– in Westminster Hall at 9:30 am on 17th January 2023.
I beg to move,
That this House
has considered the potential merits of training additional doctors.
I shall start with a quiz. Who does not like a quiz? What do Members think is the most common nationality among doctors working in the NHS who trained as doctors in Bulgaria? I know that sounds like a silly question—surely Bulgarians train as doctors in Bulgaria and come to work in the NHS—but no, two thirds of NHS doctors who trained in Bulgaria are British, not Bulgarian. Indeed, there are more British people training to be doctors at a medical school in Plovdiv in Bulgaria than there are at Plymouth medical school in Britain.
I imagine Members are thinking, “That makes no sense. How can it be?” Well, those bright, young British people who are clearly capable of being doctors could not get places at medical schools in the UK, so they went off to be trained in Bulgaria before coming back to the UK to work in the NHS. Members might think that that is a stroke of genius by British policymakers—getting other countries to train our doctors; think of the money that saves the Treasury. This has been British Government policy for decades: we do not need to train enough doctors for our needs because other countries will train doctors for us, and they will come to work for us anyway. The purpose of the debate is to show that that Whitehall orthodoxy is not just seriously flawed, but against our national interest. It also harms some of the most deprived countries in the world.
The Government launched their independent NHS workforce review at the end of last year, and it will look at many of those issues. I look forward to hearing the Minister’s thoughts on the review. The purpose of the debate is to step up the political pressure to ensure that the Government reach the right conclusion, which is that, as a country, we should aim to train enough doctors for our own requirements.
I should declare that I have a big constituency interest in the issue. South Cambridgeshire is the life sciences capital of Europe with a biomedical campus, two major hospitals and two more planned, countless world-leading medical research institutes and hundreds of life science companies. All those are impacted by our national refusal to train enough doctors for our needs.
The first thing to say about our national policy of not training enough doctors is that it has clearly failed. We would have to be hermits to be unaware of the pressure the NHS is facing, with record waiting times at A&E and waiting lists for operations. There are many reasons for those, such as it being winter and the covid backlog, but one of the biggest structural reasons is the workforce. There is a shortage of medical workers of all types, including nurses but in particular doctors, and there are a staggering 132,000 vacancies in the NHS of which 10,000 are for doctors. A recent survey by the Royal College of Physicians found that 52%—more than half—of advertised consultant posts went unfilled, primarily because no one applied for them.
Despite being among the most interesting places on the planet for doctors to work—I agree; I am biased—even my own hospitals in South Cambridgeshire struggle to fill their posts. Across the country, there are doctor deserts in which health authorities have real problems in getting doctors to come and work, and rural, coastal and inner-city areas are struggling the most to fill their vacant posts. The Government are trying to implement their commitment to increase the number of GPs by 6,000, which I strongly support, but in reality, the number of full-time equivalent GPs has been dropping by about 1% a year. There just are not enough doctors.
The international figures highlight the scale of the problem. The UK has just 2.8 doctors per 1,000 people, which is significantly below the OECD average of 3.5. It is even further behind the figure for some of our European neighbours, which have more than four doctors per 1,000 people. To reach the OECD average, the NHS would need an additional 45,000 doctors. Imagine the impact they would have on our waiting lists.
Desperate hospital managers are driven to fill the gaps by employing locum medical workers at pay rates vastly greater than they would be if those people were employed directly, and the bill for locums across the NHS is a massive £6 billion a year—a huge waste of taxpayers’ money.
I do not need to labour the arguments: there is a clear political consensus that current NHS workforce planning is not working. There are many short-term and medium-term sticking plasters for the NHS workforce crisis. We need to reduce the number of doctors who leave the NHS through early retirement, leave for other professions or seek a better life overseas. We need to retain more doctors through improved conditions and financial incentives. We need to improve working practices to give doctors greater flexibility over their lives. We need urgently to update the nonsensical pension regulations that are forcing experienced consultants and GPs to retire early.
Another medium-term solution to reduce strain on doctors is empowering physician assistants, nurses and pharmacists to take on additional duties through new regulations, for example on prescriptions.
I commend my hon. Friend on his excellent speech; I agree with every single word. Would he recognise that the inflow of doctors to the NHS is part of a wider package? He alludes to the appalling high salaries being paid to locums. That is preventing doctors from getting contracts for surgeries locally, which is a problem in Bracknell. Would he also agree that we have to bring doctors back from retirement and other professions? That is about improving inflow at every level, across the whole of the service.
I agree fully with my hon. Friend that training more doctors is just one part of the solution. There is no point training them if they suddenly leave. We need to ensure that they are not incentivised to retire early, and that they stay working in the NHS.
According to a study by the health consultancy Candesic, only one in four pharmacists are currently allowed to prescribe; 6,000 pharmacists a year could be trained to prescribe, at a cost of £12 million a year. Those are all things that we should be doing anyway, but they will clearly not solve the problem on their own.
The NHS has historically attempted to make up the shortfall of doctors by hiring them from overseas. That decades-old Government policy means that the majority of new NHS doctors are now trained overseas. Only 45% of doctors joining the General Medical Council register last year were trained in the UK—less than half. A similar percentage were international medical graduates from outside Europe, and the remaining 10% came from the European economic area.
Those overseas medical workers keep the NHS going; they provide expertise and care and are part of the exchange of ideas and experience that drives medicine forward. They are very welcome, but relying on other countries to train our doctors for us is not a long-term, sustainable solution. First, it leads to a global doctor shortage, which harms the world’s most vulnerable countries the most. We are far from being the only rich country to try to save money by getting other countries to train doctors for us. In fact, when it comes to training doctors, we are in the middle of the pack. We train 13.1 medical graduates per 100,000 inhabitants. That is more than the US, at 8.5, and Germany, at 12 per 100,000, but we are behind countries such as Italy, at 18.7 medical trainees per 100,000 people, and the world leaders, Ireland, at 25.4.
The World Health Organisation estimates that the refusal by rich countries to train enough doctors has led to a global shortfall of 6.4 million doctors. It is the poorest countries, which can least afford to retain their doctors, that are most harmed. The NHS tends to recruit predominantly from south Asia and Africa. According to the GMC register, the UK is now home to 30,000 doctors from India, 18,000 doctors from Pakistan, 10,000 doctors from Egypt, 4,000 doctors from Sudan and 3,000 doctors from Iraq. Nearly all those doctors were trained in the medical schools of their home country and left to join the NHS.
Many of those countries need their doctors even more than we do. Sudan has a doctor-patient ratio of 0.3 doctors per 1,000 people, a tenth of our doctor-patient ratio. Infant mortality at birth in Sudan is ten times higher than our own. It is ridiculous that our international aid budget is paying for health projects to try to improve health outcomes in those countries, while we strip them of their doctors. If we had supplied 4,000 doctors to Sudan, we would rightly be proud of the help we had given, but instead we recruited 4,000 doctors from Sudan. Countries such as Sudan need our support, rather than our laying out the red carpet for their medical professionals.
The WHO responded to this by setting up a red list of 47 countries that are deemed to have a low doctor-patient ratio, from which other countries should not recruit. That is a step in the right direction. The NHS no longer actively recruits from those countries, but passive recruitment continues apace. The GMC still offers professional and linguistic assessment board tests in countries such as Sudan, Ghana, Pakistan and Bangladesh. In just the past year, another 500 doctors joined the NHS from Sudan, even though the Government are supposedly not recruiting from there.
