Clause 96 - Ensuring sufficient skilled health care workers for the health service

Care Bill [Lords] – in a Public Bill Committee am 4:30 pm ar 28 Ionawr 2014.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Photo of Jamie Reed Jamie Reed Shadow Minister (Health) 4:30, 28 Ionawr 2014

I beg to move amendment 162, in clause 96, page 86, line 36, at end add—

‘(3) HEE must promote inclusive health-related education and training for healthcare workers.

(4) HEE must exercise its functions in this section with a view to ensuring appropriate long-term planning is undertaken to ensure a sufficient number of skilled healthcare workers is maintained.

(5) HEE must exercise its functions in this section with a view to ensuring that the number of skilled healthcare workers is matched closely to the health service’s need for them.’.

Photo of Andrew Rosindell Andrew Rosindell Ceidwadwyr, Romford

With this it will be convenient to discuss amendment 164, in clause 98, page 88, line 10, at end insert—

‘(12) The Secretary of State must make a statement to Parliament if HEE projects that the number of skilled healthcare workers available is lower than the required level.’.

Photo of Jamie Reed Jamie Reed Shadow Minister (Health)

The amendments seek to improve the framework surrounding Health Education England to ensure that sufficient regard is given to forward planning in work force matters.

Amendment 162 deals with two separate issues, but I will touch on the first only lightly given the airing it received in the previous debate. The amendment seeks to add further functions to the clause and therefore to extend the duties placed on Health Education England. The first new function bestowed on it is to promote an inclusive work force that should include disabled persons.

We have outlined in some detail the manner in which the whole work force benefits from extra inclusivity, and the amendment extends the logic of the argument in the previous debate. That is clear for everyone in Committee to see. This section of the amendment supports the aims of amendment 161, as discussed in the previous grouping, and again I extend my thanks to ALLFIE, which has worked so hard to bring this issue to our attention and to that of Members throughout the House to ensure that inclusive education is at the heart of what Health Education England does. As the Minister’s previous response indicated, we are all serious about that. It is a commendable aim, which I wholeheartedly support. I hope that the Minister will echo those sentiments in his remarks.

The rest of amendment 162 would add a further two duties to be placed on Health Education England. Clause 98 as it stands requires the Secretary of State to publish a document that specifies the objectives and priorities that the Secretary of State has set for Health Education England for the year ahead. Incidentally, for a Bill designed to promote the devolution of responsibilities to a local level, the Secretary of State’s inbox appears to be filling up rapidly.

Nothing in the Bill ensures that Health Education England takes a long-term approach to work force planning. It must ensure a sufficient number of skilled health care workers, that this sufficiency is maintained and that demand for staff is well matched to supply. To do so, a key focus for Health Education England is to be involved continuously with long-term planning. That is crucial in an industry where it takes years and years to train staff. Amendment 162 would therefore extend the matters to which Health Education England must have regard when exercising its functions. If the Minister opposes the amendment, I should be grateful for an explanation of how long-term work force planning can be guaranteed under the listed provisions.

On amendment 164, another key recommendation of the Francis report is the introduction of minimum staffing benchmarks to ensure a safe service. It is regrettable that the Government are dragging their feet on this, but it is a welcome step forward that Health Education England has a duty to ensure that sufficient staff are well trained. The amendment seeks to ensure sufficient parliamentary scrutiny should Health Education England fall short of that duty. I will elaborate on what the amendment would achieve and why that is necessary.

The amendment would add a subsection to clause 98 that would require the Secretary of State to make a statement to Parliament if Health Education England projected that the number of required skilled health care workers exceeded the numbers available. Therefore, if Health Education England were to project that there are or will be too few doctors, nurses, health care support workers, surgeons and so on, they would have to come to the House of Commons to make a statement on the matter. That would be necessary because hon. Members on both sides of the House would want to express their concern about what would be an extremely worrying scenario—vexatious, even—as well to scrutinise effectively the failure of a non-departmental body for which the Secretary of State had responsibility.

If Parliament’s authority is used to give Health Education England the means to function, it is right that it has effective oversight of its functions. Given that one of HEE’s key roles is to ensure that there are sufficient skilled workers in the health service, it would not be conducive to responsible governance to allow failure in that role to go by without scrutiny.

