PARLIAMENTARY DEBATE
NHS Workforce Expansion - 28 February 2023 (Commons/Commons Chamber)

I am honoured to speak in the debate and to follow my good friend, my hon. Friend the Member for Birkenhead (Mick Whitley). I, too, place on record my thanks and appreciation and solidarity with all groups of NHS workers, who go above and beyond in keeping us safe and looking after us. In the limited time available, I will concentrate my remarks on the NHS cancer workforce, particularly the NHS radiotherapy workforce. I declare an interest as the vice-chair of the all-party parliamentary groups on cancer and for radiotherapy.

It is important to think about the impact of the Government’s plan—or lack thereof. I congratulate my hon. Friend the Member for Ilford North (Wes Streeting), the shadow Secretary of State for Health and Social Care, on being a man with a plan; I hope that the Minister is a woman with a plan to address the real crisis in cancer services and to take the opportunity afforded by making the best use of and expanding our highly dedicated and highly skilled radiotherapy and cancer workforce.

Our performance as a nation is lamentable: cancer patients have been waiting longer for treatment every year since 2010, partly due to problems with workforce recruitment and retention. Performance on the two-week cancer referral waiting time has fallen to record lows and the 62-day waiting time standard for cancer treatment following a GP referral has not been met since 2014. It is really important that the potential of radiotherapy, and of the workforce, is not overlooked by Ministers. They must take steps to address the cancer backlog and improve patient survival rates.

I refer the Minister and hon. Members to an excellent article by Martyn Brown—not in the Labour-supporting Daily Mirror, but in the traditionally Conservative-supporting Express—that highlights some of the shortcomings in the radiotherapy service. In that article, Bryan Robson, the former England and Manchester United captain, expounds and explains the value of precision radiotherapy. It is quite bizarre that a treatment capable of achieving cures for as little as £3,000 to £7,000 is delivered by fewer than 6,500 specialist staff across the whole of the country. The demands are increasing: Cancer Research UK estimates that the number of cancer patients per year will jump from 384,000 to over 500,000 by 2024. Many of those patients will need radiotherapy, but at present, the workforce levels and the provision of equipment will not meet that demand. I remind the Minister that, among those people who will be diagnosed with cancer, deaths are projected to rise by a quarter.

International standards show that at least 53% of cancer patients need radiotherapy, but here in the UK, we are miles off that target. Only 27% of patients had access to radiotherapy in 2019, and that figure got worse during the pandemic. There is a crisis in cancer care; there is a lack of treatment capacity; and there is a workforce crisis in radiotherapy. The Royal College of Radiologists estimates that the NHS would need to employ 480 radiology consultants overnight to clear the backlog of CT and MRI scans within a month. Numerous workforce surveys point out that the workforce do not have the equipment to meet future demands, and 94% of respondents to one survey did not feel that the Government understood the impact of the current situation on the radiotherapy workforce. If we lose our radiotherapy workforce, we lose the radiotherapy service. If we do not give those people the tools to do the job, we will never have a world-class cancer service.

We are here today because, for a decade, the Government have failed to invest in the workforce of the NHS. Just as an example, there are more than 3,000 posts unfilled for ambulance drivers and paramedics, the highest level for five years. The Government have failed to train the staff, which in turn has fuelled record waiting times for ambulances and poorer outcomes for patients. There are 3,334 vacancies. Quite often, the Government will say, “It’s Ukraine, it’s covid”—it’s anything but Government failures—but the truth is that that figure of 3,334 vacancies is nearly double what it was a year earlier, and three times higher than in September 2020. Heart attack and stroke victims waited an average of an hour and a half for an ambulance and of course, with those illnesses, every minute matters.