The global doctor shortage is likely to get worse, as countries age and economies grow, and demand for healthcare increases. It would be foolish to think that we can always rely on importing doctors whenever we want them. We face increasingly stiff competition from the global market. From a workforce planning perspective, it is significant that the retention of UK-trained medical graduates is higher than those trained elsewhere. Nine in 10 UK graduates who obtained their medical licence in 2015 still had it in 2021, but that was the case for only two thirds of international medical graduates, and less than half of European economic area graduates. We need to minimise leakage from the NHS workforce if we are going to stop the vicious spiral of staff shortages.
The only long-term, sustainable solution, and the purpose of this debate, is to train more medical workers, particularly doctors. This really is a long-term solution, as it takes 10 to 12 years to train a GP and even longer for a specialist, but that is all the more reason to start now. We need to ensure that the supply of doctors is sufficient for our national needs, and that we retain them for the span of their whole career. It is a conclusion that the Government have arrived at before: it was once championed by the current Chancellor when he was the Health Secretary and as Chair of the Health and Social Care Committee. The Government announced an ambitious plan to increase medical training places in 2016, creating 1,500 more places—a 25% increase on the existing number. That was then the largest single uplift in our history, and it was very welcome. It was no mean feat and required the building of five new medical schools across the country, but it is still not enough.
We need to be bolder if we are to aim for self-sufficiency. It is an ambition that has widespread support: the Royal College of Surgeons, the Royal College of Physicians and the Royal College of General Practitioners are all calling for it. The British Medical Association and the Medical Schools Council support it. As I understand we will hear today, it has cross-party support. Last year, just short of 16,000 doctors joined the register. To meet our national needs, we need to double our number of training places by adding at least a further 7,500 to the existing 7,500, making a total of around 15,000 training places.
My hon. Friend makes a compelling point. Does he agree that we do not have to do a massive expansion of medical schools to expand the number of medics we are training? In Burnley we have the University of Central Lancashire, which already trains medics, but the number it trains for the UK is relatively small; it does a far bigger international programme. The university is more than willing to switch that over and train far more here for the UK. We do not need a massive number of new facilities, so the capital cost is relatively small. It is just about saying to the medical schools, “You can train more UK students.”
My hon. Friend makes a really interesting point, which I was going to touch on later. I was going to call on the Government to do a feasibility study of how we get all those extra training places, using the existing resources that we have. I was going to mention one: we now have the first medical school in the UK that does not train any UK graduates; it only trains international graduates. The facilities are absolutely there, and we need to make the most of those to start with.
I should say that training enough of our own doctors does not mean an end to international movement of doctors, and nor should we aim for that. A steady exchange of internationally trained doctors around the global health system is a force for good. It provides opportunities for doctors to experience best practice in other countries and encourages knowledge sharing, and long may that continue.
Now that the policy has cross-party support and backing from the medical profession, why are we not already training enough doctors for our needs? Well, I am afraid to say the main stumbling block has been the Treasury. The perceived wisdom in the Treasury is that it is cheaper to recruit doctors from overseas than to train them ourselves, which might be true in the short term. Medical school places are highly subsidised. Estimates vary, but it costs around £200,000, if not more, for the Government to send a student through medical school. The additional 7,500 places would equate to an additional £1.2 billion a year.
However, on closer inspection, the financial argument does not really add up, certainly not in the medium or long term. First, a considerable proportion of a trainee’s time is spent providing clinical care to patients, so training more doctors will mean that hospitals can spend less money on recruiting locums to provide the care that trainees could provide. Secondly, training more doctors will reduce the £6 billion cost of locums overall. Investing in the training of doctors will save the Treasury money in the medium term as we reduce our dependence on agency staff. Thirdly, the financial argument neglects the income tax receipts earned by the Exchequer over the lifetime of a doctor. An excellent paper just published by the think-tank Policy Exchange calculated that there is a net additional positive lifetime return to the Exchequer of £183,000 for women and £398,000 for men—why is there a difference, one might ask—compared with the most positive plausible alternative degree. In layman’s terms, the Government make a greater return if they train someone to be a doctor than if that person pursues a degree in chemistry or pharmacology.
Concerns have also been raised that taxpayers will pay for the training of doctors, who will then simply leave for countries such as Australia and New Zealand in search of better pay, working conditions and, indeed, weather—who can resist the Australian sunshine?—but that is easily sortable. The Army provides medical bursaries worth £75,000 for Army medics, in return for which they must commit to working for the Army for four years. The Government should adopt a similar policy. Trained doctors should have to commit to working for the NHS for a set period, such as four or five years; otherwise, they would have to repay a portion of their training costs.
If, as I hope the Government will do, we decide to train an extra 7,500 doctors a year, how do we make that happen? My hon. Friend Antony Higginbotham made this point earlier. Implementation of training places is difficult, but it is doable. We have done it before. Training a doctor is complex. There are interdependencies between different bodies that require collaborative thinking and co-ordination. To achieve 7,500 more places, we will need to not only increase the capacity of the existing medical schools and switch places over from international training, but also build an estimated 15 new medical schools.
Each new school will need access to hospitals with clinical training facilities. There would need to be enough clinical academics to conduct the training. Newly qualified doctors will need access to postgraduate courses, including foundation and specialist training.
Despite those hurdles, we managed to increase places by 25% following the announcement in 2016. We can do that again, on a greater scale. I am looking for a commitment from the Minister that the NHS workforce plan that is due out this year—it may be independent, but I am sure the Government have their view—will not only outline an ambition for the UK to do enough medical training for its own requirements but will also include a realistic plan of how that ambition could be implemented. Will the Government launch a feasibility study into how medical school places can be doubled to 15,000 by 2029?
In the meantime, on the path to that ambition, will the Government commit to reinstating the funding provided for additional medical school places during covid for the next academic year? That is a straightforward way to boost capacity in the short term.
Finally, there is a real problem with the transparency of the workforce in the NHS, because of the lack of data. Will the Government commit to providing third-party access to electronic staff records to encourage greater understanding of medical career lifestyles in the NHS?
There are other benefits that flow from increasing training places for doctors. At present, we have many hard-working, straight-A students who are perfectly capable of being excellent doctors but are denied places at medical school. Last year, the rejection rate at medical schools was a staggering 90%. To cling on to their dream, young people are being forced to turn to foreign medical schools for their studies, in places such as Bulgaria, but most of those who are rejected move into other scientific disciplines and are lost to the medical profession forever. If they have the hunger and the ability, we should be giving these students the opportunity to realise their dream of becoming a doctor.
There are clear economic advantages to training more doctors. Life sciences are set to be a major economic growth area in coming decades. To maintain our world-leading position, we need more medically trained people who can conduct the research and run the clinical trials.
Another benefit of training more doctors is for levelling up. The current distribution of medical schools around the country is poor. London has 22% of student places, but just 13% of doctors. That contributes to the increased difficulties for staffing in rural and coastal areas. We need new medical schools in places that are under-doctored—where the places are matters, as around 25% of students remain within 10 miles of their medical schools after graduating. The 2018 expansion capitalised on that knowledge and the new medical school in Sunderland is a fantastic case study. It recruits people from lower socioeconomic groups who are under-represented in medicine. Its graduates will help reduce the shortage of doctors in the north-east, a place where overseas recruitment has been ineffective, due to poor retention. A bonus is that a medical school contributes an estimated £20 million to the local economy.
