Examination of Witnesses (Questions 980-999)
LORD HUNT
OF KINGS
HEATH, MS
CLARE CHAPMAN
AND MR
NIC GREENFIELD
25 JANUARY 2007
Q980 Mike Penning: First of all,
can I say for those of us who have listened to other evidence
on this Committee on our deficits inquiry and have had problems
with deficits in our own constituencies, and I certainly do not
recognise the figures that have been given to this Committee today
about redundancies and job losses in my own trust. The chief executives
sat at the end of this table and told us there were 750 job losses,
in one way or another, going to come from my own trust when they
closed the hospital. Can I say to Lord Hunt, at the end of the
day you are in charge of this. If you were a chief executive of
one of the world renowned companies that your colleague worked
for before and you trained a huge amount of staff, got them qualified,
invested in those people and then for 40% of them you did not
have a vacancy at the end of it, I think your head would be on
the block because you would have just wasted a huge amount of
your shareholders' money (in this case taxpayers' money) and broke
the hearts of many dedicated health workers.
Lord Hunt of Kings Heath: On the
40% figure.
Q981 Mike Penning: I was going on
your 60%.
Lord Hunt of Kings Heath: I would
say to you that my understanding is that approximately, in a normal
year, 85% of nurses qualify and would find jobs.
Q982 Mike Penning: We are not in
a normal year, are we?
Lord Hunt of Kings Heath: No,
but—
Q983 Mike Penning: You said 60. That
means 40% have not, and that money has been wasted and those people's
careers have been affected?
Lord Hunt of Kings Heath: That
is right, but I am trying to make a comparison between what might
happen in years previously and the current year. The NHS is a
huge organisation, 1.3 million people. Ensuring that everything
fits together—
Q984 Mike Penning: It is your job.
Lord Hunt of Kings Heath: Absolutely.
Q985 Mike Penning: Or your predecessor's
job, in your case.
Lord Hunt of Kings Heath: And
it is a fantastic job and the NHS overall is getting much better
at pulling these things together: training, jobs availability,
resources, service, development, but we are talking here about
a huge number of separate organisations. We are talking about
a lot of individual people. We are talking about a lot of higher
education institutions. So pulling all that together and then
ensuring—
Q986 Mike Penning: It is your job.
Lord Hunt of Kings Heath: It is
my job, and I am delighted to do it. What I am saying to you is
that it is a very complex job. The Health Service is getting better
at it. I am determined that we will get better in the future,
but I think that, if I were to look back at our stewardship of
the NHS over the last 10 years, my conclusion would be: what was
the great problem of the NHS in 1997? It was that we had a huge
shortage of staff. We no longer have that problem. So, in terms
of the big macro picture, we have dealt with it. We are now dealing
with the issue of trying to ensure that long-term planning meets
service requirements. We are doing that, we will continue to improve,
that is why we are developing our workforce capacity, but I would
ask you to reflect on where we are now.
Q987 Mike Penning: I will say exactly
the same to you as I said to the Secretary of State, and it is
for the Chairman to stop me if he wishes, that this Committee
does not go along party lines, it is not a party political broadcast
as to what happened then and what is happening now, it is what
is happening today. We are looking at workforce planning. You
keep reverting back to 10 years ago.
Lord Hunt of Kings Heath: With
respect, you did ask me to compare the NHS to a large organisation.
What I am saying to you is that the big issue the Health Service
has faced for many years was a chronic shortage of staff. We have
overcome that, and I think that I would much rather be judged
on that had we dealt with the mega problems the Health Service
faced. I believe we have.
Mike Penning: 40% of nurses that are
trained are not getting jobs.
Chairman: David, can we move on.
Q988 Mr Amess: Congratulations, Lord
Hunt, on your reappointment and congratulations on overcoming
the obstacle that you do not appear to be Scottish!
Lord Hunt of Kings Heath: I have
a quarter Scottish in me.
Q989 Mr Amess: There we go. Just
as an aside, it was ironic that you reminded us about the inquiry
into the National Institute for Health and Clinical Excellence
because, unlike my colleague Doug (but we are not going to fall
out about it), we were making different remarks about that inquiry,
but we will see what happens with the next inquiry. Whether or
not the situation is a mess at the moment, the evidence that the
Committee has heard, as far as I am concerned, is worrying. Of
course, you and your officials will have read the evidence session
last week when we had representatives from the midwives, the pathologists
and the physiotherapists here. I did suggest how wonderful it
would have been to have had a joint session with your good self
and them together. It may be that these were three areas we plucked
out who were having difficulties, but knowing those three professions,
as I do, I am a little concerned. The final thing, before I get
on to my questions, I do not know about my two colleagues, but
I am not the least bit wounded by your veiled attack on the last
Government in the last century. I would simply say that our inquiry
is into workforce planning under the present Government and, as
such, workforce development confederations were the main means
of delivering the goals set out in A Health Service of all
the Talents. Given that was the case, why were they disbanded
after only three years, a change which was actually opposed by
the department's workforce director?
