Strikes (Minimum Service Levels: NHS Ambulance Services and the NHS Patient Transport Service) Regulations 2023

Lord Prentis of Leeds Excerpts

Wednesday 6th December 2023 Lords Chamber

[Lord Woodley (Lab)]

My Lords, I declare an interest as a former leader of Unite the Union, which represents ambulance workers and other NHS staff up and down our country. My noble friend Lady Merron has powerfully laid out the arguments against the draconian regulations we are considering today. I will emphasise three points in the short time that I have now.

First, these regulations are entirely unnecessary. Trade unions already agree life and limb cover during strike action—noble Lords know that. These arrangements work well, giving confidence and flexibility if workers are needed to leave the picket line to respond to emergencies. We have always done that. Central to the NHS disputes over the past year are the unsafe staffing levels due to poor pay and retention. Why are the Government so keen on minimum staffing levels on strike days but do not care what happens when staff are not striking?

Secondly, these regulations will simply poison industrial relations between employers and workers, as all the impact assessments have shown us. When you deprive somebody of their ability to strike after a ballot, how can you be surprised when this causes widespread anger and resentment? Without being able to take effective strike action, workers will of course seek new ways to put pressure on employers, including work to rule and overtime bans. With all good faith gone, disputes will drag on and become even more bitter. Forcing workers to cross their own picket lines, with unions made to take so-called reasonable steps to enforce this, is undoubtedly a recipe for disaster. Mark my words: when the first worker is sacked for refusing to cross their picket line, there will be a major escalation of industrial action. Is that what the Government really want?

Finally, these measures are just the latest in a long line of union-busting legislation from this Government. It is a disgrace that they continue to attack workers’ rights when they promised an employment Bill to make Britain the best place to work in Europe. Instead, they are trying again to repeal the ban on using agency staff to break strikes, despite the High Court ruling that said it was unfair, unlawful and irrational.

In this place, we are privileged to be able to hold the Government to account and to help protect people from greed and exploitation. I urge noble Lords to stand up for the hard-pressed workers of this country, already suffering from a cost of living catastrophe not of their making, and to vote down these vindictive, destructive and, above all, counterproductive measures.

[Lord Prentis of Leeds (Lab)]

My Lords, I speak in support of the amendment put forward by the noble Baroness, Lady Merron. As recently as 20 July this year, this House debated a report from our Public Services Committee, very aptly entitled Emergency Healthcare: A National Emergency. The report found the emergency healthcare workforce to be under unprecedented strain, facing significant challenges and shortages, low job satisfaction and retention rates. Ambulance staff were described as overwhelmed, fatigued and depleted. Many stated that they were suffering from work-related stress, covering for 3,000 job vacancies in the ambulance service alone.

The report concluded:

“Without concerted action to address the emergency in the system”,


many of the emergency healthcare workforce

“will leave the health service”.

The report is reinforced by the Government’s own delivery plan for recovering emergency services, also published this year. The government plan states that this is the

“most testing time in NHS history”,

which is, in its words, taking its

“toll on staff, who … work in an increasingly tough environment”.

Our ambulance services are struggling to cope. If we are to restore service to the levels that we all want, never in the history of our NHS has partnership, which has thrived in our health service for more than 75 years, been more important. The Government, employers and unions should be working together to pick the emergency healthcare workforce off the ground and to improve ways of working and service delivery for the benefit of patients.

National Health Service: 75th Anniversary

Lord Prentis of Leeds Excerpts

Thursday 30th November 2023 Lords Chamber

[Lord Prentis of Leeds (Lab)]

My Lords, 2023 is the year we celebrate 75 years of our National Health Service, and what is crystal clear, above anything, is the continuing strength of people’s attachment to our NHS. The vast majority of people—nine out of 10—believe that the NHS should remain free at the point of delivery, while eight out of 10 continue to believe that the NHS should be funded through taxation. This support extends across all political parties, across leave and remain voters, and across all age groups—and for me, personally. Twenty years ago, like millions before and after me, our NHS saved my life, and for that I will always be grateful. The health service is still there for all of us, 75 years on, from cradle to grave.

How did it come to be that the waiting list for treatment will exceed 8 million by December 2024? How did it come to be that the number of patients waiting for treatment and suffering real harm could double in three years to 7,900? We need to look no further than the recent OECD Health at a Glance 2023 report, whose international comparisons showed that the UK has among the lowest average growth in per capita health expenditure. We need look no further than the Care Quality Commission’s own works warning of the dangers of longer waits and reduced access, especially in maternity, ambulance and mental health, as already referred to.

We need look no further than this House’s own investigation earlier this year. The report was called Emergency Healthcare: a National Emergency. Emergency healthcare is facing a crisis. To quote from our report:

“Patients are delayed at every stage of trying to access emergency healthcare … Stories of ambulances being stuck outside of hospitals”,


which is “posing an unacceptable risk”. The impact on the workforce, according to the same report, is that there are

“significant challenges, including shortages, low job satisfaction and retention rates, and poor health”.

Ambulance staff were described as “overwhelmed … fatigued and depleted”. Our NHS is under unprecedented strain and our own House of Lords report drew attention to the 133,000 vacant posts in the NHS and the 91,000 vacancies in acute social care.

