NHS Pay

Justin Madders Excerpts

Wednesday 24th March 2021 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to see you in the Chair, Mr Hosie. I thank my hon. Friend the Member for Liverpool, Wavertree (Paula Barker) for securing this important and heavily subscribed debate today. She gave an excellent, impassioned introduction. She summed the issue up very well when she said that NHS staff are being asked to do more for less. That really does sum up the Government’s approach to a lot of things: more for less.

I thank all other hon. Members for their contributions today. There are too many to mention individually, but I will pick out one or two during my speech. I particularly thank my hon. Friends the Members for Luton South (Rachel Hopkins) and for Birkenhead (Mick Whitley) for co-sponsoring the debate.

Every Member spoke with great passion, sincerity and knowledge about why the Government’s approach to the NHS pay deal is flawed. It is disrespectful and ultimately self-defeating. Members who spoke showed clear support for and appreciation of the NHS workforce. Every single Member had that in common. They also have in common that they are all from Opposition parties. Not one Back-Bench Tory MP has come today to defend their party’s policy—not one. Worse still, not one has come to defend the NHS workforce. That says it all, doesn’t it?

I am sure we all agree, certainly among Opposition Members, that our amazing NHS staff have been the ones who have kept this country going during the pandemic, who have kept us safe and who have looked after our loved ones. They have been on the frontline looking after not just the 450,000-plus people who have been hospitalised with coronavirus, but everyone else who has needed medical attention, while at the same time putting their own lives on the line. Our NHS staff are feeling the strain. Do not forget that we entered the pandemic with a record 100,000 vacancies in the NHS, and with a health workforce smaller than many other countries, meaning that our NHS staff have worked longer and harder than others during the covid crisis.

For many people, the added pressure has had a profound impact on their psychological wellbeing. Almost half of NHS staff in England have reported feeling unwell from work-related stress—the highest rate recorded in the past five years—and NHS staff took 3.5 million sick days off between March and October last year due to mental health issues. The latest figures from the NHS staff survey, published this month, show that 300,000 staff have worked unpaid hours, and that almost 13,000 more staff reported working unpaid overtime compared with 2019, suggesting that over 1 million hours of unpaid overtime have been worked during this pandemic. It is little wonder that NHS staff are exhausted and that they are leaving.

My hon. Friend the Member for Liverpool, Wavertree made a strong case that pay increases can have a positive effect on retention levels, which is something that urgently needs addressing. The Minister will know all about the shocking number of healthcare staff who have left their NHS roles for better pay conditions and work-life balance in recent years, because she has seen the data—it is the Government’s own data that say this. She will be well aware that over the last year, 31,000 nurses and health visitors left the NHS—an increase of 50% since 2010-11.

[Jamie Stone]

Will the hon. Gentleman give way?

[Justin Madders]

I am sorry, but I will not have time to take any interventions.

The Minister will know that since 2010-11, there has been a 181% increase in nurses and health visitors resigning due to their work-life balance, and an 82% increase in the number leaving for health reasons. She will be aware that there has been a 57% increase in resignations since that time because people found a better reward package elsewhere.

Years of pay freezes, record vacancies and relentless pressure have had a devastating effect on our NHS workforce. Not surprisingly, as a last resort, hard-pressed staff are voting with their feet. That should ring alarm bells loud and clear that Ministers are not getting things right, that they need to change course and that they need to start listening to the NHS workforce. It is simply unacceptable that instead of giving our NHS staff the pay rise that they were promised, the Government are recommending that they should receive just 1% this year, an amount that the Government are fully aware is actually a real-terms pay cut. NHS staff are not being properly rewarded, as the Secretary of State said they would be. That is not what is set out in the legislation passed by this House, which the Government voted for in the NHS long-term plan.

As the Minister knows, the plan set out a 2.1% pay increase for all NHS staff. The head of NHS England, Sir Simon Stevens, has confirmed that the NHS did indeed budget for that 2.1% pay rise, so the Government have broken their promise. The Office for Budget Responsibility forecasts that inflation will rise by 1.5% this year, so instead of a pay rise that was budgeted for and indeed voted for, NHS staff will see a real-term pay cut of hundreds of pounds. Experienced nurses will see a paltry £3.50 per week extra in their pay packet, which is just 50p a day. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) told of a healthcare worker who will get 9p an hour extra.

