NHS Pay

Maria Caulfield Excerpts

Wednesday 13th September 2017 Commons Chamber

[Chris Philp]

rose—

[Maria Caulfield (Lewes) (Con)]

rose—

[Jonathan Ashworth]

The hon. Lady has often spoken out on this matter, so I feel I should take her intervention, but then I will make progress, if the House will indulge me.

[Maria Caulfield]

It is generous of the hon. Gentleman to give way. As he says, I support the lifting of the pay cap and I am pleased that the Government are moving on this. My concern about supporting this motion is that Labour do not seem to have learned the lessons from crashing the economy in the first place. Could he outline what level of pay rise the Labour party is proposing for public sector workers—1.5%, 2% or 3%—and how it will be paid for? That is crucial to influencing the voting intentions of Members like me.

[Jonathan Ashworth]

I have a huge amount of respect for the hon. Lady; we have had conversations outside the rough and tumble of this Chamber, and I know she takes these matters extremely seriously. I would ever so gently say to her that she has been telling newspapers that she supports getting rid of the cap; she has been hosting nurses in Parliament, saying that she would get rid of the cap; well, this evening she has an opportunity to take a stance, ignore the Tory Whips and vote for getting rid of the cap.

[Maria Caulfield]

In this debate, we must be honest with the British public about how we are going pay for the lifting of the pay cap. If Labour wants to lift the pay cap, can the hon. Gentleman explain how the Labour party will pay for it? Will it be through increased taxation or more public borrowing, or will Labour shift spending priorities? We need to know the detail in order to be able to support this policy.

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[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford). I pay tribute to her for her work on the Select Committee on Health in the previous Parliament. That work was inevitably full of expertise and always constructive; I thank her for that. I agree with her that the NHS is a team, but that team should also include the wider social care staff because we cannot continue to look at the two systems in isolation. I echo her point, thanking all our NHS and care staff for the contribution they make not just to our wider economy, but—most importantly—to patients. Those are the people we should keep at the heart of this debate.

I welcome this debate. I also welcome the relaxation of the cap because we need to give the NHS Pay Review Body greater flexibility to make recommendations about what we need to put in place for our NHS staff. I agree with the hon. Member for Central Ayrshire that we should look at the impact of pay on morale, recruitment and retention—this is an international workforce, as well as a national one—but we also need to look at pay across regions and within specialties because there is great variation. We should focus our efforts on ensuring that we are looking at the situation from the patients’ perspective by, for example, looking at the greatest areas of deprivation, which very often have the lowest ratios of NHS and care staff and who are under the greater pressure.

Seven years of sustained pressure on NHS pay is taking a toll. Nobody anticipated that it would go on for this long, so it is time to relax the cap. We should look not just at the issue of pay, but at the wider pressures within the NHS. I am delighted to announce that the Health Committee, which held its first meeting just before Prime Minister’s Question Time, has agreed that its first inquiry of the Parliament will be on the nursing workforce. We will look not just at pay, but at the wider workforce pressures, including the increased workload that comes from increasing demand across the system, morale and all the other non-pay issues that contribute to the pressures on nurses. We will also look at bursaries and the new routes into nursing, and at their impact on people entering the nursing workforce. We have heard about that already today. For example, we know that those who drop out of nursing courses are more likely to be in the younger age groups, whereas those who go into nursing as mature students are much more likely to stay. We need to look at all those wider impacts.

[Maria Caulfield]

I really welcome the news that the Select Committee is going to do a review of nursing. Will the Committee look into pay structure? The current Agenda for Change structure is being used by some trusts, in hospitals and communities, as a way of downgrading nursing roles. For example, a senior sister in one place may be paid a band 7 salary, whereas someone in the same role somewhere not too far down the road may be paid a band 5 salary. There is inequity in the current system.

[Dr Wollaston]

That is an important point. I very much hope that my hon. Friend will contribute to the Committee’s inquiry. As well as looking at the new routes into nursing, we will look at the skills mix, roles within health and social care more widely, the impact of Brexit and language testing, workload and morale. We will be seeking contributions from hon. Members across the House and from people outside.

