Steve Barclay
MP for North East Cambridgeshire · Conservative · United Kingdom
“I speak to my brief exchange earlier with the Minister. As the previous speaker, the hon. Member for Harpenden and Berkhamsted, said, the draft regulations are fairly benign and very welcome to help people who are struggling with their bills.”
“The issue is not the lack of will; the issue is the alignment between procurement, regulation and clinical leadership, particularly in the colleges, as well as the ability to scale innovation—it is not about having more ministerial pilots.”
“Just to localise it to my own constituency, the Cambridgeshire and Peterborough ICB alone paid out £14 million in redundancies last year. It merged with a number of other ICBs to form the Central East ICB, yet we know hear from the Government that it should align with metro mayors, which means going back to exactly what it was before: the…”
“My right hon. Friend is absolutely right: the Government are spending millions of pounds and there is no plan. The measure was announced without working that out, it came as a surprise to many within the system, and it has had a chilling effect on many decisions. That is not isolated.”
“I rise to speak to clause 1 on the abolition of NHS England and clause 6 on promoting innovation. What characterises the first of those is an announcement without any clear plan. That is what has driven the cost and confusion that a number of Members across the House have spoken about.”
“All this is around 18 months on from the actual announcement. The confusion seems to extend to the Government themselves, because they seem unable to answer pretty straightforward written parliamentary questions. Given the time limit, I will give just a few examples.”
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“That is also noted, Mr Speaker. May I, on behalf of the Government, note the passing of the former head of the civil service, Lord Kerslake? He had a distinguished career in public service, including as chief executive of Sheffield Council and chair of King’s College Hospital NHS Foundation Trust, as well as being head of the civil service. We send our condolences to his family and friends both in Whitehall and across the civil service. With permission, Mr Speaker, I wish to make a statement on our long-term workforce plan for the NHS. This week marks the 75th birthday of the NHS. We should celebrate its achievements, its founding principles and its people. From doctors and dentists to pharmacists and physios, NHS staff devote their lives to caring for others.”
“It is a long-term commitment from a Government who are backing the NHS through the biggest investment in the NHS estate—over £20 billion —and a series of recovery programmes, expanding our diagnostic capacity and our surgical hubs. That is why the workforce plan is truly innovative. It does not just train more staff or offer opportunities to retain more staff; it reforms as well—something that is sadly lacking in Labour’s proposals.”
“Either Labour Members want to support the junior doctors, or they do not—once again, their position seems confused. I will finish with one final area of confusion on the Labour Benches. The hon. Lady talked about the elastic non-dom revenue raiser, despite the fact that the former shadow Chancellor, Ed Balls, has said that it would not raise the funds that are claimed. He has said that it would do quite the opposite: it would deter investment in the UK. In addition, Labour has already spent those funds on a range of measures, such as the breakfast clubs that Labour Members come to the House and talk about. The reality is that it would not fund Labour’s proposals, whereas we have made a commitment to back our plan with £2.4 billion of funding from the Treasury. This is a historic moment as we celebrate the 75th anniversary of the NHS.”
“We have delivered that—a 25% expansion in the number of medical students, who will come on stream in hospitals next summer. However, as we celebrate the 75th anniversary of the NHS, it is right that we also look beyond that to the longer-term needs of the NHS. That is exactly what the plan does with its doubling of medical places, but alongside that, it innovates by embracing things like a medical apprenticeship so that we can look at different ways of delivering training. The hon. Lady talked about strikes, which is a further area of confusion on the Labour Benches. Labour Members say that they do not support a 35% pay rise for junior doctors, on the grounds that the shadow Chancellor, the right hon. Member for Leeds West (Rachel Reeves), says that they should not.”
“The ultimate irony is that the shadow Health Secretary, in one of his many interviews, including interviews to promote his book, said that the NHS “must reform or die”. He said that it must reform, yet Labour’s proposals do not mention reform at all. Labour welcomes the plan, but it goes on to say that it will take too long to implement, while claiming that it is its plan, which, again, points to the confusion among Labour Members. Let me remind the House of what has been done. We had a manifesto commitment for 50,000 additional nurses—we are on track to deliver that, with 44,000 in place. We had a manifesto commitment to have 26,000 additional roles in primary care, and we have met that, with 29,000 roles in place. In 2018, we made a commitment to five new medical schools in parts of the country where it is hard to recruit.”
