NHS Pay

Norman Lamb Excerpts

Wednesday 13th September 2017 Commons Chamber

[Mr Hunt]

I am going to make some progress, because I want to deal with the issue of morale, and then I will give way for a final round of interventions.

A lot of comments have been made about the NHS being at breaking point, at a tipping point and so on. There is huge pressure on the NHS, but, as has been said by my right hon. Friend the Member for Broxtowe (Anna Soubry), who is no longer present, that is not the whole picture. What the shadow Health Secretary did not say is that 7,000 people are alive today who would not have been had we stayed at the cancer survival rates of just four years ago. We are having probably the biggest expansion of mental health treatment in Europe, and an independent NHS England report says that for most major conditions outcomes have dramatically improved over the past three, five or 10 years.

[Norman Lamb (North Norfolk) (LD)]

I feel that as the sole Liberal Democrat present it is my duty to intervene. Does the Secretary of State accept, as a principle, that ultimately we cannot sustain the NHS on the back of real-terms cuts to people’s pay within the NHS and that that would be unconscionable year after year? Does he also accept that as the difference between public and private sector pay narrows so much, people will just vote with their feet and leave? Therefore, not only is this morally wrong, but it will not work ultimately.

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[Dr Whitford]

It is very important that people recognise the role that everyone plays, but for nurses in particular this is not just a matter of pay. Last year, we spent a lot of time debating changes to working tax credits, which can leave a lone parent nurse very much worse off. We also spent a lot of time debating the imposition of tuition fees and the removal of the nursing bursary. The nursing bursary still exists in Scotland. It is a non-means tested bursary of £6,500, potentially with a caring supplement of £3,500. We know that the average age to take up nursing study is at the end of the 20s, which means that people often have family commitments. Such people will receive approximately £10,000 a year so that, at the end, they will not face what future nurses in England will face, which is a debt of more than £50,000. The repayment on that kicks in immediately, because graduate nurses start at around £22,000, which is over the limit. At the lower end of band 5, that is another £400 a year off. By the time a nurse gets to the top of band 5, it is another £1,000 a year off. They will never manage to pay off that £50,000 to £60,000, which means that their salary will be reduced by that amount throughout their careers.

[Norman Lamb]

Does the hon. Lady agree that what appears to be happening is that many of the mature students who previously went into nursing often do not want to take on that debt? That means that we are losing people who seek to transfer from other professions, which is really damaging.

[Dr Whitford]

I totally thank the right hon. Gentleman for his intervention. That is absolutely the case. It has never been a negative—in fact it has always been a benefit—that we have attracted people who were a bit older to the role of student nurse. Perhaps they had another degree or a student loan to pay off, but they always had a bit more life experience under their belt.

As a very junior doctor in my first year, I remember what it was like when my hours alternated between 132 and 175, and I had no life that did not involve people who were dying or ill or who had been hit by a car. That is very difficult for a person who has just come out of uni, and who is used to going out for a pint and having parties. There is real advantage in training people who may have had a family and who have lived a bit of life. As the right hon. Member for North Norfolk (Norman Lamb) said, there are people who are attracted to nursing but who will not take it up because they will not put their family through it. We have seen that already with a 23% drop in applications.

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[Dr Wollaston]

The hon. Lady is absolutely right. Look, for example, at the applications for nursing courses. Even though the number of applicants has gone down, it may not ultimately result in a loss of numbers entering nursing. Some of the applicants from that overall drop in numbers might have gone on to other courses, so we need to look at the bigger picture. In opting to look at the nursing workforce, the Health Committee is not saying in any way that other parts of the workforce are not important. The NHS is a team, but it would be difficult for us to report within a certain timeframe if we looked at the entire workforce. I have no doubt that we will look at other aspects of the workforce over the course of this Parliament. I assure the hon. Lady that we will not lose sight of the bigger picture and I hope that she will contribute to the inquiry.

We need to look at the big picture regarding the total budget for health and social care. The right hon. Member for North Norfolk (Norman Lamb) has long made this point, and we have both made it clear that it is time for us to take a cross-party approach to sustainable funding for health and social care in the long term. I look forward to working with him on that over the course of this Parliament.

[Norman Lamb]

I totally agree with the hon. Lady and I am keen to continue working with her. Did she see the Independent Age survey that showed that well over 80% of Members of Parliament on both sides of the House agree that there needs to be a cross-party settlement for the future of the NHS and the care system?

[Dr Wollaston]

I welcome that and I look forward to working with the right hon. Gentleman over the coming months to try to encourage colleagues on both sides of the House, including the Front Benches, to agree to the idea. Next year is the 70th anniversary of the NHS, and I cannot think of anything more constructive we could do than to work across political parties in order to deliver sustainable long-term funding for health and social care.

I will bring my remarks to a close because I know that many hon. Members wish to speak. I look forward to hearing suggestions from colleagues in the House and outside this place about the points they would like the Health Committee’s inquiry into the nursing workforce to cover.

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[Norman Lamb (North Norfolk) (LD)]

I start by acknowledging just how long the constraints on pay in the NHS and across the public sector more generally have applied, and I say that fully recognising that I was a member of the coalition Government. I understood and accepted the reason why constraint was necessary at that time, because public sector pay had run quite a long way ahead of private sector pay, but the situation is very different now. Ultimately, we cannot justify year-on-year real-terms pay cuts for workers in the public sector as a way of sustaining our vital public services, but that is what they are facing and we have to face up to it.

