That this House has considered NHS staffing levels.
It is a pleasure to serve under your chairmanship this afternoon, Mr Hollobone. I pay tribute to all the nurses, doctors and other medical professionals—indeed, everybody who works in the NHS—for the work they do to look after patients and keep us all safe.
I have been overwhelmed by the number of organisations that have shown interest in this debate and have shared details of how the NHS staffing crisis is impacting on the people they represent. They are too numerous to mention here, but they include the Royal College of Nursing, the Royal College of General Practitioners, Versus Arthritis, Cancer Research UK, Unite the union, Parkinson’s UK, the Royal College of Midwives and many others. It is clear that there is insufficient capacity in the NHS in England to meet the needs of patients.
The NHS staffing crisis is a direct result of the failure of Conservative Governments to plan and deliver the workforce that we need. The crisis is not just about the impact of the pandemic; it predates that. In June this year, there were more than 132,000 vacancies in the NHS in England, which is up from around 98,000 the previous year and from around 105,000 in March. When we look specifically at registered nursing staff, as of June there were over 46,000 vacancies. Alarmingly, that is almost 8,000 more than in March. For medical staff, there were over 10,500 vacancies in June, which is around 2,500 more than in March.
By way of comparison, in December 2019 there were around 38,000 nursing vacancies and more than 8,800 medical staff vacancies. What was already an extremely serious situation before the pandemic has become worse. Staffing shortages create stress for NHS workers, and delays and deteriorating quality and safety for patients. As well as vacancies, waiting times for treatment and emergency services have continued to soar. Last month, of the nearly 1.4 million people who visited major A&E departments, more than 550,000 waited more than four hours from arrival to admission, transfer or discharge. That is 45.2% of attendees, which is way short of the target of 95% to be seen in four hours. In December 2019, 31.4% waited for more than four hours. Again, an already serious situation before covid has got worse.
As of last month, a total of 7.1 million people in England were waiting to start routine hospital treatment. More than 400,000 people had been waiting more than 52 weeks, and more than 2,000 longer than two years. Behind those statistics are huge numbers of people waiting in pain and anxiety. Cancer Research UK points out that, in September of this year, only 60.5% of patients started treatment within 62 days of an urgent referral, against a target of 85%. That means that, in September alone, around 6,000 people waited for more than 62 days for their cancer treatment to start. Even before the pandemic, cancer patients were waiting too long for diagnosis and treatment. The 62-day target has not been met since 2015.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
I thank the hon. Lady for making such a poignant and important speech, and for securing this debate, because we are all grappling with the issue. Does she agree that the staff in the NHS do their very best, but the future planning of the workforce is also an issue? We do not have enough staff for the future workforce plan. That is particularly the case in mental health and learning disabilities. I read that 215 young people took their lives in 2021, the highest figure since records began. Is that a concern to her, because I think it is for most of us in the House? I am sure that, in the excellent speech is making, she will want to highlight that.
The hon. Lady makes an incredibly important point. There can be no more poignant and devastating example of what this crisis is leading to.
The Health and Care Act is a privatising piece of legislation that opens the door to private companies having a greater say in the delivery of health care. Guidance by NHS England, while the Act was going through Parliament, stated that it would enable integrated care boards to delegate functions to providers, including devolving budgets to provider collaboratives. Provider collaboratives are partnership arrangements involving at least two trusts, and they can include representation from the private or independent sector.
As we now know, the delegation of commissioning from ICBs to provider collaboratives will definitely go ahead. That represents not only the opportunity for the privatisation of the NHS, but clearly has implications for NHS staff. I am concerned that a situation may well arise where a provider collaborative decides to commission services from the private sector, instead of from the NHS provider that is currently delivering the service. In that instance, NHS staff may well find that their jobs are lost from the NHS, and that equivalent work is available only in the private sector, on poorer pay and conditions of service.
