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Interim NHS People Plan

Volume 661: debated on Wednesday 5 June 2019

The NHS published its interim people plan on Monday, and I laid a written ministerial statement at the earliest opportunity yesterday.

The plan is a first, but critically important, step in ensuring that the NHS has the people, leadership and culture it needs to deliver the NHS long-term plan. The interim people plan has been developed by Baroness Dido Harding, the chair of NHS Improvement, in partnership with frontline staff, NHS employers and a wider range of other representative groups and stakeholders. It takes a tough look at the challenges facing people working across the NHS. It sets out how leaders will be supported to create cultures that empower staff and make sure that every member of staff, regardless of their background, will be able to progress.

Critically, the plan calls for all NHS organisations to set out how they will ensure that the NHS is the best place to work. The recently appointed chief people officer for the NHS will play a vital role in supporting the NHS to do this. The interim people plan sets out a number of practical steps to increase the supply of clinical staff. This includes an extra 5,000 additional clinical placements for nurse training places by September 2019 and a commitment to further expansion of medical school places.

Ultimately, the plan will ensure that the NHS is best able to retain the highly skilled and dedicated staff who choose a career in healthcare, including the most senior clinicians. Therefore, we have listened to their concerns that pension tax changes are discouraging them from doing extra work for patients. That is why Government will consult on how to introduce new flexibilities for this critically important staff group.

But we are not complacent. We know there is more work to do to secure the people, leadership and culture that the NHS needs. My right hon. Friend the Secretary of State has asked Baroness Harding to lead further work over the summer to prepare the final people plan. As has always been intended, the final people plan will be published soon after the conclusion of the spending review, when there will be further clarity on education and training budgets.

I would like to take this opportunity once again to place on record my thanks, and the thanks, I am sure, of everybody across the whole House, to all the NHS staff who do a wonderful job in ensuring that our constituents—their patients—get excellent care.

It is a pleasure, as always, to see the Minister of State, but the Secretary of State should be doing his day job and be here answering questions about the health service, not playing his Tory leadership games.

Our NHS is struggling with vacancies of 100,000. Our NHS staff are the very best in the world—and none of them wants to be part of a trade deal with the Americans, of course—but they are working under immense pressure because of these chronic shortages. Shortages put patient care at risk, and that means that standards of care are falling. This means that our constituents wait longer to get a GP appointment because we have lost 1,000 GPs. It means that women are turned away from maternity units because we are short of 3,500 midwives. It means that cancer diagnosis is delayed because of shortages in the cancer workforce. As Dido Harding’s report shows, we are short of 40,000 nurses in the workforce, and that is now critical. It means that at a time when mental health problems are increasing—The Lancet reports today on an increase in non-suicidal self-harm—we have actually lost 5,000 mental health nurses since 2010. We have problems in the learning disability sector. Health Education England today warns that because of the shortages in learning disability nursing, we are set to

“hit critical levels in the next five years”,

with vacancies of 30%. We have an ageing population. Adult social care is short of 110,000 staff, and yet district nursing has been cut by 50%. We do not have enough nurses on our children’s wards. Health visitors and school nurses in our communities have been cut.

This NHS workforce crisis is linked to decisions of this Government. As Dido Harding’s report says,

“applications for nursing and midwifery courses have fallen since the education funding reforms”.

Those education funding reforms include the abolition of the bursary. Is not that therefore a damning indictment of the decision by this Government to abolish the bursary, and will the Minister now commit to bringing it back?

The report also references continuing professional development, where budgets have again been cut, by a third. It says:

“Employers have…been investing less in their people, as pressures on NHS finances have grown.”

Is that not an admission that Tory austerity, with nine years of underfunding in the NHS, has contributed to the workforce crisis of today?

The Health Secretary has said that he wants “a new Windrush Generation” of overseas nurses to fill the staffing gap, so can the Minister explain why a commitment to recruit 5,000 extra nurses a year internationally was dropped from the Dido Harding report? Did the Government put pressure on Baroness Harding? On international recruitment, can he guarantee that no one offered a job in the NHS or care sector will be restricted by the £30,000 salary cap, as the chair of Health Education England called for yesterday at the Health and Social Care Committee?

