker

Order. We are now down to about three minutes a head if all colleagues are going to speak; it is entirely up to you.

Photo of Andrew Western Andrew Western Labour, Stretford and Urmston 3:23, 28 February 2023

I rise to support the motion before the House today. Our NHS is in crisis. It is a multifaceted crisis, but at its source it is a workforce crisis caused by years of Tory neglect. Colleagues have ably set out the scale of the issues facing the health service: a shortage of 9,000 doctors and 47,000 nurses; crises in midwifery, dentistry, general practice and mental health services; and more than 7 million people waiting months for NHS treatment, with 400,000 waiting over a year. The waiting times are the worst since records began. The system is on the brink of collapse, and the Government know it. The draft NHS workforce plan calls for a doubling of medical training places, yet the Government cut the number of medical training places this summer, in the teeth of the worst workforce crisis in the history of our NHS.

I am grateful to all our NHS workers. This situation has arisen through no fault of theirs, but it is a huge issue none the less. It is a huge issue in Stretford and Urmston, where the national shortage of GPs is seen in microcosm at one local medical centre, with some 16% of patients waiting more than 28 days for an appointment. That is outrageous, but the scary thing is that it is not unique. It is far from an outlier nationally. It is simply not good enough. The Government tell us not to worry, and that they will guarantee an appointment within two weeks—never mind the fact that under the last Labour Government the wait was two days or the fact that this Government have no plan to achieve it.

We have heard various excuses from the Government. No doubt we will hear more about covid, the weather or striking workers—anything but the Government—but waiting lists rose consistently between 2012 and 2019. The 18-week treatment target has not been met since 2016. Cancer patients have been waiting longer for treatment every year since 2010. Performance on the two-week cancer referral waiting time target has fallen to record lows. Performance declined between 2013 and 2018, and it has fallen further since the pandemic, but the problems are deeper seated than that.

I will raise a specific issue from my constituency and broaden the debate somewhat by talking about access to orthodontics. The family of a constituent have been in touch with me. This teenage girl waited almost two years for a referral, only to be told when finally referred that the waiting list for treatment is two to four years. She is almost 15. The near-constant pain at the back of her jaw causes headaches, and her overcrowded teeth are also affecting her mentally and socially at a difficult age. When her parents explain the situation, they are told to give her painkillers to manage the problem—painkillers for up to four years. The waiting list could take her past the age of 18, meaning she may not be able to access services at the end of her wait. This is a broken system and we need to take action now. Only Labour has a plan to take the action needed.

Ultimately, politics is about choices. I know what side Labour is on, and it is clear today what side the Conservatives are on. Labour chooses to scrap non-dom status, while the Conservatives protect the super-rich instead of providing an NHS workforce fit for the future. The Conservatives had a chance today to break from the long-standing truth, proven time and again, that the longer the Conservatives are in power, the longer NHS patients will wait for the treatment they so desperately need. It saddens me, and it will sadden my constituents, that they seem unwilling to do anything about that today.

Photo of Ben Bradley Ben Bradley Conservative, Mansfield 3:28, 28 February 2023

It is a pleasure to speak in this debate. I will try to skip the partisan rhetoric and get to the crux of some of the issues.

I start by thanking my hon. Friend Aaron Bell for mentioning PFI, because I also represent a hospital that, the last time I checked, spends 14% of its annual budget on repaying Labour’s PFI deal. That is incredible and a detriment to all my constituents, although it is a lovely building.

The workforce question is important, and we all want happy, healthy staff in our NHS and our wider health services. We all understand that they are under untold pressure from covid, the cost of living challenge and short staffing, but my message to the shadow Minister is that saying that, and saying that we want things to be better, is not a plan. It is nice to talk about, but it does not fix anything.

The motion is a little misleading, because it does not mention that we have 37,000 more doctors, 45,000 more nurses, record levels of recruitment and record staff numbers in our NHS. Truth be told, we have shortages in everything in our economy. We will debate the economy a little later, and we could discuss many of these things in that debate because we have a wider challenge of economic inactivity and getting people into work. This is a much bigger systems and process question than just chucking in more resources and adding more training courses. That will not fix this issue.

