I beg to move,
That this House
notes that in 2017-18 NHS pay rises have been capped at one per cent and that this represents another below-inflation pay settlement;
further notes that applications for nursing degrees have fallen 23 per cent this year;
notes that the number of nurses and midwives joining the Nursing and Midwifery Council register has been in decline since March 2016 and that in 2016-17 45 per cent more UK registrants left the register than joined it;
and calls on the Government to end the public sector pay cap in the NHS and give NHS workers a fair pay rise.
This is the first Opposition Supply day for six months, and it is my pleasure to bring a motion to the House on lifting the public sector pay cap. In the past 24 hours, the Government have been briefing that the pay cap has ended. The Chief Secretary to the Treasury has said that Ministers now have “flexibility” when setting pay above 1%. If—and it is a big “if”—that flexibility means lifting the cap for the whole public sector and giving public sector workers a fair pay rise above inflation, which stood at 2.9% yesterday, that will be a victory for the Labour party, for the Leader of the Opposition, for the Royal Colleges, for the trade union movement, for the MPs of all parties who signed the early-day motion and, above all, for the millions of public sector workers who have campaigned for fair pay. That flexibility that the Chief Secretary to the Treasury has talked about must mean giving NHS staff fair pay as well.
What a climbdown this represents for the Prime Minister! The House will recall that, in the general election campaign, she showed the deftness of touch that has come to characterise her dismal, beleaguered premiership by dismissing the heartfelt concerns of a nurse, saying that there was no “magic money tree”. It is funny that the money was there when the Conservatives needed the votes, though.
My hon. Friend is right to raise that point. It is not just, which is why the Labour party has consistently campaigned to get rid of the cap. The Conservatives have voted against getting rid of it when we have brought motions on this issue to the House.
Given that the Government are now briefing that the cap is being abandoned, I trust that they will accept the motion in the name of the Leader of Opposition and myself and not divide the House later today. If they are indeed abandoning the cap, let us put them on notice that it must apply to the whole public sector, including the 55% of workers not covered by pay review bodies. We also put them on warning that we will not accept a divide-and-rule approach that plays one set of public workers off against another. Nor will we let Ministers get away with presenting below-inflation pay offers as amounting to a fair pay rise when that is still, in effect, a pay cut.
My hon. Friend is making an excellent beginning to his speech. What is his view of the impact of this crucial question on recruitment and retention in our hospital trusts?
My hon. Friend is right to raise that point. I shall go on to explain that the pay cap is at the heart of the recruitment and retention crisis that is now facing the national health service.
Does my hon. Friend share the shock of GPs and NHS staff when they learned that, while frontline staff were limited to a 1% pay rise, the governing body of the Liverpool clinical commissioning group gave themselves rises of between 15% and 81%? None of the regulators noticed this, including NHS England and NHS Improvement, and it all took place under the nose of the Government. This shows that there is one rule for the bosses and another for the workers.
I will make a little progress now, if I may. I promise I will take more interventions later.
I say directly to the Chief Secretary to the Treasury, who will be responding to the debate later, that if Ministers are given flexibility to set pay rates, and if the pay cap has indeed been abandoned, she also needs to grant the NHS the funding that it needs. The NHS is underfunded and it is going through the biggest financial squeeze in its history. On the published figures, head-for-head NHS spending will fall in the next year. Hospitals are in deficit, waiting lists are at 4 million, the A&E target is never met and the 18-week target has been abandoned. Hospital bosses are warning that there will not be enough beds this winter. Last winter, hospitals were overcrowded, ambulances were backed up and social care was at a tipping point. Some even characterised it as a humanitarian crisis. It is not good enough for the Chief Secretary to the Treasury just to grant “flexibility” and expect hospitals to fund a staff pay increase from existing budgets.
Does the hon. Gentleman agree that the pay restraint over the past few years has been uncomfortable but necessary, in order to bring Government spending—[Interruption.]
None of us would want anyone to be paid any less, but it has been difficult but necessary, in order to control the overspending by Government and put right the financial mess that the country was left in after the last time the hon. Gentleman’s party was in government.
I agreed with the hon. Lady’s comments at the time of the debate on the Gracious Speech, when she said:
“I’m of the view we need to look at public sector pay in the light of increasing inflation.”
If those were her comments then, she should be joining us in the Division Lobby this afternoon.
I will let James Heappey in because he has been very persistent, but first let me make some progress.
It is not good enough for the Chief Secretary to grant the Secretary of State flexibility and not grant him the funding that the NHS needs. Overcrowded, overstretched hospital trusts cannot be expected to absorb pay rises from existing budgets. We need extra investment now to give the staff the fair pay they deserve.
Let me make a little bit of progress, and then I will give way.