Finally, the Minister referenced the spending review. He will have seen that the Chief Secretary said yesterday at a Select Committee that the spending review is now unlikely to be ready for 2020-21. That means that new funding for training, for Health Education England and for capital investment in public health and social care will not come on stream until 2021—two years away. Does the Minister think that that is an acceptable way to deal with the NHS crisis we are facing? I urge the Minister, for whom I have a lot of respect, to accept that we cannot keep delaying this situation further. The Health Secretary needs to abandon his leadership games, focus on his day job and get a grip.

The House will have listened to the hon. Gentleman. It is important to put out some facts, which were missing from his fact-free analysis. For example, we have had 52,000 more professionally qualified clinical staff in the last nine years, almost 16,500 more doctors and over 17,000 more nurses on our wards. He set out a list of promises, but with little detail and no means to pay for them. He asked a number of questions, which I will respond to.

The hon. Gentleman talked about the number of nurses and said that there was no plan. There clearly is. Increasing nursing is a priority, and this plan sets out—[Interruption.] If the hon. Member for Dewsbury (Paula Sherriff) would like to listen, this plan sets out a focus to ensure that we can recruit nurses. The hon. Gentleman talked about applications, but he will know that applications for nursing places are up 4% on the previous year. He will also know that the plan sets out 5,000 more clinical placements available in September this year, which is a 25% increase on the previous year. He will know that the plan sets out 7,500 more nursing associates. The plan also quite clearly sets out measures that will ensure that the NHS is the best place to work, and therefore more nurses will want to stay in it.

The hon. Gentleman spoke about a number of other issues. The Migration Advisory Committee has made recommendations, which he will have seen. He will know that the Secretary of State has made a firm commitment that we intend to continue to recruit internationally, as well as increasing domestic recruitment. He mentioned continuing professional development. It would be useful if he had read the plan, which sets out commitments to ensure continuing education and opportunities for education for all staff in the NHS. He will have seen that there will be a final level of commitment.

The hon. Gentleman speculates about the spending review. He speculates about a number of things, but it would be better not to speculate. It would also be better not to make allegations about my right hon. Friend the Secretary of State, who was doing his day job yesterday. I know that the hon. Gentleman is always interested in soundbites, and one soundbite he should have taken notice of was when my right hon. Friend said yesterday:

“the NHS is not on the table in any trade talks. The NHS is not a bargaining chip in negotiations, with the US or otherwise.”

Perhaps that is the soundbite that the hon. Gentleman and his colleagues—including the hon. Member for Dewsbury, who is shouting across the Chamber yet again—should remember.

I welcome the Minister’s announcement that the Government are giving higher priority still to the recruitment and retention of staff in the NHS. It is an undeniable fact that there are acute shortages, particularly of nurses, in practically every part of the NHS, and we urgently need to improve our recruitment and retention. With that in mind, will he confirm that in finalising the people plan, serious consideration will be given to the immigration rules that will apply to recruitment after we leave the European Union? About one in 20 of the whole staff of the NHS at the moment are citizens of the European Union, and it would make no sense at all to put new restrictions of any kind on people coming from the European Union who want to make a valuable contribution to our health service. In Nottingham, we used to run recruitment campaigns for nurses in Romania. We are a long way away from being able to in any way put restrictions on staff coming from any part of the continent.

My right hon. and learned Friend the Father of the House is completely correct. We want to make sure it is clear that the EU nationals who work in the national health service—there are more than 63,000 of them—are valued and make a huge contribution to our NHS. He will probably be aware that my right hon. Friends the Secretary of State and the Home Secretary are in continuing negotiations, to ensure that there is no change to that position. I guarantee that we want to see EU nationals continue to work in and contribute to our great health service.

I welcome the interim NHS people plan. Workforce is the greatest challenge across all four health services, but the 41,000 nursing vacancies in NHS England are simply a patient safety issue and cannot be parked on some shelf or kicked into the long grass. The plan identifies the removal of the nursing bursary and the imposition of student fees leading to a drop of over 30% in new student nurses. Will the Minister commit to re-establishing the bursary? Scotland preserved the bursary and free tuition, and our nursing vacancy rate is less than half that. The plan also calls for 5,000 new GPs. I remember the former Secretary of State promising 5,000 new GPs by next year, and rather than being close to delivering that, there are 1,000 fewer. How will the Minister deliver 5,000 extra GPs? Will he increase funding to Health Education England to deliver it?

