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NHS Strikes

Volume 727: debated on Monday 6 February 2023

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the NHS strikes.

I am grateful to the hon. Member for his question, which I am taking on behalf of the Department as the Secretary of State is attending a COBRA meeting focused on minimising the disruption experienced by patients because of today’s walkouts.

In preparation for today’s industrial action, we have again drawn on extra support from a range of places, including military service personnel, volunteers and the private sector. People should continue to use NHS 111 if they need medical help and to dial 999 in the event of an emergency. Yet even such strong contingencies, including more people trained to drive ambulances and doctors redeployed to other parts of the system, are no replacement for having the right people doing the right jobs.

Any strike inevitably means that some patients will have their treatment delayed, and I know that people are being contacted if their appointments need to be changed. About 88,000 procedures or outpatient appointments have been postponed as a result of industrial action over the last eight weeks, so I am disappointed and concerned that patients are facing disruption once again, especially because strikes by Royal College of Nursing members have now come together with action by GMB and Unite members in eight ambulance trusts.

I recognise that there have been efforts on behalf of unions to ensure that derogations are in place to keep people safe, and I acknowledge that some aspects of that can indeed be challenging, but it is essential that all unions adhere to a set of derogations at a national level so that we can plan and act with certainty. I have also been heartened to hear that on previous strike days, some devoted ambulance workers and nurses who received calls while on the picket line returned to work where derogations were not going to be met. That is a real tribute to the care and dedication we see on the frontline day in, day out.

Ultimately, both staff and the public should no longer be in this situation, because we all know that industrial action is in nobody’s best interests, especially given the collective challenges we face to help the NHS recover from the pandemic. Despite what the hon. Member for Ilford North (Wes Streeting) might imply, there is much common ground, not least our shared desire to improve the NHS and deliver better care. Last week we announced our plan to recover urgent and emergency care—the second of three plans to cut waiting times in the NHS, including our elective recovery plan and our primary care recovery plan, which will be published in the next few weeks. With such important missions ahead of us, and fewer than two months left of this financial year, it is time to move forward, to look ahead and to come together in the interests of the patients we all serve.

This week will see the biggest strike in the history of the NHS, with nurses, ambulance workers and physiotherapists all driven to walk out. Some 88,000 appointments, including 10,000 operations, have already been cancelled, with much more disruption to patients expected this week, yet Government Ministers still speak as if they are mere observers or commentators, not leaders key to solving this dispute. This is the cost of the Prime Minister’s failure to sit down and negotiate with nurses, paramedics and other NHS staff.

Let us be clear about this fact: there has not been a single minute of negotiation on pay. NHS leaders are asking the Government to negotiate. Chief nurses are desperate for the Government to negotiate. The unions have offered to call off the strikes if the Government are willing to negotiate. The public cannot understand why, even now, they will not get around the table to sort this out. What on earth are they playing at?

Developments in Wales show that there is a deal to be done. The general secretary of the Royal College of Nursing has written to the Prime Minister, but she has not heard anything from the Government for weeks. It looks to the country like the Prime Minister and the Health Secretary are the ones on strike. Where is the Prime Minister? Where is the Health Secretary? In the week of the biggest strikes in the history of the NHS, during the biggest crisis the NHS has ever faced, the Health Secretary was not available for interviews this morning and he is not available to MPs today. Are we meant to believe that at 4 o’clock in the afternoon he is talking about how to avert disruption that has been taking place all day? Don’t make me laugh. Perhaps the Health Secretary is busy briefing against the Chancellor, just as the Chancellor is busy briefing against him. All the while, the Prime Minister is too weak to do anything about it.

The power to stop these strikes is in the Government’s hands. Patients have suffered enough disruption as it is. Is it not time for the Prime Minister to swallow his pride, sit down with NHS staff and negotiate an end to these strikes by paying NHS staff fairly?