Lord Hunt of Kings Heath: I do
not know about that, but I do think that it made sense to pull
workforce planning right back in the centrality of what leaders
of health services are responsible for locally, and now that we
have got the new structure of Strategic Health Authorities down
to ten, they essentially cover a region. If I think of my own
West Midlands region, that is an ideal area in terms of the number
of staff employed, the number of higher education institutions
and the number of NHS organisations, the links with the medical
schools. That seems to me to be the ideal geographical area in
which to sort out most of these work planning issues. Should you
off-shore it into a confederation or is it better to place responsibility
and accountability on the SHA and the chief executive? I think
it is much more sensible to place direct responsibility on the
Strategic Health Authority. We have to ensure that they do the
job properly; we have to ensure that they have the capacity; but
to me it makes an awful lot of sense to pull it together with
the SHA's role in finance and service delivery and planning. In
a sense the question that I was asked by the Chairman at the beginning
is: do we pull all these things together? I think the answer is
that at the SHA level that is the place to do it. So I do not
think we have anything to apologise for in making those changes.
Q990 Mr Amess: Thank you for your
honest answer. I think Mr Greenfield is busting to shed some light
on this.
Mr Greenfield: I was one of the
WDC chief executives in the largest one in North Central London
and, as the only member of the panel who was there at that time,
I think that we have to look back and note that WDCs were a welcome
addition to the structure because they brought a new and stronger
focus on workforce, but the reality was that they were conceived
a year or two before Strategic Health Authorities. Had the Strategic
Health Authorities been in place when WDCs were formed, I would
have strongly argued (and I know my colleagues would have done
the same) that the right place for the workforce was not in a
separate silo but was integrated strongly with service and financial
planning, and it was that timing of the restructuring which did
not enable that at the time. Most of the WDCs were harmoniously
co-located or brought together with the SHAs, as indeed I did
with mine in North Central London, and they were the stronger
for it. I think the Minister's point about the integration of
service, finance and workforce planning is the one that we must
keep to the fore.
Q991 Mr Amess: So it was not a mistake
disbanding them?
Mr Greenfield: I think when you
use the word "disbanding" that tends to be a little
bit misleading. What has happened with many of them is that they
have been integrated into the new Strategic Health Authorities,
and we are absolutely key that the SHAs are going to have a fundamental
role around workforce strategic development.
Lord Hunt of Kings Heath: To put
it very simply, the organisation has changed but the kind of skills
that they develop, the experience of working with all these different
bodies that have to sort out workforce planning at a local level,
has not been lost, but having it clearly the responsibility of
the chief executive of the SHA as one of their key priorities,
it just makes much more sense to do it that way.
Q992 Mr Amess: So it would be wrong
for us to take the view that in the closure of them, demonstrated
by 2004, the NHS had badly lost sight of workforce planning priorities
as set out in the year 2000? It would be wrong for us to draw
that conclusion.
Lord Hunt of Kings Heath: Certainly
I would not draw that conclusion. I think it is much better to
put it in the mainstream management. The last thing we want, and
we have seen this before, is you take a specialty function like
HR workforce planning and you put it to one side as a kind of
silo. This does not work unless it is right there in front of
the chief executive as one of their key responsibilities.
Q993 Dr Stoate: Can I bring you back
into the fold and wish you well with your very challenging brief.
Looking back over the last few years since I have been in this
House, I remember when, at the end of the 1990s, the BMA and others
were saying that we were between five and 10 thousand GPs short
of what we absolutely needed to provide a good service. The Government
responded by increasing the number of registrars and now the BMA
is saying, "Oh my goodness, there is an awful lot of possible
unemployment amongst GPs." Similarly, we were 400 cardiac
surgeons short, so the Government quite rightly upped the training
for cardiac surgeons, and now the Royal College of Surgeons tell
us that there are unemployed cardiac surgeons and the future looks
pretty bleak for them. The question I want to ask is that the
Government is open to the criticism that we are too caught up
with short-termism and political expedience rather than taking
the long-term view. How do you respond to that?
Lord Hunt of Kings Heath: I am
very surprised that you could accuse the Government of that.
Q994 Dr Stoate: I did not accuse
the Government, I said the Government was open to the charge of
that.