There is no question but that the NHS across the UK will need non-UK staff. How will the Minister attract both EU and non-EU staff when there has been a 90% drop in European nurses coming here, and non-EU doctors are leaving because of visa charges and the £400 a year they pay per member of their family to access NHS services? What is he going to do about the pension tax allowance rules that are driving young consultants out of the NHS?

I thank the hon. Lady for welcoming the plan. I think she will accept that this is a good interim plan; it is a stepping stone. She asks what we are doing to fill nursing places. I point out yet again that we are increasing applications and ensuring that there are 5,000 extra clinical placements available, which is a 25% increase on last year. Far from being complacent about the number of nursing applicants, we are looking to ensure that more nurses can be trained in this country, beyond the 35,000 who are being trained at the moment.

The hon. Lady asked about doctors. The Royal College of Physicians has made it clear that we need more medical school students. We are committed to increasing the number of undergraduate medical school places for domestic students by 1,500, with the first 630 being taken up last year. By 2020, there will be five new medical schools across England, helping to deliver—[Interruption.] Of course it takes time, but if we do not take that step now, we will never make the end of that journey. That has been a consistent problem for many years. There are still more doctors coming through now, but we need to do more, which is why this plan is being put in place.

The hon. Lady will have heard me say to my right hon. and learned Friend the Father of the House that there are more than 63,000 EU nationals working in the health service. That is more than there were in December 2017, and over 5,000 more than there were in June 2016. She is right to point out that we want those skills in the right clinical areas. I reiterate what I said a moment ago: we wish to make it absolutely clear that the contribution of EU nationals working in the health service is extraordinary and valued and will continue to be so.

The hon. Lady briefly mentioned pensions. She will have noted that we launched a consultation yesterday, setting out some ideas. I am pleased to say that the British Medical Association has welcomed them but asked us to look at other flexibility within the pension rules. I encourage the hon. Lady and all consultants to take part in that consultation.

The Minister knows from our time together in the Department how much I welcome the interim people plan. It simply is the turnkey without which our long-term plan just cannot work. He is aware of how important retention is, and that is at the heart of the plan. I know he has mentioned this several times already—and consultations are great, and I will encourage my constituents to take part—but may I ask him to look urgently at the changes to the NHS pension scheme in relation to the annual allowance and the lifetime allowance? My trust has contacted me to say that senior consultant doctors and senior nurses are receiving unexpected tax bills of tens of thousands of pounds—up to £50,000—which is starting to have an impact on decisions about their future and the additional sessional work they are prepared to take up. This is impacting on patient care now, so on behalf of my constituents, I urge him—I know he will take this seriously—to look urgently at the NHS pension scheme issue.

Again, my hon. Friend was absolutely right at the start of his question to point out that this is a key stepping stone to making sure that the long-term plan works. He is also absolutely right to point out that we recognise and have taken extraordinarily seriously the difficulties that a number of clinicians have had with the pension tax changes. He will know from his time in the Department that we have been in continuous discussions with the Treasury about what options may be available. I have set out today that the consultation will propose a new 50:50 option for higher-earning clinicians to halve the rate of pension growth in exchange for halving contributions. I accept that that is only one part of the solution, but it is a step forward. I welcome contributions to the consultation, and I urge him and his consultants to take part.

In our area, GP practices have had serious problems recruiting, and one constituent has contacted me about surgeries being cancelled and having been told that the next routine appointment, for what is actually a serious condition, will be in August. My constituents cannot wait that long for GP appointments. Frankly, Ministers have had nine years to anticipate this crisis, and instead of making things better, they have in fact made things worse, with the King’s Fund warning that GP shortages could treble in the next five years. Frankly, the warm words the Minister has said are not urgent enough and not substantial enough to turn this around, so what is he going to do in the next six months to make a difference to my constituents, who are waiting far too long for important appointments?

The right hon. Lady is right to be angry because her constituents should not be waiting that long. If she wishes to speak to me afterwards, I will take that up directly, with her, on behalf of her constituents.

