Health and Care Bill (Ninth sitting)

The Committee consisted of the following Members:

Chairs: Mr Peter Bone, Julie Elliott, Steve McCabe, † Mrs Sheryll Murray

† Argar, Edward (Minister for Health)

† Bhatti, Saqib (Meriden) (Con)

† Crosbie, Virginia (Ynys Môn) (Con)

† Davies, Gareth (Grantham and Stamford) (Con)

† Davies, Dr James (Vale of Clwyd) (Con)

† Double, Steve (St Austell and Newquay) (Con)

Foy, Mary Kelly (City of Durham) (Lab)

† Gideon, Jo (Stoke-on-Trent Central) (Con)

† Madders, Justin (Ellesmere Port and Neston) (Lab)

† Norris, Alex (Nottingham North) (Lab/Co-op)

† Owen, Sarah (Luton North) (Lab)

† Robinson, Mary (Cheadle) (Con)

† Skidmore, Chris (Kingswood) (Con)

† Smyth, Karin (Bristol South) (Lab)

Timpson, Edward (Eddisbury) (Con)

Whitford, Dr Philippa (Central Ayrshire) (SNP)

† Williams, Hywel (Arfon) (PC)

Huw Yardley, Sarah Ioannou, Committee Clerks

† attended the Committee

Public Bill Committee

(Morning)

[Mrs Sheryll Murray in the Chair]

Health and Care Bill

We resume this morning at clause 25.

On a point of order, Mrs Murray. There have been quite a few changes on the Government Benches in the Committee. We congratulate the Under-Secretary of State for Health and Social Care, the hon. Member for Erewash (Maggie Throup), on her promotion and the Under-Secretary of State for Environment, Food and Rural Affairs, the hon. Member for Bury St Edmunds (Jo Churchill), on her transfer. If there was a Sky Sports News transfer deadline day reshuffle pack, I can see Jim White in wheels of excitement about the number of changes at the Department of Health and Social Care. We are delighted that the star striker remains in his place.

On a more serious note, the composition of the Committee has changed. Was that in order? Was some kind of approval process from the House required before that could take place?

It is all done through the Committee of Selection, so it is quite in order.

Further to that point of order, Mrs Murray. Derek Wilton on “Coronation Street” used to say, “I shall be on the cocoa by the time Trevor McDonald has finished”—a reference to people retiring for the night at around quarter-past 10 or half-past 10. We got an email at 10.22 pm last night with an updated selection list from the Chair. I do not think there are any substantive changes, but in a case where there are dramatic changes to selections and groupings at short notice, is there any rule or procedure about how much notice must be given?

There is no minimum notice requirement, but I am sure there will not be an issue in future.

Further to that point of order, Mrs Murray; I have had a few days to think about these points. The Minister very helpfully said he would write to me about the workforce amendment we put forward last week. Over the weekend, I was talking to some members of the public who are very interested in the Committee’s proceedings. They asked when that letter might be published. I know the Minister is very busy and has a lot of new inductions for his colleagues to get through, as well as his work on the Bill, so I am not going to ask when he will release it, but would it be appropriate to add that letter to the page on the Government website where all the Bill information is contained?

I am sure the Minister has heard your point of order, Mr Madders.

Clause 25

Integrated care system: further amendments

Question proposed, That the clause stand part of the Bill.

With this it will be convenient to consider:

Government amendment 14.

That schedule 4 be the Fourth schedule to the Bill.

Mrs Murray, it is—even more than usual—a pleasure to serve under your chairmanship: I am still standing before you in this Committee and opposite the hon. Member for Ellesmere Port and Neston, as seems to be our fate. He has served in his Front-Bench role longer than I have in mine, and that is going some.

Clause 25 gives effect to schedule 4, which contains minor and consequential amendments relating to the introduction of integrated care boards. The majority of the amendments relate to replacing existing references to clinical commissioning groups in legislation with references to integrated care boards. The schedule is necessary to ensure that existing primary legislation that refers to CCGs will continue to operate effectively once ICBs are established. Without it, references to clinical commissioning groups would be erroneous and the new commissioning bodies, ICBs, would not be referenced where they need to be across the statute book.

Following from that, Government amendment 14 is minor and technical. It is simply to ensure that the legislation hangs together properly. It makes no change to the status quo, but reflects that clause 15 of the Bill replaces section 3 of the National Health Service Act 2006 with a slightly amended proposed new section 3. A consequential amendment is therefore needed to section 187 of the 2006 Act so that it refers to the correct subsections. Previously it referenced subsections 3(1)(d) and (e), but those same subsections have now been moved to 3(1)(e) and (f) in proposed new section 3.

The amendment simply updates the cross references in section 187, without which section 187 would refer to incorrect subsections, which could result in regulations made under section 187 allowing for charging for the wrong services. That is, quite clearly, not our intention, and we are simply continuing the status quo and clarifying that matter.

Schedule 4

With this it will be convenient to discuss the following:

That schedule 5 be the Fifth schedule to the Bill.

Clauses 27 to 32 stand part.

NHS England and NHS Improvement, comprised of Monitor and the NHS Trust Development Authority—the TDA—requested the primary legislative changes to support the merger of their organisations, and these clauses are fundamental to fulfilling that ambition. In recent years, NHS England and Monitor, as part of NHS Improvement, have been working closely together with a view to acting as a single organisation with a single operating model. They already have aligned board and committee arrangements and joint senior executive appointments through the joint working programme. Despite the progress made, there are limits to the extent to which they can collaborate under the current statutory framework.

Establishing a single statutory body responsible for the health care system in England has several clear benefits. First, it will create a more joined-up approach across the NHS to provide national leadership and speak with one voice to set clear and consistent expectations for providers, commissioners and local health systems. Secondly, it brings services, support and improvement under a single regulatory and legislative framework. That will deliver improved care for patients, enabling better use of collective resources, removing unnecessary duplication and ultimately making better use of public money. The merger will provide clearer lines of accountability so that the public can be assured that any service they use meets the same requirements around safety and quality.

One of the problems that we have found in Nottingham around driving integration was the duplication of lots of different regulators and metrics, which meant that organisations were often working to different purposes. This obviously tidies that up a bit in terms of regulators. Does the Minister envisage going further in the future?

I am grateful to the shadow Minister for that question, which reminds me of some of the questions that he used to ask me in this room about what the future held when we discussed delegated legislation. I am always cautious not to predict the future, but hopefully it will be helpful if I set out the principles that I think should apply. I agree that unnecessary duplication that does not bring clear and tangible benefits to patient safety or improve outcomes is clearly undesirable. Therefore we will seek to streamline where appropriate, but without compromising patient safety or the outcomes that patients experience. While not predicting the future, I hope that gives him some reassurance of the direction of travel as I see it.

Clause 26, along with other provisions in the Bill, including clause 29, makes the legal changes necessary to bring these organisations together as one legal entity. Clause 26 abolishes Monitor and introduces schedule 5, which contains amendments that transfer Monitor’s functions to NHS England in order to fulfil the Bill’s intention to merge Monitor and the NHS TDA into NHS England to form a single body. The schedule transfers powers and duties from Monitor to NHS England and repeals provisions that are no longer necessary in the light of the merger. For example, Monitor’s functions in relation to NHS foundation trust mergers and acquisitions in sections 56 and 56(a) of the 2006 Act, and in relation to licensing providers in sections 81 to 114 of the Health and Social Care Act 2012, will all transfer to NHS England.