The arguments are clear. We need to ensure that, as a country, the UK trains enough doctors for our own needs. Increasing training places will be good for the NHS and its patients, good for developing countries, good for the economy, good for the taxpayer, at least in the medium and long term, and good for our bright, young people who will be able to fulfil their dreams of a medical career. In short, it is the right thing to do.
We cannot waste any more time prevaricating on this issue. The medical students who started in 2018 will not be fully qualified GPs until 2028. For too long, we have kicked this issue down the road. Short-termism has been winning the day as we blindly increase our reliance on overseas recruitment. Far too often, we take the easy route and do not make the investments we need for the future. The UK must train enough doctors and other medical workers for our national needs. That is the only sustainable, long-term solution for the NHS.
I remind hon. Members that they should bob if they wish to be called in the debate. I call Jim Shannon.
It is a pleasure, Sir George, to speak in this debate, which I thank Anthony Browne for leading. I am happy to support the thrust of it and am pleased to be the Opposition Member speaking for it—that does not take away from others who probably wished to be here.
There is no doubt that we have faced years of NHS turmoil, and one of the main issues is a lack of sufficient staffing across all aspects of the NHS—nursing and doctors being the most prominent. There are countless reasons why we should train more doctors, but there are domestic issues hindering us from doing so. The hon. Gentleman referred to them, and I will address them from a Northern Ireland perspective. I am my party’s health spokesperson, so I am happy to speak on these issues.
I first want to put on the record—others will undoubtedly do the same—my thanks to the doctors of the NHS for all they do for our health in the United Kingdom of Great Britain and Northern Ireland. We are fortunate to have two fabulous universities in Northern Ireland: Queen’s University Belfast and Ulster University. I have spoken to many students who say there seem to be some issues with the number of places available for those who want to become doctors. Northern Ireland prides itself on the opportunities we offer to international students. We have an amazing scheme, but Queen’s can offer only about 100 places a year for medicine, and there is therefore a shortfall. If that could be increased, it would benefit us in Northern Ireland and people across the United Kingdom. The Minister is always responsive to our requests, so will he outline whether he has had any discussions with the Northern Ireland Assembly and the Department back home?
The hon. Gentleman referred to levelling up, and obviously I want Northern Ireland to be part of the levelling-up process. I welcome that the Government are committed to that, but sometimes we need to see the small print, so I ask the Minister to share some thoughts on that.
I understand that more than 10% of the 100 medicine placements at Queen’s are awarded to international students. I stated earlier that there is still a fantastic opportunity for international students, but once they have completed their degrees, a large proportion do not stay in Northern Ireland and go back home to their own countries. That means there is a gap between the number of students who are trained here, and the number who enter professions and become, for example, junior doctors.
Let me give an example from back home. Two constituents I spoke to excelled in their GCSEs, AS-levels and A-levels—the hon. Gentleman referred to qualifications and the success of education. They were both A* students whose ambition was to stay at home, train and work in Northern Ireland. Unfortunately, they were not successful in obtaining a placement in Northern Ireland, and are now in Edinburgh and Wales, given that they had no other options. Those are not the options they wanted; they wanted to be at home. That is why I asked the Minister about the discussions back home.
Our junior doctors recently voted to strike. More than 173,000 members have agreed to a three-day walk-out due to staff pay, excessive rota hours and a lack of support from superiors. Those issues have to be addressed; they cannot be ignored. I have met some of those junior doctors, nurses and consultants to discuss the issues, and I must say that the excessive hours and shifts they are being asked to work are overwhelming. There is a burden on our junior doctors and those who wish to become junior doctors at a very early stage. Sometimes they work 12-hour shifts for four to five days. Just over the weekend, I heard about the pressures that an accident and emergency unit is under. Our junior doctors are tired and feel underappreciated. Again, the importance of addressing that is clear.
Hiring additional doctors seems like an easy answer to a complex problem. It is never as simple as that, of course. People say, “Well, just hire more. The country is crying out for junior doctors.” We know that, but how do we make it happen? Although that is true, the reality is that the NHS and its staff have been underfunded for years. We do not have the money to fund our junior doctor sector and ultimately hire more. The 100 university places at Northern Ireland’s largest university are simply not enough to meet the demand. It is therefore really important that we address the issue. We must encourage our students to stay and work here, but why should they do that when they feel defeated because they are not getting placements where they want—in our case, back in Northern Ireland?
The Health and Social Care Committee stated that stakeholders have recommended increasing the number of places by 5,000 a year—the hon. Gentleman referred to that—and others have suggested that the figure should be as high as 15,000 a year. As part of the levelling-up process, we need to see the benefits of levelling up for all the regions of this great nation.
The Royal College of Radiologists has been in touch with me to say that employing additional junior doctors could assist with the oncology backlogs, which we all know is a priority for many. It has stated that there is a shortfall of 17%, or 163 clinical oncology consultants, which is forecast to increase to 26% or 317 consultants by 2026 without action to tackle the workforce crisis. What we are doing today will avert a crisis down the line, which is what we are trying to achieve. That is just one example of how our lack of junior doctors ultimately has a knock-on impact on our ability to provide priority treatment.
I will conclude, because I am conscious that eight people want to speak and I want to give each and every one of them the same time, but there is much more I could say about this matter. It is important that workers in our healthcare sector know that they are valued and that we very much appreciate their endless efforts, which can go unnoticed by some. This issue arises from an enormous variety of sources, but we have consistently heard comments about how there simply are not enough university places for the students who are willing to help. Everyone in this room knows that underfunding is also a crucial factor, so let us get the job done to make sure our NHS staff have the protections they need, are not under extreme pressures and do not feel undervalued. Today’s debate gives us the opportunity to ask for that, and the hon. Member for South Cambridgeshire has done this nation proud in his introduction. I believe the other speakers will support him in his ask of the Minister.
For the information of Members present, I do not intend initially to put a formal limit on speeches, but an advisory recommendation is that if everybody sticks to five minutes, we should be able to call everybody.
It is a pleasure to serve under your chairmanship, Sir George. I thank my hon. Friend Anthony Browne for putting together an incredibly eloquent argument on an important subject. I also thank the many doctors and nurses who work in our NHS. I declare a small interest in that I worked in healthcare for a little while, in particular around general practice, which is the topic I will focus on.
My hon. Friend touched on some of the workforce and planning pressures we are facing. It is important to reflect on some of the trends he touched on, particularly the geographical disparities—the doctor deserts that he mentioned. It is also worth reflecting on the fact that we have 35% more doctors now than we did in 2010, yet we feel like we need so many more. There are some shifts underlying that, including more part-time working; yes, we are seeing some doctors return, and some doctors leave through work stresses, but working practices are changing. Our ageing society and the demographic challenge in healthcare is another real issue, but it is worth bearing in mind that the rest of the world is evolving. We use technology more and more, and the way in which we interact with each other is changing more and more, but we are not necessarily doing the same when it comes to healthcare. We are incredibly wedded to a bricks and mortar, 1980s-style of healthcare.
