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Category: Health

  • Maria Caulfield – 2022 Speech on Foetal Valproate Spectrum Disorder

    Maria Caulfield – 2022 Speech on Foetal Valproate Spectrum Disorder

    The speech made by Maria Caulfield, the Parliamentary Under-Secretary of State for Health and Social Care, in the House of Commons on 7 December 2022.

    I congratulate my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) on securing this important debate on fatalities relating to foetal valproate spectrum disorder. We all know the devastating effect that the drug can have during pregnancy, which is why we took seriously the recommendation in Baroness Cumberlege’s report. I have met the campaigners, Janet and Emma, when I was previously a Minister and since being reappointed—I can confirm that they are definitely not blacklisted by the Department. I look forward to meeting them again shortly to hear the concerns that they still have, which my right hon. Friend set out well this evening.

    To reaffirm what the hon. Member for Lancaster and Fleetwood (Cat Smith) said, we all know that sodium valproate can be a highly effective drug that is used to manage and treat epilepsy as well as other disorders, such as bipolar disorder and migraines, often when many other medications do not work or have stopped working. It is absolutely right to say that if a woman is on sodium valproate, it is crucial that they do not stop that medication suddenly but discuss it with their GP.

    We know that there are teratogenic side effects that mean that, if taken during pregnancy, sodium valproate can have harmful effects on a foetus and increase the risk of a child being born with physical defects and neurodevelopmental disorders. In relation to the point made by my right hon. Friend the Member for Romsey and Southampton North about possible death, I do not know about that specific case but I am happy to ask officials to go away and look at it, because that would be an important development.

    The risk of birth defects following the use of sodium valproate is about 11%, but with a high maternal dose, the risk can increase to 24%. There are significant risks of taking that drug and effects on babies once they are born.

    Cat Smith

    I thank the Minister for the time that she makes available for the subject, which is much appreciated. While she is on the topic of the percentage risk of harm to the unborn baby, at that stage in pregnancy, many women and couples have a very much wanted pregnancy, which is perhaps planned for and longed for, but are suddenly advised by a doctor to terminate it. Does she agree that that tragedy needs to end? We need to come together to ensure that pregnancy prevention plans really work.

    Maria Caulfield

    I absolutely agree with the hon. Lady, and I will come on to some of the changes that are being made on that point. When I have met Janet and Emma, they have very much represented women who feel that those risks were not explained and that if they had known, they would have been on contraception or spoken to their team about stopping the medication before getting pregnant. Often, those are women with complex epilepsy for whom pregnancy is a difficult enough decision in the first place.

    We have known for a long time that the drug should not be used by any woman or girl who can have children, unless they are in the proper pregnancy prevention programme. That is why, in 2018, the programme was introduced to reduce and prevent the number of pregnancies, which was high at the time, in women taking the drug. Being part of the programme means that women are supposed to have an annual review by a specialist, but I have concerns and have heard from campaigners that that does not always happen and is not always the case. There is also the valproate registry, which has now been created so that we can track every woman who is taking that medicine and ensure that the records of when they are prescribed it, when it is dispensed and what is happening to them are followed through, which has never happened before.

    The programme is designed to make sure that, each year, those women have a discussion with their health team, so should they wish to become pregnant, they can get that advice there and then. When I was in this post previously, I had concerns about the overview of the register, the annual checks and some of the other safeguards around the dispensing and packaging of the drug, which have been touched on. That is why we have reviewed the programme.

    I have met the MHRA, which has taken both campaigners’ and my concerns very seriously. It is looking at the programme, and it will be making an announcement shortly on stronger advice to GPs, but also to pharmacists, about some of the technical issues with dispensing medication, and on some safeguards we need in place so that women—once again, whether they mean to get pregnant or happen to get pregnant—have the advice they need and the reminder on the packaging when they pick up their medication.

    The registry tracks all women in England who are taking the prescribed valproate, and it identifies if they become pregnant are accessing care for pregnancy. We can track pretty accurately when pregnancy happens, so we have a handle on how many women are getting pregnant while on the medication. I can reassure the House that the numbers are falling. They are still too high in my view, but they are falling. In the six-month period from April to September 2018 68 women prescribed valproate became pregnant, and from October 2021 to March 2022 that number fell to 17 women. That is still 17 women too many, although we are making progress in reducing that number of pregnancies, but that is why the MHRA is looking at further safeguards for prescribing and dispensing such medicine. It will be making that announcement fairly soon.

    A national clinical audit is being undertaken by all community pharmacy contractors, as agreed with NHS England and the Pharmaceutical Services Negotiating Committee, which will measure adherence to current MHRA regulations. The audit will look at whether all patients are provided with a patient card and a patient guide every time the medicine is dispensed. It will also look at whether patients who are supposed to be getting a review every 12 months actually are, and what then happens to them if they are being signposted for additional advice.

    I am appearing before the Health and Social Care Committee next week to go through the Cumberlege review on its anniversary and follow up on the progress that has been made. This week, I have met the new patient safety commissioner, Henrietta Hughes, who has also met Janet and Emma, and the issue of valproate is one of her key priorities in her first few weeks in post. I have discussed with her my concerns about its dispensing and packaging, and about the monitoring of women, including whether they are getting the advice they need for a planned pregnancy or, if they are not planning to get pregnant, whether they have had reliable advice and discussion about contraception. I plan to meet the patient safety commissioner on a regular basis to make sure that the measures in place are actually reducing the number of those pregnancies and providing women with the support and information they need.

    The Department and the MHRA are consulting on a proposal that medicines containing sodium valproate should always be dispensed in the original manufacturer’s packaging. This would ensure that patients, particularly women and girls of child-bearing age, always receive the patient information leaflet about the medicine they are taking. We will shortly publish a response to that consultation, and we will keep Members updated.

    To touch on the issue of redress, it was not one of the recommendations accepted in the original response to Baroness Cumberlege’s report. However, last year I was concerned about the issues, which my right hon. Friend the Member for Romsey and Southampton North raised, for women seeking legal advice and taking on the huge challenge of getting compensation. What we have done as an interim measure is to work with NHS Resolution to launch a claims gateway, so that individual women can go to NHS Resolution and get their individual case looked at and be provided with support if they want to make a claim, without having to go independently to solicitors and lawyers. That has only just started, and we are looking at how effective it is in helping women get access to some of the compensation they feel they need. However, in my conversations with the patient safety commissioner I have asked her to look at what a potential redress scheme could look like. I am not going to make commitments on that from the Dispatch Box because it is not necessarily my decision to make—that would have to be in discussion with the Chancellor—but I am keen to look at what a redress scheme would look like, and I will follow up on that with the patient safety commissioner and see what is possible. I hope I have been able to reassure colleagues.

    Cat Smith

    Will the Minister commit on the Floor of the House this evening that after she has had conversations with the commissioner about the possibilities of the scheme she will talk to the Chancellor or someone from his team about the recommendations and how they might be implemented?

    Maria Caulfield

    I have had those discussions about what a scheme could look like with the patient safety commissioner only this week. I will need to see the details, but I hope that reassures the House that I am listening to the concerns of parliamentarians and campaigners such as Emma and Janet, who represent a huge number of affected women. I understand the situation they are facing: they have lifetime costs for their children through no fault of the women or the children. They took that medication not realising the effect it could have. We now have that information, but we did not know it at the time. My commitment is that I am exploring options and will update the House on that later.

    I want to reassure the House once again that we take very seriously the safety issues around this drug. It is an important drug in the management of epilepsy, and for some women it is the only way of managing their condition, but we need to make sure that women are aware of the implications of taking such a drug during pregnancy, that they are monitored annually to make sure those discussions are ongoing, and that every time their medicine is prescribed and dispensed that message is reinforced. We are reducing the numbers involved, which is great news, but we need to make sure they go even lower, and we need to look at how we support women who have been affected through no fault of their own.

    We will be giving evidence at the Health and Social Care Committee next week. I think I am also meeting the hon. Member for Lancaster and Fleetwood shortly, and I am sure other parliamentary colleagues too. I just want to say that I want to support women who have been affected by taking sodium valproate and that we are in listening mode on what more we can do to support them and make sure the help they need and the support for their children are at the forefront of our minds.

