NHS Workforce: England — [Mrs Madeleine Moon in the Chair]

Part of the debate – in Westminster Hall at 2:30 pm on 17th July 2019.

Alert me about debates like this

Photo of Eleanor Smith Eleanor Smith Labour, Wolverhampton South West 2:30 pm, 17th July 2019

I beg to move,

That this House
has considered the legal duties of the Secretary of State for Health and Social Care for NHS workforce planning and supply.

I am a nurse. My daughter is a nurse. Nursing is in my family and fundamentally informs who I am and what I do. Last November, I triggered a debate about investing in nursing higher education. I am here today to again carry the burning flag for the nursing profession, the wider health and care workforce, and society.

I will start by directly addressing the notion that we should not seek to further clarify the Secretary of State’s legal duties and powers. I have heard that the latest legislation sought to remove political interference in our health system. I have heard people say, “Don’t make health a political football.” Lastly, I have heard that changing the legislation to give the Secretary of State accountability for the workforce would put health and care back under political control—as if our ability to access health and care was ever out of political control.

I am sorry, but those are laughable positions. Which- ever side of the fence we sit on, it is a serious point that health is fundamentally political. It can never not be political, in terms of what we can access and what happens to people. Our great health service was created within a political agenda, and creating it was a fundamentally political act. Supporting our health and care service to thrive will never not be a political decision. Let us be proud of our history, recognise that health is political, and find a solution to the problems we face.

Now that I have addressed those weak positions, let me state that I, and many others across the political spectrum, take no issue with the idea that there should be explicit clarity in the law about the Secretary of State’s responsibilities. I am not alone in my gratitude for all that our health and care staff do. They work constantly to provide quality care by putting patients at the heart of what they do. In the NHS and the independent sector, nursing accounts for one in 10 of the labour market of the whole of England. We are, and ought to be, a fundamental force to be reckoned with.

Thanks to the scale and urgency of the workforce crisis, many people have been looking into these issues—some of us would say for far too long, and to poor result. We have a long-term plan for the NHS and an interim NHS people plan, so we have seen some movement in the way that agencies work together. However, we have no understanding of what the social care sector needs, and no assurance of workforce funding, which is entirely dependent on the forthcoming spending review and subject to the whim of a new Prime Minister. We do not have a workforce strategy that meets health and care service requirements, or that projects the future needs of the people who live in this country.

The vacancy rate has reached alarming levels, with almost 40,000 nursing vacancies in the NHS in England alone. That is not the full picture. The extent of the vacancies within social care and public health is unclear because it is not mandatory to collect workforce data. It is not possible for services designed with staffing built into their planning to run safely and effectively with so many missing staff.

Fewer people are joining the nursing profession and more are leaving. Since the referendum on the UK’s membership of the EU, more than 10,000 EU nurses and midwives have left the UK workforce. I will not be drawn on Brexit in this debate. However, while we are trying to find our way through the referendum result, frontline staff are propping up the health and care system with no credible assurances that the situation will be resolved. Our professionals are holding on as best they can, but we need to be realistic about what we can reasonably ask of them. They are starting to vote with their feet, and there is not yet the accountability to help us navigate the future that is to come.

This crisis has come about because there is no clarity in the existing legal powers and duties that would ensure that enough staff with the right skills are in the right place at the right time to provide safe and effective care. That is true not just of nursing but of every profession working within our commissioned, taxpayer-funded services, including nurses, medics, psychiatrists, physiotherapists, psychologists, paramedics, pharmacists, social workers, support workers, occupational therapists and dietitians. Literally no one—no one person—is accountable for growing and developing our health and care workforce to meet patients’ needs, now and in future.

The Secretary of State’s current legal duty is to provide a comprehensive service. The Government may say that the Secretary of State has oversight of the workforce through those general duties and powers. With all due respect, the Secretary of State’s responsibilities are too broad to understand what aspects of workforce provision they include. There are also no particular workforce duties within the range of national organisations responsible for service design and delivery. In a health and care system as complex as ours, it is easy for everyone to lose sight of ensuring that we have enough people. Clearly, that is exactly what has happened.