NHS Staffing Levels — [Philip Hollobone in the Chair]

– in Westminster Hall at 11:28 am on 22 November 2022.

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[Philip Hollobone in the Chair]

Photo of Margaret Greenwood Margaret Greenwood Labour, Wirral West 2:30, 22 November 2022

I beg to move,

That this House
has considered NHS staffing levels.

It is a pleasure to serve under your chairmanship this afternoon, Mr Hollobone. I pay tribute to all the nurses, doctors and other medical professionals—indeed, everybody who works in the NHS—for the work they do to look after patients and keep us all safe.

I have been overwhelmed by the number of organisations that have shown interest in this debate and have shared details of how the NHS staffing crisis is impacting on the people they represent. They are too numerous to mention here, but they include the Royal College of Nursing, the Royal College of General Practitioners, Versus Arthritis, Cancer Research UK, Unite the union, Parkinson’s UK, the Royal College of Midwives and many others. It is clear that there is insufficient capacity in the NHS in England to meet the needs of patients.

The NHS staffing crisis is a direct result of the failure of Conservative Governments to plan and deliver the workforce that we need. The crisis is not just about the impact of the pandemic; it predates that. In June this year, there were more than 132,000 vacancies in the NHS in England, which is up from around 98,000 the previous year and from around 105,000 in March. When we look specifically at registered nursing staff, as of June there were over 46,000 vacancies. Alarmingly, that is almost 8,000 more than in March. For medical staff, there were over 10,500 vacancies in June, which is around 2,500 more than in March.

By way of comparison, in December 2019 there were around 38,000 nursing vacancies and more than 8,800 medical staff vacancies. What was already an extremely serious situation before the pandemic has become worse. Staffing shortages create stress for NHS workers, and delays and deteriorating quality and safety for patients. As well as vacancies, waiting times for treatment and emergency services have continued to soar. Last month, of the nearly 1.4 million people who visited major A&E departments, more than 550,000 waited more than four hours from arrival to admission, transfer or discharge. That is 45.2% of attendees, which is way short of the target of 95% to be seen in four hours. In December 2019, 31.4% waited for more than four hours. Again, an already serious situation before covid has got worse.

As of last month, a total of 7.1 million people in England were waiting to start routine hospital treatment. More than 400,000 people had been waiting more than 52 weeks, and more than 2,000 longer than two years. Behind those statistics are huge numbers of people waiting in pain and anxiety. Cancer Research UK points out that, in September of this year, only 60.5% of patients started treatment within 62 days of an urgent referral, against a target of 85%. That means that, in September alone, around 6,000 people waited for more than 62 days for their cancer treatment to start. Even before the pandemic, cancer patients were waiting too long for diagnosis and treatment. The 62-day target has not been met since 2015.

On the Conservatives’ watch, millions of patients are being deprived of the timely treatment that they desperately need. Because of the unacceptable delays, some are paying for expensive private healthcare, and many are distressed to do so, because they believe in a publicly owned, universal, comprehensive national health service. They have been failed by Conservative Governments.

The staffing crisis is having a devastating impact on retention. Last month, the Health Service Journal reported that a record number of NHS workers voluntarily resigned from their jobs during the first quarter of this financial year. Almost 35,000 resigned voluntarily, which is up from around 28,000 during the same period in 2021 and around 19,000 in 2020. The most common reason for leaving during quarter 1 of 2021-22 was work-life balance, which almost 7,000 NHS workers cited as their reason for leaving.

A few months ago, I met with members of the Royal College of Nursing. They told me about the incredible amount of pressure that they are under because of staff shortages. They also told me of nurses suffering financial hardship. Some are going to food banks, some are unable to afford to drive to work, and some are leaving the profession to work in chain stores for better pay. However, it is not just about pay. The nurses told me that they often simply do not have enough colleagues to work alongside them. That is extremely stressful for them, and dangerous and deeply unfair for patients.

I turn now to industrial action. NHS staff care deeply about their patients, but they can also see that the NHS is at breaking point. Earlier this month, the Royal College of Nursing voted to take strike action in its fight for fair pay and safe staffing. That is unprecedented and has not been done lightly. The RCN has been clear: its members have voted for fair pay for nursing, safe patient care and to protect patients.

Numerous other organisations, representing thousands of workers, are also balloting for industrial action, including Unite the Union, Unison, the Royal College of Midwives and the GMB union. The Conservative Government’s failure to address the NHS staffing crisis is putting those working in the service under immense pressure and, in some instances, putting patients at risk. It is notable that, in a poll of 6,000 adults, carried out on behalf of Unite, 73% of respondents supported NHS and careworkers receiving pay rises that keep up with the cost of living. The Government should take note.

We cannot discuss the NHS staffing crisis without highlighting the Conservatives’ privatisation agenda, because it does impact on people working in the service. The Health and Care Act 2022 split the NHS in England into 42 statutory integrated care systems, each comprising an integrated care board and integrated care partnership.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

I thank the hon. Lady for making such a poignant and important speech, and for securing this debate, because we are all grappling with the issue. Does she agree that the staff in the NHS do their very best, but the future planning of the workforce is also an issue? We do not have enough staff for the future workforce plan. That is particularly the case in mental health and learning disabilities. I read that 215 young people took their lives in 2021, the highest figure since records began. Is that a concern to her, because I think it is for most of us in the House? I am sure that, in the excellent speech is making, she will want to highlight that.

Photo of Margaret Greenwood Margaret Greenwood Labour, Wirral West

The hon. Lady makes an incredibly important point. There can be no more poignant and devastating example of what this crisis is leading to.

The Health and Care Act is a privatising piece of legislation that opens the door to private companies having a greater say in the delivery of health care. Guidance by NHS England, while the Act was going through Parliament, stated that it would enable integrated care boards to delegate functions to providers, including devolving budgets to provider collaboratives. Provider collaboratives are partnership arrangements involving at least two trusts, and they can include representation from the private or independent sector.

As we now know, the delegation of commissioning from ICBs to provider collaboratives will definitely go ahead. That represents not only the opportunity for the privatisation of the NHS, but clearly has implications for NHS staff. I am concerned that a situation may well arise where a provider collaborative decides to commission services from the private sector, instead of from the NHS provider that is currently delivering the service. In that instance, NHS staff may well find that their jobs are lost from the NHS, and that equivalent work is available only in the private sector, on poorer pay and conditions of service.

The Health and Care Act, which was passed by the Conservative Government earlier this year, has the potential to undermine national collective bargaining, and the pay and terms and conditions of NHS staff. It also undermines the concept of the NHS as a publicly owned organisation that has served us so well since 1948. The Act prohibits the chair of an ICB from approving or appointing someone as a member of any committee or sub-committee that exercises commissioning functions, if the chair considers that the appointment could reasonably be regarded as undermining the independence of the health service, because of the candidate’s involvement with the private healthcare sector or otherwise. However, that is clearly open to interpretation. It by no means rules out people with interests in private healthcare from sitting on those sub-committees.

If we are serious about providing governance that rules out the possibility of the private sector influencing the expenditure of public money, an organisation carrying out the functions of an ICB on its behalf should be a statutory NHS body. It is a great pity that the Government did not legislate for that, despite an amendment in my name calling for it, which had cross-party support.

Private companies can also have influence through integrated care partnerships, which are required to prepare a strategy setting out how the assessed needs of its area are to be met. ICBs must have regard to a strategy drawn up by an ICP, which I am concerned might be influenced by private companies. Of course, the responsibility of a private company is to make money for shareholders; it is not to support a publicly owned, publicly run national health service.

Other provisions in the Act also have serious implications for staff. The Act allows for a profession that is currently regulated to be removed from statutory regulation. That is deeply concerning. Once a profession is deregulated, we can expect the level of expertise in that field to decline over time, alongside the status and pay of those carrying out those important roles. Deregulation also brings with it serious long-term implications for the health and safety of patients.

