Strikes (Minimum Service Levels) Bill

Lord Markham Excerpts

Committee stage
Thursday 9th March 2023 Lords Chamber

[Baroness Chakrabarti (Lab)]

My Lords, it is with a heavy heart that I welcome the Minister—the noble Lord, Lord Markham—to this Committee. That heavy heart is for a few reasons. The first is that in his time in your Lordships’ House I have found him to be one of the kindest and least combative members of the Government, so I can only imagine what he feels about applying this kind of approach to industrial relations in the health service.

That takes me to my second real regret about this aspect of the Bill. Of course I find the Bill objectionable per se, but I find it particularly distasteful in relation to health services. That is because these people have been the heroes of the pandemic. I am personally embarrassed that it feels like a very short time ago that I was standing with my neighbours, practically in tears, bashing pots and pans in gratitude to these people. We in this House are now talking about imposing minimum service levels on them, as if that is necessary.

What is more, some categories of these health workers are highly regulated and ethical professionals. Even outside pandemic circumstances, we all put our lives and those of our loved ones in their hands. We trust them to do things that we do not understand: that is the level of trust that we have in these people. It is, in the words of the right reverend Prelate, a terrible statement of a lack of trust—it undermines a sacred trust—for politicians to be inflicting this on these highly ethical health workers. I really wonder, if we were to have a focus group or a poll of the public, and measure the trust index of different categories of people in public life and in different professions, where nurses, doctors and other health workers would sit, compared to—dare I say it—lawyers and politicians.

That takes me to a further regret, which was put so well by the noble Lord, Lord Allan of Hallam, who, if he is not careful, is going to be competing with his noble friend Lord Paddick for who is the most legally literate non-lawyer. He hit on a very important point that is specific to health services: the litigious possibilities. In relation to the Bill more generally, we have already touched on the dangers of litigation in relation to whether the Secretary of State chooses to make regulations in an area or not. Some people might seek to challenge the making of regulations but, of course, there is also the possibility of judicial review by other groups of the Secretary of State not making regulations. This will come whenever something is effectively delegated to executive discretion. That executive discretion can be subject to judicial review and litigation. Governments of both stripes get annoyed with judicial review, but there it is: it is part of our rule-of-law system in a constitutional democracy.

In addition to that potential for litigation, we then have the negligence lawyers. As the noble Lord, Lord Allan of Hallam, put it so well, we now have oceans of possibility of claims made against particular employers for potentially not issuing these notices in circumstances in which they did not think it was necessary. To be in hospital is to be sick, and there will sometimes be bad outcomes, and we now have this new possibility for litigation about the extent to which issuing or not issuing work notices may have contributed to your loved one’s demise. That needs to be considered.

The Minister was not here during debate on the earlier group, so to help him out I say that he could borrow the script of his noble friend Lord Callanan. In relation to some points, he said, “I can’t explain this point to you because, of course, it is legal advice that I have taken; I’ve taken it very seriously but I can’t tell you what’s in the legal advice.”

When other points were put to the ever-resilient Minister, the noble Lord, Lord Callanan, he said, “The reason why this is in and that is out is a political decision”. It is either legal advice, which he will not comment on, or a political decision as to why these categories are so broad—or why there are six of them and not seven. If we wanted more, he was saying, the Government would give us more, but they would not give us fewer. The point is not about the length of this list of services but about the precision and rationale that went into making these choices.

The noble Baroness, Lady Noakes, says that it is all very well talking about the unions on the one hand and employers on the other, but I think she said that the Government are taking powers for themselves to act on behalf of service users. There are two points there: one is that when we talk about as many people as we are in the context of providers of health services, that is a lot and they are service users and providers at the same time. But the other, which was the crucial element in her remarks, is that the Government are taking powers for themselves. They should not be doing so. If legislation is truly necessary in relation to health services or anybody else, it should be for Parliament to have a Bill before it that is specific enough to provide foreseeability, in accordance with the law, and therefore comply with convention rights.

