NHS Industrial Action: Government Preparations Wes Streeting
(Ilford North) (Lab) (Urgent Question): To ask the Secretary of
State for Health and Social Care if he will make a statement on
Government preparations for industrial action in the NHS. The
Minister of State, Department of Health and Social Care (Will
Quince) 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...Request free trial
NHS Industrial Action:
Government Preparations
(Ilford North) (Lab)
(Urgent Question): To ask the Secretary of State for Health and
Social Care if he will make a statement on Government
preparations for industrial action in the NHS.
The Minister of State, Department of Health and Social Care
()
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 on contingency planning for industrial
action in the NHS. He also came before the House on the subject
twice last week: at departmental questions and for the Opposition
day debate.
We are all hugely grateful for the hard work and dedication of
NHS staff, so we deeply regret that some union members have voted
for industrial action. Our priority must be to keep patients
safe. That begins with keeping the door open. The Secretary of
State wrote to the Royal College of Nursing on Saturday asking
for further discussions as a matter of urgency. At the same time,
we are working with the NHS to minimise the disruption to
patients if the strikes do go ahead. We are engaged with
providers, professional bodies and trade unions to agree safe
levels of cover should any action take place.
In addition, this afternoon, Ministers—including the Secretary of
State—are attending a Cobra meeting focused on our contingency
plans. Our plans draw on extra support from a range of places,
including service personnel and the private sector. While we aim
to minimise disruption, with the NHS already under significant
pressure from the covid pandemic and winter pressures, we remain
deeply concerned about the risk that strikes pose to
patients.
I want to be clear that, even at this moment of uncertainty,
people must keep coming forward to get the care that they need.
People should continue to use NHS 111 if they need medical help
and dial 999 in the event of an emergency. For more routine
treatment, hospitals will do everything they can to ensure that
planned procedures go ahead, but it is inevitable that any strike
would mean some patients would have their treatment delayed.
People will be contacted if their appointments need to be
changed.
It is our hope that patients can be spared from unnecessary and
unjustified strikes. Industrial action is in no one’s best
interests, especially in this difficult winter. We have had
constructive meetings with the leadership of several unions,
including the RCN, Unison, Unite and the GMB, and we look forward
to further discussions to find a way forward together that is in
the best interests of the patients we all serve.
Thank you, Mr Speaker, for granting this urgent question. The
power to stop these strikes likes squarely with the Government
and the Secretary of State. The Royal College of Nursing and
Unison have said that they will call off strikes this week if the
Government are willing to negotiate with them seriously on pay.
That reasonable offer of compromise is surely too good to refuse,
so what on earth are the Government playing at? After 12 years of
Conservative government, patients can no longer get seen on time
and staff have been pushed to breaking point—and the Government
cannot even be bothered to try to negotiate to prevent strikes
from going ahead, at the worst possible time for patients and the
NHS. The Government should ask themselves why, under a
Conservative Government, nurses feel they have to take industrial
action for the first time in more than 100 years and why
ambulance workers are set to follow them for the first time since
1989.
It should be obvious by now what the Conservative agenda is. The
Government know that patients are going to suffer this winter and
they have no plan to fix the problems of their own making, so
instead of taking responsibility for their failure they want to
use nurses and paramedics as scapegoats to avoid the blame. It is
a disgusting plan, it is a dangerous plan, and it is a plan that
will not work. The public know that the power to stop these
strikes is in the Government’s hands. If they fail to act now,
patients will never forgive them.
How many operations have already been cancelled? How does the
Minister expect those on the waiting list to feel if their
operations are cancelled because of the Government’s gross
negligence? Can he tell patients which services will be impacted
if these strikes go ahead? Is the Secretary of State not
embarrassed at Cobra today, asking the Army to come in to clean
up the Government’s mess?
Even at this last minute, it is not too late to prevent strikes
from going ahead. Perhaps the Minister can tell us whether the
meeting with the RCN later today will involve discussions on pay.
And if not, why not? Because that is all it takes: just a few
minutes or a few hours of talk can avoid strike action. Why will
they not do it?
