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Health and Social Care Workforce

Volume 736: debated on Thursday 13 July 2023

I beg to move,

That this House has considered the Third Report of the Health and Social Care Committee, Workforce: recruitment, training and retention in health and social care, HC 115, published on 25 July 2022, and the Government response, HC 1289, published on 24 April 2023.

Today’s debate could not come at a more timely moment, although when I wrote that line, I did not realise that it would be at an even more timely moment, given the news that we had this lunchtime about the Government accepting the pay review bodies’ recommendations across the public sector. As I said earlier in the House, I welcome that very much and think it is a fair and proportionate response on behalf of the whole economy and all taxpayers. The Government, of course, have to see things in the round. I hope that all unions in the health space will show the same response that we have seen initially from the main teaching unions. I urge them to do that.

Last week we marked the 75th anniversary of the NHS, and the week before that the Government published the much anticipated “NHS Long Term Workforce Plan”. It was very much welcomed. Some 46 organisations posted messages of support for it, so I think it landed well. In the context of the last fortnight, this is therefore a good moment to look back at what the Health and Social Care Committee, which I chair, recommended in our major report last year on workforce issues, and to look forward to see how many of those recommendations have been taken up in the new workforce plan, and what remains to be done.

This follows hot on the heels of our topical evidence session yesterday, where we heard some initial views about the plan from stakeholders; we put some of the already emerging questions to them and to the medical director of NHS England, Professor Stephen Powis. We are particularly grateful to the former doctor and author Adam Kay for coming and speaking to us, and to Alex Whitfield, chief executive of Hampshire Hospitals NHS Foundation Trust, which runs the Royal Hampshire County Hospital in my constituency. I thank them for coming in. The Committee’s workforce report was published nearly 12 months ago, at the end of July 2022. It was the result of a wide-ranging and in-depth inquiry looking at workforce issues, including recruitment, training and retention across the health and social care sectors. I pay tribute to my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the current Chancellor of the Exchequer, for his work then chairing the Committee and since.

As ever, we are as one, and I endorse every one of our report’s findings. That is because it was the result of more than 150 written submissions and an extensive range of oral evidence witnesses from across the health and care sector, who put together the report. Its main conclusions were stark. The report found that the NHS and social care sector is facing the greatest workforce crisis in its history. It noted that, in September 2021, the NHS was advertising just over 99,000 vacant posts and for social care the figure was 105,000.

I thank the hon. Gentleman for securing this debate at such an important moment, when waiting lists are at record levels, if the press are to be believed. Does he agree that we need urgent improvements in the way the workforce from abroad are employed? Some really exploitative practices are going on out there in certain care homes. Does he agree that that needs to be tackled urgently?

Anybody employed in health and care should be treated properly and with respect, and they should be welcomed to this country with thanks for the work they are doing. If the hon. Lady has specific examples of something—I am guessing she may have from her intervention—I ask her to please speak in the debate and put them on the record.

I thank the hon. Gentleman for securing this debate, and I thank him and the Committee for doing the work on the report. He notes that the issues in social care are regrettably much worse than they have been before. He will know that, on 30 June, nine NHS leaders wrote to the Prime Minister calling for a workforce plan for social care. The Royal College of Nursing and others have called for it, too, including my party, the Liberal Democrats. Does he as the Chair of the Committee or the Committee as a whole have a view on that? I know that the Health Secretary has said that the work- forces are different, but I wonder whether the Committee has a view.

We very much do. I will come on to that, but I am happy to address the point straightaway. In getting the NHS workforce plan out, there were four people in that marriage: No. 10, No. 11, the Department and NHS England. The idea of producing another workforce plan for social care causes some degree of deep sigh. That said, it has to be done. When I was at NHSConfedExpo in Manchester last month talking about our integrated care systems inquiry, Patricia Hewitt, the former Labour Health Secretary, and I were talking about all these issues and there is no question: there was a huge response from the room in wanting to see a care plan alongside an NHS plan. The Minister for Social Care is on the Treasury Bench, so she will have heard this exchange. A care plan is even more difficult than the NHS workforce plan, because the vast majority of services in that sector are not delivered by the state. However, just because something is difficult—I could mention the five priorities—it does not mean they do not need doing.

I was just touching on the vacant posts, and both figures have got worse since the report was published. We think there were some 112,000 or so vacant NHS posts in England in March this year. The inquiry that led to our report found that almost every healthcare profession was facing shortages. The impact of that work- force crisis was also clear to see. The report cited, for example, that the waiting list for hospital treatment had risen to nearly 6.5 million in April last year. That waiting list stood at 7.4 million by April this year, and I dare say the strike action in recent months has not helped. I say, “I dare say”, but I know it has not helped, and the figures speak for themselves, which is why I reiterate my call for them, in the Prime Minister’s words this lunchtime, to

“know when to say yes”

to the pay offer that has been made as a final offer today.

The Committee’s report was critical of the Government’s reluctance to act decisively and noted that a workforce plan promised in spring 2022 still had not materialised. It recommended in no uncertain terms that the Government produce

“objective, transparent and independently audited”

plans with workforce projections covering the short, medium and long terms. The reason I stress “audited” is that the House will remember that the now Chancellor and I were among those who voted in favour of an independently audited workforce plan when the Health and Care Act 2022 went through this House. It is credit to the Chancellor that he has driven that agenda through in government. It was announced a couple of weeks ago that the National Audit Office would now do that assessment. We look forward to that and we as a Select Committee will offer the NAO any help we can. It is what we called for.

I am delighted that the NHS long-term workforce plan was published at the end of last month and is here. It is no coincidence that that happened once my predecessor as Chair entered the Treasury as Chancellor. It is a huge moment for the NHS, a big moment for patients and a good moment for patient safety. Patients lie at the heart of the Chancellor wishing to drive it through.

There are caveats, of course, as there always are with me. For example, the Committee called for workforce plans for public health and for social care, as was raised in my exchange with the hon. Member for St Albans (Daisy Cooper). For what it is worth, as I have said in the House before, I think the Government were right to resist the constant tedious calls from people—including me—to get on and publish the plan, because in fact the most important thing was to get it right. I have spoken about the four organisations in that marriage, and I do not underestimate how difficult it was to get the workforce plan out. Now that it is out, we can scrutinise it—of course, that is part of what we are doing today. I know that it takes time to get these things done and it was right that the Government took their time.

