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Written Answers from the Department of Health and Social Care

The Department of Health and Social Care has provided the following answer to your written parliamentary question (117394):

Question:
To ask the Secretary of State for Health and Social Care, what steps he is taking to help recruit more permanent staff to the NHS and reduce dependence on Agency staff. (117394)

Tabled on: 06 January 2023

Answer:
Will Quince:

This Government is growing the National Health Service workforce. There are now over 42,000 full-time equivalent (FTE) more staff working in NHS provider trusts and commissioning bodies than October 2021, including almost 4,700 more doctors and over 10,500 more nurses. We are working hard to deliver 50,000 nurses by the end of March 2024 and we are well on the way towards achieving this aim with over 36,000 more nurses working in the NHS now compared with September 2019.

The Government has funded 1,500 more medical school places each year for domestic students in England, a 25% increase over three years. This expansion was completed in September 2020 and has delivered five new medical schools in England. There are currently record numbers of medical students in training.

The Department of Health and Social Care has also commissioned NHS England to develop a long-term workforce plan. The plan will look at the mix and number of staff required across all parts of the country and will set out the actions and reforms that will be needed to reduce supply gaps and improve retention. A temporary workforce market allows the NHS to meet demand fluctuations without the need to increase capacity above that which would be required on a sustained basis. Staff can be drawn from internal staff banks or external agencies.

Measures were introduced in 2015 to control agency spending and include price caps, limiting the amount a trust can pay to an agency for temporary staff, the mandatory use of approved frameworks for procurement, and the requirement for all trusts to stay within the specified Annual Expenditure Ceilings for agency staff. The agency rules outlined were effective in reducing spending on agency staffing by a third between 2015/16 and 2020/21.

The answer was submitted on 12 Jan 2023 at 11:10.

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. Friend’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 Toggle showing location of Column 647number 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 £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 public’s priority—and indeed the Opposition’s priority—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 available—every time we meet another additional sum is announced—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 £20 billion, £30 billion, £40 billion or £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?

Vaccines

I do not have expertise in the chemistry or the medical effects of vaccines. If you wish to discuss this topic then go to sites that are capable of handling these issues and have articles from people who do know about them. Nor do I wish to host a debate about Mr Bridgen’s  words. As you can see I have not written about this medical issue.