The fact is that Labour is all over the place when it comes to
strikes. They criticise Ministers while admitting that the
unions’ pay demands are unaffordable. The hon. Gentleman and his
party leader are too tied to their union paymasters to be on the
side of patients. He knows that we have an independent pay review
body, and is important that both sides respect that independent
body. We accepted the independent body’s recommendations for this
year’s increase in full, meaning that over 1 million NHS staff
have been given at least a £1,400 increase in their pay. That is
on top of a 3% pay rise last year at a time when pay was frozen
across the wider public sector. The RCN, one of the unions taking
action, is asking for an increase that is 5% above the retail
prices index. Based on latest figures, that is an increase of
19.2%, or the equivalent of 6.5% of the NHS budget. To meet such
demands, we would have to take money away from clearing the
elective backlog that the hon. Gentleman referred to, something
no responsible Government would wish to do.
Throughout this period, we have always sought to have a balanced
process. Those in the private sector will not be getting a 19%
uplift, and there is a clear need to be fair to the wider
economy. We have to avoid inflationary pressures that would make
us all poorer in the end.
We will continue to listen to colleagues’ concerns, not just
about pay but many other issues affecting the working lives of
those in the NHS. We will work with them to make improvements in
a range of areas, from working conditions to patient safety,
because we believe there is so much that we can agree on. Strike
action is in no one’s best interest. We will keep working so that
the NHS continues to be there for those who need it most.
Mr Speaker
I call the Chair of the Health Committee, .
(Winchester) (Con)
With your indulgence, Mr Speaker, may I send our heartfelt
sympathies to the parents of the little boys who have lost their
lives in the west midlands overnight and say thank you to the
emergency service workers, many of whom will have been from the
NHS? I am sure they have done their best for those they pulled
out and those they were unable to save.
The Minister is right that we have an independent pay review
process, but it seems that we are coming to an interesting
junction point: either we believe in an independent pay review
process, or we do not. We cannot be in a situation where
everything is agreed until it is simply not, and then Ministers
are negotiating pay. That is not what Ministers do.
I am glad the Minister mentioned patients them at the end of his
remarks. We must keep them as our focus. I have more information
about my train services over the next few weeks than I do about
health services. Is the Minister satisfied that patients have
enough information about what is being affected and when, and how
much it will impact on the backlog? I suspect none of this will
help the workload pressures that are impacting our NHS.
I thank my hon. Friend for his question, and I echo his comments
on the tragic events in Solihull, the boys who lost their lives
and the heroic actions of those in the emergency services.
My hon. Friend is also right to say that we have an independent
pay review body, and we either agree and accept that that is the
process, or we do not.
On advice to the public, my hon. Friend is right that we have
more to do in this space. Derogations are still being worked
through with both individual unions and trusts. Patients should
continue to call 999 as normal if it is an emergency and someone
is seriously ill or injured. If they do not have life-threatening
conditions, they should use NHS 111. Ambulances will still be
responding to 999 calls. If patients have appointments, they
should please turn up unless advised not to do so. He is right to
make the point about communications, and I will be ramping this
up when we know more about derogations.
Mr Speaker
I call the SNP spokesperson.
(Coatbridge, Chryston and
Bellshill) (SNP)
Scotland’s First Minister has managed in one day to do what the
Tory Government could not—agree with the nursing unions to call
off strikes planned for this month. NHS workers are the backbone
of these countries. If they do not work, the country does not
work, and if the country is not working, it is broken. Britain is
broken, is it not? And Brexit has broken Britain, has it not? The
Tories will not negotiate and the Labour Opposition spokesperson
has branded the British Medical Association as “hostile”, while
in Scotland the strikes are off, and they are off permanently. An
offer of 7.5% has been negotiated and agreed, with an 11.24% pay
rise for the lowest paid across the board in NHS Scotland. Why
are the UK Government refusing to give public servants a decent
pay increase when they have all the financial power to do so?