We acknowledge that bringing together the commissioning functions previously exercised by the NHS commissioning board, and the regulatory functions previously exercised by Monitor, under a single organisation could be perceived as giving rise to conflicts of interest. The Bill will therefore ensure the proper management of any such conflicts, and we will work with stakeholders on robust processes that will safeguard the separation of responsibilities and improve transparency. For those reasons, clause 27 seeks to insert new section 13SA, which deals with minimising conflicts between the body’s regulatory and other functions, into the National Health Service Act 2006.

I am grateful to the Minister for his detail on those clauses, which have been very helpfully grouped. Although we have not put forward any amendments, we do want to raise some general concerns—mostly around what these clauses do not do.

As we have heard—although I do not think the Minister used quite the same terminology as we would have—these clauses have got rid of the worst trappings of the market architecture, which were characteristic of the Lansley Act. As we have heard, they enable the merger of NHS England and NHS Improvement, although I do not think that NHS Improvement is actually mentioned anywhere in the Bill. All references are to Monitor and the NHS Trust Development Authority. It is almost as if the Government want us to forget that NHS Improvement ever existed—or probably want us to forget who was chairing it.

The abolition of Monitor sounds another death knell for the Lansley Act, but does leave some of the market mechanisms in place. However, since they were ignored anyway, I can understand why the Government have not bothered to go the whole hog.

Clause 26 finally turns the Monitor off at the mains—although I think it is fair to say that it stopped working some time ago. NHS England is now the undisputed, supreme leader over commissioning and both flavours of providing, so the Bill not only tears up the Lansley reforms but quietly changes the 2003 amendments. Monitor was set up as the regulator of foundation trusts, and was to be the approver of applications to become a foundation trust.

Foundation trusts have had many incarnations, but were once heralded as the vigorous, autonomous new organisations that would shake up the NHS and bring choice and competition into healthcare. They were beyond the reach of those nasty bureaucrats who ran the rest of the NHS. However, as I think we have seen today, it has not quite turned out like that. There must be a clever saying somewhere that “All health service reforms end in failure”, just like all politicians’ careers—although the Minister is clearly an exception to that!

To rub salt into the wounds, the Bill will provide the ability for ICBs to create new trusts, which will be ordinary trusts rather than foundation trusts—I hope that the Minister can confirm that my understanding of that is correct. That prompts the question: if Monitor is going, why are we keeping foundation trusts? Perhaps more pertinently, why do we still have two different models for trusts? Let us have flexibility and a thousand flowers blooming, but having two versions of what, to all intents and purposes, are exactly the same thing seems unnecessary. We know that the Minister wants to see unnecessary duplication and bureaucracy removed, and this is perhaps a very good example of that.

One thing that Lansley envisaged was a single model, and perhaps that is the right way to go, but we are in a very strange position with two approaches and very little to distinguish between them. Why not let all NHS trusts become foundation trusts or call them all trusts? I guess that someone could work out whether it would be cheaper to change all the stationery in ordinary trusts or all the stationery in foundation trusts, so that all the letterheads and notices say “trust” or “foundation trust”—whichever one ended up being the cheaper option. Really, there is no practical distinction now. If we got rid of that distinction, we would at least want the governing body model for foundation trusts to become the standard for all, which we would perceive as a real step forward for public engagement.

Having said all that, there is one other outstanding distinction, because foundation trusts are still able, at least in theory, to retain control over their capital spending. As we will see later, however, even that is an endangered species. What are the practical differences between trusts and foundations trusts, and why do the Government consider it so important that the distinctions remain?

My hon. Friend is right in what he says. Given Monitor’s role, NHS Improvement’s role and local scrutiny of what is happening within the system—it is almost independent in some cases—there is a real gap here now. I have called them cartels before, although my hon. Friend will perhaps not use that word. With the absence of Monitor, where is the transparent and independent scrutiny? What is the new regime, and how will that accentuate the patient voice? We have also been unable to highlight how many millions of pounds have been wasted in the intervening years from 2012 with regards to how the previous Act was pushed through, and the terrible waste that has arisen as a result. Surely the patient voice must be really important in holding trusts to account.

I can assure my hon. Friend that I will not waste opportunities to refer to the waste of public money as a result of the Lansley Act, but the wider point is one that the Opposition have made already in Committee and will continue to make. There is clearly a gap where accountability ought to lie. It will be interesting to hear what the Minister says about why the governing model for foundation trusts cannot be expanded to all remaining trusts. We would particularly want to see far greater patient involvement in the integrated care systems in the Bill. Clearly, we have had that debate unsuccessfully, but I hope that we will perhaps have an opportunity to return to it once the Bill returns from the other place.

I will say a few words on the licensing scheme. Given that the Bill marks an end to the whole era of markets and competition and a move, at least in theory, to a model of collaboration and co-operation—not a cartel, as my hon. Friend the Member for Bristol South might call it—why is it necessary to license NHS bodies that are now fully under the control of NHS England and the Secretary of State? That does not seem to be a particularly good use of anyone’s time, and it will create more unnecessary paperwork and bureaucracy.

We will do our best to help the Minister in reducing obstacles to delivering patient care, so we will not oppose these clauses. However, we think that they have probably not gone far enough. They are clearly a necessary tidying-up job, but the Government should do the job fully and properly.

As ever, I am grateful to the shadow Minister. He should be optimistic—perhaps not on this issue, but more broadly—about the reception of some of his suggestions. I think I managed to take him aback slightly last week with one suggestion, although it was perhaps not the one with which he expected me to be willing to engage. I always listen to and consider carefully what he says.

The shadow Minister made a number of points. He mentioned the references to Monitor and TDA and said there are no references to NHS Improvement. That is because NHS Improvement is not the named body in law—that is simply a legal distinction. The named bodies are the NHS TDA and Monitor, which we understand and know as NHS Improvement.

I gently chide the shadow Minister. His reference to the chair of NHS Improvement, Baroness Harding, was a little unmerited. She has worked tirelessly. Colleagues will have their views, as is entirely appropriate in this place, but his reference was uncharacteristically uncharitable.

Given that the Minister, who I think is an honourable man, has mentioned that, does he think it acceptable for the chair of NHS Improvement to take the Conservative Whip in the House of Lords, as was outlined in the pre-screening scrutiny commission by the Health and Social Care Committee? Does he think that is acceptable, as other Ministers have not done so?

I believe that all appointments, including that one, are conducted entirely appropriately, in line with Cabinet Office guidance.

I move on to the shadow Minister’s substantive points, which he perhaps made more in hope than anything else. We are not resiling from the value that choice and competition can bring, but we recognise that it is not the only driver of improvement and that collaboration plays a key role, so the position is perhaps a little more nuanced than he might like to suggest or wish to see. What we are seeing here is a reflection of the reality. We are ensuring that the way the system has evolved in practical terms over time is reflected by updating the appropriate legislation.

The shadow Minister mentioned a number of specific points around foundation trusts, and I hope I can give him some reassurance. We are not abolishing foundation trusts or their rights. The licensing system that we are talking about allows for equivalent management of both types of trust in a consistent way, and the NHS will still have the power to authorise new foundation trusts in the future, if they meet the appropriate criteria.

I think the Minister probably has the gist of what I was getting at in my comments. Can he tell us how many applications for foundation trust status are currently in the pipeline?

The shadow Minister is an able parliamentarian. I hesitate to say with certainty, but my belief is none at present. However, I caveat that by saying I would not wish to mislead the Committee. If I have got that wrong, I will of course let him know.