We have record funding and record staffing in our NHS, and this Government have taken a lot of action to try to increase them. People often talk about a reduction in the number of applications, but they miss or neglect to mention that Government action, including the nursing bursaries, has led to an increase in the number of actual people doing actual nursing courses because it removed the targets, enabled more funding to flow into the system and created more spaces on nursing courses, which has led, in part, to a 25% increase in the number of people studying nursing. We can all talk rhetoric and point fingers, but the Government action was, in many ways, effective. The truth is that the issue is more fundamental than just staffing, and the shadow Minister, probably deliberately, misses that point.

I want to raise two things. First, we should not forget care. I do not understand how we can discuss this issue without talking about care. The Government’s proposal on integration is essential. The NHS, even in one county, is not one organisation—it is all sorts of different organisations trying to work together, including a care system that does not share the same data or the same processes. So much of the burden and the pressure on staff comes down to the fact that these things do not work together properly.

Ambulances are taking elderly patients with care issues to A&E. Hospitals are discharging to care homes and increasing the likelihood of people ending up back in hospital, which is also a care issue for the most part. These things are interconnected, so I am aghast that the Opposition neglected to talk about care in their motion.

Where I agree with the Opposition is that we need a joint workforce plan across health and care, not least to try to overcome some of the stereotypes of working in care, so that, when people consider a career in care, they can clearly and overtly see the pathways through the system into a health service that provides a wide range and scale of opportunities. It would be a huge step forward if we could jointly recruit across health and care into a wide-ranging and exciting set of careers.

Discharge funding has been helpful, and the Government have improved care capacity in Nottinghamshire and the ability to get people out of hospital into care. However, there is still a whole-system issue: data and process need reform, as much as anything else. I agree with the shadow Minister on community-based care but, again, saying we would like more of it is not, in itself, a plan.

Secondly, no amount of money or reform will fix the system. Demand, and public expectations of our health service, have gone through the roof. Capacity has increased, but it is never enough because we expect our health service to provide, for free, everything we want in an increasing range of services. That is not possible or feasible when we have increasingly complex and expensive needs, an older population, more working-age disabled people, more lifelong and chronic illness and more mental ill health. The NHS was never set up to deal with that or the range and complexity of services, which were never envisaged.

Most of us agree that basic healthcare, free at the point of use on and through our NHS, is absolutely right and is fundamental to what many of us feel and believe about Britain, but it cannot grow forever at the expense of services, education and infrastructure. At some point we will need to have a conversation—it will be a brave Government who have that conversation—that draws a line around a basic set of services and expectations that people can access for free, and we will need to have a proper conversation about how we do the rest, because it is not sustainable to keep chucking more money into a pot and to keep expecting hard-pressed NHS staff to offer and deliver more and more when we know they will never catch up with increasing public demands and expectations. Staffing and funding are at record highs, yet the gap grows and waiting times grow. At some stage, we will need to have a proper discussion about what the NHS is for and whether our expectations are realistic, because the NHS does many things that are perhaps not what it is for.

I know you are keen for us to wrap up quickly, Mr Deputy Speaker, so I will finish with a few points. I have touched on some big, long-term questions, but we could quite quickly change some smaller things that seem like simple common sense to most people. We still deliver paracetamol on prescription, but it costs 30p at Boots. It costs £35 to go through all the different appointments and all the different systems to get paracetamol on prescription from the NHS, at the cost of tens of millions of pounds a year. Why do we do that? Why do we add that burden to our health system?

The 111 service was set up as an advice service to help people to figure out where in the system they needed to go, but now it calls ambulances. A few weeks ago, an ambulance technician told me a story about ambulance staff being sent out on a category 2 “stroke-level emergency” because a 111 call handler had ticked the wrong box on the decision tree—the caller had actually rung to say they had been picking up ice and had cold fingers. And we wonder why there is not the capacity and the space in the system! We need to reform the 111 service so that it follows the same decision tree as the 999 service or directs people back into 999. We need to give ambulance staff the ability to say no to people who call every day and to people who are not having emergency, critical conditions or problems and live near a hospital and are sat next to somebody who has a car and could drive them there. People have this impression that they can jump the queue. All those things would relieve pressure on A&E and on NHS staff, and they seem like simple and obvious things to do.