  • Caroline Nokes – 2022 Speech on Foetal Valproate Spectrum Disorder

    Caroline Nokes – 2022 Speech on Foetal Valproate Spectrum Disorder

    The speech made by Caroline Nokes, the Conservative MP for Romsey and Southampton North, in the House of Commons on 7 December 2022.

    I start by expressing my thanks to Mr Speaker for granting this Adjournment debate. It is not the first time we have debated the issue of foetal valproate spectrum disorder in this House or in Westminster Hall, but this time we have added fatalities to the title of the debate. It is stark, and deliberately so, because this year for the first time a coroner has listed it as a contributing factor to a death.

    Jake Aldcroft was just 21 when he died in April this year after an infection triggered by problems with his kidneys. The coroner listed foetal valproate syndrome as a contributing factor to his death because of the physical damage done to Jake as an exposed baby, which meant that his bowel and bladder did not work properly and he relied on urostomy and colostomy bags. He had also suffered brain swelling that needed a drain. Jake did not experience pain in the normal way, which would have triggered the alarm sooner. That meant that when he arrived at hospital he collapsed and deteriorated quickly. His mum, Sharon Aldcroft, has been clear that she was never warned about the dangers of valproate when she took it while pregnant with Jake, who was diagnosed with FVSD as a baby.

    Christian Wakeford (Bury South) (Lab)

    I thank the right hon. Lady for raising this important topic. The fact that the warnings are still not being displayed on pharmacy prescriptions is truly shocking and needs to be corrected. Does she agree that if there is one clear message we can send from this House, it is that doctors and chemists need to be doing what they should be doing and warning any patient of the risks of this drug?

    Caroline Nokes

    Of course, the hon. Gentleman is right. One of the serious issues to do with sodium valproate has been the lack of warning and information provided to women of child-bearing age.

    I have highlighted Jake’s case, with the permission of his mum, because it gives a stark description of some of the very severe problems FVSD can cause for affected babies, and because, as far as I know, it is the first time that it has been listed as a contributory factor to a death. But the horror for many families is that they have to do everything they can to avoid infection and to manage really complex and difficult conditions because they know that, like Jake, their children are vulnerable and could, ultimately, also lose their lives to this totally avoidable syndrome.

    Jim Shannon (Strangford) (DUP)

    I congratulate the right hon. Lady. She takes part in many of the same debates as me, when we often stand together, and we stand together in this one as well. Does she not agree that the fact that up to 20,000 births have been affected by the drug means that we have waited an awfully long time to react to the dangers in pregnancy? That is the terrible lesson that so many have suffered, and it reinforces the fact that we must act on the side of caution and, what is more, admit our mistakes and appropriately compensate those living with the effects of that negligence.

    Caroline Nokes

    I thank the hon. Member for that intervention. I remember being in this Chamber when a predecessor of my hon. Friend the Minister made a full apology in line with the recommendations of the Cumberlege report. Unfortunately, not all of that report’s recommendations have been implemented for some issues, which I will move on to shortly.

    I know that I do not have to rehearse this with the Minister because she has been there—and indeed in Westminster Hall—when we have debated this issue before. There have been many debates, statements and urgent questions on this issue and on the related matters of vaginal mesh and hormone pregnancy testing, but this is the first time the syndrome has been found by a coroner to have contributed to a young person’s death—a child’s death.

    As the Minister will know, foetal anti-convulsant syndrome is a serious condition in which a baby suffers physical and/or developmental disability from his or her mother taking sodium valproate. Those disabilities can vary and will include minor and major malformations ranging from deformities just of fingers and toes to major physical disabilities such as spina bifida, malformed limbs, skull and facial malformations and malformations of the internal organs.

    Christian Wakeford

    I thank the right hon. Lady for giving way a second time. We have also recently heard that foetal valproate syndrome can be passed down the generations, so the very unfortunate victim of that awful illness can pass it on to their children as well. Although that has been confirmed only recently, we need to ensure that people are warned about the knock-on effects. Up until probably a couple of weeks ago, no one really knew about that.

    Caroline Nokes

    The hon. Gentleman makes an important point. The illness can continue down the generations, and that is not yet well understood but it is causing real fear for the families who have been affected so far.

    Additionally, problems can include learning disabilities, autism spectrum disorder, delayed walking and talking, speech and language difficulties, and memory problems. It is a long list, and it has now been listed as directly attributing to the death of a young person.

    Way back in 2018, the Government commissioned the independent medicines and medical devices review, chaired by the noble Baroness Cumberlege, and its “First Do No Harm” report was published in 2020. That excellent piece of work had nine significant recommendations, some of which have been implemented, some of which have not—or not effectively. As the noble Baroness pointed out, many thousands of women of child-bearing age who suffer from epilepsy are still being prescribed sodium valproate.

    Since 2018, when the pregnancy prevention programme was introduced, only 7,900 women are believed to have switched from valproate, which means that today approximately 20,000 women taking valproate are at risk of becoming pregnant. Information from the Medicines and Healthcare products Regulatory Agency indicates that of those 20,000 women, roughly one in three will have a pregnancy. That means that about 400 pregnant women a year have been exposed to valproate and that, of those 400 pregnancies, about one in two will have a child affected to some extent by foetal valproate syndrome.

    Cat Smith (Lancaster and Fleetwood) (Lab)

    I congratulate the right hon. Member on securing this debate on such an important issue. She is touching on the issue of women currently taking sodium valproate when they are of child-bearing age and the number of pregnancies we are still seeing. While more needs to be done with GPs to ensure that these women understand the risks and that there are pregnancy prevention plans, does she agree that it is important to say that any women listening to our debate this evening should keep taking their medication until they have had that conversation with a GP, because sodium valproate is also a lifesaving drug?

    Caroline Nokes

    The hon. Lady is absolutely right, and I will come on to say that none of us is advocating that valproate be banned.

    7.00pm
    Motion lapsed (Standing Order No. 9(3)).

    Motion made, and Question proposed, That this House do now adjourn.—(Robert Largan.)

    Caroline Nokes

    I will go on to say how important valproate is and how it is imperative that women keep taking the medication, but they need to do so in collaboration with their GP and in discussion with consultants —they need to do so being aware of the risks.

    According to the MHRA’s chief safety officer, around three babies are being born every month having been exposed to valproate in pregnancy, although The Sunday Times has estimated the numbers to be double that, at six per month. I pay particular tribute to The Sunday Times, which has worked alongside families and campaigners, such as the Independent Fetal Anti-Convulsant Trust, or INFACT, to make sure that this scandal does not get brushed to one side and forgotten about.

    As the hon. Member for Bury South (Christian Wakeford) indicated, new information suggests that valproate will affect their children too. Those mothers who already feel a sense of guilt that their medication has harmed their children now live in fear that it will impact their grandchildren too. Put simply, it is a health disaster that is not going to go away.

    Alongside other Members, I recognise the importance of sodium valproate as a drug to control epilepsy. It is crucial for some patients where other drugs have proven ineffective. At no point have I, or the APPG that I co-chair with the hon. Member for Lancaster and Fleetwood (Cat Smith), or INFACT called for it to be withdrawn, but the controls have to be more effective. We have to do better with the pregnancy prevention programme, and we have to do better at providing the necessary information to women of child-bearing age.

    The pregnancy prevention programme is just not working adequately. Information to women is not getting through. Drugs are still being dispensed in plain packaging, without the required warning notices. Many women are still highlighting through the media, through campaign groups and to their Members of Parliament that they were not warned, that they have become pregnant and then, only at that point, have they been told of the possible danger to their baby and advised to have an abortion. First-time mums excited at finding they are pregnant are advised to have an abortion. I know that the Minister, my hon. Friend the Member for Lewes (Maria Caulfield), will find that abhorrent.

    There are drugs for other conditions where I have seen far more radical and determined pregnancy prevention programmes. I have previously identified Roaccutane, where women prescribed it have to have long-acting contraception and produce a negative pregnancy test before they can collect a monthly prescription, not to mention sit with a consultant and go through a very detailed explanation of foetal abnormalities and be given a form to sign stating they will have a termination if they get pregnant. That might sound draconian in the case of valproate, but it would at least mean that every woman prescribed the drug would have had the risks spelled out very clearly.