I am not going to engage in the playing of party politics on this. The hon. Gentleman already knows that the Secretary of State is due to attend a Cobra meeting, which he and I rotate, and the hon. Gentleman may have missed it, but this morning the Secretary of State did do a media clip, and Members will have seen that across multiple outlets.

Where I do agree with the hon. Gentleman is that he is right to talk about the amazing job that our NHS colleagues do on the frontline. I know he does that, and I thank him for that, but that is even more reason why we must find a fair resolution, and NHS colleagues certainly will not get one from those on the Opposition Benches. The Opposition say that they back the independent pay review process, while disagreeing with the body’s decision when it does not suit them. They say they would not increase public spending, while failing to set out any plans for how they might pay for unaffordable pay increases. They say they believe in public safety, too, while criticising the common-sense steps we are taking to ensure safe minimum staffing levels, just as they do in many other European countries. We have got a plan—they do not.

More than 1 million NHS staff have been given at least a £1,400 increase in their pay, representing a 9.3% rise for those on the lowest salaries. NHS staff also received a 3% pay rise last year—even when pay was frozen across the rest of the public sector. We have done this because we know how hard NHS colleagues work and we recognise that there are cost of living pressures on NHS staff.

Our goal has always been a resolution that is fair for colleagues and for the country: to find a way forward that ensures we are spending money where it is needed most, and helping the NHS to recover from the pandemic, but not on pay hikes that would stoke inflation and ultimately make us all poorer. I met GMB members last week, and—together with my ministerial colleagues—I remain fully committed to working together with the unions, the NHS and others to find a responsible and fair way forward.

The NHS Pay Review Body was in front of my Select Committee last week, but it will not produce its report for 2023-24 until the end of April. Surely the longer this process goes on, the slower the resolution will be for those on Agenda for Change. Does the Minister agree that a much earlier remit letter would have been helpful, and when does he expect the Department to produce its evidence to this year’s pay review body round?

I thank the Chair of the Select Committee for his question. He is right that we are committed to the independent PRB process, which is the right way to set public sector pay and has operated successfully for over four decades. We are not changing that process, but we decided to take the step to engage with the unions on our respective evidence so that it can be as informed as possible, and we very much thank the trade unions for working with us in that spirit. We need to wait for discussions with unions to finish across Government, so I hope I can use the word “shortly”; I am mindful that we want to get this done as quickly as possible.

What does the Minister think when he looks across the border to Scotland and sees that Unison, Unite and other unions representing the majority of NHS Agenda for Change staff have accepted the 7.5% pay rise offer? There are no planned strikes in Scotland while pay deals are being considered, which clearly illustrates that negotiating with the unions is a better way of ending strikes than picking fights with them. The UK Government are unique among the four Governments of the UK in that they are the only ones who have full financial powers, and therefore the only Government who are not acting with a hand tied behind their back in offering pay uplifts to their NHS staff. Why is it, then, that the UK Government are facing the greatest number of strikes and have failed to settle any pay disputes?

I remember another Scottish National party Member making a similar comment in a previous urgent question, crowing about how Nicola Sturgeon, the First Minister of Scotland, was directly negotiating with the unions and that they had paused their industrial action, but only a handful of weeks later that industrial action was renewed. Pay is of course a devolved matter for Scotland and for Wales.

I will not make unfunded promises or pledges from this Dispatch Box. I want to have an honest and open dialogue with the unions about what is affordable for the NHS, where we recognise and reward NHS staff—who do the most incredible job day in, day out—with one eye to recruitment and retention, but it also has to be fair to taxpayers; and that is the spirit in which I approach this matter.

Can senior managers of NHS England and its various trusts make more use of pay gradings, job evaluations, promotions and increments, using pay flexibilities so that staff who are doing a good job feel valued and can be paid more?

That certainly is an option. My right hon. Friend talks about NHS managers. Understandably, the Opposition focus on nurses and paramedics, but let us not forget exactly who we are talking about: the entire Agenda for Change workforce, which is 1.245 million people. That is exactly why every 1% equates to £700 million. My right hon. Friend is right that pay is a factor, but it is not the only factor, which is why we also focus on working conditions and environment.