The plan is a real sign of hope for patients and for families. There is also hope for the staff who work in the NHS. Our report noted that the pressures on the workforce were having a “real human impact” on the people working in the service, and they still are. It pointed to the fact that

“In August 2021 alone, the NHS lost two million full-time equivalent days to sickness, including more than 560,000 days to anxiety, stress, depression”

and other mental disorders. Adam Kay, who has written movingly about his decision to leave medicine, spoke powerfully about that to the Select Committee yesterday. I refer the House to the transcript of that, if people are interested.

The talk of burnout has become commonplace. Aside from the obvious human impact, the result is a massive impact on retention. That is a vicious circle, which increases the pressure on those who remain working in the service. People can now see the hope part of what I am saying: the cavalry is coming over the hill and there is a plan. That in itself can make a difference. The pay settlement today along with the pension announcement in the Budget and the long-term workforce plan should be seen as a package of measures that I hope gives the workforce some hope that there are better times ahead.

I am alarmed, as my hon. Friend is, about the 9.1% annual loss of staff, which is a high loss rate by any standard and implies that something is wrong with the jobs or leadership. Do he and the Committee think that a lot more work needs to be done on job descriptions, job feasibility and support for people in their roles so that these jobs are perceived to be of greater value by people and they do not want to leave? Otherwise, we have the extra costs of training somebody new.

Yes. There is a part of the workforce plan, which the Select Committee discussed a little yesterday, which talks about how, every year, every member of staff should have a conversation with their employers about their pension arrangements and mental health and wellbeing. That is fantastic. I am sceptical as to how it is remotely possible in an organisation of this size. That does not mean that I do not think the ambition is right—I think that it is right—but it would be helpful to the House if the Minister touched on that in her wind-up.

The other point I make to my right hon. Friend, which I will also make later in my speech, is that we must remember that there are NHS employers, and ultimately the Government are the employer in the widest possible sense, but the direct employer when it comes to hospitals is the trusts, and they have a big role to play in retention and in workforce health and wellbeing. We sometimes duck away from saying that, but I say that here in the House as well as privately to the chief executive of my trust.

I am encouraged by the emphasis that the workforce plan places on prevention, which everybody knows is one of my great passions in life and politics. That will clearly be crucial, given the supply and demand challenges facing the health service at the moment. Prevention is, as colleagues know, a subject dear and close to the work of the Select Committee: we have launched a major inquiry into the prevention of ill health, with 10 work- streams. We have already done the vaccination workstream and have moved on to the healthy places—home and work—workstream. Details of that are available on the Health and Social Care Committee’s website.

Let me turn to some of the specifics in the Committee’s report and what action the Government have taken. One of our key recommendations was 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.”

The plan does that: it doubles medical school training places in England to 15,000 by 2031-32, which is extremely welcome. As I said to the Prime Minister last week at the Liaison Committee, I hope it is possible to make some of those new places available before September 2025, as it says in the plan. However, with a UCAS deadline of mid-October for a September 2024 start, that looks extremely challenging. We discussed that yesterday at the Select Committee. An update from the Minister on that would be welcome.

I congratulate my hon. Friend on his report. On the issue of making places available, the report talks about the 2018 to 2020 university cohort and the great success of those new university medical schools. The Government’s response echoes that. The university medical schools approved by the GMC since currently have no funded places, though they are open and are receiving students. Does he agree that it would be very welcome if there were some funded places available in those three new medical schools by the earlier deadline that he has suggested?

I thank the Chair of the Education Committee for being a guest at yesterday’s session with the medical director of NHS England in our workforce special. He is right. The Prime Minister told me at the Liaison Committee, and the medical director said yesterday, that it will take time to scale up. Yesterday, the GMC chief executive talked about training capacity in scaling up the medical places. That is right and needs to be done. However, where the medical schools are ready—even with fairly modest numbers—for September ’24, it would be an incredibly good signal of intent from the Government to allow them to start then. The money is front-loaded, so the fiscal cycle should allow that to happen. Knowing my hon. Friend, he will not let this one go. I thank him for raising it.

I see why there may be difficulties speeding up between 2022 and 2025, although, like the other contributors, I urge the Government to do all that they can. It is also the case that much faster progress is expected between 2028 and 2031 than between 2025 and 2028. I would have thought it possible to bring some of that forward, which would be welcome for future managers of the NHS.

I see no reason why not. I am always open to argument from Government Members, but in so many parts of our workforce economy, there is a shortage of people wanting to do certain roles. That is not the case for people wanting to go to medical school. I am constantly contacted by people from around the country, and certainly in my area of Winchester and Chandler’s Ford. Many children—often those of serving medics—who are straight A students want to go to medical school but cannot because there are no places. We have made the mental leap to put the places there, and bringing them forward must be possible. The Minister knows that we are on the case, and I place that challenge before her.

On medical degrees, the plan also talks about NHS England working with the GMC. We heard from its chief executive Charlie Massey yesterday about consulting on the introduction of four-year medical degrees. The Committee explored the idea of shortening training periods in its original report; principally that was in the context of postgraduate training, but I fully support it. We currently take international graduates from all over the world where there are much shorter undergraduate training programmes than in the UK. As long as the GMC standards are met, I am very supportive of shortening the medical degree. I have spoken directly and on the record to the chief executive of the GMC about it. Obviously, quality and safety must be paramount, but as long as it is satisfied with the medical licensing certificates that it will issue, we should embrace that, and I am pleased to see it in the report.

I am also encouraged by the emphasis that the plan places on apprenticeships, with a commitment to providing 22% of all training for clinical staff through apprenticeship routes by 2031-32. That is up from just 7% today. In our related report on the future of general practice—because everything comes back to workforce—we called for the Government to provide the funding necessary to create 1,000 additional GP training places each year. The plan pledges to increase the number GP training places by 50%, to 6,000, by 2031-32. Box ticked, win—thank you.

Our workforce report called for reforms to the NHS pension scheme to prevent senior staff from reducing their hours and retiring early—again, a win. The Government have listened to the Committee. Obviously, that was announced in the spring Budget this year and is incredibly welcome. It was the No. 1 ask of the British Medical Association and we responded—something I hope it will remember over the coming days. I also hope the Opposition will come around to supporting it as well. Maybe when the Opposition spokesman has her say today she might reflect on the changes to pensions in the Budget, because they have been welcomed across the health sector.

The plan makes it clear that NHS England will work with the Government to deliver actions to modernise the NHS pension scheme—there is a specific section on that—and that the Department will introduce reforms to the legacy pension scheme, so that staff can partially retire or return to work more easily. That will make a big difference to some staff, including the consultant reconstructive surgeon who gave evidence to our original inquiry. He described his retirement happening “almost against his will” as a result of pension taxes. He said the NHS was “haemorrhaging senior staff” over pension concerns. I am therefore really pleased that the issue is being addressed.

