Lord Markham:

Moved by Lord Markham

That the draft Regulations laid before the House on 20 February be approved.

Relevant document: 32nd Report from the Secondary Legislation Scrutiny Committee

My Lords, the noble Baroness, Lady Merron, has tabled a Motion to Regret, and I will first address her concerns in turn.

First, the noble Baroness noted that the regulations do not offer sufficient evidence to support the change, and that the information on the potential costs of and savings from this reorganisation are unspecified and vague. In response, I note that an amended version of the Explanatory Memorandum for these regulations has been laid, with additional information on the costs and benefits of, and evidence for, the transfer of functions from Health Education England to NHS England.

As the Explanatory Memorandum sets out, there are some smaller costs and savings relating to the transfer of Health Education England’s functions to NHS England, and more significant costs and savings related to the wider transformation programme that NHS England is currently undergoing, which would include the transferred Health Education England functions. As I will set out in more detail later, overall, the merger of HEE and NHS England will bring significant benefits to the delivery of workforce planning for the NHS.

Transition costs include the creation of the HEE transition programme office and short-term consultancy to deliver the overarching design and the new workforce function. Ongoing savings and efficiencies from the wider NHSE transformation programme are expected to include a reduction in the total size of the new NHSE, including Health Education England and NHS Digital, of up to 40%; savings from not having a Health Education Board; and removing the need for a range of duplicate processes currently in place.

These amendments to the Explanatory Memorandum are also intended to address comments on the regulations by the Secondary Legislation Scrutiny Committee in its 32nd report of Session 2022–23.

The noble Baroness’s second point was that the regulations have not been published alongside the Government’s NHS workforce plan. I will say more about the longer-term plan later, but I can confirm that the Government have committed to publishing the plan this spring and will include independently verified projections for the number of doctors, nurses and other professionals who will be needed in five, 10 and 15 years’ time, taking full account of improvements in retention and productivity.

The noble Baroness’s final point was that the regulations do not guarantee that NHS England will give long-term workforce issues sufficient priority. I can confirm that the Government are putting in place a range of measures to ensure that NHSE places sufficient priority on these vital issues. This includes setting objectives on workforce within the NHS England mandate, continuing to monitor and track expenditure on education and training, and establishing a ministerially chaired board to provide oversight and governance of workforce in the NHS.

I now turn to the regulations more widely. The intention of the regulations is to more closely align workforce planning, which is the statutory function of Health Education England, with the service and financial planning responsibilities of NHS England. This will enable service, workforce and finance planning to be properly integrated in one place, both nationally and regionally, building on the work to develop the NHS People Plan. It will also help drive reforms to education and training further and faster, so that employers can recruit the health professionals needed to provide the right care to patients in the future.

Merging Health Education England with NHS England will simplify the national system leading the NHS. It will end the separate lines of accountability for the two bodies. Currently, Health Education England is responsible for workforce planning, education and training, while NHS England is responsible for culture, retention, international recruitment, workforce and leadership. Uniting these functions will help to ensure a joined-up and long-term view of what workforce the NHS needs.

In addition to removing the need for a separate HEE board with sub-committees, the merger will also remove the need for a range of duplicate processes currently in place. These include separate clearance processes for policy and strategy documents, financial transfers between the organisations to ensure training resources can support specific service development and the need to agree or align external communications that cover both organisations’ interests.

In short, for me, as a businessman for the last 25 or 30 years, the idea of having an HR function separate to the rest of the corporate functions is totally foreign, particularly in a service such as the NHS, where we know that workforce is front and centre of everything it needs to do. For me, that is compelling logic for having one of the most important functions working in-house alongside you.

The merger of Health Education England builds on increasing co-operation and joint working over recent years between Health Education England, NHS England and NHS Improvement to help ensure that workforce investment is aligned to government priorities. Over recent years, Health Education England has also worked with NHS England and NHS Improvement, regional people boards, local systems and individual employers to undertake workforce planning.

The merger is in line with a recommendation from the Public Accounts Committee in 2020 to review the effectiveness of having a separate body overseeing the planning and supply of the NHS’s future workforce, which the DHSC accepted. I know there will be concern in some quarters that the changes may create a risk of training projects being used for other purposes, but we have put in place a range of measures to ensure that will not be the case.

Health Education England and NHS England already work closely together to ensure that the NHS has the workforce it needs for the future, and we have commissioned NHS England to develop a long-term workforce plan for the NHS for the next 15 years. The long-term NHS workforce plan will look at the mix and number of staff required and will set out the actions and reforms across the NHS that will be needed to reduce supply gaps and improve retention.

The Government have committed to publishing the plan; it will include independently verified projections for the number of doctors, nurses and other professionals that will be needed in five, 10 and 15 years’ time, taking full account of improvements in retention and productivity. The Government have already made significant progress in growing the workforce. In the past year, we have seen record numbers of staff working in the NHS, and we are on track to recruit 50,000 more nurses in the NHS by March 2024.

However, we know that demand for the NHS continues to grow, which is why we have put substantial investment into training additional healthcare professionals. This includes funding an additional 1,500 medical school places each year for domestic students in England. We have also supported diverse routes into healthcare professions through apprenticeships and blended learning programmes to make a healthcare career more accessible. We are committed to supporting our NHS, and the long-term workforce plan will help ensure that we have the right numbers of staff, with the right skills, to transform and deliver high-quality services fit for the future.

I want to pay tribute to Health Education England’s leadership and staff throughout the organisation’s 10-year existence. The organisation has played a highly effective role in the delivery of growth in the numbers of health professionals trained in England. It has promoted the creation of roles such as nursing associates and spearheaded reforms to professional training workforce growth, with record numbers now working in the NHS. It was flexible and effective during the pandemic, including in supporting the deployment of students to the front line at critical moments. The merger will continue and build on Health Education England’s great work, putting education and training at the heart of service planning for the long term.

I am delighted that Dr Navina Evans will become the chief workforce, training and education officer in the new NHS England on 1 April 2023 and that Sir David Behan was appointed as a non-executive director at NHS England on 1 July 2022. These appointments will help ensure there continues to be excellent national leadership of NHS education and training.

In conclusion, these regulations will simplify the architecture of the NHS at national and regional level and help ensure that the NHS has the workforce it needs for the future. I commend these regulations to the House.