“A wide range of reforms came about as a result of the consultation with 60 different NHS organisations and are a key feature of the plan, but in Labour’s proposals reform is not mentioned once. In addition, Labour’s proposals are for a 10-year period. Our plan covers 15 years. Its proposal covered 23,000 additional health roles; our proposal deals with 50,000. I could go on and talk about the fact that the Labour proposal does not even mention GP trainees. Labour Members keep coming to the House and saying that primary care is important, but their proposals did not even touch on the workforce with regard to GPs. They did not even mention pharmacists, even though, as part of a primary care recovery plan, a key chunk of our proposal is Pharmacy First. It is extremely important that we can deliver services to patients in innovative ways.”
“Well, that really was a confused response. The hon. Lady began with reference to Labour’s proposals and the claim that our plan followed them. I took the precaution of bringing Labour’s announcement with me to the Chamber. Members can look at it in their own time, but it does not use the word “reform” once, despite the fact that “Train, retain, reform” is a key part of our proposals. Proposals for reform include moving from five-year to four-year medical undergraduate training; the expansion of roles such as physician associate; a significant expansion in the use of apprenticeships; and flexibility for retiring consultants, so that they can return to roles in, for example, out-patient services.”
“When I talk to NHS staff, they often talk about having different needs at different stages of their career—whether for childcare commitments, which relate to the measures the Chancellor set out in the Budget, caring for an elderly relative, or wanting to retire and work in more flexible ways—and the ICSs have a key role to play in that. I welcome my hon. Friend’s comment that this is a serious and complex piece of work, and that it was right that we took our time to get it correct.”
“Characteristically, my hon. Friend the Chair of the Health and Social Care Committee makes an extremely pertinent point about the role of the ICSs. As we move to place-based commissioning and look to integrate more, the interplay between the workforces in the NHS and in social care will be a key area where the ICSs will be extremely important. The ICSs will have a particular role in the apprenticeship and vocational training, which are key retention tools in those parts of the country where it is hard to recruit, as well as in offering more flexibility to staff.”
“We are already seeing a fifth more work than last year, due to the flexibilities that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) announced, including the ability for dentists to take on more work within their commission and the changes to the units of dental activity pricing to better reflect more complex work. Of course, we have 6.5% more dentists than in 2010, but we also recognise that within the £3 billion budget, we want to go further. That is why we are looking at proposals to go further than the measures announced, but progress is being made, with a fifth more activity than last year.”
“That is a key part of the workforce plan, and I think it is a key Conservative principle that they have that ladder of opportunity throughout their time in the NHS.”
“My hon. Friend raises a brilliant point. I do not know if Members know, but there are 350 different types of role in the NHS. It is really important that we get the right information to children whose parents are perhaps not informed about those opportunities. One point on which I slightly take issue with my hon. Friend is that it is not just those at the start of their career who need to be aware of the opportunities. This is about offering opportunities to people throughout their careers to progress and to take on more advanced roles. I strongly believe that we should not define people’s future career by where they are at 21 or 22; they should have the opportunity to progress.”
“The fact that we are talking to the workforce is shown by the fact that we have reached agreement with the largest workforce group in the NHS.”
“The right hon. Lady, for whom I have a huge amount of respect, is shaking her head, but it is a fact that the largest workforce group in the NHS are those on “Agenda for Change”, which covers more than 1 million healthcare workers from nurses, midwifes and paramedics through to porters, cleaners and many others. We have reached agreement with the NHS Staff Council, and those sums—the 5%, plus the lump sum in recognition of their tremendous work—is going into pay packets this month. So we have reached agreement, notwithstanding discussions with the junior doctors. They still demand 35%, and that is not affordable.”
“I know there will be consensus in the House that that is unacceptable, so we are working with trade union colleagues on how we tackle it. Again, with racism, we still have too many cases of concern. There are a number of areas of culture that we are working constructively with trade union colleagues and others to address.”
