NHS: Pay

Lord Bethell Excerpts

Tuesday 9th March 2021 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government, further to the assumption set out in the NHS Long Term Plan Implementation Framework, published in June 2019, of a 2.1 per cent pay rise for National Health Service staff in the 2021/22 financial year, what plans they have to review their submission to the NHS Pay Review Body.

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

My Lords, our written evidence to the independent pay review body set out what is affordable. We have increased the size of the NHS workforce over the last decade and have committed a record-setting additional £33.9 billion by 2024-5 for the NHS to meet the rising demand for services. With strides being made in recruitment and retention, an enormous effort is under way to make the NHS a more inclusive and enjoyable place to work, with excellent well-being support for all staff.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, the Government say that they cannot afford to give nurses a decent pay rise, yet they have managed to squander billions of pounds on management consultants, fly-by-night companies and friends of Ministers. The long-term plan built in a 2.1% pay rise for NHS staff next year; it was factored into the funding settlement and enshrined in legislation. It is one thing for the PM to be filmed applauding his appreciation for NHS staff, but no amount of clapping will help pay for rising living costs. Does the Minister agree that the Government should reverse this evidence and give staff in the NHS the increase they deserve?

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[Lord Bethell (Con)]

My Lords, I start by saying how much nursing staff and all healthcare staff are appreciated, not only by the Government but by the entire public. Of course we stand by that appreciation, and there is no way that the Government have anything less than the most enormous amount of appreciation for all those who have committed so much during Covid. On test and trace, I remind the noble Lord that that is an essential service which delivers value for money and, of course, pay increases are recurring and last for a long time. However, the evidence to the pay review body is clear: affordability is a key challenge for the whole country and we wait for the pay body to review that evidence.

[Baroness Brinton (LD) [V]]

My Lords, last year, at the height of the first lockdown, we on these Benches argued that all NHS and social care staff should receive a one-off payment from the Government as thanks from a grateful nation for their tireless dedication and sacrifice. Not only have they not received this but the Government are now reneging on this year’s pay rise as set out in the NHS 10-year plan. What on earth do the Government plan to do to retain and recruit staff after letting them down so badly?

[Lord Bethell (Con)]

My Lords, I am not sure that retention is necessarily the challenge that the noble Baroness suggests. There has in fact been a 26% increase in acceptances to nursing and midwifery courses when compared to last year, and 1,290 more applications were made in 2020 compared to 2019. The truth is that nursing is a challenging job but one that many people want to take up. There is a long queue of people who want these positions because they are rewarding in many different ways. We appreciate the contribution made by nurses and the whole healthcare sector, but there is no disguising the fact that these are attractive jobs, which many people wish to take up.

[Lord Balfe (Con)]

Does the Minister accept that it was not a 2.1% increase but a 2.1% addition to the bill, which included a number of emoluments that are added each year? It was not 2.1% for everybody; it was a whole package. The Government need to get their case across a bit better, particularly with what the Minister just said about recruitment. I suggest that the Government pay attention to getting their case across. As the Minister said, nursing, with its lifetime pension, is a very attractive proposition at the moment.

[Lord Bethell (Con)]

My Lords, the percentages are unbelievably complicated. It is difficult to stand by one single number to represent pay that goes to hundreds of thousands of different nurses under different circumstances. However, I agree completely with my noble friend. What is at stake here is not just one pay rise in one year but the entire package of circumstances in which nurses do their job. We are determined to ensure that that workplace package is as good as it can possibly be. We acknowledge that there are cultural challenges of working in the NHS, which we are fighting hard to improve. We recognise that training opportunities for nurses should be better and we are working hard to improve those. We recognise that nurses have little capacity for holidays, which is why we are recruiting a very large number of new nurses. It is the entire package that we are focused on, which is why we have put forward the affordability argument as we have.

[Lord McNicol of West Kilbride (Lab)]

My Lords, Ministers have time and again stated that supporting our nurses is a top priority but, as unions have pointed out, an offer that amounts to £3.50 per week looks more like a kick in the teeth than a top priority. I am sure there is one thing we can all agree on: nurses and other healthcare professionals have had to work in some of the most difficult, demanding and dangerous circumstances, and they have done so with astonishing care, compassion and commitment. The Government have got this badly wrong, and I urge them to reconsider their meagre, miserly, measly 1%.

[Lord Bethell (Con)]

My Lords, I reject the rhetoric of the noble Lord. We absolutely do support nurses, which is why we are focused on recruitment, training, culture and opportunities. It is not right to think that one pay rise represents the entire and sum contribution to the welfare of nurses. That is the response we get from nurses themselves, what the public understand, and what the Government’s guidelines are about.

[Lord Willis of Knaresborough (LD) [V]]

My Lords, could you imagine any employer, other than those of the sweatshops of the Far East, seeing their workers perform heroics to save the business and, in the process, the lives of millions of their clients, only to be rewarded by having their wages actually cut? Does the Minister agree with the Health Minister Nadine Dorries, who expressed surprise at the generosity of the Government’s offer, or with the view that a good employer would first offer a substantial bonus to its staff before taking time to negotiate a fair and sensible pay award? If we can pay a bonus to local publicans for sourcing easily obtainable files, surely a bonus to those who have saved our lives should be a no-brainer for this Government.

[Lord Bethell (Con)]

My Lords, I agree with the noble Lord on the point about heroics—we appreciate those—but I do not agree that this represents a pay cut. On the broad thrust of the noble Lord’s point, I gently remind him that millions of people are out of work off the back of this pandemic. Lots of people have had an extremely tough time and face a period of unemployment. Nurses are well paid for the job, which is a secure job, and they have other benefits. There are many people in this country who look upon professional jobs in the NHS with some envy; we should not forget that some public sector jobs are, in fact, extremely well-paid.