Counting for inflation since the Conservative party took power in 2010, some NHS workers have seen their pay slashed by thousands of pounds a year. The starting salary for nurses, physiotherapists, radiographers and numerous other NHS roles has seen a real-terms pay cut of £841 per year, and average salaries have reduced in real terms by around £2,379. That is not being properly rewarded; it is not being rewarded at all. It is not good enough for those who have performed heroically over the last year to be rewarded in this way. For many, a real-terms pay cut will be the last straw. My hon. Friend the Member for Sheffield, Hallam (Olivia Blake) made the point that we are in an international market for healthcare staff and cannot afford to be complacent in such matters.

It could not be clearer that we need investment in our workforce. Waiting lists have spiralled out of control, and we will need the staff more than ever. The Government urgently need to reconsider their approach; otherwise, the exodus that we are seeing at the moment will become a flood. Hon. Members, the public, UNISON, other unions, the NHS Confederation and other bodies are all urging the Government to reconsider their 1% pay rise proposal, so what is stopping them? It cannot be a lack of money, because, as we have heard, £37 billion can be found for Test and Trace, millions can be spent on unusable PPE, and we have had £2.6 million for the Prime Minister’s new media centre. It is a political choice, and it is a choice that cannot be defended. Indeed, as we see today, it seems that no Conservative Back Benchers want to defend it.

I am sure that the Minister is well aware of the anger the proposals have generated, but let me read out a few quotes from bodies representing the workforce so that she can see the strength of feeling. The British Medical Association said it is a

“total dereliction of the Government’s moral duty”

and a kick in the teeth. The Royal College of Nursing said:

“This is pitiful and bitterly disappointing”

and “dangerously out of touch”. Unison said it is the “worst kind of insult” and “some kind of joke.” The TUC said it is

“a hammer blow to staff morale”

and Unite described it as “unyielding contempt”. So I do not think there is any mistaking how NHS workers feel.

That mood is matched by the public, who overwhelmingly oppose the Government’s position. A poll showed that 83% of the public and 78% of Conservative voters think the Government should increase their pay offer. For a Government who routinely pit people against one another when it comes to pay, that must surely tell them they are on the wrong side of the argument. If it does not, they must surely know they should think again when the former Health Secretary, the right hon. Member for South West Surrey (Jeremy Hunt), calls their offer a “miscalculation”. As understatements go, that is right up there. We do not know whether that view is widespread on the Tory Benches, because no Conservative Member is here to tell us what their view is. I am not surprised that the Prime Minister wants to avoid putting the proposals to a vote, because how could any Conservative Member look their constituents who work for the NHS in the eye if they vote for that? I do not know.

It should not have come to this. The Government really need to think again. The whole country is watching and waiting for them to do the right thing. It is not enough to say, “Wait for the pay review body” without giving a guarantee that, should the pay review body recommend a real-terms pay rise, that will be honoured by the Government. If the Minister confirms at least that today, that would be a start.

After the last year, we should not have to fight a battle to ask the Government to consider more than a 1% pay rise. It says everything about how little value those efforts over the last year have been appreciated. Our NHS staff deserve more than that. They deserve an agreed fair and sustainable pay settlement. Ministers should admit their mistakes and undertake to agree a multi-year pay deal with NHS staff. In starting talks, they should take the pay cut off the table and not set a ceiling. Time and again, the Prime Minister said that the NHS would not pay the price for the pandemic. The Chancellor promised that the NHS would get whatever it needed. It is time to put those words into action. It is time to ditch the empty promises and gestures. It is time to do the right thing.

We stayed at home to protect the NHS. We clapped for our carers during the pandemic, and we on the Opposition side meant it. As my hon. Friend the Member for Liverpool, Wavertree said, claps and smiles do not pay the bills. That is why the Opposition will not rest until our brave NHS staff get fair pay and the long-term settlement that they truly and honestly deserve.

--- Later in debate ---

[Helen Whately]

The hon. Gentleman will recognise that although the Government have to make some difficult decisions, various things are non-negotiable. One of those things is ensuring that the NHS is there for all our constituents who need it, and another thing is ensuring that we have the defence that we need to protect people from threats from overseas.