I meet two or three times a year with the presidents of all the royal colleges in my role as Chair of the Select Committee. I wondered whether it might take a while for the announcement in the spring Budget to feed through, but within weeks of the announcement being made, a number of them were reporting to me—I had asked them directly about this—that it had already moved the dial in terms of people making different decisions about leaving the service, so I think that is a good one.

I think the training bit of the plan is incredibly strong—I have given some examples—but on retention, I think the report is “could do better”, as it said in my school reports. We recommended that there should be a review of flexible working arrangements in all trusts, with a view to ensuring that all NHS staff have similar flexibilities in their working arrangements to those employed as locum or agency staff. The plan talks about a renewed focus on retention with improved flexible working options. Although there is clearly a lot of detail still to come, I was pleased to see that on this point, the Government are listening to the Committee. However, we still need more detail on that and on how it ties in with the childcare changes, for instance, that were announced recently in the Budget.

I am grateful to the hon. Member for giving way again. I could not agree with him more on the point about retention. We hear a lot about recruitment, but fundamentally we cannot recruit our way out of a retention crisis, which is what we have right across the NHS workforce. Does he agree that we need measures for retention very urgently in the sphere of general practice? The Government rightly say that they are recruiting more GPs than ever before, but we have a bit of a “one in, one out” situation, where the bucket is very leaky and for every GP we are recruiting, another one leaves. We need retention measures right across the board, but very specifically in general practice if we are to recruit more GPs to fix the front door to the NHS.

Yes. One witness at our session yesterday said that the tap is well and truly on but the plug is still half out, which is a very good way of putting it. The recovery plan for primary care published a few months ago is really strong. It is really positive: it talks about wider primary care roles and it has been created in conjunction with the Royal College of General Practitioners. We need to see a fast-paced roll-out of that plan. We need the extra money for community pharmacies to move through the contract fast, so that it moves the dial even faster, because that is critical to the retention of general practice staff, and it is also critical to this winter being better than last. So, yes—point taken.

Another important point to note about the workforce plan is that it is iterative, so it will be refreshed every two years. I guess there are two ways of looking at that and I would appreciate the Minister’s comments. I understand it is at the Treasury’s insistence that it is looked at every two years, which is fine. We can look at it two ways: either the Treasury wants to make sure the plan is ambitious enough and, if necessary, that it is more ambitious so it can put more funding behind its next iteration, or—to look at it the half-empty way—the Treasury may wish to trim back. It is very important that the Department, Ministers and the House make sure that it is the former. The iterative side of the plan is important, and while we are still in the early stages, it is also important that the plan starts to deliver quickly in a practical way for people on the ground. That is why I said what I did about working with the primary care plan.

One of the possible risks to delivery—there are a few, because the plan contains big assumptions and models of numbers—is that the plan is based on a pretty ambitious labour productivity assumption of 1.5% to 2%. During the statement when the plan was put forward, somebody in the Opposition—it may have been the Opposition Front Bencher, the hon. Member for Bristol South (Karin Smyth)—said that the NHS has struggled to achieve that kind of productivity gear change in the past, so achieving it now will be a challenge. That does not mean that it is not the right thing to do, but I would like to understand from the Government what will happen to the projections in the plan—not necessarily today, but as we go forward—if the productivity assessment is not achieved.

What assessment have the hon. Member and the Committee made of the iterative process and the Treasury’s assumptions, building in the ageing workforce and the acute nature of mental health needs among the younger population?

We have not done that yet, but I merely put down a marker today that I hope there will be a review process, so that we can be even more ambitious. If we were to write a risk register for the plan, I would suggest that one part of that register could be the productivity challenge, which the NHS has long struggled with.

Let me turn to social care. In many ways, the picture there is more challenging. The Committee’s report notes Care England’s finding that in December 2021,

“95% of care providers were struggling to recruit staff, and 75% were struggling to retain their existing staff.”

The report concluded:

“Care workers often find themselves in under-paid roles which do not reflect the value to society of the service they provide. Without the creation of meaningful professional development structures, and better contracts with improved pay and training, social care will remain a career of limited attraction”—

not poor attraction, because many people want to do it—

“even when it is desperately needed.”

I know that the Minister is passionate about this issue and that she will give a passionate response today. We noted, however, that health and social care services are obviously interdependent, and if efforts in the plan to tackle the challenges in the NHS are to be successful, capacity needs to increase across both health and care. The Minister knows that, but I feel that I have to say it. That point is crucial, and with the welcome focus on the NHS workforce, it is vital that the issues affecting the care workforce are not forgotten. The NHS workforce plan cannot succeed if the challenges facing the social care workforce are not tackled.

I visited the HC-One care home in my constituency last month during Care Home Open Week, and I met a very interesting lady from the Prince’s Trust, who is working with the care home group on the pipeline of social care staff. I recommend that the Government get in touch with the Prince’s Trust, which is doing good work in trying to inspire young people to go into a career in care. I accept that the social care workforce is a different kind of workforce and that not all the levers are under the Government’s control, as I said, but the Government know that there is much to do on this issue.

To conclude, the 75th anniversary is a huge milestone for the NHS. Millions of people still have huge affection for the organisation, but to misplace that and take it for granted would be to do the opposite of serving the NHS faithfully. The anniversary cannot be an exercise in nostalgia. It must be an opportunity to look forward and to make sure that we have an NHS that works for our constituents now and in the decades to come; that is a prevention service as much as it is a sickness service; and that is among the best organisations in the country, in the public or private sector, for the way it looks after its staff. I am very optimistic about the workforce plan. It is a big step in the right direction. The fact that it is out there is a big moment, but there is plenty still to be done, and the Minister knows that my Committee will be right there scrutinising that work as it is taken forward. The plan is just the start.

Like others, I warmly welcome the workforce plan. I am grateful to my hon. Friend the Member for Winchester (Steve Brine) and his Committee for producing a detailed and interesting report that highlights many of the things we need to study.

I suspect most of us in this Chamber, of whatever political party, accept the broad principles that we need to train more medical staff in this country and that we need to expect to recruit more people to deal with the rising workloads and rising population in the years ahead and to clear the current backlogs. And who would not want progress on better working conditions and decent levels of remuneration, so that many more people are proud to remain in these jobs?

It is not as if we have not had these issues before, and it is not as if the workforce has not been expanding. As the report reveals, the number of full-time equivalent staff in NHS England has expanded by 263,000 since 2010, which is a very substantial increase. It is rather more than 263,000 people, because it includes part-time arrangements too. Of those, some 55,000 are nurses and 42,000 are doctors, which means that more than 160,000 are not in those two leading medical professions. NHS managers, who have increased substantially in number during that time, need to demonstrate that they are recruiting the right kinds of support staff, administrative back-up and IT help so that medical professionals are better able to concentrate on treating people and doing a good job.