My final point is on the need to have an honest conversation. I agree that staffing and the need for more capacity and support to tackle waiting lists are huge priorities, and the Government are working on them, but we cannot continue to grow the health service forever. Everybody knows that—my constituents certainly do. This is a much more wide-ranging systems and process issue and a much more wide-ranging issue about our expectation of what a health service can realistically deliver. That is not something we are going to tackle today, but it is a conversation I have no doubt we will have to return to in the very near future.

Several hon. Members:

rose—

Photo of Nigel Evans Nigel Evans Deputy Speaker (Second Deputy Chairman of Ways and Means), Chair, Restoration and Renewal Programme Board Committee, Chair, Restoration and Renewal Programme Board Committee

Order. Only Opposition Members are left now to contribute. I am not going to impose a time limit, but if nobody exceeds five minutes, at least they will allow everybody to get in and have roughly equal time.

Photo of Simon Lightwood Simon Lightwood Shadow Minister (Transport) 3:36, 28 February 2023

I am pleased that the Labour party has tabled this Opposition day debate this afternoon. Like Members from across this House, I have been inundated with emails from constituents who, despite the heroic work of NHS staff, have had terrible experiences with the health service this winter. Let me share just a couple of accounts from Wakefield. A constituent contacted me after his wife had faced a gruelling 15-hour wait in Pinderfields A&E. Another was forced to wait for 11 hours while suffering with a twisted bowel. Another attended A&E after being unable to get a GP appointment for excruciating muscle pain. They waited for 14 hours on a metal chair before being sent home. Unfortunately, that person is not alone.

Many people across Wakefield are struggling to get GP appointments too. Patients at one surgery in Wakefield were sent three text messages in one week to tell them that routine appointments were not available. When people cannot see a GP and cannot get to see a practice nurse, they do not get the—sometimes essential—early treatment they need. That adds pressure to the NHS in the future and can have serious consequences for people’s health. This is shameful, and it is no surprise that on the Tories’ watch public satisfaction with the NHS has fallen to its lowest level since 1997.

Before I was elected to serve the people of Wakefield, I was immensely proud to work for the NHS for several years. It is blindingly obvious from the discussions I have had with former colleagues that the biggest issue right now is with the workforce, but it does not have to be this way. Labour has a fully-costed, fully-funded plan, which is not a sticking plaster but the long-term solution that the NHS needs: doubling the number of medical school places; training 10,000 extra nurses and midwives every year; doubling the number of district nurses qualifying each year; and creating 5,000 more health visitors. This is a really exciting plan for the future of the NHS, not only delivering what is so desperately needed, but investing in people’s careers too. And it is people’s careers that are at the heart of this.

I do not know whether Members saw the damning BBC article by Jim Reed yesterday following the Healthcare Safety Investigation Branch report, which monitors safety in the NHS in England. The article said that many staff cried during their interviews. One NHS worker gave the following account to the BBC:

“I spent four hours with an end-of-life patient. There was no hospice or district nurse available, so I had to make the choice to give them meds for a peaceful, expected death and prepare the family.

I felt ashamed that I could not stay till the end, but I had to move on to the next job as I had done all I could.”

Another paramedic said:

“The bad sides give me nightmares, flashbacks and fear, but they can also make me hyperactive, sleepless and sometimes not care about the danger I put myself in”.

It is no wonder that more than 40,000 nurses left the profession in England last year, leaving chronic shortages. Many of those who have left recently were only recently qualified—nurses who had spent years in training, but could no longer tolerate the pressure and burn-out. Many of those who stayed are having to take time off. Almost a quarter of all absences are due to anxiety, stress and depression, with hundreds of thousands of days lost each month. It is a real reminder to us here that what we decide now has far-reaching implications for the future.

The good news is that Labour has a plan to tackle the crisis. It is a plan that will be paid for by scrapping non-dom tax status, an unfair tax rule that gives tax breaks to the rich and that can no longer be justified. I know that people across Wakefield agree that we need nurses much more than we need non-doms.