The Act also provides for the revoking of the national tariff and its replacement with a new NHS payment scheme. Engagement on the NHS payment scheme is still under way, with a statutory consultation due to begin shortly. I have long been concerned that, given the requirement in the Act for NHS England to consult with each relevant provider before publishing the NHS payment scheme, including private providers, this may well be a mechanism through which the Government will give private health companies the opportunity to undercut the NHS. If that happens, I believe that one of the inevitable outcomes would be an erosion of the scope of “Agenda for Change”, as healthcare that should be provided by the NHS is increasingly delivered by the private sector.

In that event, NHS staff may then find themselves forced out of jobs that are currently on “Agenda for Change” rates of pay, pensions and other terms and conditions, with only private-sector jobs with potentially lesser pay and conditions available for them to apply for if they wish to continue working in the health service. Just like the provision around provider collaboratives, that would appear to hold risk for NHS staff and their pay and conditions. As such, I would be grateful if the Minister will guarantee that the pay rates of “Agenda for Change”, pensions, and other terms and conditions of all eligible current NHS staff will not be undermined as a result of the adoption of the NHS payment scheme. Can he also confirm that trade unions, staff representative bodies and all the royal colleges will be consulted before the NHS payment scheme is published, as Ministers in the other place assured us during the passage of the Act?

I understand that the Government are to publish a comprehensive NHS workforce plan next year, including independently verified workforce forecasts of the number of doctors, nurses and other professionals we will need in five, 10 and 15 years’ time. Such a plan is long overdue, so can the Minister provide some further details about when we will see it? Will that plan also include details of the numbers of staff we will need in the social care sector, where there is also a workforce crisis that is intricately linked to that in the NHS? Will the Minister set out what measures he is taking to address the staffing crisis this winter?

Photo of Rachael Maskell Rachael Maskell Labour/Co-operative, York Central

The reality is that today, we are training NHS professionals in the same professional silos as we did 100 years ago. Medicine has moved on massively, so in light of the fact that a new workforce plan is being drawn up, is it not right that those professions are revisited to ensure we have a workforce fit for the future, as opposed to doing things just because we have done them for so many years?

Photo of Margaret Greenwood Margaret Greenwood Labour, Wirral West

As ever, my hon. Friend makes an interesting and detailed point born of her experience. The Minister should take note.

To conclude, since 2010, Conservative Governments have let the crisis in NHS staffing develop. Instead of doing the important business of Government and bringing forward a timely workforce plan and a properly funded training regime, they have focused their energy on not one, but two, major reorganisations of the national health service designed to open it up to privatisation. Instead of tending to the needs of the workforce and the needs of patients, they have been priming the pump for shareholders. The NHS must remain a comprehensive universal service, publicly owned, paid for through direct taxation and free at the point of use for all who need it. That very concept is under threat: it has been reported this week that NHS leaders in Scotland have discussed abandoning the founding principles of the NHS by having the wealthy pay for treatment, thus creating a two-tier system. Not only would that be a betrayal of its founding principles, but it would also bring in costly administrative processes that are not currently needed, as patients would need to be means-tested.

The NHS is also under threat from this Conservative Government’s failure to get a grip on the staffing crisis, and from their privatisation agenda. This attack on the fundamental principles of a comprehensive, universal, publicly owned national health service, free to all who need it and paid for through direct taxation, has left patients neglected and staff overworked and underpaid. Patients, the NHS, and all who work in the service deserve better. The Government must come forward as a matter of urgency with a credible plan to put things right for NHS staff and set out how they are going to deal with the crisis this winter, and Ministers must give NHS workers a fair pay rise, protect NHS services, and ensure staff safety.

Several hon. Members:

rose—

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

Order. The debate can last until 4 o’clock. I am obliged to call Front Benchers no later than 3.27 pm. The guideline limits are 10 minutes for the Scottish National party, 10 minutes for His Majesty’s Opposition and 10 minutes for the Minister. Margaret Greenwood will have three minutes to sum up the debate at the end. Nine speakers are seeking to take part so we have a time limit of four and a half minutes. I will be grateful if hon. Members stick to that.

Photo of Kim Leadbeater Kim Leadbeater Labour, Batley and Spen 2:45, 22 November 2022

I congratulate my hon. Friend Margaret Greenwood for this important debate on a subject that is close to my heart. I have many friends and family who work in the NHS and I speak to them regularly about the severe pressures they are under. I doubt there is a single Member of Parliament whose inbox is not full of casework, both from patients whose treatment has been delayed because of staff shortages and from overstretched NHS workers who are frustrated that, with the best will in the world, they simply cannot meet the demands they face each and every day.

I want to mention a couple of the emails I have received in recent weeks. Eamon works in the NHS and told me:

“After over 10 years of underfunding, I see my colleagues and staff within the hospitals I visit every day look more and more dejected, run down, insulted and demoralised. Where once was pride, a smile, laughter and camaraderie, there is now worry, depression and a feeling of hopelessness.”

Tracy expressed the feelings of many long-serving health workers when she told me:

“Some of us cannot cope on the wages we earn and are considering leaving the NHS. We cannot afford to lose any more staff—we are struggling to staff wards as it is. I work six days a week to get a decent wage. I’m 60 years old and I have worked all my life. This can’t be right.”

Eamon and Tracy are hard-working professionals, dedicated to helping the patients in their care. That people like them should be so worn down and unhappy at work that they are considering leaving should be a wake-up call to the Government. Yet all we hear from the Prime Minister down is that decent wages for nurses and other healthcare workers are unaffordable. Is it any wonder that people look elsewhere in the economy and see employers doing what the Government should be doing in the NHS? That is, offering higher wages and better working conditions to help recruit and retain the staff they need.

In my constituency of Batley and Spen, Amazon is seeking to build a huge new warehouse development. I am opposing the plan for a number of reasons, not least the damage it would do to the health and wellbeing of local residents and the impact on the already-overloaded transport network. However, I also have serious reservations about the number and type of jobs such a development would create and I worry that our exhausted NHS workforce may be tempted by such developments, whatever the reality. We cannot afford for our nurses, porters, drivers and other workers who keep the NHS going to be lured away by the promise of higher wages in other sectors. We need them.

The impact of staff shortages has already led to vital services in my constituency being significantly reduced, leaving patients having to travel long distances to access care that, until recently, was available in their own communities. Such local care is really important. To take just one example, the Bronte Birth Centre was a lifeline for expectant mums, but it was forced to close—hopefully, temporarily. However, some fear it could become permanent, because the centre simply cannot get the maternity staff it needs. A recent advert for midwives did not lead to a single application.

NHS management is doing its best, looking to support recent graduates, attract back retired staff and recruit internationally. However, it is clear that the fundamental problem remains the same across the health service: low morale, wages that fail to keep up with prices and working conditions that are getting progressively worse, month after month and year after year. We remain incredibly proud of the NHS, especially on this side of the House, but I accept in other parties too. After 12 years of under-investment, it is now stretched to breaking point. Unless we take urgent action to strengthen the workforce, restore the pride that NHS staff have in their ability to do their jobs and properly reward them for their work, we are putting the future of our NHS at serious risk. I hope we can all agree that that is something we must avoid at all costs.

Photo of Kate Osamor Kate Osamor Labour/Co-operative, Edmonton 2:49, 22 November 2022

Thank you for calling me to speak, Mr Hollobone. It is a great pleasure to be part of this important debate, and I thank my hon. Friend Margaret Greenwood for securing it and for setting the dire scene in the NHS.

I will use my speech to talk about when I was a practice manager before I became an MP, and I want to speak about the way in which racism and discrimination affects the wellbeing of black and minority ethnic staff. Some 22.4% of NHS staff in England are from BME backgrounds, so they are disproportionately represented in the NHS but are under-represented in senior leadership. If we want an acceptable level of NHS staffing, it is crucial that racism and discrimination against staff from BME backgrounds is properly challenged.