There is nothing that stops the evolution of trusts into foundation trusts, if they so wish and meet the criteria. What we are saying here is that it is not one size fits all. We will not force anyone down that route, but the option remains for NHS England. I would argue that the way the system has evolved is a reflection of the strength of that system and the framework that we have put in place around it. On a serious note, I know that the point about foundation trusts is of considerable interest to the shadow Minister. When we reach clauses 51 to 57, which cover this issue and the operation of foundation trusts, I suspect that we may get into rather more detail about how they actually operate. I might even be able to confirm that my understanding of the figure for which he asks is correct.

The shadow Minister has made his points clearly, but I hope the Opposition will agree to these clauses. They are technical clauses in essence, and the shadow Minister has rightly used them to air broader issues that are related. They are technical clauses to reflect the reality of the evolution of the system.

Clause 33

Report on assessing and meeting workforce needs

I beg to move amendment 94, in clause 33, page 40, line 6, leave out from beginning to end of line 11 and insert—

“(1) The Secretary of State must, at least once every two years, lay a report before Parliament describing the system in place for assessing and meeting the workforce needs of the health, social care and public health services in England.

(2) This report must include—

(a) an independently verified assessment, compliant with the National Statistics Authority’s Code of Practice for Statistics, of health, social care and public health workforce numbers, current at the time of publication, and the projected workforce supply for the following five, ten and 20 years.

(b) an independently verified assessment, compliant with the National Statistics Authority’s Code of Practice for Statistics, of future health, social care and public health workforce numbers based on the projected health and care needs of the population for the following five, ten and 20 years, consistent with the Office for Budget Responsibility long-term fiscal projections.

(3) NHS England and Health Education England must assist in the preparation of a report under this section.

(4) The organisations listed in subsection (3) must consult health and care employers, providers, trade unions, Royal Colleges, universities and any other persons deemed necessary for the preparation of this report, taking full account of workforce intelligence, evidence and plans provided by local organisations and partners of integrated care boards.”

With this it will be convenient to discuss the following:

Amendment 2, in clause 33, page 40, line 6, leave out

“at least once every five years”

and insert “annually”.

Amendment 40, in clause 33, page 40, line 7, leave out “the health service” and insert “health and social care services”.

Amendment 41, in clause 33, page 40, line 11, at end insert—

“(3) Health Education England must publish a report each year on projected workforce shortages and future staffing requirements for health and social care services in the following five, ten and twenty years.

(4) The report must report projections of both headcount and full-time equivalent for the total health and care workforce in England and for each region, covering all regulated professions and including those working for voluntary and private providers of health and social care as well as the NHS.

(5) All relevant NHS bodies, arm’s-length bodies, expert bodies, trade unions and the National Partnership forum must be consulted in the preparation of the report.

(6) The assumptions underpinning the projections must be published at the same time as the report and must meet the relevant standards set out in the National Statistics Authority’s Code of Practice for Statistics.

(7) The Secretary of State must update Parliament each year on the Government’s strategy to deliver and fund the long-term workforce projections.”

Amendment 42, in clause 33, page 40, line 11, at end insert—

“(3) The annual report must include an assessment by the Secretary of State of safe staffing levels in the health service in England and whether those levels are being met.”

I wanted to speak to amendment 94, which is the product of a revision on my part. I initially tabled an amendment to clause 33, but it was as a result of the oral evidence sessions when the clause was discussed at length by a number of organisations that I decided to re-table amendments with further detail.

Clause 33 is one of the shortest clauses in this substantial Bill, but it is one of the most important. When it comes to looking at how we plan the NHS workforce for the next five years as the clause suggests, or the next 10 or 20 years, we face significant demographic changes in the United Kingdom. We have an aging population with sadly more co-morbidities and chronic conditions, such as diabetes, than ever before, which puts increasing pressure on not only the health service, but the health and care service. That is the omission. The clause has no mention of the care service, which needs to be dealt with.

The clause is rather perfunctory. At the moment, the duty on the Secretary of State is to,

“once every five years, publish a report describing”

—not necessarily detailing or taking any action—

“the system in place for assessing and meeting the workforce needs of the health service in England”

—not the care service.

Secondly, the report would be prepared by NHS England and Health Education England alone, not mentioning any of the other wider workforce organisations. They would,

“assist in the preparation of the report”

but only,

“if requested to do so by the Secretary of State.”

The Secretary of State holds all the cards about how the report is published and what type of data is used.

Amendment 94 sets out that we should have a report every two years. The first amendment I put down actually wanted an annual report. I know there are some amendments on annual reports, but it was very clear from organisations, such as NHS Confederation and NHS Providers, that they saw an annual report as being too bureaucratic. They would have to start the next report having just finished the previous one, hence I withdrew the amendment. In that spirit of the Committee, it is important that Back-Bench Members listen and change our amendments where possible.

I am calling for:

“an independently verified assessment, compliant with the National Statistics Authority’s Code of Practice for Statistics, of future health, social care and public health workforce numbers—

about which we have had big discussions—

“based on the projected health and care needs of the population for the following five, ten and 20 years”.

We can have that report published every five years, or every two years, as I have suggested.

If the report were simply a sampling mechanism to look into where the workforce is now, it would miss an opportunity to look at demographics and at where we will need to be to increase workforce numbers. We need to ensure that we have the training investment in place for medical schools. Medical training for doctors takes a minimum of seven years, and for nursing it takes at least four years. Those time lags need to be taken into account.

A frustration of our constituents is that our health service spends a significant amount of money not only on agency staff, who are disproportionately expensive, as we all know, but on bringing in individuals from abroad. There is nothing wrong with that, but those training places could go to people who have grown up in this country and have ambitions to become a doctor or nurse, but who have been unable to achieve that because there were no medical places.

One of the greatest anomalies in our healthcare service is the restriction on places for those entering university at 18, 19 and 20, even though demand is not met by current training places. We are spending twice because talented individuals leave school unable to fulfil their dreams of going into the health service as we do not have the places for them, and we then have to bring in nurses from south India. I have nothing against that—they are fantastic people—but it is also detrimental to the south Indian health service, because it could be training those people to help their local population.

We have to address that disjointedness. It is not fair on other countries that the NHS sucks in their talent, which should be used in their countries. At the same time, we are wasting talent. This Government are about levelling up, and we cannot level up in any greater way than by ensuring that those who want to serve their local healthcare populations in towns and cities such as Sheffield, Leeds or Doncaster can do so by going to their local universities and staying in their areas.

The right hon. Gentleman is making some excellent points. He and I share a health economy, two universities and a thriving region, but we still have problems. People in my constituency cannot get the sorts of jobs and apprenticeships that they need. How would his amendment deal with the geographical discrepancies across the country through a single two-year report, and how would we account for the different training demands in different parts of the country?

I think there is a subsection here about how clause 33 relates to clause 19 and the duties on ICBs as the placemaking organisations that can provide the training opportunities for the future. I also think there are great opportunities in the Department for Levelling Up, Housing and Communities for potential further devolution of the skills budget through a mayoral system. That skills budget will already be devolved in some of the metro Mayor areas, so I hope that it will also be devolved across wider areas that do not necessarily have a city population. The Government are clearly looking to fill that gap. Those are also the skill needs of the healthcare population, which is why, when it comes to the duties for the ICBs, I am keen that they take on board the wider non-healthcare resident population, whether in universities, colleges or elsewhere, to bring in expertise on creating training pathways for the future.

Without going off-piste, I think there are future opportunities for more flexible qualifications. We have the lifelong learning allowance. We are looking at how to allow individuals to retrain for the future, creating apprenticeship opportunities, in-work opportunities and course-based opportunities. This is not just about providing nurses and doctors; it is also about allowing nurses to move up the scales and retrain when they are in the NHS, which would help to lower the attrition rate.

