PARLIAMENTARY DEBATE
NHS Strikes - 17 April 2023 (Commons/Commons Chamber)

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the impact of the junior doctors’ strikes and what steps he is taking to prevent further strike action in the NHS.

I am grateful to the hon. Gentleman for his question. On its first part, we will not have firm figures on the number of patient appointments postponed until later today, because the NHS guidance has been to allow trusts a full working day to collate the data on those impacts. We do know from the previous three-day strike that 175,000 hospital appointments were disrupted and 28,000 staff were off. There is an initial estimate that 285,000 appointments and procedures would be rescheduled, but it is premature to set out the full impact of the junior doctors’ strike before we have that data. I am happy to commit to providing an update for the House in a written statement tomorrow. In the coming days, I will also update the House on the very significant progress that has been made on the successful action taken over recent months to clear significant numbers of 78-week waits, which resulted from the covid pandemic.

It is regrettable that the British Medical Association junior doctors committee chose the period immediately after Easter in order to cause maximum disruption, extending its strike to 96 hours and asking its members not to inform hospitals as to whether they intended to strike, thus making contingency planning much more difficult. Let me put on record my huge thanks to all those NHS staff, including nurses and consultants, who stepped up to provide cover for patients last week.

I recognise that there are significant pressures on junior doctors, both from the period of the pandemic and from dealing with the backlogs that that has caused. I do want to see a deal that increases junior doctors’ pay and fixes many of the non-pay frustrations that they articulate. But the junior doctors committee co-chairs have still not indicated that they will move substantially from their 35% pay demand, which is not affordable and indeed is not supported by those on the Opposition Front Bench.

Let me turn to the second part of the hon. Gentleman’s question and the steps we are taking to prevent further strike action in the NHS. We have negotiated a deal with the NHS Staff Council; it is an offer we arrived at together, through constructive and meaningful negotiations. It is one on which people are still voting, with a decision of the NHS Staff Council due on 2 May. The largest union, Unison, has voted in favour of it, by a margin of 74% in favour. So we have agreed a process with the trade unions, which I am keen to respect, and we should now allow the other trade unions to complete their ballot, ahead of that NHS Staff Council meeting on 2 May.

Thank you, Mr Speaker, for granting this urgent question.

Finally, the invisible man appears; the Secretary of State was largely absent last week during the most disruptive strikes in NHS history. He was almost as invisible as the Prime Minister, who previously said he does not want to “get in the middle” of these disputes—what an abdication of leadership during a national crisis. An estimated 350,000 patients had appointments and operations cancelled last week—that is in addition to the hundreds of thousands already affected by previous rounds of action. Having failed to prevent nurses and ambulance workers from striking, the Government are repeating the same mistakes all over again by refusing talks with junior doctors. Patients cannot afford to lose more days to strikes. The NHS cannot afford more days lost to strike. Staff cannot afford more days lost to strikes. Is it not time for the Secretary of State to swallow his pride, admit that he has failed and bring in ACAS to mediate an end to the junior doctors’ strike?

Last week also saw the Royal College of Nursing announce new strike dates with no derogations and a new ballot. What does the Secretary of State plan to do to avert the evident risks to patient safety? Government sources briefed yesterday that they are prepared to “tough it out”. That is easy for them to say. Will the Secretary of State look cancer patients in the eye, while they wait for life-saving treatment, and tell them to tough it out, as they are the ones who will pay the price for his failed approach?

Finally, writing in The Sun on Sunday, the Secretary of State said that he is worried about patient safety, but he offered no plan to get this matter resolved. He is not a commentator; he is nominally the Secretary of State for Health and Social Care with the power and responsibility to put an end to these strikes. When will he put his toys back in the pram, stop blaming NHS staff, sit down with junior doctors and negotiate a fair resolution to this terrible, damaging and unprecedented dispute?

The shadow Secretary of State seems to ignore the fact that we have negotiated a deal with the NHS Staff Council, and it is a deal that it has recommended to its members. Indeed, the largest health union has voted in favour of the deal—indeed it is his own health union that has voted in favour of it—and yet he seems to suggest that we should tear it up even though other trade unions are voting on the offer, and their leadership had recommended it.