I hope that the Government will adopt the motion and deliver Labour’s plan to tackle the workforce crisis. If the Government will not listen, I know that my hon. Friend Wes Streeting will be ready to implement our plans under the next Labour Government, who will put patients first and get our NHS back on track.

Photo of Daisy Cooper Daisy Cooper Liberal Democrat Spokesperson (Health and Social Care), Deputy Leader, Liberal Democrats 3:40, 28 February 2023

A healthy population and economic growth are two sides of the same coin, but, because the Conservative Government have failed to invest in our health and social care services, the ticking time bomb of ill health is starting to explode, and the Government wonder why they cannot get sustainable economic growth.

I welcome this motion today for two reasons: first, because it focuses on recruiting many of the staff that our NHS needs; and secondly because it focuses on training more district nurses and more health visitors, which would help us to shift the focus of healthcare in this country away from urgent and reactive care towards community and preventive care.

I wish to touch on GPs, dentists and social workers today. GP appointments have become increasingly difficult to secure, with some patients now resorting to DIY doctoring, by carrying out medical treatments on themselves. Our GPs are not to blame. They are overstretched and understaffed like every other part of our NHS, but the Conservative Government have repeatedly broken their promise to recruit more GPs, so where is the plan to turn that around?

There is now a crisis in this country on access to dentists, in part because of the lack of staff. The Government’s response last year was to create a one-off, time-limited £50 million emergency fund for dentists to create emergency catch-up appointments, but the uptake has been modest in most regions. In the east of England, just 13.7% of the allocated funding has been spent, and in my own constituency of St Albans that money created zero new appointments—absolutely zero.

To make matters worse, dental practices are now being penalised for under-delivery, because the funds will be clawed back from their frontlines instead of being ringfenced. The Health Service Journal reported last week that there is due to be a record Government underspend of £400 million on dentistry this year, while patients face an access crisis. Will the Government commit to ringfence this funding for NHS dentists to ensure that it is not clawed back?

The Government’s disastrous dental contract has created this access crisis. Not only has it created a two-tier system between rich and poor, but children’s life chances are being set back because of the impact of poor oral health. Our children, more than anybody else, need good teeth to set them up for later in life, but eight in 10 NHS dental practices are not taking on children.

Last November, I visited the Royal London Dental Hospital and its Tooth Fairy Project, a dedicated new surgical centre for children waiting too long for operations, which removes problematic teeth or performs multiple fillings. It was a fantastic facility to see, and the staff were extraordinary, but the statistics on child tooth extractions are terrifying. I have had cases in my own constituency of St Albans where parents simply cannot get NHS dental appointments for children. I have also been made aware of just how bad the situation has become in other areas, such as North Yorkshire, where only half of children managed to see an NHS dentist last year. In fact, last week, I was told that, in Harrogate, if a person was lucky enough to find an NHS dentist taking on any new patients, they face a two-and-a-half-year wait to see them. That is a shocking state of affairs. A Minister should visit places such as Harrogate in North Yorkshire to speak to patients and dentists and see the situation for themselves. The Government must urgently reform that broken dental contract, ringfence unspent funds and retain our experienced dental practitioners so that more patients can see a dentist when they need to.

When people cannot see a GP or a dentist, they end up in A&E. More than ever, the Government need to get around the table and agree a fair deal with all our NHS staff. We know why A&Es are under so much pressure. It is, in part, because people cannot get out of hospital when they need to as social care is collapsing as well. The number of vacancies in social care stands at 165,000, and it is rising alarmingly: in the past year alone, it increased by 55,000.

The Liberal Democrats are calling for the introduction of a carers’ minimum wage. We would pay £2 per hour more than the current minimum wage for all carers, meaning that by April this year, the hourly pay would be £12.42. A staggering 850,000 care workers would benefit from that increase in pay, and more than 80% of them would be women. Social care needs serious solutions from a serious Government, so will the Minister seriously consider introducing a carers’ minimum wage?

Our health and care services are one ecosystem. Whatever claims the Government make about how much they are spending and what they are trying to do, the British public can see that it is too little, too late. Targets are being missed left, right and centre, and everything that the Government say is worlds apart from the lived experience of our constituents, who are struggling to get the help that they need. Never again will the British public trust this Conservative Government with their NHS or their care services.