Earlier this year, the BME Leadership Network published the “Shattered Hopes” report, which was based on surveys and roundtables of staff, revealing results that were shocking to read. It found that more than half of BME NHS leaders have considered leaving the NHS in the last three years because of their experiences of racism, and that colleagues, leaders and managers were a more common source of racist treatment than members of the public, which is truly shocking.

I want to provide the Minister with some recommendations, which I hope he will be able to address in his summing up. First, it goes without saying that the Government must give a pay rise to doctors, nurses and all staff in the NHS that is at least above the current rate of inflation, to protect their standards of living and to ensure the retention of staff. Secondly, we must ensure that bursaries for nursing students are restored so that more people—particularly those from more disadvantaged backgrounds—can access training. Lastly, the Government need to provide a renewed commitment to ensure that the NHS delivers on its commitment to combat institutional racism alongside tackling health inequalities.

We need an expanded training programme to truly tackle discrimination within the NHS. Without that commitment, countless staff will have no choice but to quit working for the NHS.

Photo of Tim Farron Tim Farron Liberal Democrat Spokesperson (Environment, Food and Rural Affairs), Liberal Democrat Lords Spokesperson (Communities and Local Government) 2:52, 22 November 2022

It is a pleasure to serve under your guidance again, Mr Hollobone. I am grateful to Margaret Greenwood for securing a really important debate.

I want to say a massive thank you to NHS and care staff. Undoubtedly, every year is a tough one for those working in this area, but the last few years have been incredibly demanding. The pandemic has taken its toll on people’s mental and physical health, and has led to real attrition within the various clinical and non-clinical services. It is worth bearing in mind how much worse it would have been had we not collectively taken the right decision to try to tackle the pandemic early on. Nevertheless, it has been incredibly hard.

I will focus on a few areas that are significant for NHS staffing, starting with dentistry. It is worth bearing in mind that we all pay our taxes, so 100% of my tax-paying constituents have paid for NHS dentistry, but only about a third of them are getting it, including roughly half of the children. At the moment—I have checked—there is not a single NHS dental place anywhere in the entire county of Cumbria, which is a disgrace. That could be solved in no small part if the Government were to address the issue of the treadmill of units of dental activity. If it were done differently, it would not necessarily cost the Government any more money to make sure that they do not push dentists into a position where they feel that they have no alternative professionally than to leave the NHS, that we bring back the people who have left, and that we value the ones we have working within it.

Secondly, I want to talk about GPs. The simple reality is that we have far fewer GPs entering the service than we need. Many rural communities in Britain, such as mine, have a smaller surgery population-wise because of the vast area that they cover. We are currently dealing with the potential closure of the Ambleside and Hawkshead medical practices—the Central Lakes Medical Group. It is out to tender at the moment, because the Government removed what was called the minimum practice income guarantee, a sum of money that made small rural surgeries financially sustainable. Their removal has led to three closures that I can think of in Cumbria—one in Eden and two in South Lakeland. A relatively small amount of money would keep those surgeries sustainable and make sure that we kept people working at them. Otherwise, we have NHS staff who are determined to work and serve those communities who simply find that they cannot.

Nothing is more important to solving the NHS staffing crisis than tackling care—we have talked about that a lot—and it is outrageous that the Government have chosen to kick dealing with that issue into the long grass for another two years. We have 32% bed-blocking in the hospitals of south Cumbria at the moment. The reason why is obvious: there are not enough care packages to help people when they leave hospital, because there are not enough carers. The impact on hospital capacity, on the capacity of A&E, on ambulances that take so much longer to drop off their patients and therefore take longer to respond to calls, and the lives put at risk, is blindingly obvious. For the Government to delay dealing with care, and to think it is delayable for two years is not a tough decision for them. It is a tough decision for the millions of people who will be affected and for the tens of thousands of people working in our care sector.

The lack of availability of affordable homes for care workers and NHS workers in communities like mine is also worth bearing in mind; that is a major reason why there are not enough staff working in health and social care. We now understand that the Government will kick the Levelling-up and Regeneration Bill into the grass on the other side of Christmas. That was an opportunity for the Government to decide that they would change the law to protect homes for local occupancy.

My final comment is on the cancer staffing situation. We currently have an outrageous situation where, in the south of Cumbria, 43% of people diagnosed with cancer are not getting their first treatment for two months, and 62% in north Cumbria are not getting their treatment for two months. That is an outrage. It is costing lives. Undoubtedly, staffing is a major part of that. I am chair of the all-party parliamentary group for radiotherapy, and we are to meet the Minister or his colleagues soon. Can I press him for a date?

In the meantime, I will share one important statistic with him. Radiotherapy UK surveyed 622 radiotherapy professionals—10% of the entire workforce nationwide—and 94% of them felt that the Government did not understand the impact of the current situation on their service; 72% felt that NHS senior managers did not either. As a consequence, we are losing people from the industry. We need a workforce plan specifically for cancer.

I hope the Minister will agree to meet with me and the APPG soon so that we can give him the all-party manifesto on radiotherapy, which will solve some of the problems and give those working in the NHS, particularly in cancer, some hope for the future.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 2:57, 22 November 2022

It is a pleasure to speak in this debate. I thank Margaret Greenwood for leading the debate. Like her, I acknowledge and appreciate the incredible work of all our NHS healthcare professionals in all areas of our health system over the last number of decades, especially throughout the pandemic, when we appreciated them even more than normal. I place on the record my genuine thanks to them for their commitment and their efforts through the covid crisis, which will continue to have impacts on the efficiency of our NHS for some time.

Our national health service is one of a kind and we must do everything in our power to protect it and ensure that it is given what it needs to ensure its success. Just yesterday in the main Chamber, I asked the Chief Secretary to the Treasury about retaining our nurses. How we do that is quite simple: we pay them the wages that they need. There is something drastically wrong if someone can become agency staff and get better wages for doing the same job. I am always respectful to the Minister, and I do not say that to chasten or to be aggressive, but we really do need to pay our nurses what they deserve. Perhaps the Minister can get back to us on that point.

It is very challenging to cover all the issues about NHS staffing. The NHS is one of the largest employers in the world, with more than 1.3 million staff, with 13,000 of them working back home. There is no secret that there are staffing issues for many different reasons. I have heard before from younger people that the educational process to becoming a nurse is purely based on exam results. I understand the need for training. Nursing, mental health nursing, medicine and dentistry require degrees from universities. Many universities refuse to take students who do not achieve high grades in their entry requirements. Perhaps it is time to look at whether, if the grades are not achievable for them but they have an interest in the subject matter, they should be given training to deliver that. We do not always have to aim for the gold star ones. There are people who might not achieve all of the grades that they should, but could still be darn good nurses and do well. I ask the Minister if he could give us his thoughts on that.

Tim Farron mentioned GPs. Back home, GPs are really important. If one or two fall away from the local health clinics and surgeries, we automatically have a crisis among our GPs. So, let us encourage more GPs to come in. To do that, we will probably have to pay them better too, so that they do not wish to go anywhere else—overseas or wherever. We have all heard about the horror stories that illustrate their reasons for doing that.

I heard from a constituent just last week who was in a car accident. Her car was written off, but, luckily, there were no life-threatening injuries. However, the ambulance came and she waited in the ambulance queue for eight hours. She was not allowed to move from the stretcher, was not able to use the toilet, and had no water to drink. That is just an example of some of the crises we have. That is not the Minister’s fault—it is a devolved matter and I understand that—but it is just an illustration, and I suspect that other Members will have their own examples.

