My Lords, listening to my noble friend Lord Stevens of Birmingham, I am beginning to feel the pain of his frustration at being chief executive of the NHS and not being listened to in order to fix such an important issue as workforce planning. Also, there is a bit of déjà vu that he may remember, along with some of my colleagues who were took part in the Lords committee inquiry into the long-term sustainability of the NHS and adult social care.
Let me argue the same issues that he just presented. The report on the long-term sustainability of the NHS and adult social care, published in April 2017, looked at data on demographic and disease burden projections of the population over the next 15 to 20 years. It identified a lack of long-term workforce planning as a key threat to the long-term sustainability of the NHS. The Committee heard from the then Secretary of State, the right honourable Jeremy Hunt, who had this to say:
“workforce planning is an area where we have failed… Brexit will be a catalyst to get this right… That is an area where we need to be much more strategic”.
That was nearly five years ago and yet, there is no strategic healthcare workforce plan from the Department of Health and Social Care, as we just heard.
The solution is not going to come from an outside body, no matter how influential. It has to come from the centre, from the leadership of the NHS and social care, and not one in the isolation from the other. What we have heard from the centre and NHS organisations is many publications identifying the problem, but not the solution with a long-term plan. We are told that this may be coming in April 2022—or perhaps later.
On the other hand, there are several detailed authoritative documents on the NHS workforce from think tanks, NHS providers, the BMA, the nursing councils and many others, who have been grappling with this issue and trying to find a solution for a long time and advising the Government on how to do this. There is no lack of authoritative reports based on data related to long-term projections of population, its demography, health needs and the workforce needed
to deliver them. For example, an extensive, well-researched report by Dr Latifa Patel, a respiratory paediatrician, and Dr Wrigley, a GP of medical staff in England, projected to 2045—based on population and disease data—the number of doctors needed in each speciality and possible models of plans to deliver on this by 2032. A document extending to 60 pages is not only highly informative and well-researched but identifies a way forward.
Since the Health and Social Care Act 2012, there has been inadequate workforce planning, fuelled by inadequate regional and national workforce data and a lack of accountability for it at government level. We are not training enough doctors, despite record numbers of people applying. The latest figures, as the noble Lord, Lord Stevens of Birmingham, mentioned, show a 21% increase on previous years in applications to medical schools of highly talented young people. This means the NHS is ill-equipped to tackle the backlog of care, is not prepared for future public health crises and cannot meet patient needs, either now or in the future.
If we compare England with EU nations within the OECD, which have an average of 3.7 doctors per 1,000 people, the medical workforce in England is currently short of around 49,000 full-time equivalent doctors. Without significant intervention regarding the current rate of growth, the estimate is that the future medical workforce shortage will be between 26,889 and 83,779 full-time doctors by 2043. Such precise numbers show how well-researched this document is. Each full-time doctor in NHS England is doing an average of 1.3 full-time equivalent roles. I have three of them in the NHS and I can see what they do—although I tell them they are lazy compared to me.
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The NHS faces a huge backlog of care, post pandemic. Estimates are that there were 3.37 million fewer elective procedures and 21.4 million fewer out-patient attendances between April 2020 and March 2021. On top of this, the population is expected to grow around 9% over the next 25 years to more than 61.5 million. At least one in four adults will be aged 65 or over, and the number of people aged 85 or older will have nearly doubled to 3 million by 2043.
Staff retention is poor and is set to worsen without intervention. This is caused largely by the vicious cycle of medical workforce shortages, overworking existing staff, years of demoralising pay erosions and punitive pension taxation rules. We have 1,307 fewer qualified full-time-equivalent GPs now than in September 2015, while shortages of specialist occupational physicians and public health doctors are severely impacting efforts to keep the population healthy. The shortage of medical academics means that training the next generation of doctors has become even harder. You do not just get medical or nursing graduates by increasing the intake: you have to provide the resources—manpower, equipment and capital funding—to train them. In the last 10 years, the senior clinical academic workforce reduced by 27%, while the number of medical students grew by more than 25%. For those of us who have trained medical students and postgraduates for years, medical undergraduate training committed at least two sessions a week from each one of us—that is one day—apart
from undertaking extra duties. Not a single region in the country meets the current OECD EU country average of 3.7 doctors per 1,000 people.
The medical workforce itself is ageing, meaning that we risk losing around 16,818 secondary and 8,676 primary care doctors—a total of up to 25,494—in the next 10 years due to natural retirement. One in five doctors is saying that they will leave their career in the NHS altogether post pandemic. I repeat: one in five. This figure might be as high as 31,820 doctors. Those noble Lords who have not seen the recent report by the GMC might like to look at it, because it confirms these findings. Other health services carry a significant number of vacancies, but, even if all currently known vacant medical posts were filled tomorrow, we would still need 42,528 more full-time-equivalent doctors and doctors in training to meet the OECD EU country average of 3.7 doctors per 1,000 people in England.
International medical graduates have always been, and will remain, a key part of our medical workforce. However, international recruitment must not come at the expense of developing countries, so a sustainable, long-term workforce strategy is needed. While there is increasing multidisciplinary working within healthcare services, while there will be technological advances, and while non-medical roles have expanded in recent years, the doctors’ unique skill set is essential.
The report by Patel and Wrigley also makes estimates of cost based on data, along with reports from the Health Foundation and the Institute of Fiscal Studies report of 2018. To meet the current shortfall in the medical workforce by 2030 and increase training slots would require in the region of about £8 billion over the next three years. That is not so much when you consider, as the noble Baroness, Lady Cumberlege, indicated, that we are spending £6 billion on locum or agency fees.
I have spoken about the medical workforce, but I absolutely accept that similar problems—and perhaps even worse—need addressing in nursing and other healthcare professional workforces. I have no doubt that my noble friend Lady Watkins of Tavistock might well address that issue. I make a case for an urgent need—not in two years or three years or four years—for a strategy on health and social care workforce planning from the Department of Health and Social Care. The amendments in the name of the noble Baroness, Lady Merron, do this, and I have added my name to her two amendments. They put a duty on Health Education England to do this, and a further duty on the Secretary of State to report annually to Parliament, not only on the workforce plans but on the funding to support the plans.
There is only one thing that I would add, if the noble Baroness would accept it, and that is for the House of Commons Health and Social Care Committee to have an independent expert analysis carried out every two years on the delivery of government policy commitments on the health service workforce. An example of such an exercise is the one that the committee carried out establishing an expert panel that reported on mental health services and identified the gaps in the delivery of policy commitments in mental health. I strongly support the noble Baroness’s amendments.