Over the past seven years, a public sector worker on the median public sector wage has seen the value of their wage drop by £3,875. That is more than the cost of feeding the average family for a year. Given what we know about inflation, on the figures published yesterday and on the Treasury’s own inflation forecast, if this cap was to remain in place until the end of the Parliament, a public sector worker on the median wage since 2016 will have seen their pay drop by at least another £2,200.
The shadow Minister has been very generous in giving way. May I be helpful and invite him perhaps to revise his earlier statement that the pay rise should be universal across the public sector? Surely that would advantage those in more senior, management positions, who would disproportionately benefit from such a pay rise, and perhaps actually the Government’s position of offering Ministers flexibility to increase pay where there is a clear need is a much better proposal than the universal pay rise that would only benefit fat cat managers.
There we have it—the Conservative party playing one part of the public sector off against the other. We believe the whole of the public sector deserves a pay rise.
In my constituency, NHS staff are having to rely on food banks in order to be able to eat. A constituent, an ambulance technician who transports critically ill children across the country, told me that she does not have nearly enough money to live on. Does my hon. Friend agree that this is a disgrace?
It is a shocking disgrace, which is why the Labour party has consistently campaigned to get rid of the pay cap; it is why, in our manifesto, which we took to the British people a few months ago, we said we would get rid of the pay cap, and why it is absolutely disgraceful that Conservative Members stood on a manifesto to keep the pay cap.
Mandy McKeown’s son Liam died seven times. He survived, thanks to the dedicated work of neonatal intensive care nurses. Tracey, who came to Parliament last week, spoke of having suffered a 14% cut in pay, two-thirds of her fellow nurses taking second jobs and a haemorrhage of nurses from the profession that they love. Does my hon. Friend agree that it is utterly shameful to treat those to whom we owe the difference between the life and death of sick babies in this way?
It is generous of the hon. Gentleman to give way. As he says, I support the lifting of the pay cap and I am pleased that the Government are moving on this. My concern about supporting this motion is that Labour do not seem to have learned the lessons from crashing the economy in the first place. Could he outline what level of pay rise the Labour party is proposing for public sector workers—1.5%, 2% or 3%—and how it will be paid for? That is crucial to influencing the voting intentions of Members like me.
I have a huge amount of respect for the hon. Lady; we have had conversations outside the rough and tumble of this Chamber, and I know she takes these matters extremely seriously. I would ever so gently say to her that she has been telling newspapers that she supports getting rid of the cap; she has been hosting nurses in Parliament, saying that she would get rid of the cap; well, this evening she has an opportunity to take a stance, ignore the Tory Whips and vote for getting rid of the cap.
In this debate, we must be honest with the British public about how we are going pay for the lifting of the pay cap. If Labour wants to lift the pay cap, can the hon. Gentleman explain how the Labour party will pay for it? Will it be through increased taxation or more public borrowing, or will Labour shift spending priorities? We need to know the detail in order to be able to support this policy.
I hope the hon. Lady made those points at the rally last week, when she was talking to nurses. But I would say to her that the Government have found an extra £1 billion or so for Northern Ireland. We do not begrudge Northern Ireland that, but the Government have found more money for Northern Ireland. Also, the Government are giving away billions and billions in corporation tax cuts. They have given away £1 billion in inheritance tax cuts. Government is indeed about making choices. We would make a different set of choices, but if the hon. Lady is genuine, as I believe she is, and sincere, as I believe she is, in wanting to get rid of this cap, she needs to send a message to the Chancellor, not the Tory Whips, and vote for our motion.
I thank the hon. Gentleman for giving way on this very important issue, and I must say that I and my colleagues are minded to support the motion that he has put before the House. But it would be appropriate if true sincerity was shown by all Members of this House—if they stopped attacking the Government for giving Northern Ireland that £1 billion, so that we can alleviate the costs that would allow us to make that pay gap narrow.
I did say I did not begrudge Northern Ireland the money; I was just making the point that the Government have found the money, when they keep telling us that there is no money for anything else. But we are grateful that the Democratic Unionist party has signed the early-day motion in the name of my hon. Friend Conor McGinn, and we are aware that the DUP has said consistently that it supports getting rid of the pay cap for public sector workers. We would be very happy for the party to join us in the Division Lobby this evening.
I am really pleased to hear what Ian Paisley has said today, but I want to put it on the record that DUP Members did have an earlier opportunity to support the removal of the pay cap but actually voted against that—all 10 of them—in the debate on the Queen’s Speech. An amendment was tabled by the colleagues of Jonathan Ashworth, and the DUP voted it down, but we always welcome repentance.
I am grateful to the hon. Lady and I am grateful that she also signed the early-day motion. This issue may be debated further as hon. Members make their speeches today.
As we know, according to the Office for National Statistics, many public sector workers regularly work an average of 7.8 hours’ unpaid overtime a week, worth £11 billion to the economy. With the pay cap, the Government have effectively been asking them to do more and more on less and less. That is unfair.
I will make progress, if I may.