Retention is one of the greatest challenges we have—it is not only about training—and I am sure that the intention of clause 33 is also to get to grips with retaining the 20% of the workforce who leave over a five-year cycle. It would do so much better if it took into account statistics consistent with the Office for Budget Responsibility’s long-term fiscal projections and if we were able to look at the needs of the population. That is what subsection 2(b) of my amendment suggests—looking at workforce numbers

“based on the projected health and care needs of the population”

as well as the demographic numbers of the workforce.

I will speak to amendment 94 and the other amendments in my name and the names of my hon. Friends, since they are grouped together and we are clearly all talking about the same thing. There is probably only a cigarette paper between many elements of these amendments and, I hope, the Minister’s position when we get to the end of the debate.

One reason why there are so many amendments and they are all fairly similar is that it was clear from the evidence sessions that this is one of the few areas on which there was complete agreement among the witnesses. Clause 33 is simply nowhere near good enough. Given the importance of workforce issues, which is the most crucial issue facing our NHS and social care system—as the right hon. Member for Kingswood mentioned, social care must be included within this—it is strange that we have really quite a tepid offering in the Bill.

It feels as though the whole question of workforce is firmly in the Department’s “too difficult” box. It knows it has to do something; it knows that without the tremendous efforts of the staff the NHS would simply collapse, but rather than coming up with an effective strategy, it has produced this fig leaf of a clause to create the impression that the issue is being taken seriously and dealt with.

It is now in my inbox.

It is now in the Minister’s inbox, and he will know that what is currently in the Bill does not cut it in terms of the challenges we face. As I often do, I place on record our thanks and admiration for the whole NHS workforce, for turning from theory into reality an organisation that demonstrates the benefits of collectivism and socialism and is one of the nation’s proudest achievements—I certainly expect the Minister to agree with the latter part of that sentiment, if not the former.

I have said this many times before, and I will say it again: without its workforce, the NHS is nothing. It is not only the doctors and nurses, but all the others who contribute to the delivery of a comprehensive and universal service, free at the point of use: the radiographers, the porters, the cleaners and the allied health professionals. I will not list them all, but we should acknowledge that a number of different people contribute towards even the most straightforward engagement with a patient, and we are grateful for each and every one of them and the service they give.

I briefly refer hon. Members to the report by the Health and Social Care Committee on workforce burnout and resilience. It conducted an inquiry into the issue and found that staff shortages were

“ultimately the biggest driver of burnout.”

It was presented with much evidence from staff about feelings of low energy or exhaustion, increased mental distance from or negative feelings about the job, and reduced professional effectiveness. Excessive workload was identified as the key predictor of staff stress, workers’ intention to quit and patient dissatisfaction, and was also highly associated with the level of errors.

I draw this Committee’s attention to some of the conclusions in the report. Paragraph 22 states:

“It is clear from our witnesses that although the People Plan presents comprehensive ambition to address the failings in the culture of the NHS, and address the needs and wellbeing of NHS staff, its delivery will depend on the level of resourcing allocated to these priorities. Without adequate funding the laudable aspirations of the People Plan will not become reality.”

In paragraph 27, the Committees goes on to state that

“we strongly believe the Government should publish a 10 year plan for the social care sector as it has done for the NHS. The two systems are increasingly linked and it makes no sense to put in place long term plans for one without the other. Failure to do so is also likely to inhibit reform and lead to higher costs as workforce shortages become more pronounced with higher dependency on agency staff. Reducing the 30% turnover rates typical in the sector will also require a long term, strategic approach to social care pay and conditions.”

Again, that is absolutely on point about what needs to be done. I hope that the Minister, when he responds, will be able to explain why the social care workforce is absent from the Bill as drafted, given the clear and urgent need set out by the Select Committee for a comprehensive workforce plan.

The Committee said in its conclusions:

“The emergency that workforce burnout has become will not be solved without a total overhaul of the way the NHS does workforce planning. After the pandemic, which revealed so many critical staff shortages, the least we can do for staff is to show there is a long term solution to those shortages, ultimately the biggest driver of burnout. We may not be able to solve the issues around burnout overnight but we can at least give staff confidence that a long term solution is in place...The way that the NHS does workforce planning is at best opaque and at worst responsible for the unacceptable pressure on the current workforce which existed even before the pandemic…It is clear that workforce planning has been led by the funding envelope available to health and social care rather than by demand and the capacity required to service that demand. Furthermore, there is no accurate, public projection of what health and social care require in the workforce for the next five to ten years in each specialism. Without that level of detail, the shortages in the health and care workforce will endure, to the detriment of both the service provision and the staff who currently work in the sector. Annual, independent workforce projections would provide the NHS, social care and Government with the clarity required for long-term workforce planning.”

Finally, in paragraphs 32 and 33, the Committee states:

“We recommend again, that Health Education England publish objective, transparent and independently-audited annual reports on workforce projections that cover the next five, ten and twenty years including an assessment of whether sufficient numbers are being trained”.

That appears in the first part of our amendment 41. The Committee went on:

“We further recommend that such workforce projections cover social care as well as the NHS given the close links between the two systems…We further recommend that those projections:

Are informed by the future shape of services and anticipated demand.

Take into account the labour market as a whole.

Make clear the opportunity cost of not training, employing and retaining sufficient numbers of staff.”

That all seems pretty clear to me. Our intention is that our amendments 40 and 41, taken together, encapsulate the spirit and detail of the Select Committee report. In preparation for this debate, I looked for the Government response to the report, but on the website all I could see was “Response overdue”, and indeed it is—by about a decade. The Minister has just taken over responsibility for the workforce, so I am sure that he is looking forward to preparing that response. We will look forward to receiving it as well.

We note, as we have heard, that there is near unanimity among stakeholders on the issue. Unison, which knows quite a bit about workforce planning—the right hon. Member for Kingswood mentioned the important role of trade unions here, which is something the Opposition echo—states:

“Clause 33 adds a new duty for the Secretary of State to report on the workforce needs of the health service every five years. UNISON agrees with the recommendation of the Health and Social Care Committee that, in order for this to have any real impact on workforce planning, the duty should be considerably strengthened by requiring the publication of independent annual reports on workforce shortages and future staffing requirements, covering social care as well as the NHS. UNISON therefore supports amendments to make such workforce reporting an annual requirement.”

A joint letter from many leading think-tanks and organisations, including NHS Providers and the NHS Confederation, made it clear how urgent the task was. They recommended that

“Health Education England must publish annual, independently verified, projections of the future supply of the health care workforce in England and how those projections compare to projected demand for healthcare workforce in England for a 15 year period consistent with the long-term projections of health care spending produced by the Office for Budget Responsibility (OBR). The Secretary of State for Health and Social Care must ensure that annual independently verified projections of the future supply of social care workforce in England are published, setting out how those projections compare to projected demand for social care workforce in England for a 15 year period, consistent with the long-term projections of adult social care spending produced by the OBR”.

I will quote from a few other witnesses that the Committee heard from, because they obviously had some pretty important things to say as well. Danny Mortimer of NHS Employers said:

“the Bill can go further under the terms of clause 33…Absolutely we should support people and absolutely we should care for them, but if there are gaps in their rotas and in their teams that only increases the pressure on people who are already working flat-out. The pandemic has shown us starkly where those gaps and needs are, but we were experiencing them before the pandemic. There are parts of our workforce—mental health, learning disability nursing and some of our smaller allied health professions, such as therapeutic radiography—that absolutely need urgent long-term investment. We need that investment in staff as well as in the pressing need that we saw covered in social care settings and in hospitals during the pandemic. The requirement for a regular assessment of what the health and social care system requires to meet the needs of the population would help us to support that.”––[Official Report, Health and Care Bill Public Bill Committee, Tuesday 7 September 2021; c. 14, Q9.]

