NHS: Staff Numbers after Covid-19

Question for Short Debate

Asked by

To ask Her Majesty’s Government what plans they have for the number of National Health Service staff after the COVID-19 pandemic.

The time limit for this debate is one hour.

My Lords, I count myself very fortunate to be introducing this Question. This is an invaluable parliamentary means whereby questions can be asked in a more discursive manner than usual and the Minister will listen and, we hope, provide answers. I shall make a couple of obvious general points.

The people of Britain love the NHS, as has been seen during the Covid-19 pandemic, but there were problems prior to the pandemic. I shall make three basic points to set the scene. The NHS is the fifth-largest employer in the world, yet we spend less on health as a percentage of our GDP than almost every other developed country in the world. To compound the situation domestically, there was a shortage of hospital beds prior to the pandemic. Indeed, we are bottom of the Euro league for intensive care beds, with 7.3 beds per 100,000 of population, compared with the best, Germany, with 33.8 beds—what a difference. Thus, prior to the previous cuts we were ill-prepared, and there have been too many cuts under the austerity measures of the early 21st century.

I am certain in my own mind that it was due only to the dedication, brilliance and sacrifice of NHS staff that we got through—and I mean all staff, from the top consultant to the most junior worker. And it has been at tremendous cost to many of them in stress, burnout and mental health challenges. We owe them a tremendous amount and I hope that, in his summing up, the Minister will confirm that this will be recognised when we have won the battle with Covid-19.

I will begin with nurses. Over the years, the Minister must have become tired of me pursuing him on the issue of nurses. I remain concerned. Currently, we are at least 40,000 nurses short. Over the next seven years we will face a shortfall of 108,000 nurses. I must ask the Minister very bluntly: will HMG drastically increase the training of fully qualified nurses? What discussions has he had to ensure the provision of the educational means to do so?

My Lords, the NHS workforce has been working flat out for a year now. Their dedication, professionalism and personal sacrifices have inspired the whole nation. Vacancies stood at over 100,000 before the pandemic. The NHS now faces a huge backlog of operations with an exhausted workforce and increasing levels of sickness absence. Moving forward, a fully funded workforce plan is critical and must take priority over reforms to NHS structures.

I recently spoke to two very senior nurses working in London ICUs, who told me that what they need more than anything was time off for recovery and additional nurses to provide pre-pandemic levels of patient care.

The recent report of the Public Services Committee, looking at the lessons of Covid-19, received compelling evidence that other European countries have considerably more critical care beds per head of population than we do. Does the Minister agree that, if the pandemic has taught us one thing, it is the need to adopt the rainy day principle and build spare capacity in for future crises?

My Lords, I recognise that the Government want to address the issue of the NHS clinical workforce. The problem is not the ambition, but in having a clear long-term strategy to achieve this. Does the Minister agree that previous attempts have failed? The intensity and stressful nature of the work related to Covid and other factors, such as the recently announced pension cap, may make retaining staff difficult?

Recent surveys by the Royal College of Nursing, the Royal College of Physicians, the British Medical Association and many others have shown a very high proportion of the workforce are unhappy about their work, with low morale and mental health issues particularly related to Covid. With advances in care, NHS England is likely to require a growth in workforce of 3.2% per year over the next 15 years. That is nearly 650,000 full-time equivalent staff over the next decade. There are also issues about managing the workforce. I hope that through the new NHS Bill we can explore a long-term solution through legislation. Maybe the Minister would welcome that.

My Lords, I am most grateful to the noble Lord, Lord Clark of Windermere, for securing this short but important debate. It is always a pleasure and a privilege to follow the noble Lord, Lord Patel. I do not intend to repeat all the alarming statistics since it is abundantly clear that we are facing a crisis in the NHS workforce that is likely to get worse post Covid and which requires a co-ordinated long-term strategy. The numbers speak for themselves.

Our debate today is not just about the recruitment and retention of front-line NHS and social care staff. It also raises the issue of an ever-growing demand that drives the need for a larger workforce. There are, of course, many reasons for that, not least long lives and multiple morbidities, but alongside those go questions about lifestyle, behaviours and personal responsibility. The recent White Paper Integration and Innovation emphasises the importance of public health. What plans might Her Majesty’s Government have for making prevention a key part of their strategy for workforce development?

My Lords, with my minute I would like to highlight specifically those involved in treating perinatal mental illness. As many as one in five women experience mental health difficulties during pregnancy or after childbirth. The NHS long-term plan addressed that and workforce numbers are starting to move in the right direction, although we are playing catch-up in what has been a long neglected area.

The pandemic has resulted in women missing out on vital face-to-face interactions with health workers and support groups, so it is not surprising that during my research I found that many health professionals fear an epidemic of post-natal depression in particular. I would like my noble friend to ensure that his department reviews this, recognising that it is about not just workforce numbers but adequate training to spot early signs and to give women the personalised understanding that they need. Sadly, some women may not have felt able to speak up during the pandemic, so we do not know what the long-term effects will be on the demand for services, and I urge the Government to keep that at the forefront of their mind in their workforce planning.

My Lords, I declare my interest as a member of the GMC board. The NHS has responded magnificently to Covid but its underlying problems still exist. As the Health Foundation’s Jennifer Dixon put it, the NHS is under-resourced, under-doctored and under-nursed. The foundation forecasts that by 2033-4, vacancies will exceed 475,000 full-time equivalent, and even more will be needed to meet rising expectations and the impact of a growing older population. Yesterday’s Budget revealed a cut in spending for the Minister’s department of £30 billion from April and social care reform has once again been kicked into the long grass, so where is the long-term approach to the NHS and social care? Where is the long-term approach to workforce planning that is so desperately needed? Where is the innovation?

The GMC has used emergency powers to grant registration to over 25,000 doctors so that they can support the pandemic response, but most of them have still not been deployed. What a missed opportunity to bring those doctors back permanently to alleviate our workforce shortages.

My Lords, the NHS is critically short of staff so it is a credit to all that over the pandemic the amount of care given increased by one-third with the total workforce short by 84,000. The scale and complexity of care have risen considerably over the last few years, and I trust that the NHS pay review body will take all this into consideration.

Our Chief Nursing Officer has £28 million to recruit internationally nurses and midwives who are keen to join the NHS front line. The global market has widened for the ethical recruitment of health and care staff by aligning with the WHO code of practice. How many overseas nurses does the CNO hope to recruit? The forthcoming health and care Bill, which I hope is innovative, puts a duty on the Secretary of State to report on workforce planning responsibilities, which would be an ideal opportunity for parliamentary scrutiny. Maybe then we can revisit the issue.

My Lords, the All-Party Group on Adult Social Care—[Inaudible.]