MPs on both sides of the House have spoken out against this pay cap. We would hope that they will join us in the Division Lobby, including Ian Paisley. I pay tribute to my hon. Friend the Member for St Helens North for tabling early-day motion 132, which calls for an end to the NHS pay cap, and which we have picked up and adopted as our motion today.
I know there are many who have sympathy for getting rid of the pay cap. The reason that many in the House have sympathy for getting rid of the pay cap is that in all our constituencies we have met nurses, very directly at our advice surgeries, or indeed in lobbies at Parliament, who have told us that the cap has meant they have seen a 40% real-terms drop in their earnings since 2011.
I want to make progress; but I will try to let in as many hon. Members as possible.
We have all read reports of nurses on their way home from a shift stopping off at food banks. The Royal College of Nursing tells us that two-thirds of its members are forced to undertake bank and agency work to help make ends meet. Is that not an example of how self-defeating the pay cap is, because it is driving an agency bill of £3.7 billion in the NHS?
We have all read surveys showing that more and more NHS staff are turning to payday loan companies and pawning their possessions, and we will have heard from the RCN lobby recently of the huge hardship that our nurses are facing. Many nurses have been in touch with us.
Let me give the House the story of Rebecca, who got in touch with my hon. Friend Debbie Abrahams. Her story brings into sharp focus the impact of the pay cap, particularly when it is combined with the severe social security cuts that the Government are pushing through. Rebecca is a single parent. She was originally on working tax credit, but she was transferred to universal credit last year, with her payments falling as a result. As a consequence of that reduction and of the ongoing cap on her wages, which have lost their value, she has accrued rent arrears of over £800. Her landlord has now issued her with an eviction notice. There we have it: nurses are turning to food banks, pawning their possessions, and even being issued with eviction notices. Is that not shameful in 21st-century Britain? What a depressing human consequence of Tory economics.
I am a nurse and I believe in fairness. This is not just about paying nurses properly; it is about the porters, the housekeepers, the cooks, the cleaners and the admin staff, because they all do a good job. This is about not just healthcare workers but the whole public sector, because if the Government can find £1 billion for the DUP, they can pay the public sector properly.
It is kind of the shadow Minister to give way. Of course our hearts go out to the people in the stories he is relaying to the House, but we need to consider the whole picture. In its March report, the NHS Pay Review Body said:
“We do not see significant short-term nationwide recruitment and retention issues that are linked to pay.”
The pay review body itself says that pay is not causing retention issues, so should the House not take account of that?
Perhaps we really should, but I think the hon. Gentleman, who is an enthusiastic supporter of his Front-Bench team, is quoting selectively from the report, which I will move on to in a few moments.
Today’s motion is not just about doing what is right for NHS staff; it is about doing what is right for patients, too. I remind the House that we are significantly short of GPs and that we are short of 3,500 midwives. According to the Royal College of Nursing, we are also short of 40,000 nurses, with one in 10 nursing posts remaining vacant. Nearly 40% of the full-time vacancies advertised on NHS Jobs earlier this year were in nursing, and the Opposition know that Brexit is having an impact through nurses leaving the UK. The Nursing and Midwifery Council shows an increase in the numbers of nurses and midwives leaving its register. The average midwife has seen the value of their pay drop by over £6,000 since 2010, and we are significantly short of numbers, with 80% of midwives intending to leave the profession in the next two years as a result of the pay cap.
May I make a little progress?
The hon. Member for Croydon South said that pay does not affect retention and recruitment, but the Opposition say that the pay cap is at the heart of the retention and recruitment crisis. Earlier this year, NHS Providers, which represents hospital trusts, warned that low pay is causing staff to leave the NHS to stack shelves in supermarkets. Chris Hopson said:
“Years of pay restraint and stressful working conditions are taking their toll. Pay is becoming uncompetitive. Significant numbers of trusts say lower paid staff are leaving to stack shelves in supermarkets rather than carry on working in the NHS.”
Does the hon. Gentleman appreciate that anybody listening to his speech would take away from it a story of gloom and doom about our NHS? While there are difficulties and challenges, every day millions of people overwhelmingly enjoy one of the finest health services anywhere in the world, and I and many others are sick and tired of Labour talking it down.
The right hon. Lady says that we are talking the NHS down. We are not talking it down; this Tory Government are running it down. She seemed concerned about public sector pay in the NHS a few months ago when she tweeted:
“The important retention &
recruitment of public sector workers is about working conditions (esp in NHS) as well as pay”.
If she stands by that tweet, she should join us in the Lobby this evening.
I thank my hon. Friend for giving way, but I thank him even more for coming to Eastham in my constituency, where our precious walk-in centre is closing owing to staff shortages at our A&E, which is in crisis. The Tories says that we are talking down the NHS and lowering morale, but does he agree that it is not words that matter but action, and that is why we need action on pay?
