PARLIAMENTARY DEBATE
NHS Industrial Action: Government Preparations - 12 December 2022 (Commons/Commons Chamber)

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on Government preparations for industrial action in the NHS.

I am grateful to the hon. Member for his question, which I am taking on behalf of the Department as the Secretary of State is attending a Cobra meeting on contingency planning for industrial action in the NHS. He also came before the House on the subject twice last week: at departmental questions and for the Opposition day debate.

We are all hugely grateful for the hard work and dedication of NHS staff, so we deeply regret that some union members have voted for industrial action. Our priority must be to keep patients safe. That begins with keeping the door open. The Secretary of State wrote to the Royal College of Nursing on Saturday asking for further discussions as a matter of urgency. At the same time, we are working with the NHS to minimise the disruption to patients if the strikes do go ahead. We are engaged with providers, professional bodies and trade unions to agree safe levels of cover should any action take place.

In addition, this afternoon, Ministers—including the Secretary of State—are attending a Cobra meeting focused on our contingency plans. Our plans draw on extra support from a range of places, including service personnel and the private sector. While we aim to minimise disruption, with the NHS already under significant pressure from the covid pandemic and winter pressures, we remain deeply concerned about the risk that strikes pose to patients.

I want to be clear that, even at this moment of uncertainty, people must keep coming forward to get the care that they need. People should continue to use NHS 111 if they need medical help and dial 999 in the event of an emergency. For more routine treatment, hospitals will do everything they can to ensure that planned procedures go ahead, but it is inevitable that any strike would mean some patients would have their treatment delayed. People will be contacted if their appointments need to be changed.

It is our hope that patients can be spared from unnecessary and unjustified strikes. Industrial action is in no one’s best interests, especially in this difficult winter. We have had constructive meetings with the leadership of several unions, including the RCN, Unison, Unite and the GMB, and we look forward to further discussions to find a way forward together that is in the best interests of the patients we all serve.

Thank you, Mr Speaker, for granting this urgent question. The power to stop these strikes likes squarely with the Government and the Secretary of State. The Royal College of Nursing and Unison have said that they will call off strikes this week if the Government are willing to negotiate with them seriously on pay. That reasonable offer of compromise is surely too good to refuse, so what on earth are the Government playing at? After 12 years of Conservative government, patients can no longer get seen on time and staff have been pushed to breaking point—and the Government cannot even be bothered to try to negotiate to prevent strikes from going ahead, at the worst possible time for patients and the NHS. The Government should ask themselves why, under a Conservative Government, nurses feel they have to take industrial action for the first time in more than 100 years and why ambulance workers are set to follow them for the first time since 1989.

It should be obvious by now what the Conservative agenda is. The Government know that patients are going to suffer this winter and they have no plan to fix the problems of their own making, so instead of taking responsibility for their failure they want to use nurses and paramedics as scapegoats to avoid the blame. It is a disgusting plan, it is a dangerous plan, and it is a plan that will not work. The public know that the power to stop these strikes is in the Government’s hands. If they fail to act now, patients will never forgive them.

How many operations have already been cancelled? How does the Minister expect those on the waiting list to feel if their operations are cancelled because of the Government’s gross negligence? Can he tell patients which services will be impacted if these strikes go ahead? Is the Secretary of State not embarrassed at Cobra today, asking the Army to come in to clean up the Government’s mess?

Even at this last minute, it is not too late to prevent strikes from going ahead. Perhaps the Minister can tell us whether the meeting with the RCN later today will involve discussions on pay. And if not, why not? Because that is all it takes: just a few minutes or a few hours of talk can avoid strike action. Why will they not do it?

The fact is that Labour is all over the place when it comes to strikes. They criticise Ministers while admitting that the unions’ pay demands are unaffordable. The hon. Gentleman and his party leader are too tied to their union paymasters to be on the side of patients. He knows that we have an independent pay review body, and is important that both sides respect that independent body. We accepted the independent body’s recommendations for this year’s increase in full, meaning that over 1 million NHS staff have been given at least a £1,400 increase in their pay. That is on top of a 3% pay rise last year at a time when pay was frozen across the wider public sector. The RCN, one of the unions taking action, is asking for an increase that is 5% above the retail prices index. Based on latest figures, that is an increase of 19.2%, or the equivalent of 6.5% of the NHS budget. To meet such demands, we would have to take money away from clearing the elective backlog that the hon. Gentleman referred to, something no responsible Government would wish to do.