The Health and Care Act, which was passed by the Conservative Government earlier this year, has the potential to undermine national collective bargaining, and the pay and terms and conditions of NHS staff. It also undermines the concept of the NHS as a publicly owned organisation that has served us so well since 1948. The Act prohibits the chair of an ICB from approving or appointing someone as a member of any committee or sub-committee that exercises commissioning functions, if the chair considers that the appointment could reasonably be regarded as undermining the independence of the health service, because of the candidate’s involvement with the private healthcare sector or otherwise. However, that is clearly open to interpretation. It by no means rules out people with interests in private healthcare from sitting on those sub-committees.
The reality is that today, we are training NHS professionals in the same professional silos as we did 100 years ago. Medicine has moved on massively, so in light of the fact that a new workforce plan is being drawn up, is it not right that those professions are revisited to ensure we have a workforce fit for the future, as opposed to doing things just because we have done them for so many years?
As ever, my hon. Friend makes an interesting and detailed point born of her experience. The Minister should take note.
To conclude, since 2010, Conservative Governments have let the crisis in NHS staffing develop. Instead of doing the important business of Government and bringing forward a timely workforce plan and a properly funded training regime, they have focused their energy on not one, but two, major reorganisations of the national health service designed to open it up to privatisation. Instead of tending to the needs of the workforce and the needs of patients, they have been priming the pump for shareholders. The NHS must remain a comprehensive universal service, publicly owned, paid for through direct taxation and free at the point of use for all who need it. That very concept is under threat: it has been reported this week that NHS leaders in Scotland have discussed abandoning the founding principles of the NHS by having the wealthy pay for treatment, thus creating a two-tier system. Not only would that be a betrayal of its founding principles, but it would also bring in costly administrative processes that are not currently needed, as patients would need to be means-tested.
The NHS is also under threat from this Conservative Government’s failure to get a grip on the staffing crisis, and from their privatisation agenda. This attack on the fundamental principles of a comprehensive, universal, publicly owned national health service, free to all who need it and paid for through direct taxation, has left patients neglected and staff overworked and underpaid. Patients, the NHS, and all who work in the service deserve better. The Government must come forward as a matter of urgency with a credible plan to put things right for NHS staff and set out how they are going to deal with the crisis this winter, and Ministers must give NHS workers a fair pay rise, protect NHS services, and ensure staff safety.
Order. The debate can last until 4 o’clock. I am obliged to call Front Benchers no later than 3.27 pm. The guideline limits are 10 minutes for the Scottish National party, 10 minutes for His Majesty’s Opposition and 10 minutes for the Minister. Margaret Greenwood will have three minutes to sum up the debate at the end. Nine speakers are seeking to take part so we have a time limit of four and a half minutes. I will be grateful if hon. Members stick to that.
I congratulate my hon. Friend the Member for Wirral West (Margaret Greenwood) for this important debate on a subject that is close to my heart. I have many friends and family who work in the NHS and I speak to them regularly about the severe pressures they are under. I doubt there is a single Member of Parliament whose inbox is not full of casework, both from patients whose treatment has been delayed because of staff shortages and from overstretched NHS workers who are frustrated that, with the best will in the world, they simply cannot meet the demands they face each and every day.
I want to mention a couple of the emails I have received in recent weeks. Eamon works in the NHS and told me:
“After over 10 years of underfunding, I see my colleagues and staff within the hospitals I visit every day look more and more dejected, run down, insulted and demoralised. Where once was pride, a smile, laughter and camaraderie, there is now worry, depression and a feeling of hopelessness.”
Tracy expressed the feelings of many long-serving health workers when she told me:
“Some of us cannot cope on the wages we earn and are considering leaving the NHS. We cannot afford to lose any more staff—we are struggling to staff wards as it is. I work six days a week to get a decent wage. I’m 60 years old and I have worked all my life. This can’t be right.”
Eamon and Tracy are hard-working professionals, dedicated to helping the patients in their care. That people like them should be so worn down and unhappy at work that they are considering leaving should be a wake-up call to the Government. Yet all we hear from the Prime Minister down is that decent wages for nurses and other healthcare workers are unaffordable. Is it any wonder that people look elsewhere in the economy and see employers doing what the Government should be doing in the NHS? That is, offering higher wages and better working conditions to help recruit and retain the staff they need.