Has my hon. Friend noticed that the Government do not necessarily have to abide by the pay reviews? In other words, they could give an increase that goes further than what the pay review body recommends. The Tories are wrecking the national health service. They should put their money where their mouth is. If they really appreciate NHS and its staff, they should vote with us tonight.
My hon. Friend is absolutely right. The Tories have been running the NHS for seven years now. It is going through the biggest financial squeeze in its history and we have some of the worst waiting times on record.
The hon. Member for Croydon South should note that the NHS Pay Review Body’s March report said that
“public sector pay policy is coming under stress. There are significant supply shortages in a number of staff groups and geographical areas. There are widespread concerns about recruitment, retention and motivation that are shared by employers and staff side alike.”
Again, NHS Providers said that
“seven years of NHS pay restraint is now preventing them from recruiting and retaining the staff they need to provide safe, high-quality patient care. The NHS can’t carry on failing to reflect the contribution of our staff through fair and competitive pay for five more years.”
We agree. Addressing NHS pay and lifting the pay cap are crucial to addressing the retention and recruitment crisis now facing the NHS.
I have given way to the hon. Lady once and I have been generous, so I hope she will forgive me if I do not give way again.
We have heard several examples of what vacancies in the NHS mean for services. We have heard about the walk-in centre in Wirral, but Macmillan Cancer Support warned last week that bigger workloads and vacancies in key roles are creating “unrelenting pressure” on the cancer care workforce and that some cancer patients are attending A&E because they cannot get help elsewhere. I have mentioned midwifery, and this summer we revealed that almost half of maternity units closed their doors to patients at some point in 2016, with understaffing often used as the justification. Earlier this year, I revealed FOI requests that showed a rising number of cancelled children’s operations, with 38% of trusts citing workforce shortages as the reason for those cancelled operations. Visit any hospital and doctors will talk about rota gaps, and the latest NHS staff survey reveals that 47% of staff view current staffing levels as insufficient to allow them to do their job properly.
Not only is the pay cap unfair on hard-working staff who are struggling to make ends meet, but it is unfair on patients, who suffer the direct consequences of under-staffed, overstretched services. We look forward to the Health Secretary telling us how he will use his newfound flexibility. We look forward to his telling us what remit he will set for the NHS Pay Review Body in the coming days. He has had all summer to think through his response to these demands. I know that he got into a big argument with Professor Stephen Hawking, but we will leave that there. The Health Secretary sets the remit—he tells the pay review body what it is able to provide—so we look to him to tell us what he is going to ask it to provide. We want him to tell us today when he will publish the remit letter.
I have been very generous to Government Members, and the hon. Lady has already had a chance.
The pay cap must be scrapped, and it must be done by giving the NHS extra investment. The self-defeating nature of this policy means that we are already spending £3 billion on agency workers, and the Government have found billions for corporation tax and inheritance tax giveaways, so this new flexibility must mean more investment. We will not tolerate hospital bosses being forced to cut services to find these funds.
I have been very generous, and I want to wrap up because a huge number of Members want to speak in the debate.
As the Government are briefing that the pay cap has gone, we expect the Health Secretary or, if he cannot do it, the Chief Secretary to the Treasury to tell us what extra investment will be made available to the national health service in the coming year to get rid of this pay cap. If they are not prepared to put the extra investment in the health service to get rid of this pay cap, we can quite rightly conclude that the consequence will be further cuts to services at the frontline.
I have been extremely generous, and I will now wrap up.
If the Government are genuine and sincere about getting rid of the pay cap, I see no reason why they should seek to divide the House today. If they do seek to divide the House, I say directly to all those Conservative MPs who went to the Royal College of Nursing rally last week, to all those Conservative MPs who have tweeted that they support getting rid of the pay cap, but just not on this occasion, and to all those Conservative MPs who have responded to constituents by telling them that they have their sympathy and that they want to get rid of the pay cap: this is not a time to sit on your hands. I know Conservative MPs will be reconciling the pressures of wanting to be loyal to the Treasury Bench and to their Whip, but 1 million NHS staff, nurses and their constituents are looking to this House to show some leadership and take a stand by giving our NHS staff the fair pay they deserve.
I commend our motion to the House.
I thank the shadow Health Secretary for introducing this debate. NHS staff are doing a superb job in tough circumstances, and it is right for this House to debate whether we are giving them an appropriate level of support.
I start by addressing the areas on which we agree with the Opposition. First, it is incredibly important to have motivated staff, simply because motivated staff give better care to patients. It is critical for patient safety that we have enough staff in our NHS and social care system, so recruitment and retention matter. It is also true that, right now, it is very tough on the frontline for NHS staff as they cope with the pressures of an ageing population, of financial constraints that have not been as tough in many years, and of changing consumer expectations of what the NHS should deliver. We agree on all that, but there are some fundamental disagreements that I also need to surface.
The shadow Health Secretary talks about the former 1% cap and the pay restraint that we have indeed had for the last seven years, which his party frequently characterises as austerity—some ideological mission by the Conservatives to reduce the size of the state. [Interruption.] I can see some nods, but it is absolute nonsense.
