This week, the Government published its Brexit White Paper 24 hours after MPs voted in favour of the European Union (Notification of Withdrawal) Bill at Second Reading. The White Paper is based on the twelve negotiating principles which Theresa May outlined last month, and has faced criticism for not elaborating on the future rights of EU nationals living in the UK. The Second Reading of the European Union Bill contained little of relevance to the health sector, although several MPs expressed anger that leaving the EU would not generate the additional £350 million per week in funding for the NHS that was promised.
Elsewhere, MPs held a debate on nursing pay after a petition urging the Government to scrap an NHS pay cap of 1% surpassed 100,000 signatures. The Royal College of General Practitioners has also called for swift government action to ensure that GPs and their patients are protected from further practice closures and cuts to services; and Universities and Colleges Admissions Service said that degree applications for nursing have fallen by 23%.

Government publishes Brexit White Paper

The Government has published its White Paper on ‘the United Kingdom’s exit from and new partnership with the European Union’, following the acknowledgement that it would do so the previous week. The White Paper is largely constructed around the twelve points covered in the Prime Minister’s speech on the Government’s negotiating objectives for leaving the EU, given on 17th January, and has been criticised for not elaborating on details omitted from that speech, such as the future rights of EU nationals living in the UK. There was also no mention of the NHS or healthcare more widely in the White Paper, providing further uncertainty for the NHS, which relies on a significant number of EU nationals working in the UK.

The White Paper was published after the Second Reading debates of the European Union (Notification of Withdrawal) Bill on Tuesday 31st January and Wednesday 1st February. During these, a number of MPs expressed their anger that the claims perpetuated by some figures while campaigning to leave the EU – that leaving the EU would generate an additional £350 million per week in funding for the NHS – have not materialised.

Although this stage of the parliamentary vote to trigger Article 50 passed, Labour experienced substantial difficulties in achieving a unanimous party position on the vote. Despite a three-line whip being issued, 47 Labour MPs voted against the motion, including four shadow ministers who consequentially resigned and three Labour whips. The final vote following the Third Reading of the debate is due to take place next Wednesday, and Labour MPs such as the Shadow Business Secretary Clive Lewis have suggested they may resign if Labour’s amendments to the Bill are not incorporated at that stage.

MPs debate nursing pay

MPs have this week debated nursing pay in Westminster Hall, after a petition urging the Government to scrap an NHS pay cap of 1% surpassed the 100,000 signatures needed to trigger parliamentary debate. Opening the debate, Labour MP Catherine McKinnell called the impact of the pay cap “harsh”, adding that it is causing nurses to leave the profession they love. She said that while London is now short of 10,000 nurses, two fifths of nurses living in the capital plan to leave as they are unable to pay their rent.

Former Shadow Health Secretary Andy Burnham agreed with Ms McKinnell, arguing that the Government are pushing NHS staff beyond their limits. He noted that NHS nurses worked beyond their contracted hours, and said that goodwill was reaching its limit in the face of increasing demand. Several others also called on the Government to end its policy of pay restraint, including Conservative MPs Dan Poulter and Richard Fuller. Dr Poulter argued that pay rises for front-line staff of 0% or 1% are “unacceptable”.

Responding on behalf of the Government, Health Minister Philip Dunne denied that NHS nurses are
“undervalued”. He said that while NHS staff “undoubtedly deserve a cost of living increase”, the “Government must recognise that the financial and quality challenge facing the NHS is unprecedented.” He acknowledged that the pay cap is “challenging”, but said that staff had reported to him that “they want to know that the right number of staff will be working alongside them in the hospital or community setting”, and suggested that if the Government had given nurses more than the 1% annual pay rise, it could have resulted in fewer positions being available.

RCGP calls for urgent action to support frontline GPs

The Royal College of General Practitioners (RCGP) has acknowledged the progress being made to deliver the Five Year Forward View at the national level, but said that swift action is needed to ensure that GPs on the ground and their patients are protected from further practice closures and cuts to services. The RGCP’s interim assessment of the GP Forward View acknowledges that substantial progress has been made, highlighting initiatives such as a £16 million NHS GP health service launched this week for GPs to access free confidential advice, but criticises the lack of progress on issues such as practice resilience.

Of particular concern is the lack of impact of the £16 million GP resilience programme announced in July 2016, which was designed to support struggling practices that are finding it difficult to recruit, and in some cases facing closure. The report finds that although £16 million was allocated to the programme for 2016, only £2.5 million had been spent by the end of December. Now, it is urging for this underspend to be carried over into 2017. The 44 Sustainability and Transformation Plans which local areas set out last year also came in for criticism, with the report finding that many fail to mention the GP Forward View at all, while others simply refer to it in passing – and some in fact plan a reduction in the GP workforce.

RCGP Chair Professor Helen Stokes-Lampard said: “The overriding message to government and decision makers is to prioritise general practice as they push forward in shaping the NHS for the future of patient care. We are seeing progress at a national level – we need to see it at local level, we need to see it having a positive impact on the front line of patient care in the community, and we need to see it benefiting our patients.”

Nursing degree applicants fall 23%

The Universities and Colleges Admissions Service has said that degree applications for nursing have fallen 23% this year, after a bursary for nursing students was scrapped. Official UCAS figures show that applicant numbers for nursing courses across the UK fell by 20% from 54,270 in January 2016 to 43,590 in January 2017. The largest drop in applicants occurred in England – where the figure dropped by 23% – but there was also an 11% fall in those from Wales, 7% from Scotland and 4% from Northern Ireland.

Responding to the news, the Royal College of Nursing said it had warned the Government that the decision to charge fees to nursing students in England, and replace NHS bursaries with student loans from September 2017, would result in decreased applications, but that the Government had not listened.

RCN Chief Executive & General Secretary Janet Davies said: “The nursing workforce is in crisis and if fewer nurses graduate in 2020 it will exacerbate what is already an unsustainable situation.” Davies pointed out that fewer EU nurses are coming to work in the UK since the Brexit vote, and that by 2020 nearly half the workforce will be eligible for retirement. She added that “with 24,000 nursing vacancies in the UK, the Government needs to take immediate action to encourage more applicants by reinstating student funding and investing in student education”.