Thank you for calling me to speak, Mr Hollobone. It is a great pleasure to be part of this important debate, and I thank my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing it and for setting the dire scene in the NHS.
I will use my speech to talk about when I was a practice manager before I became an MP, and I want to speak about the way in which racism and discrimination affects the wellbeing of black and minority ethnic staff. Some 22.4% of NHS staff in England are from BME backgrounds, so they are disproportionately represented in the NHS but are under-represented in senior leadership. If we want an acceptable level of NHS staffing, it is crucial that racism and discrimination against staff from BME backgrounds is properly challenged.
Earlier this year, the BME Leadership Network published the “Shattered Hopes” report, which was based on surveys and roundtables of staff, revealing results that were shocking to read. It found that more than half of BME NHS leaders have considered leaving the NHS in the last three years because of their experiences of racism, and that colleagues, leaders and managers were a more common source of racist treatment than members of the public, which is truly shocking.
I want to provide the Minister with some recommendations, which I hope he will be able to address in his summing up. First, it goes without saying that the Government must give a pay rise to doctors, nurses and all staff in the NHS that is at least above the current rate of inflation, to protect their standards of living and to ensure the retention of staff. Secondly, we must ensure that bursaries for nursing students are restored so that more people—particularly those from more disadvantaged backgrounds—can access training. Lastly, the Government need to provide a renewed commitment to ensure that the NHS delivers on its commitment to combat institutional racism alongside tackling health inequalities.
It is a pleasure to serve under your guidance again, Mr Hollobone. I am grateful to the hon. Member for Wirral West (Margaret Greenwood) for securing a really important debate.
I want to say a massive thank you to NHS and care staff. Undoubtedly, every year is a tough one for those working in this area, but the last few years have been incredibly demanding. The pandemic has taken its toll on people’s mental and physical health, and has led to real attrition within the various clinical and non-clinical services. It is worth bearing in mind how much worse it would have been had we not collectively taken the right decision to try to tackle the pandemic early on. Nevertheless, it has been incredibly hard.
I will focus on a few areas that are significant for NHS staffing, starting with dentistry. It is worth bearing in mind that we all pay our taxes, so 100% of my tax-paying constituents have paid for NHS dentistry, but only about a third of them are getting it, including roughly half of the children. At the moment—I have checked—there is not a single NHS dental place anywhere in the entire county of Cumbria, which is a disgrace. That could be solved in no small part if the Government were to address the issue of the treadmill of units of dental activity. If it were done differently, it would not necessarily cost the Government any more money to make sure that they do not push dentists into a position where they feel that they have no alternative professionally than to leave the NHS, that we bring back the people who have left, and that we value the ones we have working within it.
Secondly, I want to talk about GPs. The simple reality is that we have far fewer GPs entering the service than we need. Many rural communities in Britain, such as mine, have a smaller surgery population-wise because of the vast area that they cover. We are currently dealing with the potential closure of the Ambleside and Hawkshead medical practices—the Central Lakes Medical Group. It is out to tender at the moment, because the Government removed what was called the minimum practice income guarantee, a sum of money that made small rural surgeries financially sustainable. Their removal has led to three closures that I can think of in Cumbria—one in Eden and two in South Lakeland. A relatively small amount of money would keep those surgeries sustainable and make sure that we kept people working at them. Otherwise, we have NHS staff who are determined to work and serve those communities who simply find that they cannot.
It is a pleasure to speak in this debate. I thank the hon. Member for Wirral West (Margaret Greenwood) for leading the debate. Like her, I acknowledge and appreciate the incredible work of all our NHS healthcare professionals in all areas of our health system over the last number of decades, especially throughout the pandemic, when we appreciated them even more than normal. I place on the record my genuine thanks to them for their commitment and their efforts through the covid crisis, which will continue to have impacts on the efficiency of our NHS for some time.