I remind Labour Members that in 2010 we inherited the worst financial crisis in our history and the worst recession since the great depression. The shadow Health Secretary was an adviser to Gordon Brown in 2010—he does not talk about that very much—and he knows just how serious the crisis was. He uses the phrase “Tory economics,” but the 2010 Labour manifesto, which he may well have had a hand in drafting, wanted to cut the NHS budget. The Health Secretary at the time, Andy Burnham, said that it would be “irresponsible” not to cut the NHS budget.
In 2015, five years on from that terrible crisis, the Labour party wanted to put £5.5 billion less into the NHS than the Conservative party did. In short, the austerity that the shadow Health Secretary criticises today is austerity that Labour wanted to go much further with when it comes to the NHS. Labour needs to recognise that if we had followed its advice we would not even have been able to honour a 1% pay rise, we would not have been able to recruit 12,000 more nurses for our wards, we would not have record numbers of doctors and we would not have record funding for the NHS.
Will the Health Secretary apologise for the current dreadful state? We have thousands and thousands of nurse places, and hospital trusts are having to go as far as the Philippines to recruit student nurses. Student nurses are coming out of university with £56,000 fees. NHS recruitment and retention is in a deep crisis. Will he apologise?
What I will not apologise for is the dreadful short staffing on NHS hospital wards that we inherited in 2010, which led directly to the problems of Mid Staffs. Nor will I apologise for sorting that out and making sure that we have 12,000 more nurses on our hospital wards today than we had in 2010.
The Secretary of State is repeating words that the Tories have used to excuse their cuts for years but that have not dealt with the deficit, which is still with us. My constituents do not care about that; they care about Eastham walk-in centre, which is closed because of staff shortages. Will he answer this simple question? When will Eastham walk-in centre reopen?
What the hon. Lady’s constituents care about is that today we announced the lowest unemployment level since 1975, which is a massive benefit to her constituents. She says that we have been repeating our reasons for this terrible financial discipline, which has been so difficult. I am not someone who says that the entire responsibility for the recession in 2010 is the Labour party’s. I recognise that it was a global crash, but what Labour cannot deny is that the recession we faced here was far, far worse than in other countries. Why is that? What did the Governor of the Bank of England say at the time?
“we came into this crisis with fiscal policy along a path that was not…sustainable and a correction was needed.”
What was he talking about in 2010? The Government borrowed £1 in every £4 that they spent. The deficit was 10.2%, the highest since records began. The reason that, say, Germany did not have to go through austerity is not because a German equivalent of the Leader of the Opposition was throwing prudence to the wind but because Germany did not allow its public finances to get recklessly out of control, which is what happened under the Labour Government.
This is a genuine question. I am a nurse, and I see the situation at first hand. I go to work once a month—I still do bank shifts—and the situation is truly awful. We are so understaffed that it is unbelievable. I looked after 10 patients on my last shift. That is not for the audience; it is the truth. The NHS is in that sort of state. Lincoln’s walk-in centre is threatened with closure. All that is going on. I take the Secretary of State’s point about paying for it, but the Conservative party talks about cutting corporation tax and it is paying the Democratic Unionist party more than £1 billion. While that is happening, he cannot talk to us about austerity and say that we cannot have decent NHS services. I am sorry, but he should listen to what I am saying. The NHS really is in crisis.
I thank the hon. Lady for her work in the NHS. I am honoured that we have nurses on both sides of the House who do a fantastic job. I agree that we need more nurses. We needed more nurses when I became Health Secretary—the NHS was planning to lose nurses, and I stopped that—and we still need more nurses. I will explain exactly how we will get those nurses.
Opposition Members are raising concerns about staff shortages and about recruiting staff from overseas. I am sure we all have hospitals serving our constituents that have had to go overseas to recruit. We do not want to see that; we want to see nurses trained in the UK and British nurses. I welcome the fact that the Secretary of State has taken action to remove the cap on nurses in training so that we can train more home-grown nurses.
I thank my right hon. Friend for the huge and strong support he has given to Princess Alexandra hospital in Harlow and to our campaign for a new hospital. I welcome the moves the Government are making on the pay cap and I look forward to announcements in the coming weeks. May I urge him to do even more than the Government are doing on nursing apprenticeships, because they are one key way forward? These apprentices do not have any loans and they can do nursing. Finally, let me make the wider point that one of the best ways of helping lower-paid nurses, and everyone in the public and private sectors, is by continuing to do what the Government are doing by cutting taxes for lower earners and acting through the national living wage.
No one in this House has championed lower-paid workers as much as my right hon. Friend does, and he is absolutely right in what he says. I want to talk about the recruitment issues.