My Conservative Home article – The aims of the government

          Rishi Sunak  in his New Year speech set out three economic targets and two promises on NHS waiting lists and illegal migrants. There is  nothing wrong with putting three economic matters top of his five point plan. It is” the economy stupid” as Clinton reminded us  that will determine the election result. It is the economy that is on most minds, as people navigate high inflation and worry about a recession. I am glad he regards economic improvement as central to his task over the  next two years. Most of the rest would flow from economic success.
         The problem is that economic language and overlapping economic targets do not set the pulses racing or reveal much about the vision. All main parties want inflation down, debt under control and some growth. The issue on the economy is who has the best policies to achieve those aims? Who is most likely to see it through?  What do those generalised abstractions mean for individuals trying to pay the gas bill, seeking a better job or running their own small business? If you are in government and have been in office for some time you need to show you have produced good results and have done all you can to maximise people’s life chances and minimise financial pain.
         The first aim to halve inflation should happen this year. The Bank of England has shifted from too lax a policy promoting inflation in 2021, to too tough a policy now, leading us into recession. This will bring prices down the hard way. Halving price rises still leaves inflation well above the 2% target.
          The second is to “grow the economy”. That is an excellent aim, but not one we will see for much of 2023 on current policies. The government needs urgently to present to Parliament a growth package. Several of the pro jobs and business tax proposals in the Truss/Kwarteng budget would help, along with the more vigorous Free Ports, Enterprise zones, public/private partnerships and realistic energy policies that they proposed. These need to shaped into an affordable package, balanced by some spending reductions as the government wrestles with public sector budgets that are costing too much and delivering too little. Encouraging and helping more people into work would be  an obvious win win that would help by cutting benefit payments and raising tax revenues. Stopping the Bank of England taking so many losses on its badly bought bond portfolio would also assist. Producing more something for something pay deals in the public sector to lift productivity from its current deep low could be transformational. Pushing through more UK oil and gas production would not only cut imports but boost tax revenue.
         The third of the economic aims is to “get our national debt down, so that we can secure the future of public services”. It turns out this relates to the old Maastricht target of debt falling as a proportion of GDP, a target even the EU has suspended. It  relates to five years hence, well into the next Parliament so it is no early constraint on action. The best way of achieving such a goal if you must is to promote faster growth – or reverse a recession – as debts and deficits fall when growth generates more revenue and cuts the  cost of unemployment as more get jobs. Putting up taxes this year does not lower the deficit in five years time, as the recession and energy support payments are going to mean a lot more borrowing this year than was planned in the March budget Rishi put through himself.
         The fourth aim is to cut NHS waiting lists so people can get  care more quickly. That should receive almost universal agreement. The issue is not the aim but the means. It also leaves open why hasn’t this happened before.
         The fifth aim is Rishi’s first stated priority when he became Prime Minister. He will legislate to ensure if you come illegally you will “be detained and swiftly removed”. That would be popular with many Conservatives. It assumes Ministers now know which powers they need to take to make sure the courts and lawyers do not thwart their wishes again, as this has long been the stated aim. We are awaiting early legislation in Parliament.
            The speech went on to stress the need for innovation in business to power higher productivity and higher wages, stronger communities, world class education, better healthcare for patients and placing the family at the heart of social life. Most of this was general in nature but drew on his own family background well to illustrate the themes. The one specific, more maths education for all six formers, is an idea in search of a policy. It does not mean all have to take maths A level. It  will require consideration by teachers over what can be taught to those not offering specialist maths/ There is the problem who can teach it and what assessment or qualification if any would follow.
              Many ask me if this is a winning vision. I think the Prime Minister is right that his strength must be  competence so what he needs to do is to demonstrate he can deliver on these five promises he has made. He chose the ending of illegal migration as his first priority, seeing the political significance of not being able to control our own borders. He understood the resentment felt by many to see young men pay substantial sums for a dangerous boat trip to enter illegally and to be put up in hotels with free medical care paid for by UK taxpayers. Stopping this would be an important achievement, saving lives and giving proper priority to the asylum seekers from Afghanistan or Ukraine where we have legal routes of entry for them. There will be a success to report when we see many hotels return to their proper use.
               Getting  NHS waiting lists down will be difficult. The fast growing population from migration and the backlog of health cases brought on by covid disruption of other NHS services means the NHS is under pressure. There are too  many unfilled vacancies and the employees are unhappy.  The PM will need to persuade the senior management of the NHS to expand capacity quickly, which will need more beds and medical staff. The government does  not have the time nor mandate to embark on major reform of the NHS before the election. It can encourage managers to improve staffing arrangements, reduce pressures where waiting lists and times are unacceptable and expand capacity as much as possible. It is odd how resistant NHS managers are to putting in more beds with the medical staff to support them. The latest package offers us virtual beds, not the real things in hospitals. Some of the many extra billions provided to the NHS needs to find its way into extra capacity rather than more quangos, Diversity Officers and management consultants.
                 It will be the economy that determines how most voters feel about the government come election day. You cannot hope to create a better economy just in time for the election and expect people to forget what has gone before. By 1997 the then Conservative government had recovered the economy well, but the public was not willing to forgive them for the deep  recession brought on by their policy of joining and then getting ejected from the European Exchange Rate Mechanism. It is most important this government is seen to be battling against recession as  the Bank of England and the other major Central Banks deliberately slow things down to curb inflation. Allowing the Bank to overdo  it and give us a long and deep recession would be bad economics and worse politics.
                    That is why the government urgently needs a growth package. If we can boost investment in energy, in food, in transport and all the other areas where there are shortages which create inflationary pressures we will be tackling growth and inflation at the same time. Urgent and successful interventions to limit the downturn, to increase  investment  in the future mainly through private sector action, to get more people into work and to promote better pay for more output in the public services would be a winning combination. It does now require visible improvement, not just words, from a Prime Minister who rightly stresses the  need to deliver.