Matthew Taylor of the NHS Confederation told us during the evidence sessions:

“In a world where work is evolving very quickly and population needs are evolving, five years is simply far too long. If it were one year, we would be happy.”

Well, we would like to make him happy with our amendment. He continued:

“We have fastened on to two years. That would be the minimum that we would want as a gap between assessments of workforce need.”

If we think back to what the world looked like two years ago, it now looks very different. There were of course reasons for that, but it shows that a two-year gap is possibly a little too long. That is why we went for annual reports in our amendment, as per the Select Committee recommendations. Saffron Cordery of NHS Providers said in answer to the same question:

“Anything that starts to move towards a collective perspective on workforce needs and workforce planning will be absolutely critical.”––[Official Report, Health and Care Bill Public Bill Committee, Tuesday 7 September 2021; c. 47, Q59.]

Professor Helen Stokes-Lampard of the Academy of Medical Royal Colleges said

“the workforce, in clause 33 particularly, is the one area where we probably still have the greatest concern. We feel that it needs to go further.”

Pat Cullen of the Royal College of Nursing said in answer to the same question:

“We are asking for the Secretary of State for Health and Social Care to not only clearly have full accountability and responsibility for the assessment of workforce planning, but ensure accountability for the delivery of the workforce. It is not just about the assessment. We are all clear about and know about—it has been played out well—the shortages of nursing staff. We had 40,000 vacancies heading into the pandemic. We make up 26% of the workforce. Everywhere you see a patient, you see a nurse, and we need nurses. That is the only way to provide the best care for our patients. We say that the legislator at the highest level must have that accountability and responsibility for the assessment and the delivery of the workforce shortages in nursing.”––[Official Report, Health and Care Bill Public Bill Committee, Thursday 9 September 2021; c. 100, Q138.]

The Committee will be relieved to know that I will not go through every witness who gave evidence. I am more than happy to do so if Members wish, but I think I have probably made the point. I will refer to one final witness, Martin Marshall of the Royal College of General Practitioners, who said:

“Without an adequate workforce, it will be very difficult to deliver any of the ambitions of the Bill, so we are absolutely in favour of a much stronger emphasis on workforce. I think workforce planning is an oxymoron and has been for many years in the NHS. This is an opportunity to do something about it.”––[Official Report, Health and Care Bill Public Bill Committee, Thursday 9 September 2021; c. 101, Q138.]

That is the nub of it. If not now, when? When will the Government finally accept the obvious that has been staring them in the face for many years?

No doubt in his response the Minister will tell us that in July Health Education England was commissioned to work with partners and review long-term strategic trends—he is just scribbling out that bit—for the health and social care workforce, and that for the first time ever the framework will also include regulated professionals working in social care, such as nurses and occupational therapists. The Minister will no doubt tell us that that work will look at the key drivers of workforce demand and supply over the longer term and will set out how they may impact on the required shape of the future workforce to help identify the main strategic choices. That is all welcome, and it is a start, but the many quotations I have cited today demonstrate that it is nowhere near enough.

As we have demonstrated, what is clearly needed, and what we believe can be delivered by these assessments, is a system that has the following basic components. First, the responsibility has to be with the Secretary of State, and Parliament must be updated on the gaps and the plans to fill them annually, as set out in amendment 41(7). The Secretary of State must not only present the report but set out how any workforce gaps will be addressed over the period. That means that it must not be another box-ticking exercise just setting out what the demand will be. It must be backed up with a credible, sustainable plan.

Secondly, as set out in subsection (3), the information produced has to cover requirements and projected requirements over five, 10 and 20 years, as per the Select Committee recommendations. Thirdly, the assumptions behind the projections must be set out and justified by evidence meeting the relevant standards in the UK Statistics Authority’s code of practice. That is detailed in subsection (6), and is important, because we believe there has to be an accurate measure of the current workforce, and one definitive way of counting that.

Fourthly, the gap analysis has to be sufficiently detailed, not only on jobs but on skills. Fifthly, any report must reflect the factual background, and the views and experience of the workforce itself. The wider system needs to be consulted, and the report must especially cover their views on the reasons for shortages. It must cover all of healthcare and social care—it goes without saying that it needs to be far more than just doctors and nurses.

Publishing a report is a good start, but it is not the end point. It is a method to compel the Secretary of State to take action, but that in itself is not a substitute for actual action. Any plan needs credibility, and that comes not only from an independently verifiable source but from a realistic and costed plan of action that has proof of delivery. Those are the essential ingredients for a proper workforce strategy to be a success, not a piece of paper that is waved about every five years or a lengthy tome that gathers dust on a shelf.

I have one last quotation from the King’s Fund for context:

“The staff working in the NHS are its greatest asset and are key to delivering high-quality care. This has been exemplified more than ever throughout the Covid-19 pandemic with staff demonstrating remarkable resilience and commitment. However, a prolonged funding squeeze combined with years of poor workforce planning, weak policy and fragmented responsibilities have resulted in a workforce crisis. Despite this, there has been no national NHS workforce strategy since 2003…The size and complexity of the workforce challenge is such that addressing it will require concerted and sustained action across the system on workforce planning, pay, training, retention and job roles. Yet, the response so far has been piecemeal and accountability for improving the situation remains unclear.”

I hope our amendments will put that right, and I urge the Minister to take the opportunity that we have presented.

I entirely concur with the comments of my hon. Friend, who asked: if not now, when? The right hon. Member for Kingswood described this as a short clause, but one that is hugely important. I do not want to quote everyone who has given us evidence, but we all agree that this is a major issue for the service and has been for a number of years. It is the major omission from this Bill, which has had all sorts of other things added to it but does not look at this issue seriously. This is a massive missed opportunity, unless the Minister takes on board some of what has been said today and supports some of these amendments, to indicate to the service, post pandemic, that this message has been heard loud and clear. The Secretary of State seems to want to take on a lot of responsibilities, and this is something quite significant that he could do something about. He could give that indication.

As I said to the right hon. Member for Kingswood earlier, we have to recognise the differences between health economies and parts of the country. Fairly recently, the Government expanded medical training places in parts of the country where there is a low take-up, and to which people are not moving to work. We know that if we train people locally, they stay local and if the Government would like a quick and easy way to level up—however they want to define it—that is it.

In my constituency, I have tried to focus, while hitting barriers all the time, on getting the army, particularly of women, in Bristol South who are working in the care and health sector, but at very low levels and who are desperate for themselves and their families, to earn more, provide more care and rise up the skills ladder. That is entirely possible in lots of those professions, but people are stopped in various ways on the way, either because they do not have the basic entry skills or because they have not been able to pick up those skills as they go along. That is why I chaired the all-party parliamentary group on apprenticeships and why I have tried to work with and meet Health Education England and local providers regularly to ask what the real barrier is between the Department for Education and the Department of Health and Social Care around pulling the training together and recognising that in our communities there are people—mainly women—ready to do the work and bring more income into those local communities.

The barriers exist locally, they exist between the Departments and they exist in how hospitals are funded. Getting to grips with that would make a massive difference to so many. It is barn-door obvious. It was a major problem before the pandemic, and the shortage in mental health and particularly in learning disabilities—something we rarely talk about—is scandalous. Incentives need to be put in place to try and encourage more people into those very rewarding professions. The fact that financially they are not so rewarding should shame us all.

