I should like to make some progress. The hon. Gentleman had a very long time at the Dispatch Box and I think there should be more than just the three of us.
It is important to recognise the impact of the loss of the nursing bursary in 2016. The number of nursing student applications fell in England after the bursary was cut, so perhaps this is one of the ideas that I am sharing. The numbers recovered to some extent in 2019, when the bursary was brought back, but it is only £5,000, and tuition fees are more than £9,000 a year. Nurses in England are graduating with debt of about £50,000, and they need to begin paying it back immediately, which means that the money is coming out of their salaries. Perhaps that could be looked into.
If the number of medical students is increased, it is necessary not only to ensure that there are places on the ward where they can learn—this was mentioned by the hon. Member for Bosworth (Dr Evans), who is no longer in the Chamber—but to expand and fund the training places in hospital they will occupy after they graduate. There was a real problem last year when the extra medical students who were graduating could not find foundation jobs until the last minute. If graduates do not go through the foundation scheme, they cannot practise as doctors. We also need to invest in middle-grade specialist training in order to create consultants.
We need to recruit more from overseas, because progressing from student to consultant or GP takes nine or 10 years, while progressing from student to consultant surgeon takes about 15 or 16 years. Adding more student places will not solve the problem in the short term. We must, however, avoid recruiting from low and middle- income countries on the World Health Organisation red list. That is simply unethical, and is being reported as direct recruitment from trusts in England. We should be ruling that out. It should not be allowed and I think the Government could tackle the matter.
We have, unfortunately, lost freedom of movement, and it is clear from what Labour is saying that it will not return. That is a challenge for us in Scotland, because
we need people: we are facing a huge demographic challenge. The Government should put all health and social care roles on the shortage occupation list, and reduce visa costs and hassle. Forty-nine per cent. of overseas GP trainees in the UK report these issues, and 17% of those say that they may leave. The obstructive process of dealing with the Home Office is driving doctors away. The Government should perhaps also waive the NHS charge for staff who work in health and social care.
However, I agree with all the Opposition Members who have said that what is most important is retaining staff, because otherwise we will lose experience. Some decent pay would be a start, and after the pay freezes and after covid, those staff certainly deserve it. The Government are keen to rave about the independent pay review body when it suits them, but to ignore it when it does not. Nurses in Scotland were already being paid between £1,300 and £2,500 more than those in the rest of the UK, and to catch up with what is being paid to Agenda for Change staff in Scotland, the UK Government will need to provide a 14% pay rise for the coming year. If they did give a decent pay rise to the incredible staff who work in the NHS, devolved nations would also be able to fund a decent pay rise for their staff. Both Scotland and Wales are limited by having no real borrowing powers.
We need a review of the pay, terms and conditions and support for junior doctors, of how their rotas are managed and of their quality of life, because we need to understand why they are leaving the UK—part of that is wanting the adventure and experience of working overseas, so perhaps we should consider building that into our training schemes, giving junior doctors a flexible year in which to do research, work as a volunteer or work in another country—and, of course, we need reform of the mess that is the NHS pension. The lifetime and annual tax allowance system is penalising senior staff who do extra work. Many are refusing extra roles such as that of clinical director or educational supervisor. They are turning down the overtime that is critical to clearing the backlog, going part time, or even retiring earlier.
The Scottish Government and, I am sure, the Welsh Government are offering pension recycling and “retire and return”, but that is all the devolved Governments can do. The problem lies in the Treasury. This system was introduced in 2015, supposedly to deal with tax evasion and avoidance. It is nonsensical to apply it to a public sector defined benefit scheme. Pensions cannot be played with that way. The problem is that increases in the pension pot are being counted as income. Staff have no way to predict that, and end up being faced with vast bills simply for being able to work some extra weekends.
We also need to maintain the wellbeing projects that were started during the pandemic. All NHS staff are still facing a huge amount of stress this winter, which is made worse by the staff shortages and the increased demand resulting from covid, influenza and other respiratory infections. The covid data from 2022 shows that there was no respite. Unlike in 2020 and 2021, hospital admissions stayed relatively high, even between the peaks, which means that staff have literally been running non-stop for nearly a year and a half. As has
been said, staff are willing to work hard—they have always worked hard—but the problem is that when they go home at night feeling they did not do a good job and when they feel that their ward is not safe, that undermines both their commitment and their ability to do the job. The General Medical Council reports that burnout and dissatisfaction are the two main factors driving senior staff out of the NHS.
However, we must not forget social care staff. I was surprised that they were not mentioned in Labour’s motion. The standard measure of NHS performance in all four health services is the four-hour A&E target because it assesses the flow through a hospital from admission to discharge. It started to deteriorate in England in 2013, following the changes introduced in the Health and Social Care Act 2012, but it fell in all four health services in the later phases of the pandemic as hospitals tried to restart elective work. NHS Scotland is also struggling after covid, but let me gently point out, notwithstanding the snide comments from Tory and Labour Members, that Scotland is still the best-performing of the four nations in this regard.
Struggling A&E performance is driven not by A&E issues but by the back-pressure of patients who are waiting for beds—in other words, by delayed discharges. The lack of care workers to deliver home care is what is actually driving the A&E issue, and this should be the thermometer to test the temperature of the entire acute system. There are currently more than 160,000 vacancies for social care in the UK. We cannot fix the NHS without fixing social care, so we need a workforce plan for NHS and social care. As in Scotland, we need to respect care staff: pay them a minimum of the real living wage, not the pretendy living wage; pay sleepovers when they carry them out; and pay travel time. To have them doing all these things unpaid is undermining their take-home pay.
In Scotland, care staff are now registered and getting access to professional training and development. This is part of our plan for a national care system, but care staff need decent pay. They also need recognition and respect for the very tough job of looking after our loved ones. I cannot imagine anyone in this Chamber who could do the job. They need a career path so that good staff who enjoy delivering care can remain in the care sector and not just use it as a stopgap until they can get a better paid job on the till in a supermarket.