In the past, I have led a couple of large industrial groups, and in the days before we had an elected Assembly to run the Government of Wales, I was responsible for the very substantial public sector workforce in Wales, including the NHS workforce, as Secretary of State, so I have some experience of the complexities and difficulties of helping to supervise or run large workforces. I freely confess that none of those workforces was on the scale of NHS England, which is another degree larger, with a workforce of 1.5 million. None the less, whether it was tens of thousands or hundreds of thousands, I understand the complexities of dealing with large workforces.

I have reflected on what worked and on my experiences. My first reflection reinforces the point we have heard from the Committee. If I had experienced a 9.1% rate of turnover each year, I would have been quite alarmed. Had that been added to by a 6% or 7% absence rate, as is reported in some professions and areas of NHS England, I would have been even more alarmed. Although I had lesser problems with absence and loss of talent, I regarded them as a challenge that the leadership and management teams had to take on. To deal with the frictions, there were nearly always things that could be done to improve conditions of employment and to improve the understanding between management and those trying to execute policy.

The frictions were not always about pay. Of course, increasing pay is greatly helpful, and I welcome the results of the independent review—I was one of the many voices saying the independent review had to be implemented—but we now need something for something. We need to complement pay by making good decisions so that people feel they have a worthwhile, feasible job.

The one thing on which I disagree with my hon. Friend the Member for Winchester is his point that, with an organisation this big, it might be rather difficult to do the right kind of mentoring and individual treatment. The NHS is a series of small organisations under a general umbrella. There have been endless arguments, not particularly on party lines, about how much should be decided by experts and well-paid people at the centre and how much should be decided in the hospitals and surgeries—about how much delegated power there should be.

There is certainly management at all levels. As my hon. Friend reminded us, there are chief executives and other senior staff in hospitals, and there are practice managers and others in GP surgeries. Quite a lot of the mentoring, understanding, and evolution of a person’s role or job must occur in those local places, where one of the local management’s main tasks must surely be ensuring that their staff are looked after and well motivated. This service is a great example of a people-led service. It has millions of potential patients and a million and a half staff, and it is the interaction between them that matters. The quality of service is almost entirely dependent upon the skills, attitudes and approach of the medical professionals and their support workers in delivering a good quality of service to those who turn up as patients.

We need to say to the 36,000 managers of the NHS England system that they have an important task; that surely they know their staff and what some of their staff’s problems are; and that it is in their hands, not in the hands of Ministers, how the jobs are described and made into realistic jobs, with tasks that people want to do and can do. It is for those managers to work out how staff are rostered and how people become eligible for a promotion. Good staff management is about managing all those things.

Let me further the debate on this. We talked to the trust chief executive about this yesterday. She said that she does good exit interviews with people who leave her trust. They leave for varying reasons, but often it is because they have got a different job in a different part of the country, and their family circumstances have changed—they are not always off to Sydney. So this comes down to leadership. The Secretary of State would talk about the Messenger review—I assume the Minister would concur—which talks about leadership in trusts and integrated care systems. That is not as good everywhere as it might be.

That is right. I hasten to add that there are many examples of good practice in the NHS. In the hundreds of trusts, units and management commands in the NHS, there are some very fine examples. In a large organisation such as this, part of the skill lies in spreading the best practice from the places that know how to do things and are doing them well to those that need help or support. They may not be aware of what is feasible, given the resource to which they are committed. I have found whenever I have been involved with something that was not working well that bad management have often made a mistake and appointed some good people but not in the positions of influence and power where they can really make things happen. Where someone is trying to recover something that is not running well, it is often about identifying the people who are good but who may be sidelined, frustrated or not being used properly, and then transferring them into different roles, to give the idea to the others that the organisation can be a good one.

My hon. Friend was hinting at where someone wants to get to if they are leading any organisation. They want success, because success breeds success; people want to work for a successful and happy organisation. If morale is allowed to sink, performance starts to get poorer. If performance sinks, really good people perhaps do not want to be associated with it or they are frustrated that they are not given the power to sort it out. The organisation could then get into a downward spiral, which it needs to avoid.

Let me move on to a slightly tougher message and spoil the party. I take as my text the work that the Chancellor of the Exchequer and his team have been doing and his recent big speech at the Guildhall on productivity. His research revealed that productivity in crucial public services, particularly the NHS, is considerably below its 2019 levels. We are all sympathetic to the fact that there was a major disruption of the NHS’s work for the period 2020-21, and probably we would also expect there to have been difficulties in in 2022 after the impact of a major diversion of effort and activity into tackling the pandemic. We are all very grateful to those brave and talented staff who did what they needed to do to see people through. However, over that period a large additional amount of money was provided, not just for the pandemic, but now on a continuing basis, along with some additional staff, as we have been commenting on, yet we are still not back to the productivity levels we were at in 2019.

As the managers of the NHS go about creating a more contented and happier workforce, in the way I have been describing, they need to say to people, “You are going to be better paid, but we can also look at your promotion, grading and job specifications,” because the good ones should be able to get additional pay and go up the scale into more important jobs. There has to be something for something. The managers have to help the staff to deliver more treatments, consultations and diagnoses, which must be possible because we are not even at the levels we were at in 2019.

I have met scores of people working in the NHS at different levels; I am sure the right hon. Gentleman has too. When I talk to them about the productivity gap, they give me two or three clear examples of why there is a productivity problem. One is that there are more sick days because of burnout and exhaustion. It is unfortunate that the Government are cutting funding for mental health hubs, which have been a huge source of help for staff, particularly in hospital settings.

The NHS workers I have spoken to also talk about scanners that are way past their use-by dates and take far too long to get going, and about IT systems that do not speak to each other. They have to use eight or nine different IT systems between wards, or even on one ward, and old computers take too long to set up in the morning. It is that kind of tiresome daily grind. We sometimes know about that here in Parliament, when computers do not start in the morning and things do not work, and people end up getting frustrated.

Does the right hon. Member recognise that the productivity problem is not just about rotas, but about investing in technology, IT and scanners that work, making sure that water is not coming through the ceilings and giving mental health support?

I agree with all that. I have been very careful not to criticise the staff; I am talking about a management problem. If there are too many agency staff, then time has to be spent explaining to them how that particular hospital or department works, which would not be necessary if the regular staff had turned up. If there are gaps because of staff absences or people having resigned, that puts more strain on people and the system does not work efficiently.