Throughout this period, we have always sought to have a balanced process. Those in the private sector will not be getting a 19% uplift, and there is a clear need to be fair to the wider economy. We have to avoid inflationary pressures that would make us all poorer in the end.

We will continue to listen to colleagues’ concerns, not just about pay but many other issues affecting the working lives of those in the NHS. We will work with them to make improvements in a range of areas, from working conditions to patient safety, because we believe there is so much that we can agree on. Strike action is in no one’s best interest. We will keep working so that the NHS continues to be there for those who need it most.

I call the Chair of the Health Committee, Steve Brine.

With your indulgence, Mr Speaker, may I send our heartfelt sympathies to the parents of the little boys who have lost their lives in the west midlands overnight and say thank you to the emergency service workers, many of whom will have been from the NHS? I am sure they have done their best for those they pulled out and those they were unable to save.

The Minister is right that we have an independent pay review process, but it seems that we are coming to an interesting junction point: either we believe in an independent pay review process, or we do not. We cannot be in a situation where everything is agreed until it is simply not, and then Ministers are negotiating pay. That is not what Ministers do.

I am glad the Minister mentioned patients them at the end of his remarks. We must keep them as our focus. I have more information about my train services over the next few weeks than I do about health services. Is the Minister satisfied that patients have enough information about what is being affected and when, and how much it will impact on the backlog? I suspect none of this will help the workload pressures that are impacting our NHS.

I thank my hon. Friend for his question, and I echo his comments on the tragic events in Solihull, the boys who lost their lives and the heroic actions of those in the emergency services.

My hon. Friend is also right to say that we have an independent pay review body, and we either agree and accept that that is the process, or we do not.

On advice to the public, my hon. Friend is right that we have more to do in this space. Derogations are still being worked through with both individual unions and trusts. Patients should continue to call 999 as normal if it is an emergency and someone is seriously ill or injured. If they do not have life-threatening conditions, they should use NHS 111. Ambulances will still be responding to 999 calls. If patients have appointments, they should please turn up unless advised not to do so. He is right to make the point about communications, and I will be ramping this up when we know more about derogations.

I call the SNP spokesperson.

Scotland’s First Minister has managed in one day to do what the Tory Government could not—agree with the nursing unions to call off strikes planned for this month. NHS workers are the backbone of these countries. If they do not work, the country does not work, and if the country is not working, it is broken. Britain is broken, is it not? And Brexit has broken Britain, has it not? The Tories will not negotiate and the Labour Opposition spokesperson has branded the British Medical Association as “hostile”, while in Scotland the strikes are off, and they are off permanently. An offer of 7.5% has been negotiated and agreed, with an 11.24% pay rise for the lowest paid across the board in NHS Scotland. Why are the UK Government refusing to give public servants a decent pay increase when they have all the financial power to do so?

I thank the hon. Gentleman for his question. My understanding is that the industrial action in Scotland has been suspended, not cancelled, as the hon. Gentleman suggested. The Scottish Government have made a considerably higher offer, partly because a politician has got involved in pay negotiations, directly in contrast to the independent pay review body, and it will be interesting to see whether the First Minister of Scotland is going to do this every single year and go against the recommendations of their pay review body.

Would the hon. Gentleman like to confirm—I appreciate he cannot do it now—whether the Scottish Government have also looked at things such as leave and working times? I think it is important to stress that every 1% increase for the “Agenda for Change” workforce equates to about £750 million. That is £750 million that will come out of the NHS budget and that we will not be able to spend on things such as tackling the elective backlog, which is so important to people up and down the country.

Our military actually enjoy stepping in when a Government Department occasionally cannot manage, such as with flooding and so forth, or on rare occasions when a strike takes place. However, what we are seeing this month is unprecedented, with so many sectors choosing to strike exactly at the same time, and this places a huge burden on our armed forces. Could I ask the Minister, first, whether all the units that may be required to mobilise have been informed already, and whether, if we are going to see strikes at this level, it is now time for Departments to introduce minimum service levels to make sure that our armed forces are not overwhelmed?

