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Jumat, 30 Juni 2023

Will the plan to tackle NHS staffing shortages work? - BBC

By Hugh Pym

Health editor

Rishi Sunak has announced a plan to increase the number of people working for the NHS in England, which he says will put the service on a secure footing for the long-term. But despite the prime minister's pledge there are still many questions.

Will it work?

That answer is yes for recruitment, though with a caveat.

The plan is funded for the first five years but for 10 years after that there is an assumption that future governments will find the money to keep up with the required growth in training places.

It is hard to believe a new administration would dilute NHS workforce growth and the training of thousands more doctors and nurses.

But, never say never when it comes to public finances.

Expanding the number of clinical staff to the extent which is envisaged in the plan will eventually have a positive impact for patients - but retention will be a bigger ask.

The plan's policies to improve morale and hang on to staff look a little vague. Recruitment will not achieve much if there is a continued exodus at the same rate as now.

Is it the right approach?

Recruit and retain have long been held up as the required twin-track approach for the NHS.

Health think tanks and charities were queueing up to welcome the plan as it had adopted the policies called for by most experts.

Then again the enthusiasm must in part have been relief that at long last there was an NHS workforce plan after nothing comparable in the previous two decades.

Modelling of future patient demand seems reasonable and health think tanks were invited to kick the tyres of the numbers.

Productivity assumptions were included. Some of the medical Royal Colleges have noted the plan is ambitious and they want to see more detail.

The idea of medical apprenticeships is radical with staff in other NHS jobs training to be doctors.

But, the precise workings of this scheme will need time to work out.

Why is pay not part of the plan?

Pay is certainly the elephant in the room.

Most large organisations drawing up a workforce plan would have a section on appropriate remuneration to attract and motivate the best staff.

That is one thing NHS England can't do with its strategy.

NHS pay is the preserve of the government and it is ministers who decide. Most of the NHS pay disputes have been settled but the doctors' campaign is far from over with further strikes planned.

Health unions have long argued that the best way to hold on to staff is to raise wages at a time of acute cost of living pressures.

Senior management have had to stand on the side-lines of the argument and cope with the consequences of walkouts.

Is it going to make a difference?

In the short-term - no, when it comes to raising the number of doctors, nurses and other health staff.

It takes several years to train clinical professionals and the expansion of new places at medical schools and universities won't begin until the autumn of 2024.

Implementation may be slowed if there are not enough experienced doctors and nurses to set aside time to run the training.

Retention initiatives aimed at reducing the number of NHS staff quitting might make a bit of a difference over the next year or so.

But, patients currently frustrated at not getting a GP appointment or are on a long waiting list for an operation probably won't notice.

Is now not the time for a broader strategy?

Planning the training of tens of thousands of health staff right through till beyond 2030 is admirable.

There has been nothing comparable in recent years with only sporadic time-limited initiatives.

But, what will the rest of the NHS look line by then? Will the service have kept up with the increasing burden of sickness linked to an ageing population?

Will the public be willing to keep funding the NHS through taxation? Might payment for some services have been introduced? How much difference will technology and AI make?

There is no long-term plan for investment in buildings and IT - in other words the hospitals and clinics where the new staff will work and the computers they will use.

Perhaps the publication of a multi-year workforce plan will spur politicians to come up with broader strategies for health funding and reform over a decade or more.

But don't hold your breath.

Being welcomed

There will also be a major drive on retention - including more flexible-working options and career development to provide clear routes to senior jobs. Last year, more than 40,000 nurses left the NHS.

The plan is being welcomed by many in the health service.

Matthew Taylor, of the NHS Confederation, which represents health trusts, called it "bold and ambitious".

The same commitment was now needed for the social care workforce, he added.

Others have pointed out the drive to increase training places could be undermined by the lack of placements on the front line - half of a nurse student's degree is spent working in the NHS.

It will also take years before this expansion starts to have an impact on current shortages - it takes five years to complete a medical degree and three a nurse degree.

Is it enough?