Some might argue that that scrutiny and oversight role would be better suited to, and carried out more effectively by, the Health Committee. That might be right, but the amendment would not stop HEE officials from being called to give evidence to that Committee. The amendment refers to the Secretary of State for the simple reason that, under clause 98(1), he or she will have responsibility for setting out objectives and priorities for Health Education England

“in relation to the education and training to be provided for health care workers”

If a shortfall in the number of required workers manifests itself, the Secretary of State will be as culpable as the non-departmental body for which he is responsible. Given the lack of requirement for long-term planning in the Bill, there appears to be the potential that a problem could be stored up for years to come. Indeed, reports are beginning to appear stating that that is the case, such as that from the future hospital commission of the Royal College of Physicians.

We need a system of checks and balances to be built into the system to ensure that there is accountability. The Secretary of State must shoulder at least some responsibility for any shortfall in the number of staff. Last year, the Care Quality Commission reported that 17 hospitals were operating with “unsafe staffing levels”. Now that the Government are creating a new quango to ensure that there are sufficient numbers of staff, while retaining influence by making yearly direction to Health Education England, we need scrutiny of the Secretary of State’s role in that. Does the Minister agree with Opposition Members that any shortfall in the number of staff needed would be serious and that it would be right for hon. Members to be able to scrutinise those responsible effectively?

Photo of Daniel Poulter Daniel Poulter The Parliamentary Under-Secretary of State for Health

The Government’s mandate to Health Education England sets it a clear objective to ensure that the right numbers of staff, with the right values, skills and competencies, are being trained and developed to meet future needs. HEE will co-ordinate and perform a leadership role in making recommendations more broadly about health education and training and, just as we recognise that there is independence in much of what NHS England does, we anticipate similar independence in HEE’s role after the passage of the Bill.

It will be for Health Education England to take on board the views of different groups of providers, commissioners and the Royal Colleges to ensure that it comes up with robust proposals, based on its own evidence, for not just short-term, but medium and longer-term work force needs when developing its plan. Equally, as considerable public money is spent—for very good purpose, of course—on undergraduate training for many health care workers, it is important that we can see that supply and demand are closely aligned. For the first time, we will have what amounts to an independent body taking the short, medium and long-term view about work force education and training for the health service, which is a strong step forward and something of which we should all be proud.

Health Education England’s objective is to work through the local education training boards—LETBs, as they are often called—to lead a process of improved work force planning to ensure that sufficient staff are trained with the right skills and are available in the right locations to enable health care providers to deliver their commissioning plans. HEE will take a strategic role on those health care professions for which number controls are determined nationally, including medicine and dentistry. It will work with partners in the Higher Education Funding Council for England, the Department of Health and the Department for Business, Innovation and Skills to determine the number and distribution of undergraduate places. Health Education England will consolidate local work force plans into a national five-year plan for England, which will be published and reviewed annually.

Amendments 162 and 164 focus on the need for integrated and long-term work force planning. I hope I can reassure the hon. Members for Copeland and for Leicester West that that is already provided for in the Bill as part of the scope of the work that Health Education England performs. Amendment 162 would require Health Education England to exercise its functions with a view to promoting inclusive health-related education and training for health care workers, and to ensuring that appropriate long-term planning is undertaken and that the supply of skilled workers is matched closely to demand for them.

I hope I can reassure hon. Members that the Government’s mandate to the Health Education England special health authority includes a specific objective for HEE to ensure that the principles of equality and diversity are integral to education, as we discussed previously, and that there is training and development across the NHS and the public health system. Those objectives will continue to apply to Health Education England when it becomes a non-departmental public body.

I entirely agree that it is fundamental that Health Education England undertakes long-term work force planning. It sometimes takes the best part of a decade or more to train a work force—certainly more than a decade if we look at some of the medical work force from the beginning of undergraduate training through to the completion of specialist training. That training can sometimes take a dozen or so years, so it is important that there is a longer-term view on work force planning. That was why we strengthened the Bill in the other place following feedback, consultation and the pre-legislative scrutiny carried out by my right hon. Friend the Member for Sutton and Cheam.

Clauses 98(5) and 104(3)(e) require HEE and LETBs to have regard to long-term objectives for work force planning and the delivery of education and training. Even if it was not explicit before, following the amendments we have made, and thanks to some excellent pre-legislative scrutiny from my right hon. Friend and further discussions in the other place, we have already strengthened the Bill to ensure that long-term work force planning is at the heart of what Health Education England does.

All work force planning—at national level by HEE, or locally by LETBs—should be based on a well-informed long-term work force strategy that looks at needs over the following five or 10 years—or beyond, when that is required. Health Education England special health authority published its first five-year plan for England in December 2013, and it is considering its longer-term strategy for the work force.