Let me return to the matter in hand and set out a bit more about the process that we are going through on NHS pay. As I mentioned, the evidence that we recently submitted to the NHS pay review covered a wide range of data that was relevant to the decisions that that pay review body will make. The pay review bodies themselves are independent advisory bodies made up of industry experts. Their recommendations are based on a comprehensive assessment of evidence from a range of stakeholders, including trade unions. The wide range of factors that they will consider includes the cost of living, recruitment and retention in the NHS, affordability and value for money for the taxpayer, and comparisons with wider public and private sector earnings.

As the pay review bodies are independent, I cannot, and would not wish to, pre-empt their recommendations. We have asked the NHS pay review body, and the review body for doctors and dentists, to report later in the spring, and we will carefully consider their recommendations when we receive them.

[Justin Madders]

The Minister is setting out the pay review process, but it is also the case that she voted for a 2.1% pay increase only last year. Why has that changed?

[Helen Whately]

I am very glad that the hon. Gentleman has brought this point up. There have been no changes to the 2.1%. I specifically looked into that, and we are absolutely consistent—the 2.1% in the long-term plan will be invested in the workforce as planned. That 2.1% includes the funding not only for the pay agreements that we will reach through this process, but for existing pay deals and further workforce development, so we will be standing by that 2.1%.

As would be expected, I have had many conversations with NHS staff, from porters to healthcare assistants, nurses, allied healthcare professionals, junior doctors and consultants, both during the pandemic and for many years before. I have asked many times what would help; what do staff most want? Pay is rarely mentioned in those conversations—[Interruption.] The hon. Member for Warrington North (Charlotte Nichols) may laugh, but I am describing the many conversations I have had over many years with NHS staff, including during the pandemic. What is most often mentioned to me is that staff want more colleagues. They want more staff working alongside them so that they can have more time to give patients the care that they want to provide.

[Justin Madders]

Will the Minister give way?

[Helen Whately]

I will make some progress, as time is limited. Staff have told me many times that they want to feel genuinely supported and valued in their work. Someone said that one of the upsides of the pandemic is that when a colleague asks them how they are, they feel that the question is actually a meaningful one at the moment. If they say, “No, I’m not okay”, it has led to a conversation in which they have talked about what would help. I would like to see that continued in easier times.

Staff told me many times that they would like more autonomy in their jobs, and to be able to really make a difference and make improvements in the area they work in. Most recently, staff told me how much they want to be able to take time off, to have some time to spend with their families and time to recover and recuperate from the stresses and strains of the pandemic. I am determined that we shall deliver all those things for our NHS workforce.

Throughout the pandemic, I have worked with NHS England to make sure that all possible support is in place for staff. That includes practical support, like hot food and drinks and the free parking that has been much talked about; and psychological support: mental health support, “wobble rooms”—which I have spoken to staff about and they value them—dedicated support lines and helplines, and access to specialist support through new mental health and wellbeing hubs. As set out in the people plan, we are working with the whole NHS to build a more supportive, compassionate and inclusive culture. A culture in which those who care are cared for in turn.

On the first of the asks that I mentioned, that NHS staff want more colleagues, we are making real progress. In the NHS there are now over 6,500 more doctors, almost 10,600 more nurses and over 18,700 more health support workers compared with a year ago, and we are well on our way to delivering 50,000 more nurses for the NHS by the end of this Parliament.

We estimate that there are 70,000 nurses and midwives in training at the moment, and that includes 29,740 students who began nursing and midwifery courses this academic year. That is an increase of 26% from last year. Forty-eight thousand students have applied to start nursing and midwifery courses later in the year. That is an increase of over a third compared with the number of applicants at the same time last year, so I can assure hon. Members that the supply of people training and coming forward to train to work in the NHS is strong.

Vacancies in the NHS—indeed, there are vacancies, but they are decreasing—have fallen by over 11,000 since last year. There are 2,500 fewer nursing and midwifery vacancies and 1,800 fewer doctor vacancies.

NHS and social care staff do a fantastic job, and they continue to go the extra mile time and again, especially during the pandemic. We must recognise their skill and dedication and make sure the rewards of work in the NHS support the recruitment and retention of the workforce our health service needs. That is why we have the independent pay review bodies. They will properly assess all the evidence, and the Government will consider their recommendations and respond in due course.

Those of us who have spoken today may disagree about many things, but we all care deeply about our NHS and our NHS staff. I thank all the hon. Members who spoke today for showing their support.