Agenda for Change: NHS Pay Restraint

Andy Burnham Excerpts

Monday 30th January 2017 Westminster Hall

[Dr Whitford]

Yes; I would expect to speak at the end, if other Members wish to speak.

[Andy Burnham (Leigh) (Lab)]

rose—

[Mr Nigel Evans (in the Chair)]

I call Andy Burnham.

[Andy Burnham (Leigh) (Lab)]

Thank you, Mr Evans. I also thank the SNP spokesperson. I had not intended to speak but will grab this opportunity because it is an incredibly important debate.

First, I pay tribute to the Royal College of Nursing and the Nursing Times, which have captured the voices of nurses all over the country. We heard some of those voices in the excellent speech by my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell), and I think they speak for the vast majority of those in the nursing profession.

We meet at a time when the NHS is under unprecedented strain—certainly in recent times. Workforce morale is at the heart of the quality and sustainability of NHS services. What is often forgotten and missed when we debate this subject is that the vast majority of nurses in the NHS—nearly all, actually—work beyond their contracted hours.

I will never forget being at a meeting in Bristol with a nurse from the Bristol Royal infirmary. It was when the Government were looking at introducing regional pay, which the RCN led a campaign against. At the time, the nurse was being presented with a contract and asked whether she was prepared to vary her Agenda for Change conditions by moving from a 37-hour working week to a 39-hour one—it may have been 39 to 41 hours, but it was an increase. I asked her, “What did you do?”, and she said, “Well, I signed it straight away.” I asked why, and she said, “Because I’m currently doing a 45-hour working week, but they don’t know that.” In many ways, that illustrates the point: management do not know the value of what they get from the nursing profession.

That anecdote tells the story about the job. It is more than a job to people. As my hon. Friend the Member for Newcastle upon Tyne North said, people give all of themselves to this job, but they have limits. When they feel as though those above them do not understand the commitment and the huge contribution they make to the NHS, and when they feel taken for granted, the good will and morale start to dry up. That is when the Government are in danger of achieving a false economy. The price of holding down nurses’ pay in the way that has been done over the past six years is, in the end, nurses not feeling able to go above and beyond as they normally willingly do.

[Stephen Timms (East Ham) (Lab)]

I agree with the points that my right hon. Friend is making. The RCN has told us that the pay of a significant group of nurses has fallen in real terms by 14% over the period he refers to. Does he agree that that is a pretty startling statistic?

[Andy Burnham]

My hon. Friend the Member for Foyle (Mark Durkan) said that this is a pay cut. We should not call it a pay freeze because it is, in fact, a pay cut. The Government have manipulated the figures in this area. Let us call it what it is: a pay cut that has now been sustained over a number of years.

People are at their limits. They cannot carry on having their pay cut every single year while they face other pressures and rising costs, such as accommodation costs, without there being a consequence. The consequences will be for their own sense of wellbeing, their own mental health or, indeed, their children’s quality of life. Nurses are now saying, in large numbers, that enough is enough.

[Mary Glindon (North Tyneside) (Lab)]

Further to what my right hon. Friend just said, does he agree that there is a culture under this Government and the previous coalition Government of devaluing the whole of the public sector? This is one stark example of what is happening across the public sector.

[Andy Burnham]

That is how it begins to appear. The Government are pushing people beyond their limits. There was the attempt to introduce regional pay, and there was the attempt to cut what is called the unsocial hours payment—there has been a whole series of initiatives that try to strip away support for the profession. It begins to feel like an attack on the profession. That is certainly how junior doctors felt, and I think GPs feel the same. The nursing profession is making clear today that it feels the same too.

As I said, this is a false economy. As well as damaging the good will and the extra hours that people were willing to offer before, it has also, as my hon. Friend the Member for Foyle indicated, pushed people into the arms of private staffing agencies. That, in the end, is another false economy for the national health service. Over recent years, we have seen the bill for private staffing agencies in the NHS increase year on year, to the point where it is now in the region of several billion pounds every year. Many trusts are in the grip of the private staffing agencies. That, of course, is also a factor in the cuts to nurse training that we have seen in recent years.

[Dr Poulter]

The right hon. Gentleman is making some very fair points. I hope he recognises that one of the first things I did in ministerial office was to reverse what was happening on regional pay and stick to the national pay contracts. He makes an important point about temporary staffing. If we look at the approach with the junior doctors’ contract, many junior doctors will now see a huge reduction in in-house locum pay for the work they are doing; it is sometimes a reduction of £10 an hour. That will feed locum agencies and drive up the temporary staffing bill. We need to see nurses and other Agenda for Change staff paid properly, to stop them needing to do agency work. That is one of the main drivers of the agency business.