In the end, I have to hand it to the right reverend Prelate: the issue is about health services being too broad. As my noble friend Lady O’Grady of Upper Holloway asked, will it cover Amazon? I look forward to the answer on that because it would be pretty sweeping and concerning if it did. “Health services” is broad; it is not precise as a concept. My real sadness about health services being attacked in this way is the issue of trust. The Government should be building trust, post pandemic most of all, between people and vital healthcare workers and not undermining it.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

I thank the noble Lord, Lord Collins, and the noble Baroness, Lady O’Grady, for their amendments. I also thank the noble Baroness, Lady Chakrabarti, for her kind words.

Amendments 3 and 4 seek to remove the health sector and health services from being within scope of having minimum service levels implemented. As my noble friend Lord Callanan said earlier, the key sectors outlined in the Bill broadly stem from the 1992 Act, as amended by the Trade Union Act 2016, as they have long been recognised as important for society to function effectively. Strike action in some areas of health services can put lives at risk or cause serious harm to patients. As my noble friend Lady Noakes rightly pointed out, it is about protecting the patients; that is why we have brought this provision. It has the potential for far-reaching consequences for members of the public who are not involved in the dispute. That is why we are looking to include the health services within the legislation.

I will try to answer some of the specific questions from the noble Baroness, Lady O’Grady, the noble Lord, Lord Allan, and others on why we are including health in the minimum service levels. We need to point only to recent experience in the ambulance negotiations, where there were concerns that many trusts were not sure, right up until the night before, whether derogations would be approved. The thinking behind the need for consultation was that we can have that certainty.

At the same time, the nurses’ and the doctors’ unions said, in their recent strikes, that they would not cover A&E. In those circumstances, noble Lords must accept that there was a real possibility of not being able to provide A&E services, which would obviously threaten the lives of patients. That is why we feel the need to put those protections in the minimum service levels. However, the most important thing in all this is that the Bill is just enabling legislation; our sincere hope is that it is never needed.

[Lord Allan of Hallam (LD)]

On the recent actions, the Minister talked about how often discussions went to the wire and agreements were reached the night before. Are there any instances he would share with the Committee in which the cover of the voluntary arrangements actually failed, as opposed to going to the wire but getting there in the end?

[Lord Markham (Con)]

We absolutely try to guard against that possibility and get there in the end. The sincere hope is that none of this is ever needed but, as both the nurses and the unions are saying that they will not provide A&E cover—we are seeing a lot of dates where there might be strike action by more than one union at the same time—I think all noble Lords can see a real possibility that A&E services could not be provided in those circumstances. It is those aspects we are trying to protect here. The hope is very much that it is never needed because the trusts, as has happened to date, will be able to put in place the right voluntary agreements. That is the purpose behind this.

I will try to answer the questions raised by the right reverend Prelate the Bishop of London, the noble Lord, Lord Prentis, and others, about trying to undermine the trust between the hospitals, in this instance, and employees. I go back to the position that it is for the trust to work with local unions to work out what the best level is, in the hope and knowledge that this will probably never be needed. It is just enabling legislation because we can see that there are circumstances, as I mentioned before, where it might be needed.

I will try to answer some other questions. On the point about the treatment of devolved Governments, I go back to the point of it being up to individual trusts.

[Lord Collins of Highbury (Lab)]

Before the Minister moves away from the trust issue and the point made by the right reverend Prelate, does he think that the threat of this law will impact trust and confidence in the current arrangements? Does he sincerely believe that the threat being introduced will not impact that trust?

[Lord Markham (Con)]

I believe that the principles are there in the derogations. Again, I believe no one wants to see any circumstances where there is a threat to life. That is felt uniformly by all of us and everyone in wider society. At the same time, the point I made is that, if you have nurses, doctors and ambulance workers all on strike at the same time and all saying that they are not going to provide A&E cover, we can all see the very real prospect that that is going to be a threat to life and limb. Those are the circumstances that we are talking about.