I am going to make some progress and then I will give way further. I want to talk about the recruitment issues raised by Catherine West and others, but I wish to conclude on the point about financial discipline, of which Opposition Members are so critical. The consequences for a Government of losing financial discipline are not just pay freezes and 1% caps, but 1 million people unemployed—as a result of that recession post-2008. Every Labour Government in modern times has left office with unemployment higher than when they arrived. That is why this afternoon’s motion is so bogus, because the difference between the Government and the Opposition is not about a desire to invest in public services; it is about the ability to deliver a strong economy so that we can make that investment.
I want to make some progress on the recruitment issues, which a number of hon. Members have raised. The argument we seem to be hearing from the shadow Health Secretary is that Labour’s policies would mean more nurses for the NHS and better care for patients, but nothing is further from the truth. Let us look at Labour’s policies at the last election. What did the independent Institute for Fiscal Studies say then about Labour’s spending plans? It said there was a black hole of up to £29 billion, which made even Gordon Brown look like the paragon of prudence that he never was. How can a black hole like that be filled? There are only two ways of doing it. The first is by raising taxes on ordinary people—this is what the IFS said would be one of the biggest tax increases in the past 30 years, equivalent to a 7% increase in income tax. For a nurse on average earnings, this would be a £1,400 tax hike every year. Alternatively, the hole could be filled by increasing borrowing, but that simply passes on debts to future generations in a con as explicit as the con of telling students before an election that their debt will be waived only to cancel the promise after the election.
My right hon. Friend does not even need to cite the IFS to see what things would be like with Labour in charge of the UK NHS—he just needs to look to Wales, where the NHS has been cut by 10% and one in seven people are on the NHS waiting list. That is Labour in action.
My hon. Friend is absolutely right about that. The whole problem with the tone of the argument made by the shadow Health Secretary is that he is saying that the difference between the Government and Labour is about our support for public sector workers, but we all agree, in all parts of the House, that they do a fantastic job. I see that in the NHS every week. The difference between us and Labour is about knowing what harms public sector workers the most; it is between ignoring and repeating the mistakes of the 2008 crash, as Labour Members are, and what we think, which is that we need to learn from those mistakes and not repeat them.
Does my right hon. Friend agree that Labour was not the only party with an irresponsible policy at the general election on funding health and social care, and that although the Liberal Democrats can muster only one MP to debate this important subject today, their 1p on income tax gimmick would have gone nowhere far enough to funding the properly increased services they promised?
Will the Health Secretary take a few moments to address the serious issue of staff morale in the NHS? In Northern Ireland, we have no Assembly and, thus, no Health Minister, so there is no mechanism by which to give our nurses any pay increase. He needs to speak to the Secretary of State for Northern Ireland, as a start, and to address the crucial and concerning issue of staff morale, which is affected by low pay and the pay cap.
I will make some progress now, because I know that lots of people want to speak in this debate.
The other completely bogus claim we have heard this afternoon is that somehow the financial discipline of pay restraint that we have had to have has been deliberately targeted at ordinary people. Again, that is absolute nonsense, as we see when we look at what has happened. Despite the recession and the pressures on public finance, this Government have taken 4 million of the lowest-paid people out of income tax altogether. At the same time, the top 1% are paying more and the top 20% are paying more, and we have gone further, introducing the national living wage, which since its introduction in April has increased the pay of people at that level of pay by £1,400 per annum. The record overall—this is where we see the most obnoxious untruth spread by the story on austerity—shows that over the past seven years we have seen 600,000 fewer people in absolute poverty and 200,000 fewer children in absolute poverty. Income inequality has reduced to its lowest level for 30 years. Why is it that this apparently evil Tory Government have reduced inequality? It is because we have done what Labour never does, which is grow the economy, with 1 million new businesses, 3 million new jobs and unemployment at its lowest since 1975. Today, youth unemployment is below 5% for the first time and there has been a 40% drop since 2010.
I am going to make some progress, because I want to deal with the issue of morale, and then I will give way for a final round of interventions.
A lot of comments have been made about the NHS being at breaking point, at a tipping point and so on. There is huge pressure on the NHS, but, as has been said by my right hon. Friend Anna Soubry, who is no longer present, that is not the whole picture. What the shadow Health Secretary did not say is that 7,000 people are alive today who would not have been had we stayed at the cancer survival rates of just four years ago. We are having probably the biggest expansion of mental health treatment in Europe, and an independent NHS England report says that for most major conditions outcomes have dramatically improved over the past three, five or 10 years.
I feel that as the sole Liberal Democrat present it is my duty to intervene. Does the Secretary of State accept, as a principle, that ultimately we cannot sustain the NHS on the back of real-terms cuts to people’s pay within the NHS and that that would be unconscionable year after year? Does he also accept that as the difference between public and private sector pay narrows so much, people will just vote with their feet and leave? Therefore, not only is this morally wrong, but it will not work ultimately.
