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House of Lords Hansard
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13 November 2018
Volume 793

Question

Asked by

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To ask Her Majesty's Government what plans they have to ensure that British citizens are recruited and trained to staff the National Health Service.

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My Lords, the Department of Health and Social Care is working with a range of partners to improve the recruitment and retention of staff required to deliver safe and effective NHS services. In England, we are increasing domestic doctor training places by 25%, there are now more than 52,000 nurses in training, and we have made more funding available to universities. Furthermore, we are increasing midwifery training places by 3,000 over the next four years.

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My Lords, I thank the Minister for his Answer, which is a little disappointing. I remind him that there are currently 100,000 vacancies in the National Health Service. There is a shortage of doctors, nurses, physiotherapists and radiographers, and I could go on. There is a shortage throughout the service, and it is no good the Government telling us what their aspirations are. In the light of the Chancellor’s Budget Statement, in which he concealed that there is to be a £1 billion cut for the NHS in the year beginning in 2019, will the Minister explain how the cut in funding for the training of nurses, doctors and other members of staff coincides with the aspirations he has told us about? And please, do not give any excuses whatever about the pension miscalculation.

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We agree that there is a need for more staff, and indeed there are more NHS staff than ever. I can tell the noble Lord that we are increasing doctor, nurse and midwife training places, and more GPs than ever started training in the NHS this year. With an ageing and growing population, we absolutely recognise the need for more doctors, nurses, midwives and many other professions. The Budget made no changes to health spending.

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My Lords, will my noble friend acknowledge that, as nurses are not paid highly, they will not repay the loan for their maintenance grant or tuition fees? Therefore, would it not make sense to allow them to go back to bursaries? In the long run, this would save the taxpayer money and mean that 30 years from now we would not have to write off a substantial loan—or, rather, the nurses who have not benefited from that support would not have to pay to write off that loan. Is it not time that the Government looked at the fiscal illusion that has led to this state of affairs and moved instead to a system that would help in the recruitment of more nurses?

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I greatly respect my noble friend on this topic, which we have gone around several times. As he knows, I defend the current system as being the most progressive. Nevertheless, I am grateful for his report, which he sent me and which I am reading with interest. However, at this point, we are confident that we have the right policy.

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My Lords, how are the Government determining the safe level of staffing? In the Health and Social Care Act, one of the requirements was to look for safe levels. Could the Minister tell us how the Government will assure us that they are safe levels?

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I am grateful to the noble Baroness for that question. First, we have safe levels by recruiting more staff. We recognise that there is a need for it, and we are recruiting more staff in every category. The actual safe level of staffing is a trust-level issue that needs to be determined in response to the case load they have at any moment.

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My Lords, I understand that medical students in England could soon be fast-tracked through their studies, advancing registration by a year. This would put them on wards one year earlier, with a year’s less training than their predecessors. What is the Government’s current thinking on this? Who are they consulting? What risk analysis will be done in making this decision?

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The noble Baroness will understand that the safety of NHS patients, and the NHS as a whole, is paramount when considering workforce. We are looking at whether additional flexibilities can be explored, but that will only be done if we can assure ourselves and others of that safety. These issues are being considered in the workforce plan.

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My Lords, the Government have placed great emphasis on mental health recently. Could the Minister tell the House what is the current shortfall of mental health professionals—particularly psychiatrists, and particularly child psychiatrists—in the National Health Service, and how the Government intend to address that shortfall?

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The noble Baroness is right to highlight that issue. Only around 30% of those who should be seen for treatable mental health illnesses currently are, which means that we have an important and urgent task to expand mental health places. There simply are not enough mental health staff in any category. This affects all developed countries. A big expenditure is being made, and around 21,000 new posts are being created across all specialties.

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Does my noble friend agree that the production of a workforce plan by Health Education England for the first time is a significant step forward for the health service and for healthcare in this country? Will he assure the House that providing Health Education England with the resources to deliver that plan is a priority in the forthcoming spending review?

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I am grateful to my noble friend, who set the foundation for this long-term workforce plan—indeed, the long-term plan for the NHS. He is right. It is not just a workforce plan for health workers but also looks at care workers. We need more staff, and that decision will be taken at the spending review, but it does have the highest priority.

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My Lords, does the Minister agree that the concerns expressed in this Question apply equally or even more to social care services? Unless social care is adequately staffed, the rebound on the health service will be enormous. I hope that, in future, social care will be given priority along with the health service.

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I agree. Indeed, my Secretary of State has made workforce one of his top priorities. We are responsible for health and social care, and the Green Paper we will publish this autumn will contain more detail on the social care workforce plan.

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My Lords, 63,000 NHS staff in England are EU nationals; that is 5.6% of all staff. London in particular relies on staff from EU countries, with one-third of all EU NHS staff working in London. We seem to be facing a Brexit emergency here. How will the Government manage both the transition and the long-term recruitment and staffing of the NHS under these circumstances?

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EU nationals and staff from across the world play a vital role in delivering our NHS and social care and we absolutely want them to stay. I can tell the noble Baroness that there are 4,300 more EU 27 nationals in the NHS now than in June 2016. I hope that is a reflection of the fact that they know they are wanted and welcome. We are making sure that the settlement scheme is open to them. Health and care staff will be the first cohort of staff to use the scheme, so that we can give them the opportunity to remain where they are very much wanted.