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NHS and Social Care Services: Parity of Esteem

Volume 792: debated on Thursday 5 July 2018


Asked by

To ask Her Majesty’s Government what action they will take to ensure that their strategy for National Health Service and social care services recognises the importance of parity of esteem, including pay and professional standing, for staff across hospital, community and social care settings.

My Lords, having the right number and quality of clinical and non-clinical staff is essential to realising our ambitions for the NHS, community and social care. Last week we agreed an Agenda for Change multi-year pay and contract deal, while the introduction of the national living wage has boosted pay for the social care workforce. Later this year, we will publish a 10-year integrated health and care workforce strategy informed by our recent consultations.

I thank the Minister for his response. It is right today to pay tribute fully to the work and dedication of staff across the whole of health and social care. But for the future, both the NAO and our own Long-term Sustainability of the NHS Committee strongly criticised the absence of any long-term joint strategy to secure the well-trained and committed workforce that we need for a fully integrated service. The Minister told the House on 18 June that he is considering the implications of the very recent and welcome NHS staff three-year pay increase for the independent care sector. He recognised the need for the latter to be able to compete on a “level playing field”. Does he acknowledge that for the social care sector in particular that means aiming to level-up pay and professional standing between social care and the NHS, and accepting that parity of esteem is one of the key drivers to building integrated services for both patients and service users?

I join the noble Baroness in paying tribute to staff, not just across the NHS of course but across all the caring professions. We published the draft strategy and will publish a joint strategy for the health and care workforce precisely for the reasons that she set out. We need to make sure that there is joined-up care across all sectors. That means that we need extra funding—a sustainable funding solution—for the social care sector. We have put in an extra £9 billion over the course of this spending review since 2015 to provide a short-term solution. The Green Paper is about providing a long-term solution. Some of the principles in the Green Paper emphasise the importance of this integration, delivering quality and integration, a valued workforce and sustainable funding. Those are the conditions necessary for what she wants to achieve.

The Minister will know that in the social care field there are now numerous independent providers. What mechanism is there to ensure parity across the whole sector, including all aspects of social care?

The noble Lord is right to point out that there are differences between the two workforces: clearly the NHS has a largely publicly employed workforce and social care has a largely privately employed one, so there will inevitably be some differences in form. We need to make sure that those workforces work together and are as attractive as one another, which is why finding a sustainable funding solution is so important so that those private contractors have the ability to pay what is necessary to attract the right staff.

My Lords, the NHS proves that, with determined leadership, democracy can deliver long-lasting benefits to society. Will the Minister join me in paying tribute to those parliamentarians—in spite of them all being Labour—who, over 70 years ago, time and again traipsed through the Lobbies to bring about the National Health Service?

Well, they say that success has many parents and we should pay tribute to the Liberal MP William Beveridge, the Conservative Health Minister Henry Willink, and the Labour Health Minister Nye Bevan in the founding of the NHS. It is important to point out that the Conservative Party has been in power for 43 of the NHS’s 70 years and it has thrived under our leadership.

Will my noble friend confirm that when Nye Bevan established the NHS he said that the demand was going to be strictly limited?

Limiting demand is one of the challenges that we face to make sure that we are able to deliver a health service, but the NHS has proven to be highly effective not just in dealing with acute disease but now in supporting people with chronic disease, which is the greatest health challenge that we face.

My Lords, what advice would the Minister give to the management of organisations throughout the NHS and social care services about maintaining morale, retaining staff, promoting professional development and rewarding good work when there is often little increase in funding from local authorities, which themselves face continuing cuts in their grant from central government?

I recognise that staff work under a great deal of pressure and there are two ways we can help alleviate it. One is obviously to have social care and NHS staff work more closely together, and that is a stated ambition that we all want to achieve. The other is making sure that there are more resources, both to pay people better and to make sure that there are more people. That is what we are focused on delivering.

My Lords, is the Minister concerned to hear that, when speaking recently to a mental health nurse, I was told that she had received only four of her monthly supervision sessions in the last eight months? Does he agree that to ensure high-quality care across health and social care, all professionals and carers need their entitlement of regular supervision? Will he discuss with his colleagues in the education department whether there might be clinical supervision in some schools, to allow the mental health of children in schools to improve?

I am concerned to hear the story that the noble Earl has raised: I am sure that he will write to me with specific details. We know that at the moment only 25% of people with a mental health problem are seen. That needs to rise. We want to get that up to 33%, but clearly that is not enough. To do that we need more staff at every level. We have committed to training another 21,000 mental health workers to provide exactly the kind of leadership and support that he describes.

Is the noble Lord aware that on 4 July 1948, on the eve of the creation of the National Health Service, Aneurin Bevan also said that the NHS was the highest expression of moral leadership? Does he agree that we now need an equally high expression of political moral leadership? The fundamental of that is to tell the truth about the funding challenges facing the NHS, whether they are in manpower or in innovation and drugs. Does he agree, therefore, with the Prime Minister that there will be a Brexit dividend? How much is it going to be and where is it likely to be accounted?

I agree with the noble Baroness about the need for leadership and I think the Prime Minister has shown that leadership. Despite the many challenges that we face at the moment as a country and have done for many years, she has committed to a five-year funding settlement worth more than £20 billion extra in real terms by 2023-24. That is an admission that there are funding challenges, not just in the NHS and social care, and of course one of the ways that that will be funded will be through our not paying subscriptions to the European Union any more.