Secondly, the shadow Secretary of State says that we should sit down and negotiate. We have made an offer of 10.75% for last year, compared with the Labour Government in Wales, who have offered just 7.75%, which means that, in cash terms, the offer in England is higher than that put on the table by the Welsh Government, whom, I presume, he supports. He says that he does not support the junior doctors in their ask of 35%, and neither does the leadership there. We need to see meaningful movement from the junior doctors, but I recognise that they have been under significant pay and workforce pressures, which is why we want to sit down with them.

The bottom line is that the deal on the table is reasonable and fair. It means that just over £5,000 across last year and this year will be paid for a nurse at the top of band 5. The RCN recommended the deal to its members, but the deal was rejected by just under a third of its overall membership. It is hugely disappointing that the RCN has chosen not to wait for the other trade unions to complete their ballot and not to wait for the NHS Staff Council, of which it is a member, to meet to give its view on the deal. It has chosen to pre-empt all that not only with the strikes that come before that decision of the NHS Staff Council, but by removing the derogations—the exemptions—that apply to key care, including emergency care, which is a risk to patient safety.

Trade unions are continuing to vote on the deal. The deal on the table is both fair and reasonable, including just over £5,000 across last year and this year for nurses at the top of band 5. The deal has been accepted by the largest union in the NHS, including, as I have said, the shadow Health Secretary’s own trade union. It pays more in cash to Agenda for Change members than the deal on the table from the Labour Government in Wales. It is a deal that the majority of the NHS Staff Council, including the RCN’s own leadership, recommended to its members. We have always worked in good faith to end the disruption that these strikes have caused and we will continue to do so. None the less, it is right to respect the agreement that we have reached with the NHS Staff Council and to await its decision, which is due in the coming weeks.

I call the Chair of the Select Committee.

Reports over the weekend suggest that the British Medical Association has asked its members not to engage with trusts if they intend to strike, as the Secretary of State has confirmed today. That is putting trust chief executives—and this is not their fault—in an impossible position. They are being asked to meet very challenging targets that we are rightly setting them, not least with respect to the covid backlog. What more can he do by his good offices to break that impasse? It is patients who are losing out.

I agree; it is extremely surprising that the BMA has asked its members not to liaise with NHS managers as they put in place those contingency plans. I urge the BMA junior doctors committee to think of those colleagues who have to provide the cover for those strikes. I reaffirm my thanks to all those staff in the NHS who provided cover following the Easter period, but it puts more pressure on other NHS staff if the BMA junior doctors committee is not willing for its members to liaise with management on sensible contingency measures, as I urge them to do.

The bigger dereliction of duty by the Secretary of State is not addressing the retention crisis among junior doctors, who have the choice of going to New Zealand or Australia, to be paid more than double what they receive now, or to move over to work as locums, where they will not carry the stress levels they currently do. What is he doing to address the retention crisis of junior doctors in the NHS?

In part, that is why my door is open and I am keen to discuss with junior doctors the pressure they face not just on pay, but on non-pay issues. There is the issue of support for the number of doctors and the workforce plan we have committed to bring forward to boost recruitment, but other non-pay issues are also frequently raised by junior doctors, such as booking annual leave and rostering. I am keen to work constructively with junior doctors to address those, but for us to do so they need to move from an unrealistic and unaffordable 35%, which the Leader of the Opposition himself has recognised is an unreasonable position.

The Secretary of State is right to say that the pay offer that has been put on the table, notwithstanding the junior doctors, is fair and reasonable. What should drive all parties in this situation is putting patients first, moving forward to address the serious challenges of recovering from covid and seeking to address the issues within the NHS. Everyone should be focused on patients first as this situation moves to a resolution.

I very much agree with my hon. Friend that this is a fair and reasonable settlement. As I say, it is more than £5,000 at band 5, and the NHS Staff Council has recommended it. The majority of trade unions, including the RCN, recommended this deal to their membership. That is why we should respect the NHS Staff Council process, respect the ballot that is still live and allow those votes to continue.

Has the Secretary of State seen the recent report on the BBC that billions of pounds—my words, not the BBC’s—are being squandered on agency labour from private providers, with huge profits being generated? Is it right that one doctor alone received £5,200 for a single shift, as was reported by the BBC? What does the Secretary of State think the impact of that would be on his own staff? How can it be right for him to use bellicose language about the staff associations and unions while larding money into the pockets of the private agency providers?