We have talked about investment. The Minister has said that there will be an extra £14 billion for the NHS over the next two years, but she fails to accept that, because of the Government’s poor planning, trusts have been backed into a corner. The North West Ambulance Service has spent over £15 million on private ambulances in the past year—how many staff would that money fund? We are talking about short-term fixes, rather than long-term plans. That is not the only example. NHS trusts across England increasingly rely on expensive agency staff. One organisation is shelling out as much as £2,500 for a single agency nurse shift. We have nurses on picket lines to oppose the pittance they get. The NHS paid more than £3 billion to agencies to provide nurses and doctors at short notice during 2021-22. That was a 20% increase on the year before, when health services paid out £2.4 billion on short-term fixes, leaving long-term problems. Temporary staff have vital roles in providing safe care, but they should not be continually used to offset a shortfall in permanent staff. Sadly, my fear is that that will become the norm.

Trusts in England spent £6 billion on bank staff in 2021-22, taking the total spend on additional staffing to around £9.2 billion. Published analysis suggests that one in three NHS trusts paid an agency more than £1,000 for a single shift, while one in every six trusts paid more than £2,000. That is a disgraceful indictment of the health service. You almost think people are trying to privatise it through the back door—underfund it, destroy it and let the private sector pick it up.

That comes amid a record nurse shortage across the NHS. We have heard about the additional staff we have, but I would like to know where they are, because we have 47,000 vacancies for nurses. Again, we have a short-term fix and long-term pain. This crisis cannot go on and we need to understand that it is a Government failure. I welcome the shadow Secretary of State bringing this debate forward, because the situation has become urgent and it needs serious discussion and serious plans. It is disappointing that the hon. Member for Newcastle-under-Lyme (Aaron Bell) was critical of Scottish and Welsh Members being here. It is interesting to see the Government Benches: there is no one here to defend the record because it is indefensible.

It is not just about ambulances and nurses. The hon. Member for St Albans (Daisy Cooper) mentioned district nurses, dentists and GPs. According to the BMA, we now have 2,078 fewer GPs than we had in 2015, despite Ministers telling us we have thousands more. Where are they? They are certainly not in Blackburn. Then we come to cancer patients. Again, we hear constantly about covid. Someone close to me, through a late diagnosis and a lack of treatment, sadly died in 2017. Had he got that diagnosis earlier, he would still be here today. That brings me on to Macmillan and cancer support.

Cancer waiting times in England have plummeted to the worst on record. Last year was the first in the 13-year history of Government records in which all national cancer targets in England were missed for at least a month. In a system that has already reached breaking point, we need the Government to take measures now to address cancer workforce shortages and to put urgent plans in place to help cancer services. As my hon. Friend the Member for Easington (Grahame Morris) says, 3.3 million people will be living with cancer by 2030. We need our workforce capacity to grow by 3,371 nurses.

Macmillan was encouraged by the Chancellor’s commitment to work with NHS England to develop a long-term workforce plan and to publish workforce forecasts for the next five to 10 years. Sadly, we have already lost 10 years, and too many people have paid the price—patients who through failure of treatment have lost their lives, and staff who are burned out. We have ambulance staff on stress medication, and nurses concerned about how they will manage to feed their families. Is that an NHS to be proud of? It is certainly something I am not proud of. I was always proud of the NHS in the UK, which was held up as a great example across the world. We are now embarrassed by the state of the NHS. I watched a programme last week about hospitals with burst sewer pipes and not enough nurses to make sure that patients were saved. It is disgraceful. This Government must bring forward not the gloss of “We are doing this, this and this”, but a serious plan identifying serious role shortages, a plan to fix it and to make sure the resources are put in place to carry those promises through.

We have two speakers left before the wind-ups. I should imagine that the wind-ups will start at about 4.20 pm, if those Members stick to five minutes, so anybody who has taken part in the debate so far should head back to the Chamber.

Staffing in the NHS is at crisis point. Not many days pass before I find myself retweeting a job being advertised by the North Tees and Hartlepool NHS Foundation Trust. These jobs include many senior roles such as consultants, specialist paediatric nurses and theatre staff, but we of course need staff across the trust, and they are not easy to come by. In recent times, nurses have been recruited from as far afield as the Philippines, and they continue to play important roles in our two local hospitals. On Teesside, we desperately need the staff to provide the services to address some of the worst health inequalities in the country. Apart from training the staff, we need them to have a good place in which to work, and I hope that our new diagnostic centre in Stockton town centre will provide the best of working conditions and technology. However, as I always say in health debates, it is a new hospital that we need in Stockton if we are really going to get to grips with those health inequalities.