Photo of Karin Smyth Karin Smyth Labour, Bristol South 3:46, 28 February 2023

Having spent most of my career in NHS management roles before becoming an MP, I often reflect on my own motivation for choosing two such unpopular careers—ones that, like the England manager job, virtually everyone can do better. One of our colleagues said recently that NHS managers are utterly useless and overpaid, which is what many of our constituents might say about us. As someone who has always been a manager and active in the Labour party, I was often told rather gently by my colleagues that I was too political to be a manager in the NHS, and my colleagues in the party often say that I am a bit too managerial to be an MP, so I think I am somewhere just about right.

The truth is that the NHS is an intensely political construct. NHS managers do not have the neutrality cloak of civil servants or the freedom of many business leaders. The lack of clarity around the role of NHS management is, I think, problematic, and it often leaves managers isolated and less able to do the job that we crucially need them to do. The Secretary of State’s pledge to cull managers yet again comes at a time when the challenges faced by the system are the greatest that we have ever seen, even without taking the pandemic into account. Industrial relations are at an all-time low, capacity and demand are massively out of kilter, the physical estate is crumbling, with £10 billion-worth of backlogs, and morale is at dangerously low levels.

We need much better management, but managers need to be clear with us. Ten years on from the Francis report and the introduction of a duty of candour, we—the public, Members of Parliament and patients—have to know where and when our system is and is not safe. We have to be informed about the trade-offs between cost and quality, and we should be active parts of the discussion about the future of technology and big data in healthcare. I am disappointed that the Minister has again trotted out the figures of inputs but has not addressed the crucial issues. We did not do that before the pandemic, and it is quite extraordinary that the Government are still not receiving the messages from the frontline.

The increased recruitment to NHS unions, more support for strikes and the reality of people’s experiences all tell us the same message. The Government’s current response is all about getting rid of the current crisis: the money that they are putting in is too little and too late to be of real value, and instead of collaborating with local authorities, which are now worrying about the pick-up rates, they are fragmenting many local relationships. The uncertainty about payment by results and the faltering steps towards better collaboration mean that the deckchairs are still moving, and for our constituents, things are not improving.

Our focus in government, of which I am enormously proud to have been a part in an NHS trust and then as a manager, was on patient choice. That was not because we think that the NHS is a market, as is often said, but because we think that the NHS needs a stronger patient voice to co-produce individual care, and because we are asking people to pay more in this age of long-term conditions and co-morbidity, so we have to ensure that they have more local accountability in the system. The system is not accountable locally.

I repeat my comments about Scotland and Wales. The Welsh waiting lists are not acceptable. The Scottish waiting lists are not acceptable. None of this is acceptable. As politicians, we all need to start addressing some of the underlying issues we share and start learning from one another.

I am proud of my time in the NHS and fully aware of the scale of the task ahead, but with good clinicians, good managers and, dare I say it, good politicians, we can develop a longer-term plan and turn this around, should we choose to. The workforce is the right focus to start with, but other improvements in quality of care can happen if we trust the local. Let us build improvements where we can and work with the willing. Let us rejoin the dots destroyed by the disastrous Lansley reforms.

I recently received an updated join strategic needs assessment from my local authority—the plan for my constituency. These are all things I worked on over 10 years ago, and it is utterly heartbreaking to see. Cervical screening coverage for all women in Bristol is lower than average. Bristol is below the national average for HPV vaccination in boys and girls. Breast cancer rates are 16% higher in Bristol than the England average, and the prevalence of osteoporosis is rising much faster in Bristol than in England. One in four attendances at A&E for falls is a resident of my constituency. I remember the old falls service 10 years ago. This is not a new disease to be eradicated; we do not need a new cure. These are all entirely, and fairly cheaply, preventable problems of public health.

The local NHS priorities are now excess weight management, harmful use of alcohol and falls in old age—all public health preventive work—but with child and adult social care taking up more than 60% of local authority revenue budgets, public health has been hollowed out and is entirely reliant on the voluntary sector. People living with profound disability and ill health are dying earlier and in worse condition. The next debate is about employment. Let us get those people back to better health and back to work. Let us help them care for the older people and people with disabilities they need to care for, but crucially, let us give them their life back. The Government need to join the dots. Instead of bad-mouthing and culling more management, let us give local government and the NHS the tools they need to do the job.