Taxpayers want NHS staff to be there when they need them, but as more and more staff leave the service, flipping over to work for agencies because they simply cannot afford to work for the service on their salaries, their money is being spent in the wrong way. On Friday, when I met NHS staff who came in on their day off, they said that the thing that is breaking them is the Government’s contempt for them. They simply want the Government to negotiate—so why will they not?

I thank the hon. Lady for her question, but she could not be more wrong. I was in Darent Valley hospital today and I was in Watford hospital last week, and I have the utmost respect for all those who work in our NHS. Everybody in this Chamber wants those who work in our NHS—in fact, all public sector workers—to be paid more, but the independent pay review process is a tried and tested process that has been used for more than 40 years, and it is important that the unions engage with it so that we get this right from April.

Due to the covid pandemic, the NHS has a large care backlog, which my constituents in Kettering are keen to see addressed. Will the Health Minister confirm that spending on the NHS is at record levels and that the Government have a plan to reduce NHS backlogs, which the strikes are disrupting? For every day of NHS strike action, how many NHS operations and procedures are lost?

I will gladly write to my hon. Friend on the specifics, but he is right to point out that NHS spending in England this year is about 11.4% higher in real terms than it was in 2019-20. He is right to point to his constituents on the waiting lists, and I want to get the numbers down as quickly as possible, particularly for those who have been waiting the longest. On top of a £2 billion recovery fund, we have invested £8 billion over three years; we have already opened 92 community diagnostic centres, and we will open 160 by March 2025; and we have opened 89 surgical hubs, with an aim to open 140. Our aim is 9 million more treatments and diagnostic appointments by 2024, so that constituents of my hon. Friend who have been waiting too long get that service.

Ministers are hiding behind the independent pay review process. The Minister knows that recommendations have been ignored when it suited the Government in the past. NHS employers want negotiations, the unions want negotiations and the public want negotiations. The Minister says it is time to come together in the interests of patients. He is right, so why do the Secretary of State and the Prime Minister not come together with the unions and sort it out?

I have met employers, and I believe in open and honest dialogue. What the hon. Gentleman has not accepted—and I appreciate that being in opposition is the easiest job in the world—is that, as I have pointed out, every 1% is £700 million. I have a budget this year of £153 billion and, yes, that is rising, but I have some huge challenges. We have huge challenges to tackle within our NHS. The hon. Gentleman the shadow Secretary of State just says, “Negotiate, negotiate”—

Yes, yes—but where exactly is the funding coming from? The hon. Gentleman rightly pushes me on the elective backlog and he rightly pushes me on urgent and emergency care, but every 1% is £700 million that I would have to find from our NHS budget. That is exactly why we have to ensure that the pay review body makes the recommendation from April that is affordable to the NHS and recognises and rewards NHS staff, taking account of recruitment and retention and some of the challenges that we face, but that is fair to taxpayers too. That is why I would encourage the unions to get involved and take part in that pay review body process, so we can get it right.

The Minister says that opposition is the easiest job. Well, we are hoping he is soon performing it. When he opened his response this afternoon, he said that the Secretary of State was at a Cobra meeting, but would it not be more worthwhile if he negotiated and met the unions themselves? In advance of the next meeting for discussions of wages, maybe he could visit a picket line, because if Conservative Members visit the picket lines, they will find groups of staff—nurses and ambulance workers—who are extremely distressed. I have met many of them who were in tears—tears because they are worried about the patients whom they want to support, but also tears because many of them cannot survive doing the service they want to provide due to their low wages. Unless negotiations are started soon, the Government could do irreparable damage to the national health service, so the Secretary of State needs urgently to leave the Cobra meeting, sit down with the unions and start negotiating.

