To ask His Majesty’s Government what assessment they have made of the reasons why this year’s NHS spending on short-notice agency doctors and nurses is 20 per cent higher than the previous year.
My Lords, demand for temporary staff supplied through staff banks and external agencies has increased. This is largely due to the increase in activity involved in our service recovery plans. Even taking account of recent increases, agency spend is still lower than in 2015-16 as a result of measures introduced to control spend. When adjusted for inflation, last year’s agency spend reflects a 25% reduction compared to 2015-16.
My Lords, the shortage of NHS staff is unsustainable, as is the NHS paying up to £5,200 for a single doctor shift. This year, in addition to the £3 billion paid to agencies providing doctors and nurses at short notice, a further £6 billion was spent on bank staff when NHS staff were paid to do temporary shifts. What cost-benefit analysis has there been of this expenditure, compared with investing in recruitment, training and retention of the workforce? Does the Minister agree that it would have been much better if we had had, and actioned, the long-awaited and costed NHS and social care workforce plan?
I totally agree with the noble Baroness: it is always better to invest in recruitment and retention, and that is what we are doing. There is no cap on the number of nurse graduates, and we have more than 70,000 in training right now. During the last three years, we have increased the number of nurses by 32,000—well towards our target of 50,000—and the number of doctors has increased by 4,000 in the last year alone. At the same time, I welcome the long-term workforce plan. It is a crucial tool going forward.
My Lords, I have asked the Minister before about the NHS’s plans to retain its clinical personnel. He has acknowledged the importance of the issue but there seems to be no real urgency attached to it. There is absolutely no good will among NHS personnel towards the NHS as an institution—those are not my words but the words of NHS staff. When is this crisis to be addressed with the urgency which is so clearly required?
I believe the urgency is there. This has been demonstrated more than anything by the measures in the Autumn Statement and by the long- term workforce plan, which will be reporting early in the new year and is what we all want. Commitments are being made to prioritise well-being, health, culture and leadership, and to operationalise this as per the 2020 NHS People Plan. Do we need to do more? Clearly. Is it a high priority? Yes.
My Lords, the increase in agency staffing costs reflects the Government’s failure to invest sufficiently in staff training and recruitment over the years. To what extent does the Minister believe that the change of course he has indicated—a staffing plan and increased investment—will reduce agency costs in 2023?
I think all of us in this House agree that these are long-term plans. Part of the increase in agency costs is also because we are trying to get more output and more activity. I am delighted that there are 70,000-plus nurses in training, but it takes a while for this to come through the pipeline. We are focused on making sure that we continue to invest in this pipeline. There is no cap on graduate or undergraduate places for nurses, and we will continue to invest.
My Lords, I declare my interest as a member of the GMC. The Minister has referred to the forthcoming workforce plan. Can he assure me that it will actually put numbers on the future training of different professional staff, together with a commitment to funding these places?
Again, I will check, but my understanding is that fundamental to any plan is the number of new places needed and recruitment, both internally, through graduate schemes, and externally. Apprenticeships also provide an opportunity. I know we are not taking up all our apprenticeship value; we refund some of it back to the Treasury. There is clearly an opportunity here to get more people on the pathway to becoming a nurse, so that anyone from any walk of life can get on it.
My Lords, have the Government made any assessment of sickness absence rates among NHS staff and how that might be contributing to increased agency costs?
My noble friend is correct to bring this up; it has been an issue. I am glad to say that sickness absences at the moment are much closer to pre-pandemic levels, so I think we are coming down the other side of the curve, so to speak. But undoubtedly it has been an issue over the past year, when Covid has still been an issue, which has caused more absenteeism and so the use of more bank and agency staff.
My Lords, the Government have changed the pension rules for doctors, creating an incentive for them to retire earlier. The Government are committed to looking at that issue, but they do not seem to be doing anything. When can we expect a change in that policy so we can retain our doctors?
The noble Lord is completely correct; we need to make sure that this is one of the key retention elements. There is also the issue of the hours doctors work: we know that, beyond a certain level, they find it uneconomic. A high priority is looking at what we can do on pension rules, or simply paying doctors the equivalent amounts as a straight salary, to make sure that we solve that problem.