I ask the Minister, if not now, when? It is a gap in the Bill. There is plenty of work and expertise out there and it would make such a difference to our local communities if we could reward those people who worked throughout the pandemic by giving them an optimistic future in which they can rise up the skills ladder, earn more and support the health needs that we know are going to be so desperate in the coming months and years.

I am grateful to all the hon. Members for tabling the amendments. They relate to increasing the Government’s accountability for assessing workforce planning and setting workforce projections. Before I turn to their substance, as the hon. Member for Ellesmere Port and Neston suspected, I entirely agree with the latter half of his sentiment about the achievement that is the NHS. I am not sure I would necessarily attribute that to unbridled socialism, which tends to fail where it is tried. However, as Opposition Members will know and as set out well in the book written about Nye Bevan by their right hon. Friend the Member for Torfaen (Nick Thomas-Symonds), which I re-read over the weekend, the genesis of the NHS was a complex one, which owed much to all parties in the House.

I am glad the Minister has time to be reading such excellent tomes over the weekend. Can he remind us what the Conservative party did when voting on the original National Health Service Act 1946?

Could the hon. Gentleman remind me what the Labour party did when in government, resulting in the resignation of the architect of the NHS?

The point I make is a serious one. The genesis of the NHS which, quite rightly, we are all proud of and recognise as a great achievement, is far from as simple as sometimes it might be portrayed by both parties in the House. The hon. Gentleman is right to highlight the fact that while the new hospitals we are building, the developments in drugs and therapeutics, and the new technology and new kit are all hugely important, they are limbs of the NHS. Its beating heart is its workforce and he is right to highlight that. I join with him, as I often do on these occasions, in paying tribute to all those who make up that beating heart.

Continuing to grow the workforce remains a top priority for the Government. Although I may disappoint some hon. Members, I am genuinely grateful to those who tabled amendments and spoke to them today, because this is a crucial debate, and I suspect the matter will continue to be raised, not just during the passage of the Bill but, rightly, more broadly. As ever, I am grateful to my right hon. Friend the Member for Kingswood, who brings a high degree of expertise to this subject, as the only hon. Member or right hon. Member to have occupied both the office that I now occupy and that of Minister of State for Universities, Science, Research and Innovation. He brings to the Bill the perspective he has gained from both those offices.

When I got this job back in September 2019, which seems like an age ago, I was responsible for workforce for a few months, until that responsibility was taken on by my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) at the beginning of 2020. One of my first visits was to the University of Lincoln, which had just opened its medical school. That medical school had been campaigned for very hard by my hon. Friend the Member for Lincoln (Karl MᶜCartney), who was out of office at the time, and by the then Opposition Member for Lincoln.

I certainly did not intend to upbraid him for not responding, given that he took over responsibility only yesterday. He will be aware of the importance of the report and of an official response.

I am, of course, and I reassure the hon. Gentleman that prior to the reshuffle I was looking at a number of issues related to the recovery of our workforce. A fit, healthy and supportive workforce is crucial to that. I have read and considered the report, and, with my new responsibility, I will endeavour as swiftly as I can to ensure that the Government respond as appropriate to the Committee, and to Committee reports more broadly, in a timely fashion.

We believe that the proposed duty in clause 33, which inserts proposed new section 1GA into the National Health Service Act 2006 in order to require the Secretary of State to produce a workforce accountability report at least every five years, addresses one of the main issues in the current system: the need for greater transparency and accountability for the various bodies involved in the workforce planning process in England. The proposal in the Bill is to ensure that there are proper structures and accountability for ensuring that the necessary workplace planning and projections are carried out and co-ordinated effectively by the various bodies in the system. For example, the report will set out the role and responsibilities of the new ICBs and how they will support the delivery of effective local and national workplace planning.

Draft guidance issued by NHS England, which covers the role of ICBs regarding the workforce, sets out the direction of travel in that regard. It sets out the ICBs’ responsibility to develop system-wide plans to address current and future workforce supply for the local area, with demand and supply planning based on population health needs. The guidance also refers to their responsibility to provide workforce data to regional and national workforce teams in order to support aggregated workforce planning and to inform prioritisation of workforce initiatives and investment decisions.

I fear that my remarks may be a little more lengthy than usual, but I think that that reflects the importance and breadth of this issue. Turning to the other amendments in the group, amendment 2 would require the Secretary of State to publish the report on assessing and meeting the workforce need annually, rather than at a minimum of every five years. I acknowledge the witnesses’ comments, which the shadow Minister has rightly highlighted, but we need to be a little cautious. We cannot predict all future evolution and needs, which is why we have mandated the report to be published at a minimum of every five years. That flexibility allows us to provide an updated report in order to reflect any changes to roles and responsibilities earlier than the statutory required period, if necessary, but requiring an annual report would impose an unnecessarily prescriptive and, I fear, rigid arrangement on the production of this document and would be disproportionate to the level of change in roles and responsibilities that we expect to see in the system on an annual basis. I therefore suspect that it is a matter for debate as to what the most appropriate timescale is—we have therefore set a minimum period, rather than a maximum period.

I will not tempt the Minister to tell us what will be in that, but his confidence that it will be an improvement on the current position is noted. Does he anticipate that the White Paper will also include a very clear commitment to a workforce strategy, along the lines that we have discussed?

I do not know whether the shadow Minister has seen what I was about to say, but after two years of doing this together, he has become relatively psychic. I anticipate that the White Paper will set out in detail how we propose to fund social care professionalisation, as well as initiatives or plans to improve workforce wellbeing and further reforms to improve social care recruitment and support.

Turning to the question of workforce projections, amendment 41 would create an additional duty on Health Education England to publish a separate report on long-term workforce projections for the NHS and social care. The provision would also place a duty on HEE to consider a number of different bodies in the preparation of such a report, and it contains a requirement that the Secretary of State provides an update to Parliament annually. Amendment 94 would amend the proposed duty on the Secretary of State to prepare and publish a workforce accountabilities report in several ways, including by requiring the report to be published every two years, to cover the social care and public health workforce and to include an independently verified assessment of workforce numbers, and by imposing a statutory duty to consult a number of bodies.

Earlier in our debate, I set out why we cannot support amendments that mandate an increased frequency for the plan and the inclusion of the wider social care workforce, but I wish to focus on a plan setting out workforce projections. The duty to create a report as set out in the amendments is unnecessary. Regarding amendment 94, I have concerns about involving another body in workforce planning for two reasons. First, an independent body would be distant from day-to-day planning decisions in the NHS and the needs of service delivery. Secondly, it would risk duplicating HEE’s statutory responsibility for workforce planning, which it discharges in collaboration with NHS England.

I do not believe that the report in amendment 41 about enhanced or additional duties on HEE would assist us fully in meeting the workforce demands of the system. What is needed is greater transparency and accountability for the various bodies involved in workforce planning, along with concerted non-legislative action, which is already under way.

I reassure the Committee that we are already investing resources in England into taking a longer-term look at workforce issues that are within the scope of the amendment. That is where I turn—the shadow Minister has mentioned this, so I will not repeat it—to the commission to HEE back in July. He was right to allude to that, because I believe it is, or has the potential to be, a significant step forward. I will be taking a close interest in that as I assume the additional responsibilities in my portfolio.

HEE’s “Framework 15” will help to ensure that we have the right numbers, skills, values and behaviours to deliver world-leading clinical services and continued high standards of patient care. For the first time ever, the framework will include registered professionals working in social care, such as nurses and occupational therapists, as I have mentioned. That will require close working with partners and stakeholders from all levels and sectors, so that we can build a shared set of assumptions and common goals to provide that clear shared framework within which more detailed workforce plans can be developed and delivered nationally and locally, resulting in better care and better work for all.

