Jonathan Ashworth
Let me make a little bit of progress, and then I will give way.
Over the past seven years, a public sector worker on the median public sector wage has seen the value of their wage drop by £3,875. That is more than the cost of feeding the average family for a year. Given what we know about inflation, on the figures published yesterday and on the Treasury’s own inflation forecast, if this cap was to remain in place until the end of the Parliament, a public sector worker on the median wage since 2016 will have seen their pay drop by at least another £2,200.
Jonathan Ashworth
The Chief Secretary says it is not true. These amounts are based on her own Treasury figures.
The Secretary of State for Health (Mr Jeremy Hunt)
I thank the shadow Health Secretary for introducing this debate. NHS staff are doing a superb job in tough circumstances, and it is right for this House to debate whether we are giving them an appropriate level of support.
I start by addressing the areas on which we agree with the Opposition. First, it is incredibly important to have motivated staff, simply because motivated staff give better care to patients. It is critical for patient safety that we have enough staff in our NHS and social care system, so recruitment and retention matter. It is also true that, right now, it is very tough on the frontline for NHS staff as they cope with the pressures of an ageing population, of financial constraints that have not been as tough in many years, and of changing consumer expectations of what the NHS should deliver. We agree on all that, but there are some fundamental disagreements that I also need to surface.
The shadow Health Secretary talks about the former 1% cap and the pay restraint that we have indeed had for the last seven years, which his party frequently characterises as austerity—some ideological mission by the Conservatives to reduce the size of the state. [Interruption.] I can see some nods, but it is absolute nonsense.
I remind Labour Members that in 2010 we inherited the worst financial crisis in our history and the worst recession since the great depression. The shadow Health Secretary was an adviser to Gordon Brown in 2010—he does not talk about that very much—and he knows just how serious the crisis was. He uses the phrase “Tory economics,” but the 2010 Labour manifesto, which he may well have had a hand in drafting, wanted to cut the NHS budget. The Health Secretary at the time, Andy Burnham, said that it would be “irresponsible” not to cut the NHS budget.
In 2015, five years on from that terrible crisis, the Labour party wanted to put £5.5 billion less into the NHS than the Conservative party did. In short, the austerity that the shadow Health Secretary criticises today is austerity that Labour wanted to go much further with when it comes to the NHS. Labour needs to recognise that if we had followed its advice we would not even have been able to honour a 1% pay rise, we would not have been able to recruit 12,000 more nurses for our wards, we would not have record numbers of doctors and we would not have record funding for the NHS.
Catherine West
Will the Health Secretary apologise for the current dreadful state? We have thousands and thousands of nurse places, and hospital trusts are having to go as far as the Philippines to recruit student nurses. Student nurses are coming out of university with £56,000 fees. NHS recruitment and retention is in a deep crisis. Will he apologise?
Mr Hunt
What I will not apologise for is the dreadful short staffing on NHS hospital wards that we inherited in 2010, which led directly to the problems of Mid Staffs. Nor will I apologise for sorting that out and making sure that we have 12,000 more nurses on our hospital wards today than we had in 2010.
Alison McGovern
The Secretary of State is repeating words that the Tories have used to excuse their cuts for years but that have not dealt with the deficit, which is still with us. My constituents do not care about that; they care about Eastham walk-in centre, which is closed because of staff shortages. Will he answer this simple question? When will Eastham walk-in centre reopen?
Mr Hunt
What the hon. Lady’s constituents care about is that today we announced the lowest unemployment level since 1975, which is a massive benefit to her constituents. She says that we have been repeating our reasons for this terrible financial discipline, which has been so difficult. I am not someone who says that the entire responsibility for the recession in 2010 is the Labour party’s. I recognise that it was a global crash, but what Labour cannot deny is that the recession we faced here was far, far worse than in other countries. Why is that? What did the Governor of the Bank of England say at the time?
Several hon. Members rose—
Mr Hunt
Hang on. I think it is important to listen to what the Governor of the Bank of England said. Sir Mervyn King said:
“we came into this crisis with fiscal policy along a path that was not…sustainable and a correction was needed.”
What was he talking about in 2010? The Government borrowed £1 in every £4 that they spent. The deficit was 10.2%, the highest since records began. The reason that, say, Germany did not have to go through austerity is not because a German equivalent of the Leader of the Opposition was throwing prudence to the wind but because Germany did not allow its public finances to get recklessly out of control, which is what happened under the Labour Government.
