NHS Pay

Philippa Whitford Excerpts

Wednesday 13th September 2017 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

We have had many debates on the NHS in the House, and as I have said previously, the workforce is one of our biggest challenges, which is why it is so important to get this right. The debate is focused on NHS staff, but we are discussing all public sector workers. We are talking about all workers within the NHS: we must not only consider those at different grades, but not allow a separation between frontline and back-of-house staff. As a surgeon, if I turn up at a clinic and there are no case sheets and the patient has not been informed of their appointment, it is a totally pointless exercise. We need to realise that the NHS is a team, and if we do not look after the team, it will not work.

Obviously this all started with the crash. I will defend Members further along the Opposition Benches, because I get really bored with the Labour party being given responsibility for the crash. Labour did not have that degree of world domination. It was a world crash. At the time of the crash, it was right to look at public sector pay, because it is a big outlay. The reason given at the time was to avoid redundancies and keep people in their jobs. However, although in Scotland we have had no compulsory redundancies, there have been 20,000 NHS redundancies over the past seven years and more than 40,000 compulsory redundancies among public sector workers. That means that people in England had a pay freeze for three years and then a pay cap, but they still lost colleagues.

I still work in the NHS and, until the recent campaign, I would have heard comments from nursing colleagues about not money but staffing—people being on shifts and feeling thinly spread, unable to care, anxious about the danger to their patients. I would say that that is the No. 1 concern, but people in England have had a double whammy: they have had the pay freeze and the pay cap, yet they have still had redundancies. From what we read, there could be a lot more to come from the sustainability and transformation plans, and that is just plain wrong.

In Scotland, we focused what money we had in a different way. The people on less than £21,000 got 3% rises every year, with an absolute minimum in 2010 of £250, which has now risen to £400. If we focused only on percentages, a consultant like me would be sitting on a great pay rise, while the person who is cleaning the bedpans and making the beds would get a pitiful rise, so it is important that more of the money is pushed lower down. In Scotland, we pay the real living wage, not what we Scottish National party Members call the pretendy living wage—the national living wage. A living wage should be a wage on which someone can live. It is as simple as that. Our public sector workers demand no less than that.

[Ian Paisley]

I appreciate the points the hon. Lady makes. She has creatively reflected on how the Scottish Government have directed resources differently, which is exactly what we and the Northern Ireland Executive want to do with the £1 billion resource. It will allow us to direct resources differently so that we can then address the other critical issues. Does she agree that people who begrudge Northern Ireland’s getting that money are actually begrudging public sector workers their rights?

[Dr Whitford]

I do not begrudge people in Northern Ireland the money that they have gained from that deal. All that the rest of us are asking for is to have something similar elsewhere. Nurses in Scotland, Wales and England are struggling as much as those in Northern Ireland. To be honest, it is a distraction to keep focusing on that deal. I disapprove of it, but not because people in Northern Ireland are getting a bit more of the help that the rest of us would be glad to receive.

We had the pay freeze and then the pay cap, but there have even been times when the pay review bodies’ recommendations have not been carried through. That has resulted in a band 5 nurse in England being paid £300 less a year than a band 5 nurse in Scotland. We have pushed the money down the way, so for a healthcare assistant or nursing auxiliary, the difference is more than £1,100 a year. However, it is not just a matter of the people at the bottom. In a way, the people who have experienced the freeze the most are those at the top of their grade who are not getting any more increments and are not changing grades. In actual fact, their pay has not moved for several years, and then it has moved by only 1%. Other people’s pay has gone up by increments, so at least they have seen a change in their pay. Earlier, a Labour Back Bencher was talking about a senior nurse. Such senior staff, who are within 10 years of retiring and who carry the experience of the NHS, are looking at other jobs in which that kind of life experience would be much more highly rewarded, and they are thinking, “Can I even afford to stay in this job if I am to look after my family?” In Scotland and elsewhere, we have tried to tackle this appalling issue of low-paid staff in a caring public service such as the NHS, but now we must realise that, for people higher up the grades, the time is over.