    For thousands of families, the damage has been done. At this point, I pay tribute to Emma Murphy and Janet Williams of the INFACT campaign group, who are the women who have kept up the pressure on Government. They are the ones who have kept digging for information on what was known by the authorities and how long ago. They are the ones who persuaded my right hon. Friend the Chancellor of the Exchequer, when he was Chair of the Health and Social Care Committee, to launch an inquiry into the use of sodium valproate, which The Sunday Times has described as a scandal bigger than thalidomide. Why is it a scandal bigger than thalidomide? Because it is still happening. Those babies are still being born to parents who have simply not had the level of warning and practical prevention measures that they need.

    That brings me to redress and recommendation 4 of “First Do No Harm”. I know that successive Ministers have decided that redress should come via the courts and medical negligence claims, but I would like us all to reflect a little on that and the added strain it puts on families already caring for a disabled child or, in some cases, children—children who we now know can have their death caused by foetal valproate syndrome.

    We know that the costs of caring for a disabled child are high. We know that in this cost of living crisis the energy costs for any family living with a disabled child will be higher. We know that in terms of physical effort and mental anxiety it is simply harder to look after a disabled child. We also know, unequivocally, that the dangers of valproate were known the best part of 50 years ago, so it is especially tough and insensitive to suggest to those same families that redress should be via a courts system that is itself under immense strain and subject to delays.

    The noble Baroness recommended in her review not only that an independent redress agency be set up, but that there be separate schemes for the three medicines or devices covered. Specifically, recommendation 4 states:

    “Separate schemes should be set up for each intervention—HPTs, valproate and pelvic mesh—to meet the cost of providing additional care and support to those who have experienced avoidable harm and are eligible to claim.”

    To my mind, the specific relevance here is around the additional care needed, which we all acknowledge, and the bare fact of avoidable harm.

    I have three asks of the Minister, and I look forward to her response. The first is for an acknowledgement that sodium valproate has contributed to a death. A young person has died avoidably, and we need the Government to reflect on the very serious conditions that too many babies were exposed to the risk of. What additional controls does she think should be put in place in the light of the knowledge that valproate has caused a young man to lose his life?

    Secondly, the pregnancy prevention programme needs to be more effective. Some 200 babies are at risk every year. Is the Minister satisfied that the programme is adequately effective and that the information is properly communicated to women of child-bearing age? If not, what more is she planning to do?

    Finally, we need redress. Back in 2019, the disability equality charity Scope reported that a family with disabled children faces average extra costs of £581 a month. That was three years ago. Fuel inflation and food price inflation have increased since then, and the stark reality is that families with disabled children are struggling. These children were, in the words of the “First Do No Harm” report, “avoidably harmed”. It is no sort of redress to suggest that those struggling families resort to the courts.

    My suggestion to the Minister, who I believe is dedicated to her job, works extremely hard and can be very persuasive, is the following.

    Christian Wakeford

    Will the right hon. Member give way?

    Caroline Nokes

    I will, one final time.

    Christian Wakeford

    I thank the right hon. Member for giving way a third time. As we know, both Emma and Janet have unfortunately been blacklisted by the Department of Health and Social Care, so if I could be so bold as to suggest another recommendation, it would be that they are never blacklisted again, to ensure that their voices are listened to, and the voices of those children and mothers are constantly heard.

    Caroline Nokes

    The hon. Gentleman makes an important point, but I am absolutely confident that the Minister will be very pleased to meet both Janet and Emma. I look forward to her agreeing to do so from the Dispatch Box.

    My final point to the Minister is this: the Chancellor of the Exchequer, when he was Chair of the Health and Social Care Committee, was incredibly active on this issue. He launched the inquiry when he was still the Chair. His successor, my hon. Friend the Member for Winchester (Steve Brine), is equally committed and is continuing with the inquiry, and both Janet Williams and Emma Murphy will give evidence to the Committee next week. I would like the Minister to use her powers of persuasion and ability to convince the Chancellor of the Exchequer that he needs to keep going on this issue. He is now in a position where he could put in place the finances to allow a redress scheme to be set up. I urge her to persuade him to do just that.

  • James Murray – 2022 Speech on the NHS Workforce

    James Murray – 2022 Speech on the NHS Workforce

    The speech made by James Murray, the Labour MP for Ealing North and Shadow Minister, in the House of Commons on 6 December 2022.

    There can be no doubt that the NHS is in crisis. We have heard shocking stories today from hon. Members about what their constituents are having to endure. Each and every one of these deeply distressing stories helps to confirm the devastating impact of the Conservatives’ neglect of the NHS. Patients deserve so much better than this Government and everyone who works in the NHS deserves so much better, too, for the invaluable work they do.

    We all know that from the experience we have in our constituencies, as we have heard so powerfully today. My hon. Friend the Member for West Ham (Ms Brown) spoke powerfully and in detail about the impact of vacancies in the NHS, particularly in maternity services, in her constituency and the surrounding areas. My hon. Friend the Member for Coventry North West (Taiwo Owatemi) spoke about the role of community pharmacists and the wider struggles that NHS workers face. She was speaking with particular authority, given her background in the NHS before becoming an MP. My hon. Friend the Member for Ilford South (Sam Tarry) spoke about the severe impact of vacancies and exhaustion in nursing after 12 years of the Conservatives.

    My hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) spoke about the impact that workforce shortages were having, even before the pandemic, on crucial radiotherapy services in her constituency and beyond. My hon. Friend the Member for Streatham (Bell Ribeiro-Addy) spoke about the scale of the crisis that we face in NHS recruitment and retention. My hon. Friend the Member for Leeds East (Richard Burgon) rightly mentioned those shameful attacks by Conservative Ministers on nurses.

    My hon. Friend the Member for Bristol South (Karin Smyth) spoke with great experience, having spent three decades working in the NHS, about the growing crisis of retention over the past decade. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) spoke about the NHS crisis and set it in the context of the Government’s unfair decision in the recent autumn statement. My hon. Friend the Member for Halifax (Holly Lynch) gave a wide-ranging and powerful speech that drew attention to the genuine sense of fear among people across the country at the prospect of not being able to access vital NHS services. My hon. Friend the Member for Wirral West (Margaret Greenwood) made it clear that the staffing crisis in the NHS is the failure of 12 years of the Conservatives.

    Madam Deputy Speaker, that is the truth. The Conservatives have spent 12 years running down the NHS and letting our economy fall further and further behind, but, make no mistake, this is not inevitable. After 1997, Labour not only grew the economy 1.5 times the rate that the Conservatives subsequently managed, but delivered an NHS to be proud of, and we are proud of our record.

    Although the challenges now are even greater than they were in the late ‘90s, if we take office at the next election, we will, again, deliver a modern, sustainable NHS that is fit for the future that we face. We know that, to make the NHS fit for the future, it needs a prescription of reform and sustainable funding from a growing economy. For our economy to grow, we need to start getting our public services back on track, too. As my hon. Friend the shadow Health Secretary set out, one of the first steps that a new Labour Government will take to get the NHS back on track is to deliver a workforce plan that addresses the root cause of the crisis it is in.

    Under our plan, we would double the number of medical school places to 15,000 a year. We would double the number of district nurses qualifying each year. We would train 5,000 new health visitors a year and we would create 10,000 more nursing and midwifery clinical placements each year, too—all part of a long-term workforce plan for our NHS.

    Steve Brine

    On the doubling of the number of medical school places, can the hon. Gentleman tell me what the cost of that is, especially as the shadow Chancellor is so handily sitting next to him? It would be helpful for those of us on the Select Committee to put the price tag on that one.

    James Murray

    All the pledges that the Opposition make are fully costed and fully funded. [Interruption.] If the hon. Gentleman waits one second, I will address that point. Today is about political choices. It is not just a political choice of whether we invest in the NHS; it is a political choice of how we pay for it. That is why we have made it clear that, to pay for our NHS workforce expansion plan, Labour would abolish the unfair, outdated non-dom tax status. Non-dom tax status is passed down through people’s fathers and it costs the public purse £3.2 billion a year, while failing to support economic growth in the UK. Under the current arrangements, a small group of high-income people who live in the UK are able to avoid paying tax on their overseas income for up to 15 years. We would abolish that 200-year-old tax loophole and introduce a modern scheme for people who are genuinely living in the UK for short periods. We believe that if a person makes Britain their home, they should pay their taxes here.