I am sure that members of the Committee will agree that it is not possible to set in primary legislation exact time frames regarding what work force plans should look like. We all recognise that the health care work force is diverse. It is a multidisciplinary work force. While it takes five or six years to train a medical undergraduate, the period of training for nursing or other disciplines may be a shorter. Postgraduate training for medical specialities—for example, very topically, the training of an A and E consultant—will take, following the completion of foundation training, a further six years. A GP requires three more years’ training after foundation training, while the training for obstetrics  and gynaecology involves another seven years. That period can be longer in some specialities if people undertake further sub-specialist training.

Owing to such variations, it is not desirable to set out in primary legislation exact time frames for work force planning. We have to recognise the important fact that time frames differ for various groups when developing work force planning. However, there is a clear requirement for HEE to have regard to work force planning, and it has already committed, with a five-year work force plan that it published in December, to give us clarity about its thinking.

As someone who works in the health service, albeit on a part-time basis, I recognise the importance of having the right numbers of staff with the right skills in the right place to deliver safe care locally. That is why we have placed a duty on Health Education England under clause 96 to ensure the supply of sufficient skilled health workers. To underpin that duty, clause 99 places a clear duty on Health Education England to have regard to NHS England’s priorities for the provision of health services, likely future demand for those services, and the numbers of skilled and trained staff required to meet those priorities.

The Bill places a strong emphasis on partnership working and, through the LETBs, requires local health care providers to demonstrate strengthened leadership and ownership of work force planning and development. Amendment 164 would require the Secretary of State to make a statement to Parliament should HEE project that the number of skilled health care workers available was lower than the required level. It would be inappropriate to legislate for the Secretary of State to make statements in Parliament about such projections. HEE, as a public body, will publish annual plans and be held to account by its board. It is always possible for parliamentary debates to be held and urgent questions to be tabled on work force planning. Hon. Members may influence what is written into the mandate for HEE through such discussions—not least discussions in Committee—should there be a strong desire to change policy. However, one of the great advantages of HEE is that it can take a more independent view and will not necessarily need to have regard to the short-term political expediency that might have characterised work force planning in the past—it is able to take a more holistic view about what is in the interests of the health service. It is good that we have a body with such a role.

HEE is already obliged to report to Parliament annually on its progress on the exercise of its functions under paragraph 28(3) of schedule 5. The Bill sets out a transparent system for work force planning in clause 104, involving the annual publication of work force plans, and clear systems and processes for working closely with partners to produce such plans. When plans project work force challenges or shortages—they will often be looking ahead five years, 10 years or more—Health Education England will be expected to demonstrate evidence of the action it is taking to address that in partnership with arm’s length bodies and partners in the health and care system.

Clause 99 sets out that, in its work force planning, Health Education England must have regard to the likely future demand for health services and for persons to work as health care workers. HEE will, of course, try to match supply to demand as far as possible. As  everybody knows, work force planning in the health care system is complex and varies from one work force group to another. As increasingly more care will be delivered—for the right reasons—by multidisciplinary teams, it is important that Health Education England looks at health care more broadly and at how it can be delivered more effectively by those multidisciplinary teams, rather than simply looking at silos of individual work force groups.

Changes in health care service provision, new drugs and technological advances in how care is delivered have a big impact on work force planning. That challenge faces every health care system, but it is one that HEE will look at specifically when it puts in place longer term work force plans. Of course we understand that it is in no one’s interests to have an under-supply of health professionals graduating from courses or training programmes, which is why there is a clear duty on Health Education England under clause 96 to ensure security of supply.

Clause 98(8) requires Health Education England to keep its plans under review and to publish any revisions. The first five-year work force plan for England was published in December 2013 and will be subject to ongoing review and revision annually. By drawing on plans developed by local health care providers through the LETBs, Health Education England will be able to identify work force pressures early, so far as is possible.

I hope that hon. Members will feel reassured by those remarks, and I ask the hon. Member for Copeland to withdraw his amendment. He and other Members should be assured that Health Education England will take a longer term view of how it does its business and looks after the future interests of our health and care work force.

Photo of Jamie Reed Jamie Reed Shadow Minister (Health) 4:45, 28 Ionawr 2014

I am, of course, disappointed that the Minister does not crave ministerial statements from the Secretary of State for Health in the same way as I do, nor as frequently, but I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 96 ordered to stand part of the Bill.

Clauses 97 to 99 ordered to stand part of the Bill.