[Martin Whitfield (East Lothian) (Lab)]

Following Audit Scotland’s report, which pointed out that in Scotland one third of NHS staff are over 50; that we have a vacancy rate of more than 4.5% for nurses and just under 7.5% for consultants; and that we have a Government in Scotland who put forward a 1% rise to the pay review body, does the hon. Lady agree that now is the time to say that the cap should go? The cap itself and the attitude towards it is driving people away from the NHS and out of the NHS, and it is doing a great disservice to our population on both sides of the border.

[Dr Whitford]

If the hon. Gentleman had been following what has been happening in Scotland over the summer, he would know that, following the debate in May, the Cabinet Secretary in Scotland had open discussions with NHS staff side. In June, the Cabinet Secretary for Finance and the Constitution said that our Budget at the end of this year would be looking to get rid of the pay cap. It did not just happen the other week when the programme for Government was announced; it has actually been there all summer. The vacancy rate in Scotland may be 4.5%, but, as the shadow Secretary of State said, it is more than twice that in England. We should be focusing on the fact that nurses and other NHS staff in England are getting almost the rawest deal, which is not right, because they are working just as hard as others.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

Does my hon. Friend agree that it is also extremely important that, if we are to achieve parity between physical and mental health services, we address this issue, particularly for specialist mental health staff—nurses and allied health professionals—who want to work in the service but for whom the work is just not cost effective, as they then seek employment elsewhere?

[Dr Whitford]

That was exactly the point I made at the start of my speech. Although the Royal College of Nursing led the campaign and the image has been of nurses, the issue affects everyone. I echo what the hon. Member for Lincoln (Ms Lee) said—[Interruption.] Well, it was the RCN out at the front.

[Ms Lee]

Unison were a part of it.

[Dr Whitford]

Okay—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I appreciate that the hon. Member for Lincoln (Ms Lee) is new to the House, but Members do not make interventions while they are sitting down. If you wish to intervene, you must stand up to do it. I have noticed this happening quite a lot. This is not a general discussion, but a debate.

[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.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

As a fellow NHS consultant, I entirely agreed with the hon. Lady when she said that this was about not just the nurses, but the NHS as a team and the value of the whole package of care. One cannot work effectively without the other. Yes, there is a debt accrued in doing a nursing career, but the Health Secretary has proposed a new technical route into nursing, which will mean that people can get an apprenticeship in nursing, allowing them to work and earn throughout their training. Therefore, nurses will be able to qualify while working and supporting their families without accruing any debt.

[Dr Whitford]

I welcome the hon. Lady’s intervention. I definitely welcome other routes into nursing. Of course when I was a wee doctor, we had two routes: the enrolled nurse and the degree nurse. That disappeared with Nursing 2000, but we are now coming back to that discussion. I have no problem with that, but we will need degree nurses. We have nurses in very advanced practitioner roles, which means that they require a more academic design—a more balanced and weighing-up-the-evidence kind of approach. It is important that we do not make it that the only route most people can afford to follow is the healthcare assistant route. I welcome it, but I certainly would not like to see people limited by it. The Secretary of State tells us that this is not an issue, because we still have more applicants than places—as yet, according to the universities, the number of places has not expanded by very much—but what we do not know is the talent that exists among that 23%. It may be fine numerically, but if we are excluding people who might have been absolute leaders in the nursing profession and in the NHS then we are the poorer for it.

We know that 40,000 vacancies need filling, and the pay cap is definitely making it harder to fill them. Brexit is not exactly helping either. Everyone here knows that my other half is a German GP in our NHS who, 15 months on, still has no idea what our rights and opportunities will be. The pay cap is definitely contributing to that problem and it is time for it to go, but it must be funded, or else it will mean a cut in services, which will hurt not just patients, but staff, who will feel that they are damaging the very service in which they work, and they will feel guilty about that. As that service is cut and contracts, their working day and working life will get worse.

The Government often talk as if spending on public service staff is money wasted. It is as if we cannot afford that money because we need to get the debt down, but in actual fact money that is put out by public sector workers is irrigating the economy—the money is spent. Some of it comes back in income tax—20% of everything all of us spend comes back. Money disappears when it is pushed at the top. It goes into banks and offshore, and is therefore outside our economy. Money that is in our economy encouraging commerce and business is helping us to recover.