“My hon. Friend is exactly right. As a former Health Minister, he knows these issues extremely well. There is a requirement—this is something the chief medical officer, Professor Sir Chris Whitty, has spoken about—for more generalist skills in the NHS, not least given that one in four adults now has two or more health conditions. We need flexibility to respond to changes not just in technology, but in service design, which will evolve as well. My hon. Friend is also right about the wider issues of culture. I think the whole House was concerned about recent reports of sexual assaults linked to the NHS. One of the key features of the agreement we have reached with the NHS Staff Council is to work more in partnership on violence against members of NHS staff.”
“As we set out a long-term workforce plan, we are setting out that ambition for England, but we see very little from the Labour party in Wales.”
“It is simply not correct to say that this is simply about flexibility—for example, look at the very significant changes made on pension tax. That was the No.1 demand of the British Medical Association consultants committee, and the Government agreed to it. A significant amount of work is going on. The NHS people plan talked about not just flexibility but some of the cultural points that are important. Some roles that have been introduced need to expand, such as some of the advanced positions like advanced clinical nurse or physician associate, where there are opportunities for people to progress their careers. It is worth pointing out that, once again, not a single Welsh Labour MP has turned up to defend their party’s record in Wales.”
“Friend the Chancellor announced up to £7.5 billion for social care in the autumn statement, recognising that what happens in social care has a big impact on discharge in hospitals and hospital flow, which in turn impacts on ambulance handovers.”
“My right hon. Friend makes a valid point about the integration between health and social care, and that was a flagship part of the reforms in 2022, which brought the NHS and social care together through the integrated care system. I join him in welcoming the news about William Harvey Hospital, which is extremely important to the local area. On social care more widely, we must also be cognisant of the differences. The NHS and social care employ roughly similar numbers at around 1.5 million people, but one is one employer and the other is 15,000 employers, so the dynamics between the two are different. The prioritisation of that integration is exactly right. That is why my right hon.”
“There are measures upstream on boosting capacity in emergency departments and downstream on things such as virtual wards. A huge amount of work is going on. We are putting more than £1 billion into 5,000 more permanent beds to get more bed capacity into hospitals. On social care, in the autumn statement the Chancellor committed up to £7.5 billion of further investment over two years, and it was part of our reforms to better integrate health and social care.”
“That repeats the previous question, so I will not repeat the answer. It is slightly ironic to call for a plan for a new hospital programme and for a long-term workforce plan, and then criticise us when we deliver on both of those, as we have done with more than £20 billion of investment in the new hospitals programme, which we announced last month, £2.4 billion in the first ever long-term workforce plan and the biggest ever expansion of workforce training in the history of the NHS. Of course we need to take action in the short term to deal with the consequences of the pandemic. That is what our recovery plan does. The urgent emergency care plan that I announced in January takes specific action on demand management in the community.”
“My hon. Friend is absolutely right. As we boost our domestic workforce training, there will be scope to reduce the number recruited internationally. From 1948 onwards, international recruitment has always played an important role in the NHS, and we are hugely grateful for the service offered by those recruited internationally, but we also recognise that as demography changes in other countries, there will be increasing competition for healthcare workers around the world, so it is right that we boost our domestic supply. That is what this plan does, and it is why this is a historic moment for the NHS in making that long-term commitment that will in turn reduce the demand on the international workforce.”
“That means that people can get to the specialist they need, which in turn frees up GPs for those things that only GPs can do and ensures that patients can access care much more quickly.”
“The hon. Gentleman ignores the fact that since 2010, there has been a 25% increase in the NHS workforce. More than a quarter of a million more people now work in the NHS than was the case in 2010. There is a 50% increase in the number of consultants working in the NHS today compared with 2010, but the reality is that demand has increased as a result of an older population, advances in medicine and in particular the demands of the pandemic, and that is what we are responding to. We are also taking measures in parallel. We are on track to deliver our manifesto commitment for 50,000 more nurses, with 44,000 now in place. We also have beaten our manifesto target on primary care, with 29,000 additional roles in place.”