To answer the question from the noble Baroness, Lady O’Grady, if a trust within a devolved Government does not want to take this up, it does not have to. In exactly the same way, a trust in England does not have to take this up if it does not feel that it is needed, but it is there as a last resort.

To further answer some of the questions on whether that could involve private companies, maybe the best example is the case of the train services. That is obviously a different aspect of this, but in some areas of health we know that we are moving towards a digital world. As the noble Baroness knows, it is something I am personally responsible for. We can see digital services being the backbone of the health service more and more. In some cases, their ability to be there will be vital for the protection of life and limb. These may be unlikely circumstances but, in all honesty, I can see circumstances where that would need to be involved if it meant that there was some risk to life and limb.

[Lord Fox (LD)]

I have not been participating in this group, but I have been for the rest of it. I am intrigued by that answer. I am wondering how a private company would know that it falls within the remit of the Bill. Is the first time it would find out when it is required by the Government to deliver a work order to its employees? Will there be some other form of formal notification that may fall within the ambit of this legislation when it commences?

[Lord Markham (Con)]

I thank the noble Lord. This again relates to consultation. In all of these circumstances, for services that we think could be critical, we would go through the 12-week consultation process, followed by the 12-week implementation period. That is how the private company in this example would know there was a possibility of becoming involved in this, and there would be the consultation process to consider the matter fully.

On whether this is compatible with Article 4, again, we are talking about only circumstances where people potentially going on strike would cause a threat. We have circumstances like that already: the police and the military are not allowed to strike, and it is not considered that that conflicts with Article 4. So I do not think there is a read-across in the same way—

[Lord Collins of Highbury (Lab)]

In the two cases that the noble Lord mentioned, commitments were put in place for both the Army and the police. Does he think that those sorts of commitments should be given to our health service workers, who delivered a lot during the Covid epidemic, as he knows?

[Lord Markham (Con)]

We all agree that they did a huge amount. I do not think that there is a particular difference in circumstances: the principle behind the derogations today is to provide that life cover. That is absolutely there, which is why the hope and the thought is that this legislation might never need to be used. As I said, it is very much a back-pocket thing because, in the circumstances described today, it has managed—

[Baroness Chakrabarti (Lab)]

“Health services” need not be as broad in the Bill. In his gracious response, the Minister talked about the life and death level of risk. If that is the case, why should the provision not be narrowed from “health services” generally, which is incredibly broad—it covers everything from dental hygiene to nutrition advice—and tightened to the life and limb cover he refers to?

[Lord Markham (Con)]

We are talking about the absolute minimum services. As I said, we had the consultation process. Clearly, we would be saying that this is an area where there is a real concern over the risk to life and limb—that would not apply to some of the noble Baroness’s examples—and we would then go into the 12-week consultation period to work through that. The burden will be very much on us to show that that risk to life and limb absolutely is there, because that is that principle behind all of this.

[Lord Collins of Highbury (Lab)]

So is the noble Lord saying that those are the circumstances in which the powers in the Bill would be introduced? If so, can he explain passenger transport to me?

--- Later in debate ---

[Lord Markham (Con)]

I am well versed only in the area of health, and I will defer to my noble friend to deal later with that. I am replying specifically on health.

[Lord Fox (LD)]

The Minister needs to understand that we are taking the whole Bill in this Committee, not just the health part—we are thankful that he has come to speak to that part. But we are trying to understand how we have train services at one end and resuscitating people on the verge of death at the other, and we are trying to find a common legal structure that fits them all. Does the Minister agree that there is a big difference between the minimum service level on a commuter line from Croydon and the minimum service level in an accident and emergency hospital? Can he explain how we are supposed to square those two issues within the framework of this legislation?