I would make a plea on behalf of the Royal College of Psychiatrists, which has stated that, over the past year, the number of full-time-equivalent consultant child and adolescent psychiatrists in the NHS has declined, while referrals to child and adolescent mental health services have increased by 24%. We have countless debates in this place relating to better provisions for children’s and teenagers’ mental health, and the RCP tells us that there are simply not enough psychiatrists. Again, I am throwing this at the Minister at very short notice, but I know that his responses are always very helpful. I ask for some help in raising that.

I am also aware of the challenges that the staff face. I thank each and every one of them—I thank them and I praise them. They go home after their shifts, tired and disheartened. Margaret Greenwood mentioned that earlier on. It is the truth. With that in mind, we must do more.

I very much welcome the additional money allocated in the autumn Budget, and the Barnett consequentials mean that we will get £650 million. That is a massive help, and I understand that. I certainly hope that that will shield the NHS from inflammatory staffing pressures, but I hope that the Minister can undertake discussions with the devolved Administrations on this issue, and on how we can do it better together. I am always very conscious that the Minister is a gentleman and responds well; I very much look forward to his reply.

Photo of Paulette Hamilton Paulette Hamilton Labour, Birmingham, Erdington 3:02, 22 November 2022

I congratulate my hon. Friend Margaret Greenwood on bringing forward this important and timely debate. In all areas of healthcare, it is incredibly important that our NHS is able to cope with the growing demand for its services.

Across the board, staffing shortages in the health service, let down by 12 years of Tory chaos, are endemic. In nursing, 40,000 registered nurses in England have left the NHS in the past year. We have lost 4,700 GPs in the last decade, and hundreds of practices have closed since the last election. That has resulted in GP surgeries being massively overstretched, such as the one in my constituency that has 3,200 people on its books.

The cuts are not just numbers; they have a real impact on people’s lives. One of my constituents is a PE teacher with a chronic knee injury. She was unable to book a GP appointment and could not get an MRI scan. So that she could continue to work safely, she felt that she had no option but to book it privately, costing her £300.

In mental health services, local trusts are seriously struggling with a lack of capacity. Last year, around 2.8 million people had contact with NHS mental health, learning disability and autism services in England. That is around 5% of the population, and my city of Birmingham had the third highest percentage of adults in contact with those services. Despite the obvious problems in this area, the Royal College of Physicians has reported that, nationally, we can expect an increase of just 4,000 more mental health nurses by 2024, when more than 12,000 are required to meet demand. We know that the pressures that hospitals face lead them to rely on NHS staff banks and agency workers to cover for the lack of capacity. This year, 83% of nursing staff said that staffing levels on their last shift were not sufficient to meet patient needs safely and effectively.

The new Chancellor of the Exchequer said in 2015:

“For too long staffing agencies have been able to rip off the NHS by charging extortionate hourly rates which cost billions of pounds a year and undermine staff working hard to deliver high-quality care.”

However, this autumn’s Budget pledge to increase NHS spending by £3.3 billion next year is not enough to plug the £7 billion shortfall that the NHS could experience.

I was a nurse for 25 years. I understand how important it is for the NHS to have sufficient levels of staff, and the disastrous effect that staffing shortages have. Nurses work long hours day in, day out, to support people all across the UK. They often do this on very low pay, and we know that many hospitals across the country have opened food banks specifically to feed their staff. After 12 years of mismanagement by the Tory Government, it is no wonder that our nurses have been driven to take industrial action for the first time. As I said earlier, nurses are leaving the profession in droves; some 40,000 quit last year. I for one do not blame them. I cannot say, hand on heart and with 25 years of nursing experience, that I could do the job now. The blame for the mess lies squarely with the Conservatives.

Photo of Taiwo Owatemi Taiwo Owatemi Labour, Coventry North West 3:06, 22 November 2022

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank my hon. Friend Margaret Greenwood for securing this important debate.

As the newly elected chair of the all-party parliamentary pharmacy group, I want to take this opportunity to outline some of the main concerns facing staff in that sector. Before being elected to this House, I worked in the NHS as a senior cancer pharmacist, and I still regularly volunteer at my local hospital, Coventry and Warwickshire hospital, in cancer care. The opportunity to serve on the frontline of our health service was and continues to be a privilege that I feel every time I set foot in the hospital. There are very few more rewarding things in life than being able to help those in need and provide care for patients at what are often very difficult moments of their lives.

Because of that, I know first hand how important pharmacists are to the provision of healthcare across the country, yet the Government continue to fail those key workers. A recent study published by the Pharmacists’ Defence Association revealed that almost a quarter of pharmacists want to leave their current sector and move to another part of pharmacy and, of those, almost a third are considering leaving pharmacy altogether. As with most healthcare professionals, low and stagnating pay and working conditions are the main reason for seeking a change. With just one in 10 pharmacists feeling that they get adequate breaks, it is no wonder that so many are looking to leave. The longer the Government ignore the exodus of pharmacists to other industries, the more money it will cost to recruit and train new staff.

As a member of the Health and Social Care Committee, I was part of a team who put together earlier this year a workforce report that recommended that the Government better utilise the pharmacy workforce and, in doing so, optimise workload across primary care, reduce pressures on general practice and hospitals, and support integrated care systems. Community pharmacists are willing and eager to take on more responsibilities in order to become the first port of call for patients and take the pressure off overburdened GP surgeries. The Government talk the talk about investing in our NHS, but if they are unwilling to take the necessary steps, waiting times and patient dissatisfaction will continue to grow.

As part of our report, the Select Committee recommended that pharmacists must have clear structures for professional career development into advanced practice. The Government have completely ignored that call; and I know, from my own experience, that far too many in the industry feel that those opportunities are sparse at the best of times. Like everyone else, pharmacists need to know that there are chances for growth and the acquisition of new skills in different areas. If the Government are serious about supporting pharmacists, as they have said repeatedly, that must be a priority.

Retaining pharmacists is also vital to the long-term health of the NHS as a whole. Until the Government tackle the issues of low pay, poor working conditions and a lack of opportunities for career progression, I fear that we will see a weaker and weaker pharmacy sector, which none of us can afford. Sadly, the issue that I have outlined is not specific to pharmacists but applies to all healthcare professionals.

I turn to cancer waiting times in my constituency of Coventry North West. In August, only 57% of patients at University Hospital Coventry, where I volunteer, began their treatment within two months of being referred by their GP, but the NHS target is that the trust should aim to see 85% of patients within 62 days. That simply is not good enough. Cancer patients in Coventry were put on the backburner during the pandemic, and as a result we see more and more cases of late-stage cancer. Those patients need to be seen urgently, and simply cannot wait. Many pancreatic cancer patients in Coventry have been in touch to let me know of their anger at being forced to wait so long. They are being let down.

I know how hard NHS staff work. Despite their efforts, cancer waiting time targets continue to be missed. Unless the Government invest in our beloved institution, we will continue to see more of the same. We need to strengthen our NHS workforce. We need to be able to invest in retaining the staff that we currently have. We also need to pay our nurses, and all healthcare professionals, adequately and appropriately for their hard work and dedication.

I thank all the NHS staff in Coventry, and across the country, for their dedication and hard work, and for all that they do to look after our loved ones. Lastly, I ask the Minister to meet me to discuss the future of pharmacies and the workforce.

Photo of Naseem Shah Naseem Shah Shadow Minister (Home Office) 3:11, 22 November 2022

It is pleasure to serve under your chairmanship, Mr Hollobone. I thank my hon. Friend Margaret Greenwood for bringing forward this important and timely debate.

The reality is that the national health service that we clapped for, that we care so deeply for and that is the last line of defence for our families and loved ones is literally at breaking point. There may well be some dividing lines between voters, but when it comes to the NHS, whether someone votes red, green, blue or yellow, the NHS matters to them. Yet 12 years of Conservative Government has managed to bring the NHS to its knees.