The right hon. Lady says that we are not taking this seriously and not acting urgently enough. She will know that this interim people plan makes sure we will have not only more people recruited to the NHS, but more people wishing to stay working within the NHS. One of the key issues the NHS has faced is that a lot of people have decided not to work within it, and the key part of the people plan—this being the interim before the final is published later—is actually about ensuring we have more staff there. I reject what the right hon. Lady says. We are taking this seriously, and we are acting on it now.

I welcome the record amounts of investment going into the NHS, but may I seek assurances from the Minister that we will be using those resources to ensure that specialist clinicians in areas such as blood cancer and heart disease are properly supported so that we have the training for those personnel to tackle those conditions in particular? I say that as the chairman of the all-party groups on both conditions.

My hon. Friend will know, because I have been in debates with him before, that I recognise the exceptional work that those two all-party groups do. He will know from the long-term plan that we have set out new commitments on diagnosis for all cancers and for cardiac. He will know that the reason why we have set out an interim people plan and will then set out a final people plan is that a long-term plan cannot work unless we have the people to back it up and are training the right number of people. This plan sets out how to recruit more people, how to train more people, how to give people the skills to deal with what will face the clinicians and the physicians of the 21st century, and that is key to delivering what he has asked for.

Baroness Harding, who is a Conservative peer, and Sir David Behan, the head of Health Education England, told the Health Committee yesterday in absolutely clear terms that both the abolition of nursing bursaries and Brexit are seriously exacerbating the staffing crisis in the NHS. Are they wrong?

I am sure they will also have said that one of the things Health Education England has explicitly set out is that one of the biggest barriers to more nurses was that there was not the placement capacity. I am sure Sir David Behan will also have set out that he therefore welcomes entirely the 5,000 extra clinical placements that are being made available, which is a 25% increase on last year.

The right hon. Gentleman will also know, as I have set out, that there are more EU nationals working in the NHS now than there were at the time of the referendum. However, one of the reasons why we are having an interim people plan is that we are not complacent. There are huge challenges, as I set out not only in my written ministerial statement, but in my opening remarks. That is why this plan is addressing the shortages in nursing, and it is right that we do so.

I welcome very much this initiative, and I am delighted by all that has been said. The chief executive officer of Shrewsbury and Telford Hospital announced his departure on Monday, following a catalogue of failings. Despite these failings, formal complaints to Dido Harding and others and a series of calls for his dismissal, the CEO has apparently resigned of his own volition to take up another highly paid job within the NHS and is not going to work his notice because he has too much holiday to take. Does the Minister agree that senior management in any organisation, including the NHS, must be held to account for their performance, and will the people plan deliver this?

My hon. Friend makes a very powerful statement on behalf of her constituents about the change of leadership. I am obviously aware of the change of leadership, including the departure of the chief executive, and I am aware that it raises a number of issues, which she and I may wish to have a meeting to discuss. She is right to ask whether we are tackling the culture to make sure that we have the best leaders in the NHS, whether we are ensuring that they are properly trained for the challenges of the 21st century and whether we are making sure that they are not only held accountable but supported to make sure they are doing the best they can. That is why Sir David Behan led a chapter in the whole draft people plan, which will lead into the final people plan, on leadership. The right leadership for the NHS will make sure that our constituents get better care.

It has been reported this week that there has been a dramatic rise in self-harm, with one in five girls cutting, burning or poisoning themselves. Despite this, the NHS trust in my constituency has cut the Lewisham child and adolescent mental health services budget, due to central Government cuts. We desperately need more funding and more staff. Given that the Government are not on track to meet their mental health workforce target for 2020-21, is the Minister really confident that we can meet these new, larger recruitment targets?

I am confident that we are putting in place the measures that will allow those targets to be met. There is a comprehensive expansion of mental health services, with an additional £2.3 billion being invested over the next four years, which will make sure we resolve the problems the hon. Lady has highlighted. In particular, 350,000 more children will get the support they need, which I am sure will translate into dealing with the issues at local level that she has raised.

GP retention is a significant challenge in my constituency, and GPs do often raise the impact of the current pension system. May I say to my hon. Friend that I very much welcome the consultation on pension arrangements for clinicians, but can he set out the potential timing of when those changes may come into force? He will be aware that GPs are making decisions right now about things such as early retirement, and we need this as a matter of urgency.