Representing the garrison city of Colchester, I have nothing but the utmost respect for our armed forces. It has not escaped my notice that many of them are on lower pay than NHS staff and will be giving up their time over Christmas to cover strike action. My right hon. Friend is right that to mitigate the impact of planned industrial action in the ambulance sector, NHS England has explored a range of measures, which include engaging with the Ministry of Defence on military support. As a contingency, a MACA request—a request for military aid to civil authorities—for a limited number of personnel has been submitted to the MOD. It was submitted at the end of last week, and the plan is that MOD personnel will be trained to drive ambulances, but only deployed where they are needed across the country.

The Government need to stop hiding behind the pay review body. The pay review body sorts out the distribution of the funding, while it is the Government who determine the size of the envelope, and it is the envelope that is in dispute. Why will the Minister not get a Treasury Minister alongside him and make sure they negotiate on the size of the envelope? If they can afford the right hon. Member for South West Norfolk (Elizabeth Truss), they can afford a nurse.

The average pay settlements in the private sector range between 4% and 6%, and we want to have a fair deal for both NHS staff and the taxpayer. The hon. Lady makes reference to the pay review bodies, but it is important to stress that they are made up of independent experts. They recommended the uplifts for NHS staff, and in formulating their recommendations, the review bodies carefully considered evidence from a wide range of stakeholders, including NHS system partners and trade unions. The independent pay review body is a respected mechanism, and we should accept its recommendations, which we have.

May I commend my hon. Friend on his response to the urgent question, and say how much I agree with him? Can he set out his thoughts on how things would be likely to proceed in the NHS if we ended up in the scenario which the shadow Secretary of State appears to want, in which Ministers negotiate directly with unions on pay every winter? Does he think that that would lead to upward pressure on pay at the expense, crucially, of the public, whom we serve and who need those operations and the elective care for which we have budgeted, and that that should not be eroded by unrealistic pay demands of 19%?

My right hon. Friend is right. We have an independent pay review body mechanism for a reason, and it has worked for a number of years. That is why I made reference to the First Minister in Scotland. Is this a procedure we are going to go through every single year when a pay review body recommendation is made and unions do not like it, and politicians have to get involved? The point of the independent pay review body is that it depoliticises the issue, and Ministers do not negotiate directly with unions. The independent pay review body looks at the issue in the round, along with the wider economy and a number of other factors, then forms a recommendation which the Government can choose to accept or refuse. It is important to stress that in this case the Government accepted the recommendations in full.

I was a nurse for 25 years. Nurses work long hours, day in, day out, to support people all over the country, often on very low pay. I know from experience how tough it can be, and it is shameful that many hospitals have opened food banks specially to feed their staff. Let us be absolutely clear: the power to stop these strikes, which nurses themselves do not really want, lies squarely with the Government. How can Ministers justify refusing to talk to the unions?

I thank the hon. Lady for her question and for her service as a nurse. We value hugely and appreciate all our NHS staff. We have given them a pay rise this year, on top of 3% last year, when pay was frozen in the wider public sector. As I have said a handful of times, we accepted in full the recommendations from the independent pay review body. Of course, I do not want to see anybody needing to use a food bank, let alone a member of our NHS. That is exactly why the Government have a broader package of support in place.

I have to take issue with one of the hon. Lady’s comments. She asked who held the power to call off these strikes. There is only one answer: the unions.

I have been out on shift with my local ambulance service, and have seen how hard it works and how important that work is. We are really grateful for what it does, and my constituents are worried. If the ambulance strikes go ahead, will the Minister explain which categories of call we will ensure are responded to?

We are currently having those derogation discussions with the unions, and they will also happen at an individual trust level. As my hon. Friend will know, having been out with her trust, 999 calls are triaged and categorised from category 1 to category 4, and on days of ambulance strike action it is likely that category 1 and category 2 calls, where there is an immediate threat to life, will be responded to. We are looking at ways in which we can provide additional support for category 3 and category 4, including things such as block-booking taxis and support through community healthcare, local authority fall services and community support.

The hon. Lady talks about NHS staffing levels; we have 1.2 million staff within our NHS, and compared with last year, we have 3,700 more doctors and 9,100 more nurses, and compared with 2019, we have 29,000 more nurses and 2,200 more GPs, but we do have high vacancies. That is why it will not have escaped her notice that we have commissioned NHS England to publish a long-term workforce plan, and that will be independently verified as set out by the Chancellor in the autumn statement.