“Previously, in our most deprived communities we were detecting lung cancer late—80% were diagnosed late—but in those pilots we turned that on its head with 76% detected earlier. I know that my right hon. Friend, as a former Chair of the Public Accounts Committee, will agree that by detecting earlier, not only are patient outcomes far better but treatment is far cheaper, whether that is for lung cancer or through our innovation on HIV screening in emergency departments picking up HIV in people who do not realise that they have it. When we treat it early, the patient outcomes are better, and it is fiscally much more sustainable. That is how we will address some of his concerns.”
“I hope my right hon. Friend is pleased to see the measures we are taking with the Lord O’Shaughnessy review on clinical research trials to make it easier and faster to do research in the NHS. That in turn attracts private investment to the NHS. He will have seen the announcement I made on Tuesday of £96 million for 93 different research projects, such as at Great Ormond Street Hospital, where we have allocated £3.5 million for research into rare conditions in children. That translates into research that is then deployed, usually in adults. We are investing there, and we are screening 100,000 children through Genomics England. We have got a deal with Moderna and BioNTech so that we can have bespoke cancer vaccines. On Monday, we rolled out national lung cancer screening.”
“So the plan addresses the points she raises; that just does not seem to be the answer she wants to hear. As for flexibility being important to mums, yes it is, and the NHS has a largely female workforce, but it is also important to dads. It is important to all NHS staff that we have that flexibility.”
“I think there is actually a lot of agreement between the hon. Lady and I. She talked about the plan, and having read it a number of times—that is part of my role—I know that childcare is specifically referred to in the summary, no less, in terms of the key issues that it goes on to set out. It goes into detail about our proposals, including linking up to the NHS people plan and greater flexibility in terms of roles and people retiring. One aspect of the NHS Staff Council deal is the expansion of pension abatement rules. So there is a huge amount. The hon. Lady calls for more flexibility. I set out a number of the areas, and she does not seem to realise that there are three sections to the plan, with the second being all about giving greater flexibility to help retain our staff.”
“Those are both fair points. I know that my hon. Friend comes at this with great commercial experience, and I hope he knows that I have an interest in those issues. Just to reassure him, the plan is iterative; it is not a one-off. It is a framework from which we will do further work. Indeed, one of the areas that I am often criticised for is my interest in data and variation in data across the NHS—he and I probably agree on that more than some of those who are critical. That speaks to his point—the Chair of the Health and Social Care Committee’s point relates to this—that in a system the size of the NHS, data on the performance of the integrated care boards and their role in terms of the workforce is one area that the House will want to return to.”
“All I can say is that the hon. Gentleman clearly has not read the plan. If he had, he would have seen that it is developed by NHS England. That the Labour party is claiming authorship of it is slightly odd. As I pointed out in response to the shadow Health Minister, the hon. Member for Leicester West (Liz Kendall), Labour’s plan fails to mention reform at all, or GP training or physios. Our plan is 15 years, Labour’s is 10; it is a fraction of the size and it is flawed in many other ways. This plan has been developed by NHS England with contributions from 60 different organisations across the NHS. That is why it has been so widely welcomed by many in the NHS, who have called for it for some time.”
“I am pleased to see those services going into Scunthorpe. That underscores the investment we are making now while preparing for the long term, through the largest ever expansion in workforce training in the NHS’s history. My hon. Friend is right about the importance of tie-ins. Let me explain why that matters in particular for dentists: around two thirds of dentists do not go on to do NHS work. That is why the plan has looked at tie-ins for dentistry, which we will explore in the weeks and months ahead. [Official Report, 12 July 2023, Vol. 736, c. 7MC.]”
“The question started by saying that we do not want plans for the future, we want to deal with the present, and finished by asking if we can have a plan for the future rather than for the present. The plan sets out significant additional numbers. Significant investment is going into eye services here and now. Let me give the House one example: at King’s Lynn hospital, in addition to our investment in a new hospital to replace the reinforced autoclaved aerated concrete hospital, and in addition to the new diagnostic centre, I had the opportunity in the summer to open a new £3 million eye centre, which is doubling the number of patients who receive eye care in King’s Lynn. That is just one practical example of our investment in eye services now.”