Strikes

The government’s statement on proposed new strikes legislation was short and simple. It praised the nurses for agreeing minimum service levels before going on strike, recognising their greater duty to the public to avoid action which could lead to the death of a patient. The government said it needed to put in place similar minimum service agreements for the NHS , the fire service, education, railways, nuclear decommissioning and borders. They argued they had no wish to take away the right to strike, and were copying practices in some other European countries. The Opposition saw it as an attack on workers rights and said they would oppose.

It will be interesting to see how the government proposes to enforce any such law, as by definition if people have gone on strike it is difficult to get them to come back to work against their will. The Bill implies action for damages against Unions not ensuring the minimum standard, but it will need clarification. Certain workers will  be identified as essential to maintain the minimum service and they will be expected to turn up.  It will also be difficult to decide what is a safe necessary minimum standard of rail services, given the way motor transport, planes and boats can be substituted for trains. The government intends to consult on minimum standards which will doubtless produce a  variety of views. I would be interested in comments on these matters as I do not have settled views myself on how this will work.

A Health package

At last Ministers had something to say about getting waiting lists for treatment down and waiting times at A and E reduced. The fundamental principle of the NHS is free access to health care based on need. Rationing by delay is not part of the deal to taxpayers who are now paying  very large sums for the service.

The NHS needs more medical capacity. It needs more GP surgery slots, more hospital beds and more operations performed. The backlogs are unacceptable. This is why I and others have been calling for a Manpower Plan. This needs to set out expectations of manageable workloads per employee and realistic targets for staff  numbers needed to cope with likely demand. They also need extra to get rid of the oversized waiting lists.

This raises various questions over training, recruitment and retention. Could we introduce high standards of training in specific areas that take less time than a full doctor’s qualification to staff specialist centres for cataracts, knee surgery and the other high volume standard procedures for elective surgery? Can nurses and pharmacists have more authority  over prescribing and providing medicines? Can medical tests be streamlined and  be more efficient?

When it comes to retaining doctors that does highlight the general tax issue where people get taxed at 60% in the £100,000 to £125,000 range, and where the allowed level of savings for pension has bee cut  back substantially. It would be good to ease these tax issues for all as doctors tell us they lead more to retire early when we still need their skills.

The Secretary of State yesterday announced more money to buy bedspaces in care homes to allow earlier discharge from hospital for some elderly patients. He also announced the equivalent of 7000 extra beds in the form of virtual wards where people are clinically supervised remotely by professionals whilst be in bed at home. he also announced some increase in capacity through adding modular units to allow more day care in A and E. He also proposed more work for pharmacies to cut the demands on GPs.

There is still no full workforce plan,  nor stated plans to add beds with relevant staff to hospitals. As the population keeps on growing, and as an ageing population needs more hospital care the NHS does need to expand its core bed capacity.

The railway strikes

It is most important the government does not settle the rail dispute with more subsidy for little or no improvement.

The public sector has progressively removed a proper role for private capital and competition in the industry. In the early years post privatisation use of the railways expanded. There were sufficient service improvements  and new investments for John Prescott to praise it. Important investments which the nationalised industry never prioritised like linking Heathrow into the national rail network to capture many more travellers were made by the private sector.

Then Labour nationalised Railtrack, taking track, signals and stations back into state ownership. Successive governments tightened the controls over timetables and service patterns. Successful experiments in competition to increase services as with Hull were made difficult or blocked. Then governments started into to take various lines directly into public ownership.

Today we effectively have a nationalised railway. Ministers have been dragged into strike discussions as they seek to limit the  ability of management and staff agreeing to big increases in pay bills with no improvements to productivity or service quality.  The  collapse of fare revenues since 2019 should be a major preoccupation of management and staff, as government needs to limit  subsidies for running near empty trains with rising costs and little revenue.

Ministers are right to expect nationalised and residual private sector managements to sort out smarter working. They should also advise on a better timetable and route pattern to raise fare receipts. The old nationalised industry performed badly and relied on overcharging the  then reliable commuter passengers. Railway bosses threatened Ministers with commuter disruption if subsidies were not big enough. Today the  commuter is not 5 days a week and can work from home on strike days.Those negotiating need to grasp this changes things a lot. It means we need a new pattern of rail services and new positive attitudes by managers and employees. The leisure railway mainly thrives on heavily discounted tickets, leaving taxpayers with unacceptable bills.