Right now, in Bradford and across Britain, patients find it impossible to get a GP appointment. People suffering from heart attacks or strokes are waiting longer than one hour for an ambulance. Some 401,537 patients have been waiting for more than a year for an operation, and “24 Hours in A&E” is no longer just a TV programme: it is the patients’ everyday experience. That brings great shame on us all.

Just today, Labour’s shadow Health Secretary, my hon. Friend Wes Streeting, highlighted the case of a 16-year-old who has been given a hospital appointment in 2025—in three years’ time. Will that 16-year-old put their health and life on hold for three years? Similarly, an elderly lady in my constituency of Bradford West had an operation this year that was three years on from when it was originally planned. The pain and suffering that she endured while she waited was unbelievable.

One of the key reasons for all that is, of course, staff shortages in the NHS, which all Members have highlighted. Twelve years of Conservative Government have left the NHS understaffed and unable to deliver timely care. Under the Conservatives, medical school places fell by 30% this summer—thousands more straight-A students turned away from training and becoming doctors when we need them more than ever. The latest NHS Digital vacancy statistics show 132,139 vacancies across England on 30 June 2022. For registered nursing staff alone, there was a vacancy rate of 11.8%, or more than 46,000. That is an increase from March 2022, when the rate was 10.3%, or over 38,000. In my local hospital in Bradford, that rate increases to more than 15%. One senior clinician told me today that if she had a magic wand, she would scrap university fees so that she could open up the profession for people who cannot afford to go into nursing.

Last year’s NHS staff survey showed the level of concern about the impact of NHS staff shortages in Bradford. When asked to respond to the statement:

“There are enough staff at this organisation for me to do my job properly”,

only 15.3% of respondents at Bradford Teaching Hospitals NHS Foundation Trust said they agreed or strongly agreed—down from 32.2% in 2020. The responsibility for that lies firmly at the feet of this Government. The NHS is now approaching winter with the longest waiting times in its history and record shortages of staff. NHS staff are slogging their guts out, but there are simply not enough of them.

Labour has a plan to combat the crisis in the NHS. The next Labour Government will double the number of district nurses qualifying every year, train more than 5,000 new health visitors, create an additional 10,000 nursing and midwifery places every year and double the number of medical school places that so we have the doctors we need in our NHS. It is time we had a party in government that is serious about protecting the NHS, not just clapping for it.

Finally, I put on the record my thanks to local NHS staff in my constituency—from those working in GP practices to staff nurses and doctors, and from health visitors to those providing care at home, including all the key workers we clapped for who provided home care and gave people dignity in their own homes, even during the covid pandemic. As my hon. Friend Kim Leadbeater rightly pointed out, doctors and nurses have burnt out. They have told me that they have not recuperated from the impact of covid, let alone prepared for the coming winter. The mental health stress put on our nurses and doctors is not okay. The Government need to step up and do something about that.

Photo of Peter Dowd Peter Dowd Labour, Bootle 3:16, 22 November 2022

It is a pleasure to speak under your stewardship, Mr Hollobone. I thank my hon. Friend Margaret Greenwood for initiating the debate.

Where do I begin on this subject? It is difficult to know because Members have brought forward a plethora of information, but I will start with the House of Commons Library briefing, which is always a good source of information, and its research is based on independent sources. It says that the Health and Social Care Committee has said:

“The National Health Service and the social care sector are facing the greatest workforce crisis in their history.”

The NHS, which is the best part of 80 years old, is facing the worst crisis in its history, with a vacancy rate of 9.7%, which is 132,139 members of staff.

There is significant shortfall in staff across the piece. Tim Farron talked about vacancies in pharmacy, dentistry, radiology, podiatry, ambulance staff, back-office staff—as those people who are at the heart of the service and keep it going are disparagingly called—cleaners and porters. Everybody says the whole NHS is under huge stress.

Photo of Rachael Maskell Rachael Maskell Labour/Co-operative, York Central

I want to highlight the neuroradiology profession and the reality that staff shortages have an impact on clinical outcomes. Hardly any of our NHS trusts have neuroradiologists, but they could save 9,000 lives lost to strokes by being able to advance new techniques. Does my hon. Friend agree that it is important to look at the clinical outcomes that health professionals could bring?

Photo of Peter Dowd Peter Dowd Labour, Bootle

My hon. Friend is right: it is crucial that we do that. A whole range of issues are beginning to affect staffing. For example, there is a £9 billion maintenance backlog in the NHS. Patients are being treated in hospitals that are not, in certain situations, fit for purpose and, importantly, staff have to work in those environments. In many cases, radiology equipment is not up to date, so staff and patients are either working or being treated in an environment in which the conditions and the equipment are not good. That goes to the heart of the staffing crisis as well.

There are lots of suggestions about how the Government could get to grips with the situation. Community Pharmacy England has plans to “resolve the funding squeeze”, which seems pretty straightforward, to

“tackle regulatory and other burdens” that are affecting staffing, to

“help pharmacies to expand their role in primary care” and to

“commission a Pharmacy First service”.

All those things go to the heart of enabling staff to feel wanted and that they are working in an environment where they are treated properly.

Of course, we then get people leaving in droves because of pay. I looked at some of the figures in relation to the pay restraint that we have had for the past few years: since the Government came to power in 2010, for all intents and purposes there has been either no pay increase or an increase of 1% here and 2% there.

Photo of Clive Lewis Clive Lewis Labour, Norwich South

I thank my hon. Friend for making such an excellent speech. Will he comment on the fact that at the University of East Anglia medical school we saw a fifth of new nurses, or training nurses, drop out of the course after the Government cut the nursing bursary? With the low pay, crisis of staffing and pressure that is going on, we expect those nurses to work in the NHS as they are training and rack up debt at the same time. If we are going to get the numbers back up, we must surely reintroduce the bursary.

Photo of Peter Dowd Peter Dowd Labour, Bootle

Yes, we must. When these professionals come into the NHS and work their socks off, for all the hours that God sends, they do not even get a decent pay rise. They have had to pay to do the job, then they pay to do the job again because we are not giving them enough money. My hon. Friend is absolutely right. The amount of funding the NHS gets falls well short of our international competitors in terms of revenue and current and capital expenditure. We spend about £3,055 per person on health; in our competitor countries, which are similar economies with similarly sized populations—such as France and Germany—the figure is £3,600. That difference, of the best part of £600 per person, is absolutely significant. We are falling further behind as the years go by.

The Government say, “Well, this year we have accepted the independent NHS pay review body’s recommendation.” I suspect that this is the first time in many years that they have accepted, championed and blown the bugle for it. Let us look at the detail and analyse it. The terms of reference include

“the need to recruit, retain and motivate suitably able and qualified staff”.

That is not happening, is it? That is nowhere to be seen. They also mention

“regional/local variations in labour markets and their effects on the recruitment and retention of staff”.

That is not working either, is it?

The terms of reference mention:

“The funds available to the Health Departments, as set out in the Government’s Departmental Expenditure Limits”.

In effect, the Government tell the pay review body what it can do, because of the amount the Department has, and then, when the body agrees with what the Government say, they say it has been an independent assessment. It is not as simple as that.

Here is another one: “the Government’s inflation target” is a factor. We all know where that is—whose fault is that? It is not the Government’s fault; it is the Bank of England’s fault.

The terms of reference mention:

“The principle of equal pay for work of equal value in the NHS”— which was referred to earlier and is not happening. They talk about:

“The overall strategy that the NHS should place patients at the heart of all it does”— but it is far from putting them at the heart of the service. In conclusion, staff need a pay rise and better working conditions; the only way they will get that is with a Labour Government in two years’ time.

Photo of Stephanie Peacock Stephanie Peacock Shadow Minister (Digital, Culture, Media and Sport) 3:23, 22 November 2022

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank my hon. Friend Margaret Greenwood for securing this incredibly important debate.