I thank my hon. Friend for that question. The Department will launch the consultation at the end of this month. It will set out the proposals, which we spoke about yesterday, to introduce greater pension flexibility. They are designed to take away the disincentives not only for senior clinicians but clearly for GPs. That consultation will last for the normal length of time, and I hope we will be able to proceed quickly thereafter.

When I came to Parliament 35 years ago, I had served for three years on the royal commission on the NHS. We made many recommendations. When I hear the Minister talk about things that will be done and say that notice has been taken of reports, I am reminded that that report landed on Margaret Thatcher’s desk. The recommendations that we made were never carried out. One was about the shortage of doctors. Thirty-five years ago, we knew that there would be a shortage of doctors. We made many other important points, which should have been acted on. What assurances can the Minister give so that on this occasion the recommendations in the report will be acted on? What is the point of all these words and all this work done by people on things such as royal commissions unless the Government take action?

The Government are taking action specifically on the points that the right hon. Lady made. We committed to increase the number of undergraduate medical school places by 1,500, and 630 are already in place.

I thank the Minister for grappling with the NHS pension scheme issue. I am not convinced that the 50:50 option is a long-term, sustainable option, so will he confirm, as the Secretary of State said yesterday, that the consultation will be open to exploring other mechanisms? In particular, will he keep banging at the Treasury’s door, because the ultimate solution is in its power? The way in which it has tried to dodge this and pass it to the Department of Health and Social Care is a bit of disgrace.

My right hon. Friend—I am sorry, my hon. Friend; I am only presaging something that will happen in future—will know that when my right hon. Friend the Secretary of State speaks he says what he means. The consultation will be open to looking at other schemes and other potential flexibility. My hon. Friend will know that the British Medical Association has welcomed the 50:50 option but would like to see other options. He will also know, much as the Department might like to make tax policy, we do not do so, so it would be injudicious of me to commit, but I am happy to continue our long-standing conversations with the Treasury on this matter.

There will be no people plan if Donald Trump gets his hands on our NHS. Unlike Donald Trump, the NHS does not discriminate, and staff value everyone who walks through the door as equal. Does the Minister agree that the NHS was not for sale yesterday, it is not for sale today, and it must not be for sale tomorrow?

The good news is that I think the hon. Lady was agreeing with my right hon. Friend the Secretary of State, who set that out yesterday. I welcome the fact that she supports him.

The fishing village of Mevagissey risks losing its GP surgery because the last remaining doctor there has handed the contract back to the NHS. The people of Mevagissey have launched an incredible campaign to find a new GP for their village. Does the Minister support their campaign, and will he spread the message far and wide that there is an amazing community waiting for a new GP and that all expressions of interest are welcome? Can he reassure me that the new people plan contains measures not only to recruit more doctors but to ensure that rural and coastal communities can find the GPs they desperately need?

My hon. Friend is right, and I am happy to support the campaign by the people of Mevagissey, which is a wonderful part of the country to live in. I am happy, too, to assist him in that campaign if he wishes to come and speak to me about it. He is right that the plan sets out ways to recruit and retain more doctors, including GPs in rural and coastal locations, as well as those in urban locations.

Would the Minister join me, first, in congratulating the Royal College of Nursing on backing a people’s vote? Does he accept that one reason for that was doubtless that the number of nurses and midwives from the EU has dropped by 5,000 in the past two years? Will he set out what extra cost and complexity will be associated with the recruitment of nurses and midwives from the European Union, if indeed we leave the EU, in future?

I am sorry, I wholeheartedly apologise to the right hon. Gentleman. I certainly join him in welcoming the RCN’s welcome for a people plan. It is a great and sensible step forward, without being complacent about what needs to be done in the next phase, which will be published later in the year. He will know that we have been working with other EU members to ensure that, after what I hope is an orderly Brexit, there is continued recognition of medical qualifications. He will know that the European Commission has already set out its desire for a wide-ranging, extensive reciprocal healthcare agreement, and the Government continue to work to achieve that ambition.