I want to touch on the question of what we want the doctors we are training to do. That may seem like a strange question, but doctors—particularly those in general practice—have become almost a catch-all for all the problems we are looking to solve. Without identifying what the different strands of healthcare can do, we are creating a crisis in almost every bit of it. General practice is not working, and in my opinion is a model that needs reforming almost entirely, but that is creating a huge strain on our hospital system. When it comes to training young people, it is worth bearing in mind that there are three times more applicants to study medicine than there are places available; it is not that people do not want to become doctors. I know my hon. Friend David Johnston is going to talk about the people who want to become doctors, so I will not steal his thunder, even though he has a really good stat that I like a lot.
We need to look at the doctors we are hiring. I agree with my hon. Friend the Member for South Cambridgeshire that we need a covenant to say that people need to stay working in the NHS, although I do not think five years is anywhere near long enough because it costs £230,000 to train a doctor. If we are going to ask doctors to stay in the public sector, as we absolutely should, we need to square up with them and say, “Actually, we can use technology in a completely different way.” For example, people who are under 50 and have no underlying health conditions should be able to see a doctor in another part of the country using technology. That would help to solve a huge issue. We should train doctors to use technology for communication and for monitoring. We do not do that, despite huge advances on that front.
We also need to square with the public what healthcare is meant to be. I agree with many comments made about other aspects of healthcare, particularly regarding the way community pharmacists and diagnostic centres can take away some responsibilities from doctors. There is no point in hiring another 7,500 doctors every year if we reinforce the problems that are already built into the system.
Given that I have only five minutes to speak, I would like to finish with the thought that if we are going to try to train more doctors, let us use them wisely and think about the role they can fulfil. We are a long way from full utilisation, especially in general practice.
I entirely agree that we need to train additional doctors; there is no question about that. The point has already been made that we need a diverse workforce and the creation of a number of new careers with shorter training periods. As my hon. Friend Anthony Browne said, developing someone into a fully qualified GP, never mind a hospital consultant, is extremely time consuming. As my hon. Friend Mark Fletcher said, we need to look at what we want our medically qualified practitioners to do and at how we can create the right career paths, some of which will be shorter and more specific to meet the needs that have been clearly demonstrated. There is no question but that various factors, including the growing population, covid and the ageing population, mean we face a real challenge.
I declare an interest because I represent a rural constituency in Devon and I have chaired the all-party parliamentary group for rural health and care. A couple of years ago, the APPG produced a report on the issue, looking at what needed to change. There are particular barriers in rural communities, compared to other areas. We have an increasingly ageing population with complex co-morbidities and a problem with attraction because, as has already been said, qualified doctors tend to want to stay where they were trained and not come to what they may see as a rural backwater. We also have a challenge finding accommodation for them, because our accommodation rates are very high compared to the level of income.
For me, one challenge is recognising the issues and then training and developing accordingly. We need more specifically oriented rural training opportunities and rural medical schools. There are one or two now, with the latest being in Lincoln, but the curriculum does not have adequate rural content or experience in all cases. It is abundantly clear, as demonstrated by the examples given by hon. Members, that that challenge will be met by recruiting people who live in rural areas. That may sound discriminatory but it would fill the national need for individuals to work in rural areas, and it has proved successful elsewhere.
Australia is well ahead of the game in terms of specific training programmes, but closer to home, in Scotland, there is a programme at the universities of Dundee and St Andrews where 50% of the course, in terms of content and practice, is focused on working in the highlands and other rural locations. Scotland and England may appear to be different, but some very rural parts of England face exactly the challenges as those in Scotland, so there is no reason why the same approach should not be applied. Scotland is also looking at conversion courses for nurses and pharmacists to become doctors—a point that was made earlier—but they are still awaiting approval.
The other key point is that many doctors will find themselves disproportionately in general practice and disproportionately dealing with geriatrician-type problems, so we need to ensure that general training goes through many more years of the curriculum because it often drops off once doctors get into F1, F2 and beyond. We also need to ensure that more doctors have a geriatric element in their training courses, rather than just leaving it to the specialisms, because every single doctor, whatever they land up doing, will find themselves dealing with older people with complex comorbidities. There is no question about that at all.
The real challenge is to focus on not just the need for more doctors, but to recognise what those doctors will be asked to do. That will impact not just on how and who we recruit, but on the nature and content of the training courses. It also ought to give us an insight into the big issue of retention, which is one of our biggest challenges. In the south-west, vacancy rates for doctors and nurses in 2018 was 7,743. In 2022, it was 10,755, so those are big issues that need to be addressed. I shall end on that note so that others can continue, hopefully in a similar vein.
It is upsetting for young British students who have the grades and desperately want to be doctors in a country that desperately needs them to be turned down. I nearly went through that as a parent; I have an interest because my eldest daughter is a junior doctor, and the agonies that she went through, and that we went through as parents, wondering whether she would get the grades and get a place, were awful. Many British families go through that, and it is simply not right when, as my hon. Friend Anthony Browne has said, we have 30,000 doctors from India and 3,000 from Iraq. We should be able to train more.
I am encouraged that the Chancellor of the Exchequer has at last said that the Government will introduce a plan to ensure that the NHS has the workforce it requires to meet future need. The plan will be for the next five, 10 and 15 years, taking into account improvements in retention. That is absolutely right and, frankly, we should have backed it when he was Chair of the Health and Social Care Committee and made the same point. But better late than never—a sinner who repents and all that.
I want to talk mainly about general practice, but we have to get the training right for our doctors everywhere—in hospitals and in general practice. They work incredibly hard under huge stress. I will be delighted to visit the junior doctors’ mess at the Luton and Dunstable Hospital, as I had an invitation recently. I will listen very carefully to what is said there. Today I want to talk about general practice, and in particular about ensuring we have somewhere to train those young GPs as they go through their career. I was very upset to learn last Wednesday that my integrated care board—Bedfordshire, Luton and Milton Keynes—had to turn away eight trainee GPs, because there is nowhere for them go. That is an appalling situation.
Some 14,000 new homes are being built in my constituency. The NHS uses the measure of 2.4 people per home, which means 33,600 new residents, and we are really struggling to expand general practice. Last Wednesday, my integrated care board scrapped 30 of the 53 proposed expansions in primary care across its area—where we could have trained young GPs—for the lack of £2.95 million out of a £1.7 billion budget.
I think about those eight trainee GPs that Bedfordshire, Luton and Milton Keynes had to turn away. My constituents are particularly angry because to the east of Leighton Buzzard is a big new development called Clipstone Park. I have with me a copy of what Barratt Homes, Taylor Wimpey and David Wilson Homes say in the planning application, which states that the development will see the delivery of a doctor’s surgery. No ifs, no buts, no caveats; it will happen. People bought those homes on the basis that there would be a surgery where we could train the young doctors we are talking about. It is not happening, so is it surprising that there is a breakdown in trust among our constituents? It is simply not good enough. Two health hubs that desperately believe in integrated health and care have also not been given the go-ahead. Furthermore, I have discovered that of the £7 billion of section 106 money to fund facilities, including healthcare facilities to train doctors, less than £187 million went into health. That is simply not good enough.
We either take health seriously or we do not. We need to get waiting times down in hospitals. However, we also need to get down the time that many of our constituents spend waiting at 8 o’clock every morning, day after day, trying to see a young doctor, so many more of whom we need to train.
I remind Members that I will be calling speakers from the Front Benches at 10.30 am. To get everybody in, I will now impose a formal four-minute limit on speeches.
It is a pleasure to serve under your chairmanship, Sir George. We all agree that we need more doctors and I think we all welcome what the Government have done to increase the number of places and of medical schools. We had 2,671 trainees start in 2014 and we have had 4,000 start in the most recent year. That is all welcome. We know it takes time and costs money, in the region of £250,000 per person, but it is clear the Government want to get a grip on the problem.