As we have heard in previous contributions, we are proud of our NHS—and rightly so—but it is clear that our NHS is in crisis. Understaffing piles pressure on the existing workforce, tipping them to breaking point. The national NHS vacancy rate sits at 9.7%—that is one in 17 vacancies unfulfilled for doctors and one in 10 for nurses. The pandemic was an unprecedented strain that created an employment backlog, but staff shortages were critical well before covid. These are not just statistics: vacancies are all too often the difference between life and death. The autumn statement pledged £3.3 billion to the NHS, which is of course welcome, but funding and wages are still below 2010 levels in real terms, with sky-rocketing inflation further exacerbating an already dire financial situation. We know that it takes years to recruit and train healthcare professionals.

I have been contacted by many constituents who are facing unacceptable waiting times for GP and dentistry appointments. As we have heard in the debate, this problem extends across the whole NHS, whether it be in respect of pharmacies, cancer or ambulance wait times. When we see delays with GPs and dentistry, that sometimes leads to further pressure on other NHS services that could have been prevented had problems been identified earlier.

Tim Farron outlined some of the issues with dentistry, which were reflected in the constituency-wide survey that I did in Barnsley East, in response to which many of my constituents said they really struggled to get a dentist appointment. That is concerning when we consider that Barnsley has the fourth highest rate of tooth decay in the country. In Yorkshire and the Humber as a whole, 98% of dental practices cannot take new patients.

One constituent contacted me just last night about their very concerning and upsetting experience in hospital. They have been waiting almost a year for a neurology appointment after an initial injury in March 2021. They are in constant, excruciating pain due to a herniated disk and now have sustained a secondary injury. They are unable to work so have lost their job. Because of the current cost of living crisis, they are having to choose between heating and eating, as many across the country are. This constituent is unable to enjoy the things they once used to and is experiencing great distress and financial difficulty. They are unable to walk for more than 15 minutes at a time and cannot sit for sustained periods. They feel they have nowhere to turn, with no sign of an appointment any time soon, to find a solution to this pain. This is obviously a heart-breaking situation and one that people should not have to endure due to pressure and staff shortages.

There is not much more that NHS staff can do to give every patient the time they deserve. GPs are frequently seeing three times the safe number of patients, often taking up to 90 appointments a day. Some are reported as having taken 200 appointments a day. This results in warning signs for conditions such as dementia being missed. In South Yorkshire specifically, sickness absence is at 7.1%. NHS staff are becoming exhausted and getting sick themselves. How can they be expected to carry on in such pressurised working environments and meet the high standards that we are used to?

Almost 10,000 doctors left the NHS last year, with many citing conditions as their reason for leaving. Some 20,000 more are expected to leave in the next year. The NHS urgently needs more Government investment and not empty words. After 12 years of a Conservative Government, our NHS needs a Labour one. As has been outlined today, Labour’s fully costed plan would double the number of university medicine places available per year, provide 10,000 more nursing and midwifery clinical places each year, provide 5,000 more health visitors a year and double the number of district nurses qualifying each year.

In closing, I put on record my thanks to NHS staff. My mum worked in the NHS for 40 years as a midwife and a nurse. I know how hard she worked and I know, from talking to NHS professionals across Barnsley, how hard they work. I know that we all thank them for their service. The reality is that the NHS and this country simply cannot afford this Conservative Government any longer.

Photo of Steven Bonnar Steven Bonnar Shadow SNP Spokesperson (DEFRA Team Member) 3:28, 22 November 2022

It is nice to see you in the chair this afternoon, Mr Hollobone. I congratulate Margaret Greenwood on securing and leading this vital debate on NHS staffing levels. I also thank all Members who have made valuable contributions. I place on the record my thanks and admiration, and that of my party, for all those who work in our NHS in Scotland and in all social care settings.

We live in unprecedented times. We have endured the worst pandemic in living memory; we have witnessed the worst Prime Minister and Chancellor in living memory; we have an energy and cost of living crisis thanks to the invasion of Ukraine by the egomaniac Vladimir Putin and persistent public spending cuts that have crippled our economy; and we have the small matter, which very few dare to mention in this place, of the most horrific act of self-harm in living memory—Brexit. We in this place can dance around any fact we like, but the real reason for the staff shortages and real pressures in our NHS is Brexit. Because of all those combined factors, our greatest asset, the national health service, is under the greatest strain in its 74-year history across all the nations of the United Kingdom.

Consistently poor and, frankly, dumb economic choices undertaken by the Government have led to unprecedented inflation, limiting the Scottish Government’s ability to act in the areas in which they are required to do so due to the significant cuts to the Scottish budget. The previous Prime Minister’s catastrophic mini-Budget wiped £1.7 billion from the Scottish Government’s forthcoming budget in a matter of just a few days, dwarfing any increase announced recently by the newest Chancellor’s autumn statement. Scotland has been left with an additional £200 million shortfall and Scottish health spending power has been reduced by £650 million. Is that what we have to be thankful for? It is most certainly not our Union dividend or our Brexit bonus.

Together with the Welsh Health Minister, the Scottish Health Secretary Humza Yousaf recently wrote to the UK Government calling for the Chancellor to announce additional funding for this year in the NHS budget so that health boards and the devolved Governments can afford to pay the wages that our NHS staff so rightly deserve. Covid costs continue to eat into funding, despite the UK Government stopping covid funding altogether. The UK Government are pulling their usual stunt of giving with one hand while taking away with the other. Unless the Government take urgent action to immediately increase their budgetary spend, the NHS as we know will be in extreme peril.

A hard Tory Brexit—and one backed and endorsed by the Labour party, as the people of Scotland are fully aware—means that Scotland has endured the greatest depopulation of any of these island nations. As a result, we have a shortage in available workforce, as reported on page 3 of today’s Financial Times so illuminatingly. Scotland needs people to come in and bring their skills with them. We need a migration system that works for all of us and is fit for purpose. There is no other option if we are to fill the national labour shortages in our NHS and social care settings, as well as in other sectors that are in dire need of an eligible workforce—hospitality, transport, agriculture, fishing and many more. Again, Brexit is causing problems throughout every sector. The SNP’s position is that immigration powers must be devolved to Scotland and the Scottish Parliament. If the UK Government do not want to solve the problems effectively, if indeed at all, it is time to get out of the way and allow us to do so.

The Royal College of General Practitioners has found that more than 40% of GP trainees are international graduates. Forty-nine per cent. of that number have reported issues with the visa process and 17% are considering leaving the United Kingdom altogether and, as a result, taking their much-required skills elsewhere. That is talent that we should be nurturing and harnessing, but we are instead pushing it away and rejecting it. The UK Government have consistently hamstrung the NHS with their privatisation and red tape agendas, and now an immigration mess is adding to the chaos. Now we have different NHSs across the nations of the UK competing internally with one another to attract and retain staff in our healthcare settings. It is one sorry mess, and the architects of Brexit must shoulder the responsibility.

GP numbers were touched upon earlier, and there have been concerns about GP numbers in Scotland, as well as elsewhere across the United Kingdom. It is worth noting that Scotland has a record number of general practitioners working across our nation, with more GPs per head of population in Scotland than across the rest of the UK’s nations. The Scottish Government are committed to further increasing the number of GPs practising in Scotland by 800 by the end of 2027, investing £170 million each year for that purpose. We are making good progress on that commitment, with Scotland’s GP headcount increasing by 277 to 5,195 between 2017 and 2021.

The Scottish Government continue to look for ways to encourage staff into working for our world-renowned NHS service and will continue to work co-operatively with the UK Government wherever possible to encourage sufficient inbound migration to plug the labour shortages and support the full staffing of our national health service. Last week, the Chancellor announced that more than 600,000 people on universal credit will be asked to have a meeting with a work coach so that they can get the support they need to increase their hours or their earnings. Instead of sanctioning the poorest people in our communities and attacking workers’ rights by restricting trade unions, the UK Government must get real and focus on creating a fair and tailored immigration system that works for the people of Scotland and, indeed, the rest of the United Kingdom. However, it cannot be any clearer—other than to those who choose not to see—that the ramifications of Brexit are now beginning to bite in the very areas we knew they would, and we see nothing at all from this Government to suggest anything other than that the best future for Scotland’s NHS and for Scotland as a whole is one in which the representatives of the Scottish people directly decide on how best to safeguard all that we hold dear. That only comes with our country’s independence.