One of the concerns at the moment is the BMA rate card, which is significantly increasing the cost of providing the required cover for the strikes, and in turn taking money away from things NHS staff have raised with me, such as improving our tech offer, improving the NHS estate and the many other priorities on which money could be spent. I am keen, as I am sure the hon. Gentleman is, to bring down the cost of agency workers. That is why we have the commitment to the NHS workforce plan and why I am keen to sit down constructively with the junior doctors committee, in the same way that I did with the NHS Staff Council. After we reached our deal, the leader of those negotiations for the trade unions commented on the meaningful and constructive approach that we took with the Agenda for Change negotiations. We are keen to do the same with the junior doctors, but that has to be based on a reasonable opening position from them.

When union bosses open their pay demands at 19% for nurses and 35% for junior doctors, is it any wonder that some ordinary members feel let down when they have been asked to settle for a generous and fair 5%? Would it not be far better if the BMA junior doctors committee revised its ludicrous demand for 35%, got around the table and did its members some service by negotiating for a fair and reasonable pay offer?

I agree with my hon. Friend. The fact that even the Labour party does not support 35%—the Leader of the Opposition himself says that is not affordable —indicates how out of step the junior doctors committee co-chairs are on what is realistic to get the balance right in bringing down inflation and on the wider economic pressures we face. We stand ready to engage constructively with the junior doctors committee but, as my hon. Friend says, that has to be on the basis of a meaningful opening position.

On 5 July, the British public will want to celebrate 75 years of our amazing NHS, but if they are still feeling the brunt of NHS strikes at that time, does the Secretary of State think it would still be right for him to be at the Dispatch Box?

We have agreed an offer with the Agenda for Change staff council. That is something that the staff council and the majority of trade unions have recommended to their own members, and that the largest health union has voted in favour of. I think we should allow that ballot to take place; it reflects meaningful and constructive engagement. That was reflected in the fact that trade union leaders themselves recommended the deal to their members. I hope that, when we come to the 75th anniversary, we can celebrate that.

What actions are senior NHS managers taking to resolve non-pay issues for which they could offer better work experiences to doctors? What use can they make of flexibilities over pay increments, promotions and gradings so that good staff can be better rewarded?

As ever, my right hon. Friend raises an extremely important point. As part of the negotiation with the AfC staff council, a number of non-pay issues were discussed. Job evaluation is one such issue. Likewise, for junior doctors, areas such as e-rostering are extremely important. I share his desire for investment in technology, and to look at the time spent by clinicians that could be spent by others in the skills mix or through better use of artificial intelligence technology and a better estates programme. That is why it is important that we continue to have that funding, as well as reaching the offer that we have with the AfC staff council.

Nurses, junior doctors and paramedics do not take strike action lightly; it is a last resort after more than a decade of working harder and longer for less and less. The Secretary of State will say that there is no money for a fair pay deal, but that is not true: it can be paid for by taxing the richest and redistributing the wealth. Ending non-dom status would raise £3 billion; introducing a 1% tax on assets worth over £10 million would raise £10 billion; and equalising the capital gains and income tax rates would raise £14 billion. What do the Secretary of State and Conservative Members prefer: nurses having to use food banks, or taxing the richest and making them pay their fair share?

The odd thing is that the hon. Lady seems to be disagreeing with the trade union leadership, which is not her usual position. Unison described it as a “decisive outcome” when 74% of its members voted in favour of the deal. It is odd that she wants to deny the GMB and other trade unions the space to vote on what their leaders have recommended—the GMB leadership has also recommended the deal to its members. Even the RCN leadership recommended the deal to its members. As Pat Cullen herself said:

“Negotiations work by compromise and agreement. We did not get everything and nor did the government. Ministers made improvements every day of those three weeks because we were able to say that returning to striking was the clear alternative. No union could enter negotiations and flatly say ‘no’ until you get everything you want. These talks will not be reopened if members reject this pay offer.”

The leadership of the RCN recommended the deal, as did the leaderships of the GMB and Unison. It is odd that the hon. Lady does not want to recognise that.