I agree with the right hon. Gentleman that when deciding policy on pay we absolutely have to look at the impact on recruitment and retention, and that if we are going to deal with the pressures of an ageing population in the way that he and I would both want, we are going to need to recruit many more doctors and nurses for the NHS over the years ahead.
The progress that we have made in the NHS in improving outcomes for patients, despite the huge pressure on the frontline, is possible because of the brilliant staff we have in the NHS. I want to recognise that pay restraint has been extremely challenging, which is why yesterday my right hon. Friend the Chief Secretary to the Treasury announced a new policy, allowing Departments flexibility where there are recruitment and retention issues, and where productivity savings can be found. We will also honour the commitment we made prior to yesterday’s announcement, which was that before we take any decisions we will listen to the independent advice of the pay-review bodies.
To value staff also means to look at non-pay issues as well. It means we should look at making sure that we are training enough staff, so that when hospitals have the budgets to employ staff, they are there for them to employ; it means we should look at flexible working—on which, frankly, the NHS can do a lot better—if we are to tackle the agency bill that the shadow Health Secretary spoke about; it means we should put in place measures to encourage nurses to return to practice, which is why Health Education England is increasing the number of return-to-practice training places to 1,250 from 2019-20; it means we should look at new support roles for nurses, such as the 2,000 nurse associates who are starting training this year; and it means we should look at new routes into nursing, such as the nurse apprentice route that we are opening this year.
I assure the hon. Lady that we are making reforms because we want to train more nurses and to fund more nurse training places. There has been a dip in the number of people taking up nurse training places this year, as there was when the higher education reforms were introduced in 2012, but it recovered soon after that and we now see in other parts of higher education record numbers of students from poorer backgrounds going to university.
On my right hon. Friend’s earlier point about the recruitment and retention of staff, one problem, which I know from having spoken to the Worcestershire Acute Hospitals NHS Trust and the Alex Hospital in my constituency, is the constant negative messaging the public receive. Members from all parties deeply back NHS workers, appreciate and respect how hard they work, and recognise the challenges. If Opposition Members really care about easing the recruitment and retention crisis, I call on them to join us in talking about some of the good news and the good messages that are coming out of the NHS. Those are the things that get through to the public’s mind and that encourage nurses to join the profession, and that is why we have twice the number of applicants for nursing places this year.
My hon. Friend is absolutely right. From some of the debates we have in this House, a person would never know that in July, for the second time running, an independent American think-tank looked at health systems in all the world’s major countries, compared us with the United States, Germany, France, Australia and others, and said that the NHS was top—the best healthcare system of any major country. We have a huge amount to be proud of.
I am going to conclude my comments by asking three questions. First, who is the real friend of public sector workers—the party that wrecked the economy, leading to massive cuts, or the party that turned the economy around with 3 million new jobs? Who is the real champion of public services—the party that did not only wreck the public finances but wants to do so all over again, or the party that is restoring discipline to the public finances so that we can start to invest more in our public services? Who is the real friend of the NHS—the party that has delivered more doctors, nurses and funding than ever before in its history, or the party that plays politics with the NHS in election after election, despite doing it so much harm?
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.
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?
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.
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.
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.
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?
Order. I appreciate that 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.
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.
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.
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 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.
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.
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.
It is a pleasure to follow Dr Whitford. I pay tribute to her for her work on the Select Committee on Health in the previous Parliament. That work was inevitably full of expertise and always constructive; I thank her for that. I agree with her that the NHS is a team, but that team should also include the wider social care staff because we cannot continue to look at the two systems in isolation. I echo her point, thanking all our NHS and care staff for the contribution they make not just to our wider economy, but—most importantly—to patients. Those are the people we should keep at the heart of this debate.
I welcome this debate. I also welcome the relaxation of the cap because we need to give the NHS Pay Review Body greater flexibility to make recommendations about what we need to put in place for our NHS staff. I agree with the hon. Member for Central Ayrshire that we should look at the impact of pay on morale, recruitment and retention—this is an international workforce, as well as a national one—but we also need to look at pay across regions and within specialties because there is great variation. We should focus our efforts on ensuring that we are looking at the situation from the patients’ perspective by, for example, looking at the greatest areas of deprivation, which very often have the lowest ratios of NHS and care staff and who are under the greater pressure.
Seven years of sustained pressure on NHS pay is taking a toll. Nobody anticipated that it would go on for this long, so it is time to relax the cap. We should look not just at the issue of pay, but at the wider pressures within the NHS. I am delighted to announce that the Health Committee, which held its first meeting just before Prime Minister’s Question Time, has agreed that its first inquiry of the Parliament will be on the nursing workforce. We will look not just at pay, but at the wider workforce pressures, including the increased workload that comes from increasing demand across the system, morale and all the other non-pay issues that contribute to the pressures on nurses. We will also look at bursaries and the new routes into nursing, and at their impact on people entering the nursing workforce. We have heard about that already today. For example, we know that those who drop out of nursing courses are more likely to be in the younger age groups, whereas those who go into nursing as mature students are much more likely to stay. We need to look at all those wider impacts.
