Agenda for Change: NHS Pay Restraint

Jim Cunningham Excerpts

Monday 30th January 2017 Westminster Hall

[Mark Durkan (Foyle) (SDLP)]

It is a pleasure to serve under your chairmanship, Mr Evans. It is a particular pleasure to follow the excellent contribution from the hon. Member for Newcastle upon Tyne North (Catherine McKinnell). She set out the compelling case for why the pay regime for nurses, midwives and associated health service professionals across our health services is becoming increasingly exploitative.

The hon. Lady spoke of the particular experience in England; I obviously speak from the experience of Northern Ireland. Unfortunately, the Administration in Northern Ireland have chosen to void the clear recommendations from an independent pay review body, as in England, and have not taken the more constructive approach followed in Scotland to pay recommendations and to meeting the proper pay needs and aspirations of hardworking professional staff. As other hon. Members have said, those staff provide such a valuable service day in, day out. They work long hours with huge responsibilities, but with less and less of a sense of reward and with ever more inadequate remuneration.

We now have the situation in which many things have been brought forward. People were promised that Agenda for Change would ensure greater equity and transparency on pay, that they would see salary paths improving naturally—with more than just token increments—and that it would reward people’s sense of vocation. Of course, it does nothing of the sort, because people have found themselves locked into highly contested bands. Certainly in Northern Ireland, people doing the exact same work in different trusts are paid differently, which is causing huge frustration and a grave sense of grievance and injustice for many people.

The health and social care system in Northern Ireland is supposed to be operating increasingly as a single employer, with the commissioning role of Health and Social Care Board moving to the Department and the Minister. However, we have the bizarre situation in which people who are doing the same job and delivering on the same targets set by Ministers and the Executive are supposedly employed by different trusts and are paid differently—not because their working terms are different, but because the terminology on their contracts might be different here or there. The slightest difference in terminology in job descriptions is being used to keep people in lower pay bands than their counterparts in a neighbouring trust who are doing the exact same job. Of course, not being able to address those issues absolutely suffocates people with frustration.

This has happened in the context of those staff being locked into the 1% pay rise cap that has endured for a number of years. It is one thing to ask people to take a pay freeze in the name of austerity and managing public financial pressures for a year or two, but it is another to be locked into such a pay freeze while seeing other people, including on the public sector payroll, being able to escape those constraints. Again, it adds to the sense of injustice.

[Mr Jim Cunningham (Coventry South) (Lab)]

On the pay freeze, over the past five or six years it has worked out to roughly the equivalent of between a 6% and 8% wage cut. That is the reality that those people face. The Government say they value people in the health service, but the only way to demonstrate that is through their wage packets at the end of the day. The other issue, which will certainly affect mature students who want to be either a nurse or a midwife, is that the education maintenance grant has also been cut. So much for valuing people who work in the national health service.

[Mark Durkan]

I agree with all of the hon. Gentleman’s points; they touch on points made in interventions by other hon. Members. Let us be clear: the long-standing freeze is, in essence, a long-term pay cut in real terms. People are left feeling frustrated and aggrieved by that. People are leaving the profession; they feel they are being driven out—we heard references to the number of people who are switching to agency roles, but many people do not want to do that, and their sense of vocation is being exploited in a way that now probably more than borders on the cynical. A better response is needed.

I have made points particularly on Northern Ireland. On Agenda for Change, we know, as other hon. Members have mentioned, that pay in the lower bands actually falls below living wage standards. One appalling vista—which will bite this year in Northern Ireland, where these adjustments are being made—is that the money for that 1% pay rise will be used to bring people in the lower wage bands up to the living wage. In other words, if the 1% envelope is to be used to cover that, other people will lose out; there will be a trade-off between nurses and health service professionals in different grades, with that 1% being prioritised towards bringing people up to the living wage. Nobody should be asked to endure inadequacy as the price of affording a micro-concession to equality for those who are locked into the lower bands that pay below the living wage. That is going to bite in Northern Ireland this year.

It should not, because as part of the Stormont House agreement and other things, Northern Ireland has a voluntary exit scheme that was meant to reduce the cost of the public service payroll. If that overall voluntary exit scheme saves money on the public service payroll, my party made the point that, rather than those savings being used to pay for a cut in corporation tax in future years, they should be used for restorative pay measures—starting first in the national health service for those staff who have suffered as a result of freezes and who are stuck on inadequate and unfair pay bands under Agenda for Change. Their case could be met because public sector payroll savings are on the way.

Health service staff in Northern Ireland will be asked to manage yet more change. People already work long hours in heavy-demand services, but more structural changes will be made to health services following the Bengoa review and others. If people are being asked to manage all of those changes and keep those services going during those transitions, the one thing they are entitled to is some long overdue consideration of the inadequate pay they have been asked to endure.

--- Later in debate ---

[Andy Burnham]

I am glad to hear the intervention of the former Minister, whom I worked well with in the previous Parliament. I want to take this opportunity to say that he did listen on regional pay. We made an argument about that issue, backed up by the RCN and others, and, to be fair, it did not go any further than the experiment in the south-west. I give credit to him for that. I also give credit to him for consistently showing a real regard for the pressures faced on the frontline.

The hon. Gentleman makes an important point that the Minister would do well to reflect on. There is a huge false economy here. It makes sense to have fairness in terms of headline pay for staff, to maintain good will, but on top of that, it makes sense to provide them with incentives to give any additional shifts or time to the in-house bank, rather than private staffing agencies. The Government have lost sight of that in recent times.

[Mr Jim Cunningham]

My right hon. Friend makes an interesting point. It can be a false economy to rely on agencies to staff hospitals, whether it be nurses or doctors. At the end of the day, training suffers. That makes it difficult for the NHS to recruit, so it is a false economy in a number of ways.

[Andy Burnham]

It is not only a false economy; it directly damages the quality of patient care. When people arrive on the ward who do not know the team or the environment and have to be told everything, it builds in confusion and delays because staff have to take them through things. It does not make sense to use private staffing agencies to the extent that they are being used in the NHS. The cost is exorbitant—that is No. 1—but it also damages morale, because it leads to staff in the permanent employ of the trust working on the ward alongside people who are being paid significantly more than them for the same shift, despite having just arrived on that ward. That does not build a sense of team on the ward; it builds a sense of resentment.