As I have a few wee minutes left, I will say to any hon. Members who represent English constituencies that the groundbreaking Pharmacy First service is excellent. It is working so well in Scotland, and I am glad that it will be rolled out across the rest of the UK. In Scotland, anybody under the age of 26 is now eligible for free NHS dental treatment. We have free annual eye tests for everybody in Scotland, and biannual tests for those over 65, free prescriptions for all, and free hormone replacement therapy and sanitary products. We are not getting it all right, but there is an ambition to get better, and we need the support of the UK Government to do so.

Photo of Feryal Clark Feryal Clark Shadow Minister (Health and Social Care) 3:36, 22 November 2022

It is a pleasure to serve under your chairmanship, Mr Hollobone. I pay tribute to my hon. Friend Margaret Greenwood for securing this important debate, and praise all the Members who have spoken this afternoon for their brilliant contributions.

The NHS is a cornerstone of communities up and down our country. It is the biggest employer in Europe and one of the biggest in the world, supporting the livelihoods of millions of British families. A publicly funded healthcare service that is free at the point of need is a lifeline for so many, and the people of this country are overwhelmingly proud of it. The pride and respect we have for the NHS means that it will always have people to stand up and defend it when things are going wrong.

However, the reality is that patients are finding it impossible to get a GP appointment due to chronic shortages of doctors, as we heard from my hon. Friend Mrs Hamilton. Stroke and heart attack victims are waiting an hour for an ambulance, and over 400,000 patients have been waiting more than a year for an operation. We have gone from an NHS that treated people well and on time to not just a winter crisis, but a year-round crisis, and an NHS that is understaffed and unable to deliver timely care.

The NHS is facing the greatest workforce crisis in its history. Right now, there are 132,000 vacancies across the NHS, and 165,000 in social care. We are short of 40,000 nurses, and we are losing midwives faster than we can recruit them. We are short of 12,000 hospital doctors, yet this summer, medical school places were cut by 30%, turning away thousands of straight-A students from training to become doctors when we need them more than ever. As we have heard again and again this afternoon, the consistent failure to train and retain the nurses and doctors our NHS needs has left staff overworked, overstretched and struggling to cope.

Photo of Peter Dowd Peter Dowd Labour, Bootle

The Royal College of Physicians produced a short, medium and long-term plan for the NHS, specifically in relation to staffing. I was shocked to read that the measures to increase satisfaction and retention of current staff—getting the basics right—included access to hot food and drink, and rest facilities, at all hours of the day. The Royal College of Physicians putting that into a document shows how poor the situation is. Would my hon. Friend agree that the Government have to listen to that?

Photo of Feryal Clark Feryal Clark Shadow Minister (Health and Social Care)

I wholehearted agree with my hon. Friend. With nurses already doing an average of £2,000 a year in overtime to make up shortages, the Government cannot rely on good will to get us through this crisis. They cannot afford to play politics and refuse to get around the negotiating table to avoid strike action.

It would be far too simplistic to suggest that pay is the sole cause of this crisis, as we have heard in this debate. Members who have spoken with NHS staff in their communities will know that the problems run far deeper than that. In this debate we have heard how staff are demoralised, burnt out and undervalued, and are working in poor conditions. Staff members are working harder than ever, but are unable to deliver the level of service they want for patients.

When I speak to NHS staff in my constituency of Enfield North, their passion and dedication is in no doubt whatsoever. One of the clear themes that came through in a local healthcare survey run over the summer was an appreciation in our community for the efforts of NHS staff. On a recent visit to Chase Farm urgent care centre, I saw at first hand the pride that staff had for the work they did, and their desire to deliver the best for patients, despite chronic shortages of staff and the most trying of circumstances. They are going above and beyond the call of duty.

We cannot keep relying on the good will of staff. We need to see their attitude matched by action from the Government. Staff need to know that they will not be hung out to dry and that help is there for them. What reassurance can the Minister give to staff, at places such as Chase Farm, that their cries for help will be heard? If the Minister believes that what we heard from the Chancellor is sufficient, then he is very much mistaken. I am pleased that, after long calls from the Back Benchers, the Chancellor has dragged his party into agreeing to an independent assessment of our NHS workforce needs, but does the Minister really expect that assessment to say that the NHS has the people it needs to deliver a safe standard of care for patients?

Talking will not cut it for NHS staff. We need a plan of action. I was pleased to hear from my hon. Friends the Members for Bradford West (Naz Shah) and for Barnsley East (Stephanie Peacock), who set out Labour’s plan so well. Labour’s plan will deliver the biggest expansion of medical school places in history, doubling the number to give the NHS the doctors it needs to get patients seen on time. It will also include an extra 10,000 nursing and midwifery places, helping to close the gap caused by the loss of 800 midwives in the NHS since the last election. Labour would double the number of district nurses qualifying each year and train 5,000 more health visitors. That would be funded by abolishing non-dom status, a move that brings in double the £1.6 billion investment that our NHS workforce needs. The Chancellor has described our plan as something that

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

Given that statement, I look forward the Minister bringing the plan forward as the Government’s own, sooner rather than later.

We know that getting more staff into the system will not, on its own, solve the problem. Our NHS has brilliant staff working in it already, and we must do more to give them the confidence to stay. The Government are simply not doing enough, and unless we improve retention, extra recruitment will not deliver the numbers we need. As we have heard, staff are leaving faster than we are recruiting. The scale of the crisis means that we cannot simply wait things out and hope it blows over. We need a plan and some action from the Government now. I look forward to the Minister telling us how they will deliver that.

Photo of Will Quince Will Quince Minister of State (Department of Health and Social Care) 3:45, 22 November 2022

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am grateful to Margaret Greenwood for raising this important issue. I join her in thanking all NHS staff for everything they do for us. The workforce are the beating heart of everything our NHS does and stands for. I hugely value the work of everyone who works in health and care, from consultants to care workers, nurses to neurosurgeons, and porters to physios. I thank all hon. Members from across the House who have taken part in this important debate. In the time available to me, I will try to respond to as many of the themes raised as possible—I have been franticly scribbling throughout the contributions.

I have only been in post for a handful of weeks, and in that time I have seen the very best and the future of our NHS with cutting-edge technologies and innovation. For example, it was only earlier this week when I saw genuinely world-leading world genome sequencing. Innovation and technological advancement is only as good as the highly trained and qualified clinicians who operate it or, importantly, who interpret the data. Health is a human business. I know this from my own family’s experience of the NHS, and I am sure hon. Members know that too. Only caring NHS staff can provide the patient-centred and compassionate care that we all hope and expect when we interact with our NHS. That is why I am personally passionate about supporting our health and care staff, particularly when we are in challenging times. Last week, the Chancellor announced an additional £3.3 billion a year in the autumn statement to assist in this endeavour.

I turn first to workforce pressures, which were raised by the hon. Members for Batley and Spen (Kim Leadbeater), for Westmorland and Lonsdale (Tim Farron), for Bradford West (Naz Shah) and for Birmingham, Erdington (Mrs Hamilton)—I am particularly grateful to her for sharing her 25 years of nursing experience. I am acutely aware that the workforce remain under sustained pressure. Staff worked tirelessly through the pandemic and they have my huge thanks and gratitude for doing so.