All my remarks are made in the context of what I said at the beginning about trying to make these jobs more worthwhile and feasible. We need to look at how that can be done, and managers have to answer questions about whether some of them are imposing too many requirements on people that are not directly related to them performing their tasks better. There have to be limits on how much other general management information or other management themes they want to pursue, when the main task is to clear the backlogs and to treat the patients. The patients should come first, second and third, and that is not always possible if managers are making many other demands. So that is where the management teams need to take the organisations.

I was coming to the other good point that the hon. Member for St Albans (Daisy Cooper) makes, which is also well made the workforce plan. We are living through an extremely exciting digital revolution. It may even be speeding up with the developments in artificial intelligence, which could be dramatically helpful. There is a continuing task in the NHS, which sometimes thwarts those attempting it, to make sure technology is applied in the right way and is understood and friendly to use, so that hard-pressed and busy medics can find it a support, rather than a tribulation or a barrier.

Given the NHS’s huge range of data and experience, artificial intelligence should be an extremely valuable support, aiding diagnosis and decisions on treatment. I am not one of those who think that computers can do these things on their own or are about to take over the world. In the model we are talking about, the computer is an extremely important assistant that can do research and produce first drafts—that kind of thing—in a way that speeds up the work and effectiveness of the professional. However, it has to be controlled and guided by the medical professionals, who have the judgment, wider experience and expertise. The quality and speed of what they do could be greatly enhanced with the right kind of AI backup. For example, if they are facing a condition they do not know much about because it is rare, the computer would be able to give them immediate access, one assumes, to the details of what has happened in similar cases, what it looks like and how it might be treated.

We have the time, so let us explore that briefly. My right hon. Friend is right to talk about technology and AI in particular. We produced a report a couple of weeks ago on digital NHS. We are struggling with first base on digital. Medics talk to us about having to log in to multiple systems in order to do one very simple task. I worry that, while we are talking about 21st or 22nd century technology on assistive AI, we are struggling with first base. We were at the Crick Institute yesterday. Teams there were talking to us about the challenges of bringing together all the datasets that exist across the NHS to assist in their research, and they cannot even do that. This should be an assistive help to the workforce, but we have a long way to go on that. I know the Secretary of State is very seized of this opportunity, but my right hon. Friend knows that there are problems.

Yes, indeed. Wishing to be optimistic, I was pointing out, as many will do, that there is huge opportunity in this area. None the less, my hon. Friend is quite right that there are all sorts of issues and questions, such as: what the existing technology delivers; whether the systems talk to each other sufficiently; and whether it has data in a format that can easily be transferred to a more common and modern system. We are obviously back into arguments on—I do not have a strong view on this, but experts should—how much has to be laid down centrally, so that there is an England-wide, or NHS-wide, system that is freely interoperable, and how much is best determined by local units, which know their own needs and will be organising the training and will want things that their own staff find helpful to them and fit into the sometimes differentiated approach that an individual hospital or a GP surgery may have.

It is good news that we are taking future manpower requirements seriously. It is good news that we are having an informed conversation about what might be possible. It is good news that most people, I think, agree that technology is part of the answer. Having better motivated and happier staff is clearly fundamental to the answer. I hope that, when the Minister sums up, she will have a few thoughts for me on what actions the senior management of the NHS and its various trusts are taking so that they can get those absence rates down, so that they can get the loss of staff substantially reduced, so that they have fewer staff saying, “This is not feasible,” or, “I am burned out,” and more staff saying, “I am really proud to work here,” or, “This is going extremely well; we cut our backlog last week,” and, “Did you know that many people are now getting over this condition because of our treatments?”

That is clearly what we want. We want high-morale organisations. That takes money and the right number of staff. It also requires great leadership, but it is not just leadership from the political top; it must be, above all, leadership from the very senior managers at the top of NHS England percolating down to the very important senior managers that we have in every trust and every major health institution under the framework of NHS England.

It is a pleasure to speak in such a very well-informed debate. I thank my hon. Friend the Member for Winchester (Steve Brine), who chairs the Health Committee, for inviting me to guest with the Committee on the issues of the long-term workforce plan. I think in this, as in many other areas, there is a great deal of crossover between the work that we do on the Education Committee and the work that he does in the health space.

I join my hon. Friend in welcoming today’s announcement about the public service pay negotiations. It is very welcome news that the education unions have suspended strikes. I join him in urging the health unions to look very carefully at the offer on the table to try to do the same.

I want to raise a few points in this debate, and the first is not related to the meeting we had yesterday, nor necessarily to the main theme of the workforce plan, but it has come up through my work on the Education Committee: the pressing and urgent need to ensure that when we look at workforce, we include child and adolescent mental health services, and the resources and people available in that space. I have spoken to people at my health and care trust in Worcestershire, who interestingly told me that they feel that they are quite well resourced and have the relevant people to meet adult mental health needs, but that there is further work to be done to make sure they can adequately meet child and adolescent mental health needs. Everything I see from the school sector—including some pressures we are looking at as part of our inquiry into recruitment and retention for the teaching workforce—makes it clear that the pressing mental health pressure on schools is a big part of the challenge. Anything the Minister and the workforce plan can do to address that would be extremely welcome.

Let me turn to the very interesting Committee meeting I attended yesterday, which demonstrated the great achievement of the Health Committee, under its previous and current Chairs, in pressing for a long-term workforce plan. That is something to be celebrated, and its shows the role of this House and its cross-party Select Committees, including when it came to the weightiness of the document we were scrutinising. We heard some interesting and useful evidence about the recruitment challenge and the retention piece. I share the concerns of my hon. Friend the Member for Winchester, echoing the evidence that was given to the Committee, that there is more work to do on retention and that it will require a great determination from the NHS and Ministers to address those issues in the long run.

We also heard plenty of evidence—this has also been made clear to me on a local level—that recruitment, training and upskilling the workforce can play a key role in inspiring senior doctors to stay in and play their part in bringing forward the next generation. It was interesting to hear evidence from the General Medical Council and GPs about the benefits of those doctors being able to play a part in training the next generation. I have heard the same from many doctors within the Worcestershire Acute Hospitals NHS Trust and in our local primary care services in Worcestershire. It is one reason why we have a unanimous view from all the trusts across Worcestershire, Herefordshire, Gloucestershire and Dudley that they want to see a medical school up and running, training local students in Worcester, where we have a university that the Department values and recognises, to the extent that it has been the fastest growing nurse training university in the country over a number of years, and which the GMC has now approved to have a medical school—so far, so good; that is extremely welcome. I am grateful to the NHS and to Ministers for all the work that has gone into getting to that stage. We do, however, face a challenge.

