Strikes (Minimum Service Levels) Bill

Baroness Watkins of Tavistock Excerpts

Committee stage
Thursday 9th March 2023 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I support Amendment 18 in the name of my noble friend Lord Patel. I remind noble Lords of my registered interests; in particular, that I am a practising clinician. The amendment, and my noble friend’s introduction to it, clearly lay out an important point about the consequences with regard to practice on non-strike days if a minimum level of staffing is defined for clinical areas on strike days. It is possible that, on non-strike days, staffing levels will fall below the minimum defined for a strike day. Under those circumstances, would it be appropriate for the healthcare organisation in question to continue to deliver service in that clinical area where the minimum service or staffing level defined for a strike day has been breached?

What would be the consequences for a clinician—a regulated healthcare professional—offering to work and participate in the delivery of clinical care in a clinical environment whose staffing would, on a strike day, be considered to have fallen below a safe level? What would be the consequence for a regulated healthcare organisation of continuing to promote the delivery of care, on a non-strike day, in an area that it would consider unsafe on a strike day if the staffing level were below that defined? For instance, what view have the professional and system regulators taken of this potential situation?

Would there then be a greater risk for potential litigation associated with the delivery of care in a clinical area that had failed to provide, on a non-strike day, staffing levels that were considered the minimum level to be provided on a strike day? Would that have a chilling effect on the capacity or willingness of clinicians and healthcare professionals to participate in the delivery of care under those circumstances? These are important issues that need to be explored in some detail to ensure that they are not unintended consequences of proceeding with an approach that secures patient safety on strike days but, unfortunately, fails to have determined that appropriate protection of patient safety on non-strike days.

[Baroness Watkins of Tavistock (CB)]

My Lords, I support the amendment in the names of my noble friends Lord Patel and Lord Kakkar, and I agree with everything they said. I return to the issue of life and limb. We need to recognise that we have people in hospitals and care homes who, if they did not receive compassionate care, would be left in unclean beds, would not be fed and would not receive what we think of as ordinary, everyday care. Therefore, the whole issue of what minimum levels should be needs to be thought about really carefully. It needs to be thought about outside the opportunities of strikes and in terms of ordinary, everyday care.

I am worried that, without the amendment proposed, it is possible that we would have safer, or better, care on strike days than on non-strike days. I am also worried that, unless we tackle the workforce shortage, which has driven staff to their current level of discontent in health and care, we will continue to have problems. This is not just about people striking for an increase in salary; it is about people’s real concern about being unable to deliver the service they wish to deliver.

[The Lord Bishop of London]

My Lords, I shall speak to Amendment 18 in the names of the noble Lords, Lord Patel and Lord Kakkar, and add my voice to many of the points already raised. I thank the Minister for being much more specific around health. I hope that we can define it much more clearly, rather than having that very broad category, as well as the issue around life and limb.

I remind the Government that, in this Chamber, they have resisted introducing legislation for minimum staffing levels on a number of occasions. It seems incredible that they now want to put in levels of minimum service, which clearly require minimum staffing levels, but are willing to do it only on strike days.

As I indicated earlier, this amendment goes to the heart of one of the key issues with the Bill; namely, that people in the health service who strike do so partly because safe staffing levels are not in place on non-strike days. We have already heard that the healthcare system is under huge pressure, trying to provide quality care with fewer staff, and there are workforce problems. The most recent statistic I have shows that there are 124,000 vacancies across the NHS—that is 13,000 more than this time last year. The Royal College of Nursing published a survey in May 2022 showing that only 25% of shifts have the planned number of registered nurses and 83% of respondents said that there were not enough nursing staff to meet all patient needs safely and effectively on their most recent shift.

Staff on non-strike days are thinly stretched and cannot provide the level of care that they would want to, which puts huge pressure on their health and well-being. The distress that they experience is causing an increase in illness to them. Reporting on the past year, the Healthcare Safety Investigation Branch noted that the additional pressure that staff were under was causing sickness. As a new student nurse put it, “I no longer want the career as it is. The reality feels as though I must sacrifice my own health and well-being for less than satisfactory pay.”

The notion that the Government could legislate to require minimum service levels in healthcare settings, which are already committed to safe strikes, while there is a lack of investment and workforce planning—which is the reason for the action—is unfathomable. I would welcome the Government legislating to ensure appropriate staffing levels on non-strike days that are greater than the strike day cover. That would be welcomed by nurses, because it would mean more resources and more workforce planning than the health service has seen for years. It would also resolve one of the reasons why nurses are taking strike action. I have spoken about trust, as have a number of noble Lords. Accepting this amendment would go some way towards to rebuilding the trust that has been eroded, and will be eroded further by this Bill.

Amendment 13 in the name of the noble Lord, Lord Fox, seeks to make a similar point but through a different route. Along with my right reverend friend the Bishop of Manchester, who is unable to be here, I express my support for that amendment as well.