Political and Parliamentary Monitoring
Week Commencing 17th December 2018


This week, the Government revealed its eagerly anticipated immigration white paper, setting out how the UK’s border system will operate post-Brexit. The white paper, aspects of which will continue to be consulted on over the coming months, will prove influential as the National Health Service plans its services moving forward. The incoming Chief Executive of the King’s Fund, Richard Murray, called on the Government to “grasp the nettle of migration policy and allow in [to the country] many more health and social care staff from abroad.”


It is unclear whether the white paper lives up to Mr Murray’s demands, with many concerned that a £30,000 minimum wage cap, which sets the threshold for what is defined as a ‘skilled migrant’, could prove detrimental to the social care sector. Those earning under the £30,000 cap may find it difficult to secure long-term visas.  Although the Cabinet is still divided over what the exact cap should be, and further consultation is likely, the £30,000-figure has been touted as the preferred cap by the Home Office based on recommendations by the Migration Advisory Committee.


Given the average salary of a care worker is in the region of £20,000, and the starting salary of a nurse is in the region of £22,000, it is unsurprising that many in the health sector have raised their concerns over whether desperately needed staff from abroad will be able to gain access in to the UK. The Cavendish Council of health and care organisations said it was “extremely concerned” that visa proposals would prevent the health service and businesses accessing the number of care staff needed to sustain services.


For those health workers earning more than £30,000 (predominantly doctors, consultants and other specialists) the removal of the cap on number in the existing tier 2 visa route made the sponsorship system less bureaucratic for employers. This has since benefitted non-EU doctors attempting to gain entry in to the UK.


This is the last monitoring document of 2018. Monitoring will resume on Friday 4th January 2019. The Secretariat wishes the PCF a Merry Christmas, and a prosperous and peaceful New Year.



  • NHS will still be short of nurses in five years
  • First ever drop in teaching assistant numbers “concerning”
  • Act now to reduce health inequalities


NHS will still be short of nurses in five years

Ian Dalton, Chief Executive of NHS Improvement, has said it will be more than five years before the number of nurses the NHS needs are available. Speaking ahead of an anticipated long term plan on workforce strategy, Mr Dalton said that the shortfall in nurses was proving hard to solve and that he expected reaching breakeven would take at least five years.


Recent figures from NHS Improvement show that the number of vacant posts in the health service has risen by almost 10 per cent in the first quarter of the year, with more than 42,000 nursing posts being advertised across England and Wales. Mr Dalton, along with Simon Stevens, the Chief Executive of NHS England, have previously indicated that increases in staffing will be closely linked with additional resources provided to the NHS. Dame Donna Kinnair, the Acting Chief Executive of the Royal College of Nursing, said that “swift action” was required to avoid a recruitment crisis.


NHS Improvement has said that it will be working with those Trusts with the lowest retention rates to improve the training and opportunities available to staff. At the same time, NHS England said that it hoped that the recent recruitment campaign for the NHS would continue to be funded as part of the NHS’s long-term plan.


The news regarding the number of nursing vacancies will be of concern to the PCF. Delays in treatment can negatively affect the standard of living for those with bladder and bowel complaints, and can often create the ‘stop-go’ style of care which damages trusts in clinicians. The Secretariat  will continue to monitor recruitment and retention figures.


NHS’s long-term plan delayed until January

The HSJ has learnt that the NHS’s long-term plan has been delayed until at least January, with the political fallout over Brexit preventing the document from getting approval from all cabinet ministers. The plan commissioned by the Prime Minister when she announced the NHS’s £20 billion funding settlement in the summer – was initially expected to be published in November. Simon Stevens, the Chief Executive of NHS England, then said the plan would be delayed until early December. It is now understood that the document will not be revealed until 2019.


The plan is expected to set out the priorities for the NHS over the next five years – which are covered by the £20 billion funding settlement – and some targets for improvements over the next decade. A planning timetable sent to NHS Chief Executives suggests that the financial documents associated with the long-term plan will continue to take place over 2019. Responding to the news about the delay, Jonathan Ashworth, the Shadow Secretary of State for Health, said that patients “deserved better”.


Niall Dickson, Chief Executive of the NHS Confederation, which represents organisations across the healthcare sector, said the new plan must be “radical” but needed to avoid being “unrealistic”, adding that the current situation facing the NHS was “very serious”, with overstretched services. NHS England declined to comment on the delay, except to say that it was important to get the long-term plan right.


The Secretariat is prepared for the launch of the report early in 2019, and will inform the PCF of the exact date when it is released. The Secretariat will also provide expert insight and analysis in the announcement and the possible implications for paediatric continence care.


‘Catastrophic’ funding gap could pause district nurse supply for a year

The supply of district nurses coming into the NHS could drop to zero in 2021 unless the government provides additional funding, it has emerged. Health Education England’s national funding for the one-year postgraduate course is due to finish in 2019-20, with the government planning for the apprenticeship levy to provide funding for a part-time two-year course from 2020-21. However, nurses training through the apprenticeship route would only qualify in 2022, meaning no new recruits in 2021.


The Chief Executive of Queens Nursing Institute, Crystal Oldman, has said that this would be “catastrophic”, whilst NHS Providers said this would have a “severe” impact on the nursing workforce. As the PCF will be aware, district and community nursing is essential for supporting vulnerable people, including children and young people with bladder and bowel issues which may effect mobility or their ability to access treatments. At the same time, district and community nurses play a crucial role for those remote communities who may have little or no direct contact with major centres of healthcare.


In response to the news, a Department of Health and Social Care spokeswomen said, “we are working with HEE on funding for the specialist qualification for district nursing”, whilst earlier this year the Care Minister, Caroline Dinenage, said that the Government would offer “golden hellos” worth £10,000 to new post-graduates who wish to train as a district nurse.


The Paediatric Continence Forum will be concerned about this news. Given the growing demand for paediatric continence care services, the prospect of no district nurses entering the Health Service in 2021 risks exacerbating the challenges the Service faces in recruiting new staff.