I would like to concentrate on the staffing and funding challenges facing the palliative care sector. People with a terminal illness rely for their end-of-life care on specialist palliative care workers employed mainly by charitable hospices, and also on generalist health and social care workers. GPs and district and community nurses also play a particularly important role alongside hospice at home services in caring for the increasing numbers of people dying at home. I admire each and every one of them—it is not a job I could do—and we need to ensure that staff get the ongoing support they need, including ongoing professional development, to help to deliver the care that is needed.

Despite the fact that every health and social care worker is likely at some point in their career to be involved in caring for people experiencing dying, death or bereavement, for many, palliative care and end-of-life care training is not currently a compulsory part of either initial training or continuing professional development. This must be addressed to ensure that the entire health and social care workforce are able to provide the end-of-life care we need. Marie Curie, with which I have had the privilege of working over my time in Parliament, has worked up recommendations for the current challenges. It proposes a long-term funding settlement to enable the palliative and end-of-life care sector to attract and retain a workforce sufficient to ensure no one misses out on the care and support they need at the end of their lives.

In the next 25 years, the number of people aged 85 years and over in the UK will almost double—I hope that I will be one of them—so demand for palliative care and end-of-life services will increase due to larger numbers of people living longer, with multiple and complex health conditions, and it is important that every person at the end of their life receives the care and support they need. However, as this debate has laid bare, there is a real crisis in training and recruitment across the NHS, and it is reflected in the palliative care sector. The failures in training and recruitment are damaging our ability to deliver care to some of our most needy people—people at the very end of their lives. Only Labour’s plans will put it right. It is time for that general election.

It has been a long wait to speak—and it is a pleasure to follow my hon. Friend the Member for Stockton North (Alex Cunningham)—but I tell you, Mr Deputy Speaker, that the longer the Conservatives are in power, the longer patients in Putney, Roehampton and Southfields will have to wait for healthcare treatment. The Conservatives blame everything, from the weather to the pandemic and even NHS staff themselves, but it is the 13 years of their failure that has broken the NHS and brought us to the state that we have outlined in this Opposition day debate.

More than 7 million people are waiting for months, even years, for treatment, and held back from working and living their lives to the full. I declare an interest because my parents have been on waiting lists for their operations for a long time, as have other family members, one of whom sent me a message before the debate:

“Long term pain is very debilitating, and not waiting in pain for many months would have been better for my mental and physical health.”

That is the toll that being on a waiting list and waiting for treatment is taking for 7 million people across the country right now. There are more than 133,000 vacancies across the NHS, which is an all-time high, and the NHS is short of more than 47,000 nurses, 9,000 hospital doctors, and 4,200 GPs.

I knew the situation was bad, but I did not realise how bad until I spent the afternoon at my local A&E at St George’s Hospital back in January. The staff are providing excellent care, under what are increasingly very difficult circumstances. Everyone I spoke to said that it was the worst time they have experienced, and they have been through covid. The winter ward opened in St George’s last winter, but had to stay open all last year. There is now no more space on the A&E ward, and they are having to take on corridor care for the first time ever. They do not want to have to do that, but that is the state they are in.

Let me briefly highlight some gaps in our community care, in the social care plan, which I hope soon to be hearing about from the Government. First is the critical bed shortage for those with eating disorders. Second is the care shortage for Korsakoff dementia patients. Third is frail patients—those who have had a stroke or a fall and who need much better support. Fourth is those with functional neurological disorder and the need for bed-based neuro-rehab treatment. I have raised that issue in previous debates, and people who are treating those with FND have got in touch to say that yes, there is a critical gap. Finally, there is the impact on breastfeeding support and end-of-life care because of the shortage of district nurses and health visitors, as outlined in Labour’s plan. The Royal College of Nursing has issued an unprecedented warning that district nurses are “critically endangered” and face extinction by the end of 2025 if urgent investment is not made. It makes financial sense to have more care at home, rather than people going into hospital, but the past decade has seen a 47% reduction in the number of qualified district nursing staff in England. That is why we need Labour’s plan.