There are challenges making sure the expansion of training places are successful. The first one is making sure there are enough people interested in pursuing a career in health care.

That is less of a problem for doctors - medical degrees are heavily over-subscribed.

But the number of applications for nursing degrees is falling - with universities saying the cost of living crisis is putting people off.

However, perhaps the biggest challenge of all is ensuring existing staff are retained - nurses are leaving the NHS almost as quickly as new ones are joining.

There has been very little detail so far about how this will be addressed - and of course pay is not part of this plan and that is a key factor in keeping staff.

Pay awards going forward will be determined by two things - the size of the NHS budget and what is happening with inflation.

It is why the £2.4bn committed to boost training in this plan over the next five years is being welcomed, but on its own will not determine its success.

'Dismal reality'

Dr Billy Palmer, of the Nuffield Trust think tank, said while it was good to see the plan published, there had been "years of drift".

And he warned the "dismal reality" of working in the NHS at the moment could undermine the push to tackle shortages in the long term.

"There is a risk that we will feed more and more people into training only to burn them out ever faster," Dr Palmer said.

Speaking to the BBC, shadow health secretary Wes Streeting said "congratulations to the government for listening to Labour", claiming that ministers had "nicked" the opposition's plan.

He continued: "There is a reason why the NHS is understaffed, and it's the lack of a workforce plan for the last 13 years."

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'Making inflation worse'

"It allows in people with cognitive skills - lawyers, accountants. But we have no shortage of those people.

"In the age of artificial intelligence, many of those jobs can be done by robots in future.

"At the other end of the scale, we don't allow in people with dextrous skills - these are the skills robots find hardest to do. People who work in food factories for instance."

Such jobs were also where there were "acute labour shortages", he added.

Mr Eustice said the government should "completely reappraise" what it defined as skills and introduce a temporary visa scheme lasting two to three years for sectors such as food processing, which had "acute labour shortages that are contributing to inflation".

These shortages, caused by not having enough migrant workers, were "exacerbating" the rate of inflation by contributing to higher food prices, along with rising energy costs, he argued.

Robots

"Perhaps up to a third of inflation that we're seeing in food is down to shortages of labour. That is driving up the cost of labour, affecting availability of output," he said.

He hoped the independent review would recognise that "dextrous skills [like fruit-picking] can actually be put on the skilled list and some of the professions such as lawyers and insolvency practitioners, the people we don't really need any more of, could be removed from that list".

Mr Eustice warned it might be "many years" before robots were capable of skills like fruit-picking.

"Robots find it easier to replace cognitive skills. You can train a robot to be a grand master of chess quite easily. You can't train a robot to be a fielder and catch a cricket ball.

"Those dextrous skills that humans have are actually quite difficult to replicate in robots," he said, adding that fruit-picking involved environments that were "too unpredictable and too variable".

Ms Braverman has insisted the UK can train its own fruit pickers and lorry drivers to bring down immigration. These sectors have suffered particular labour shortages following Brexit and the Covid pandemic.

Mr Eustice agreed that domestic workers should receive better training, but said he completely disagreed with the home secretary's main point.

"Every developed country in the world has seasonal worker schemes for agriculture. We're going to need to have a seasonal workers scheme for the long term, the next five years, probably longer," he said.

The government has said 45,000 visas for seasonal workers will be available in 2023, with the potential to increase that number by a further 10,000 if necessary.

A campaign to recruit more UK-based workers for seasonal farm roles was scrapped in 2021 after a relatively small number of people signed up.

Kamis, 29 Juni 2023

Rwanda policy: Suella Braverman says plan to stop the boats is being held back - BBC

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By James Gregory & Sean Seddon

BBC News

"Phoney humanitarianism" is holding back plans to tackle small boat crossings, the Home Secretary has said.

Suella Braverman told MPs the abuse of the UK asylum system was "lining the pockets of people smugglers" and "turning our seas into graveyards".

It follows a Court of Appeal decision which ruled government plans to send asylum seekers to Rwanda were unlawful.