I thank the hon. Gentleman for his question. My understanding is
that the industrial action in Scotland has been suspended, not
cancelled, as the hon. Gentleman suggested. The Scottish
Government have made a considerably higher offer, partly because
a politician has got involved in pay negotiations, directly in
contrast to the independent pay review body, and it will be
interesting to see whether the First Minister of Scotland is
going to do this every single year and go against the
recommendations of their pay review body.
Would the hon. Gentleman like to confirm—I appreciate he cannot
do it now—whether the Scottish Government have also looked at
things such as leave and working times? I think it is important
to stress that every 1% increase for the “Agenda for Change”
workforce equates to about £750 million. That is £750 million
that will come out of the NHS budget and that we will not be able
to spend on things such as tackling the elective backlog, which
is so important to people up and down the country.
(Bournemouth East) (Con)
Our military actually enjoy stepping in when a Government
Department occasionally cannot manage, such as with flooding and
so forth, or on rare occasions when a strike takes place.
However, what we are seeing this month is unprecedented, with so
many sectors choosing to strike exactly at the same time, and
this places a huge burden on our armed forces. Could I ask the
Minister, first, whether all the units that may be required to
mobilise have been informed already, and whether, if we are going
to see strikes at this level, it is now time for Departments to
introduce minimum service levels to make sure that our armed
forces are not overwhelmed?
Representing the garrison city of Colchester, I have nothing but
the utmost respect for our armed forces. It has not escaped my
notice that many of them are on lower pay than NHS staff and will
be giving up their time over Christmas to cover strike action. My
right hon. Friend is right that to mitigate the impact of planned
industrial action in the ambulance sector, NHS England has
explored a range of measures, which include engaging with the
Ministry of Defence on military support. As a contingency, a MACA
request—a request for military aid to civil authorities—for a
limited number of personnel has been submitted to the MOD. It was
submitted at the end of last week, and the plan is that MOD
personnel will be trained to drive ambulances, but only deployed
where they are needed across the country.
(York Central)
(Lab/Co-op)
The Government need to stop hiding behind the pay review body.
The pay review body sorts out the distribution of the funding,
while it is the Government who determine the size of the
envelope, and it is the envelope that is in dispute. Why will the
Minister not get a Treasury Minister alongside him and make sure
they negotiate on the size of the envelope? If they can afford
the right hon. Member for South West Norfolk (), they can afford a
nurse.
The average pay settlements in the private sector range between
4% and 6%, and we want to have a fair deal for both NHS staff and
the taxpayer. The hon. Lady makes reference to the pay review
bodies, but it is important to stress that they are made up of
independent experts. They recommended the uplifts for NHS staff,
and in formulating their recommendations, the review bodies
carefully considered evidence from a wide range of stakeholders,
including NHS system partners and trade unions. The independent
pay review body is a respected mechanism, and we should accept
its recommendations, which we have.
(Middlesbrough South and East
Cleveland) (Con)
May I commend my hon. Friend on his response to the urgent
question, and say how much I agree with him? Can he set out his
thoughts on how things would be likely to proceed in the NHS if
we ended up in the scenario which the shadow Secretary of State
appears to want, in which Ministers negotiate directly with
unions on pay every winter? Does he think that that would lead to
upward pressure on pay at the expense, crucially, of the public,
whom we serve and who need those operations and the elective care
for which we have budgeted, and that that should not be eroded by
unrealistic pay demands of 19%?
My right hon. Friend is right. We have an independent pay review
body mechanism for a reason, and it has worked for a number of
years. That is why I made reference to the First Minister in
Scotland. Is this a procedure we are going to go through every
single year when a pay review body recommendation is made and
unions do not like it, and politicians have to get involved? The
point of the independent pay review body is that it depoliticises
the issue, and Ministers do not negotiate directly with unions.
The independent pay review body looks at the issue in the round,
along with the wider economy and a number of other factors, then
forms a recommendation which the Government can choose to accept
or refuse. It is important to stress that in this case the
Government accepted the recommendations in full.