It is ironic to hear the British Medical Association complain about staff shortages when it has in the past resisted the expansion of training places for doctors. When there have been disputes in the health service, those involved have always taken steps to ensure that lives were not endangered by the dispute. That appears to be no longer the case. That is, to my mind, a dereliction of professional duty. Will my right hon. Friend send the strong message to those involved that preserving life is a professional duty that must be maintained?

My right hon. Friend is absolutely right to focus on patient safety and the duty that all involved have to safeguard it. Indeed, I have previously given the Royal College of Nursing’s leadership credit and praise for granting strike exemptions, known as derogations—notwithstanding our disputes, I was happy to recognise that on the record. Given that less than a third of the RCN’s total membership has voted against the deal, and that the RCN’s leadership recommended it, it is very odd that it has now hardened its position and removed those exemptions. I very much hope that it will reflect further on the matter in the coming days, because I think its previous stance of granting exemptions was right.

We need to be clear: junior doctors have had a 26% real-terms pay cut. Restoring their pay would cost around £1 billion a year. That is less than half the giveaway handed to the super-rich through the non-dom tax avoidance scheme. Is it not the case that a proper pay rise for junior doctors is affordable—it is just that the Government have the wrong priorities?

It perhaps will not surprise the House to hear that the hon. Gentleman disagrees with his party’s leader on that, because the Leader of the Opposition says:

“I don’t think 35% is affordable”.

The hon. Member for Leeds East (Richard Burgon) is also wrong on the quantum, because the cost would be £2 billion, not £1 billion as he says. [Interruption.] Well, that has never been how departmental budgets operate—not when his party was in power, and certainly not now. He is wrong on the amount and wrong on the policy.

Given that the terms “emergency care” and “intensive care” imply that the life of those who need them is at risk, does my right hon. Friend share my dismay that people in that predicament are now clearly being targeted by strikers? Will he—and hopefully his Opposition counterpart—represent to the medical unions that whatever other strike action they take, they should not endanger the life of people in emergency or intensive care?

My right hon. Friend makes an extremely important point. Patient safety should come first for all parties in this dispute. That is why I urge the Royal College of Nursing to wait for the NHS Staff Council decision on the offer. Voting is still ongoing, and it would be premature to announce strike action ahead of that decision.

Nurses and junior doctors are being pushed to breaking point, because there simply are not enough of them, and the Government have failed to plan the workforce properly. A nurse I spoke to at the weekend told of the terrible queues in corridors, and said that patients were waiting in pain, and not in the dignified environment that they should be in. She also spoke of the lack of care packages to enable the safe discharge of many patients. Why are we still waiting for the NHS workforce plan, which the Government promised? Can the Secretary of State tell us on what date we can expect to hear a statement on it? Also, what urgent action will he take to address the social care crisis?

On social care, which relates to the hon. Lady’s point about discharge, she will recall that in the autumn statement the Chancellor put additional funding into adult social care—funding of up to £7.5 billion over two years, which is the largest ever increase in funding for social care. Also, I announced at the Dispatch Box in early January a reprioritisation of funding in the Department—it was a £250-million package—in the light of urgent and emergency care pressure. That included funding to support greater discharge, to get more flow. I touched on the workforce plan earlier. We will publish it shortly; in the autumn statement, the Chancellor committed to doing so.

Does my right hon. Friend agree that the BMA pay demands are over four times the average private sector pay increase and that, were the Government to agree to them, they would place a huge additional tax burden on hard-working taxpayers across the country—including in Southend West—at just the time when they are battling with an unprecedented cost of living crisis?

I do agree with my hon. Friend. If that demand were agreed to, it would mean some junior doctors receiving a pay rise of over £20,000. We need to find a balance, with a fair and reasonable settlement for NHS staff, recognising the huge pressure from the pandemic and the backlogs it has caused, while at the same time bringing inflation down, because that matters not just to NHS staff, but to all working people who are impacted by inflation.

The BMA has made it crystal clear that it is willing to enter into negotiations, so will the Secretary of State commit right now to asking ACAS to negotiate and mediate? If not, why not?

As I have said, we need to see meaningful movement from the BMA. The 35% demand that it has set out is not affordable, which is a point that is recognised by most colleagues across the House—certainly, Opposition Front Benchers recognise it. We need to see significant movement from the BMA to be able to have constructive and meaningful engagement.