By the end of Labour’s time in office, public satisfaction with the NHS was at an all-time high of 70%. It is now at a 25-year year low of 36%. Currently, four in 10 people attending A&E wait for four hours to be seen. Under Labour, 95% of A&E patients were seen in under four hours. Things can be very different. As has been highlighted, the Chancellor, the right hon. Member for South West Surrey (Jeremy Hunt), has said that Labour’s plan was

“something I very much hope the government also adopts on the basis that smart Governments always nick the best ideas of their opponents”.

Labour Members hope that those good ideas—Labour’s plan—will be nicked. Labour will double the number of medical places, will deliver 10,000 more nursing and midwifery clinical placements, will train twice the number of district nurses per year, and will deliver 5,000 more desperately needed health visitors. Labour’s plan is fully costed and fully funded, and the Minister is welcome to it. Will she take it and save our NHS?

I commend the powerful contributions from my hon. Friends the Members for Stretford and Urmston (Andrew Western), for Wakefield (Simon Lightwood), for Bristol South (Karin Smyth), for Birkenhead (Mick Whitley), for Easington (Grahame Morris), for Blackburn, for Stockton North (Alex Cunningham) and for Putney (Fleur Anderson), as well as the hon. Member for St Albans (Daisy Cooper). We also heard speeches from the hon. Members for Newcastle-under-Lyme (Aaron Bell) and for Mansfield (Ben Bradley), although most of the parliamentary Conservative party seem to be absent today.

Before he became Chancellor, the right hon. Member for South West Surrey (Jeremy Hunt) sent an email in which he addressed Labour’s NHS workforce plan. He said:

“Smart Governments”—

chance would be a fine thing with this lot—

“always nick the best ideas of their opponents.”

It has been interesting to watch those on the Government Benches tying themselves in knots to try to unpick our workforce strategy when they know that their Chancellor privately supports it and will, in all likelihood, be forced to swallow his pride and nick it sooner rather than later. They do so to try to mask the depressing truth: they have no plan and have not had one for years.

The NHS has a current shortage of 9,000 hospital doctors and 47,000 nurses. Staff are at breaking point and patients are being failed on an unprecedented scale. Some 7 million people—let that sink in—are waiting months and even years for treatment. Heart attack and stroke victims are routinely waiting over three hours for an ambulance. Patients are finding it impossible to get a GP appointment when they need one. The system is in crisis and the Government will not even admit it, let alone address it. I do not know what cloud cuckoo world the Minister who opened this debate is living in, but it is not the one that my constituents live in and I suspect it is not the one her constituents live in. The reality is that they have cut medical school places and wasted precious time trying to force through an unworkable and unethical Bill to sack striking nurses. They have had 13 years and the best they can do when faced with an acute workforce shortage is threaten to sack NHS staff, an idea that would be farcical if it were not so dangerous.

In the absence of a coherent Government strategy, there are already rumblings on the Tory Back Benches about the future of the NHS. Just a few months ago, a former Health Secretary said he thought that the NHS should start charging for A&E and GP visits. The absolute brass neck of it! To neglect a service for 13 years, fail to train the necessary staff, systematically mismanage it, and then pretend there is no alternative but to charge patients money to fix the mess they made. Not on Labour’s watch. The core principle of the NHS—a publicly funded service, free at the point of need—is non-negotiable. The problem is not the NHS; the problem is how it has been managed by this out-of-touch and out-of-ideas Government.

It is worth saying it over and again: Labour has a plan to build an NHS fit for the future. We would double the number of medical school places to 15,000 a year; double the number of district nurses qualifying each year; train 5,000 new health visitors; and create 10,000 more nursing and midwifery placements each year. We would train 8,500 mental health professionals and put hubs into the heart of our communities, so that people can access vital mental health treatment within a year. That would come alongside a 10-year strategy for change and modernisation within our NHS. It would be funded by abolishing the non-dom tax status, because patients need treatment more than the wealthiest need a tax break. I hope that in her response the Minister will give clarity on why the Government have decided to side with the non-doms rather than the nurses.

