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

Part of the debate – in Westminster Hall at 3:33 pm on 17th July 2019.

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Photo of Sharon Hodgson Sharon Hodgson Shadow Minister (Public Health) 3:33 pm, 17th July 2019

It is a pleasure to serve under your chairmanship, Mrs Moon. I thank my hon. Friend Eleanor Smith for securing this important debate, and for her excellent and knowledgeable speech. I also thank all other hon. Members who made excellent speeches. They are all very knowledgeable, and some have had long careers in the health service, which really adds to the quality of the debate.

I pay tribute to the approximately 1.4 million members of the dedicated and hard-working NHS workforce, who are responsible for making our health service one of the best in the world. This debate is absolutely not about criticising them or the NHS, as others have said; it is about criticising the Government, who have continued to undervalue the NHS workforce. NHS staff too often find themselves working under unacceptable levels of pressure following nearly a decade of mismanagement and underfunding. They are consistently asked to do more with less. That pressure has led to abhorrent working conditions. Staff shortages in the NHS have spiked consecutively over the past few years. Recent estimates suggest a shortfall of about 100,000 staff, including 40,000 nurses and 10,000 doctors. If the trend continues, it is estimated that the shortfall will more than double by 2030.

We know that staff shortfalls put patients at risk. They prevent treatment and lead to a poorer quality of care. A 2017 study concluded that lower staffing levels can lead to necessary care being missed, patients being more likely to die following common surgery, and lower patient satisfaction, yet hospitals frequently have gaps in rotas and lack medical cover, which prompts significant concern about safety. Does the Minister believe that is appropriate care for patients and their families? If those substantial staff shortages continue, we will face even longer waiting lists and a deteriorating quality of care, and money ring-fenced for NHS frontline staff and services will go unspent due to lack of staff.

The effect of staff shortages is already evident. We have already seen care homes shut, an increase in agency hires, and chemotherapy treatments postponed because of a lack of staff at hospitals across the country. The effect that staffing shortfalls have on patients must not be underestimated, but we must also remember the effect on the staff themselves. NHS staff are consistently asked to take on additional responsibilities, to work harder, to do more intense shifts and to take on an excessive number of patients. Working in an already high-pressure environment without adequate resources or support not only puts patients at risk but damages the mental health of staff, leading to lower morale, poor wellbeing and a poor working life.

Working life is becoming intolerable for some of our NHS staff. It is no wonder that 20,000 nurses have left the NHS since 2010, and that the NHS has seen a 55% increase in voluntary resignations, with staff citing a poor work-life balance as their primary reason for leaving. The number of voluntary resignations due to health problems and stress has increased threefold in the past 10 years. The recent interim NHS people plan states that people are “overstretched” and admits that people no longer want to work in the NHS. What steps will the Minister take to ensure that NHS staff are retained once they are trained and experienced?

The standards of protection and safety that are rightly expected by staff and enshrined in the NHS constitution are being abandoned. On top of the cuts to staff wellbeing services that have consistently been made across England since the introduction of the Health and Social Care Act 2012, the number of understaffed shifts and overworked practitioners is forcing staff to take time off work and has led to increased requests for employed staff to take on extra shifts. That risks their health and can lead to increased locum use to cover staff rota gaps and vacancies. Staff shortages can have a significant impact on patient and professional safety.

It is welcome news that NHS Improvement will monitor trusts’ use of safe staffing guidelines. However, five years after the Francis report, the action taken on safe staffing simply is not good enough. The exodus of dedicated staff over the past 10 years, staff shortages, long waits for treatment, and frequent cancellations of operations demonstrate that the National Institute for Health and Care Excellence’s suspension of work on setting evidence-based staffing rules in 2015 was a mistake.

One way of ensuring the system has the number of staff it needs would be for England to follow the approach that is taken in Wales and is planned in Scotland, which is to legislate for safe staffing levels, yet the Government have continuously refused to bring forward legislation on safe staffing levels. Will the Minister reconsider that?

It remains unclear who is responsible for interventions in the workforce supply, as the Government certainly seem to be abdicating responsibility. The Government must consider seriously the legal proposals put forward by NHS England and NHS Improvement to amend the Health and Social Care Act to ensure that the workforce crisis is meaningfully and explicitly addressed. Can the Minister explain what impact workforce accountability requirements would have on the current legal framework? Surely the fact that Scotland and Wales have explicit accountability for the provision of the workforce across health and social care but England does not will lead to unequal progress and quality of care across the country and, inevitably, to a postcode lottery for patients.

We cannot tackle this problem if the pool of talented medical professionals in Britain continues to shrink. Safe staffing is not just a numerical issue; it is about having enough staff with the right skills, experience and knowledge. The UK trains only 27 nursing graduates per 100,000 of population, compared with the average of 50 across other OECD countries. The Government have continually undermined incentives to join the NHS workforce, which is demonstrated by their treatment of junior doctors, their introduction of salary caps, their cuts to bursaries and funding opportunities for students, and their hostile approach to those who travel from overseas to join the NHS. Does the Minister recognise that restrictive migration policies act only as a further barrier to tackling the NHS workforce crisis?

Does the Minister also recognise that the Health Education England budget has been cut by 17% in real terms since 2013-14? Applications to nursing training have fallen by 30%, particularly since the nursing bursary was removed. The NHS long-term plan set out some ambitious targets, such as diagnosing 75% of cancers at an early stage by 2028, expanding emergency service care and increasing the availability of mental health services. However, without a long-term, fully funded staffing plan for the NHS, those targets are impossible to reach.

The Government’s warm words and commitments to increase the number of NHS staff working and in training “as soon as possible” are appreciated. However, legislative action must be taken to ensure that patients and staff are not exposed to unsafe staffing levels, which can have dire consequences for patient outcomes and workforce retention. I look forward to the Minister’s response.