Alongside the moral case is the fact that the cap simply will not work. The Royal College of Nursing says that the NHS in England is some 40,000 nurses short, and that has consequences. Among the doctor workforce, rota gaps are endemic—I suspect the hon. Member for Tooting (Dr Allin-Khan) recognises that. It is particularly bad in some parts of the country and in some specialties. The hon. Member for Halesowen and Rowley Regis (James Morris) spoke about psychiatry. According to the survey published by the Royal College of Psychiatrists earlier this week, the numbers of psychiatrists vary significantly around the country, with some areas disturbingly short.

We often talk about doctors and nurses in this House, but so many other people work in the NHS. Allied health professionals, caretakers, orderlies and all sorts of other people are affected by the cap, many of whom are on very low pay. I want to give a particular shout-out to paramedics in the east of England, many of whom regularly work very long shifts and often get home utterly exhausted after dealing with traumatic events. I pay particular tribute to the 70 staff from the East of England Ambulance Service NHS Trust who have signed up to become blue light champions to highlight the importance of mental health among that organisation’s workforce. That has been done with the support of Unison and the involvement of Mind, which does really important work with frontline workers.

When we talk about pay levels in the NHS, we should also think about pay levels in social care. Non-payment of the minimum wage is endemic in many parts of the social care system, which is intolerable. Too many workers who provide care in people’s homes are still not properly paid for travel time. Information I got from Her Majesty’s Revenue and Customs recently showed that millions of pounds of unpaid wages had been recovered following an exercise in social care. When we talk about the need for a fair deal for NHS workers, we also need to talk about a fair deal for people working in social care, who do often very unattractive but vital work.

[Danielle Rowley (Midlothian) (Lab)]

The right hon. Gentleman mentioned public sector workers more widely. In Scotland, despite voting not to scrap the cap in May, the Scottish National party Government have now listened and done so. However, public sector workers in UK bodies in my constituency and across Scotland are still left out, and will continue to be left out by the recent Tory announcement to lift the cap selectively. Will he join me in urging the Government to value and properly pay all public sector workers across the UK and ensure that none is left behind?

[Norman Lamb]

I agree that we have to treat people with justice across the public sector to ensure that they are not unfairly and unreasonably left behind.

On the comments made by the hon. Member for Totnes (Dr Wollaston), behind this issue is the inescapable question of the amount of money that we are putting into health and care services, because that ultimately determines how much we can pay and how many people we can employ. The bottom line is that we cannot carry on as we are; it is not sustainable. We are not being honest with the British people. The truth is that, at the last election, none of the political parties had a solution for the NHS and the care system. I was challenged earlier about the fact that the Lib Dems argued for a 1p increase in income tax. I absolutely acknowledge that that is not a panacea and would not solve all the problems, but it would provide an immediate £6 billion, which would have a big impact on the sustainability of the system.

The bottom line is that we need to work together across the party divide. If we do not, we will be letting down the people of this country. We can continue to shout at each other, but that does not help the family whose loved one is let down by failures of care because the NHS and the care system do not have sufficient resources. More than 1 million older people have care needs that are not being met because of the underfunding in social care. As the Independent Age UK survey showed, well over 80% of Members of Parliament, on both sides of the House, agree that we need to work together to come up with a long-term, sustainable solution. Please, Government, get on with it.

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[Kwasi Kwarteng]

That was a fair intervention, but I completely disagree with the hon. Lady’s point. The deficit had nothing to do with the then Secretary of State for Health. It was not the previous Secretary of State for Health who caused the £160 billion deficit the Government inherited in 2010. Naturally, when running a huge deficit—I think it was something like 12% of GDP—one has to find savings in the budget. The question I pose to Labour Members is, how would they find the extra money? There are only two ways to do that: the Government can either raise the money through taxation, or the Chancellor has to borrow the money. It is very unclear to me what the Labour party proposes to do to increase the pay of public sector workers. No doubt it will have a plan to increase it by 5% or 10%—I do not know by exactly how much it wants to put up public sector pay—but it would have to fund that. I looked at the Labour election manifesto and I think it spent the tax on people earning over £80,000 about 10 times over to fund their various projects and policies.

We cannot go on kidding ourselves and kidding the British people. I very much like the point made by the right hon. Member for North Norfolk about the fact that we have to be serious about how we are going to fund the NHS and social care provision. He described the current model as—his word—unsustainable. I do not share that view—I think we can fund the NHS adequately for the rest of the Parliament—but his general message was right. It does not make any sense for Labour Members to scream, holler and shout about Tory cuts without having a serious proposal.

[Norman Lamb]

To work together in a constructive, rational and mature way requires the Government to agree to do it. We are still waiting. I met the Prime Minister in February. Please make a decision.

[Kwasi Kwarteng]

I am not privy to the conversations the right hon. Gentleman has had with the Prime Minister—that is something he might wish to take up with her—but this is a serious debate. As he said, we cannot be honest with people on this issue if we are simply screaming and shouting across the Dispatch Box.

Conservative and Opposition Members have made the point that we have extremely impressive professionals across the public services. The level of public service provision here in Britain is right at the top of the global rankings. I have spent time in Europe, Africa and across the middle east. The public services we have in Britain are really world class and we must never lose sight of that in these discussions. The nature of the debate has been very fruitful and we have had a measure of courtesy, but it does not make sense simply to holler “Tory cuts.” That is what I have heard in seven years of trying to address what are very serious problems.