My Speech on the NHS Long-term Strategy – Opposition Debate

Rt Hon Sir John Redwood MP (Wokingham) (Con): No one can deny that the health service is under extreme pressure. No one can look at it and not realise that there has been a big surge in extra demand, that there are problems from the hangover of covid when a large waiting list for less urgent treatments built up, and that we are short of doctors and nurses, not because Ministers will not authorise their appointment but because there are vacancies to be filled. As one of those who has been urging for some time to see a published workforce plan, I welcome the decision of Ministers to insist on that, and the sooner we get it the better. However, I am quite sure that there are a whole series of workforce plans already in the many dozens and hundreds of working trusts and quangos that constitute the NHS. It is about aggregating and making sense of those plans.

Yes, indeed. From my hon. Friendā€™s own expertise, I am sure she is right. When people talk about productivity, they do not believe that hard-pressed staff have to work harder; they are saying there must be smarter working, making jobs more manageable or enabling them to concentrate on the things they are most skilled at, with more relief for the other necessary record keeping, which may indeed need slimming.


Dr Caroline Johnson (Con): We often talk about the shortage of doctors. We know we cannot create a doctor overnight. It takes a substantial amount of time to train them. The Chancellor, a former Health Secretary, invested in five new medical schools to increase the number of doctors in training. Does my right hon. Friend agree that the Chancellor, with the Health Secretary, needs to invest more money in more medical schools and medical school places, but also look at how we increase the number of doctors by reducing the amount of bureaucracy and paperwork they have to fill in, so that they can spend more time doctoring and less time filling in forms?


Rt Hon Sir John Redwood MP (Wokingham) (Con): My hon. Friend is right that we could expand our training places further, but as we have heard there has been a big increase in educational provision and it takes seven years for it to flow through. I am glad we are getting to the point where we will see some benefits from that. We need more homegrown talent. Many people are attracted to the privileged career of being a doctor and the more we can allow to do that, the better. However, given the immediate urgency of needing more capacity, and therefore more doctors and nurses, the most obvious place is to look at all those who have already had the training and have left the profession or the NHS for one reason or another. Some may be in early retirement. That is probably not something my hon. Friend wants to change because she enjoys her new job, but there are many others who are not in a very important job like her who might be attracted back. I hope the Treasury will be engaged in the review, because I hear from doctors, as many do, that the quirk in the tax system at just over Ā£100,000 where some of the better paid doctors are resting, producing a more penal 60% rate, is an impediment to extra working. I also hear about the pension problems that have been cited on both sides of the House. The Government need to take those issues more seriously if they wish to accelerate returns.

Ministers have very clearly set out that they want more NHS staff and have obtained much larger budgets in the last three years to help bring that about. They have also said very clearly that the publicā€™s priorityā€”and indeed the Oppositionā€™s priorityā€”is to get more treatments and get those waiting lists and waiting times down for those needing more urgent or emergency care. Those Ministers must translate that through the senior health service managers into ways of spending that extra money. If it needs a bit more extra money, there is always some extra availableā€”every time we meet another additional sum is announcedā€”but it has to be well spent. It has to be spent on motivating and recruiting the medical workforce.

I had better not, because we are very short of time for colleagues.

The money has to be well spent and I hope that senior managers, as they give us a published workforce plan, will share more of their thinking. It is not good at the moment that there is such a breakdown in relations with talented and important staff in the health service. There is a complex system of pay reviews, increments, promotions and gradings of activities. All those things have flexibility within them. I look to the senior managers

We need more supply because there is excess demand, for understandable reasons. Huge sums of money were tipped into the system to deal with covid. Not all of it was well spent, but that was understandable given the unknown nature of the beast at the beginning, and the obvious pressures in this place and elsewhere to get instant results with personal protective equipment, testing and so forth. That is now behind us, but unfortunately it disrupted normal hospital work and normal GP work and created backlogs.

I urge the Government to understand that part of the answer is having more bed spaces in hospitals, with the staff to back them up. I do not know why so many senior health executives never want to admit that. They always say that there are lots of bottlenecks and other issues. Yes, of course we need to move people on from hospital as soon as it is safe to do so, and of course we need more capacity in social care, but I say to Ministers that it would be great to have a bit more capacity in the main hospitals to give us extra flexibility and take some of the pressure off. Could not some of the extra Ā£20 billion, Ā£30 billion, Ā£40 billion or Ā£50 billion that has been found in recent years be spent on the combination of physical capacity and the staff to support it that we so need?


  1. David Paine
    January 13, 2023

    Long term – Has any thought been given to introducing training contracts for doctors and nurses whereby they get government support/scholarships for training but with a contractual obligation to pay back that support if they leave the NHS within so many years (on a tapered basis maybe)?
    Short term – Why not offer doctors a tax-free cash bonus for each year they remain in service beyond the age at which they can take early retirement? The bonus could be sufficient to offset the extra tax they would pay for exceeding their lifetime pensions allowance plus marginal higher tax rate? Such an approach could mean that the Treasury would not be under pressure to introduce complicated tax/pensions exemptions for doctors nor to change tax/pension thresholds universally thereby avoiding extra work for the poor darlings.

    1. Berkshire Alan
      January 15, 2023

      Far too sensible and simple solution to ever be introduced.

  2. Lynn Atkinson
    January 13, 2023

    I cannot comprehend why you think the Govt should run the Health Industry. You will not become involved in the Pandemic debate because you have no expertise. What expertise does Westminster have to run a health service? It canā€™t even fathom that if there are too few beds for the worldā€™s citizens they need to be retained exclusively for British Citizens.
    Robert Kennedy Jn Group is suing ā€˜Trusted News Initiativeā€™ including the BBC, for suppressing debate on the pandemic. A number of issues that TNI branded ā€˜disinformationā€™ have proven to be accurate information.
    Now that is an issue Westminster and one of its most able Members should be addressing – after all the BBC is also under the ā€˜careā€™ of Westminster.
    This is a mess of Government making.
    Now letā€™s assume, just to put the cherry on cake, that the MOD, uniquely, has not been politicised and is competent! All they have left is the button and a House full of idiots who will push it!

  3. Jude
    January 13, 2023

    Totally agree, John. We need transparency of spend which is complicated as there numerous trusts. The hierarchy is top heavy & would be helped by merging trusts. Also, there should be centralised online NHS agency. To take on those who want to work freelance. Which would save huge external agency costs. All staff trained in UK should be contracted to work for at least 5 years after qualifying. Or buy themselves out of they leave sooner. Procurement is similar & needs major review to ensure lowest cost for quality products. Not mates rates!!! Having trained in NHS back in late 60s, sadly the mismanagement & dodgy buying practices seem to still remain!!

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