My Lords, I declare my interest as I recently stepped down as chair of NHS Improvement and as interim executive chair of what has become the UK Health Security Agency, including NHS Test and Trace. I congratulate the noble Lord, Lord Stevens, on his excellent maiden speech, and welcome him. Clearly, he will be a great addition to this House.
I am very supportive of the central thrust of the Bill, that of putting system-based working in health and care on a statutory footing. Modern medicine is a multi-disciplinary, cross-functional team effort. Most patients have multiple conditions and are cared for by multiple organisations. As the noble Lord, Lord Mawson, has just said, the largest determinants of healthy lifespan are not our health services but education, housing and the economy. To deliver great healthcare, the different parts of the NHS must work together, and to have longer, healthier lives, we need our NHS to work collaboratively with local government, public health, social care, the third sector and the private sector. This Bill puts that permissive, collaborative, systems-based leadership on a legal footing and, as such, I am pleased to support it. However, there are issues that we should challenge and probe in the Bill. I will focus on two.
The first, as many others have said, is workforce. These last two years have been challenging for virtually everyone in the world, but it is people working in health and care who have had to dig deepest, work hardest and bear the brunt of the fight against Covid. I thank every person working in health and care for what they are doing for all of us, day in, day out, night in, night out. Sadly, the Bill lets these people down by not being honest about the single biggest challenge that our health and care system faces: workforce. We do not have enough clinically trained people in almost every discipline, from healthcare assistants to consultants. When I joined the NHS four years ago, it was clear that we needed to do much more to support our people. From the basics of no hot food for people working overnight, to limited mental health support for people doing highly stressful jobs, through to the lack of honest and fair performance management, talent planning and career pathways, many of the basics that you would expect to find in large people organisations are not consistently available.
One of the things that is most glaringly absent is open and transparent planning for workforce numbers. Three years ago, I was asked by the then Secretary of
State to lead the development of the NHS people plan. The Interim NHS People Plan, published in June 2019, set out significant programmes to make the NHS a better place to work, to improve leadership culture, to recruit more nurses and to change the skills mix, but it did not contain any forecasts of workforce numbers. Why was this? It was not because the work was not done—it was—and not even because the Government disagreed with the numbers. There are no forecasts because we could not get approval to publish the document with any forecasts in it. My experience is clear. Unless expressly required to do so, government will not be honest about the mismatch between the supply and demand of healthcare workers.
It is depressing that we are debating the publication of plans, because it is not plans that the service needs but people, which means spending money on training. Over the last eight years, Health Education England’s budget has remained flat, while spending on NHS services has grown by over 40%. Unbelievably, today, a month after the Government’s spending review, Health Education England does not have an agreed budget even for next year, let alone longer-term funding. Clearly, we must also change how we work; otherwise, roll everything forward 20 years and virtually the entire UK adult workforce will be needed to work in health and social care. However, none of that change is likely unless we are honest about the real size of the problem. The Government refused to accept an amendment to Clause 35 in the other place, and I urge them to reconsider.
My second concern is in the drafting of the new powers of direction that this Bill gives to the Secretary of State. It is right that Ministers who account to Parliament daily on NHS issues should be able to direct the NHS to act, but it is also important that we have the right safeguards in place, especially when the inevitably short-term pressures of politics conflict with the longer-term realities of science. Will my noble friend the Minister carefully consider feedback on the safeguards required for the many expanded powers of direction in this Bill, including reconfigurations, organisation structures, HSIB investigations, and foundation trusts’ use of capital? The collaborative systems leadership at the core of the Bill requires openness and honesty about the difficult trade-offs that are inherent in managing our most precious public service. The Bill needs more of it.
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