I know that every day hundreds of thousands of NHS staff provide high-quality care under considerable challenges. As well as the pressures we see every winter, in the summer, which is usually—I am told in the NHS you cannot use the Q-word, which stands for quiet—less busy, we had covid waves where we would not ordinarily. There is also the recovery of elective care and the 7 million people on waiting lists, including the 400,000 who have been waiting over a year, as the hon. Member for Wirral West rightly pointed out. There is the rising number of covid and flu cases—I take this opportunity to make a public health announcement encouraging people to check their eligibility and get their covid and flu jabs if they have not already done so.

Of course, it is vital that we support the workforce, not just now but for the future. The NHS workforce have grown since last year, with an extra 3,700 doctors and 9,100 nurses, but I understand that—this point was made eloquently and articulately by hon. Members—demand is growing significantly, too.

Photo of Paul Girvan Paul Girvan Shadow DUP Spokesperson (Education), Liberal Democrat Lords Spokesperson (Transport), Shadow DUP Spokesperson (Transport)

In the light of workforce planning, somebody seems to have taken their eye off the ball. We have doctors who decide they want to be locums and get three times the shift rate. We have nurses who leave the NHS and sign up with the agency, costing three times more. When will we grasp the nettle of workforce planning and deal with it?

Photo of Will Quince Will Quince Minister of State (Department of Health and Social Care)

The hon. Gentleman is right that that is happening and I will come on to that matter in more detail. I would be happy to meet him, because it is an issue that I know needs gripping not just at the national level but by local integrated care boards too.

As hon. Members have pointed out, training the doctors, nurses and allied health professionals of the future takes time. We have to plan for the next decade now, as Rachael Maskell said. Despite the challenges, we have a growing NHS workforce. We have record numbers of staff working in our NHS. There are record numbers of doctors and nurses. The NHS now has over 1.2 million full-time equivalent staff. In the last year alone, there were over 15,800 more professionally qualified clinical staff in trusts, and 129,800 more hospital and community health service staff than in 2019. Nursing numbers are 29,000 higher than in 2019, which means that we are on track to meet the 50,000 extra nurses manifesto commitment.

However, as the hon. Member for Wirral West pointed out, we face challenges. There are over 132,000 vacancies, including, as she rightly said, 40,000 nursing and midwifery vacancies, and vacancies for around 10,000 doctors. As Paul Girvan rightly pointed out, that means an over-reliance on bank and agency staff. They have their place, but they come at a significant cost, of which we have to be mindful.

We have a long-term workforce plan, which is an NHS England-commissioned project that will set out what workforce we need across the next five, 10 and 15 years. As the Chancellor said in the autumn statement, it will be independently verified. It will look at recruitment, retention and productivity. It will look at where the challenges and the gaps are. As the hon. Member for York Central, who is no longer in her place, rightly asked, what do we need the NHS to look like? Do we need specialists? Do we need more generalists? Do we need a mixture of skills, where people are specialists but also retain generalist skills so that they can do other work? The plan is for the project to report back by the end of this year—very soon—and that independent verification process will then take place. Integrated care boards will need to do the same, or a similar, piece of work at local level.

I am also aware that there are specific challenges. The hon. Members for Strangford (Jim Shannon) and for Westmorland and Lonsdale rightly raised mental health services. An extra £2.3 billion is going in, and our plan is to recruit an extra 27,000 staff, but it is a challenge, which is why we have the advanced bursary in that area. We have increased staff in the area by an extra 5.4%. I know that is not enough, and I know the challenges on local mental health services, so we have to do more.

There is a similar challenge in rural and coastal communities, which the hon. Member for Westmorland and Lonsdale has raised with me many a time. We have to look to expand the apprenticeship route and blended learning programmes so that people do not have to travel to big towns and cities to undertake their training. That work is being done, and there is an extra £55 million for additional placement capacity.

Investment in training is also important. We funded an extra 1,500 medical school places—a 25% increase—last year and this year. That was an investment in five new medical schools. The £5,000 non-repayable grant for nursing, midwifery and allied health professionals has been in place since 2020. There is also additional funding for certain courses, and for things such as support for childcare, dual accommodation, and costs and travel.

Photo of Will Quince Will Quince Minister of State (Department of Health and Social Care)

Mental health does not fall specifically within my brief—it falls within that of the Under-Secretary of State for Health and Social Care, my hon. Friend Maria Caulfield—but I am happy to write to the hon. Gentleman on that point.

Let me turn to staff wellbeing, which is an important point that the hon. Member for Wirral West rightly laboured. It is not just about pay; it is about many other issues. Recruitment is important, as Taiwo Owatemi pointed out, but retention is equally important. We have to ensure that we keep the highly qualified, highly experienced people we have in our NHS. I am determined to ensure that staff are supported and that the NHS works to ensure that staff feel valued, not just by us at the national level, but locally.

The NHS people plan and the people promise set out a comprehensive range of actions that we are taking, such as expanding flexible working. That is important. For example, if somebody does not feel that they can do a full shift but they can work two or three hours, we should be saying, “Yes, of course we want you to work in our NHS and give us what you can.” Flexible working is important, as are improving leadership and ensuring that there is high-quality line management. People often say, “We leave the line manager; we do not leave the organisation.” We must support staff wellbeing and mental health. We also have the NHS retention programme, and we are growing occupational health and wellbeing.

I am conscious that time is short, but I want to turn to the issue of pay, which was mentioned by many hon. Members. I cannot touch on pharmacies today, but that is a hugely important issue and I would be happy to meet the hon. Member for Coventry North West to discuss it. I completely understand that pay is a hugely important factor in looking after staff, and we hugely value the hard work and dedication of NHS staff. I deeply regret that some union members have voted for industrial action, but I understand that these are challenging times for many, largely as a result of global economic pressures, and we are working hard to support NHS workers.

As hon. Members have rightly pointed out, we accepted the recommendations of the independent NHS pay review body in full. That means a pay rise of at least £1,400, or the equivalent of 4% to 5%, for most nurses, which is broadly in line with the private sector. It is important to point out that that is on top of a 3% award last year, when wider public sector pay was frozen, and the Government’s cost of living support with energy.

Through the programme of current work and long-term planning, we are building the robust and resilient workforce that our NHS needs for the future. We are working to ensure that we have the right people with the right skills in the right places, and to ensure that they are well supported and well looked after, so that they can look after those who need our great NHS services and keep delivering the world-class standard of care that people need now and in the future.

Photo of Margaret Greenwood Margaret Greenwood Labour, Wirral West 3:56, 22 November 2022

This has been such an important debate, and I thank every Member who contributed to it. My hon. Friend Kim Leadbeater spoke of the dejected and run-down state of mind of many NHS staff. My hon. Friend Kate Osamor spoke powerfully about how racism affects black and ethnic minority staff and how they are under-represented at senior management level—an issue that needs desperate attention.

My hon. Friend Mrs Hamilton spoke about her experience as a nurse for 25 years and the disastrous impact that staffing shortages have on her colleagues. We also had contributions from my hon. Friends the Members for Coventry North West (Taiwo Owatemi), for Bradford West (Naz Shah) and for Bootle (Peter Dowd), and the hon. Members for Strangford (Jim Shannon) and for Westmorland and Lonsdale (Tim Farron). I thank them all for their contributions.

We have heard powerful testimonies about the impact of the NHS staffing crisis on both staff and patients. We need the Government to come forward with a credible plan to show how they will address the crisis with a fair pay rise for NHS staff, and an urgent plan to deliver the colleagues that those staff so desperately need working alongside them. We also need the Government to call a halt to their privatisation agenda and to reinstate the service as a publicly owned, universal and comprehensive national health service that is free to all when they need it and paid for through direct taxation.

The NHS is one of this country’s proudest achievements, but it is clearly in crisis. NHS workers should not be pushed into industrial action through Government negligence. They deserve our support, and they deserve a pay rise.

Question put and agreed to.

Resolved,

That this House
has considered NHS staffing levels.

Sitting suspended.