3. Statement by the Cabinet Secretary for Health and Social Services: Valuing the NHS Workforce

Part of the debate – in the Senedd at 2:57 pm on 6 March 2018.

Alert me about debates like this

Photo of Vaughan Gething Vaughan Gething Labour 2:57, 6 March 2018

Thank you for that series of questions. I'll try and take them in a sensible order. I want to start at the outset by saying that I don't think my statement does avoid the reality of some of the challenges we face. I'm very explicit about those challenges in this statement as well. It's certainly not any desire on my part not to paint the full picture. If you wanted a complete, detailed picture, I'd still be on my feet for some time, which I might be happy to be but other Members may not be so. But, it is an undeniable fact, not a claim—it is an undeniable fact—that we do have record numbers of NHS staff. That is an undeniable fact. But, within that, we recognise there are challenges within different staff groups and also how we get our staff groups to work in a different way now and in the future. That's so much of what we have to spend our time upon.

I'll try and deal with your questions about doctor recruitment at this point as well, and training. I don't think we have really been ambiguous about our expectation for north Wales. I've been clear that I wanted to see as much medical training and education as possible taking place within north Wales. I've deliberately not committed to saying absolutely what that would be because I don't have a plan in front of me to do so, and I need to understand the evidence of what is possible, the discussions that I've indicated in my statement that are taking place, and then there will be a signed-off plan. At that point, there'll be more detail.

Not only that though, but hearing the Cabinet Secretary for Education intervene, there's a serious point about the work that we have to do together—that we have to continue to do together—on funding, because there are pressures in the budget, as everyone in this room will know. So, it's not just about having a plan that looks and sounds great, but actually we have to fund it. If we're going to fund a plan to do that, about who we expect to take up those places, and really then see a benefit for us as a whole and actually see more doctors from Wales being able to train, work and live within Wales, but also more doctors then staying in Wales, wherever they come from, at the end of their period of study, we can't avoid these very real and practical discussions that we need to have and it can't simply be that I announce a great policy position and I then say to the Cabinet Secretary for Education, 'You now need to pay for it.' It's not as simple as that and nor should it be.

On the broader point about the future of the workforce, that's why I made reference to Health Education and Improvement Wales, and actually what will come from that and the long-term plan for health and care in Wales. We'll need to understand, for that future workforce, the models of care we want to have and the staff we'll need to be able to deliver that too. I just want to make this point about—. You mentioned GP challenges; well, that's why the first phase of ‘Train. Work. Live.’ with GPs has been so successful and such good news for us that we overfilled our places as a country. But it's also worth pointing out when we talk about GP numbers that the great majority of GPs are not employed by the national health service. They contract with the national health service to provide services, and part of our challenge in delivering a future NHS workforce is having models of employment that allow us to do that.

I'll deal with your questions about nurse recruitment as well. We do have a record number of qualified nurses right across the national health service. Some of that varies from one health board to another. I recognise that you were making points about north Wales, but I'm really clear that this is about qualified nurses, and this goes back to the point about the Nurse Staffing Levels (Wales) Act 2016, which will be commenced in April. Commencement is not being delayed, and I expect to report in the future to this place on the early stages of doing that to see the impact of that and to see whether we are seeing improvements in the quality of care as a result, because that was the point of the Act. It is to make sure that we see improvements in the quality of care delivered. But there's something about saying that those will be qualified nurses, so we're not moving down the track with the NHS workforce that they've been taking in England where they're introducing nurse associates. The Nursing and Midwifery Council have agreed to regulate them, but I am genuinely concerned, as are indeed the chief nursing officers of Wales, Scotland and Northern Ireland, about whether this is really about role substitution and really about the financial saving rather than having appropriately qualified staff to do the right jobs and deliver the right quality of care.

I'll make one final point, because you mentioned Brexit. We have real challenges in nurse recruitment in Wales and across the UK and across the wider western world. We know that we'll need more nurses. It's part of the reason why we continue to invest more money in nurse training—because we know we need to grow lots more of our own. But also, to keep the service running, we need to continue to recruit staff from other parts of the world. That's also why I made it explicitly clear that the national health service has always relied on staff from every community but also from every country around the world as well. It's part of our success story that the national health service has actually made the country more cosmopolitan and multicultural. If you look at the people who exist within Wales now in different communities, they're here because of the national health service.

That's why I really do hope at some point for an outbreak of common sense on Brexit and the position we will take on actually having equivalence in both standards, whether it's pharmaceutical issues or about qualifications, and our ability to recruit staff from within the European Union and also much further afield than this. I don't often say pleasant things about Jeremy Hunt in public, but I actually think that, on the challenge of recruiting staff from outside the European Union and the wider world, I think Jeremy Hunt wants to be able to do that in a way that's sensible. The challenge is that, within the UK Government, the Home Office continue to stand in the way of doing that. That is a challenge for all of us. I really do hope there'll be an outbreak of common sense within the UK Government for the Home Office to get out of the way of recruiting the right sort of healthcare staff for every part of the national health service in all four nations of the UK.