Labour attacks the GP partnership

I see nothing wrong with the idea that GP s form partnerships, finance their own surgeries, can run their own pharmacies and have a contract to supply services free to patients paid for out of taxation via the NHS budget.

It was decided by the post war government not to nationalise doctor practices in order to secure their agreement to the idea of the NHS. It left GP s free to offer private services in addition to the work they do for the NHS. It means we have thousands of GP small businesses innovating, offering variations of service and providing some choice for patients. The  closer we move to an all salaried profession with GP s as employees of a centralised NHS  the less choice and innovation will be on offer.

One of the problems today is the reluctance of younger doctors to take on the responsibilities of co ownership and management of a partnership. Many opt for part time salaried employment.This makes it more difficult to provide sufficient cover and irregular hours which Home visits and emergencies can entail.

There is also an issue over early retirement. Some GP s argue that the reduction of limits on tax free pension saving stops them working more years to build a better pension pot. Many GP s are also in the pay band above £100,000 where the effective marginal tax rate is 60% , discouraging full time or longer hours working.

Government needs to listen to GP s over tax and pensions, and look at a range of ways to facilitate more GP surgeries and practices. We are short of capacity. GP surgeries can be places where a whole lot of tests, diagnoses, treatments and procedures can be successfully carried out relieving pressure on hospitals and providing a service close to home for more people.

Telegraph article on managing the public sector

I reproduce below and article I wrote for the Telegraph recently:

    More money for the public sector must be something for something. 

If we work smarter and produce more then we can be paid more. Growing the country’s income per head is central to creating the greater prosperity and the wider opportunities people expect. The covid lockdowns imposed a heavy price, destroying business and tax revenues and  limiting output. They led  to massive public borrowing to tide us over the difficulties. Many people and enterprises came to rely on state handouts.  Output and output per head slumped.

Productivity sounds technical and tedious yet it is the key to economic and individual success. If you help produce something lots of  people want you usually generate more revenue, allowing your employer or your business to pay you more. If you make something unique like a best selling book or movie, or a new app which is a must have, you can be extremely well rewarded. If you help a company produce oil or pharmaceuticals or some other very investment intensive activity with few people in relation to valuable output you can benefit from the high pay the activity will allow. Markets determine the value of people’s output and so influence their pay.

The public sector tends to assess the pay of its staff by reference to market based private sector comparisons. In  the 22 years from 1997 to 2019 public sector productivity rose by just 3.7% over the whole time period though public sector staff got pay awards based on comparisons with a private sector that was doing a lot better at raising output per person.

 Real state output soared under Labour from 1997 to 2009  by a massive  50% , but productivity fell  2% over the 12 years. Under the Conservatives pre covid by 2019 output was up again by a more restrained 8%, with productivity edging ahead to show a 3.7% gain for the entire 22 year period. By end 2021 output was up again by almost a tenth  but productivity was down on 1997 levels by 3.7%.. So over nearly a quarter of a century of fast automation and technical advance in the wider economy  the UK public sector saw a fall in  productivity.

Now the state is much deeper in debt to pay for that huge expansion of public sector activity over the last quarter of a century as a result. We did not see savings for all the investment in computers, on line services, new trains and the rest.  We cannot go on like this. It is bizarre that productivity has fallen a lot in an area like benefit processing, given the big investment in electronic  systems to speed the efficiency of the process. Having an ever more complex tax system raises the costs of collection.  The collapse of commuter five day a week travel on the railways has gravely damaged fare revenues leading to a surge in state subsidy to support a far less productive railway. Subsidising too many near empty trains makes little sense financially or environmentally.

The government needs to go through the reasons for failing productivity department by department, function by function. It needs a series of something for something pay deals, that recognise people’s wishes for pay that keeps up or beats prices. It needs to meet aspirations where it can afford them through promotions, increments, adjustments to pay scales that are based on more output through smarter working.