[Lord Markham (Con)]

I thank the noble Lord. I believe that there will be a group of amendments specifically on transport later on. That will be the opportunity to answer those questions. I have been drafted in—dare I say it—at the last moment, because it is a very important issue and I wanted personally to talk about the health aspects, which I am attempting to do, so please forgive me if I try not to stray into other areas. There will be the opportunity to discuss transport later on.

The noble Lord, Lord Allan, asked who wants this. It is a backstop power. Trusts will never need to use it if they do not want to. I believe that most trusts, and I hope all, have excellent relations and are able to make sure that these provisions are never used or needed.

[Lord Allan of Hallam (LD)]

It is helpful having the Minister here—we appreciate it—because he will be responsible for those health trusts. I am cautious about the notion that it is a backstop power. It is something that the Minister repeats often, but is he concerned that there will be pressure either for the legal reasons that the noble Baroness, Lady Chakrabarti, and I have outlined—that there will be judicial processes that force trusts to think that they have to impose a minimum service level whether or not they want to—or just political pressure? The Government have brought this legislation in. If trusts say, “Look, we don’t want to impose this, because we think it is bad for our area”, are Ministers really going to sit back and say, “Fine, we’re not going to bother”?

[Lord Markham (Con)]

As I answered earlier on the devolved Governments, by definition, we accept that different trusts have the ability to work out what is best for their own area. Clearly, devolved Governments will each have their own opinion on how they want to act. The same principle exists in each place. We are not saying to each trust, “Thou shalt enact it in this way”; we are just giving those backstop powers. The most important thing here, which I think we all agree on, is for there to be the ability in all circumstances to protect life and limb. If doctors, nurses and ambulance crews all go on strike at the same time and say as part of that that they do not want to provide A&E cover, that is a circumstance where we are not able to provide those minimum services. I think that most fair-minded people would conclude that there is a risk to life and limb in that case.

The points made about civil claims—I know that they are very much the concern of the noble Lords, Lord Kakkar and Lord Patel—will be addressed in considering later amendments.

[Lord Thomas of Cwmgiedd (CB)]

I want to take up the Minister’s point in relation to devolved Governments and health services. As I understand him, assuming the Bill goes through and the Secretary of State for Health decides that there is to be a minimum service level, that does not compel the Governments in Scotland and Wales to adopt it; it is completely voluntary for them, just as it is for trusts. Have I understood the Minister correctly? If neither trusts nor the devolved Governments are in any way bound to impose this, it seems to me a matter of such importance that it ought to be dealt with by specific provision in the Bill. Otherwise, one will have problems for the future. The last thing we want ever to do is to have to rely in any actions that follow on an assurance given in this House—not that I am doubting it for a moment; it is just a question of clarifying how this works. It is a matter of such importance that it must be clarified. The Bill can easily be amended to make it clear, both in respect of devolved Governments and of health trusts, that these are the standards set but the devolved Governments do not have to impose them.

[Lord Markham (Con)]

Again, my understanding is that there will be later groups of amendments where we will talk specifically about the devolved Governments, so there will be further opportunities then to discuss this matter. However, on the principle the noble and learned Lord raises, we are setting down, in consultation, what we think the minimum service levels need to be to protect life and limb in these circumstances. In the case of ambulances, which was mentioned, that covers the ability to answer 999 calls, to categorise whether it is a category 1 or category 2 call—by the way, we are not seeking to change the definitions of category 1 and category 2—and to ensure that those calls can be answered, because they are life-threatening circumstances. To enact that, it is up to the employer—in this case, the trust—to work with local unions to ensure that it is in place, and how trusts decide to do that is up to them. It would be fantastic if they never needed to refer to that, but we, the Government, want to protect these circumstances so that we will not have occasions when A&Es are unable to operate.

[Lord Thomas of Cwmgiedd (CB)]

It may be that we need to go into this matter in some more detail, but what concerns me is this: I do not really know the detail of health law but let us assume that trusts are under a legal duty to carry, and to provide for, hospital services. So I assume that the Minister is saying that, as this goes forward, there will no comeback from the Government on a failure to exercise a legal duty to follow that, if they decide, “No we don’t want to impose this”. There will be no comeback, because it will be up to them.