I do not think that the Minister is taking this seriously. In the past two years, 5,000 nurses and midwives from EU countries have left the NHS, at a time when we are 40,000 nurses short. Does he agree with David Behan, the chair of Health Education England, who agreed yesterday that Brexit was exacerbating the NHS staffing crisis?

I have already set out the fact that the Department, the whole NHS management, the whole NHS, and we as a country welcome and recognise the huge contribution of EU nationals in the NHS. I have set out our desire to continue to ensure that EU nationals work in the NHS. Alongside that, I know that Sir David Behan will have also said to the hon. Gentleman that it is important that we have more routes into nursing to ensure that those 40,000 vacancies that he discussed do not continue, which is why we have set out in the plan more nursing apprenticeships, more nursing associates and more clinical placements. It is important to have both international and domestic recruitment.

The Minister has talked a lot about leadership. He said in his opening statement that there was a need to create in the NHS leaders who could create cultures that empowered staff. What is he going to do about the bullying at the top of the NHS, including in NHS England and NHS Improvement, which Dido Harding admitted yesterday at the Health Committee?

The hon. Lady is right: that culture is not acceptable and must be driven out. She will have read the interim people plan, which talks explicitly about ensuring that we create leadership that stops that culture. There is a chapter on making the NHS the best place to work. She will know that we have been working across the country to ensure that all staff know that they are valued, that they have the right to speak up and that the culture of bullying must be driven out. I shall speak with Baroness Harding, as I do regularly, to ensure that that message is spread throughout the NHS and that staff know that they are valued.

I realise that health is devolved to the Scottish Government. Nevertheless it has to be said that the Scottish Government are having enormous trouble with their workforce planning, which means that doctors and nurses have to pick up the slack and that we are wasting good money on employing agency staff, which need not happen. May I make a plea to Her Majesty’s Government to share workforce planning and best practice with the Scottish Government so that they can get that right?

As the hon. Gentleman rightly pointed out, health matters in Scotland are devolved, but I am delighted to share any of the excellent initiatives that are set out in the draft people plan with the Scottish Government.

Despite the vital role played by carers in society, they merit just a paragraph in the plan. Will the Minister ensure that his Department matches Labour’s commitment to publish a full strategy for carers and to increase carer’s allowance to the same rate as jobseeker’s allowance?

I welcome Labour’s commitment to publish a paper, but the hon. Lady will know that the Department is going to publish a Green Paper on adult social care. We are finalising that. [Interruption.] The hon. Member for Leicester South (Jonathan Ashworth) shouts at me. I know he makes a lot of promises without detail. We want to make promises that have detail and can work.

This is an important report into NHS people planning. It is an interim report, so there is an opportunity to identify any deficiencies. My particular concern is about the cancer workforce, in particular the point made by my hon. Friend the Member for Leicester South about the loss of bursaries not just for nurses but for therapeutic radiographers. May I draw the attention of the Minister, with due respect, to the fact that the radiotherapy and oncology course at Portsmouth University recently closed? Concerns are being expressed and not just by politicians on the Opposition Benches. Mr Richard Evans, chief executive of the Society of Radiographers, said that he has concerns about whether our hospitals and specialist cancer centres will be able to recruit enough skilled and trained personnel. This could even threaten the delivery of cancer treatment and the ambitious plans that the Minister has in the new cancer strategy.

The hon. Gentleman is right: this is a serious plan. As he rightly points out, it is an interim plan. It sets out a number of specific actions for this year. It also sets out a number of clear action paths and trajectories to ensure that the people plan is achieved. I would be delighted to meet him and other officers of the all-party group to ensure that we get the skills in the right places to ensure that the ambitious and deliverable plans in the long-term plan can happen.

I raised the cost of the Babylon GP at Hand app and the cuts in the number of conventional GPs at Prime Minister’s questions but, with respect to the Minister for the Cabinet Office, he missed the point, astonishingly. Even if NHS England funds £21 million of the shortfall for this year, that is still money from the public purse and it does not address the past cost to Hammersmith and Fulham of at least £12 million or any future costs. Will the Government suspend the Babylon contract while there is a proper investigation into this privatisation of the NHS?

It is not a privatisation of the NHS; it is a scheme allowing greater access to GP services. The hon. Gentleman will know that it is delivering healthcare to a number of his constituents as well.