[Andy Burnham]

I am glad to hear the intervention of the former Minister, whom I worked well with in the previous Parliament. I want to take this opportunity to say that he did listen on regional pay. We made an argument about that issue, backed up by the RCN and others, and, to be fair, it did not go any further than the experiment in the south-west. I give credit to him for that. I also give credit to him for consistently showing a real regard for the pressures faced on the frontline.

The hon. Gentleman makes an important point that the Minister would do well to reflect on. There is a huge false economy here. It makes sense to have fairness in terms of headline pay for staff, to maintain good will, but on top of that, it makes sense to provide them with incentives to give any additional shifts or time to the in-house bank, rather than private staffing agencies. The Government have lost sight of that in recent times.

[Mr Jim Cunningham]

My right hon. Friend makes an interesting point. It can be a false economy to rely on agencies to staff hospitals, whether it be nurses or doctors. At the end of the day, training suffers. That makes it difficult for the NHS to recruit, so it is a false economy in a number of ways.

[Andy Burnham]

It is not only a false economy; it directly damages the quality of patient care. When people arrive on the ward who do not know the team or the environment and have to be told everything, it builds in confusion and delays because staff have to take them through things. It does not make sense to use private staffing agencies to the extent that they are being used in the NHS. The cost is exorbitant—that is No. 1—but it also damages morale, because it leads to staff in the permanent employ of the trust working on the ward alongside people who are being paid significantly more than them for the same shift, despite having just arrived on that ward. That does not build a sense of team on the ward; it builds a sense of resentment.

[Dr Huq]

My right hon. Friend makes a powerful point about the lack of continuity with agency staff coming in. He talks about recruitment and retention. The NHS traditionally has had a large overseas workforce. Does he agree that the £35,000 salary required to settle in the UK has not helped matters? Nurses normally start at £23,000. Our NHS would crumble without overseas workers. We have also heard that in the post-Brexit climate, people from overseas feel less welcomed by this nation. Does he have any comment on that?

[Andy Burnham]

My hon. Friend makes two important points. The first was on the effect that Home Office immigration rules could have had on the nursing profession. I think the former Home Secretary, now the Prime Minister, made some changes in that regard.

My hon. Friend is right that there is a much bigger context here: the post-referendum climate. The Government have been absolutely wrong not to guarantee the status of EU nationals currently working in our national health service. I have an example from my constituency of a Polish community nurse, who every day gets up early to go on her local round delivering insulin to vulnerable patients who are diabetic and housebound. One morning she heard a cry of, “Go home!”, out of one of the bedroom windows opposite. What does that make that nurse feel like, and is she likely to stay when we are in this prolonged period of uncertainty in which this growing hostility is felt to be around? There is a real risk here. We cannot simultaneously refuse to give clarity to those tens of thousands of nurses from other parts of Europe who are currently working in our NHS and run down the good will of nurses who are UK nationals. In the end, something will give, and it will be patient care, if we operate policies of that kind.

Alongside that, there is the attack on nurse training. We have seen cuts to nurse training places over a number of years, so there is a shortage of nurses coming through. Many places are being and have been forced to recruit from overseas. In those circumstances, with everything else that I have described, including the downward pressure on headline pay, how can it possibly make sense to scrap the nursing bursary? Will that not just be another factor that adds to the growing sense of crisis in the profession? Every single piece of support that is there to develop the nursing profession is systematically being stripped away.

We have seen years of that approach and are beginning to see the consequences in the national health service. Labour, of course, did not get everything perfect—I am not saying that—but I can say with some pride that when I was a Minister in the Department of Health, we brought through a major programme of investment in the nursing workforce, through Agenda for Change. It was the subject of hard discussions, but in the end it was agreed between the trade unions and the Government of the day. We did have in the Department of Health a social partnership forum, which brought together NHS Employers, trade unions and the Government to iron out problems relating to the nursing workforce. We did massively increase the numbers in the nursing profession. We did ensure that they were properly rewarded and had proper access to training. My worry is that we are seeing some of that break down.