Ms Karen Lee
This is a genuine question. I am a nurse, and I see the situation at first hand. I go to work once a month—I still do bank shifts—and the situation is truly awful. We are so understaffed that it is unbelievable. I looked after 10 patients on my last shift. That is not for the audience; it is the truth. The NHS is in that sort of state. Lincoln’s walk-in centre is threatened with closure. All that is going on. I take the Secretary of State’s point about paying for it, but the Conservative party talks about cutting corporation tax and it is paying the Democratic Unionist party more than £1 billion. While that is happening, he cannot talk to us about austerity and say that we cannot have decent NHS services. I am sorry, but he should listen to what I am saying. The NHS really is in crisis.
Mr Hunt
I thank the hon. Lady for her work in the NHS. I am honoured that we have nurses on both sides of the House who do a fantastic job. I agree that we need more nurses. We needed more nurses when I became Health Secretary—the NHS was planning to lose nurses, and I stopped that—and we still need more nurses. I will explain exactly how we will get those nurses.
Several hon. Members rose—
Helen Whately
Opposition Members are raising concerns about staff shortages and about recruiting staff from overseas. I am sure we all have hospitals serving our constituents that have had to go overseas to recruit. We do not want to see that; we want to see nurses trained in the UK and British nurses. I welcome the fact that the Secretary of State has taken action to remove the cap on nurses in training so that we can train more home-grown nurses.
Robert Halfon (Harlow) (Con)
I thank my right hon. Friend for the huge and strong support he has given to Princess Alexandra hospital in Harlow and to our campaign for a new hospital. I welcome the moves the Government are making on the pay cap and I look forward to announcements in the coming weeks. May I urge him to do even more than the Government are doing on nursing apprenticeships, because they are one key way forward? These apprentices do not have any loans and they can do nursing. Finally, let me make the wider point that one of the best ways of helping lower-paid nurses, and everyone in the public and private sectors, is by continuing to do what the Government are doing by cutting taxes for lower earners and acting through the national living wage.
Several hon. Members rose—
Mr Hunt
I am going to make some progress and then I will give way further. I want to talk about the recruitment issues raised by the hon. Member for Hornsey and Wood Green (Catherine West) and others, but I wish to conclude on the point about financial discipline, of which Opposition Members are so critical. The consequences for a Government of losing financial discipline are not just pay freezes and 1% caps, but 1 million people unemployed—as a result of that recession post-2008. Every Labour Government in modern times has left office with unemployment higher than when they arrived. That is why this afternoon’s motion is so bogus, because the difference between the Government and the Opposition is not about a desire to invest in public services; it is about the ability to deliver a strong economy so that we can make that investment.
Mr Hunt
I want to make some progress on the recruitment issues, which a number of hon. Members have raised. The argument we seem to be hearing from the shadow Health Secretary is that Labour’s policies would mean more nurses for the NHS and better care for patients, but nothing is further from the truth. Let us look at Labour’s policies at the last election. What did the independent Institute for Fiscal Studies say then about Labour’s spending plans? It said there was a black hole of up to £29 billion, which made even Gordon Brown look like the paragon of prudence that he never was. How can a black hole like that be filled? There are only two ways of doing it. The first is by raising taxes on ordinary people—this is what the IFS said would be one of the biggest tax increases in the past 30 years, equivalent to a 7% increase in income tax. For a nurse on average earnings, this would be a £1,400 tax hike every year. Alternatively, the hole could be filled by increasing borrowing, but that simply passes on debts to future generations in a con as explicit as the con of telling students before an election that their debt will be waived only to cancel the promise after the election.
Julian Knight (Solihull) (Con)
My right hon. Friend does not even need to cite the IFS to see what things would be like with Labour in charge of the UK NHS—he just needs to look to Wales, where the NHS has been cut by 10% and one in seven people are on the NHS waiting list. That is Labour in action.
Mr Hunt
My hon. Friend is absolutely right about that. The whole problem with the tone of the argument made by the shadow Health Secretary is that he is saying that the difference between the Government and Labour is about our support for public sector workers, but we all agree, in all parts of the House, that they do a fantastic job. I see that in the NHS every week. The difference between us and Labour is about knowing what harms public sector workers the most; it is between ignoring and repeating the mistakes of the 2008 crash, as Labour Members are, and what we think, which is that we need to learn from those mistakes and not repeat them.
James Heappey
Does my right hon. Friend agree that Labour was not the only party with an irresponsible policy at the general election on funding health and social care, and that although the Liberal Democrats can muster only one MP to debate this important subject today, their 1p on income tax gimmick would have gone nowhere far enough to funding the properly increased services they promised?
Lady Hermon
Will the Health Secretary take a few moments to address the serious issue of staff morale in the NHS? In Northern Ireland, we have no Assembly and, thus, no Health Minister, so there is no mechanism by which to give our nurses any pay increase. He needs to speak to the Secretary of State for Northern Ireland, as a start, and to address the crucial and concerning issue of staff morale, which is affected by low pay and the pay cap.
Several hon. Members rose—
Mr Hunt
I will make some progress now, because I know that lots of people want to speak in this debate.