Will the hon. Gentleman give way?

I will not give way.

I appreciate that scrapping the non-dom tax status might be awkward for the Chancellor’s relationship with his next-door neighbour, but I fail to see how he, or indeed any hon. Member on the Government Benches, can justify inaction. In fact, I fail to see how anyone can look at the state of our national health service and vote for non-doms over NHS staff. On that, I will give way to the non-dom-loving hon. Gentleman.

I would like to inquire whether the Labour party takes donations from non-doms, because the Leader of the Opposition and the shadow Chancellor have refused to rule it out. Does the Labour party take donations from non-doms?

The point is that we will tax them. I do not know what the hon. Gentleman is getting at. Perhaps he should give an intervention on something he knows about, rather than something he does not. Siding with the non-doms is the position of this Tory Government.

When the Minister stands up to speak, she will reheat the lukewarm excuses from a Government allergic to accountability. She will blame the pandemic—we have heard it before—even though waiting lists were at a record high before covid hit these shores. She will blame striking NHS staff, conveniently ignoring that her Government do not have the decency even to talk to staff about pay. For months, she could have averted the strike action. She will blame anyone but herself and her Government. She will not mention the 13 years they have had in power. Instead, she will talk as if she has only just started on the job. “A plan is coming,” she will say, while this rudderless Government flip-flop around behind the scenes and patients continue to wait in agony.

Why should the people of this country have to settle for such mediocrity? The NHS is an institution that, if run properly, can and should be the envy of the world. Things do not have to be this way. The last Labour Government left office with the lowest waiting times and the highest patient satisfaction on record. That golden legacy has been torched by the Tories. I do not trust the arsonists to put out the fire, and neither do the British public.

If after telling Conservative MPs to vote against our plan, the Chancellor does decide to nick our workforce strategy, my hon. Friend the Member for Ilford North (Wes Streeting) and I will be delighted, because it will prove once and for all that there really is no point in this clapped-out Government if all they do is dither, delay, U-turn and nab Labour’s policy anyway.

In closing, I suggest that it would be much better for this zombie Government to move out of the way, call a general election and let the next Labour Government get on with the job of rebuilding our country after 13 years of Tory managed decline. Until then, Labour’s message to patients is clear: the cavalry is coming. We will give the NHS the staff, the tools and the technology that it needs to thrive. That will come alongside a relentless mission to improve patient standards and reform the systems within the NHS that are currently failing patients. We will build an NHS fit for the future; we have done it before and we will do it again. I commend our motion to the House.

Let me first pay tribute to all the wonderful staff across the NHS who day in, day out give their all for their patients. I should mention doctors and nurses but also cleaning staff, porters, receptionists, radiographers, physios and many others who make such a difference to patients’ experience.

It is disappointing that, once again, the Opposition have used the debate to talk down the NHS and not to recognise the incredible achievements and progress made: treating more patients than ever before; working on our plans to eradicate cervical cancer; progress for people with HIV, who are now able to have a normal life expectancy; reducing stillbirths by 21%; and reducing neonatal deaths by 17%. Those are just some of the achievements of our incredible staff for patients in this country.

Anyone listening to Opposition Members would think that life under the previous Labour Government was a health panacea. When we came into government, MRSA was rife across the NHS, with wards and hospitals closed, operations cancelled and patients dying from infection. Clostridium difficile was the same—in 2008, there were 8,300 deaths. Deep cleaning was needed across hospitals to keep them open and try to prevent infections. The Labour Government’s pledge to end mixed-sex wards failed; the then Health Secretary, Alan Johnson, announced that they had “got it wrong” when they could not manage it. Elderly women were sharing bays with young men, separated by just a curtain—there was no dignity for patients at all.

Then there was the PFI scandal, as my hon. Friend the Member for Newcastle-under-Lyme (Aaron Bell) pointed out, with £300 billion of debt for the taxpayer for projects worth just £54.7 billion. There was a £26 billion IT scheme that never saw the light of day. Undeterred, the Labour leader is now doubling down on his “fit for the future” plans for the NHS. When Labour was last in government, its “fit for the future” plans closed hospitals up and down the country, with plans to close the Princess Royal in Haywards Heath in my constituency. Between 2003 and 2010, in the last six years of the Labour Government, 26,000 beds were closed. That was the legacy of the last Labour Government for the NHS.