The Government need to do that. I have had a huge population growth in my constituency and have seen a number of GP surgeries close their books. I have seen a surgery in Wallingford close its books, as have all the surgeries in Didcot. In some parts of the constituency we have helped a building expand to ease the problem, but here, without more doctors, it becomes difficult to serve the growing population.
Will the Minister comment on one thing that concerns me about the people we are training? I had an interesting conversation with one of my GP practices just a few weeks ago and I was told that a lot of the trainees now want a portfolio career. Of the cohort from which they have a trainee at the moment, only one intends to be a salaried GP. No one wants to be a partner; it is seen as the drudgery or boring part of the profession. People want to do some days as a locum in urgent care, specialist clinics and so on. I do not know the extent to which Government are looking at that and at how the profession is marketed. It seems to me that a salaried GP is a key pillar of the community, but, much like other people of their age, trainees are looking to do a range of different things, rather than the thing I believe we most need them to do at the moment.
My hon. Friend Anthony Browne set out the challenges of training in superb detail and I am grateful to him for securing the debate. As my hon. Friend Mark Fletcher commented, one key issue for me is about the make-up of the profession. Medicine is the most socially exclusive profession in the country. Only 6% of doctors come from a working-class background and someone is 24 times more likely to become a doctor if their parent is a doctor. If anyone wants to intervene and say that that reflects the country’s talent, they are welcome, but I simply do not believe it.
Medicine outstrips every other profession that we think has a problem, such as politics, journalism and law. In all the work I did on social mobility with young people on free school meals, a high proportion of whom are from ethnic minorities, inner-city areas, coastal towns and so on, it was the most popular profession. As others have said, this is not an issue of medicine not being popular or people not applying or not meeting the grades, as the grades have to be met to be able to apply. Applying is a complex process that involves all sorts of things, from personal statements to interviews and work experience. People get work experience very easily if they are related to a consultant but they do not get it without those connections, yet it is essential to getting into the profession. To make the most of the country’s talent, the profession needs to look at that very closely.
It is a pleasure to serve under your chairmanship, Sir George. I congratulate my hon. Friend Anthony Browne on securing the debate.
At the core of the debate lies the increasing demand for healthcare and how we meet it. As our population ages and new treatments emerge, the demand for doctors will grow, not just in the UK but overseas. I note that in 2018 the Government increased the number of medical school places in England from 6,000 to 7,500 a year and opened five new medical schools. Yet is that cap the right one for the future? Does it reflect the demand-based decision making that we should have, or does it reflect funding-based or supply-side decision making, particularly from the Treasury? As has been mentioned, the cap is not down to a lack of demand among domestic students to be a doctor. In 2022, the Health and Social Care Committee found that record numbers of students are applying to medical school, but around three times more people are applying than there are spaces available. There are vacancies, but there is still strong demand to be given the chance to train for a career as a doctor.
Before I briefly turn to how domestic training levels should change, I must turn to what has inherently been the fall-back option when the domestic supply of doctors has not met domestic demand: recruiting abroad. I helped to create the health and care visa and supported the setting up of the Talent Beyond Boundaries pilot scheme, which assists refugee doctors in taking up jobs in our NHS, so I am delighted to see the many amazing medics who make the UK their home. They are the backbone of many local NHS and social care services and they help to sustain and improve them. I therefore thank them, particularly those who work in Torbay’s NHS, who literally make our bay better.
We must not assume, however, that international recruitment is always guaranteed. During my time as Immigration Minister, I often found that for some employers it became an article of faith that immigration would always provide access to an unlimited pool of skilled labour, and that therefore any vacancies must be solely down to there not being a good enough visa for the role—rather than to a lack of training or planning for the future needs of the industry concerned. With doctors, as in many other cases, there is a shortage of that skill across the whole world, which means that access to global labour markets via visa policy can make only a contribution: it is not a guaranteed long-term solution.
We need therefore to fix and ensure a sustainable supply of doctors to meet future demand here in the UK. Last year, the Health and Social Care Committee concluded that,
“the number of medical school places in the UK should be increased by 5,000 from around 9,500 per year to 14,500”, and that
“the cap on the number of medical school places offered to international students should be lifted”.
The then Chair of the Committee is now the Chancellor of the Exchequer, which makes this an opportune moment to raise the issue.
I am conscious that the Minister with us today would not want to pre-empt the publication of the longer-term strategy that is now due, but it would be interesting to hear his thoughts on, for example, how the Government will seek to future-proof such a plan given the advance of new technology in creating new treatments. How will the decision making on future training places be determined? Will it be demand-led, or will it be funding-led? It has often been funding-led: we argue about what we should spend on medical training, and then a few weeks later have a meeting to talk about what future demand will be. In particular, how will the Government work to expand geographical locations for training? There are some exciting projects, such as the building a brighter future project at Torbay Hospital, which will expand regional health services. Is there an opportunity to expand training as well?
The debate is not just about the future of our NHS services. As has been so well argued, it is about ensuring that youngsters have the chance to follow their ambition to join those they feel inspired by: the people they see working across the community to save lives and provide care.
I strongly congratulate my hon. Friend Anthony Browne on laying out the arguments and highlighting the need for more training places for doctors to level up our great country. More training places would be an engine for social mobility, as my hon. Friend David Johnston pointed out, and level up our rural counties, as my hon. Friend Anne Marie Morris pointed out so well.
I declare an interest in the Alexandra Hospital in Redditch. I have never stopped campaigning on it, and I have been re-elected twice to continue campaigning for the hospital and the healthcare that my constituents deserve. Key to that is training more doctors locally in our wonderful new Three Counties Medical School, which was opened and supported by the Government. That is the obvious route, and I very much welcome the Government funding that has enabled the medical school to open in order to train more doctors locally.
When doctors are trained locally, they want to stay and work locally. In Worcestershire, over the years we have seen a problem where local young people who are training to be doctors do not stay in the county because they have opportunities to work in Birmingham and in larger centres elsewhere. That is great for Birmingham, but not so great for Redditch. Better services for my constituents in Redditch is absolutely what I want—and what they deserve, more to the point—but we need more people to deliver them. We always come back to services being constrained because we lack the workforce to deliver them.
I am grateful for the chance to support what my hon. Friend is saying about the Three Counties Medical School. It serves the three counties of Worcestershire, Herefordshire and Gloucestershire, building on the partnerships established through the Royal Three Counties Show and the Three Choirs Festival—the country’s oldest festival. Does she agree that it would be great if the Minister could say whether the Government will support the Three Counties Medical School? In the absence of that, does she agree that all 14 Members of Parliament for the three counties should get together with the Minister to pursue that case?
My hon. Friend makes an excellent point. I strongly agree with him and I hope the Minister will respond. While I am speaking about our three counties, I thank my hon. Friend Mr Walker who has led the discussions with the health and care trust and other health and care authorities—including Health Education England—to continue to press the case.
The University of Worcester has funded 20 places at the Three Counties Medical School. Unfortunately, we have not been successful in attracting any Government funding from the Minister’s Department. It seems like a missed opportunity. Will the Minister speak to his colleagues in the Department and at NHS England to see what he can do to get the medical school fully funded? I want to give young people in Redditch and Worcestershire opportunities to follow their dreams to practise locally, for the benefit of my constituents.