The other completely bogus claim we have heard this afternoon is that somehow the financial discipline of pay restraint that we have had to have has been deliberately targeted at ordinary people. Again, that is absolute nonsense, as we see when we look at what has happened. Despite the recession and the pressures on public finance, this Government have taken 4 million of the lowest-paid people out of income tax altogether. At the same time, the top 1% are paying more and the top 20% are paying more, and we have gone further, introducing the national living wage, which since its introduction in April has increased the pay of people at that level of pay by £1,400 per annum. The record overall—this is where we see the most obnoxious untruth spread by the story on austerity—shows that over the past seven years we have seen 600,000 fewer people in absolute poverty and 200,000 fewer children in absolute poverty. Income inequality has reduced to its lowest level for 30 years. Why is it that this apparently evil Tory Government have reduced inequality? It is because we have done what Labour never does, which is grow the economy, with 1 million new businesses, 3 million new jobs and unemployment at its lowest since 1975. Today, youth unemployment is below 5% for the first time and there has been a 40% drop since 2010.
Several hon. Members rose—
Mr Hunt
I am going to make some progress, because I want to deal with the issue of morale, and then I will give way for a final round of interventions.
A lot of comments have been made about the NHS being at breaking point, at a tipping point and so on. There is huge pressure on the NHS, but, as has been said by my right hon. Friend the Member for Broxtowe (Anna Soubry), who is no longer present, that is not the whole picture. What the shadow Health Secretary did not say is that 7,000 people are alive today who would not have been had we stayed at the cancer survival rates of just four years ago. We are having probably the biggest expansion of mental health treatment in Europe, and an independent NHS England report says that for most major conditions outcomes have dramatically improved over the past three, five or 10 years.
Norman Lamb (North Norfolk) (LD)
I feel that as the sole Liberal Democrat present it is my duty to intervene. Does the Secretary of State accept, as a principle, that ultimately we cannot sustain the NHS on the back of real-terms cuts to people’s pay within the NHS and that that would be unconscionable year after year? Does he also accept that as the difference between public and private sector pay narrows so much, people will just vote with their feet and leave? Therefore, not only is this morally wrong, but it will not work ultimately.
Mr Hunt
I agree with the right hon. Gentleman that when deciding policy on pay we absolutely have to look at the impact on recruitment and retention, and that if we are going to deal with the pressures of an ageing population in the way that he and I would both want, we are going to need to recruit many more doctors and nurses for the NHS over the years ahead.
The progress that we have made in the NHS in improving outcomes for patients, despite the huge pressure on the frontline, is possible because of the brilliant staff we have in the NHS. I want to recognise that pay restraint has been extremely challenging, which is why yesterday my right hon. Friend the Chief Secretary to the Treasury announced a new policy, allowing Departments flexibility where there are recruitment and retention issues, and where productivity savings can be found. We will also honour the commitment we made prior to yesterday’s announcement, which was that before we take any decisions we will listen to the independent advice of the pay-review bodies.
To value staff also means to look at non-pay issues as well. It means we should look at making sure that we are training enough staff, so that when hospitals have the budgets to employ staff, they are there for them to employ; it means we should look at flexible working—on which, frankly, the NHS can do a lot better—if we are to tackle the agency bill that the shadow Health Secretary spoke about; it means we should put in place measures to encourage nurses to return to practice, which is why Health Education England is increasing the number of return-to-practice training places to 1,250 from 2019-20; it means we should look at new support roles for nurses, such as the 2,000 nurse associates who are starting training this year; and it means we should look at new routes into nursing, such as the nurse apprentice route that we are opening this year.
Mr Hunt
I am going to wind up my comments now, because lots of people wish to speak. [Hon. Members: “Oh!”] Okay, the House has persuaded me. I shall give way first to the hon. Member for Hornsey and Wood Green (Catherine West) and then to my hon. Friend the Member for Redditch (Rachel Maclean).
Catherine West
I thank the Secretary of State for his generosity in giving way to me twice. Will he look again at the issue of student bursaries? It is such mistake.
Mr Hunt
I assure the hon. Lady that we are making reforms because we want to train more nurses and to fund more nurse training places. There has been a dip in the number of people taking up nurse training places this year, as there was when the higher education reforms were introduced in 2012, but it recovered soon after that and we now see in other parts of higher education record numbers of students from poorer backgrounds going to university.
Rachel Maclean
On my right hon. Friend’s earlier point about the recruitment and retention of staff, one problem, which I know from having spoken to the Worcestershire Acute Hospitals NHS Trust and the Alex Hospital in my constituency, is the constant negative messaging the public receive. Members from all parties deeply back NHS workers, appreciate and respect how hard they work, and recognise the challenges. If Opposition Members really care about easing the recruitment and retention crisis, I call on them to join us in talking about some of the good news and the good messages that are coming out of the NHS. Those are the things that get through to the public’s mind and that encourage nurses to join the profession, and that is why we have twice the number of applicants for nursing places this year.