After the tragedies of this summer—from the terrorist attacks to Grenfell—people right across this Chamber have quite rightly praised NHS staff and emergency workers. Now is the time for us to show not just what we think of them, but how we value them.

--- Later in debate ---

[Andrew Selous (South West Bedfordshire) (Con)]

I warmly congratulate the hon. Member for Portsmouth South (Stephen Morgan) on a polished maiden speech, and we all wish him the very best in his time in this House.

Conservative Members agree with what the hon. Gentleman said about the wonderful work that public sector workers do, not least in our NHS. The NHS saved my life when I was 24. I have two children heading to work in the NHS, one of whom worked as a healthcare assistant over the summer. Members of my family are also frequent users of the NHS.

Over the last few months, I have had the pleasure of spending a day at the Bassett Road GP practice in Leighton Buzzard, and I am full of admiration for the doctors and practice nurses I saw working there. I also spent time at my local hospital, the Luton and Dunstable, which has the best accident and emergency service in the country, and we are learning lessons from it all around the country, which are being spread by the Department of Health. Really importantly, I have also spent time with the social care staff of Central Bedfordshire Council and elsewhere, and seen the independent living schemes that will be key to the sustainability and transformation plans in my area.

In these debates, we seem to focus entirely on the top line of departmental budgets. In 2016-17, the Department of Health had a departmental expenditure limit of £120.6 billion and annually managed expenditure of £16.2 billion—£136 billion in total. We need to reflect on the words of Jon Thompson, a permanent under-secretary at the Ministry of Defence, speaking to the Institute of Government recently about the attitude, often, of Select Committee members from across this House:

“They seem to live in a resource unconstrained world…in the end I’ve got a limited amount of money and I have to prioritise.”

Those are words we need to hear.

There is another way to free up money within that £136 billion and improve outcomes for patients that could lead to our having more money for NHS staff— that is, to focus on improving quality, something that hardly ever gets a look-in in this House. If we look at the work that the Government are doing with the Getting It Right First Time programme, we see a 25-fold variation in infection rates for patients. Not only is going through that a deeply unpleasant experience for a patient, but the cost of surgical infections can vary from £75,000 to £100,000. If we get this right, not only do we treat patients better but there is more money to put into staff pay.

It goes on and on. Many hospitals are not using the right hip implants—they are using more expensive non-cemented hip implants. We get better outcomes with cemented implants that actually cost less.

[Dr Whitford]

It is really important that we are very careful about things that will be implanted permanently in a patient. We have had debates about mesh in this place, and we will be having debates about Essure, which is designed to obstruct the fallopian tubes and is also causing problems. Non-cemented implants are for younger people who may need another implant later on. I would be very careful—think of the PIP breast implants scandal—about cutting the quality of what is left in a patient.

[Andrew Selous]

I am talking about the data available in the national registry, now, for the first time ever, being properly compiled in every hospital. We should follow the evidence and look at the clinical outcomes, as the hon. Lady has done herself on the Health Committee.

Forty-five per cent. of surgeons are doing five or fewer complex hip and knee revisions, yet we know that clinical outcomes are better where surgeons do 35 or more a year. As a result of doing only a few operations with worse outcomes, which cost more, they also have to hire in expensive loan kits. Hospitals are spending, on average, some £200,000 a year on loan kits—some hospitals, £750,000 a year. Professor Tim Briggs, with whom I have had the honour of working over the past nine years on the Getting It Right First Time programme, said that

“there is no way right now I would ask for more money for the NHS. The waste and variation out there is unbelievable and we have got to get our act together across all the specialties to improve quality and unwarranted variation and complications. And it is not just orthopaedics.”

We are now, for the first time ever, looking at variations in litigation rates—huge amounts of money go out on litigation—in infection rates, and in revision rates. We are making progress, because litigation rates, which went up by 8% in orthopaedics in 2013-14, are down by 5% in 2014-15 and down by 8% in 2015-16.

