My Lords, this has been an extremely rich and vital debate on crucial amendments, albeit conducted in two parts. I will briefly offer the Green group’s support for all of these amendments. I aim not to repeat anything that has been said but to offer some uniquely Green perspectives on this set of amendments.
I will take them in two groups, starting with Amendments 170 and 173 in the names of the noble Baronesses, Lady Cumberlege and Lady Merron. These are particularly important because they very clearly and explicitly lay out the responsibility of the Secretary of State. When I tabled some amendments last week on the Secretary of State’s duty to provide, they met with something of a frosty reception in some quarters—but it is clear from all sides of your Lordships’ House that it has to be the responsibility of the Secretary of State to ensure that there is a plan for the workforce. I stress that that is coming from all sides of your Lordships’ House.
It is worth referring to the King’s Fund briefing, which I do not think anyone has mentioned yet. I will quote one sentence:
“The measures in the Bill to address chronic staff shortages remain weak.”
That is what a respected outside observer says. Your Lordships’ House is seeking to plug that gap. The noble Lord, Lord Lea, suggested that this was all terribly difficult, and that is undoubtedly true, but a lot of people have been thinking about this for a very long time. I was at a briefing for the Royal College of Physicians before the pandemic, in person, with no masks in sight. It was more than two years ago and they were talking about the need for workforce planning, saying, “We know how this should be”. Indeed, on the Royal College of Physicians’ website, more than four score organisations are listed as backing these amendments for workforce planning. So the support is very much there.
That focuses particularly on the medical side of things, but I will refer also to the Age UK briefing. We have had some very valuable contributions about care workers from the noble Baronesses, Lady Verma and Lady Hollins, but Age UK considers that we need to
look at this much more broadly. It is calling for a robust accreditation scheme for care workers working in CQC-accredited facilities. We need a different system.
I think it was the noble Baroness, Lady Hollins, who talked about how this is a low-pay sector, but we also need to talk about this differently and recognise that it is also a high-skill sector. I think of some of the care workers whom I have met: care workers who cared for doubly incontinent, aggressive, advanced Alzheimer’s patients, and who had done so for decades. Anyone who claims that these are not people with amazing levels of skill really is denying an obvious fact. We need to acknowledge the skills of care workers and to make sure that they are appropriately remunerated.
I want to pick up another, perhaps specifically Green Party, point that no one else has picked up on. I noted that the chief executive of NHS England was recently forced into a new deal with private hospitals, which she said did not provide good value for money. The deal provides more care in private hospitals to help recovery from the Covid pandemic; it sees the Government going against NHS England and deliberately pushing up the role of the market in healthcare. For those who deny that this is happening, I am afraid this is very clear evidence of it.
I turn to a report of the Centre for Health and the Public Interest, which notes that the great majority of private hospitals rely entirely on NHS staff contributing outside their NHS hours on a self-employed basis. We are talking here about doctors and associated health professionals such as anaesthetists and other clinicians. The NHS paid for their training, pays for their pensions and covers their insurance, yet we talk about private hospitals “helping the NHS”. Listening to this debate, I think that perhaps as part of the amendments on Report, we need to think in the context of workforce planning about the financial contribution to be made by the private sector to the cost of training to adequately recompense the NHS for what the private sector gets out of it to make profits.
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I come now to a second group of amendments—Amendments 86 and 214—which look at local responsibilities. I want to make the point that in many cases the needs are local, and that if you train up local people who are already embedded in the community, they are very likely to stay in the community. That is why it is crucial that we have local plans and training pathways, so that a care worker who might want to take those care skills and then become a nurse and maybe a doctor over a lifetime of learning and education can bring all those different skills together, stay in one community and bring all those skills to that community.
I think it was in an earlier debate that the noble Baroness, Lady Brinton, referred to the problem of the shortage of dentists. We have just had the Great British Oral Health Report, and one stat from that which really struck me was that 22% of people in the north-west have not been able to register for a routine dental appointment. This is just the kind of supply problem we are seeing all the time. In the Morecambe Bay area, there are only 49 dentists for 100,000 people, which is obviously grossly inadequate.
I will make one final point, which picks up points made in particular by the noble Lord, Lord Kakkar, and the noble Baroness, Lady Whitaker, about the global aspect of this. There was a recent report from the International Centre on Nurse Migration, working with the International Council of Nurses, which stated that there is now a global shortfall of almost 6 million nurses. On top of that, it is estimated that 13 million more nurses will be needed over the next decade. Currently, the whole workforce is 28 million. This picks up a point that the noble Lord, Lord Patel, raised about pay erosion for all medical professionals, but it is particularly evident with nurses. The noble Lord, Lord Lea, again said that it was difficult to plan. We have to acknowledge that any medical professional in the UK can potentially take those skills and find a ready place to use them all around the globe. We know that many British doctors have gone to Canada, Australia and all around the world—and nurses the same.
We are a wealthy country. Traditionally, we have imported these skills, all too often from places that have a gross shortage—even far greater shortages than we have. We have to stop doing that. We have to train significantly more people than we need, because quite a number of them will, for whatever personal reasons, decide to go elsewhere, even if we are providing them with the best possible working environment we can. So we have to train vastly more people. That is our global responsibility.