I welcome the Secretary of State’s acknowledgement that junior doctors deserve a pay rise, and not just because my wife is a junior doctor, and his focus on non-pay issues. For all the talk about ACAS from Opposition Members, is it not the case that so long as the BMA leadership maintain that their starting point is 35%, there is no point in going to ACAS, because the BMA is not prepared to negotiate? It is setting its face against the interests of doctors and patients. The only way to get through this is to get around the table with a meaningful starting point, and that cannot be 35%, as the Leader of the Opposition has said.

I very much agree with my hon. Friend, and he is right to highlight the wider issues that we want to discuss. The previous negotiation with the junior doctors included, for example, setting up a higher pay band, which has meant that there has been a cumulative increase of over 24% over four years. It included targeted action such as a £1,000 a year allowance for junior doctors who work less than full time, and targeted action around unsocial hours and weekend work. Those are the meaningful discussions that we want to enter into with junior doctors, but that has to be on the basis of a realistic and deliverable discussion, and 35% is not that.

I am not sure the Secretary of State understands just how angry people are. My constituents are absolutely furious with the Government’s stewardship of the NHS. Hull is the most under-doctored area in the country; we have the longest waits in A&E in the country; and we have had a very poor Care Quality Commission report on our local hospitals. On the junior doctor strikes, when will the Secretary of State start to put patients first? I want to make sure that he goes away from this Chamber and gets ACAS involved, so that we can get the junior doctors back at work, with no further delays and cancellations for my constituents and patients in Hull.

The rather odd thing is that we have a larger cash offer on the table for 2022-23 than the Labour Government in Wales, and we have reduced our longest waits far more than they have in Wales. We have a deal that the trade union leaders themselves have recommended, that the majority of staff councils have recommended and that the largest health union has voted emphatically in support of. It is right that we allow time for that deal to go through, and we stand ready to have similar meaningful and constructive engagement with the junior doctors once they move from what is an unrealistic position.

Regulars in this Chamber will know that Opposition Members have habitually taken to urging Ministers to adopt their own policies. Does the Secretary of State share my difficulty that, in respect of this urgent question, none of us has any idea what their policy is?

In short, the position of the shadow Health Secretary seems to be to deny the vote of his own union, Unison, which voted 74% in favour; to not wait for the NHS staff council to reach its decision; and to unravel to some extent what has been meaningful and constructive engagement with the “Agenda for Change” staff council. My right hon. Friend is right to be confused about the Opposition’s actual position.

I can see at least two other Members in the Chamber who know from personal experience that early diagnosis and treatment of cancer can save lives. I very much hope that any action taken over the next few weeks will not affect that, because that could mean people losing their lives before their time.

I have two significant worries about the long-term future of the NHS. One is seeing so many people, including those from poor constituencies and poor families, using all their life savings to buy an operation, because they know that that is their only means of getting back to work as there is such a long backlog. That feels like a form of privatising the NHS.

Secondly, there are terrible problems with recruitment and retention, with more than 110,000 vacancies in the NHS. I really hope we will see the workforce paper soon. It has been promised for a very long time, and I suspect “summer” may go on until autumn—it tends to every year, I suppose. It would be good to see that paper soon, because there are so many different parts of the NHS where we need to recruit more people. Everybody in this round is worrying, “Will the NHS be worth working for in 10, 15 or 20 years’ time?”. We can only do this if there is real confidence in the future.

The hon. Gentleman makes two important points. The workforce plan is critical, and I have referred to that already. He also raises the importance of early diagnosis of cancer, and he is absolutely right on that. He will have seen that the faster diagnosis standard was met in the latest operational performance data for February, which was extremely welcome news. There is obviously more still to do. That is why we are rolling out the programme of diagnostic centres and surgical hubs. We are redesigning patient pathways to streamline those journeys, and we are looking at variation in performance on such things as faecal immunochemical tests. There is a huge amount of work, but I hope he can see some progress in the latest figures.

More widely in terms of elective recovery, we made progress in the summer on the two-year waits, in stark contrast to Wales, which was significantly above 50,000. We got it under 2,000 in the summer. I will update the House shortly on the 78-week waits. We are working through the key actions in our elective recovery plan as we deal with the consequences of the build-up from the pandemic.