This is a really powerful way to get better outcomes for patients and make sure that there is more money for NHS staff. That is exactly what the sustainability and transformation plans are there to do. As Simon Stevens has said, this is

“the biggest national move to integrating care of any major western country.”

If we can end our fragmented, silo-ed care through a massive expansion of out-of-hospital care, we will get better outcomes, save money, prioritise prevention, and keep patients out of hospital. If we do that, we will free up precious budget in order to pay NHS staff the decent rates we all want to pay them.

--- Later in debate ---

[Trudy Harrison (Copeland) (Con)]

I am grateful for the opportunity to speak in this debate. West Cumberland Hospital in my constituency has faced significant challenges over many decades in recruiting and retaining enough doctors and nurses. It was because of those challenges that our midwifery unit was under threat of losing 24-hour, seven-day-a-week consultant-led maternity care. In a rural area such as mine, abundant with farms—I am proud to support the National Farmers Union’s Back British Farming Day today—that could mean a two-hour journey on a single-carriageway road up to Carlisle hospital, often being held up by slow-moving vehicles. Having been through four childbirths myself, I simply cannot agree that having to travel an extra 40 miles is an acceptable modern-day service, especially if the mother experiences complications.

I was pleased that the Minister of State, Department of Health, my hon. Friend the Member for Ludlow (Mr Dunne), came to West Cumberland Hospital to see the challenges for himself, and that the Secretary of State came to the hospital in Carlisle, Cumberland Infirmary, to hear for himself the concerns of clinicians. Not one mentioned the 1% pay cap, but concerns were expressed about morale, recruitment and retention, and how to ensure that enough doctors and nurses join the health sector. In my role on the Education Committee, I look forward to considering how we can recruit doctors and nurses through technical and academic routes. I am really pleased by the huge investment that has been made in our hospital and our NHS trust.

[Dr Whitford]

The hon. Lady mentioned recruiting doctors and nurses through a technical route. Do she or the Government really propose that route into medicine, without a degree?

[Trudy Harrison]

I thank the hon. Lady; I should have been clearer in saying that I support technical and academic routes into all employment in the health sector, because I understand that it is a team effort.

Over the past seven years, more than £90 million has been spent on the brand-new hospital in Whitehaven—more investment than ever before. I am delighted that we have been awarded more than £40 million of extra capital investment to refurbish and rebuild parts of the hospital estate, to bring it up to date and improve the experience of patients and staff. The funding will help to deliver faster diagnosis of conditions including cancer, easier access to mental health services and an expansion of our A&E department, leading to shorter waiting times for operations and more services in GP surgeries. There has been huge progress in improving patient care, and the funding will help to secure the highest-quality, most compassionate patient care anywhere in the world. Some £30 million of new funding will be invested across south Cumbria to modernise mental health facilities and improve A&E facilities at our hospitals, and nearly £10 million of the new capital funding has been earmarked for modernising mental health in-patient services.

Ensuring that we have a full complement of doctors, nurses and other staff on wards is essential. We simply cannot run wards without the appropriate staff. Our public sector workers, including nurses and other healthcare staff, are some of the most talented and hard-working people in the UK. Like everyone else, they deserve to have fulfilling jobs that are fairly rewarded in their take-home pay. We now have 12,000 more nurses working in our hospital wards than we did under the Labour Government, and retaining hard-working nurses and doctors is vital to maintain the service that we all appreciate. I am pleased that yesterday the Treasury decided to remove the 1% pay cap across the board.

One point I would like to draw attention to is the need to assist our talented, highly qualified medical clinicians to be able to do what they are trained to do and experienced in practising. From speaking to midwives both at my local hospital and elsewhere in our trust, I know that they are regularly spending up to three hours of their eight-hour shifts ploughing through administration work, stuck at a computer screen, rather than being out on the wards doing the work that they are trained to do—assisting mothers in labour and delivering children safely. I ask Ministers to look at innovative ways in which our trained staff can use the skills that they have.

It is the 42-year record low unemployment rate and our seven-year track record on deficit reduction that have made the end to the pay freeze possible.