Anyone who uses NHS services knows that they are only as good as the staff who are treating them. These are workers who were on the front line during the long months of the Covid crisis. Many left—exhausted and shell-shocked by what they went through. If our NHS is struggling with the huge gaps in staffing and is struggling to motivate those who remain, our NHS will always struggle to deliver the quality of care that it wants to.

However, there is some good news on the horizon. The NHS Long Term Workforce Plan has finally, after many years, been published. Much of the plan is positive, particularly the focus on boosting the use of apprenticeships. But even this plan was massively delayed. Now, the challenge of providing a thriving and sustainable NHS workforce for the future has become even greater.

The biggest problem with the plan, as with so much of healthcare policy, is a continuing failure to provide any solution to the deteriorating situation in social care. The state of social care is appalling, with the number of vacancies now reaching 152,000 in England alone. It is a service kept alive by the use of migrant labourers, who legally can be paid 20% less than the existing workforce. There is now growing evidence of widespread exploitation of migrant staff in the social care sector. There is growing evidence of care workers from overseas having money deducted from their wages to cover dubious fees, facing demands to repay thousands of pounds when they try to move jobs and being forced to pay extortionate rents for sub-standard accommodation. It is an adult social care service that is not fit for purpose and is causing gridlock at the interface with the National Health Service.

As the Government have prevaricated and delayed, so the sector has moved further into crisis. There are questions that must be answered. We have a long-term workforce plan for the NHS, but why is there no corresponding social care strategy? We have a successful NHS social partnership forum, but why is there not one for adult social care? Why are the Government willing to participate in the NHS forum but stand aloof—conspicuous by their absence—from a social care forum?

What is needed more than anything is ambition and a proper overhaul of the adult social care system. In short, we need the introduction of the national care service that we on this side of the House are calling for. The vision that led to the creation of our NHS is as valid today as it was in 1948. Today, it treats 1.3 million people per day. It is productive, despite little investment in capital works. It gives value for money, but, as demand increases, so do the pressures. Innovation is vital—that goes without saying—but so is the NHS long-term workforce plan. NHS England believes it could mean an extra 60,000 doctors, 170,000 nurses and 71,000 more allied health professionals by 2036.

Such a transformation will be achieved only if the Government of the day have the ambition to see the plan as their priority and provide the resources needed. The vision that underpinned our NHS has stood the test of time. We have all benefited from the courage of those involved in 1948. It is our duty now to ensure that our NHS continues to evolve so that it is there for future generations. Like everybody, I would like to quote from Aneurin Bevan. My favourite quote has nothing at all to do with the NHS, but Nye Bevan said this, and I have always used it as a way forward: “If you walk down the middle of the road, you get run over”.

Social Care

Lord Prentis of Leeds Excerpts

Thursday 30th March 2023 Lords Chamber

[Lord Prentis of Leeds (Lab)]

My Lords, I declare an interest: I was the general secretary of Unison, the public service union, which represents over half a million health and social care workers—members who worked throughout the pandemic.

As we have heard today, despite all the inquiries, reports and initiatives, no matter what the Government may say, social care has not been fixed—far from it. As we have also heard today, it is quite simply broken. This has been said not just in this Chamber. The King’s Fund states that there is no credible programme to address the issues and that the workforce is in crisis. The social care ombudsman highlights an underresourced system, unable to consistently meet the needs of those whom it is designed to serve. The Care Quality Commission, the independent regulator, despite its own workforce challenges, states that the workforce crisis in adult social care needs to be addressed urgently.

I do not detract from the issues involved in kinship care and unpaid care, which have to be addressed as a matter of urgency, but there is also consensus across social care that nothing can be achieved in the sector until the workforce crisis is addressed. A third of staff leave every year. There are over 165,000 vacancies—more than in the NHS. Vacancy rates are at over 10% and are growing by the day. Many staff are on zero-hours contracts and many have no sick pay arrangements. Many people who work in domiciliary care are not even paid travelling time between visits to people in their care, meaning that they earn less than the minimum wage. There is alarming exploitation of migrant workers, with repayment clauses tying them to their jobs and employers. This is done throughout social care.

A small number of councils do show the way, agreeing ethical care charters with their providers and unions that cover training, pay rates and standards of care. A small number are sharing best practice. But these councils are few and far between. In too many areas, career development and progression are simply non-existent. The pay differential between a new starter and an experienced, long-serving member of staff in social care has been squeezed down to a measly 7p an hour. This feeds the increasingly high turnover rate of staff and reinforces the image of care work as a low-skilled, unregulated profession.

Astonishingly, despite the massive problems, the social care sector has no workforce plan and the Government lack ambition to deal with the crisis in care. What is needed more than anything is a Government committed to a national care service. Call it what you want, but we are crying out for a national care service, with a Government who recognise the beneficial impact that social care could have on the economy. It would boost the independence of those who receive care and allow more women who deliver the bulk of unpaid care to play a larger and more active role in our economy.

We need to raise the status of the care sector in our society, with a new deal for care workers, making social care an attractive sector to work in. Caring for the future is an integral part of any industrial society moving forward, and something that is long overdue. We need a Government who will ensure that no private equity firm is able to profit from running care homes where they are failing residents and underpaying staff. We need a Government who care for carers; a new Government who will boost the status of social care, making it the profession it really should be—one that people want to work in. We need a new Government who will change the perception of social care from being merely a drain on resources and make it a crucial component of the drive to boost economic growth. That is where the future of social care should lie. It is a massive challenge to all of us, but one that we have a duty to tackle together.