The right hon. Gentleman says that many who work in the NHS are worried about patients: I spend every single day worrying about patients; I spend every single day ensuring the NHS has the resources it needs to provide the level of care and service our constituents rightly expect. I have a budget, and that budget has already taken into consideration a 4.75% on average pay award, with more than 9% for some of the lowest earners. There is an independent pay review body process for a reason; it is only two months away, in April, and I encourage the unions to take part in it. Of course I meet with unions, and of course I do and will meet with nurses and those who work in our NHS. I believe some of the points the right hon. Gentleman makes are correct, and I know those who work in the NHS genuinely want to ensure we are attracting and retaining the very best; that is all the more reason for us to get it right, and the way to get it right is the independent pay review body process.

There were no strikes in the NHS over 13 years of the last Labour Government, and the cavalry is coming to rescue our health service with the next Labour Government. The Minister just asked where the funding is coming from to pay for NHS staff: we will train a new generation of NHS staff paid for by abolishing non-dom tax status so that the NHS has the workforce it desperately needs. Why will the Government not do as the Chancellor has suggested and adopt this policy now?

The hon. Lady says the cavalry is coming; how many more unfunded pledges—[Interruption.] Labour Members say they are fully funded: absolute tosh. I have heard the Opposition spend that non-dom money more times—

Once? The shadow Home Secretary, the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper), has spent it twice over already. And that is if indeed it would raise any money; I know I look very young, Mr Speaker, but I am old enough to remember a former Chancellor, one Ed Balls, say he did not believe taxing non-doms would raise any money whatsoever.

I declare my interest, Mr Speaker.

We have spent a lot of time talking about pay, but making working conditions for frontline staff much better is key, so what are the Government doing to focus on improving the simple things in a clinician’s life such as joining up testing, improving prescribing, and making sure that 10% to 15% of a GP’s workload is not spent chasing admin? These are simple things that would make a huge difference and improve outcomes for both patients and staff.

I completely agree with my hon. Friend. Ensuring that we support the mental health and wellbeing of NHS staff and that working conditions and working environments are the best they can possibly be is how we can attract and retain the best. Measures such as wellbeing champions, training for line managers, occupational health services and flexible working are very important, but the key to this is having conversations with the unions, because they are the representatives, ambassadors and advocates. That is why I very much hope they will engage in the pay review body process and continue to have those conversations with me, not just about pay, but about how we can improve working conditions and working environments and reduce the bureaucracy that makes the job so difficult.

It is now clearly established that the workforce crisis in the NHS is mirrored by vacancies in adult social care. There are more than 165,000 vacancies in social care, up by 52% in a year. The Liberal Democrats are calling for a carers’ minimum wage of £12.42 per hour from April; will the Minister support a £2 per hour uplift in that minimum wage for care workers by doubling the tax on the profits of online gambling companies?

The hon. Gentleman got a plug in for his policy there, but I am not entirely sure how relevant it is to this statement. On NHS staffing, we have 10,500 more nurses and 4,800 more doctors than last year. But I know adult social care represents one of the biggest challenges for our NHS, and it puts pressure on the rest of the system. That is why in the autumn statement the Chancellor put in place £7.5 billion, the largest ever investment in adult social care.

The Minister will know about the ministerial code and about keeping the House updated, so will he tell us when the Secretary of State for Health met Pat Cullen of the RCN? If cannot tell us now, will he write to us and put that letter in the library, please?

Of course I am happy to do that, and I think these things are put on the public record in any event. I do not know when the Secretary of State met specifically with the RCN, but I can tell the House that I have met the unions, I believe, on 9, 12, 25 and 31 January.

I have just come from the nurses’ picket outside St Thomas’s Hospital, on the other side of Westminster bridge, where nurses made the point that they were not striking against the NHS but to save the NHS. They have been underpaid and overworked for too long; their pay is down 20% on what it was when the Tories came into power, and now there are a record 50,000 nursing vacancies in England. That is not just unfair but incredibly unsafe. As one nurse said, “Patients aren’t dying because nurses are striking. Nurses are striking because patients are dying.” Will the Minister finally listen to NHS staff, get around the table to talk about pay and give them the pay rise they deserve?