My medical school, the Three Counties Medical School at Worcester, which serves a very large area of the country, is opening in September. It is bringing in students and has uniquely managed to find funding to support domestic students to start their medical training without funded places allocated by what used to be Health Education England and is now part of NHS England. The challenge is that the funding is finite. It has enough funding—which has been raised locally from local health trusts and charitable donations—to support a cohort of 20 students to start this September and to take them all the way through their training at the university, and hopefully onwards into the NHS.

Clearly, 20 students is not a large enough cohort to sustain a medical school, so alongside those 20 students in the first intake, there will be 28 international students. The evidence we heard yesterday was interesting on this point. I think we all recognise, and the report that the Select Committee published recognises, the benefit of international recruitment to the NHS. We absolutely want to attract talent, but we also need to recognise—as per the many arguments I have as Chair of the Education Committee when it comes to international students in general—that the majority of international students do leave; they do not necessarily stay and work long term in the NHS.

If we want to solve the recruitment and retention problem in the long run, we need to train more of our own doctors. We need to train those doctors locally. In health, just as in teaching, many people who train in a particular area are likely to stay in that area and pursue their careers there. That is also something that has been put to me over many years by my local trust and my local GPs as a reason to have a three counties medical school in Worcestershire.

I am very grateful for the support that the NHS and colleagues on the Front Bench have provided over the years in marching us up the hill to a position where the building is there, the university will be opening that medical school this year and the first students will be starting. That is fantastic.

My concern, and it is a concern shared by many colleagues—six Worcestershire MPs wrote to the Health Secretary last week about it—is that where the long-term plan, which is extremely welcome in most respects, sets out the plan to double medical training places, it carries the line:

“The first new medical school places will be available from September 2025.”

The three universities that have been given the go-ahead to host a medical school—Worcester, Brunel and Chester—have not yet had the opportunity to bid for funding places, so that date is frustrating. It means that, after the first year’s intake of locally trained domestic students at the Three Counties Medical School, we have the slightly bizarre potential for the following year’s intake to be entirely international students. I hope the NHS and Ministers can avert that, because it does not make sense from either a value for money or a long-term workforce planning perspective.

I appreciate that I did not give my hon. Friend the Minister advance notice of my intention to speak in this debate, so I do not expect her to be able to answer all my questions. However, I ask her to take this issue away and ensure that the Health Secretary looks very carefully at the letter he has received from all the Worcestershire MPs. I understand that the University of Worcester will also be writing to NHS England to make the case for additional funded places this year—that would be wonderful, but I appreciate that it would be very difficult—and for an allocation of funded places next year.

That is certainly something worth considering. It would help with recruitment, with retention and with some of the challenges that our local health service in Worcestershire has wrestled with for a long time—challenges that I am well aware of, having spoken to trust leaders and doctors in all areas of the NHS. Not only would it benefit us in Worcestershire, but it has the support and the placements are already there. That is crucial, because I understand the reasoning given in the NHS workforce plan is that the Government and the NHS need time to work out where the placements are and where they are required.

It is already clear that there are well over 100 placements available across Worcestershire, Gloucestershire, Dudley and Herefordshire for the medics when they come out of that training, so that problem is solved. It is already a four-year, graduate entry course, so the problem of long courses and things taking too long is also solved. I encourage colleagues on the Front Bench to engage with the request and see whether we can make the workforce plan even better by getting those funded places going at the universities that the General Medical Council has already determined are ready to go, to help meet the workforce challenge.

One other thing I would say, having listened to my hon. Friend the Member for Winchester and some of the debate yesterday on the Select Committee, is that no single Department has a monopoly on wisdom. As Select Committees, we are there not only to challenge and to criticise, but to welcome things when they go right. I was quite struck by the discussion of the importance of retaining trainers and the pressures currently facing them in the NHS, which the GMC raised concerns about.

We face a similar challenge in the education space, and the early career framework, designed to support teachers starting their careers in schools, is a very interesting model to look at—particularly when we look at the importance of mentoring and, for teachers, off-timetable hours to get that mentoring. There may be similar things that could be designed into the NHS; I would not claim to be any kind of an expert on that, but it is worth looking to see whether there are elements of that model that could even further strengthen the very welcome NHS long-term workforce plan.

I thank the Backbench Business Committee for scheduling this debate and the hon. Member for Winchester (Steve Brine) for his opening comments. I also thank the right hon. Member for Wokingham (John Redwood) and the hon. Member for Worcester (Mr Walker) for their speeches.

It is good that the Chair of the Education Committee, the hon. Member for Worcester, has joined up with the Health and Social Care Committee to line up discussions, particularly on apprenticeships. I hope that that progresses because there are a great many problems in the assumptions that the plan makes on apprenticeships. I think that he will highlight that to the Committee.

The report and the work done by the Health and Social Care Committee were hugely important in shining a light on the problems facing our health services at a time when the Government were still denying the scale of those problems. I thank all members of the Committee for their dedication in producing the original report. Indeed, they had another good session yesterday. They have rigorously pursued this issue across parties for a number of years.

As the hon. Member for Winchester said, since the Government’s response in April, we have had a further response, which I think is helpful for this debate, in the long-term workforce plan. I cast my mind back to Committee stage of the Health and Care Bill and to the many debates held in this place and the Lords. I, among others, including the hon. Member, tried every which way to get the Government to agree to an independent review process. In those heady days, many of us were on the WhatsApp broadcast list of the right hon. Member for South West Surrey (Jeremy Hunt). I find that those messages do not come as frequently now as they did then.

Workforce problems were the primary issue facing our health and social care services then and they still are now. My Labour colleagues and I have been warning about that for many years. When we were in government in 2000, we produced a 10-year plan of investment and reform—a plan that delivered not only 44,000 more doctors and 75,000 more nurses, but the lowest ever waiting times and the highest ever patient satisfaction rates in the history of the NHS. It has taken this Government some 13 years to even attempt something similar.

We must not forget why the workforce plan is so crucial. Thousands of patients are waiting for surgery, families are trying to get support for care in the community, and people are struggling to get through to their GPs. They are all being denied the quality care that we all deserve. It is the health and care staff who are left to pick up the pieces of a system that the Government have allowed to fall apart around our ears—sometimes quite literally in the case of the estates.

The hon. Member for Winchester spoke very well—his usual style—about the burnout issue that his Committee has heard about, which is very real. As a former NHS manager, I take issue slightly with what the right hon. Member for Wokingham (John Redwood) said. This cannot be laid at the door of management, because we are also losing managers from the system.

