My Lords, I have added my name to Amendment 146 in the name of the noble Baroness, Lady Merron, but I support all the amendments in this group. Taken together and perhaps integrated a bit better, they strengthen the focus in the Bill on workforce issues and workforce planning. I also congratulate the noble Lord, Lord Stevens, on his contribution to open government.
For too long, we have been preoccupied with the funding of our health and care system and have tended to assume—I confess that as a Minister I certainly did this to some extent—that if Governments made enough money available, we would be able to acquire the staff we needed, always forgetting, I think, that health and care is a highly labour-intensive industry, possibly the most highly labour-intensive industry in our country.
We were often very good at masking the shortcomings in our planning system by historically relying on recruitment from abroad. There were doctors from Africa, India and Europe, nurses from the Philippines and elsewhere, and we had a lot of staff coming in from the EU to work in our social care sector. Brexit and our national preoccupation with limiting immigration has changed all that, and that is before we calculate the effect of Covid on health and care staff recruitment. To give your Lordships just one example, pre-Brexit, 40% of the social care staff in London came from the EU. You simply cannot make that ground up very quickly.
Today’s reality for recruiting health and care staff is that we are operating in a highly competitive national and international labour market. That situation will not change any time soon. The probabilities are that we will have to pay more for staff and give more thought to our working practices and conditions. We will have to do a much better job of planning ahead and take much more seriously the training, support and recruitment and retention of this increasingly scarce resource—people.
I suggest that Ministers—I include all of us who have been Ministers—must stop political bragging about how many new doctors and nurses a Government will produce, often without the foggiest idea of how long it will take to do so. Ministers might want to give more consideration as to whether they have the right skills in the sector in the first place, before commissioning the training of highly paid, highly skilled professionals. We have not done a very good job of looking at the extent to which many of the jobs done by doctors could be done by other professionals. Our attempt to train nurses in prescribing has been only half-hearted in using the skills that we have paid for them to develop.
7.30 pm
The number of amendments in the Bill that focus on workforce supply and its use is considerable. It is clear from listening to this debate and looking at all
these amendments that, across the Committee, there is a strong desire for the Bill to include many more provisions about measuring and assessing the adequacy of the health and care workforce and planning ahead to meet future needs. The amendments in this group make clear that this work needs to be done at both local and national level, and changes in the Bill will need to reflect that consideration. I suggest that we need to get together, across the Committee, to collect and secure the right mix of amendments on Report. The Government would do well to begin discussions with all parts of the Committee on amendments that would meet the concerns expressed today.
While I support the amendments in this group as making a big improvement on the current situation, I do not think they go far enough to deal with DHSC short-termism. The noble Lord, Lord Patel, mentioned the House of Lords Select Committee that reported in 2017. Much more should be done because, as my noble friend Lord Stevens eloquently described, we may not be able to trust any Government to keep their mind consistently on this issue. History is not terribly reassuring on that. I am not making a party-political point; across the parties, there is a danger that we lose sight of this issue when it becomes inconvenient. Even a well-intentioned Health Secretary can be subdued by his colleagues in the Cabinet—I mention no particular names or offices.
That is why I have tabled Amendment 285, which talks about establishing an office of health and care sustainability which would bring together the issues of money and workforce planning. It basically implements a recommendation from the 2017 Select Committee report and is based on the experience of the Office for Budget Responsibility. The noble Lords, Lord Patel and Lord Kakkar, have tabled a similar but slightly less detailed amendment with Amendment 286. Between now and when we reach those amendments, we need to consider whether we are confident that amending the Bill to rely on the Secretary of State doing the right thing, without some independent outside influence, is the right way forward. We want to give the Secretary of State the job, but we also want to ensure that he does it. I mention, if I dare, that the amendment proposed by that 2017 report was put to Jeremy Hunt, who did not act on it—though I am pleased to see that the sinner has repented and decided that there was perhaps some merit in having a national body to look at this kind of issue.