This becomes very important when one turns to the liability of trade unions, because if a liability is imposed on the health trust for failing to comply with minimum standards, and it does not do so for various reasons, is there any consequential liability to the trade unions? This is quite a difficult and important subject, but for the devolved Governments, and, in this case, for health trusts, it is critical to know to what extent they are bound, when they take a different judgement on how to deal with the strike, to follow the minimum standards established by the Government. It is a critical question, and I do not want to be unfair to the Minister by making an intervention.

[Lord Markham (Con)]

I thank the noble and learned Lord for his comments. As I have said, in these circumstances we are talking about putting in place those minimum service levels for the trust to be armed with and to be able to enact. We are not trying to put in place any legal framework that we can use to go back and sue the trust for not holding to it, and we are not trying to put legal obligations on the trust to do it. Instead, we are trying to give an enabling ability, to be used only, as I said, as a backstop in these circumstances, and with the hope that they will never need to take that forward.

[Baroness Chakrabarti (Lab)]

I appreciate that the framework of the Bill as a whole is not the Minister’s responsibility; he is in Committee to talk about health services in particular. So I will ask him a question specifically on health services. Given his very clear answers that he anticipates the life and limb health provision being a matter only for the Bill, would it not be wise, advisable and appropriate for the reference to “health services” in the Bill to be tightened, so that it is clear that the regulation-making power is only about the life and limb provision he has talked about so extensively and explicitly?

[Lord Markham (Con)]

Again, I believe that it is trying to work off the 1992 definitions and work. The beauty of these debates, as I have come to appreciate about the House of Lords and the job that it does, even in the short time that I have been involved, is that they make sure, through this good critical challenge, that we can ensure that the legislation is doing exactly what we want it to do. We need to make sure that we get those definitions correct and, clearly, the beauty of where we are at this stage is that we have that ability. I thank noble Lords for that, and I hope that they can see by my responses that this is something that I want to make sure we get right.

I am glancing through the remaining questions—but I hope that I have answered the substance of the questions.

[Lord Allan of Hallam (LD)]

I appreciate the Minister taking so many interventions. On the question of whether the Government have done any modelling, when they did their analysis of the legislation, was any modelling done to try to understand the potential impact on legal liability, civil claims and claims against the NHS for compensation? It would be helpful for us to have that information, because it will be a material factor as to whether a trust, as the Bill says “may” issue work orders; it says “may” rather than “shall”. Whether the trust feels that it can exercise that discretion will depend very much on whether it is incurring additional legal risk. If there is material on that, it would be helpful for us to have it as we go through the scrutiny process.

--- Later in debate ---

[Lord Markham (Con)]

First, yes, that has been worked through on this. Secondly, that is one of the purposes of the consultation. Thirdly—this is the point that I was about to make—as the noble Lord will know from my contributions, I always like to follow up in writing when there is a detailed question. If I have missed anything or the opportunity to make more thorough points, I shall take the opportunity to do so.

I hope that I have given a good sense of direction of where we are coming from on this and why we feel that this provision is essential in these circumstances to protect the patients.

[Lord Hendy (Lab)]

I am very grateful to the Minister for spelling out the criterion for minimum service levels in the health sector, which is life and limb. Can I explore that a bit further? Life and limb would obviously have applicability to A&E and, clearly, to the ambulance service. Is not the implication that that means 100% service for the ambulance service? I cannot see how ambulance staff are going to know, until they get a call, whether it is a life and limb situation or simply somebody who has fallen, is uninjured but needs helping up—or whatever the situation might be. Can the Minister assist me on that?

[Lord Markham (Con)]

Yes, that is very much what happens at the moment, so that is the categorisation process that is entered into—and, from that, they categorise whether it is category 1, 2, 3 or 4, and the response will depend on that.