We all recognise how hard junior doctors work, but if we are to have successful negotiations, we need honesty and integrity in them. Does the Secretary of State share my concern that the BMA’s figure—its central campaign claim—of £14-an-hour pay for junior doctors has been shown to be misleading?

I do share my hon. Friend’s concern. Full Fact has shown that the figure is inaccurate. It disregards higher pay later in the evenings and at weekends. It ignores the 20% that goes into pensions and that junior doctors, probably more than any other profession, have very quick pay and career progression. That is why, as part of our listening exercise, we made changes to pensions in the Budget. That was a reflection of the fact that senior doctors have often accumulated those pension pots, which is one of the other challenges we are dealing with. It is an indication of the career and pay progression that many junior doctors will see later in their careers.

I thank the Secretary of State very much for his endeavours to find a pay settlement, ever mindful that it is more than pay that some NHS staff wish to see. To give an example of that, I recently sat listening to one of my constituents who is in foundation year 1. She was brought to tears by the stress and pressure on her young shoulders. When she finally finishes shifts, she lies awake going over the decisions made. In her view, she would keep her pay the same to have more qualified staff available. How will the Secretary of State’s proposals make adequate support on the wards possible?

The hon. Gentleman raises an important issue, and there is a lot more we can do around the skills mix in the NHS and ensuring that people operate at what is referred to as the top of their licence and make the maximum of the training they have. Often there are restrictions in place. We are looking at physician associates and medical examiners and at the role of pharmacists within primary care, as well as at how we get the right continuing professional development to train people, so that we get more of the career ladder from different roles.

There is a lot that we are looking at, in the context of the workforce plan, around the right skills mix, the right training and job evaluation. That was one of the issues in my discussions with the staff council—for example, there was a particular focus on apprenticeships. Sometimes people take a pay hit when they go into an apprenticeship if they were at the top of their previous band. That is one of the things we agreed to work on with the staff council. Again, I am sure that an area of consensus in the House will be that apprenticeships offer great opportunities for people to progress, and we should not have a financial penalty when people pursue them.

Many hon. Members have raised extremely important points, but the central issue is that the reckless and irresponsible actions of two trade unions are putting the lives of my constituents and people throughout the country at risk. The right to strike can never trump people’s right to receive healthcare and not have their life threatened by the actions of left-wing trade unions. Can I ask what my right hon. Friend is going to do to address this issue and to hold trade unions to account if they continue with this appalling behaviour?

I share my hon. Friend’s concern. We have worked constructively with the Royal College of Nursing and, as I say, I was happy to put on the record my acknowledgment of the exemptions it had previously granted. I hope that between now and the end of the month, it will further reflect on the fact that the 48 hours of continuous strike action will happen without consultation with other staff council members and without waiting for the decision of other trade unions that are currently balloting. He will know that “Agenda for Change” is a deal that covers all the trade unions, not just the RCN in isolation, and I think it is right to wait for all the trade unions to vote and for the staff council to meet.

I draw the attention of Members of the House to my entry in the Register of Members’ Financial Interests.

On Friday, I was working at the hospital and my usual clinic had cancelled all but one patient. I spoke to the secretaries about the various cancellations they had had to make as result of the strikes, and I was really sad to hear not only that they had often been verbally abused by people who were upset, but that they have had to cancel some patients on two occasions because of the earlier strikes and the more recent ones. I was also sad to hear that we are looking at further strikes in the next few weeks.

Will the Secretary of State join me in thanking the members of staff who came into work, who did not strike and who continue to deliver a very important and valuable service? What is he doing to expedite the legislation on minimum service guarantees, so that we do not have any implications from strikes on emergency and intensive care in particular?

First, I thank my hon. Friend for her service and for the work she was doing on Friday. I join her in putting on the record my thanks to all those staff who did provide cover, as I said in my opening remarks. She is right to highlight the minimum service legislation, and we will obviously need to reflect on recent events in that context. She also points to the fact that the decision by the BMA junior doctors committee to advise members not to notify hospital management about whether they were striking obviously made it more likely that clinics would be cancelled, even when it then transpired that doctors could have provided cover. That is clearly regrettable and indicates the need for resolution, and we want to work constructively with the junior doctors on this.