“The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O'Brien) is looking at how we deliver more services within the existing contract, and at what incentives and reforms can be put in place to ensure that the parts of the country that find it hardest to recruit dentists are best able to do so, through both our domestic supply and international recruitment.”
“Barnett consequentials will apply to the £2.4 billion funding over the five years. In respect of new roles, regulatory changes apply on a UK-wide basis. The plan itself is for the NHS in England, but we stand ready to work with partners across the United Kingdom where there is shared learning on which we can work together.”
“My hon. Friend raises a perfectly valid point. As we expand the primary care workforce, there is a capital consequence. The 50% expansion he talks about builds on the expansion from 2,100 in training in 2014 to 4,000 now, so there has already been an expansion, but we are taking that further by 50%—and on the higher figure. His point about section 106 applications is absolutely valid, and that is part of the primary care recovery plan. I understand that he is discussing the importance of getting that funding in place with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough.”
“Our deal with Moderna, which is looking at individual bespoke vaccines for hard to treat cancers such as pancreatic cancer, will allow us to get ahead on that. We are already seeing a significant reduction in cervical cancer as a result of prevention measures. Likewise, by going into deprived communities with a high preponderance of smoking, the lung cancer screening programme is detecting lung cancer, which often presents late, much earlier, which in turn is having a significant impact on survival rates.”
“To take the hon. Gentleman’s first point, the plan does not get into individual specialties. That was a Health Committee recommendation, which I have discussed with the Committee’s Chair, my hon. Friend the Member for Winchester (Steve Brine). There is a clear reason for that. Within the framework of numbers, the impact of AI and service design will evolve over the 15 years, so it is right that we commit to the number and then the NHS take that work forward with individual specialities and have discussions with the royal colleges. The hon. Gentleman made a perfectly valid point about boosting capacity. We have already rolled out 108 of the 160 community diagnostic centres that we have committed to deliver. We are also looking to innovate, and I will give two practical examples.”
“Without repeating my previous answer on specialty, we are boosting a number of areas. There are 5,000 more doctors and almost 13,000 more nurses this year than last year. I have already touched on increasing the numbers in primary care. There are 44,000 more nurses, so we are on track to deliver our manifesto target of 50,000. There are 25% more within the workforce of the NHS compared with 2010. We are boosting the workforce overall. The plan is iterative and further work will go into which specialities are developed and how resource is prioritised as services are redesigned.”
“The hon. Lady raises a fair point. It also applies to the issue of stroke. The elderly population has increased in many coastal and rural communities. That has created significant pressure: for legacy reasons, services are often in other parts of the country. We have five new medical schools in place, and we have looked at those parts of the country where it is often hard to recruit. Part of the expansion will be to look further at what services are needed in different areas. The hon. Lady’s point also speaks to that raised by the Chair of the Health and Social Care Committee. By giving greater autonomy to place-based commissioning through the integrated care systems, we will enable people at a more local level to design the services and the workforce that they need, and that includes the flexibilities required to retain local staff.”
“All those developments will in turn help us to prevent health conditions, and treating those conditions early will be not only better for the patient, but better value for money for the taxpayer.”
“First, this is a plan developed by colleagues in NHS England, so these are assumptions that have been agreed by those who lead within the NHS. It is about ensuring that people operate at the top of their licence. It is about having new and expanded roles, such as advanced practitioners and associate roles, that allow people to progress in their careers and, in doing so, freeing up capacity for senior clinicians, who often spend time doing things that do not need to be done by people in those roles. Of course, there are also rapid changes in technology. We often talk about the developments in artificial intelligence, and I have touched on developments in the life sciences industry. I have also mentioned advances in screening and genomics.”
“I want to reassure the House that the new body will have teeth and will work at speed, that it will have the power to fine those who refuse to give evidence when they are required to do so, and that its predecessor’s investigations were typically concluded within a year. I hope that today’s announcements will be of some comfort to the bereaved families who have done so much to raise awareness of the failings of mental health care in Essex and elsewhere. I want them to know that the Government are committed to obtaining for them the answers that they deserve, and to improving mental health across the country. I commend this statement to the House.”