I thank everybody in Redditch who works for the NHS, across the whole healthcare system. GPs, doctors in different services, mental health providers and nurses are all part of the effort. Social care is also a vital ingredient. We have a great story to tell in Redditch. The Alexandra is a fantastic hospital. It is receiving record levels of Government investment thanks to this Government and previous ones, and the efforts of current and previous Health Secretaries. That investment will see expansion into innovative services and lifesaving treatments, such as robotic surgery for people with prostate conditions, as well as diagnostics and other innovations. The hospital has a bright future ahead of it.
I want to continue campaigning to enable the hospital to deliver services for everybody who lives in Redditch, which is a growing town. My hon. Friend Andrew Selous also made that point. When new residents come in, they expect local healthcare to be there. I am looking forward to the Minister’s update on the NHS workforce plan, which I am sure is the route to solving this conundrum.
I thank my hon. Friend Anthony Browne for bringing forward this important and timely debate. Health services in Cornwall are under strain, as they are in other places. I put on record my thanks to all the doctors and health and social care practitioners in Cornwall for their outstanding work, not only throughout the pandemic but throughout what is proving to be a difficult winter following a difficult summer. I will touch on that later.
In Cornwall, we actually have a slighter greater number of GPs than we had in 2018, but more are choosing to work part time, owing to the intensity of the workload. Our register of GP trainees has also slightly increased in head count since 2018, but the whole-time equivalent has slightly decreased over the last four years despite the head count going up.
Further good news is that the Cornwall training hub has had success in attracting GPs into Cornwall through the introduction to Cornwall scheme and flexible working international GP initiatives, which is encouraging those who train here to remain in Cornwall. However, our geography means we cannot share staff with other areas or trusts, so such schemes are vital to our staffing levels.
The University of Exeter’s Medical School Truro campus is a centre of excellence for the delivery of medical education and training at the Royal Cornwall Hospital. The centre does an excellent job of training up the next generation of doctors; I would like to see more junior doctors training at the university considering a move to Cornwall to start their careers. Who would not want to move to Cornwall? Those who do will find themselves surrounded by a community of extremely welcoming and friendly people, both students and staff, as well as the beautiful outdoors, with the ocean on their doorstep. Who would not want that?
As chair of the APPGs on baby loss and on women’s health, I am grateful to the Government for commissioning NHS England’s long-term workforce plan. My co-chair of the baby loss APPG is now the Chancellor; this is an issue that he has campaigned on for a really long time, so I am encouraged that we will get somewhere now. The Government are growing the health and social care workforce, with more than 4,000 more doctors compared with last year, and it is so important to Cornwall that those doctors are spread throughout the country.
I go back to my point about the hard summer. Because Cornwall is so beautiful, we get 2 million visitors a year. Unlike in other parts of the country, our health service gets no respite in the summer before a difficult winter. Staff have been working at top speed since the beginning of the pandemic without any respite. We need to talk to the Government about fairer funding to try to mitigate some of the effects so that staff can take holidays and have some respite, so that there are enough staff to pick up the slack, and so that our health service can move forward in caring for our ageing population. As I already mentioned, our geography means that we cannot share staff.
The Government must do all it can to tackle Cornwall’s housing crisis. GP surgeries and other employers across the entire health service in Cornwall often say that they offer jobs but that people cannot take the work because they cannot find housing. That applies for every kind of healthcare worker, from healthcare assistants to consultants; it certainly applies to our GPs and hospital doctors. As I have called for in Parliament before, we must ensure that key workers in both the public and private sectors can afford to buy and rent affordably in the area. I am pleased to say that that will be a priority for developments in Langarth and in Pydar Street in Truro.
I join my colleagues in calling for additional training places for doctors. I hope that the Government recognise that those wishing to train in Cornwall are a key part of the solution. I look forward to continuing to work with the Government on all aspects of improving the health service, with a particular tilt towards rural and coastal areas and, of course, I invite the Minister to Cornwall to talk to our healthcare providers to see their particular challenges.
I am grateful to Anthony Browne for securing this debate, which provides me with the opportunity to make a number of political points, but, with your indulgence, Sir George, I will start with a personal one. I put on the record my gratitude and thanks to all the staff of the Scottish NHS. This happens to be my first debate back since being taken ill at the end of last year and undergoing emergency surgery. I am pleased to say that, from every angle—from the local GP right through to the Royal Infirmary in Edinburgh—I was treated fantastically, despite which I hope that I do not have to avail myself of those services again any time soon.
In opening the debate, the hon. Member for South Cambridgeshire said much with which I agree. In fact, we have heard much on which there is probably a great degree of consensus. For years now, across the UK, there have been various issues with finding qualified staff to fill vacancies in our NHS, especially in a number of specialities. When combined with the aftermath of covid, that has resulted in a backlog that is putting immense pressure on frontline services and those who bravely staff the wards.
Staff shortages lead to delays in the whole system, which can mean longer waits for appointments, operations and getting home from hospital. It is vital that each of our nations is fully able to further recruit both domestic and international professionals. We should not ignore the fact that Brexit is exacerbating difficulties in recruitment. In addition, we have the related issue of staff retention.
As Members will know, health is a devolved area, but many of the levers affecting staffing levels, such as pensions and immigration, remain reserved to Westminster. Along with many others, the Scottish Government warned the UK Government of Brexit’s effect on the health and social care workforce, the supply of medicines and medical devices, and the economic impacts that would inevitably harm health outcomes.
Research by the Nuffield Trust in June, based on data relating to May 2021, suggests that NHS England could be short of 12,000 permanent hospital doctors and over 50,000 permanent nurses and midwives. The Nuffield Trust also recently produced research marking six years since Brexit, which demonstrated that
“Across medicine, nursing and social care, there has been a decline in EU recruitment and registration since the EU referendum in 2016.”
The Nuffield Trust also found:
“There is clear evidence that Brexit is likely to be reducing the incomes of people in the UK relative to a counterfactual of continued membership, through its impact on GDP, investment, and trade. The current economic situation means that this is likely to be an additional reduction on already falling real incomes, rather than slower growth. The link between health and income is well documented, and this is likely to lead to worse health outcomes and higher demands of the NHS.”
I share those concerns, and anti-immigration rhetoric around Brexit should have no place in our NHS or anywhere else in our society. Scotland needs people. Perhaps the Minister can tell us whether his Government will devolve control of immigration powers, so that Scotland can get labour force that it wants and needs—or is that a level that we will only benefit from with independence? Where Scotland does currently have powers, it has seen the number of doctors in training rise by 24.3% under the SNP. Scotland already trains more doctors per head than elsewhere in the UK. Scotland’s share of the UK intake in undergraduate medicine has grown to 13%.
While it is right that we discuss recruitment, we must also consider staff retention. That is why pay and terms and conditions are so important. I implore the UK Government to get around the negotiating table with health unions, just as the Scottish Government are doing, to mitigate the risk of strikes.
The number of staff leaving the profession is also of concern. NHS figures show that in the last year there has been the highest turnover rate in a decade. Between March 2021 and March 2022, although 19,309 staff joined the NHS, 15,389 left. The Scottish Government published their workforce strategy for health and social care in March. The target is to grow the NHS workforce by 1% over the next five years. It is no surprise that winter plans also include aims to recruit additional staff, including some from overseas. As part of Scotland’s recovery plan, the Scottish Government launched a new national recruitment campaign and established a national centre for workforce supply.