As I said, we will miss something if we just look at the issue as one of pay. Pay restraint is estimated to contribute between £3.3 billion and £3.5 billion of the five year forward view efficiency savings up to 2019-20. If that goes, what will fill the gap? We have to be careful that there is no loss of services or losses in the workforce, because workforce pressures—probably more than any other issue—contribute to nursing staff leaving the profession. We have to look at the bigger picture.

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[Maria Caulfield (Lewes) (Con)]

I declare an interest as a nurse who has worked for over 20 years in the NHS, and who still works as a nurse on my hospital bank. I worked through 2010 to 2015, when the pay freeze and then the pay cap was introduced, so I know exactly how difficult it is to manage on a nurse’s wage and not see an increase. Inflation is now close to 3%, so it is becoming increasingly difficult. Seven years is enough for anyone to have lived with a pay cap or a pay freeze, so I support the RCN’s campaign to scrap the cap.

No political party comes out of this unscathed. There was a recognition among colleagues back in 2010 that we in the public sector had to tighten our belt if we were to protect jobs and frontline services. We recognised that we had to step up to the plate and play our part, and we did. However, we were promised by those on the Government Benches that that would be for roughly a five-year period. The Government have to take responsibility for not having tackled the deficit completely and for keeping the pay cap going. It is not fair on frontline staff that they are the ones still picking up the pieces of the mess the last Labour Government left the country in.

It is time now to scrap the cap. Nursing has changed dramatically over the last 20 years. It is now a graduate-only-entry profession. Nurses are taking more advanced roles, including nurse prescribing, and extended roles, such as biopsies and minor ops. Today is National Sepsis day. In A&E, it is often a nurse who sees a patient and, if they suspect sepsis, cannulates, takes blood, does the blood cultures and, if they have done their prescribing course, starts the first line antibiotics. That is done long before the doctor ever sees the patient. That is not because nurses are becoming mini-doctors; it is because they are extending their role, improving outcomes for patients and improving patient experience.

I want to send a message to Ministers: there are two myths doing the rounds at the moment about nurses’ wages. The first is that nurses are on an average of £43,000 or even £37,000. That is completely untrue. Most nurses are in bands 5 or 6, the average wage for which is £27,000—for an experienced nurse—and the starting salary roughly £21,000. The banding system is used to downgrade nurses and pay them as little as possible. When I do a hospital bank shift, I am on the lowest band 5 wage—after 20 years of working as an experienced cancer nurse who is chemo and intravenous-trained.

The incremental rise we hear about is also a myth. The banding system is used to start nurses on the lowest-possible salary. They have to wait seven years—each year going up a little bit—till they reach the top of their banding. In no other profession would that happen. We do not see MPs in the 2017 intake being paid less than those in the 2015 intake because they are less experienced or new to the role, but that is exactly what we do to nurses, and then we tell them they should be grateful for that incremental rise. They should be paid what is due for that job, not wait seven years to get the actual pay the job is worth. We do not say to the editor of the Evening Standard, “You’ve never been a journalist before, so you should be paid less than any other journalist in this country.”

This is about fair pay for a fair day’s work. We are asking people to save lives or put their own lives on the line to save the lives of others. The time has come to end the public sector pay cap, and I welcome the moves by the Government. As for the motion, I hear that the Labour party wants to scrap the cap, but there is not the money to do it across the board, although there are ways to give nurses, public sector workers and other NHS staff a pay rise. If we focus that pay rise on bands 1 to 7 and help those in high-cost areas with high-cost living allowances, we can make a difference, but using this as a political football will not score any goals. It is incumbent on all of us from all parties to work together.

When Ministers stand up at the Dispatch Box and say, “More schools than ever are good or outstanding”, “More patients are being treated than ever before” or “There is less crime than ever before”, they should remember it is because of the hard work of public sector workers. We need to reward them for their hard work and effort.