Mr Hunt
My hon. Friend is absolutely right. From some of the debates we have in this House, a person would never know that in July, for the second time running, an independent American think-tank looked at health systems in all the world’s major countries, compared us with the United States, Germany, France, Australia and others, and said that the NHS was top—the best healthcare system of any major country. We have a huge amount to be proud of.
Several hon. Members rose—
Mr Hunt
I am going to conclude my comments by asking three questions. First, who is the real friend of public sector workers—the party that wrecked the economy, leading to massive cuts, or the party that turned the economy around with 3 million new jobs? Who is the real champion of public services—the party that did not only wreck the public finances but wants to do so all over again, or the party that is restoring discipline to the public finances so that we can start to invest more in our public services? Who is the real friend of the NHS—the party that has delivered more doctors, nurses and funding than ever before in its history, or the party that plays politics with the NHS in election after election, despite doing it so much harm?
The Chief Secretary to the Treasury (Elizabeth Truss)
We have had an important debate, in which it is fair to say that both sides of the House have recognised the importance and hard work of workers across the NHS. I saw this hard work in action on the Becket ward of Worthing Hospital a few weeks ago, where deputy sister, Sue Grace, and her team were in an improvement huddle, where every day they look at how they can make life better for their patients. That goes on right across our NHS. Because of the hard work of NHS workers across the country, there have been 1 million more operations and cancer clear-up rates have improved.
The Health Secretary recognised in his opening comments that there are challenges to address. We need to ensure that we retain those hard-working staff, that we can recruit the next generation into the service and, as my hon. Friend the Member for Totnes (Dr Wollaston) pointed out, that we are able to recruit people in specialisms. We need to look at making jobs more flexible so that people have a good work-life balance and we need to look at banding, as my hon. Friend the Member for Lewes (Maria Caulfield) pointed out. That is why the Government announced yesterday that we are moving from a blanket approach of having a 1% public sector pay cap to greater flexibility in each workforce across the public sector.
Just to be clear—because there seems to be some confusion on the part of Opposition Members—the prison officers and police settlements were for 2017-18. Our new policy is for 2018-19. There is already a clear process in place for that. The Health Secretary will submit evidence to the independent pay review body. It will look at issues such as recruitment, retention and affordability, and will then come back with a recommendation. That is the way we should do it; we should look at the evidence. Rather than shouting out numbers in the debate, we need to look at the circumstances. We need to ensure that pay is fair for people in the NHS, but that it is also fair for the taxpayers who fund those services.
OECD figures show that we spend 9.8% of our GDP on health and social care. That is above the European Union average of 8.6%. We are able to do that because we have run a strong economy. Today we announced record levels of employment. We have not heard any concrete proposals from Labour Members this afternoon. We have just heard reckless pledges that they will spend more money without looking at how they are spending it. As my hon. Friends the Members for South West Bedfordshire (Andrew Selous) and for Copeland (Trudy Harrison) pointed out, the Conservatives do not just spend more money. We actually make sure that the money goes to the frontline, that it helps and empowers people there to do their jobs, and that it makes those jobs more fulfilling.
It is not just about spending more money; it is also about the way we spend it. If we followed the Labour party’s advice, we would end up crashing our economy in exactly the same way the Greeks did with their economy. What was the result of that? They ended up cutting health service spending by 36%.
We have recognised that there are challenges in the national health service and in other parts of our public sector, and this policy applies right across the public sector. We have reflected on that situation, and we have moved to a more flexible policy that looks at issues of recruitment and retention.
However, it is important, as my hon. Friend the Member for Walsall North (Eddie Hughes) pointed out in an excellent speech, that we also look at fairness for the people who pay for our public services. It is only by having a strong economy and by being disciplined in our approach to debt that we can get the great public services that we all want.
Question put and agreed to.
Resolved,
That this House notes that in 2017-18 NHS pay rises have been capped at one per cent and that this represents another below-inflation pay settlement; further notes that applications for nursing degrees have fallen 23 per cent this year; notes that the number of nurses and midwives joining the Nursing and Midwifery Council register has been in decline since March 2016 and that in 2016-17 45 per cent more UK registrants left the register than joined it; and calls on the Government to end the public sector pay cap in the NHS and give NHS workers a fair pay rise.
Jonathan Ashworth
On a point of order, Mr Deputy Speaker. Is it not now clear that the House has been unanimous in saying that we should end the pay cap in the NHS and give health workers a fair pay rise? Is it not also clear that the reason the Government did not divide on this motion is that they knew they would lose?