Despite what the hon. Lady says, there are 47,100 more nurses this year than there were in 2010 and 10,500 more than last year, and we have 72,000 nurses in training. The Government hugely value the work not just of nurses—I remind the hon. Lady that she is also talking about the 1.245 million people who work on the Agenda for Change contract. She is right that we have to get pay and other matters right, and that is why we have an independent pay review body process where we look at affordability, reward and recognition, and pay, alongside recruitment and retention and achieving a package that is fair to taxpayers. That independent pay review body will make a recommendation, and it is then for the Government to look at it and accept it or reject it.

I stand in solidarity with nurses and other NHS workers who are taking action in their fight for fair pay and improved patient safety. Miriam Deakin, the director of policy and strategy at NHS Providers, has said that its key ask is that

“the Government does sit down around the table with the unions for formal negotiations on pay, and for that to be applied to pay this year.”

She has described the absence of formal negotiations as “very worrying”. Does the Minister accept that responsibility for the continuation of strike action by NHS staff lies firmly with the Government? Does he agree with Pat Cullen, the general secretary of the RCN, that

“this government has chosen to punish the nurses of England instead of getting round a table and talking…about pay”?

I thank the hon. Lady for her question, but nothing could be further from the truth. We accepted the independent pay review body’s recommendation of an average of 4.75% in full. That is over and above a 3% pay award last year, when the rest of the public sector saw a freeze. The hon. Lady, like me, will have lots of other public sector workers, and indeed private sector workers, in her constituency who will also earn between £30,000 and £50,000 a year. They will also have seen pay awards this year of between 4% and 6%, but they will not have 20% pension contributions or up to 33 days of annual leave a year. We have to keep these things in context, and any award also has to be fair to taxpayers more broadly, which is why we have an independent pay review body process. I want to address many of the issues that the hon. Lady has raised. We have that process; it is important that we use it, and I hope that the unions and others, including providers, will engage with it.

Our NHS staff—all of them—saw us through the pandemic, many without proper protective equipment. They have now seen us through the catch-up exercise, and they are working hard, but they are at the end of their tether. Meanwhile, the Minister says there is no money, but the Government wasted £15 billion on personal protective equipment—money that could have given everyone a 20% pay rise. Is it not time that the Government understood the issues in this strike, got around the table and talked about pay to the nursing unions?

First, let me correct what the hon. Lady said about PPE. I was not a Health Minister at the time, but let us not forget that 97% of all PPE was usable. Despite being a Minister in another Department, I remember that those on the Opposition Front Bench rightly agitated on this issue, saying, “Do anything, strain every sinew and take a risk, but make sure you get PPE as quickly as possible.” It was the most desired global commodity, and Governments around the world were fighting for it.

Nevertheless, the hon. Lady raised a good point, and of course NHS staff got us through the pandemic. That is exactly why we accepted the independent pay review body recommendation in full. It is exactly why we accepted the recommendation last year of a 3% award when the wider public sector was frozen. Of course we value all those who work in our NHS, and that is exactly why have to get this right for the next independent pay review body. That is why we have to ensure that not just the Government but the unions, providers and others give evidence to that body.

Just over two hours ago, I joined Lorraine and other colleagues from the Royal College of Nursing over the bridge at St Thomas’s Hospital. They do not want to be on strike and they do not want to be on a picket line, but they want a fair day’s pay for a fair day’s work. A key message from them to the Minister is to get round the negotiating table and give them a fair deal.

Opposition Members keep saying, “Get round the table and negotiate.” I encourage the next one who says that to tell me exactly where each block of 1%, each £700 million, will come from out of our NHS budget. [Interruption.] They point at me, but I remind the hon. Gentleman that we accepted the independent pay review body’s recommendations in full. We stand ready to look at the independent pay review body’s recommendations for next year, which of course is only two months away, because it starts in April. It is really important that we all engage with that process, so we can get it right and address many of the issues the hon. Gentleman and others raise.