I know it is not the done thing for Whips to contribute to debates, but because I have been a care worker, this part of the Bill is close to home for me. I wanted to touch on the word that the Minister used when he spoke about “assumptions” about workforce planning. Does he agree that actual independence takes away the need for Ministers to make assumptions, and that is why the amendment is important? Otherwise, Ministers are in danger of marking their own homework when it comes to whether they have met the workforce projections that they say they have met.

The hon. Lady alludes to it not being normal form for a Whip to intervene, but her contribution is, as ever, extremely valuable in this context—particularly given the work that she did before she became a Member of this House—and I am grateful to her. My counterpoint would be that we need to be cautious about a separation of projections and planning from the reality of day-to-day delivery. The system, as envisaged, will bring together an actual knowledge of what is going on on the ground with those projections and data delivery.

I suspect that I will not convince the hon. Lady, but I recognise and acknowledge the expertise that she brings to the area. Back in my days as a councillor, I was a cabinet member for adult social care and saw at first hand the amazing work done by care professionals and by volunteers in the care sector. Notwithstanding any political disagreements we might have, I pay tribute to her for that.

Finally, regarding the consultation requirements in amendments 94 and 41, I assure the Committee that consultation already happens throughout the workforce planning and delivery process. To give a recent example of such engagement, HEE completed a call for evidence as part of its refreshed “Framework 15”. That call for evidence closed on 6 September and received responses from a wide variety of bodies. Between October and April of next year, engagement and consultation will continue through various events led by HEE. I am sure that as I assume my new responsibilities, I will occasionally be questioned on those by the shadow Minister, either across the Dispatch Box or in written questions and letters, as is his wont and, indeed, his right.

At local level, ICBs will be under various workforce-related responsibilities and obligations, as I have set out. As part of that work, we can expect ICBs to work with local stakeholders in their area. We expect all this stakeholder consultation to continue, but we want engagement to be flexible, in keeping with one of the principles—the permissive principle—behind the Bill.

I thank the Minister not only for his kind words to me personally, but for his considered response to this set of amendments. It is clear that he is mulling over this, and I would like to give him time to think about potential opportunities for changing the clause. I know how these things work; I have sat in the very same seat that he is sitting in. I know he has to spin off various pieces of paper that have been provided to him by departmental officials. The officials who are sitting here have listened to this debate and will want to go back to the Department to discuss with their colleagues what has been mentioned in Committee today.

There is a gap between the sector’s expectations of what workforce planning might look like and what is currently written in the Bill. The Minister has proven my amendment to be defective. It is already highlighted in the legislative remits of Health Education England that it has to consult the social care sector and also the wider sector. I will not press the amendment to a vote, but I do think there is an opportunity. If we can plan in advance and create systemic frameworks, we will save ourselves time—a stitch in time saves nine. We have an opportunity to provide certainty and security for the workforce and to provide a sustainable framework, although I am not sure whether the five years is sustainable.

As I have mentioned before, I was here 10 years ago on the Committee for the Health and Social Care Bill, which became the Health and Social Care Act 2012. We are now removing parts of that, and the Minister at the time, in the very same seat, argued until he was blue in the face that there would be a benefit. We can learn from that experience, but the lived experience of professionals suggests we need to be more frequent in our assessment of the workforce needs of the NHS and the care sector.

We know that the demographic train that is coming down the tracks is going to hit us. We have seen what has happened with gas supply prices and the energy sector; we knew nine years ago that we had only about four days’ gas supply, and yet no action was taken. If we transpose that over here, we know that we face workforce issues, if not a crisis, in the next 10 years. That will all come down the tracks in a perfect storm of increasing healthcare issues, an ageing population and an attrition rate in a workforce that cannot currently keep up with demand.

Is everyone content that amendment 94 be withdrawn?

I would just like to say a few words about amendments 40 to 42, if that is acceptable, Mrs Murray. We wish to press amendments 40 and 41 to a vote, with your permission. It is clear from the evidence that there is a demand for something to be done. It is interlinked with patient safety and cannot be ignored. Our main concern is: if we do not do this now, when will we?

Amendment proposed: 40, in clause 33, page 40, line 7, leave out ‘the health service’ and insert ‘health and social care services’—(Justin Madders.)

10|0|5|9|The Committee divided:|Question accordingly negatived.||0|0

Amendment proposed: 41, in clause 33, page 40, line 11, at end insert—

‘(3) Health Education England must publish a report each year on projected workforce shortages and future staffing requirements for health and social care services in the following five, ten and twenty years.

(4) The report must report projections of both headcount and full-time equivalent for the total health and care workforce in England and for each region, covering all regulated professions and including those working for voluntary and private providers of health and social care as well as the NHS.

(5) All relevant NHS bodies, arm’s-length bodies, expert bodies, trade unions and the National Partnership forum must be consulted in the preparation of the report.

(6) The assumptions underpinning the projections must be published at the same time as the report and must meet the relevant standards set out in the National Statistics Authority’s Code of Practice for Statistics.

(7) The Secretary of State must update Parliament each year on the Government’s strategy to deliver and fund the long-term workforce projections.’—(Justin Madders.)

Question put, That the amendment be made.

11|0|5|9|The Committee divided:|Question accordingly negatived.||0|0

I beg to move amendment 85, in clause 33, page 40, line 11, at end insert—

‘(3) The Secretary of State must consult the Welsh Ministers before the functions in this section are exercised.”

I will be brief, given that much of what I would otherwise have said has been covered in the debate on the previous group of amendments. I will just say to those on the Front Benches, in their discussion of the genesis of the NHS, that success has many parents. Aneurin Bevan of Tredegar was the father of the NHS, based on his experience of the provision of health in that area, but it was also based on the foundation that was set up by my predecessor but three as Member for Caernarfon, David Lloyd George.

Having got that out of way, the amendment would place a duty to consult the Welsh Government on workforce assessments. Although the amendment is a probing one, I am concerned that the devolution settlement remains somewhat complicated and sometimes unclear, even in its current iteration. As a piece of history and a reference to how that settlement can cloud matters, I will mention a question I asked a former Labour Secretary of State for Health, Mr Alan Milburn, some years ago about nurses’ pay. His response, which I committed to my memory, was “It is one of the abiding joys of my life that I have no responsibility for things Welsh.” Unfortunately for both Wales and him, he actually had responsibility for nurses’ pay at that time. Even Secretaries of State are not perfect, let alone Ministers of State and others. That situation has now been resolved.

The danger is always that the remaining integration of parts of the Welsh health service and health service in England might be overlooked. I referred to that earlier in respect of services and people from Wales—and people from England, for that matter—accessing health services on the other side of the border. People in north Wales specifically will recognise the names of individual hospitals in England. I refer briefly to Alder Hey on the Wirral, which provides services to children with severe conditions. There is the Royal Liverpool; the Christie in Manchester, which provides specialist cancer treatment; and the hospital in Gobowen, which has for a long time provided orthopaedic services. Recently, severe casualties and people who have suffered road traffic accidents have been helicoptered to Stoke for specialist treatment. As I said the other day, around 13,500 Welsh people access GP services in England, and 21,000 or so people from England access GP services in Wales. Those are the 2019 figures.

It is a pleasure to serve with you in the Chair once again, Mrs Murray, and to follow the thoughtful contribution by the hon. Member for Arfon.

The hon. Gentleman’s points about interdependency are important. Of course, we cherish and build on the devolved settlement, but we understand that we still have important relationships, not least at our borders. I thought that his point about specialised care was a thoughtful one, too: we know that as conditions or treatments become complex, there will be specialisations, and we would never want artificial barriers to get in the way of people accessing specialised care. His point about training was also good and jumped out to me.