    Paul Bristow

    My hon. Friend the Member for Winchester (Steve Brine) asked the hon. Gentleman a very specific question about the exact cost of doubling the number of places at medical school. Is the hon. Gentleman able to confirm the exact cost of that—not the non-dom cost, but the exact cost of doubling the number of medical places?

    James Murray

    I thank the hon. Gentleman for his intervention. I have set out that scrapping the non-dom status would raise £3.2 billion, and that our workforce expansion plan would cost £1.6 billion, so we would be well able to afford that measure from the amount of money that we have raised from scrapping this outdated, unfair tax loophole.

    Non-dom status should have no place in our modern tax system. It is unfair. When the Government are making working people pay more tax, it is simply wrong to allow wealthy people with overseas income to continue to benefit from an outdated tax break. It is also bad for UK business: the loophole prevents non-doms from being able to invest their foreign income in the UK, as bringing it here means it becomes liable for UK tax. Abolishing non-dom status would end that barrier to UK investment—and, as I have said, raise £3.2 billion, money we would use to put towards priorities including expanding the NHS workforce.

    To be honest, we would have thought abolishing non-dom status, replacing it with a modern system and using the money to strengthen the NHS and economy would be a no-brainer. What is it about this Conservative Government, led by the right hon. Member for Richmond (Yorks) (Rishi Sunak), that makes them so reluctant to close that loophole? Last week, during the rushed debates on the Government’s autumn Finance Bill, I asked Treasury Ministers to confirm whether the Prime Minister had been consulted on the option of abolishing non-dom status and whether it was ever considered as an option for last week’s Finance bill. I also asked whether, when the current Prime Minister was Chancellor, he had ever recused himself from discussions on the matter, for obvious reasons.

    I put these questions to Treasury Ministers on three separate occasions last week, but they refused each time even to acknowledge the questions, never mind answer them. For a Minister to overlook a set of questions once might be an oversight, but to ignore them three times looks like something else. Perhaps the Minister will today show that they have nothing to hide by answering the questions I have raised.

    In the autumn statement and last week’s Finance Bill, the Chancellor chose to leave non-dom status untouched, while picking the pockets of working people, including nurses, with stealth taxes such as freezing income tax thresholds and pushing up council tax. Today, the Secretary of State for Health only mounted a brief defence of non-dom status; I wonder whether his colleague from the Treasury will, in her closing remarks, repeat some of the defences that Treasury Ministers tried to set out last week.

    Last week, Ministers tied themselves in knots trying to find a justification for the £3.2 billion tax break for non-doms. They tried to pretend that the Government’s investment relief is working, when only 1% of non-doms invest their overseas income in the UK in any given year, and last week they tried to win praise for ending permanent non-dom status, while keeping quiet about the new loophole they created, which allows people to use trusts to retain non-dom benefits permanently.

    The truth is that, unless the Conservatives vote with us today to abolish non-dom status once and for all, the British people will be clear that no amount of reason or common sense will get this Government to come round. The British people need a fresh start and a new Labour Government that would take those fairer choices on tax to support the stronger NHS we so desperately need.

    The NHS is an achievement we share together as a country and one that we all have a personal relationship with. We all want to know that when we have medical symptoms, concerns or needs, the NHS will be there for us. We want to know it will be there as a publicly funded service, free at the point of use, able to provide us with the high-quality help we need. That is what I wanted to know in my early 20s, when I started to notice symptoms of what would later be diagnosed as myasthenia gravis, a rare neurological condition that caused muscle weakness throughout my body.

    After the best care I could have hoped for from my brilliant consultant and his team and colleagues at the National Hospital for Neurology and Neurosurgery in Queen Square, I have been symptom-free for many years now, but the memory of first feeling those symptoms and then finding my way towards the right treatment sticks with me. I would never want anyone to feel symptoms like mine and not be sure whether the NHS would be there to help.

    We all know stories like that. We all need the NHS to diagnose and treat us when we are worried. We all need to be able to turn to the NHS so that we get that treatment in good time. We all connect with the NHS through our own lives and the lives of our family and friends. That is why the NHS matters so much to us all and why we are so determined to deal with the crisis the NHS is facing and to make sure it is ready for the modern challenges we face.

    At the heart of our vision for the country are stronger public services and stronger economic growth. We know that getting public services back on track will support a growing economy, which will in turn support modern, sustainable public services. Before us today we have a chance to end the unfair 200-year-old tax loophole, which lets a small number of people avoid tax on overseas income, and use the money saved to fund one of the biggest workforce expansion plans in the history of the NHS. That is the choice in front of us today, and I urge all MPs to do the right thing by backing our plan.

  • Margaret Greenwood – 2022 Speech on the NHS Workforce

    Margaret Greenwood – 2022 Speech on the NHS Workforce

    The speech made by Margaret Greenwood, the Labour MP for Wirral West, in the House of Commons on 6 December 2022.

    It is clear that we have a crisis in NHS staffing. For the very first time in its 106-year history, members of the Royal College of Nursing have voted for strike action in their fight for fair pay and safe staffing. I express my solidarity with them. They do not do this lightly. Consecutive Conservative Governments have brought them to this situation.

    Staff shortages are putting immense pressure on the NHS. There were more than 133,000 vacancies in the NHS in England in September 2022, up from around 103,000 the year before. There were more than 47,000 registered nursing vacancies in September, about 8,500 more than in March, and there were more than 9,000 medical staff vacancies in September, over 1,000 more than in March.

    We all know things were bad before the pandemic, but an already extremely serious situation has got worse. This staffing crisis is a direct result of the failure of Conservative Governments to plan and deliver the workforce we need, and it is leading to very high levels of stress for staff and extraordinarily long waiting lists for patients.

    Two weeks ago, I led a Westminster Hall debate on NHS staffing. Numerous organisations provided briefings in advance of that debate, and I will share some of their concerns about staff shortages, the pressures on the NHS and the impact they are having on workers and patients. Their observations reflect the depth of the crisis in the NHS, along with the complexity of medicine and the immense level of expertise in this country. The Government really should listen to them.

    Research by the British Medical Association points to a lack of doctors in comparison with other nations. The average number of doctors per 1,000 people in the OECD’s EU nations is 3.7, but England has just 2.9. Meanwhile, Germany has 4.3.

    Parkinson’s UK has said:

    “People with Parkinson’s are facing huge waiting times for diagnosis, mental health support, check-ups and medication reviews. This is due to critical shortages of NHS staff across England who are available to see people with Parkinson’s. Problems with finding healthcare professionals who understand the condition and accessing the right specialist services have been exacerbated by the pandemic. Waiting times for a consultant after diagnosis are up to two years in some areas.”

    The Royal College of Midwives has expressed serious concerns that the NHS in England has 800 fewer midwives than it did at the time of the 2019 general election and that

    “midwife numbers are falling in every region of England.”

    According to the latest census by the Royal College of Physicians

    “52%—more than half—of advertised consultant physician posts were unfilled in 2021. That is the highest rate of unfilled posts since records began, and of the 52%, 74% went unfilled due to a lack of any applicants at all.”

    The Royal College of Speech and Language Therapists has said:

    “Speech and language therapy services across the entire age range are facing unprecedented demand and there are simply not enough speech and language therapists currently to meet the level of demand.”

    Last year’s report by the British Society for Rheumatology found that

    “chronic workforce shortages mean departments lack sufficient staff to provide a safe level of care.”

    This means

    “patients are experiencing progressively worse health, leading to unnecessary disability and pain.”

    Cancer Research UK has pointed out that

    “critical staff shortages impact all aspects of cancer care”—

    I would have thought the Secretary of State would like to listen to what Cancer Research UK has to say. It highlights:

    “In 2020-21, £7.1 billion was spent on agency and bank staff to cover gaps in the NHS workforce, an increase of almost £1 billion from an already enormous £6.2 billion spent the year before. This is money that could be spent on training and recruiting full-time equivalent NHS staff, but instead is”—

    being used—

    “in an attempt to mitigate chronic NHS staff shortages.”

    Unison has said it is

    “very concerned that NHS services are in a dire state due to there being insufficient staff numbers available to deliver safe patient care.”