[Lord Hendy (Lab)]

My Lords—

[Lord Markham (Con)]

I shall just finish and get the point out, and then happily hear the noble Lord’s follow-up question. In these circumstances, we are saying that it is around category 1 and 2, where we really believe that there are those life-threatening circumstances.

[Lord Hendy (Lab)]

That is absolutely understood—but is not the implication that the ambulance crews have to be in the ambulances? They cannot be standing on a picket line; they have to be in the ambulances to receive the calls. It is only when they receive the call that they are going to know whether it is category 1, 2 or 3, or whatever the specification is. Surely it follows that 100% service must be provided by the control room and the ambulance service—or have I got it wrong?

[Lord Markham (Con)]

As I say, we have some good experience, because of course this is exactly what is currently happening. What is agreed between the local trusts and the unions in those circumstances is something along the lines that 50% of calls—that is my figure as an example, and please do not take it as read—are category 1 and 2. The others are not in that category, so because of that we would look for a level of workforce to cover that level of calls. Please do not take the 50% as read; I am just taking that as an example, so that the noble Lord understands the principle behind this.

[Lord Hendy (Lab)]

I am so sorry to intervene again; this is absolutely my last intervention. If the criterion is life and limb then many of the categories listed by my noble friends Lord Collins and Lady O’Grady—community health services, pharmacists, mental health services, sexual health services and so on—can have no fear that there will be minimum service levels prescribed for them, because they are never in a life and limb situation.

[Lord Markham (Con)]

Correct. I emphasise once more the process set out here: if it were decided that there was that threat, that is the point at which we would go into consultation. That is the thinking behind the process. We would have to believe that in such an area there would be a threat to life and limb, and would then go into consultation on minimum service levels. I hope that this has been helpful. It has been helpful to me as well, as ever, to see the value of the Lords. I am a big believer in critical challenge.

[Lord Fox (LD)]

The Minister will get plenty of that here.

[Lord Markham (Con)]

The noble Lord never disappoints me. I always say, from my business life, that two plus two equals five. Whenever you try to develop a new service or product, you need critical challenge along the way; you take points on board and you add to it, and you end up with a better product. I thank noble Lords sincerely, and I think they know me well enough to know that I will continue to take their input as we go through this process. I hope there is an understanding by noble Lords that we are trying to strike a reasonable balance here between the right to strike and the right to protection of life and limb, and that, in those circumstances, we cannot support these amendments.

[Baroness O’Grady of Upper Holloway (Lab)]

I thank the Health Minister for that reply, especially given that, as he said, he was drafted in at the last minute. I thank him also for his sentiment that he sincerely hopes that the provisions in the Bill will never need to be used.

I must share with the Minister my sincere hope that the NHS will be properly funded and staffed, and that its staff will be fairly rewarded so that they will never need to vote for strike action. However, the truth is that I cannot rely on that, which is why the human rights that have been spoken about are so important. I feel very strongly that the human rights of workers should not be treated as somehow second-class or requiring less scrutiny and parliamentary accountability; they are fundamental to millions of people’s working lives. In the health service, as we have heard, this is going to continue to be a big issue for us to address.

What I did not hear was an adequate answer to the real-world consequences of the Bill on the morale of NHS staff and on the industrial relations situation in the NHS. The Minister will know how burned-out, demoralised and concerned many staff are. This is not a luxury option; it is absolutely core to how people feel they are being treated, whether they are being respected and whether their professionalism is being respected. They are dedicated to the service and any suggestion that they are not is felt to be deeply insulting. I know the Minister understands how important that is.

It is not just unions saying it. As we have heard, the employers have said that they do not want the Bill, and I hope the Government will listen to them too. By the way, there is a third part of the equation, which is service users. As I have already said, we have seen that two-thirds of the public support the nurses and ambulance workers on strike. They understand that those staff are defending the service, as much as themselves, against real cuts in pay.