There are three precious elements of the NHS. There is the building infrastructure, which we are putting £10 billion of capital funding into this year—that is part of the 40 hospitals that we are now building to create better infrastructure for the future. We are also introducing state-of-the-art facilities, with over 90 rapid diagnostic centres and over 90 surgical hubs now open. We are eliminating our two-year wait for procedures, and are on track to eliminate our 18-month wait from April.

Of course, our staff are the most precious element of all. We are not pretending that things are perfect. As the hon. Member for Bristol South (Karin Smyth) said, there are pressures, backlogs and delays in England, Wales and Scotland. It is pointless to play politics with the issues; those are the facts.

Let me list exactly what we are doing now to invest in our staff. We are on track to deliver 50,000 more nurses across the NHS by next year. We have 38,000 more nurses than in 2019. We have record numbers of staff in the NHS, with more than 1.25 million members of staff—41,800 more than a year ago. We have 4,800 more doctors and 10,900 more nurses. Last year, we had 72,000 people training to be a nurse, 9,000 people training to be a midwife and 30,000 people training to be an allied health professional. We had a 16% increase in students accepted on nursing and midwifery courses. We had 3,400 people starting a degree nurse apprenticeship, earning while they are learning and not accumulating student debt. We had student nurses supported with a student bursary of £5,000 a year.

Last year, we had over 19,400 non-UK nurses and health visitors joining the NHS. We had 11,600 non-UK doctors. We have funded 1,500 more medical places each year—a 25% increase over three years. We have five new medical schools, which are in Tyne and Wear, Essex, Kent, Lincolnshire and West Lancashire. We have 7,630 new entrants to undergraduate medical courses. We have introduced medical degree apprenticeships. With regard to retention, we have suspended until 2025 the rules on nurses who retire and the restricted hours that they can do, and we are consulting on removing pension barriers.

We are developing a workforce plan, as set out by the Chancellor. We are working with midwives, with Birthrate Plus, on staffing ratios in maternity units. We are on track to have 27,000 more mental health workers. We are rolling out mental health support teams in our schools. We are introducing Oliver McGowan training on autism across healthcare. We have had 3,000 undergraduate student dentists over the past few years. We had an increase of 539 dentists providing NHS services in the past year. In England, we have 2,500 pharmacists entering training each year. We have had a net increase of 1,400 pharmacists a year since 2016, and we are increasing the number of pharmacy technicians.

I could go on, because that is just the tip of the iceberg when it comes to our investment in our staff. I will take no lectures from Opposition Members, because RCN statistics show that Labour-run Wales has 2,900 nurse vacancies and is spending £140 million on agency nurses. In fact, the emergency medicines workforce census this year says that there is one consultant in Wales for every 7,784 patients at A&E. [Interruption.] Opposition Members may laugh, but in Wales there are simply not enough staff to cope.

I will finish by addressing Labour’s non-dom tax plan, which is as much use as an ashtray on a motorbike. Labour Members’ non-dom tax plan for transforming the health service would raise just £3.2 billion. Not only have they spent that 10 times over, but their flagship policy—the shadow Secretary of State wants to scrap GP partnerships—will cost more than £7 billion, and buying them out and tearing up GP contracts will cost £1.7 billion a year. The Opposition are economically illiterate. [Interruption.] The shadow Secretary of State has said on the record that he wants to abolish GP partnerships. Perhaps he wants to clarify that and say it is not what he wants to do, but I do not see him rising to intervene.

This Government will not fall for the fairytale Labour party policies. As I have said, we are delivering now—not in the future—the many ways in which we are increasing our NHS workforce. We are focused on tackling covid backlogs, improving our services for patients, and increasing our NHS workforce in England. Let us see what happens in Wales with the Labour plans, but we value each and every one of the members of the NHS who deliver for patients day in, day out.

Question put: