NHS and Social Care Workers

Lord Davies of Brixton Excerpts

Thursday 15th December 2022 Lords Chamber

[Lord Davies of Brixton (Lab)]

My Lords, I thank the noble Lord, Lord Allan of Hallam, for raising this issue today. As he says, this debate is extremely timely. I have to say that I am a bit surprised and disappointed that so few speakers have signed up for this debate. It is obviously for noble Lords to make their own decisions about which issues they wish to raise, but this one is crucial. You only have to look at the front pages of today’s newspapers to realise how important this is.

There is a whole range of issues that could be raised in discussing these issues; I will focus on just two. That is in no way intended to diminish the importance of other issues. As a veteran of the long-lost and unlamented healthcare Bill, I am glad mention was made of the workforce plan. There was a whole debate then in which the Government were resistant to introducing a workforce plan, but it has suddenly become a priority for them. Maybe there is a case there that they need to listen.

The first of the two issues I will focus on is pay in general, and because today is today, I will talk about nurses’ pay. Secondly, I am going to take this opportunity to talk about pensions in the National Health Service and, in particular, the impact of taxation rules, particularly the annual allowance and the lifetime allowance, on employment in the NHS. When I first thought of contributing to this debate, I thought I would have less time and would focus on just that issue. However, now I have the luxury of 10 minutes, I have expanded my remarks.

First, pay is an issue across the whole service. All workers within the National Health Service have seen problems with their pay and the need for action to be taken to overcome the clear requirement to sort out the problems that we face. I do not think there is any question that there are big problems and that sorting out pay is a crucial element in resolving them. It is not the only answer, but it is the one I am focusing on today.

In particular, I am focusing on nursing, where we have compelling figures: there are 47,496 nursing vacancies. No doubt the Government will tell us that they have increased the number of nurses, but there is still a horrendous level of nursing vacancies. Over 7 million people are waiting for treatment in the National Health Service, and there are 363,000 people who are out of work because of long-term illness. So, pay is one of the direct measures to address those issues. I hope the Minister will say that he recognises that, even though the Government believe that they are under various constraints. The issue, therefore, is not about whether we can afford to meet the demands that have been made for improved pay; the issue is, with the problems faced by the health service, can we afford not to sort out pay?

To be clear, I support the nurses’ demand for a significant pay rise, achieved through collective bargaining. The Government cannot hide behind the independent pay review process because it is clearly broken. I will not undertake a full analysis of the pay review process today, but sticking the word “independent” into a phrase does not make it independent. The Government appoint the members of the pay review body and issue a remit letter that sets out what they can do. It is no criticism of the members of the pay review body to say that this is not a truly independent process: they have to play the cards that they are dealt.

The nurses’ action today—the fact that they are on strike—is a clear indication of the gravity of the problem. CPIH, the agreed appropriate prices index, has increased by about 33% since 2010. Private sector earnings have gone up faster than that, by something like 40%, providing a real-terms increase. Public sector pay in general has gone up by a lesser amount: it has gone up by only 28%, which is a 5% real reduction. Within that, the nurses have done particularly badly, with an increase of under 20%. So there has been a real-terms reduction of over 10% over the last 12 years. One can only admire their moderation in seeking to recover only half of that fall in real terms. A similar case can be made for other groups of employees within the health service, but the Government have to recognise that the way to see this issue resolved is to accept the RCN’s request for direct negotiations. The so-called independent pay review process is just not working any more.

On pensions, a consultation is of course currently under way, and the Government say that this will

“retain more experienced NHS clinicians and remove barriers to staff returning from retirement.”

This is actually the Government’s second go at this issue: some regulations have already gone through, but we will have a debate, which I am looking forward to, with the Minister early in the new year on the previous set of regulation changes—and now we are going to get a different set, following a period of consultation. Unfortunately, my regret Motion on the first set still stands. They will be insufficient to address fully the problems with staff retention in the NHS arising from the NHS pension arrangements that the House of Commons Health and Social Care Committee described in its report last autumn as a “national scandal”. The committee was of course chaired by the current Chancellor of the Exchequer.

Given that we will have another debate, and probably further debates on further regulations, I will spare the House a full discussion of this issue—I do not have enough time for that in any event. The issues are complicated, but they are explained on the BMA website, and I invite noble Lords and noble Baronesses to see what the issues are. I admit that, in the regulations currently under consultation, the Government do address one particular issue about the mismatch of the CPI on various indices—but that was not the only problem, and they do not propose to address one of the worst problems. So I am using this opportunity to focus the Minister’s mind on this issue, which we will return to. I hope that he will perhaps give us a commitment today that he will take the issue seriously and take part in further discussions.