Health and Care Bill

Lord Davies of Brixton Excerpts

Lords Hansard - Part 3 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Lord Davies of Brixton (Lab)]

I wish to address Amendments 201A, 201B and 201C—my name has been left off Amendment 201A for some reason, but I support all three. Indeed, I support the stand-part debate initiated by the noble Lord, Lord Lansley.

I have attended virtually the whole debate in Committee and have been pretty sparing in my contributions, but on this occasion, I am going to make three speeches in one. I have been asked to pass on the thoughts of my noble friend Lord Hendy, who is unable to be here this evening, particularly given the time—though we are meeting a bit earlier than we perhaps expected. The same is true of my noble friend Lady Blower. Both my noble friends have considerable experience in this area and wanted their thoughts to be added to our debates this evening.

My noble friend Lord Hendy tabled these amendments. I have his remarks here; what he says might be of assistance to the noble Lord, Lord Lansley, in that he explains that this Bill, among other things, is designed to facilitate the outsourcing to private contractors of NHS services which are currently carried out in-house. That may not be explicitly stated, but it is clearly one of the underlying aims.

That is the Government’s policy, even though it is firmly opposed by most of the citizens of this island. That said, the purpose of these amendments is to protect NHS workers from the consequences of this policy. Usually when public services are outsourced, the contractor makes profit by reducing the number of staff performing the work formerly done in house and by cutting staff wages, terms and conditions. The TUPE regulations mitigate that process, but usually only by delaying it.

These amendments do not prevent staff reductions consequent on outsourcing beyond the protections in TUPE. In any event, the danger of staff reductions is diminished, bearing in mind that at the end of last year the NHS had 93,000 vacancies and an additional 110,000 staff off sick, half with Covid.

Amendment 201A seeks to prevent cuts to the wages, terms and conditions of NHS staff who are outsourced, and prevent contractors’ staff on worse terms undercutting in-house staff. It does so by requiring that the pricing rules for paying contractors must preserve, then and for the future, NHS staff rates and terms as negotiated between the NHS unions and NHS employers. Payment of those prices will depend on honouring those terms.

I hope the Minister will accept the legitimacy of the need to protect NHS staff in this way, perhaps—my noble friend adds—by better drafted amendments than mine. I am sure the Minister recognises that NHS staff need protection from wage cuts consequent on outsourcing. We must not have a two-tier workforce.

NHS staff are grossly underpaid and the real value of their wages is falling. After years of pay freeze, last year’s miserable 3% wage increase is destroyed by 6% inflation this year. The inadequacy of their terms and conditions is the prime reason for the extraordinarily high level of vacancies—a vacancy rate that increases as more and more work is done by fewer hands. Only heroic dedication by NHS staff prevents the vacancy level becoming a catastrophe.

Amendment 201A also protects against a different kind of two-tier workforce: contractors using the NHS payment scheme to fund salaries above NHS rates to attract certain categories of staff away from NHS posts. The current starting salary for an NHS nurse is £25,655, whereas the equivalent in the private sector is £37,500. No one could begrudge nurses earning whatever they can for their vital work, but NHS funds should not be used to finance a higher rate outside the NHS than within it.

Amendments 201B and 201C are intended to ensure that unions are among the consultees on the likely impact of payment schemes. Obviously, the workforce should be consulted.

My noble friend Lady Blower added her name to all three amendments, and she draws our attention to the fact that my noble friend Lord Hendy is one of our foremost labour lawyers. Some in your Lordships’ House have long experience of trade unions and trade unionism. I therefore hope that they will recognise this quotation:

“Trade unions have been an essential force for social change, without which a semblance of a decent and humane society is impossible under capitalism.”


That was not Marx, Engels or any of the great leaders of the TUC, or a general secretary of a major trade union. The quotation is actually from Pope Francis. Given that we all want to live in a decent and humane society, we should all promote the important role of trade unions. This is in part what these amendments would do; they are about fairness and justice for workers.