Lord Hunt of Kings Heath: I think
I need to get back to the House of Lords, Chairman! It is interesting,
the comments of the BMA, which probably one would expect from
the BMA but it does show one of the issues. Why workforce planning
is not easy is simply the huge long lead-time and the years it
takes to train a consultant. How do you ensure that we know today
what kind of Health Service we need in 15, 20 years' time? Of
course the answer is that we have some ideas but no-one here could
predict, could they, the exact type of Health Service we are going
to require in two generations time given the pace of medical science
and technology. We can make assumptions and we have to have a
system which keeps in touch with what is happening and can make
adjustments, and that is what we have now got in place, but, with
hand on heart, I cannot say to the Committee that I can guarantee
for all time that the decisions we make now will ensure you have
absolutely the right number of GPs or pathologists or midwives
in 10 or 15 years' time. That cannot be done, no one could do
it, but what we can do is try and get it as accurate as possible
and that is what we are really seeking to do. That is why we are
continuously getting figures from the Health Service about future
trends so that, where you do identify either potential shortages
or surpluses of staff, you do try and make adjustments as quickly
as possible. The traditional NHS route has been to wait for the
crisis to happen, then make the adjustment, the adjustment is
too sharp and then you have an opposite reaction in another five
or six years, and that is what we have got to stop. We are always
going to have, there are always going to be, some discrepancies
between people available and places, but what we have got to try
and do is get those discrepancies as small as possible.
Q995 Dr Stoate: I appreciate that
obviously, that predicting exact future workforce requirements
is an impossible task, but just to go further in being devil's
advocate, last week Sir Jonathan Michael, CEO of Guy's and St
Thomas' NHS Foundation Trust, actually told us that we should
not be going down this road of central planning at all, but we
should leave it entirely for local organisations and in that it
should be entirely led by the market. He put forward what sounded
a perfectly reasonable case for saying, "Let the market decide.
Chief executives up and down the country will work out their own
needs, will recruit according to need and the market will provide
those needs". He made that case. Personally, I do not agree
with that case, I think that is a recipe for very great difficulties,
but I just wonder what you think about it.
Lord Hunt of Kings Heath: Well,
I have got great respect for Sir Michael and he has done a great
job, but I do not agree with him on this matter. I do not think
you can simply have a free-for-all where I suppose you would depend
on the universities to decide how many people they were prepared
to train and then it would be up to each individual organisation
to simply do the best they could. I do think that very rigid centralised
planning is not appropriate. Actually, the NHS has tried that.
Historically, it has tried it and it has not worked, so what you
have got to do is to establish a national strategy with a lot
of accurate information and then you have got to get ownership
at local level, and that is why the role of the Strategic Health
Authority working with the individual trust is so important. My
job essentially is to make sure that Strategic Health Authorities
do look at the long term, that they do not get into short-termist
approaches, and to ensure, as far as possible in terms of, say,
training commissions, that we do forecast as exactly as possible
the numbers that are required. I do think of course you need to
give individual trusts flexibility, and that is our problem with
a guarantee, for instance, that every nurse who is qualified or
physio could be guaranteed a 12-month job because I do not think
it is right for us to sit in Whitehall and to determine that the
individual trust has to do it, but I do think that, as part of
the National Health Service where we want much more devolved authority,
actually workforce planning is one of those bits of the architecture
that sits in terms of national leadership and it is essential
to carry on with that.
Q996 Mike Penning: Lord Hunt, we
have seen evidence and we have been given evidence that planning
is poorly integrated with financial planning and the service planning
when it comes to workforce planning. Do you accept this criticism?
Lord Hunt of Kings Heath: I think
there are clearly going to be instances where it has not been
as good as it should have been. I believe that it is getting better
and I hope, from what I have said this morning, that you will
understand that I want to make sure that the three elements are
pulled together as tightly as possible. That is what the Strategic
Health Authorities are charged with doing.
Q997 Mike Penning: The NHS as a whole
and the Department you are a Minister of are partly responsible
for this poor planning?
Lord Hunt of Kings Heath: I do
not think I accept your word "poor" planning. I think
I said that there clearly may be instances where workforce planning,
finance and services do not completely dovetail together.
Q998 Mike Penning: That is fascinating
because in the Department's evidence on workforce planning and
education planning, it actually says there that workforce planning
lacks integration with finance planning, so your own Department's
document agrees with me, not you.
Lord Hunt of Kings Heath: I am
not sure that I read it that way. I think clearly we have identified
that we need to do better and I am not running away from that
at all. What I am really saying here is that workforce planning
in the Health Service is in a hell of a better state than it has
been before. Of course there are instances where it is not working
as well as we would want it to work and we know that people have
had to make some short-term decisions this year because of the
financial deficit. That is not in question, but the—
Q999 Mike Penning: Let us help you
a little bit, Minister. Would you agree that the Department of
Health is equally to blame for failing to accurately predict the
workforce planned expansion and the cost of it, especially when
it comes to central negotiation of contracts? Are you going to
take any blame in the Department at all for the contracts which
were imposed on the trusts which has cost them so much money?
Lord Hunt of Kings Heath: Well,
the Department clearly played a major role in the contracts and
of course I accept responsibility for what the Department has
done.
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