Photo of Mick Whitley Mick Whitley Labour, Birkenhead 3:52, 28 February 2023

I draw the House’s attention to my entry in the Register of Members’ Financial Interests. I would like to begin by placing on record my solidarity with the junior doctors who are set to stage three days of strike action over pay later this month, as well as with members of the ambulance service whose dispute is still ongoing.

The Royal College of Nursing has now suspended its planned strike action to allow for the commencement of pay negotiations with the Government. There can be no doubt that our nurses deserve a fair pay rise that truly reflects the extraordinary work they do, but I must warn the Health Secretary that the cost of living crisis is being felt in every profession in the NHS at the moment, and I hope he will give serious consideration to the warnings issued by other health unions regarding the dangers of entering into unilateral talks with a single union. He must understand that any deal he reaches with the RCN will have broader implications for the entire “Agenda for Change” pay band system and risks prolonging disputes with other parties even further. I urge him to act in the best interests of patients, health workers and the NHS itself by inviting all unions that are in dispute around the table and by working to find a resolution on an NHS-wide basis.

I have been proud to stand with striking health workers on their picket lines over the last few months and to learn more about what has driven them to take strike action, some for the first time in their lives. In every instance, pay has been the immediate catalyst for a dispute. Far too many people working in our NHS are struggling to make ends meet, and the scourge of low pay is deterring far too many bright and determined young people from seeking a career in the health service in the first place.

However, while the cost of living crisis was an issue for everyone I spoke to, most people seemed more concerned with the state of the NHS itself than with their own personal circumstances. They had got used to real-terms pay cuts under the past 13 years of Conservative misgovernment, but none had seen the NHS in such a state as it is today, crippled by gaping staff shortages, crumbling facilities and the highest backlog in its history.

Those discussions led me to reflect on how much has changed in the 13 years that the Conservative party has been in charge of our health service. Conservative Members may not want to admit it, but when Labour left power, our national health service was world leading by any metric. In fact, a 2010 Commonwealth Fund report singled out the NHS for its efficiency and shorter waiting times. That is a far cry from today when 7.2 million patients are being prevented from moving on with their lives because they are waiting for treatment, and delays in emergency care cause hundreds of deaths every week.

In 1997, it fell to the Labour party to save a health service that had been driven to its knees by the mismanagement, arrogance and carelessness of the Conservative party—and so it proves again today. The plan that has been put to the House by my hon. Friend Wes Streeting, the shadow Health and Social Care Secretary, will help to lay the solid foundations for the recovery and revival of the NHS. I hope that when the Chancellor comes before this House to deliver the Budget, he looks as favourably on it as he did when it was first announced, when he called for it to be adopted

“on the basis that smart governments always nick the best ideas of their opponents.”

In recent years, he has made great political capital out of his support for the NHS, even if that has often been at odds with his deeply questionable record as Health Secretary. On 15 March, he has the opportunity to show that he cares more for nurses than for the super-rich by backing Labour’s plans to end non-dom status.

It seems increasingly likely that soon enough, Labour will be responsible for the stewardship of our health service, so I urge my hon. Friend the Member for Ilford North not to let his ambitions falter. These plans are undoubtedly a step in the right direction, but it is also crucial to engage meaningfully with those on the NHS frontline about what more needs to be done to support the NHS workforce in the immediate term.

In that vein, I ask my hon. Friend and the Secretary of State to listen to the EveryDoctor campaign group about its practitioner-led plan to revive the NHS, which includes steps to strengthen mental health support for NHS staff; to remove the locum fee caps that restrict our ability to maintain safe staffing levels during periods of extreme crisis; and to cut red tape in the Home Office so that people can start the job that they came to this country to do. I also ask my hon. Friend to guarantee that confronting the immediate pressures facing the NHS workforce will not prevent our party in government from making the bold, structural reforms that we promised in our last manifesto, including ending privatisation in the NHS.

Several hon. Members:

rose—