[The Lord Bishop of Worcester]

My Lords, I appreciate the immense, unprecedented and unforeseen pressure that the Government are under as they struggle with the devastating effects of the pandemic on public finances. At the same time, as has been noted, we all want to recognise the huge debt of gratitude that we owe to nurses and other health workers. Recognising that would best be done by a pay increase. We are told that a 1% increase is all that can be afforded. Can the Minister comment on whether he thinks tackling the estimated £2 billion lost annually through inefficiencies related to unnecessary A&E attendance and GP consultations might give more wriggle room?

[Lord Bethell (Con)]

My Lords, I completely endorse the right reverend Prelate’s point about the heroics of—and the debt that we owe—nurses, but I just cannot agree with him that the best way of recognising the contribution of nurses is to give them a pay increase. That simply is not my experience of workplace engagement. Yes, pay rises are important and a recognition of work done, but there are other, much more important reasons why people work. They work for the status of that role, for the opportunities that it gives them in their life, for the security that it gives them and for the collaboration of working with fellow members of staff. There is a whole package of reasons why people do the work that they do. We live in extremely economically challenging times. It is right that the advice given to the pay review body looks at the entire package, not just at the pay increase.

[Baroness Thornton (Lab)]

The Minister is quite right: it is not just about the 1% rise. A newly qualified nurse will earn £21,000 in 12 months; that is their starting salary. The consultants building the track and trace system, at £7,000 an hour, earn more than that amount in under four hours. Perhaps that will help the Minister understand why so many people are outraged at the proposed 1% so-called pay rise. Will he explain to the House what values and priorities he holds that lead him to believe that the Government’s decision is an acceptable one?

[Lord Bethell (Con)]

My Lords, the noble Baroness makes some vivid comparisons on completely incomparable pay differentials. The values that we have are absolutely aligned with public service values. We are determined to create a workplace that is just, fair and equitable. We are committed to giving people a fair reward for the work that they do and to giving people decent job prospects within that role. Those are the values that people go to work for and are motivated by. We need to put together a package that works across the piece and is not narrowly focused on one particular material point, such as pay. I stand by what I said previously: the package of measures that was put in our evidence to the pay review body sees all those values in the round.

[Baroness Jolly (LD) [V]]

My Lords, for the last 10 years NHS pay has lagged behind inflation. Year on year, health professionals have had less to spend than they had the previous year, and the 1% pay rise does not help as inflation removes any increase. Apart from the moral case put by noble Lords, this is not good economics. If people are paid more, they spend more by putting cash back into the economy. Will the Minister ask the Chancellor to look at this again?

[Lord Bethell (Con)]

My Lords, I am at a slight disadvantage because I am not quite sure that I can substantiate the noble Baroness’s view that pay has lagged behind inflation. Her economics lesson is extremely interesting but not one that the Chancellor is necessarily persuaded by. Where she is entirely right is that pay is an important aspect of any recruitment campaign by the NHS, and that is why we have put recruitment at the heart of our commitment to it. That is why we are recruiting 50,000 nurses and making a very large number of GP appointments. We are seeing huge gains in achieving those targets, which reflects the fact that there is not a massive or structural misalignment in our pay arrangements.

[Lord Sikka (Lab) [V]]

My Lords, the Government paid consultants up to £7,000 a day for advice on test and trace but nurses risking their lives are offered less than £1 a day. Does the Minister agree that this contempt for nurses is disgraceful because a higher award can easily be funded? For example, taxing capital gains in the same way as earned income can generate additional tax revenues of £14 billion a year.

[Lord Bethell (Con)]

I am grateful for the economics lesson from the noble Lord. I will take those recommendations and pass them on to colleagues at the Treasury.

[Lord Scriven (LD) [V]]

My Lords, the £37 billion found for the predominantly private sector-led test and trace system equates to spending more than £1 million every day for the next 100 years. How does the Minister reconcile that with the statement that the Government cannot find the money to fund more than a 1% pay increase for front-line NHS staff?

[Lord Bethell (Con)]

My Lords, the test and trace system is part of an essential response to a virus pandemic that has shaken the world, and the costs of that pandemic are enormous. I regret them very much and wish with all my heart that we did not have to spend this money on our pandemic response, but there is no other way of cutting the chains of transmission and responding effectively to this awful disease. The ongoing pay arrangements for nurses and doctors are commitments that we will live with for years to come, and there is a difference between the two.

[Lord Harris of Haringey (Lab) [V]]

My Lords, I should declare that my wife works in the NHS. Does the Minister agree with his ministerial colleague Nadine Dorries that the 1% settlement is generous because it is better than a pay freeze? Nurses get maybe 70p a day while billions are wasted on crony contracts and £200,000 is being spent on titivating a Downing Street living room, replacing decorations that are barely three years old. Does the Minister—or the Chancellor, for that matter—have any idea what living on £25,000 a year is really like?

[Lord Bethell (Con)]

My Lords, I cannot hide from the noble Lord the fact that across the public sector there is a pay freeze. The only area that that does not apply to is the NHS, a point that I think my colleague made very thoughtfully. I remind the noble Lord that many in the private sector have lost their jobs and prospects altogether and that there is a massive economic challenge on the horizon. We fool ourselves if we close our eyes to that and regard the public sector as somehow sacrosanct and immune to the larger economic challenge.