The Scottish Government have sought to retain junior doctors by preventing them from working seven full night shifts in a row and more than seven days or shifts in a row, as well as implementing a rest period of 46 hours off following a run of full shift nights. The Scottish Government agreed with the British Medical Association last year that by February this year, no junior doctor rota will contain more than four long shifts in a row, and we are already 99% compliant with that target. However, internationally and within the UK, there is competition to recruit staff. With record high vacancies, it will take a major drive to plug the workforce gap.
The Scottish Government have introduced new national guidelines, making it easier for retiring NHS staff to return to the NHS to support it as it continues to recover from the pandemic while also drawing their pension. However, there is a substantive issue of pension tax rules encouraging senior clinicians to reduce their commitments or retire early, and pension taxation is a wholly reserved matter. The UK Government need to provide a permanent solution that will help efforts to retain senior NHS staff.
There is little doubt that training of more doctors is required to attain the adequate levels of staffing that we all need, but people should be under no illusion that with fiscal and immigration powers reserved to this place, Scotland has to achieve that with one hand tied behind its back. Given yesterday’s unprecedented use of a section 35 order to strike down devolved legislation, even devolved powers may now be under attack, such that the days of devolution are numbered. All of this demonstrates the need for Scottish independence.
It is a pleasure to serve under your chairmanship this morning, Sir George. I thank Anthony Browne for bringing this important debate to Westminster Hall, and I praise the contributions of all Members, which covered the whole host of issues affecting the NHS workforce.
We have heard throughout the debate that we must train more doctors, yet this summer the Government cut medical school places by 30%, turning away thousands more straight-A students from training to become doctors when we need them more than ever, with the NHS in the midst of a chronic workforce crisis and people finding it impossible to get a GP appointment or an operation when they need one. We have 7.2 million people waiting to start planned NHS treatment; the Minister will want to know that that is nearly triple the number in 2010, when Labour left power.
As we have heard, there are over 133,000 NHS vacancies, 10,000 of which are for doctors. There are simply too few doctors to meet demand. The latest Royal College of Physicians census found that 52% of advertised consultant physician posts went unfilled in 2021, the highest rate since records began. I am therefore really pleased that we are discussing this issue today.
We cannot build a healthy economy without a healthy society, and we cannot have a healthy society without training more doctors. The chief executive of the NHS, Amanda Pritchard, said recently that more medical school places are needed. However, I worry that the Government are being short-sighted and are unwilling to provide those places. It was only recently that they finally heeded their own Chancellor’s calls to assess workforce needs.
The Government are missing open goals. This weekend, we heard that the Three Counties Medical School at the University of Worcester, a new school set up to boost the number of doctors in England, has been told that it will not receive funding for domestic students. This sounds mad but, during a massive crisis in the number of doctors, the Department of Health and Social Care is maintaining its cap on the number of university medical school places that it funds.
The University of Worcester says that, next year, it will have to recruit only international students, who are less likely to stay and work locally. That is despite the NHS Herefordshire and Worcestershire integrated care board spending over £70 million a year on locum and agency staff because it does not have enough doctors. Thousands of straight-A students are being turned away from studying medicine and the Government have no long-term answer or solution.
Members will not be surprised to hear that Labour does have a plan for the NHS—the hon. Member for South Cambridgeshire referred to it. Labour will double the number of medical school places from 7,500 to 15,000, train 10,000 extra nurses and midwives every year, double the number of district nurses qualifying each year and create 5,000 more health visitors. That will be paid for by abolishing non-dom tax status, because patients need treatment more than the wealthiest need the tax break.
I do not have much time, so I am going to continue.
The Government could have adopted Labour’s policy, which the Chancellor himself said that he agrees with. In an email to supporters of the patient safety charity that he founded, he wrote:
“The medical school place increase is something I very much hope the government adopts on the basis that smart governments always nick the best ideas of their opponents.”
I would be grateful if the Minister set out why his party has decided not to listen to its own Chancellor.
Let me turn to retention. We need to train additional doctors—we have heard no opposition to that in today’s debate—but we must also focus on keeping the doctors that we already have. More than three quarters of respondents to a December 2022 survey of Royal College of Physicians members said that they were very or somewhat stressed at work, with clinical workload and staff vacancies in teams being the leading factors. The 2021 NHS staff survey found that 31% said they often thought about leaving. The Royal College of General Practitioners 2022 GP survey found that 42% of GPs say that they are planning to quit the profession in the next five years. I would be grateful if the Minister considered job satisfaction, and therefore retention of current staff, and set out what the Government are doing about that.
Existing doctors need support and additional training so as not to get burned out and to stay in the role, and training of new and current staff cannot come soon enough. Patients and NHS staff cannot afford to wait. I look forward to the Minister’s response.
It is a pleasure to serve under your chairmanship, Sir George, and I am hugely grateful to my hon. Friend Anthony Browne for raising this important issue and for his hugely constructive proposals and suggestions.
The workforce are the beating heart of everything our NHS does and stands for, and doctors make up an important part of the workforce and are invaluable to our NHS. I am hugely grateful for the incredible work they do day in, day out. I also thank all those who have contributed to the debate. I will try my best to respond to as many of the themes raised as possible in the time available to me.
Let me turn first to workforce pressures, which were raised by a number of hon. Members. We know, and I certainly recognise, that the workforce remain under sustained pressure having worked tirelessly through the covid pandemic to provide high-quality care to those who need it. I recognise, too, the huge and important role that doctors play in supporting our NHS. That role is as important as it ever was, which is why I am passionate about supporting our doctors, particularly in challenging times.
As Jim Shannon rightly said, it is vital that we support the workforce not just now, but in the future. I recently met with the British Medical Association, the Hospital Consultants and Specialists Association and other unions to discuss, among other things, what we can do to ensure that NHS staff continue to feel valued in their work, but also how we can improve such things as their working environment and working conditions, which are really important. I look forward to continuing those discussions.
The crux of the debate is growing the workforce. What have we seen in the past year? We have seen record numbers of staff, including record numbers of doctors working in our NHS—since October 2021, 4,700 more doctors, representing a 3.7% increase—but I recognise that demand for NHS services continues to grow, which is why we have done a significant amount already to invest in training additional doctors and our future workforce.
As my hon. Friend the Member for South Cambridgeshire said, the Government have created and funded 1,500 more medical school places each year for domestic students in England. That is a 25% increase over three years, and the expansion was completed in September 2020. It has delivered five new medical schools for England. My hon. Friend mentioned levelling up, which of course was part of the motivation behind that expansion, hence the new medical schools in Tyne and Wear, west Lancashire, mid-Essex, Lincolnshire and Kent.
My hon. Friends the Members for Gloucester (Richard Graham) and for Redditch (Rachel Maclean) mentioned the Three Counties Medical School. I know some of the issues around that, some of which I think are specific. I would be happy to meet my hon. Friends, and my hon. Friend Mr Walker, who has also raised the matter with me, to discuss this further.
In addition—I am conscious of the fact that we are talking about medical places—we temporarily lifted the cap on medical places for students completing A-levels during the pandemic, in 2020 and 2021. That resulted in an intake of nearly 8,500 in each year, which was significantly above the planned figure of 7,500.