“My Department has therefore agreed to work alongside the Healthcare Safety Investigation Branch to prepare for the launch of a national investigation of mental health in-patient services, which will commence in October, when the HSIB receives new powers under the Health and Care Act 2022. The new Health Services Safety Investigations Body will investigate the following themes: how providers learn from deaths in their care and use that learning to improve services, including post-discharge services; how young people are cared for in mental health in-patient services and how that care can be improved; how out-of-area placements are handled; and how to develop a safe staffing model for all mental health in-patient services. Across all those areas, it will explore the way in which providers use data.”
“Dr Strathdee has made recommendations for how data and evidence can be used to identify risks to patient safety and failures in care more quickly and effectively. The findings and recommendations of the rapid review will be published today, and I will deposit a copy in the Libraries of both Houses. The Government will consider its findings carefully and respond in due course. We recognise, however, that patients and families want to know how their concerns will be taken forward as soon as possible, and I also recognise that a wide-ranging statutory inquiry relating to other settings, or covering multiple patient safety issues, would not deliver those answers quickly.”
“The Government are committed to improving mental health care across England, which is why we are boosting mental health funding by at least £2.3 billion this year compared with four years ago, why we are making urgent mental health support available through 111, and why we are delivering three new mental health hospitals to provide specialist care and cut waiting lists. In January, we commissioned a rapid review of how data is used in in-patient mental health settings in England. More effective use of data has the potential to reduce duplication, ensuring that healthcare professionals can spend more of their valuable time with patients. The review team—well led again by Dr Strathdee—heard from more than 300 people representing every part of the in-patient mental health sector, including former patients and frontline staff.”
“She has informed me that, owing to personal reasons, she will not be continuing as the inquiry’s chair, so I want to thank her once again for all her commitment and hard work. I am sure the House will agree that she is a true public servant. Our work to find her successor is proceeding at pace, and I will update the House on the progress of setting up the inquiry in due course. I recognise that Members’ concerns about mental health in-patient facilities are not confined to Essex.”
“In my assessment, I cannot properly investigate matters with this level of engagement.” She has also raised with me concerns about ongoing safety issues at the trust. To quote from her letter once again, she said: “I am very concerned that there are serious, ongoing risks to patient safety. Due to the nature of these issues, I am confident that these cannot be properly investigated by the Inquiry without statutory powers.” The Government take both concerns extremely seriously, and I agree with Dr Strathdee that we have now reached the point where the only appropriate course of action is to give the inquiry statutory powers. Statutory inquiries do take longer, but this does not mean that work will start from scratch. Dr Strathdee’s existing findings will inform the next phase of the inquiry.”
“Compared with 2019, patients absconding from care has decreased by more than 60%, and the use of inappropriate restraint has fallen by 88%. However, in January Dr Strathdee raised concerns with me about a lack of engagement with the inquiry by current and former EPUT staff. I know that many right hon. and hon. Members share her concerns. Since then, the inquiry and the trust have worked together in a concerted effort to increase staff engagement. None the less, I have listened to Dr Strathdee’s concerns that the inquiry still needs further staff engagement to get victims’ families the answers they deserve. In a letter to me in March, she said that “30 percent of named staff, those essential witnesses involved in deaths we are investigating, have agreed to attend evidence sessions.”
“The Government appointed Dr Geraldine Strathdee, a former national clinical director for mental health for NHS England, to chair the inquiry. I want to place on the record my thanks to Dr Strathdee and her team, because a lot of good work has been done. I applaud the bravery of all the victims and their families who have come forward to tell their stories. I also recognise the work that the Essex Partnership University NHS Foundation Trust—EPUT—has done to assist with the inquiry. The trust has been in the spotlight, and progress has already been made to learn lessons and improve in-patient mental health care. EPUT’s chief executive, Paul Scott, joined in 2020, and since then the trust has invested £20 million in its mental health in-patient wards and a further £20 million in community services.”