I am grateful to the noble Lord because that was a point I was hoping to come to when I lost my line. The budget will be agreed by the start of the new financial year and, as in all previous years, following the outcome of the 2021 spending review, spending plans for individual budgets in 2022-23 to 2024-25 inclusive will be subjected to a detailed financial planning exercise, and it will be finalised in time. We have also commissioned NHS England to develop that long-term workforce strategy and the key conclusions from this work will be set out.
Clause 35 will increase the transparency and accountability of the workforce planning process. Noble Lords referred to Her Majesty’s Treasury. The department is working closely with the Treasury to deliver a bigger and better NHS and social care workforce. The spending review 2021 provides a further £23 billion for the NHS for April 2022 to March 2025 and gives a three-year settlement. It will keep building a bigger and better-trained workforce.
Noble Lords also referred to agency staff. The flexible staffing policy aims to provide sufficient temporary staff to the NHS to meet fluctuations in demand. In 2015 the Secretary of State announced the introduction of several measures to reduce the agency spend, including price caps, procurement frameworks and expenditure ceilings. These have contributed to the NHS reducing spending on agency staff by one-third, but we recognise that there is more work to be done. We also recognise that the health and social care workforces are often spoken about separately, and the department is working to integrate the two workforces, as outlined in the integration White Paper. Noble Lords will recall that, in addition, we have started a voluntary register for care staff, which we hope to move to being mandatory in due course, following a consultation to better understand the landscape of the workforce, and to look at different qualifications and make it a better career.
We know that work on long-term workforce planning at a national level will need to be replicated at a local level. Subject to the passage of the Bill, ICBs should be the vehicle to support that. To guide that work, in August 2021 NHS England published draft guidance for ICBs explaining their central role, ensuring that the health and care system has the necessary workforce to meet the needs of the populations it serves. A copy of this guidance has been laid in the House Library. In addition, the amendments on ICBs’ forward plans and
annual reports will require ICBs to report on how they exercise their duty to promote education and training for the current and future workforce.
Amendment 82 refers to safe staffing. The Government are committed to ensuring that we deliver safe patient care and that there are safe staffing levels across the NHS. Safe staffing should remain the responsibility of local clinical and other leaders, supported by guidance and regulated by the Care Quality Commission. The ultimate outcome of good-quality healthcare is influenced by a far greater range of issues than how many of each staff group are on a shift, even though that is clearly important, and it is why the Government are committed to continuing to grow the workforce.
I now turn to the amendment addressing GP distribution. We fully support the intention, particularly as part of our agenda to level up and recover from the pandemic. However, the pandemic’s impact on the workforce is not yet fully understood and the system is moving to meet the impact in new ways. As a result, a review of GP distribution is likely to be premature but, as noble Lords will recall, we have opened new medical schools in areas where there has been a lack of workforce, in the knowledge that many people stay in the areas where they were trained. That is part of our plan to make sure that there is more equitable distribution. We will also use the targeted enhanced recruitment scheme to incentivise trained doctors to work in hard-to-recruit areas.
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On Amendment 168, we will act on the underlying issue of underrepresentation of the royal colleges in the appointment of consultants. My officials are looking to undertake improvements regarding these regulations and what has been said is clearly common sense. Both royal colleges referred to have great reputations; many great surgeons and others have been trained there in the past—indeed, Arthur Conan Doyle studied in Edinburgh. It is important to remember that this is common sense. I assure the House that I am advised that the current regulations do not prevent trusts seeking alternative members to contribute to the consultant appointment process.
I am grateful to everyone who contributed to the debate. I hope I have given some reassurance. I hope noble Lords will recognise that I have engaged with them on a number of different issues in an attempt to close the gaps. I am afraid that, on this issue, I am unable to go much further at this stage. On that basis, I hope—perhaps in vain—that my noble friend will feel able not to press her amendment.