The charity which brought the challenge welcomed the ruling, but the government says it will appeal.

A spokesperson for Asylum Aid said the decision taken by the court on Thursday was a "vindication of the importance of the rule of law and basic fairness".

The plan to send people who arrive in the UK illegally to Rwanda was first unveiled in April 2022 in an attempt to deter crossings on the English Channel on small boats.

It has been subject to several legal challenges, including the latest at the Court of Appeal where judges ruled that Rwanda had not provided enough safeguards to prove it is a "safe third country".

Two out of the three judges found that there was a risk that asylum seekers sent to Rwanda could then be forced back to the country from where they were originally fleeing. This means the UK government's immigration policy contravenes the European Convention on Human Rights, which protects against torture.

However Ms Braverman said this did not mean that Rwanda itself was not safe.

Addressing the Commons, the Home Secretary said she respected the judgement, but added that it was "disappointing" and that the government would be challenging it.

Ms Braverman said that the "abuse" of the asylum system was "unfair" on local communities, taxpayers and "those who play by the rules".

She added that it "incentivises mass flows of economic migration into Europe, lining the pockets of people smugglers and turning our seas into graveyards, all in the name of a phoney humanitarianism".

Shadow Secretary Yvette Cooper said the government's Rwanda scheme was "completely unravelling" and described it as "unworkable, unethical and extortionately expensive."

"This is their chaos, their Tory chaos, their boats chaos and their broken asylum system," she said.

The Rwandan government insisted it was "one of the safest countries in the world" and had been recognised for its "exemplary treatment of refugees".

The case was brought by Asylum Aid, which argued the policy was unlawful, as well as 10 people from countries including Syria, Iraq and Albania, who arrived in the UK in small boats.

The High Court had backed the government's policy at an earlier hearing, but that decision was scrutinised by Appeal Court judges Lord Chief Justice Lord Burnett, Sir Geoffrey Vos and Lord Justice Underhill in this latest stage of the process.

While Lord Burnett sided with the UK government, the others concluded that the assurances from the Rwandan government were not "sufficient to ensure that there is no real risk that asylum seekers relocated under the Rwanda policy will be wrongly returned to countries where they face persecution or other inhumane treatment".

They said that sending asylum seekers to Rwanda will be unlawful "unless and until the deficiencies in [its government's] asylum processes are corrected".

The judges stressed that they all agreed that the Rwandan government's assurances of the policy had been made "in good faith".

Tessa Gregory, a partner at law firm Leigh Day which represented Asylum Aid in the case, said: "We are delighted that the Court of Appeal has ruled that the Rwanda removals process is unlawful on grounds of safety."

It acknowledged that not all of the charity's challenges had been accepted by the court, but said the ruling had affirmed there are "clear deficiencies" with the policy.

Other human rights groups have welcomed the court's decision, with Freedom From Torture describing it as a "victory for reason and compassion".

Rishi Sunak at a podium which reads "Stop the boats"

The Rwanda policy has hit several roadblocks since it was first announced last April.

The first deportation flight was halted minutes before it was due to take off after a legal challenge was granted in June 2022.

In December, the High Court decided that the plan did not breach the UN's Refugee Convention - which sets out the human rights of anyone seeking asylum - and ruled that it was legal.

But the following month it was decided that some of the parties in that case should be allowed to appeal against elements of that decision - and have the case heard by the Court of Appeal.

This week the Home Office said it expects it to cost £169,000 for every person deported and processed under the Rwanda scheme - more than it currently costs to house an asylum seeker in the UK.

But the same analysis warned rising accommodation costs could mean the cost of housing an asylum claimant in the UK could be £165,000 per person within four years.

The Home Office says it currently spends almost £7m a day on hotel accommodation to house asylum seekers.

Prime Minister Rishi Sunak has said he respects the court's decision but he will do "whatever is necessary" to disrupt criminal gangs operating small boat crossings.

Asked after the ruling if the government was confident the first deportation flight would take off before the next general election, a Downing Street spokesman said it could not "put a timetable on that".