    It points out:

    “While the government has belatedly accepted the need for an independent assessment of the numbers of health professionals needed in future, they repeatedly refused to write such plans into the Health and Care Act 2022, despite a broad coalition of more than 100 healthcare organisations calling for this.”

    The TUC is calling on the Government to put in place

    “an urgent Retention Package, with a decent pay rise at its heart.”

    The 2022 pay award is well below current inflation levels, so it amounts to a real-terms pay cut. The TUC went on to say:

    “The 2022 pay uplift needs to be set at a level which will retain existing staff within the NHS”,

    is attractive to new recruits,

    “and recognises and rewards the skills…of health workers.”

    In recent weeks, we have seen announcements of industrial action from other organisations representing NHS workers, including Unite the union, Unison and the GMB. In addition, the Chartered Society of Physiotherapy is balloting members and the British Medical Association will ballot next year. As with the Royal College of Nursing, this is not being done lightly. NHS workers care deeply about patients and the service as a whole, but they can also see that the NHS is at breaking point. It is notable that, in a recent poll of 6,000 adults carried out on behalf of Unite, 73% of respondents supported NHS and care workers receiving pay rises that keep up with the cost of living.

    The Conservative Governments’ failure to address chronic staffing shortages in the NHS is putting those working in the service under immense pressure and, in some instances, it is putting patients at risk. Since 2010, instead of focusing on and planning and delivering a well-resourced, well-staffed NHS, the Conservatives have focused their energy on not one but two major reorganisations of the NHS, designed to open it up to privatisation. This ideological agenda is causing immense suffering to patients and great stress for staff.

    The Health and Care Act 2022 provided for the revoking of the national tariff and its replacement with a new NHS payment scheme. The national tariff is a set of rules, prices and guidance that covers the payments made by commissioners to secondary healthcare providers for the provision of NHS services. Engagement on the NHS payment scheme is ongoing, with a statutory consultation due to begin this month. Given the requirement in the Act for NHS England to consult each relevant provider, including private providers, before publishing the scheme, I am very concerned that this may well be a mechanism through which private health companies will have the opportunity to undercut the NHS. If that happens, one inevitable outcome would be an erosion of the scope of “Agenda for Change”, as healthcare that should be provided by the NHS is increasingly delivered by the private sector. I ask the Minister to give us an assurance that that will not be used in that way.

    As I have said, the Conservative Governments’ failure to address chronic staffing shortages in the NHS is putting those working in the service under immense pressure and, in some instances, it is putting patients at risk. Since 2010, instead of focusing on planning and delivering a well-resourced, well-staffed NHS, they have focused on a privatisation. In the second reorganisation, they held a consultation, allegedly, when NHS staff were working incredibly hard during the pandemic. It was very unfair to carry out a consultation while the people to be affected most by it were dealing with the worst public health crisis we have seen.

    The staffing crisis has been created by the Conservatives on their watch. The comprehensive workforce plan announced in the autumn statement is due to be published next year. It is long overdue and it will need to be backed up by sufficient resources. In the meantime, the Government bear a responsibility in relation to how the NHS fares this winter. They have the opportunity to avert industrial action and should do all in their power to do so. They must support those who work in the service and make sure that NHS workers receive a fair pay rise.

  • Holly Lynch – 2022 Speech on the NHS Workforce

    Holly Lynch – 2022 Speech on the NHS Workforce

    The speech made by Holly Lynch, the Labour MP for Halifax, in the House of Commons on 6 December 2022.

    It is a pleasure to follow my hon. Friend the Member for Salford and Eccles (Rebecca Long-Bailey), who made an incredibly powerful speech.

    I do not think I am being dramatic when I say that a genuine sense of fear has set in across the country about being in a position of needing to use the NHS. Almost every family now have a story about how they or, even worse, a loved one have needed to access care and have had a very difficult experience. People’s experiences range from waiting at A&E to waiting for an ambulance, from being unable to get a dentist appointment when they were in pain and urgently needed one to facing a wait years long to see a specialist. One member of my team called up on 25 November and was told, “You’re in luck: there’s been a cancellation at the GP’s, so they’ll book you an appointment—but it’s for a telephone consultation on 20 December.” The chronic pressures in staffing across the board are affecting healthcare in every part of the country.

    Margaret Greenwood

    This afternoon we have heard some horrendous stories about people waiting for ambulances: hideous delays of 16 hours or more for people in pain and sometimes truly tragic circumstances. Does my hon. Friend agree that that shows the abject failure of this Government to provide a health service that we can all be proud of?

    Holly Lynch

    My hon. Friend is absolutely right. Not only is there a massive impact on patient safety and care, with detrimental outcomes for patients, but there is a loss of service to others: while paramedics and ambulances wait outside A&E, there is an impact on care for all the other people who need that provision. My hon. Friend makes a really powerful point.

    I want to focus on some key areas of the NHS workforce, starting with midwifery. The chief executive of the Royal College of Midwives, Gill Walton, has told the Health and Social Care Committee that England is more than 2,000 midwives short of the numbers it needs, and the situation is getting worse. The RCM’s analysis shows that midwife numbers fell by a further 331 in the year to November 2022. We need a plan because, as other hon. Members have said, the staffing shortages are driving further staffing shortages. More than half of all midwives surveyed by the RCM said that they were considering leaving their job, with 57% saying that they would leave the NHS in the next year.

    In November last year, I joined a March with Midwives rally in Halifax, where midwives held up signs that they had made themselves and that said things like, “I’m a physically and mentally exhausted midwife”, and, “I can’t keep saying sorry for no beds, no midwives, no support and no time”. What really brought home how it is not just about the impact of short staffing on patients and patient safety was the signs that midwives’ children had made themselves. One sign said, “My Mum falls asleep on the driveway after work”. It was made by a girl who told me that she had come out of the house one morning ready for school, only to find that her mum had driven home after a nightshift, pulled on to the driveway and fallen asleep in the car because she was so exhausted. A younger child had made a sign that simply said, “Mummy being late from work equals me being a lonely kid”.

    Case studies conducted by the Royal College of Midwives highlighted not just the strain on the service, but the strain in the workforce and their families. A midwife called Julia said:

    “We’re reducing the time we give to women, having to close facilities, reduce antenatal education, postnatal visits cut to a minimum. Stretched physically is one thing, you can rest your body eventually when home, but the mind, the mind does not have an easy off switch. The constant unrealistic expectations on maternity staff is damaging their mental health, it’s impacting on the wider service and it’s putting women, babies and families hopes and dreams in danger.”

    This is why a Labour Government with a commitment to train 10,000 additional nurses and midwives every year cannot come fast enough.

    Karin Smyth

    My hon. Friend is making some excellent points, particularly about the impact of those exhaustion levels on families. In my speech I spoke about the recruitment of families who looked forward to their jobs and were proud of working in the NHS. That is important to bringing future generations into the health service, and giving encouragement to young people in schools. It is still a fantastic career, but does my hon. Friend agree that helping young people not to be deterred by that negative publicity and helping them through training routes is a crucial way of solving the current workforce problems?

    Holly Lynch

    We have all told stories about the NHS heroes in our constituencies today, but my hon. Friend is right about the need to transform that into an attractive skills plan. Some of the midwives and their children whom I met were extremely proud to be in NHS families. Every member of those families is affected by that shared sense of pride, but also by that shared sense of exhaustion, and there are problems for the whole family when there are problems for the NHS worker. My hon. Friend has made a powerful point.

    Emma Hardy

    As I pointed out in my speech when I was talking about radiotherapy, the reason people are leaving the profession is to do with the work-life balance. It is not just a question of the number of people who are leaving midwifery, but a question of the number of people in midwifery who are reducing their hours to try to achieve that balance. Does my hon. Friend agree that something is seriously amiss when people have not fallen out of love with the job, but are simply finding that they cannot do the job while also maintaining the home life that they need?

    Holly Lynch

    Once again, my hon. Friend is absolutely right, as I know when I meet those children of NHS staff who hold up signs saying, “When my mummy is late home it means that I am a lonely kid”. As other Members have pointed out, when NHS workers are exhausted at the end of a shift but find that the cavalry is not arriving and there is no one to take over, they cannot walk out of their jobs as other people might be able to. They have to stay and deliver patient safety, rather than leaving those patients at risk. Questions about the life-work balance and childcare—who will feed the kids when they get home?—are not easy questions for workers in that position to answer.