Inflation is the real enemy here, because it makes us all poorer. We have a political and economic choice: we either tackle it, or we give in to an inflation pay spiral. The Minister was right to mention that the Royal College of Nursing pay demands are in excess of three times greater than the average private sector payment at the moment. Does my hon. Friend agree that public sector pay demands of almost 20% would embed inflation for years to come and make us all poorer?

My hon. Friend is absolutely right: granting double-digit pay rises would sustain higher levels of inflation and have a bigger impact on people’s income in the long term, as well as eroding the value of savings, which is important to many of our constituents.

These strikes are not just about pay levels; they are also about patient safety. NHS workers care deeply about their patients, and I stand in solidarity with them. Members of the Royal College of Nursing have told me how stressed and burned out they are because they do not have enough colleagues to work alongside them. That is dangerous and extremely unfair on both patients and staff, and it is the result of the failure of consecutive Conservative Governments to provide enough resources and training places and to carry out the necessary workforce planning. The Minister mentions the independent pay review body, but he knows full well that there is a role for Government in ending this dispute. Will his Government get around the table with the unions and avert the strike action?

The hon. Lady is right that this issue is about more than just pay. That is what the unions are telling us. It is about things such as staffing levels and working conditions. If that is indeed the case, let me repeat: my door is always open, and I would be happy, as would the Secretary of State, to discuss those issues with the unions at any point they would like.

Would there not be more money available for relatively poorly paid frontline NHS staff if there were fewer layers of management bureaucracy paid at substantially higher rates within the NHS?

I thank my right hon. Friend for that question. I am sometimes staggered by the number of people on six-figure salaries within our NHS, but in an organisation of its size, management is also important. It is about getting the balance right, but we always continue—[Interruption.] The hon. Member for Ilford North (Wes Streeting) chunters from a sedentary position. The balance may not be right, and we always continue to look at the ratio of management to frontline staff to make sure we are getting that right.

The Government will blame anybody and everybody for these avoidable strikes, but he knows full well that the RCN is not even affiliated to the TUC, let alone the Labour party. If these strikes go ahead, the Secretary of State is to blame, because he has the power to sort out this mess. Why does he not just get on with it?

The hon. Gentleman puts it in his usual blunt way. The pay review body process is the established mechanism for determining pay uplifts in the public sector, outside of negotiating multi-year pay and contract reform deals. Despite what he says, industrial action is a matter for the unions, and we urge them to carefully consider the potential impacts of industrial action. The Secretary of State and I have been clear that our door is open. We have already met with the unions, and we would be happy to do so again.

Now then. In 2014, the shadow Health Secretary said that he would support strikes within the NHS, even if there was a Labour Government in power, but he is remarkably quiet today about whether he actually supports the strikes—unlike the RMT strikes, which I am sure that he supports. Does the Minister think that the shadow Health Secretary and Opposition Front Benchers are playing politics with this issue?

I am not one to cast aspersions on the shadow Secretary of State, other than to say that I and the Secretary of State refuse to play politics with this issue. This is all about patient safety and ensuring that if industrial action goes ahead—[Interruption.] The shadow Secretary of State again shouts “Negotiate” from a sedentary position, but he knows that we have an independent pay review body, process and mechanism. It is important that we respect that.

We simply cannot afford to lose any more nurses and valued NHS staff. We already have huge workforce shortages—40,000 nurses resigned last year and there are more than 130,000 vacancies across the NHS—so cancelling Christmas for members of the armed forces will not fix these problems. Will the Minister explain how paying nurses insufficiently and drafting in military personnel over Christmas serves to attract new recruits to the NHS and the armed forces?

That is a bizarre question, because the only reason we have to put in a MACA—military aid to civil authorities—request is that the unions have called strike action over Christmas. As the hon. Member asks about recruitment and retention, let me cover off that issue. As I have set out, we are committed to publishing a comprehensive workforce strategy, which will be independently verified; we have set out new pension flexibilities; we have already recruited about 29,000 more nurses and are on track to meet our 50,000 target; and we plan to boost international recruitment. However, I hope that the hon. Member agrees—in the interests not only of our armed forces, many of whom will have to cancel their Christmas leave, but of patient safety—that we do not want industrial action to take place. I urge the unions to meet us to discuss a way forward.