What is the Minister’s estimate of the number of people in England who have had their appointments or operations cancelled today, compared with Wales and Scotland where there are no strikes? Why are the Conservative Government so indifferent to the suffering of patients in England that they refuse to do what the Governments in Scotland and Wales have done, which is to get round and negotiate a settlement?

We do not, as yet, have the details of today’s and tomorrow’s industrial action, but we will certainly be able to publish that information in due course. I can tell the right hon. Gentleman, as I mentioned in my opening response to the urgent question, that over 88,000 appointments have been rescheduled so far and over 58,000 shifts have been missed. Of course I deeply regret that and wish that there was no strike action. [Interruption.] Of course I do.

If we had not accepted in full the independent pay review body’s recommendations, the right hon. Gentleman and others would have an argument to make to say that we had not, but we did accept them in full. We accepted them in full last year, too, despite them being over and above the evidence submitted by the Government in respect of affordability. That is why I look forward to the next independent pay review body process, and why it is so important that the unions and others engage with that process so that we get it right.

I have more than enough cause to thank my local NHS for the lifesaving treatment it has given me, but so has every single family in this country. Why do the Government not get it, as the public clearly do, that our health workers, like all public sector workers, are at the end of their tether? Get round the table to resolve these disputes and give them the proper wage rise they so desperately need and deserve.

First, let me agree entirely with what the hon. Gentleman said about NHS staff and how we all owe them a debt of gratitude for the service they have given, not just to us but to all our families. Again, he may have missed it when I asked that if any Opposition Member was going to raise the same question, they might also stand up and say exactly where each block of £700 million would come from, out of my £150 billion budget. [Interruption.] The hon. Member for Brent Central (Dawn Butler) says, “Show us the books.” She knows exactly where the NHS funding goes. I want to ensure that we have an open and honest dialogue. I have been having those conversations with the unions and I have set out exactly the challenges we face. Any pay has to be affordable not just to the NHS but to the wider budget. It has to recognise and reward those who work in the NHS. Of course I want to retain and attract the very best, but it also has to be fair to taxpayers, and that is the point I think the hon. Gentleman and others are missing.

I thank the Minister for his answers. For nurses and many others in the NHS, striking is not what they want to do: all they want is dialogue and to try to move forward with an agreed wage structure. They have been left vulnerable by understaffing on the wards, and the pressure that adds is repugnant to them. The Government must move from their entrenched position to find a workable solution. Will the Minister commit to reopening dialogue and looking at the situation, not from the angle of enshrined principle but from a safety angle, which concerns us all?

I thank my hon. Friend for his question. We accepted in full the independent pay review body’s recommendation this year of 4.75%, which was over and above last year’s figure of 3% when the rest of the wider public sector was frozen. He asks about dialogue. Of course I am happy to have dialogue with the unions; my door has always been open and it will continue to be so. What I am not going to do is reopen this year’s pay review. We have the independent pay review body process and we accepted that recommendation in full. What I am willing and happy to do is to have that dialogue about next year’s independent pay review body recommendation. Let us not forget that it is in only two months’ time that the new financial year starts, and we have to get that right. I hope that he will encourage unions and others to take part in that process so that we can get it right, because we all want to ensure that NHS staff get the right pay rise that recognises the huge service they give.

Half of the successful revised offer by the Welsh Government is in the format of a one-off payment. Will the British Government confirm that that element of the pay settlement will be recognised as cost of living support and not as income, and treat it as such for tax and benefit purposes?

Pay is a devolved matter and I understand that the full details of the Welsh offer are yet to be finalised. They will include a number of non-pay commitments, and I understand that the cost of those measures could be substantial. I will look carefully at what the hon. Gentleman says. In any event, it would not be a matter for me as a Health Minister but for the Treasury.