My Lords, the present Health Minister and his predecessors for a number of years—far too many years, frankly—should not be surprised by these amendments, all of which cover the issue of workforce planning. Often, Ministers’ words and aspirations have been supportive but the reality is that, without proper long-term workforce planning, the NHS and our social care sectors will struggle to be able to plan for the medium term, let alone the short term.
My noble friend Lady Walmsley introduced this group by saying what is needed in workforce planning and why, and I support her brief but critical amendment to ensure patient safety. The other amendments in this group set out the how: whether the workforce planning reports or clinical and healthcare training needs in Amendment 171, the duty on the Secretary of State in Amendment 173, the report on parity of pay in Amendment 174 or the important Amendment 214 from the noble Baroness, Lady Finlay, on workforce boards. I am looking forward to hearing the expert contributions to follow on them from the noble Lord, Lord Stevens, and many other noble Lords, and I hope that the Minister will take note of how the lack of effective workforce planning is hobbling the provision of health and care services in England.
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I will focus on Amendment 170 from the noble Baroness, Lady Cumberlege, which I have signed, which sets out the reporting structures for appropriate long-term planning, addressing future workforce supply
over the next five, 10 and 20 years, along with who should be consulted and, importantly, that independent assessors should confirm that the data used is correct. We need to remember that, in the election in 2019, the Prime Minister promised 6,000 more GPs by 2024 and, before him, his predecessor Theresa May had promised an extra 5,000 GPs by 2020. Both were setting themselves up to fail, because it takes five to seven years to recruit and train a GP and another two or three years to provide the extra staff on clinical undergraduate and postgraduate courses to teach them. It is worth noting that the full-time equivalent number of GPs in 2015 was 42,961, which had dropped—not increased—to 35,991 last year. That is a drop of around 15%, and evidence of the burnout and drop-out that my noble friend Lady Walmsley referred to earlier.
Workforce planning must look beyond the traditional doctor and nurse workforce numbers that appear in election manifestos. We know that our healthcare practices are changing, with nurse practitioners, specialist physios, occupational therapists, radiographers and many others all picking up tasks formerly carried out by doctors. With in-patient stays reducing in time thanks to advances in surgery and new treatments, our health and social care system needs to develop new pathways in community deliveries. Without a specialist workforce plan for community deliveries, it will also fail.
The fundamental problem here is, I presume, the cost of clinical courses. Ministers have chosen in the past to rely on bringing qualified healthcare staff in from abroad, especially from low and middle-income countries. This is morally wrong. I am really grateful for the correspondence from Professor Rachel Jenkins, who rightly reminds us why the NHS’s constant use of clinicians and healthcare professionals from lower and middle-income countries, rather than increasing the university and training places for our own home-grown health professionals, is so damaging:
“The heart of the problem is the sheer scale of loss of health staff from low and middle income countries (LMIC) to high income countries, especially to the UK, which has 30% of its doctors recruited from and trained by low and middle income countries, approaching double the OECD average of recruitment from LMIC, and with the situation escalating fast.”
Around 20 years ago, when I was a trustee of Christian Blind Mission, a global disability charity, I saw the consequences of this in practice. CBM worked with the exceptional surgeon Steve Mannion, who provides innovative club-foot surgery and treatment and trains Malawian medical students and doctors in his ground-breaking surgical practices. In 2003, along with local surgeons across Africa, he helped to set up COSECSA, a surgical college to cover central, eastern and southern Africa. He did this because, as he said in 2003, he was the only orthopaedic surgeon for the central and northern regions of Malawi, a catchment population of 6 million to 7 million people. He was clear that this was caused by countries like the UK offering attractive posts in our hospitals, which had catastrophic consequences on medical services in their own countries. In 2003, there were more Malawian surgeons in Manchester than in Malawi.
Because of the lack of workforce planning and funding in place to train those needed for our NHS, many of our hospitals have had to rely on this willing, responsible and committed cohort of professionals from across the world. We are still depriving Africa of surgeons and countries such as the Philippines of nurses, and it is not good enough. My local hospital, Watford General, has a good scheme by which nurses from the Philippines come for a specific time only, and return home with not just experience but further qualifications under their belts.
There is a place for this type of arrangement, but it must not be at the cost of draining the skills from lower-income and middle-income countries and should not be a replacement for the responsibility we bear to ensure that we have the ability to train our own local workforce. I am really grateful to Professor Jenkins for her timely letter. She also pointed out that the ratios of doctors and nurses in lower-income and middle-income countries are still sometimes a third of the numbers we have in more developed countries.
I return to the principles behind the amendments in this group. The lack of proper and effective long-term workforce planning exacerbates many of the problems in our NHS and social care sector. This Bill and these amendments give us the right number of staff that we need to be able to do this, but, without any workforce planning, it will be entirely hit and miss. We need resilience. We cannot continue to lose staff because of the pressure we are putting them under. We must not have a service that becomes unsafe because staff step up to do extra shifts, over and above, when they are extremely tired.
We have to have clear career pathways linked to workforce planning, not just in the NHS but in social care. We cannot have the position we have at the moment, where social care is being denuded of nurses because they are all going to the NHS, which can offer them more pay. Above all, we need a key tool for the design, funding and delivery of health and care services in England in future. These amendments, especially Amendment 170, set out how we can do that. I look forward to the Minister’s response.