Our national health service is one of a kind and we must do everything in our power to protect it and ensure that it is given what it needs to ensure its success. Just yesterday in the main Chamber, I asked the Chief Secretary to the Treasury about retaining our nurses. How we do that is quite simple: we pay them the wages that they need. There is something drastically wrong if someone can become agency staff and get better wages for doing the same job. I am always respectful to the Minister, and I do not say that to chasten or to be aggressive, but we really do need to pay our nurses what they deserve. Perhaps the Minister can get back to us on that point.
It is very challenging to cover all the issues about NHS staffing. The NHS is one of the largest employers in the world, with more than 1.3 million staff, with 13,000 of them working back home. There is no secret that there are staffing issues for many different reasons. I have heard before from younger people that the educational process to becoming a nurse is purely based on exam results. I understand the need for training. Nursing, mental health nursing, medicine and dentistry require degrees from universities. Many universities refuse to take students who do not achieve high grades in their entry requirements. Perhaps it is time to look at whether, if the grades are not achievable for them but they have an interest in the subject matter, they should be given training to deliver that. We do not always have to aim for the gold star ones. There are people who might not achieve all of the grades that they should, but could still be darn good nurses and do well. I ask the Minister if he could give us his thoughts on that.
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On the Conservatives’ watch, millions of patients are being deprived of the timely treatment that they desperately need. Because of the unacceptable delays, some are paying for expensive private healthcare, and many are distressed to do so, because they believe in a publicly owned, universal, comprehensive national health service. They have been failed by Conservative Governments.
The staffing crisis is having a devastating impact on retention. Last month, the Health Service Journal reported that a record number of NHS workers voluntarily resigned from their jobs during the first quarter of this financial year. Almost 35,000 resigned voluntarily, which is up from around 28,000 during the same period in 2021 and around 19,000 in 2020. The most common reason for leaving during quarter 1 of 2021-22 was work-life balance, which almost 7,000 NHS workers cited as their reason for leaving.
A few months ago, I met with members of the Royal College of Nursing. They told me about the incredible amount of pressure that they are under because of staff shortages. They also told me of nurses suffering financial hardship. Some are going to food banks, some are unable to afford to drive to work, and some are leaving the profession to work in chain stores for better pay. However, it is not just about pay. The nurses told me that they often simply do not have enough colleagues to work alongside them. That is extremely stressful for them, and dangerous and deeply unfair for patients.
I turn now to industrial action. NHS staff care deeply about their patients, but they can also see that the NHS is at breaking point. Earlier this month, the Royal College of Nursing voted to take strike action in its fight for fair pay and safe staffing. That is unprecedented and has not been done lightly. The RCN has been clear: its members have voted for fair pay for nursing, safe patient care and to protect patients.
Numerous other organisations, representing thousands of workers, are also balloting for industrial action, including Unite the Union, Unison, the Royal College of Midwives and the GMB union. The Conservative Government’s failure to address the NHS staffing crisis is putting those working in the service under immense pressure and, in some instances, putting patients at risk. It is notable that, in a poll of 6,000 adults, carried out on behalf of Unite, 73% of respondents supported NHS and careworkers receiving pay rises that keep up with the cost of living. The Government should take note.
We cannot discuss the NHS staffing crisis without highlighting the Conservatives’ privatisation agenda, because it does impact on people working in the service. The Health and Care Act 2022 split the NHS in England into 42 statutory integrated care systems, each comprising an integrated care board and integrated care partnership.
If we are serious about providing governance that rules out the possibility of the private sector influencing the expenditure of public money, an organisation carrying out the functions of an ICB on its behalf should be a statutory NHS body. It is a great pity that the Government did not legislate for that, despite an amendment in my name calling for it, which had cross-party support.