The scale of the problem is massive. I thought that I had a pretty good grasp of the problem, but as I read the Government’s long-term workforce plan, my jaw dropped further and further towards the floor. How on earth did things get quite so bad? Nothing now says what 13 years of the Tory party’s mismanagement has done to our country better than the evidence in the plan. The gap between the current state of the workforce and what we need to prepare for the future is huge. The Government’s failure to get to grips with that sooner means that the work needed to bridge that gap, and the costs, will, sadly, be much greater.

We have talked of hope this afternoon. In the long-term workforce plan, we have a clear statement of how bad things are—we look forward to the National Audit Office looking at it independently—but we also need to try looking forward, which I will try to do with some hope. However, the plan is largely based on the system today; it is not really based on the system of tomorrow. Personalised medicine, genome therapy, new dementia and obesity drugs and artificial intelligence will all transform service delivery—we talk about that a lot in this place—and will therefore transform the necessary job roles. The 15-year plan does not account for those imminent changes. Although I recognise that, in the foreword to the plan, the chief executive acknowledges that, of course, we cannot predict everything over the next 15 years, and we hear talk, although I am not entirely sure it has been confirmed, of the plan being reviewed every two years—perhaps the Minister can confirm that—the Government have missed the opportunity to indicate in that long-heralded document what the future might look like for those delivering and receiving care.

Crucially, we do not really have a plan for how things will get better—there is no plan for delivery. On the promised figure of £2.4 billion, there is no indication of where that money will come from, how it will be disbursed or what costs are actually covered in that figure. Has the Minister considered the downstream implications for the workforce who will support our clinicians—for example, the porters, caterers, cleaners and the wider workforce—rather than those who are mentioned?

While the work to model current and future requirements is admirable, we do not know much about the assumptions that underpin the plan, but we have some hints. Page 23 says:

“Beyond core terms and conditions, which are outside the scope of this Plan, we will need government to support this Plan by providing the necessary continued and sustained investment in infrastructure, reforming education funding and strengthening social care provision on which the success of this Plan depends.”

The question for the Minister is, will the Government do that?

In my long experience of reading NHS documents, much like a sports fan reading the newspapers, I go straight to the back pages. That is where the key risks to this plan are identified. Paragraphs 14 and 15 of chapter 5, on page 109, state:

“the modelling recognises the balance of risk around productivity”—

an issue that was discussed by the right hon. Member for Wokingham and the hon. Member for St Albans (Daisy Cooper). It goes on:

“Achieving the productivity improvements assumed in the Plan is dependent on two key factors. First, it requires a sustained increase in capital investment in the ageing NHS estate, including in primary care, to replace equipment that has passed its recommended lifespan… This would enable staff to function more efficiently, and shorten diagnosis and treatment times in areas such as cancer”,

which is surely something the Government want to see. It continues:

“Second, it requires investment in digital infrastructure throughout the NHS, including appropriate training and support”.

The next paragraph says:

“The modelling for this Plan assumes that the balance of care between the NHS and social care will remain broadly the same. However, an increase in the capacity of and access to social care would likely contribute to reducing the assumed growth in demand for NHS services”.

The Minister’s response to those paragraphs would be very useful. We do not know the cost or the delivery route for any of these factors, even though they are in the plan.

However, we do have a workforce plan published. There is hope—it was in my speech before Members raised it today—that at least the Government will start to tackle the crisis that they have created. Integrated care systems bring us an opportunity to ensure local delivery and some accountability. Will the Minster confirm that ICSs will have the resources and support needed to implement strategies to recruit and retain staff?

Finally, Labour will introduce plans only when we can show how they will be paid for, because that is what taxpayers deserve. The Government are welcome to borrow our plan to fund it by scrapping the non-dom tax status. The Government have a lot of form in making grand announcements and promises of money, only for us to see that money disappear or, worse, the funding reduce in another part of the system, adding to the burnout problem. Can the Minister assure those in the NHS and our constituents that that will not happen?

My grandfather was a doctor, my mother was a doctor, my father was a surgeon and my aunt a nurse, so when I think of the NHS, I do not picture a hospital or an ambulance; I picture the people—the doctors, nurses, pathologists, radiologists, physios, healthcare assistants, porters and all the other people who make the NHS what it is. The NHS is its workforce, and the same is true for social care. Life is made possible for hundreds of thousands of people thanks to the hard work, skills and compassion of social workers, nurses, care workers, care home managers and all the other people who work in social care. That is why I welcome this chance to talk about our health and social care workforce.

I thank my hon. Friend the Member for Winchester (Steve Brine), the Chair of the Health and Social Care Committee, for his comments and for all his and his Committee’s work on their report. In the Government’s response to that report, we were right behind the key recommendation to publish workforce projections, and last week we put that into practice when we published the NHS long-term workforce plan. It is an ambitious plan to train many thousands more doctors, nurses and other health professionals; retain more of their talent and experience; and reform how they train and work to secure the future of the NHS, backed by an investment of £2.4 billion. I will not try to set out everything in that plan this afternoon, but I will share some of the highlights and respond to the points made by my hon. Friend the Member for Winchester and other hon. Members.

In brief, the plan forecasts the increase needed in the NHS workforce between now and 2037, and sets out how we will expand the numbers of doctors, nurses and other health professionals that we train. We will double the number of medical school places, boost the number of GP training places by 50%, increase the number of adult nurse training places by over 90%, and expand the number of dentists we train by 40%. We will widen the talent we bring into the NHS by increasing the number of staff trained as apprentices from 7%, as it is now, to 22% by 2032. That will give more people the opportunity to earn as they learn, widening access to healthcare careers to more people from different backgrounds.

However, as hon. Members have highlighted, the NHS is already full of talented people whose skills we want to retain. Of course, some people will always want to move on to new things or indeed retire, but the NHS can and must do better at retention. That is why we made retention an integral pillar of the long-term workforce plan. The NHS is the UK’s largest employer, and it should set a real example in how it cares for its staff. As the plan says, the NHS will do more to support people throughout their careers, increase opportunities to work flexibly, and look after its workforce’s own health and wellbeing.

My right hon. Friend the Member for Wokingham (John Redwood) spoke about the importance of individual trusts as employers, and the importance of their leaders and managers to staff retention. I very much agree with him about that—I have spoken about it previously in this House, probably as a Back Bencher. How well people are led and managed is probably the biggest determinant of their experience at work, and is therefore a big factor in retention. I would flag to my right hon. Friend that the Messenger review, which I expect he is familiar with, is excellent in this area, and the long-term workforce plan references that review’s recommendations. Taking them forward will be an important part of the plan.