In the immediate aftermath of the financial crash, it was acceptable, it seems to me, to ask the nursing profession to make a contribution to deficit reduction, but here we are, six years on, expecting people who are out there today, working flat out to keep an NHS in crisis going, to take pay cuts for the privilege of doing so. At some point, that strategy begins just to fall apart, and the NHS falls apart with it. I say to the Minister that we are not far from that point now.

[Chris Stephens (Glasgow South West) (SNP)]

Is there not a wider economic point that if we keep pay freezes in place for so long—six years—that ends up harming the private sector economy, because if 70p in every pound of public sector money ends up in the private sector economy, some of that is wages, including nurses’ pay?

[Andy Burnham]

Of course, and the point is very well made, but I will also say again that it does not help deficit reduction if nurses are being pushed into the grip of private staffing agencies as a consequence of pay policies. That is another way in which the Government’s short-sighted approach has not in the end produced benefits for the economy, as the hon. Gentleman says, nor helped us meet the target of deficit reduction, because so much money is being wasted every year.

I will conclude on that point. The voices that have been mobilised in support of the lobby of Parliament today are real voices, as we heard from my hon. Friend the Member for Newcastle upon Tyne North. These people are the backbone of the national health service, the backbone of our communities and the backbone of our country. They have limits, though. Their limits are higher, but they do have limits, like everyone else. They feel taken for granted. Right now, the NHS cannot afford to lose the good will of the nursing profession. The Minister needs to listen carefully to what is being said today and he needs to make urgent representations, through the Secretary of State, to the Chancellor of the Exchequer in advance of the spring statement. A signal needs to be given to the nursing profession that the Government are listening and will take action, within the bounds of what is possible, to treat the nursing profession properly. I hope that, if nothing else, the Minister takes that message away from today.

[Mr Nigel Evans (in the Chair)]

There being no one else standing in their place, we will move to the winding-up speeches.

--- Later in debate ---

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Evans. I congratulate my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) on the eloquent and knowledgeable way that she introduced this debate on behalf of not only the Petitions Committee but the more than 100,000 people around the country who signed this petition.

When she introduced the debate, my hon. Friend said that it is not enough for us simply to state our support for NHS staff—it has to be shown. The excellent attendance that we have had today, despite the important international business taking place in the main Chamber, has shown the huge support for our NHS staff and it is high time that the Government matched that support with action. In an intervention, the hon. Member for Kettering (Mr Hollobone) put the proposition that it is incredibly hard for the Government to justify ignoring the recommendations of an independent pay review body when we as Members of Parliament have our own pay agreed and implemented by an independent body. Can the Minister not see how repeatedly ignoring independent pay reviews strikes at the very heart of the bond of trust that exists in an employment relationship? Can he not see how it makes us look like we are uncaring and wrong? It is self-defeating and the approach needs to change.

My hon. Friend rightly highlighted the particular problems in ambulance trusts and the issues with the recruitment and retention of paramedics. She described the expenditure on agency staff as “nonsensical”. Certainly, no business would consider this a sustainable model. The personal testimonies that she gave from her constituents were compelling. None of us could fail to appreciate how difficult the situation is for some of our nurses. One said that she grieves for her profession, and that highlights just how dire the current situation is.

We also heard from the hon. Member for Foyle (Mark Durkan) about his perspective in Northern Ireland. He told us how the use of terminology appears to lead to people in different jobs being paid lower rates of pay for effectively the same job. That is certainly not how Agenda for Change should work in practice, and the pay freeze only exacerbates the sense of injustice that individuals feel. He summed up the situation perfectly when he said that the long-term pay freeze is in fact a pay cut. He said their sense of vocation “is being exploited”. He was right about that, but is it not incredibly sad that a Member of this place can say that without fear of contradiction? Just how low have we sunk?

We also heard from my right hon. Friend the Member for Leigh (Andy Burnham), who has great experience in the health service. He rightly said that nursing is “more than a job” and it is clear that he appreciates that, but he is right that when nurses feel that those above them do not appreciate what they are doing, it becomes a false economy and drives people into the arms of staffing agencies.

[Andy Burnham]

My hon. Friend has just mentioned people feeling a sense of fairness, particularly in the pay of those above them. Does he share my concern that in this current climate, while nurses’ pay is being cut, we are seeing large pay increases self-awarded to members of clinical commissioning groups and senior management? Does that not completely demoralise the whole local profession?

[Justin Madders]

I agree entirely. We all know—it is well documented—the financial pressures that the health service is under. It defies belief or explanation that those in senior positions can still fly in the face of that. I can only sympathise profusely with how nurses must feel when they see those headlines.