    We have to transform the experiences of mothers and families using maternity services. Like almost every other parent who has had to use those services in recent years, I can say that it is a massive worry. You are told, “Once your waters have broken and your contractions are this regular, come to the hospital”, but even after that point I kept being asked not to come to the hospital, because there was only one bed left and it might be needed for someone else. That is the last thing you want to hear when you are in labour. Worrying about staffing and bed shortages compounds what is already one of the most stressful experiences that women—indeed, parents—can go through.

    Let me now say something about paramedics, and all those working on the frontline of our ambulance services. I have worked closely with paramedics, in particular with the GMB’s union representative, Sarah Kelly, on the Protect the Protectors campaign, and I have spent a day out with paramedics, seeing just how relentless their days are. Analysis carried out by the GMB found that there were 7.9 million calls for an ambulance in 2010-11, but by 2021-22 that had risen to 14 million, a pretty staggering increase of 77%. The monthly handover delays report from the Association of Ambulance Chief Executives reveals that the performance of ambulance services fell to its lowest ever level in October. The report shows that, across the month, 169,000 hours of ambulance crew time were lost due to delays. That meant that paramedics could not answer over 135,000 calls for help. That number represented 23% of ambulance services’ total potential capacity to respond to 999 calls. All three of these metrics are the worst in the NHS’s history.

    Staff have balloted for industrial action, and we can see how they do not feel listened to and that they are carrying so much responsibility. My hon. Friend the Member for Ilford North (Wes Streeting) has already made this point powerfully from the Dispatch Box. None of us here in the Chamber today has to face the reality multiple times a day of knowing that, no matter how hard we work, there could be fatal consequences for the vulnerable people we are looking after because the system in which we work is fundamentally failing. We do not carry that burden; we ask the paramedics, and all NHS staff, to carry it.

    We know that, in addition to this, too many workers—after making such an exhausting contribution to the NHS—are facing financial hardship for their efforts. Like in midwifery and other areas of the NHS, research indicates that one in 1,000 ambulance workers have left since 2018 to seek a better work-life balance or better pay, or to take early retirement. It is not that workers are asking for more pay for the sake of it; it is because inflation is at 11%, energy bills have gone through the roof and the cost of fuel to enable them to get to work has shot up. The National Institute of Economic and Social Research has predicted that around 30,000 households could see their monthly mortgage repayments become greater than their monthly income in the months ahead. If the Government got a grip of these factors, they would not have so many workers being forced to ask for more pay just to make ends meet. I ask the Government to please speak to workers, to work with their trade unions and to work through their concerns, which are very real.

    Turning to NHS dentistry, I presented a petition to the Government on 1 November on access to NHS dental care, signed by 549 people online as well as a number of signatures in hard copy—some are still coming into my office. Like all MPs, I have had so much casework in recent months where local people simply cannot see an NHS dentist. The British Dental Association says that more than 43 million dental appointments were lost between April 2020 and April 2022, including more than 13 million appointments for children.

    Dentistry is now the No. 1 issue raised with HealthWatch, with almost 80% of the people who contact the organisation saying that they find it difficult to access dental care. The General Dental Council says that almost a quarter of the population—24%—report having experienced dental pain in the last 12 months. More locally, HealthWatch in Calderdale contacted every dental practice across Calderdale last year to establish whether they were willing to accept new NHS patients, whether they would register a child and whether they were offering routine appointments. Every dental practice told HealthWatch that it could not currently register a new NHS patient of any age. It is the same story.

    Data from the British Dental Association reveals that 3,000 dentists in England have stopped providing NHS services since the start of the pandemic. For every dentist leaving the NHS entirely, 10 are reducing their NHS commitment by 25% on average. A BDA survey from May 2022 shows that 75% of dentists plan to reduce the amount of NHS work they do next year, with almost half planning to change career, seek early retirement or enter fully private practice. As in other areas of the NHS, the combination of pressures and remuneration is driving what remains of a depleted workforce away. It is a self-defeating cycle that the Government have to step in to break.

    Other Members have made points today about the potential of community pharmacies. Having worked in a pharmacy when I was in the sixth form doing my A-levels, it became clear to me that this was often the longest standing and most trusted relationship that members of the community had with a healthcare professional. The pharmacy was the shopfront that was always open during the pandemic, where people could go and meet somebody who knew them and knew their circumstances. That really is the value of community pharmacies. We know they have the capacity to do so much more, and hon. Members on both sides of the House have spoken about unlocking that potential and relieving some of the pressure on A&E departments and GP surgeries by empowering community pharmacies to deliver the work they are best placed to deliver because of their deep roots in our communities.

    Labour has a plan for the NHS. It is costed, comprehensive and will save the NHS. In today’s debate, the Government have not had the humility even to acknowledge that there is a problem in the NHS, never mind having a plan of action. That is why a Labour Government cannot come soon enough.

  • Rebecca Long-Bailey – 2022 Speech on the NHS Workforce

    Rebecca Long-Bailey – 2022 Speech on the NHS Workforce

    The speech made by Rebecca Long-Bailey, the Labour MP for Salford and Eccles, in the House of Commons on 6 December 2022.

    The national health service is facing one of the worst workforce crises in its history. The decentralisation and deliberate marketisation of large parts of the health service, the driving down of staff pay, 12 years of austerity and so-called efficiency savings have brought frontline services to the brink of collapse.

    A report by the Health Foundation revealed that the UK has spent around 20% less per person on health each year than similar European countries over the past decade. As a result of sustained real-terms pay cuts, some hospitals have food banks for staff, some are handing out welfare packages, and there are even reports of NHS staff sleeping in their cars as they cannot afford the fuel to and from work. It is no surprise that there are more than 133,000 vacancies across the NHS.

    However, instead of helping to address the pressures faced by an overworked, underpaid and demoralised NHS workforce, the Government appear to be deliberately picking a fight with the trade unions representing those key workers by fiercely resisting entirely reasonable pay claims. There is genuine desperation out there among those workers and other key workers like them who are experiencing the definition of in-work poverty. They are not able to afford the basics of food, clothing, housing and privatised utility bill payments. It is therefore no surprise that they are left with no option but to publicly voice their desperation over low pay, unmanageable workloads and patient safety.

    GMB, Unison and Unite have confirmed this week that there will be national walk-outs across the ambulance service. Nurses will strike this month for the first time in their 106-year history; they simply cannot take any more. The Royal College of Nursing’s last shift survey report found that eight in 10 shifts were unsafe, and 83% of nursing staff surveyed said that staffing levels on their last shift were not sufficient to meet all patients’ needs safely and effectively. For context, an experienced nurse’s salary has fallen 20% in real terms since 2010.

    As we heard, midwives are balloting for strike action. A recent survey carried out by the Royal College of Midwives shows that more than half of staff are considering leaving the profession, citing inadequate staffing levels and concern for the quality and safety of care that they can deliver. It also estimates that the UK is short of more than 3,500 midwives.

    The NHS workforce was rightly lionised by the British public for their selfless devotion and service during the pandemic, yet the abject response of the Government is to unleash yet more austerity on public services that are already cut to the bone, and to further hold down the wages of hard-pressed workers. We had reference to the autumn statement today but, staggeringly, although those workers continue to suffer, hidden in the depths of that statement was not an admittance of culpability for the current economic crisis or a plan to reverse NHS decline, but a massive tax cut on bank profits. The bank surcharge was cut from 8% to just 3%. That comes on top of the removal of the cap on bankers’ bonuses a few months ago and the abject refusal to abolish non-dom tax status. As my hon. Friend the Member for Ilford North (Wes Streeting) said at the start of the debate, the Government made choices—and the choice they made was to prioritise the interests of a select few over the interests of the NHS, patient safety and the welfare of workers in the health service.

    Today the Government have the opportunity to recognise their gross misjudgment and make the right choice. They have the opportunity to increase resources across the NHS and set out an urgent workforce plan with measures to increase retention and support staff. They have the opportunity to introduce an immediate restorative pay rise for NHS staff that reflects the value that society places on their vital work. They must also award recruitment and retention premiums to new entrants and existing staff and provide financial support for those who are studying to become NHS professionals.