Private companies can also have influence through integrated care partnerships, which are required to prepare a strategy setting out how the assessed needs of its area are to be met. ICBs must have regard to a strategy drawn up by an ICP, which I am concerned might be influenced by private companies. Of course, the responsibility of a private company is to make money for shareholders; it is not to support a publicly owned, publicly run national health service.
Other provisions in the Act also have serious implications for staff. The Act allows for a profession that is currently regulated to be removed from statutory regulation. That is deeply concerning. Once a profession is deregulated, we can expect the level of expertise in that field to decline over time, alongside the status and pay of those carrying out those important roles. Deregulation also brings with it serious long-term implications for the health and safety of patients.
The Act also provides for the revoking of the national tariff and its replacement with a new NHS payment scheme. Engagement on the NHS payment scheme is still under way, with a statutory consultation due to begin shortly. I have long been concerned that, given the requirement in the Act for NHS England to consult with each relevant provider before publishing the NHS payment scheme, including private providers, this may well be a mechanism through which the Government will give private health companies the opportunity to undercut the NHS. If that happens, I believe that one of the inevitable outcomes would be an erosion of the scope of “Agenda for Change”, as healthcare that should be provided by the NHS is increasingly delivered by the private sector.
In that event, NHS staff may then find themselves forced out of jobs that are currently on “Agenda for Change” rates of pay, pensions and other terms and conditions, with only private-sector jobs with potentially lesser pay and conditions available for them to apply for if they wish to continue working in the health service. Just like the provision around provider collaboratives, that would appear to hold risk for NHS staff and their pay and conditions. As such, I would be grateful if the Minister will guarantee that the pay rates of “Agenda for Change”, pensions, and other terms and conditions of all eligible current NHS staff will not be undermined as a result of the adoption of the NHS payment scheme. Can he also confirm that trade unions, staff representative bodies and all the royal colleges will be consulted before the NHS payment scheme is published, as Ministers in the other place assured us during the passage of the Act?
I understand that the Government are to publish a comprehensive NHS workforce plan next year, including independently verified workforce forecasts of the number of doctors, nurses and other professionals we will need in five, 10 and 15 years’ time. Such a plan is long overdue, so can the Minister provide some further details about when we will see it? Will that plan also include details of the numbers of staff we will need in the social care sector, where there is also a workforce crisis that is intricately linked to that in the NHS? Will the Minister set out what measures he is taking to address the staffing crisis this winter?
In my constituency of Batley and Spen, Amazon is seeking to build a huge new warehouse development. I am opposing the plan for a number of reasons, not least the damage it would do to the health and wellbeing of local residents and the impact on the already-overloaded transport network. However, I also have serious reservations about the number and type of jobs such a development would create and I worry that our exhausted NHS workforce may be tempted by such developments, whatever the reality. We cannot afford for our nurses, porters, drivers and other workers who keep the NHS going to be lured away by the promise of higher wages in other sectors. We need them.
The impact of staff shortages has already led to vital services in my constituency being significantly reduced, leaving patients having to travel long distances to access care that, until recently, was available in their own communities. Such local care is really important. To take just one example, the Bronte Birth Centre was a lifeline for expectant mums, but it was forced to close—hopefully, temporarily. However, some fear it could become permanent, because the centre simply cannot get the maternity staff it needs. A recent advert for midwives did not lead to a single application.
NHS management is doing its best, looking to support recent graduates, attract back retired staff and recruit internationally. However, it is clear that the fundamental problem remains the same across the health service: low morale, wages that fail to keep up with prices and working conditions that are getting progressively worse, month after month and year after year. We remain incredibly proud of the NHS, especially on this side of the House, but I accept in other parties too. After 12 years of under-investment, it is now stretched to breaking point. Unless we take urgent action to strengthen the workforce, restore the pride that NHS staff have in their ability to do their jobs and properly reward them for their work, we are putting the future of our NHS at serious risk. I hope we can all agree that that is something we must avoid at all costs.
We need an expanded training programme to truly tackle discrimination within the NHS. Without that commitment, countless staff will have no choice but to quit working for the NHS.