Mrs (Birmingham, Erdington)
(Lab)
I was a nurse for 25 years. Nurses work long hours, day in, day
out, to support people all over the country, often on very low
pay. I know from experience how tough it can be, and it is
shameful that many hospitals have opened food banks specially to
feed their staff. Let us be absolutely clear: the power to stop
these strikes, which nurses themselves do not really want, lies
squarely with the Government. How can Ministers justify refusing
to talk to the unions?
I thank the hon. Lady for her question and for her service as a
nurse. We value hugely and appreciate all our NHS staff. We have
given them a pay rise this year, on top of 3% last year, when pay
was frozen in the wider public sector. As I have said a handful
of times, we accepted in full the recommendations from the
independent pay review body. Of course, I do not want to see
anybody needing to use a food bank, let alone a member of our
NHS. That is exactly why the Government have a broader package of
support in place.
I have to take issue with one of the hon. Lady’s comments. She
asked who held the power to call off these strikes. There is only
one answer: the unions.
(Scunthorpe) (Con)
I have been out on shift with my local ambulance service, and
have seen how hard it works and how important that work is. We
are really grateful for what it does, and my constituents are
worried. If the ambulance strikes go ahead, will the Minister
explain which categories of call we will ensure are responded
to?
We are currently having those derogation discussions with the
unions, and they will also happen at an individual trust level.
As my hon. Friend will know, having been out with her trust, 999
calls are triaged and categorised from category 1 to category 4,
and on days of ambulance strike action it is likely that category
1 and category 2 calls, where there is an immediate threat to
life, will be responded to. We are looking at ways in which we
can provide additional support for category 3 and category 4,
including things such as block-booking taxis and support through
community healthcare, local authority fall services and community
support.
(Bristol South) (Lab)
What we have got is a Government who refuse to govern. Retention
and sickness rates were reported to the Health and Social Care
Committee in June 2019 as higher than average by Health Education
England, and if retention rates were kept at 2012 levels we would
have 16,000 more nurses in the system. The Minister has talked
about safe levels of cover during the strike, but the unions have
told us that when they look at staffing levels, in some places,
they are currently below what is safe. The issue for us as
Members of Parliament and for our constituents is that none of us
knows whether our local systems are safe or not. Can he tell us
which hospitals across the country are currently operating at
safe staffing levels, and which are below those levels, before
the strike even starts?
The hon. Lady talks about NHS staffing levels; we have 1.2
million staff within our NHS, and compared with last year, we
have 3,700 more doctors and 9,100 more nurses, and compared with
2019, we have 29,000 more nurses and 2,200 more GPs, but we do
have high vacancies. That is why it will not have escaped her
notice that we have commissioned NHS England to publish a
long-term workforce plan, and that will be independently verified
as set out by the Chancellor in the autumn statement.
(Broadland) (Con)
Inflation is the real enemy here, because it makes us all poorer.
We have a political and economic choice: we either tackle it, or
we give in to an inflation pay spiral. The Minister was right to
mention that the Royal College of Nursing pay demands are in
excess of three times greater than the average private sector
payment at the moment. Does my hon. Friend agree that public
sector pay demands of almost 20% would embed inflation for years
to come and make us all poorer?
My hon. Friend is absolutely right: granting double-digit pay
rises would sustain higher levels of inflation and have a bigger
impact on people’s income in the long term, as well as eroding
the value of savings, which is important to many of our
constituents.
(Wirral West) (Lab)
These strikes are not just about pay levels; they are also about
patient safety. NHS workers care deeply about their patients, and
I stand in solidarity with them. Members of the Royal College of
Nursing have told me how stressed and burned out they are because
they do not have enough colleagues to work alongside them. That
is dangerous and extremely unfair on both patients and staff, and
it is the result of the failure of consecutive Conservative
Governments to provide enough resources and training places and
to carry out the necessary workforce planning. The Minister
mentions the independent pay review body, but he knows full well
that there is a role for Government in ending this dispute. Will
his Government get around the table with the unions and avert the
strike action?
The hon. Lady is right that this issue is about more than just
pay. That is what the unions are telling us. It is about things
such as staffing levels and working conditions. If that is indeed
the case, let me repeat: my door is always open, and I would be
happy, as would the Secretary of State, to discuss those issues
with the unions at any point they would like.