    NHS staff are ringing the alarm and saying that funding, pay and patient safety are inextricably linked. They are the true heroes. They do not ask for thanks; they do what they do day in, day out without fanfare because they truly care. It is time the Government showed them the respect they deserve.

  • Karin Smyth – 2022 Speech on the NHS Workforce

    Karin Smyth – 2022 Speech on the NHS Workforce

    The speech made by Karin Smyth, the Labour MP for Bristol South, in the House of Commons on 6 December 2022.

    In 1948, at the dawn of the NHS, we were around 50,000 nurses short. By the 1960s, 40% of junior doctors were from India, Bangladesh, Pakistan and Sri Lanka. Thousands came from the Caribbean. It is estimated that by the 1970s, 12% of British nurses were Irish nationals, my own family among them. My Aunt Margaret Carter came to Stockport and my cousin Maureen McNulty came to Leeds. Britain welcomed them; they were not invaders. We trained them, we gave them accommodation, we offered them prospects. In the three decades I have worked in the NHS, the hundreds of nurses I have worked with remember their first job. They remember being greeted and welcomed. They remember their new belts. They remember it with great pride. We welcomed them nationally and, crucially, we welcomed them locally. We supported them with accommodation, transport and decent prospects.

    In January 2019, the then Secretary of State, the right hon. Member for West Suffolk (Matt Hancock), made a statement about the long-term plan and the recommendations. Like the Secretary of State today, he talked about the largest increase in health spending. What he failed to admit, as did the Secretary of State today, was that we had witnessed a decade of the lowest growth the NHS had ever had. In particular, it badly hit public health, capital spending—why we have a £10 billion backlog on maintenance—and workforce education and training. Even if we skirt over the suppression of Exercise Cygnus and pandemic planning, we entered the pandemic unprepared. That is why we had rushed, ad hoc, WhatsApp-panicked procurement processes—about which we will hear much more later today. That is why 2020 was so bad.

    Members do not have to take my word for it. In June 2019, following that earlier statement, Baroness Harding and Sir David Behan, chair of Health Education England, gave evidence to the Health and Social Care Committee. I recommend that hon. Members read it. I totally agreed with Baroness Harding that the way we solve the workforce crisis is all about staff retention. It is all about people feeling that their careers were not being developed and that they did not have an opportunity to get on. At the time, retention rates were higher in any other profession. It was also noted that if we had kept at 2012 retention levels, we would have had 16,000 more nurses in 2019 than we had at the time. That is the problem.

    There are solutions and we have heard some of them today, but they are a mix of the national and the local. At national level, we need to welcome people. We will always need overseas recruitment, but upwards of 80% of NHS staff are homegrown. We need to incentivise retention—it is cheaper, it is quicker, it is the smart thing to do. The reasons for loss of staff are well known. The Government need to revisit the Augar review. They need to notice what has happened with the loss of bursaries. We need to involve further and higher education in that retention work.

    We also need to look at regional solutions. The Lansley Act, the Health and Social Care Act 2012, destroyed the regional architecture but there is still a role, still some semblance of a network, possibly grouping ICSs—we talked about that today—where NHS England could have a role without the performance stick. The emergency planning architecture, which was ignored at the beginning of the pandemic but still exists in some places and did rise to the challenge, linking local authorities and public health, could offer a skeleton of a service to co-operative supportive networks above trust and ICS level. But eventually everything is local. Just as we welcome people nationally and have national support structures to retain staff, we absolutely have to do things locally. We need to look at housing, transport, progression and, as has been said, pay and retention.

    I am not particularly interested in the large figures that have been bandied around today, including the millions of people on waiting lists and the 165,000 social care vacancies; I want to know what is happening in Bristol. I want to know what is happening to GP waiting times in Whitchurch, Bedminster and Bishopsworth. I want to know the vacancy rates at the Bristol Royal Infirmary and Southmead Hospital. When I asked the Secretary of State about the vacancy rate in North East Cambridgeshire, obviously, he could not answer, because none of us in this House can answer that question. As MPs, we should know the scale of the problem in our constituencies and, frankly, we do not. We need to know and to communicate to local people what the problem is. We need to help with the local situation and priorities, and we have to build our way out of it.

    There are no easy solutions, but there is a path. Sadly, the Government have not even started on that path. If we are to keep spending ever more of our country’s wealth on the NHS and care system—as we will, although it would help if we had grown the economy more in the last 10 years—local people must have a say in that. They have to understand the trade-offs and, crucially, be able to hold someone to account locally for the parlous state of our waiting lists.

  • Richard Burgon – 2022 Speech on the NHS Workforce

    Richard Burgon – 2022 Speech on the NHS Workforce

    The speech made by Richard Burgon, the Labour MP for Leeds East, in the House of Commons on 6 December 2022.

    Just two years ago, in the middle of the greatest public health crisis in decades, millions of people came out to clap for the nurses, doctors and other NHS workers who were putting their lives on the line to save the lives of others. As people will remember, Conservative Members were only too happy to be seen joining in the applause. How times have changed.

    We now have Tory Ministers wheeled out on the media to attack those same NHS workers with sick claims that their planned action for fair pay is aiding Putin’s abhorrent war on Ukraine. Those disgraceful remarks appear to be the opening salvo in a Tory propaganda war that seeks to blame NHS workers for the deep crisis in our health service. The Tories will attack nurses, as they do every other worker forced to defend their pay and conditions. But nurses did not create the NHS staffing crisis. Nurses did not create record NHS waiting lists. Nurses did not underfund our NHS. Nurses did not hand tens of billions of pounds that should have gone to the NHS over to the private sector, including in corrupt contracts. Whoever the Tories try to blame, the simple truth is this: it is 12 years of Conservative party rule that has created the crisis in our NHS.

    At its core is a crisis in the NHS workforce, with workforce shortages at an unprecedented level across the NHS. The statistics are eye-watering, with 133,000 NHS vacancies in England alone and a record high of 47,000 nursing vacancies. This Tory-created staffing crisis is why patients are struggling to get a GP appointment, why heart attack patients face ambulance waiting times of more than an hour and why many are not getting the life-changing operations they urgently need.

    Today we will vote on an important policy to scrap the non-dom tax status that is exploited by the super-rich to avoid £3.2 billion in taxes every year. Scrapping that, as Labour advocates, could fund a long-term plan to train enough NHS staff. For example, it could double the number of medical training places and deliver 10,000 more nursing placements.

    The Tories should back that plan to put the NHS before non-doms and invest in our NHS instead of lining the pockets of the super-rich. It is a plan that would help bring about a long-term solution to this crisis. For the next two years that they are in government—that is all it will be—they should take the action needed to address the workforce crisis in the immediate term, and we cannot solve that unless we resolve the NHS pay crisis.

    A third of public sector workers are actively considering leaving their jobs, and pay is a key factor in that. Key workers in our NHS still earn thousands of pounds a year less in real terms than in 2010. For example, nurses’ real pay is down by £5,200 compared with 2010, while hospital porters’ real pay is down by £2,500. Now the Government expect it to fall even further.

    Staff, however much they love their jobs, simply cannot afford to stay in them. Their pay is not covering their essentials. Hospitals are even having to open up food banks for staff. That falling pay is why, over the coming weeks, nursing staff and—it was announced today—ambulance staff will be taking industrial action. Nursing staff do not want to take action, but they feel they have been left with no choice because Government Ministers will not even meet them to discuss pay.

    Nurses hope that the Government will listen and open up the pay talks so that they do not have to go out on strike, but if they do strike, they will have public support and I will go and support them. It is not too late for the Government to avoid strikes. They have chosen strikes over negotiations, but they can stop this at any point. The Government need to open up the talks and they need to pay NHS workers properly. They need to give NHS workers the pay rise they deserve.

  • Daisy Cooper – 2022 Speech on the NHS Workforce

    Daisy Cooper – 2022 Speech on the NHS Workforce

    The speech made by Daisy Cooper, the Liberal Democrat MP for St Albans, in the House of Commons on 6 December 2022.