Nothing is more important to solving the NHS staffing crisis than tackling care—we have talked about that a lot—and it is outrageous that the Government have chosen to kick dealing with that issue into the long grass for another two years. We have 32% bed-blocking in the hospitals of south Cumbria at the moment. The reason why is obvious: there are not enough care packages to help people when they leave hospital, because there are not enough carers. The impact on hospital capacity, on the capacity of A&E, on ambulances that take so much longer to drop off their patients and therefore take longer to respond to calls, and the lives put at risk, is blindingly obvious. For the Government to delay dealing with care, and to think it is delayable for two years is not a tough decision for them. It is a tough decision for the millions of people who will be affected and for the tens of thousands of people working in our care sector.
The lack of availability of affordable homes for care workers and NHS workers in communities like mine is also worth bearing in mind; that is a major reason why there are not enough staff working in health and social care. We now understand that the Government will kick the Levelling-up and Regeneration Bill into the grass on the other side of Christmas. That was an opportunity for the Government to decide that they would change the law to protect homes for local occupancy.
My final comment is on the cancer staffing situation. We currently have an outrageous situation where, in the south of Cumbria, 43% of people diagnosed with cancer are not getting their first treatment for two months, and 62% in north Cumbria are not getting their treatment for two months. That is an outrage. It is costing lives. Undoubtedly, staffing is a major part of that. I am chair of the all-party parliamentary group for radiotherapy, and we are to meet the Minister or his colleagues soon. Can I press him for a date?
In the meantime, I will share one important statistic with him. Radiotherapy UK surveyed 622 radiotherapy professionals—10% of the entire workforce nationwide—and 94% of them felt that the Government did not understand the impact of the current situation on their service; 72% felt that NHS senior managers did not either. As a consequence, we are losing people from the industry. We need a workforce plan specifically for cancer.
I hope the Minister will agree to meet with me and the APPG soon so that we can give him the all-party manifesto on radiotherapy, which will solve some of the problems and give those working in the NHS, particularly in cancer, some hope for the future.
The hon. Member for Westmorland and Lonsdale (Tim Farron) mentioned GPs. Back home, GPs are really important. If one or two fall away from the local health clinics and surgeries, we automatically have a crisis among our GPs. So, let us encourage more GPs to come in. To do that, we will probably have to pay them better too, so that they do not wish to go anywhere else—overseas or wherever. We have all heard about the horror stories that illustrate their reasons for doing that.
I heard from a constituent just last week who was in a car accident. Her car was written off, but, luckily, there were no life-threatening injuries. However, the ambulance came and she waited in the ambulance queue for eight hours. She was not allowed to move from the stretcher, was not able to use the toilet, and had no water to drink. That is just an example of some of the crises we have. That is not the Minister’s fault—it is a devolved matter and I understand that—but it is just an illustration, and I suspect that other Members will have their own examples.
I would make a plea on behalf of the Royal College of Psychiatrists, which has stated that, over the past year, the number of full-time-equivalent consultant child and adolescent psychiatrists in the NHS has declined, while referrals to child and adolescent mental health services have increased by 24%. We have countless debates in this place relating to better provisions for children’s and teenagers’ mental health, and the RCP tells us that there are simply not enough psychiatrists. Again, I am throwing this at the Minister at very short notice, but I know that his responses are always very helpful. I ask for some help in raising that.
I am also aware of the challenges that the staff face. I thank each and every one of them—I thank them and I praise them. They go home after their shifts, tired and disheartened. The hon. Member for Wirral West (Margaret Greenwood) mentioned that earlier on. It is the truth. With that in mind, we must do more.
I very much welcome the additional money allocated in the autumn Budget, and the Barnett consequentials mean that we will get £650 million. That is a massive help, and I understand that. I certainly hope that that will shield the NHS from inflammatory staffing pressures, but I hope that the Minister can undertake discussions with the devolved Administrations on this issue, and on how we can do it better together. I am always very conscious that the Minister is a gentleman and responds well; I very much look forward to his reply.