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NHS: Working Conditions

Volume 783: debated on Wednesday 5 July 2017


Asked by

To ask Her Majesty’s Government what proposals they have to improve working conditions for NHS staff.

My Lords, the Government are improving working conditions for NHS staff by recruiting record numbers of doctors and nurses over recent months. Furthermore, we are helping trusts to become employers of choice through more flexible working, improving staff health and well-being, and tackling bullying of and violence against NHS staff.

I thank the Minister for his reply, but it indicates to me that the Government are still in a state of denial. He talks about recruiting extra nurses. Has he seen the report last week that showed that for the first time ever there were more nurses leaving the profession than joining it? How does that stack up with his assertion that they are recruiting more nurses? Does he not accept that it is only on account of the dedication and commitment of all NHS staff, including doctors, nurses and ancillary staff, who on occasion work in appalling conditions, that the service is as good as it is? Why do the Government, as a first step, as a gesture, lift the pay cap so that the nurses and the doctors can have a salary that they deserve?

I join the noble Lord in paying tribute to the commitment and selflessness of NHS staff. I am of course aware of the report that he talked about. That is why we need to increase the numbers of both nurses and doctors in training, which has happened. On pay, I think we all know that everybody has had to make sacrifices as we get the public finances in order. That is well understood. My right honourable friend the Secretary of State is shortly meeting the leaders of the Royal College of Nursing, for example, but of course any decisions on pay will be made as a consequence of the reports from the independent pay review bodies.

My Lords, in the 2016 NHS staff survey, 47% of staff who responded said that staffing levels were insufficient for them to be able to do their job properly. One in five GP training places were unfilled, mental health and community nurse numbers fell by 13%, and district nurse numbers fell by 42%. Given that workload is the major reason given for staff leaving the service, how do the Government plan to increase the number of patients treated in primary care and in the community as opposed to in acute settings in hospital, as recommended by a number of authoritative reports, including that of the Select Committee of your Lordships’ House?

I can only reiterate that I recognise the pressures on the workforce. That is why we are recruiting more GPs and nurses. There are more than 50,000 in training, and we are aiming to get 5,000 more GPs into the NHS over the next few years. On the noble Baroness’s point about moving treatment out of hospitals and into the community, that is one of the core drivers of the STP process, which is about reorganising care so that it happens sooner and, ideally, in a preventive way rather than after the fact.

My Lords, I think the Minister will be aware that GPs are routinely required to see, diagnose and treat 80-plus patients in a day. What plans do the Government have to ease that situation when it is still getting worse month by month and it is proving impossible to recruit GPs? In the meantime, until things improve, will the Minister have discussions with the CQC and the ombudsman about how best they should undertake their jobs, taking account of the horrendous pressures on NHS staff and on GPs in particular?

The noble Baroness is quite right to talk about the importance of having more general practitioners. I have talked about the increases in recent years—there have been net increases of 5,000 over the last 10 years—and the fact that we are recruiting another 5,000 over the next few years. I do not pretend that it is easy to recruit them, but the numbers are increasing. One of the keys to solving this problem is through the new models of care. In its General Practice Forward View, which was published last year, NHS England demonstrated a renewed emphasis on general practice and reforming it. That is one way of ensuring that GPs can cope with what is of course an increasing workload.

My Lords, I just do not understand the Government’s response to this very pressing question. Already, recruitment from other EU countries has ground to a halt because of the anti-EU rhetoric of the party opposite. In this country we now have a net loss in the number of nurses coming into the NHS. Is the Government’s policy to recruit nurses from overseas countries other than the EU, as we have for generations? If it is, and I hear that the NHS is recruiting hugely in those countries, does that not make a mockery of the Prime Minister’s ludicrous target to reduce immigration?

As the noble Lord knows, we have talked about one of the reasons for the drop-off in nurses coming from the European Union; it is because of the stricter language testing. Stricter language testing was brought in for reasons of patient safety and was supported by the noble Lord when the regulations went through in 2015. Indeed, I think there was cross-party support for that. As for anti-EU rhetoric, I do not recognise that in anything that we have said. We absolutely value the contribution of anyone who is living and working here in the UK, and indeed have made a very generous offer to solve this problem as part of the talks for leaving the European Union. As for recruitment, of course we want to recruit as widely as possible. We want the brightest and the best to be here, and that is an absolutely core part of any immigration strategy.

My Lords, are we not in danger of missing an important point in this discussion? Simon Stevens, the head of the NHS in England, recently talked about the abuse of the system by those who selfishly and drunkenly turn up at A&E on a Friday evening expecting the NHS to bail them out. There is the abuse of health tourism, and indeed abuse by those who simply fail to turn up their appointment. Is there not an abuse here that is costing hundreds of millions, if not billions, of pounds to the NHS, disrupting the service for those who really need it? Should we not be doing more to crack down on this abuse?

I completely agree with my noble friend. That is one reason why we are taking steps to deal with health tourism and to ensure that people who not only abuse the system but actually abuse NHS staff, which unfortunately is far too prevalent, are properly prosecuted.

My Lords, will the Minister explain how the STPs will be achieved without further investment in continuing professional development so that people such as paramedics and nurses can work effectively in the community?

I can tell the noble Baroness that investment is going into STPs not just in recurrent spending for the purposes she described but, as was announced in the Budget, in capital spending to achieve the transformations that we all want to see.