    Let us imagine what this debate could have been. If the former Prime Minister—the former former Prime Minister, I should say—had accepted the workforce amendment to the Health and Care Bill 13 months ago, this debate could have been so different. The Government could have crunched the numbers, NHS frontline workers would know that the cavalry was coming, and patients would be able to see light at the end of the tunnel. Instead, here we are as Members of Parliament with a roll-call of horror stories, because somehow, in 2022, waiting more than 12 hours for an ambulance is the new normal. How on earth has it come to this?

    We know that there are workforce problems in every part of our health and social care sector and every corner of our country, whether general practice, dentistry, pharmacies, midwifery, nursing—all are overstretched and understaffed. But it is midwives who send me their most distressed emails, because they often train for their dream job, only to be plagued by nightmares that they have not done enough to help new mothers and their babies in their time of need.

    Just last week I spoke with paramedics and other ambulance staff as I took a three-hour ride out with my local ambulance service. At 7 o’clock in the morning we were called to see the first patient. That patient had been waiting at home, on the floor, since 6 pm the night before—13 hours. Before we could get to see that patient, we were called to a more urgent call. When we finally got to the hospital with that second patient, the paramedics checked the list of patients who had arrived at the hospital. They were distressed that they had not been able to get to that first call, and wanted to make sure that another ambulance had done so. They were exhausted. They said that in a 12-hour shift they may get only one 20-minute break. They were exhausted because there are not enough staff.

    For most of my constituents, day in, day out, access to their GP really matters, and too many of them are struggling. That is no wonder, because the Government said they had a target of recruiting 6,000 more GPs, but they have admitted within three years that they will fail to meet that target. It is frustrating for patients, but it is also dangerous for GPs and their staff. This summer we heard reports from Walton-on-Thames in Surrey, where police had been called to a GP surgery because people were making threats of physical violence. That is surely unacceptable. Where is the urgent drive to recruit and retain our GPs?

    How on earth will we retain and motivate highly trained professionals when our hospitals are on the verge of collapse? Up and down the country there are hospitals in dire need of repair. In Eastbourne—I see the hon. Member for Eastbourne (Caroline Ansell) is in her place—there have been concerns for a long time about whether the hospital may or may not be coming. It was recently reported by some staff that they had been told—allegedly—that a new hospital was even a bare-faced lie.

    Caroline Ansell (Eastbourne) (Con)

    I thank the hon. Lady for advising me ahead of the debate that she might mention the hospital in my constituency. I am not sure of her particular interest in Eastbourne, although it was named by Time Out as its place to visit in 2023. For the benefit of those in my constituency who may be following this debate, am I pleased to share that, in relation to the workforce—the matter before us today—there has been a 25% increase in full-time staff over the past 10 years. That is a 10-year increase in nurses and midwives, a 10-year increase in doctors and dentists, and a 10-year increase in allied health professionals. They also report £20 million—[Interruption.]

    Madam Deputy Speaker (Dame Rosie Winterton)

    Order. It is important to have fairly short interventions.

    Caroline Ansell

    Thank you, Madam Deputy Speaker. Is the hon. Lady therefore pleased and relieved to hear that, despite staff concerns that there would not be a new hospital, there has been a run of incredibly positive meetings and we are assured that, in the words of the chief executive, “once-in-a-generation” investment is coming?

    Daisy Cooper

    The hon. Lady asks about my particular interest, and she will be aware that as the Liberal Democrat spokesperson for health and social care I have asked the Government on 10 occasions about releasing funds for my local trust, and other hospital trusts across the UK, for the new hospital programme that the Conservatives promised in 2019.

    Other hospital trusts are deeply concerned about the lack of progress on the new hospital programme. In Sutton, for example, St Helier Hospital was built before world war two. My own trust, West Hertfordshire Teaching Hospitals NHS Trust, which covers St Albans, Watford and Hemel Hempstead, has buildings that are life-expired. I have been there a number of times and seen the extraordinary work by professionals in my local hospital trust. We had the first virtual ward during the pandemic, and we have two robotics suites. We also have a lift that breaks down right next to the ward that treats children who are ill. When that lift breaks down, ambulances have to be stationed outside one side of the hospital so that they can drive around to the other side. This is completely unacceptable.

    Will the Minister confirm that all of those hospitals right across the UK—wherever they may be—will get the funding they were promised under the new hospital programme and that there will not be delays and penny-pinching? A Conservative Member no longer in his place asked where we would train all of the planned thousands more doctors and nurses. If there is any penny-pinching on the size of our new hospitals, they certainly will not get trained in our area.

    Our NHS and social care need people, tech, beds and buildings. There is no silver bullet to solving all of the issues in our NHS and social care, but getting some proper workforce planning in place would be the closest thing to that. That is why my Liberal Democrat colleagues and I are happy to support the motion.

  • Bell Ribeiro-Addy – 2022 Speech on the NHS Workforce

    Bell Ribeiro-Addy – 2022 Speech on the NHS Workforce

    The speech made by Bell Ribeiro-Addy, the Labour MP for Streatham, in the House of Commons on 6 December 2022.

    The importance of this debate should not be understated because the NHS is in a dire state, and that is largely the result of a severe staffing crisis. Other than the generally inept economic policies we have seen from the Government, there is no denying that the Brexit deal has had a direct impact on staffing numbers, and that chronically low pay and poor working conditions have resulted in an exodus of staff leaving the NHS to work in the private sector, work abroad or leave the healthcare profession entirely.

    I would like to start with one of the most undervalued groups in our NHS, which is the first that most of us meet in modern Britain—the midwife. The Royal College of Midwives has estimated that it has an existing and long-standing shortage of more than 2,000 midwives, and that for every 30 who are trained, NHS England loses 29. Vacancies for nurse positions are estimated to be at an all-time high, with a survey at the start of the year finding that 57% of nursing staff across healthcare settings are thinking about quitting or actively planning to quit their jobs.

    With figures such as these, we cannot blame existing staff for wanting to leave or blame others for not wanting to fill these vacancies, particularly when we see the TUC’s estimates that, since the Conservatives took office in 2010, midwives have had a total real-terms pay cut of £5,657, nurses’ pay is down by £4,310 in real terms and the pay of all doctors is down by about 7.4%. We cannot forget the thousands of non-medical staff, who are often overlooked, but are integral to keeping the NHS running. Cleaners, security guards, porters and other important workers have, along with other NHS staff, faced real-terms cuts in pay since 2010.

    Is it any wonder that the NHS waiting list has now tipped to over 7 million? When we hear of the scale of the vacancies, can we really be surprised that some A&E patients are left waiting for over 12 hours, or that ambulances are repeatedly failing to meet their target response times? The staffing crisis in the NHS is having a dire impact on patient safety, and if we are going to tackle the NHS backlog, address the crisis in staff recruitment and retention, and bring the NHS back to the standard it should be, we first and foremost have to address pay. We cannot be gaslighting nurses by saying that they should drop their pay demands to send a message to Putin, which is absolutely ridiculous.

    We have to pay nurses what they are worth, and if the Government were not aware of what they are worth, the pandemic should have shown them. We called them key workers because we could not do without them, yet the Government justify their pay by calling them low-skilled workers. There is no such thing as low-skilled work; there is only low-paid work. All work is skilled when it is done well, and our NHS staff are the best example of this. On the contrary, Ministers, who are paid multiple times more but who have shown little skill in running the country, if the cost of living crisis and the economic situation are anything to go by, are completely different. They get paid so much more, but we cannot see their sense of skill in running this country.

    In the past year, a number of NHS personnel have been taking strike action against low pay, and nurses will be striking later this month for the first time in the Royal College of Nursing’s 106-year history, while ambulance staff have announced their strike today. If that does not show us the scale of the crisis facing workers in the NHS, I do not know what does. No one wants to have to take strike action, least of all the workers in our NHS, but the dire situation of chronic underpayment and poor conditions is leaving them no choice. This Government have left them no choice. When we have 27% of NHS trusts operating food banks for their staff, when one in three nurses is taking out a loan to feed their family and when NHS staff across the board are severely underpaid, of course they are at the point of saying that enough is enough.

    No one goes to work for the NHS for the money, but it cannot be fair to expect people to live on poverty wages. If the Government want to address this crisis in recruitment and retention, they must get over this ideological aversion to paying public sector workers what they are worth. That means committing to a proper cost of living pay rise, and setting out plans to reverse a decade of real-term cuts in pay for our NHS workers.