(New Forest East) (Con)
Would there not be more money available for relatively poorly
paid frontline NHS staff if there were fewer layers of management
bureaucracy paid at substantially higher rates within the
NHS?
I thank my right hon. Friend for that question. I am sometimes
staggered by the number of people on six-figure salaries within
our NHS, but in an organisation of its size, management is also
important. It is about getting the balance right, but we always
continue—[Interruption.] The hon. Member for Ilford North () chunters from a sedentary position. The balance
may not be right, and we always continue to look at the ratio of
management to frontline staff to make sure we are getting that
right.
(Kingston upon Hull East)
(Lab)
The Government will blame anybody and everybody for these
avoidable strikes, but he knows full well that the RCN is not
even affiliated to the TUC, let alone the Labour party. If these
strikes go ahead, the Secretary of State is to blame, because he
has the power to sort out this mess. Why does he not just get on
with it?
The hon. Gentleman puts it in his usual blunt way. The pay review
body process is the established mechanism for determining pay
uplifts in the public sector, outside of negotiating multi-year
pay and contract reform deals. Despite what he says, industrial
action is a matter for the unions, and we urge them to carefully
consider the potential impacts of industrial action. The
Secretary of State and I have been clear that our door is open.
We have already met with the unions, and we would be happy to do
so again.
(Ashfield) (Con)
Now then. In 2014, the shadow Health Secretary said that he would
support strikes within the NHS, even if there was a Labour
Government in power, but he is remarkably quiet today about
whether he actually supports the strikes—unlike the RMT strikes,
which I am sure that he supports. Does the Minister think that
the shadow Health Secretary and Opposition Front Benchers are
playing politics with this issue?
I am not one to cast aspersions on the shadow Secretary of State,
other than to say that I and the Secretary of State refuse to
play politics with this issue. This is all about patient safety
and ensuring that if industrial action goes ahead—[Interruption.]
The shadow Secretary of State again shouts “Negotiate” from a
sedentary position, but he knows that we have an independent pay
review body, process and mechanism. It is important that we
respect that.
(Tiverton and Honiton)
(LD)
We simply cannot afford to lose any more nurses and valued NHS
staff. We already have huge workforce shortages—40,000 nurses
resigned last year and there are more than 130,000 vacancies
across the NHS—so cancelling Christmas for members of the armed
forces will not fix these problems. Will the Minister explain how
paying nurses insufficiently and drafting in military personnel
over Christmas serves to attract new recruits to the NHS and the
armed forces?
That is a bizarre question, because the only reason we have to
put in a MACA—military aid to civil authorities—request is that
the unions have called strike action over Christmas. As the hon.
Member asks about recruitment and retention, let me cover off
that issue. As I have set out, we are committed to publishing a
comprehensive workforce strategy, which will be independently
verified; we have set out new pension flexibilities; we have
already recruited about 29,000 more nurses and are on track to
meet our 50,000 target; and we plan to boost international
recruitment. However, I hope that the hon. Member agrees—in the
interests not only of our armed forces, many of whom will have to
cancel their Christmas leave, but of patient safety—that we do
not want industrial action to take place. I urge the unions to
meet us to discuss a way forward.
(South Dorset) (Con)
I find it regrettable, as I think most people do, that Opposition
Members continue to use the NHS as a political football. This is
about the care of patients, and if Opposition Members do not
think that Government Members care about patients, they are
living in another world. My hon. Friend is doing a great job. We
all accept—even the shadow Secretary of State does—that the NHS
needs a radical reform. Surely it is time for an independent body
to look at that argument and make the NHS run far more
efficiently.
I thank my hon. Friend for his question. We are constantly
looking at how we can improve productivity and increase
efficiency in the NHS. We have an acute issue not just with
winter, but with proposed strike action. The shadow Secretary of
State mentioned that the NHS needs reform, and we are undertaking
that. Will further reform need to be undertaken? Yes, and if my
hon. Friend the Member for South Dorset () has particular ideas, I am
very happy to meet him to discuss those further.