Yesterday, I spoke to a surgeon in my community who took great pride in working in the hospital where he was born. In between, he had gone away; I am told that there are parts of the world other than Nottingham—I dispute that fact—and he wanted to go and see some of them. That will inevitably involve crossing borders, and it is important that that is reflected in the Bill. That will happen from nation to nation, but in the future it will happen from integrated care system to integrated care system. Where there is divergence, we need to be thoughtful of it.

The statement of values relating to cross-border care said:

“no treatment will be refused or delayed due to uncertainty or ambiguity as to which body is responsible for funding an individual’s healthcare provision.”

That is an important principle because it sets out that it is the job of the system rather than the individual to understand and navigate the separation between different bodies that may diverge but which work together in common purpose. That is easy to say, but hard to do at times. As I say, that is something that we will see between integrated care systems in time, too. That is true for patients, but also for staff, whether those staff work in Wales but live in England or vice versa, and for the important interrelationships between border integrated care systems on the Welsh border and the NHS in Wales.

I am grateful to the hon. Member for Arfon. Although I represent an east midlands constituency, in sunny Leicestershire—the hon. Member for Nottingham North would argue that Nottinghamshire is sunnier—I have a huge affection for Wales. In every speech he gives, the hon. Member for Arfon brings to the fore his pride in Wales and his constituency. In the vein of highlighting successful politicians representing Welsh constituencies, I take this opportunity to put on the record a tribute to my former Parliamentary Private Secretary, my hon. Friend the Member for Ynys Môn, who has become the PPS to the Secretary of State for Wales. I congratulate her on that appointment. It is well deserved; she has looked after me very well during her time in this House. I am grateful to her and put my congratulations to her on the record.

I am grateful to the hon. Gentleman for bringing the amendment before the Committee. It would require the Secretary of State to consult Welsh Ministers before the functions contained in clause 33 were exercised. Clause 33 would insert proposed new section 1GA into the National Health Service Act 2006, which, as we have just debated, would require the Secretary of State to publish, at least once every five years, a report describing the system in place for assessing and meeting workforce needs of the health service in England.

The shadow Minister, the hon. Member for Nottingham North, alluded to a point regularly made to me by my hon. Friend the Member for Vale of Clwyd. Although politicians and people in this House might see neat administrative boundaries drawn on a map, the reality is often much more complex. Certainly, those boundaries should not be seen in their everyday lives by constituents and others, who on occasions rightly need to exercise their right to access specialist services in England; I dare say there will be occasions where the counterpoint is true, and people living on the English side of the border may access health services on the Welsh side. We need to recognise that and work pragmatically with that reality.

The report will set out how the workforce planning system is set up in England to assess and meet the workforce needs of the health service in England. As a result, the various bodies with responsibilities for workforce planning that will be discussed in the report all have England-only remits, given that health is a devolved matter. Most notably, they will include HEE and NHS England, both of which are explicitly referred to in proposed new subsection 1GA(2).

Equally, the clause does not restrict in any way the powers of the devolved Administrations in relation to their health workforces; it is England-only in its intent and application. A duty to consult might, I fear, make that a rather more fuzzy definition or arrangement. What I can do is reassure the hon. Gentleman that the Department, at an official level as well as through our arm’s-length bodies, such as HEE, already works closely with the other home nations on workforce and education matters. That work will continue.

I hope I can reassure the shadow Minister: as I have previously stated in this Committee, although I may not always agree with Baroness Morgan, the Welsh Health Minister, about everything, I would like to think that I have a positive and constructive relationship with her. We spoke just last week and are due to speak again next week. We tend to spend a fair amount of time in one another’s company, if only remotely, discussing matters relevant to both England and Wales—and seeking, where we can, to find a pragmatic, common-sense way forward. Thus far she has been extremely constructive when engaging with me, and I hope that she feels the same in return.

For those reasons, I gently encourage the hon. Member for Arfon to consider not pressing his amendment to a Division.

I am not entirely reassured by the Minister’s words; possibly the best response is, “We shall see”.

I make one further point, if I may, in reference to his former Parliamentary Private Secretary: people from Ynys Môn are known in Welsh as people from “Gwlad y Medra”, which translates as “the land of I can do it”. Clearly, she can do health, and we look forward to seeing her performance at the Wales Office as well. I add my congratulations to her. I beg to ask leave to withdraw the amendment.

Question proposed, That the clause stand part of the Bill.

Can I clarify, Mrs Murray, that we have a hard finish at 11.25 am?

We do.

I will endeavour not to be on my feet at that moment.

Clause 33 inserts new section 1GA into the National Health Service Act 2006, which sets out a duty on the Secretary of State to report on workforce systems. Under the duty, the Secretary of State is required to publish, at least once every five years, a report describing the system in place for assessing and meeting the workforce needs of the health service in England. A duty is also placed on HEE and NHS England to assist in the preparation of the report, if asked by the Secretary of State to do so.

As we have discussed this morning, the report will describe the workforce planning and supply system for healthcare workers, including those working in the NHS and public health, alongside regulated healthcare professionals working in social care and other sectors in England. The report will be published at a minimum—I emphasise in each of my remarks that word “minimum”, although the shadow Minister may feel that it is not sufficient—of every five years. However, I can commit to that publication cycle being kept under review by the Secretary of State, should circumstances change.

Clause 33 will provide greater clarity and transparency on how the workforce planning and supply system operates in England. The report produced under it will describe in one single document the workforce planning and supply roles and responsibilities of relevant national bodies, including the Department, HEE and NHS England, the new integrated care boards and individual employers, and how they work together in practice at national, regional and local levels.

Clause 33 will complement our ongoing non-legislative steps and investment in workforce planning in England. In July 2021, the Department commissioned HEE to work with partners to review longer-term strategic trends for the health and social care workforce. This important programme will review, renew and update the existing long-term strategic framework for the health workforce—HEE’s framework 15—and will genuinely help to ensure that we have the right numbers, skills, values and behaviours to deliver world-leading clinical services and continued high standards of care.

I will not detain the Committee for long; I have said more than enough on the subject—not persuasively, clearly.

The Minister made the point that I did not think that a minimum of five years was sufficient for a report on the workforce, and that is absolutely correct—and I am not alone, by any stretch of the imagination. Every stakeholder and every person who gave evidence to the Committee said that five years was simply insufficient to deal with the magnitude of the challenge that we face. If the Department really wants to grasp the nettle, it should be taking heed of what those stakeholders said.

The workforce is a very complicated and ever-changing issue. It is part of a world market in healthcare staff. What the right hon. Member for Kingswood said about his amendment was important: simply to dip into other parts of the world when we are running short is not a solution. Not only is it morally difficult to justify, but it does not represent a long-term solution—we are as prone to losing staff to other parts of the world as anyone else. People will remember that the junior doctors’ dispute resulted in an exodus to Australia and other parts of the world. Going around the world and dipping into other countries’ healthcare resources is not a solution to the challenges that we face. We are not going to divide the Committee on clause 33, but we think that it is insufficient.

I repeat the Health and Social Care Committee’s finding that

“workforce planning was at best opaque and at worst was responsible for unacceptable pressure on staff.”

That really cannot be ignored. We cannot keep kicking the can down the road. I hope that when the clause gets to the other place, there is more success in putting the onus on the Government to deal with the challenge.

I hear what the shadow Minister says, and I hope that I can give him some reassurance: the Government will continue to reflect very carefully on the points made both in the debate today and in our evidence session.

Ordered, That further consideration be now adjourned. —(Steve Double.)