My hon. Friend Anne Marie Morris asked what we are doing to look at new routes into medicine. That is an important point: yes, we have the traditional routes, but what are we doing to consider other ways in? I am delighted that, only last week, Health Education England announced funding for the first 200 apprentices to begin training as doctors over the next two years. That marks an important step in making a career in medicine more accessible. My hon. Friend David Johnston made a similar point: we have to make medicine more accessible. I am really excited about those apprenticeships and what can be done in that space.
Turning to the long-term workforce plan, I heard what my hon. Friend the Member for South Cambridgeshire and others said in calling for us to be bolder and more ambitious, and I know that we need to do more to ensure that the NHS has the workforce that it needs for the future. I heard my hon. Friend’s call for a feasibility study on doubling the number of places, and I will take that away and look at it. I also heard his call for an increase of circa 1,000 places next year. That would have a significant financial implication, which would not sit within our spending review allocation. Again, I will have to take that away and look at it, and have those conversations with the Chancellor.
We have commissioned NHS England to develop a long-term plan for the NHS workforce for the next 15 years. That high-level, long-term NHS workforce plan will look at the mix and number of staff required across all parts of our country, and it will set out the actions and reforms needed to reduce supply gaps and improve retention. My hon. Friends the Members for Bolsover (Mark Fletcher) and for Torbay (Kevin Foster) eloquently set out why we need a workforce that will reflect the changing nature of medicine and technology, and demographic changes. That is vital, and those will be key parts of the NHS long-term plan.
My hon. Friend the Member for Wantage rightly said that those going into medicine understandably want a portfolio career. General practice is still an attractive option and we have more people wanting to be GPs, which is a great thing, but I wonder how many people would want to be Members of Parliament if they were just doing surgeries, which is part of the role, all day every day. In medicine, a portfolio mix involves some time in the hospital and some time in general practice. It is really important that people have the ability to develop their skills and have a specialism, but they should not lose their generalist skills. I think we will see more people wanting to be GPs but also to spend time in hospitals and other settings, and our NHS long-term plan must reflect that.
We have committed to publishing the plan this year. As the Chancellor set out in the autumn statement, it will include independently verified forecasts for the number of doctors, nurses and other professionals needed in five, 10 and 15 years’ time, taking full account of the improvements that we need in retention and productivity. The plan will ensure that we have the right people with the right skills to transform and deliver high-quality services fit for the future.
The hon. Member for Strangford asked about Northern Ireland. He is absolutely right to do so, because a plan cannot work in isolation. NHS England is looking at the NHS long-term plan, but it could not do so without having those all-important discussions with the devolved Administrations around our United Kingdom. There are a number of plans, but there is commonality of interest because of the nature of our United Kingdom, and inevitable join-up. I know that NHS England is having those conversations, and I will ensure that we have them at ministerial level too.
We have touched on international recruitment. As we grow the domestic workforce, ethical international recruitment remains a key element of achieving our workforce commitments, and we are ramping up efforts through targeted support for NHS trusts with recruiting from overseas. My hon. Friend the Member for South Cambridgeshire mentioned our code of practice for international recruitment, which aligns with the latest advice from the World Health Organisation. It guarantees stringent ethical standards when recruiting health and social care staff from overseas, and ensures that we can work collaboratively with other Governments around the world. Although it restricts active recruitment from particular countries, which my hon. Friend correctly referred to as the red list, he rightly pointed out that an individual still has the right to migrate. Therefore, we will still see individuals applying independently for vacancies in our NHS in the UK, which is known as direct recruitment. We are not actively recruiting, but people can nevertheless apply.
Our long-term NHS workforce plan is about ensuring that we get the balance right between international recruitment and domestic training places. As health systems develop around the world, we have to build our domestic resilience to ensure that we are training enough doctors here in the UK. Having said that, internationally trained staff have been a key part of our NHS since its inception in 1948, and they continue to play a vital role. Let me put on the record that we value hugely their contribution to providing excellent care.
Retention was another issue raised. I do not underestimate the importance of staff retention, which is as important as recruitment. As well as training more staff, which is vital, we have to ensure that we keep those highly qualified, experienced clinicians. We have to ensure that they feel supported and valued within in our NHS, not just at a national level, but at a local, individual trust level. We have the actions set out in the 2020 NHS people plan, which are helping us to build that culture and will help support us to ensure we get it right. They include a much greater focus on health and wellbeing, strengthening leadership and increasing opportunities for flexible working, which I know is important in a modern workforce.
A number of hon. Members mentioned pensions, and I understand that challenge. I meet the senior clinicians we need to retain in our NHS. We announced a package as part of our plan for patients in the summer, continuing the temporary retirement-return easements. We also announced the intention to introduce a number of permanent retirement flexibilities from
In the short time I have, I will cover specialty training. My hon. Friend Andrew Selous rightly raised the important issue of GP training places. One challenge with more funding for medical schools is to ensure that there are specialty places for people to go into. It pains me when I hear that people want to train as GPs but there is not the space in GP practices for those specialty places. I know my hon. Friend has met my fellow Minister, my hon. Friend Neil O’Brien. I am also happy to meet him to discuss this issue from a workforce perspective.
I was pleased when, only last week, Health Education England announced the creation of nearly 900 more specialty placements. That is hugely important, especially because there is a focus on areas such as mental health and cancer, where we know we have shortages. It pains me to hear of anyone wanting to be a GP but not having access to specialty training, because I know we need more of them.
Conscious of the fact that I intend to leave a little time for my hon. Friend the Member for South Cambridgeshire to respond, I thank all hon. Members for their constructive contributions to this morning’s debate. It has given me, the Department and, dare I say it, the Treasury some food for thought about the long-term future of medical training places.
Through the programme of work that I outlined and the long-term planning that NHS England has under way, which will be published this year, we are ensuring that the NHS has the robust and resilient workforce that we know it needs for the future. Doctors are, of course, an integral part of that. We are working to ensure that we have the right people with the right skills in the right places. We are working to ensure that they are well supported and looked after so that they, in turn, can look after those who need our great NHS services, and so that they can keep delivering that great standard of care that people need now and in the future.
It has been a pleasure to take part in this debate under your chairmanship, Sir George. I thank my hon. Friends the Members for Truro and Falmouth (Cherilyn Mackrory), for Newton Abbot (Anne Marie Morris), for Redditch (Rachel Maclean), for Torbay (Kevin Foster), for Bracknell (James Sunderland), for Burnley (Antony Higginbotham), for Wantage (David Johnston), for South West Bedfordshire (Andrew Selous) and for Bolsover (Mark Fletcher), and Jim Shannon—it is not a debate if he is not here—for their very constructive contributions.
There has been huge support from Members from across the House, including from Labour and the DUP, for increasing the number of training places for doctors, for all the reasons that I laid out and other Members raised in their contributions. I thought the social mobility point was incredibly well made. I am also delighted that so many people invited doctors to go and train in their constituencies, including down in Cornwall. I will pass that on to some of my trainee doctors.
I particularly welcome the Minister’s very constructive support. The Government are aware of this issue and want to do the right thing. The message I want to send the Government—the Department of Health and Social Care and the Treasury—is that there is huge political appetite and cross-party support for increasing the number of training places. We really need to do that for the sake of the NHS and the country. I am sure we will all be watching the developments over the coming months as the NHS develops its workforce plan. We fully support the Government’s aim to be as ambitious as possible.
Question put and agreed to.
That this House
has considered the potential merits of training additional doctors.