(Newcastle upon Tyne Central) (Lab)
During the dark days of covid, it was the NHS that gave us hope,
not Ministers partying in Downing Street. The Tories now seek to
demonise the very NHS staff that we clapped from our doorsteps,
because they have voted to strike. They are overworked,
underpaid, without a proper workforce plan, concerned about the
security and safety of patients, and forced to use food banks. Do
our NHS staff not deserve at least a face-to-face meeting on pay
negotiations with the Government?
I do not know where the hon. Lady got the impression that I or
anybody else was demonising NHS staff—far from it. The unions
have chosen to bring forward this action. As I said, I hugely
value and appreciate all NHS staff. That is why we have given
them a pay rise this year, on top of the 3% pay award last year,
when pay across the wider public sector was frozen.
(Rhondda) (Lab)
I think the Minister knows that there is no clinician in the land
who really wants to go on strike. Many clinicians feel that the
crisis has been coming for a long time because of the issues
around morale and lack of workforce, which I have asked the
Minister about on many occasions. He keeps saying that the
workforce plan is imminent, but that will not solve the immediate
problems.
One nurse said to me the other day that what worries her most is
that at any one time, several hundred thousand people in the
country are waiting for their test results, particularly in
relation to cancer. How will the Minister ensure that people get
their cancer results in time to meet all the other cancer plan
deadlines?
I thank the hon. Gentleman for his question; I know that he has a
particular interest in the matter. We are looking to ensure that
as many NHS services as possible continue during strike days. On
his broader point about pay settlements, the average pay
settlements in the private sector are within the range of 4% to
6%.
Not in the NHS.
Within the private sector it is 4% to 6%. The uplifts strike a
careful balance in recognising the huge importance of public
sector workers while minimising inflationary pressures and, of
course, having an eye on managing the country’s debt.
(Wakefield)
(Lab/Co-op)
The Minister challenged back on who had the power to avert these
strikes. Let me reiterate what my hon. Friend the Member for
Ilford North () said: trade unions have been clear that strikes
can be averted if Ministers initiate face-to-face pay
negotiations. So far, they have completely failed to do so. The
power to stop these strikes lies squarely with the Secretary of
State. How can the Government justify refusing to even talk?
We have already been clear that we would be very happy to meet
the unions, and I understand that a meeting is being organised,
but let me reiterate the point about what exactly the Royal
College of Nursing is asking for: an uplift that is 5% above RPI
inflation. Uplifting pay for all staff—this is based on 19.2%,
within the agenda for change—would cost approximately an
additional £10 billion. The hon. Member for Rhondda () talked about things like test
results; the £10 billion that we would spend on such an uplift is
£10 billion that would come out of the NHS budget. That is £10
billion that we would not be able to spend on hugely important
issues such as tackling the elective backlog.
(Strangford) (DUP)
I was on the picket line with NHS staff in Newtownards in my
constituency this morning. I do not expect to be reprimanded for
that, by the way—I am quite sure I will be okay.
I want to ask the Minister a positive, constructive question. All
the men and women want who were on the picket line at Ards
Community Hospital in Newtownards this morning is a wage that
helps them to survive. The women and men I talked to this morning
are not surviving; they are visiting food banks. It is not just
the nurses: it is the porters, it is the ward staff, it is
everyone. Will the Minister and the Government go just that wee
bit further to get a settlement?
I understand why the hon. Gentleman is asking that question, and
I am sorry to sound like a broken record, but we accepted the
independent pay review body’s recommendations in full. As a
result, more than 1 million NHS workers were given a pay rise of
at least £1,400. For newly qualified nurses, it was a 5.5%
increase. Those on the lowest salaries, whom the hon. Gentleman
referred to, are seeing a pay rise of up to 9.3%. Again, that is
on top of 3% last year, when public sector pay was frozen.
Nobody wants to see industrial action go ahead. My message to the
unions is “It’s good to talk—let’s talk. I know the meeting is
being set up. Let’s do all we possibly can to avoid industrial
action this winter.”
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