I should also mention pay. Pay is not the only factor affecting recruitment and retention—in my many years of talking to NHS staff, I have heard far more often that having enough colleagues on their team is arguably the most important thing—but it does matter. NHS staff should be fairly rewarded for the work they do. That is why we listened and reached agreement on pay for staff on “Agenda for Change” contracts. Under that deal, over 1 million NHS staff, including nurses, paramedics, midwives and porters, have received a 5% pay rise and extra one-off payments. In addition, as we announced today, the Government have accepted the recommendations of the doctors’ and dentists’ remuneration body for this year in full.

We should not forget that the NHS pension scheme is one of the best that can be found, and we have made it more flexible to make the most of the experience of staff who are particularly close to retirement. Since April, former NHS staff claiming NHS pension scheme benefits can return to work and rejoin the scheme, and from October we will introduce a partial retirement option that gives more flexibilities to staff, meaning that patients will benefit from their skills for longer. We have already acted on the tax treatment of pensions, which we know is a factor in the decision of some doctors and other NHS staff to retire early or reduce their hours. My hon. Friend the Member for Winchester referred to that as the BMA’s No. 1 ask.

The final part of the plan I will mention is reform, because as care changes, so must how we work and, indeed, how we train staff. That is why the plan includes reforms to training, such as increasing the number of apprentices, which I mentioned; increasing the focus on generalist skills alongside specialisms; increasing the share of training in settings outside of hospitals, such as GP surgeries; adopting more blended learning and the use of simulation; and making sure that we get the right duration of training programmes. When it comes to how people work in the NHS, the places that people receive care are changing, with more care outside of hospital and closer to home. As such, the plan envisions a faster rate of increase in the number of staff working outside of hospitals, with the mental health workforce growing fastest, followed by community and primary care. In fact, over the period of the plan, the NHS community workforce is planned to double.

The way people work will also change, with staff working more in integrated teams coming together from different parts of the NHS and, indeed, together with social care. Joining up care is better for patients and their families. It is more effective, but also more efficient.

On productivity, all of this will be supported by new technology. We will use advances in technology in how we train and in how people work. We will use technology such as AI to support clinicians, increase efficiency and improve patient care, so giving staff the gift of time—time to spend with patients.

Equally important in our future health and care system is our social care workforce. As my hon. Friend the Member for Winchester said, this is indeed something I am passionate about. I have heard many calls, including today, for a social care workforce plan. The good news is that we are well under way with substantial social care workforce reforms. They were first set out in the White Paper, “People at the Heart of Care”, and then described in more detail in our next steps plan published in April. We are investing £250 million in reforming care as a career, with a new care qualification, specialist training courses for experienced care workers and a new career structure for care workers to support career progression.

Those reforms build on the work we are already doing to build the social care workforce, with record funding available for local authorities to spend on social care—up to £7.5 billion announced in the autumn Budget—which, through the fees local authorities pay, supports care providers to pay their staff better in turn. The reforms also build on our introduction of Care Quality Commission assurance of local authorities’ care duties and our introduction of the care worker visa, so that care providers can draw on international recruitment.

On that point, I will pick up on the intervention made by the hon. Member for St Albans (Daisy Cooper) on the question of exploitation of international recruits. I think that is very serious, and I am very concerned about it. I say that against the backdrop that, as we know from the data from Skills for Care, the number of care workforce vacancies is falling—that very good news was published yesterday—coupled with what I hear from the many care providers I speak to, which is that international recruitment is really helping fill vacancies and meet the care needs of our society.

In general, I know that care providers are working very hard to support the international workforce they are recruiting, but I am very disappointed that we have heard stories of exploitation at a minority of care providers. I do not want anyone working in health or social care to be exploited. That is why we have provided guidance to people who are receiving a care worker visa on their employment rights and how to seek help. We are also funding local support to be provided to international recruits into social care, and we are working across Government—including my Department, working particularly with the Home Office—on tackling exploitation.

All in all, I would say that what we are doing to support the social care workforce is working. The number of care vacancies is falling, retention is improving and care is on the path to getting the recognition it deserves.

In closing, I thank the Chair of the Health and Social Care Committee for welcoming the NHS long-term workforce plan. I was very glad to hear him say that many boxes had been ticked by the plan. I hope my response has provided him and other hon. Members with further assurance. The NHS long-term workforce plan is historic in its ambition to recruit, retain and reform the NHS workforce. Our social care workforce reforms are also ambitious to make care work a profession that gets the recognition it deserves. The workforce are the heart of our national health service and social care. All that skill, compassion and dedication is essential to the lives of people up and down the country, and that is why we are looking and planning ahead to secure the future of our health and social care system.

I will close by thanking the Minister, my right hon. Friend the Member for Wokingham (John Redwood), my hon. Friend the Member for Worcester (Mr Walker) and the hon. Member for Bristol South (Karin Smyth) for their contributions, as well as my Clerks, my predecessor and the many members of the Committee who produced the report.

The Minister is right that many boxes have been ticked, but she also knows me well enough to know that I am always creating new boxes. We have not discussed NHS dentistry today. That is mentioned in the report, but it requires a great deal more exploration. Indeed, tomorrow we will produce the Committee’s report on NHS dentistry services—I know the Government are looking forward to that. The long-term workforce plan is a big moment, but there are boxes that are not ticked around the volunteer workforce, which I know the NHS cares greatly about, and around sexual health services, which I do not see any mention of in the plan. We will return to some of those themes.

The thing about health and the NHS is that it is never done. As I said in my remarks, we have to see the workforce plan as part of the context of the recovery plan for primary care, the urgent emergency care plan, the choice agenda in tackling waiting lists and the pension reforms—it is part of the ecosystem. The longest serving Health Secretary, who is now the Chancellor, and I have been very honest in saying that when we were at the Department, we wished we had pursued the workforce plan. There were other plans such as the NHS people plan that were shorter term, but we regret not doing this then. That is why it is so important that from the learning we have all done, we have this plan in place.

It is, I think, typically honest of the Prime Minister to produce a 15-year plan. I sincerely hope that he is re-elected next year, but of course that might not happen. The Conservative party could be out of office and back in office before the 15-year plan is complete. This is about doing the right thing for the health service, for patients and for our constituents, and doing the right thing for the country. I hope that whoever stands at that Dispatch Box next will continue this plan and build on it, because there is no alternative. The NHS is precious and we cherish it, and this plan proves that.

Question put and agreed to.


That this House has considered the Third Report of the Health and Social Care Committee, Workforce: recruitment, training and retention in health and social care, HC 115, published on 25 July 2022, and the Government response, HC 1289, published on 24 April 2023.