The railway is a good place to start. The government should not be offering more subsidy which is now more than double  the fare revenues. It should be seeking ways to cut the cost to taxpayers, expecting from management and unions together a new approach to identifying how to use the railway to better effect to collect more fares and incur less cost. There is no need to have compulsory redundancies but there is every need to reduce manning levels where technology can do the job, to use new methods  for track inspections, to amalgamate guard and driver tasks and a range of other measures which can help. Above all they need a more imaginative timetable that fits modern travel needs. They should have ticket pricing that offers larger discounts the more often you travel a route to try to get more people back commuting more regularly.

In the NHS Ministers should expect more achievement and more transparency from their many higher paid managers in the quangos and Trusts that employ the staff and spend the money. The NHS clearly needs more capacity. Management passion to reduce or limit bed numbers over the years has left it short of physical capacity for an expanding population. It needs an effective workforce plan, as it has many vacancies that need filling and many Agency staff who should be recruited into permanent roles to save the Agency fees and the frictional costs short term employment generates. Quality and output are normally enhanced by allowing people to specialise in areas that they then become good at handling. The NHS under Labour developed more ways to buy in activity and skill from the private sector, whilst preserving the all important free at the point of delivery for the patient. More use can be made of this to encourage centres of excellence and special treatment centres by type of procedure and illness.

Taxpayers are paying large sums to retain 33,000 NHS managers. They expect to see better results from all that planning, hiring and memo writing. Higher output and quality can go together, and depend on a well motivated, respected and professional workforce. As we watch the strikes and delayed access on the  news broadcasts we need to ask how they can do things better. We need a public sector productivity revolution, which requires inspirational managers and positive workforces to get together for the sake of better services and higher pay. The two go together.  Taxpayers are happy to pay for a good service through their taxes, but resent tipping more money into services where productivity is falling and where services do not meet the public’s needs.

 

 

Written Answers from the Department for Business, Energy and Industrial Strategy Regarding Wind

These answers reveal a worry about discussing the magnitude of special payments to renewable generators, and confirms that there are too many days when wind produces little electricity, leaving us dependent on gas, coal and biomass.

The Department for Business, Energy and Industrial Strategy has provided the following answer to your written parliamentary question (112033):

Question:
To ask the Secretary of State for Business, Energy and Industrial Strategy, how much was spent on National Grid constraint payments to wind generators in 2022. (112033)

Tabled on: 16 December 2022

Answer:
Graham Stuart:

The National Grid Electricity System Operator publishes data on the costs and volumes of electricity system balancing services monthly. This includes a breakdown of constraint costs by fuel type, including wind farms. The total amount paid to wind generators for 2022 has not yet been finalised. Further detail on wind farm payments paid in October can be found in The National Grid Electricity System Operator’s monthly Balancing Services Summary.

The following documents were submitted as part of the answer and are appended to this email:

  1. File name: Monthly Balancing Services-october-2022.pdf
    Description: Monthly Balancing Services Summary 2022/23 October

The answer was submitted on 28 Dec 2022 at 10:24.

 

 

The Department for Business, Energy and Industrial Strategy has provided the following answer to your written parliamentary question (112032):

Question:
To ask the Secretary of State for Business, Energy and Industrial Strategy, how much has been paid to wind generators in subsidies in 2022. (112032)

Tabled on: 16 December 2022

Answer:
Graham Stuart:

The Government supports wind generators through a number of schemes. Finalised data for total payments made in 2022 are not yet available.

The answer was submitted on 28 Dec 2022 at 10:26.

 

 

The Department for Business, Energy and Industrial Strategy has provided the following answer to your written parliamentary question (112031):

Question:
To ask the Secretary of State for Business, Energy and Industrial Strategy, on how many days did wind power provide less than 10 per cent of UK electricity output in 2022. (112031)

Tabled on: 16 December 2022

Answer:
Graham Stuart:

The Department for Business, Energy and Industrial Strategy does not hold daily electricity generation data. However, for the Public Distribution System in Great Britain only, Elexon’s figures show that up to 20th December, there were 64 days in 2022 where generation from wind provided less than 10 per cent of total generation. This excludes net imports from interconnectors.

Source: Elexon half-hourly balancing mechanism reports, available at: https://www2.bmreports.com/bmrs/?q=generation/fueltype

The answer was submitted on 28 Dec 2022 at 10:28.