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NHS: Agency Doctors and Nurses

Volume 826: debated on Wednesday 14 December 2022


Asked by

To ask His Majesty’s Government what assessment they have made of the reasons why this year’s NHS spending on short-notice agency doctors and nurses is 20 per cent higher than the previous year.

My Lords, demand for temporary staff supplied through staff banks and external agencies has increased. This is largely due to the increase in activity involved in our service recovery plans. Even taking account of recent increases, agency spend is still lower than in 2015-16 as a result of measures introduced to control spend. When adjusted for inflation, last year’s agency spend reflects a 25% reduction compared to 2015-16.

My Lords, the shortage of NHS staff is unsustainable, as is the NHS paying up to £5,200 for a single doctor shift. This year, in addition to the £3 billion paid to agencies providing doctors and nurses at short notice, a further £6 billion was spent on bank staff when NHS staff were paid to do temporary shifts. What cost-benefit analysis has there been of this expenditure, compared with investing in recruitment, training and retention of the workforce? Does the Minister agree that it would have been much better if we had had, and actioned, the long-awaited and costed NHS and social care workforce plan?

I totally agree with the noble Baroness: it is always better to invest in recruitment and retention, and that is what we are doing. There is no cap on the number of nurse graduates, and we have more than 70,000 in training right now. During the last three years, we have increased the number of nurses by 32,000—well towards our target of 50,000—and the number of doctors has increased by 4,000 in the last year alone. At the same time, I welcome the long-term workforce plan. It is a crucial tool going forward.

My Lords, I have asked the Minister before about the NHS’s plans to retain its clinical personnel. He has acknowledged the importance of the issue but there seems to be no real urgency attached to it. There is absolutely no good will among NHS personnel towards the NHS as an institution—those are not my words but the words of NHS staff. When is this crisis to be addressed with the urgency which is so clearly required?

I believe the urgency is there. This has been demonstrated more than anything by the measures in the Autumn Statement and by the long- term workforce plan, which will be reporting early in the new year and is what we all want. Commitments are being made to prioritise well-being, health, culture and leadership, and to operationalise this as per the 2020 NHS People Plan. Do we need to do more? Clearly. Is it a high priority? Yes.

My Lords, the increase in agency staffing costs reflects the Government’s failure to invest sufficiently in staff training and recruitment over the years. To what extent does the Minister believe that the change of course he has indicated—a staffing plan and increased investment—will reduce agency costs in 2023?

I think all of us in this House agree that these are long-term plans. Part of the increase in agency costs is also because we are trying to get more output and more activity. I am delighted that there are 70,000-plus nurses in training, but it takes a while for this to come through the pipeline. We are focused on making sure that we continue to invest in this pipeline. There is no cap on graduate or undergraduate places for nurses, and we will continue to invest.

My Lords, I declare my interest as a member of the GMC. The Minister has referred to the forthcoming workforce plan. Can he assure me that it will actually put numbers on the future training of different professional staff, together with a commitment to funding these places?

Again, I will check, but my understanding is that fundamental to any plan is the number of new places needed and recruitment, both internally, through graduate schemes, and externally. Apprenticeships also provide an opportunity. I know we are not taking up all our apprenticeship value; we refund some of it back to the Treasury. There is clearly an opportunity here to get more people on the pathway to becoming a nurse, so that anyone from any walk of life can get on it.

My Lords, have the Government made any assessment of sickness absence rates among NHS staff and how that might be contributing to increased agency costs?

My noble friend is correct to bring this up; it has been an issue. I am glad to say that sickness absences at the moment are much closer to pre-pandemic levels, so I think we are coming down the other side of the curve, so to speak. But undoubtedly it has been an issue over the past year, when Covid has still been an issue, which has caused more absenteeism and so the use of more bank and agency staff.

My Lords, the Government have changed the pension rules for doctors, creating an incentive for them to retire earlier. The Government are committed to looking at that issue, but they do not seem to be doing anything. When can we expect a change in that policy so we can retain our doctors?

The noble Lord is completely correct; we need to make sure that this is one of the key retention elements. There is also the issue of the hours doctors work: we know that, beyond a certain level, they find it uneconomic. A high priority is looking at what we can do on pension rules, or simply paying doctors the equivalent amounts as a straight salary, to make sure that we solve that problem.

My Lords, the Opposition target the abolition of a particular tax to raise funds to put into the NHS, but does my noble friend believe that is the silver bullet they purport it to be?

I thank my noble friend. I do not pretend to be an expert on tax, but my understanding is that the so-called non-dom tax does not end up increasing the revenue raised and would therefore have a detrimental impact on the economy.

My Lords, the Minister is putting a lot on the success of the new workforce plan. Is part of the problem of gaps in staffing numbers that, until recently, the Government refused repeated requests for an NHS workforce plan?

I do not know, is the honest answer. All I can say is that we are doing it now, and I think we all welcome it as a good thing. That has not stopped us investing in new places, and we have increased the number of nurses by 32,000. So it is not as if we were not heavily involved in recruiting and retaining staff in the meantime, but it is great that we are now going to get it.

My Lords, does the Minister think that he might have had a better chance of recruiting more nurses if there had not been a 20% drop in real-term wages over the past 10 years?

Clearly, salary is a very important part of all this, which is why we have always followed the recommendations of the independent pay review body, as Governments of all colours have done since 1984. Clearly, it is that body’s job to look into all such issues. Going forward, I am sure that we will continue to support its findings and invest on the back of that.

My Lords, a report from this House’s Public Services Committee has suggested that demand will outstrip supply in the workforce due to the demographics of this country. It suggests that the Government should work closely with civil society and the private sector to make sure that we are delivering public services. One problem is that, often, the NHS does not work as well as it should with civil society and private partners. Can my noble friend go back to his department and find out what it and the NHS are doing to make sure they work in tandem with civil society and private providers, and can he comment on that today?

I thank my noble friend and agree that, in looking to recruit so many people, we need to consider every possible source. I mentioned the private sector earlier, and there are also apprenticeships. Noble Lords will remember that years ago, there were two nurse entry levels, one for graduates and the SEN scheme, which my mum was able to join, with a lower bar and training on the job. We need that sort of modular training approach, so that people can build up their qualifications as they go through the system, and we need to welcome people who are not graduates into the service. Those are all vital ways to get the numbers we need into the workforce.

My Lords, although we all acknowledge the acute shortage of nurses right across the services, there are particular issues with children’s palliative care services. How do the Government intend to address this urgent priority?

We are trying to address every area. As I mentioned, in the past year alone there has been an increase of 9,000 in the number of nurses. We have to make sure that that increase goes to every area where it is needed, including children’s palliative care.

Sitting suspended.