I find it regrettable, as I think most people do, that Opposition Members continue to use the NHS as a political football. This is about the care of patients, and if Opposition Members do not think that Government Members care about patients, they are living in another world. My hon. Friend is doing a great job. We all accept—even the shadow Secretary of State does—that the NHS needs a radical reform. Surely it is time for an independent body to look at that argument and make the NHS run far more efficiently.

I thank my hon. Friend for his question. We are constantly looking at how we can improve productivity and increase efficiency in the NHS. We have an acute issue not just with winter, but with proposed strike action. The shadow Secretary of State mentioned that the NHS needs reform, and we are undertaking that. Will further reform need to be undertaken? Yes, and if my hon. Friend the Member for South Dorset (Richard Drax) has particular ideas, I am very happy to meet him to discuss those further.

During the dark days of covid, it was the NHS that gave us hope, not Ministers partying in Downing Street. The Tories now seek to demonise the very NHS staff that we clapped from our doorsteps, because they have voted to strike. They are overworked, underpaid, without a proper workforce plan, concerned about the security and safety of patients, and forced to use food banks. Do our NHS staff not deserve at least a face-to-face meeting on pay negotiations with the Government?

I do not know where the hon. Lady got the impression that I or anybody else was demonising NHS staff—far from it. The unions have chosen to bring forward this action. As I said, I hugely value and appreciate all NHS staff. That is why we have given them a pay rise this year, on top of the 3% pay award last year, when pay across the wider public sector was frozen.

I think the Minister knows that there is no clinician in the land who really wants to go on strike. Many clinicians feel that the crisis has been coming for a long time because of the issues around morale and lack of workforce, which I have asked the Minister about on many occasions. He keeps saying that the workforce plan is imminent, but that will not solve the immediate problems.

One nurse said to me the other day that what worries her most is that at any one time, several hundred thousand people in the country are waiting for their test results, particularly in relation to cancer. How will the Minister ensure that people get their cancer results in time to meet all the other cancer plan deadlines?

I thank the hon. Gentleman for his question; I know that he has a particular interest in the matter. We are looking to ensure that as many NHS services as possible continue during strike days. On his broader point about pay settlements, the average pay settlements in the private sector are within the range of 4% to 6%.

Not in the NHS.

Within the private sector it is 4% to 6%. The uplifts strike a careful balance in recognising the huge importance of public sector workers while minimising inflationary pressures and, of course, having an eye on managing the country’s debt.

The Minister challenged back on who had the power to avert these strikes. Let me reiterate what my hon. Friend the Member for Ilford North (Wes Streeting) said: trade unions have been clear that strikes can be averted if Ministers initiate face-to-face pay negotiations. So far, they have completely failed to do so. The power to stop these strikes lies squarely with the Secretary of State. How can the Government justify refusing to even talk?

We have already been clear that we would be very happy to meet the unions, and I understand that a meeting is being organised, but let me reiterate the point about what exactly the Royal College of Nursing is asking for: an uplift that is 5% above RPI inflation. Uplifting pay for all staff—this is based on 19.2%, within the agenda for change—would cost approximately an additional £10 billion. The hon. Member for Rhondda (Chris Bryant) talked about things like test results; the £10 billion that we would spend on such an uplift is £10 billion that would come out of the NHS budget. That is £10 billion that we would not be able to spend on hugely important issues such as tackling the elective backlog.

I was on the picket line with NHS staff in Newtownards in my constituency this morning. I do not expect to be reprimanded for that, by the way—I am quite sure I will be okay.

I want to ask the Minister a positive, constructive question. All the men and women want who were on the picket line at Ards Community Hospital in Newtownards this morning is a wage that helps them to survive. The women and men I talked to this morning are not surviving; they are visiting food banks. It is not just the nurses: it is the porters, it is the ward staff, it is everyone. Will the Minister and the Government go just that wee bit further to get a settlement?

I understand why the hon. Gentleman is asking that question, and I am sorry to sound like a broken record, but we accepted the independent pay review body’s recommendations in full. As a result, more than 1 million NHS workers were given a pay rise of at least £1,400. For newly qualified nurses, it was a 5.5% increase. Those on the lowest salaries, whom the hon. Gentleman referred to, are seeing a pay rise of up to 9.3%. Again, that is on top of 3% last year, when public sector pay was frozen.

Nobody wants to see industrial action go ahead. My message to the unions is “It’s good to talk—let’s talk. I know the meeting is being set up. Let’s do all we possibly can to avoid industrial action this winter.”