Part of the debate – in the Senedd at 4:53 pm on 3 December 2019.
Thank you for the series of questions. I think some of that was slightly outside of where we are with 'Train. Work. Live.', but I'll do my best to respond to the points today and I'm pretty sure that, with debates on nursing tomorrow and potentially in the future, there will be plenty of opportunities to talk about workforce.
On male nursing, we won't have the figures until at least the end of this year and into next year to see if there's a trend, and, interestingly, this is an issue of concern both to the Royal College of Nursing and, indeed, Unison as well, where they've had particular issues about wanting to see nursing as a career for men, because the traditional images of nurses are women and then, for all the Charlie Fairheads, there are lots of others in terms of our regular depiction of the nursing workforce. So, there is a challenge there, and, as you say, it was a deliberate choice to pick a male nurse to head up the recruitment campaign last year, but I think it would be an unfair challenge to set to say that there should be a significant turnaround within one year, because we're dealing with a cultural turnaround to be required, but it's important we're deliberately trying to address it.
And, again, in terms of your point about learning from the Scots and attracting people to careers in the NHS, I'm happy to take good ideas from where they come from. If they're effective, I'm interested in how we could adapt and adopt them here in Wales rather than to try to point out how and why they couldn't work. And ideas that work within the context of the UK family of nations are much more likely to be adapted and adopted within Wales because of the similarities within our systems. So, I genuinely remain curious and interested in what other UK nations are doing in the face of broadly similar challenges. We should also have more information at the end of this year on some of the information on the return to nursing work and the trends that we see. So, there's a challenge in understanding what we do so that people return to a career in the NHS if they've left, but also how we retain some of those people who would otherwise leave, and that is something about some of the working patterns that we have. It's also something about the flexibility we want to see in the workforce as well, because some people may want to carry on working on a part-time basis. Now, what I don't want to do is to get into an artificial exercise of saying, 'Well, even though our nursing numbers have gone up by a net amount, when you think about it, it's gone up by more because we've kept people in who would otherwise have gone.' I don't think that's very helpful. But I do want to be able to set out how much more could we do with the flexibility we want to offer to keep people in the national health service, regardless of whether they are porters, admin workers or nurses or otherwise.
On the agency spend, look, part of this is the reality of wanting to roll out the legislation that we have done, when you think about wanting to have adequate staffing across the workforce, the ability to flex and deliver that, particularly with the challenges we've had with recruitment—. Because we can't ignore the reality that about 90 per cent of nurses who were otherwise registering on the NMC who registered in Europe are no longer coming. That puts big pressure on the nursing workforce we've already got. We know, within the western world more generally, there is pressure on nursing numbers. So, actually, regularising our ability to recruit and retain nurses from Europe is a big part of what we want to do, as well as international recruitment as well. But that is in the hands of the voters and others in the coming weeks about what our future relationship will be. But the significant investment in nurse training is to make it clear it's not just about recruiting from other people's countries, it is, actually, about training our own, who are much more likely to stay. Because nurses who go into the workforce tend to already have responsibilities and ties to an area, and that is not the same in other parts of the recently graduated workforce.
In terms of your point about the diagnostic workforce, you can expect to see some of that within the joint workforce strategy, but I think you'll see more of that as I come back to talk not just about the cancer workforce but more specifically about diagnostics as an area. In terms of retaining our existing GPs, we've got a range of work that I've regularly spoken about on reforming the contract, on the work on resolving indemnity in the short Bill that is in front of the Assembly right now. The challenge is on wanting to recruit people in and it to be done successfully, and a big part of it is actually about having more training practices. And that is something that GPs have told me, and HEIW themselves, would help them to want to sign up to stay within the health service system as well, within the national health service.
In terms of the reform agenda, though, it's important that they're able to see something's being done to general practice, because lots of that reform is being driven by people in the service. At the national primary care conference, one of the most impressive parts of it was to look at the cluster handbook that has been provided, where each cluster talks about what it is choosing to do and the leadership from general practice, working with others. And it's not because I have told them specifically what they should do—there's much greater ownership and ideas and innovation that's coming together. When I met the cluster leads in two particular meetings, I was really impressed by some of the enthusiasm to own some of the challenges and to come up with answers from them. Because, as you and I know, sadly, it's the case that, whatever speeches I may make, people don't always believe that a politician is the person they should listen to on how they should improve their job within the service. They are prepared to listen to their peers who are delivering the future already. And that is the encouraging part: the future's here already in other parts of the system here in Wales. Our challenge is how we share that and deliver that more consistently. But I look forward to being able to do that.