I really welcome the news that the Select Committee is going to do a review of nursing. Will the Committee look into pay structure? The current Agenda for Change structure is being used by some trusts, in hospitals and communities, as a way of downgrading nursing roles. For example, a senior sister in one place may be paid a band 7 salary, whereas someone in the same role somewhere not too far down the road may be paid a band 5 salary. There is inequity in the current system.
That is an important point. I very much hope that my hon. Friend will contribute to the Committee’s inquiry. As well as looking at the new routes into nursing, we will look at the skills mix, roles within health and social care more widely, the impact of Brexit and language testing, workload and morale. We will be seeking contributions from hon. Members across the House and from people outside.
As I said, we will miss something if we just look at the issue as one of pay. Pay restraint is estimated to contribute between £3.3 billion and £3.5 billion of the five year forward view efficiency savings up to 2019-20. If that goes, what will fill the gap? We have to be careful that there is no loss of services or losses in the workforce, because workforce pressures—probably more than any other issue—contribute to nursing staff leaving the profession. We have to look at the bigger picture.
I have been a nurse for 40 years, but this is not just about nursing. There are other groups as well, including occupational therapists and physiotherapists, who are also registered professionals. Along with everybody else, they are just as important as nurses.
The hon. Lady is absolutely right. Look, for example, at the applications for nursing courses. Even though the number of applicants has gone down, it may not ultimately result in a loss of numbers entering nursing. Some of the applicants from that overall drop in numbers might have gone on to other courses, so we need to look at the bigger picture. In opting to look at the nursing workforce, the Health Committee is not saying in any way that other parts of the workforce are not important. The NHS is a team, but it would be difficult for us to report within a certain timeframe if we looked at the entire workforce. I have no doubt that we will look at other aspects of the workforce over the course of this Parliament. I assure the hon. Lady that we will not lose sight of the bigger picture and I hope that she will contribute to the inquiry.
We need to look at the big picture regarding the total budget for health and social care. Norman Lamb has long made this point, and we have both made it clear that it is time for us to take a cross-party approach to sustainable funding for health and social care in the long term. I look forward to working with him on that over the course of this Parliament.
I totally agree with the hon. Lady and I am keen to continue working with her. Did she see the Independent Age survey that showed that well over 80% of Members of Parliament on both sides of the House agree that there needs to be a cross-party settlement for the future of the NHS and the care system?
I welcome that and I look forward to working with the right hon. Gentleman over the coming months to try to encourage colleagues on both sides of the House, including the Front Benches, to agree to the idea. Next year is the 70th anniversary of the NHS, and I cannot think of anything more constructive we could do than to work across political parties in order to deliver sustainable long-term funding for health and social care.
I will bring my remarks to a close because I know that many hon. Members wish to speak. I look forward to hearing suggestions from colleagues in the House and outside this place about the points they would like the Health Committee’s inquiry into the nursing workforce to cover.
It will be obvious to the House that a great many people wish to speak this afternoon. We have a limited time for this debate, which will probably finish at around 4.30 pm. Therefore, after the next speaker, I will impose an initial time limit of five minutes, which might be reduced further depending on how many people still wish to speak. There will, however, be no time limit on the next speaker as I call Mr Stephen Morgan to make his maiden speech.
Today’s debate on public sector pay is about the sort of people who ensure that this Fratton boy had the sort of opportunity and aspiration that I want every single young person in Portsmouth to have. Public sector workers and Pompey people are key to delivering this ambition for my constituency. I will say more about that later.
First, I am grateful to those who have made it possible for me to make this maiden speech today—the people of Portsmouth South, who put their trust in me at the election. I promise that, as long as I have the privilege of serving in this place, I will be an active local campaigner and a strong national voice for Portsmouth, across every single community. I would like to thank my family and friends for also putting me here in this place, and the good employers of Basingstoke Voluntary Action for allowing me some holiday to fight the election.
I pay tribute to my immediate predecessor, Flick Drummond. While only in this place for two years, she served it well and was an advocate for women’s and transgender rights. I wish her well as the new deputy police and crime commissioner for Hampshire—a task, sadly, made harder by cuts to police in Portsmouth.
My first job in Portsmouth was as a playworker, serving the most deprived parts of the city—a city where, even today, too many families are still living in poverty, and where too many are still being held back. Coming from a working-class family with a background in public services—my father, a former youth worker, and my mother, a hospital cleaner—I have learned the value of good public services, of meeting local needs and of working hard to help others.
Proud to be Portsmouth through and through, it is my great city I now want to talk about. The home of Dickens, Kipling, Conan Doyle, Brunel and Amanda Holden, Portsmouth is a city of many firsts: the first to hold a football league game under floodlights, the home of the first person to use an umbrella, the first to open free clinics for the treatment of venereal disease, and the first co-operative set up by dockyard workers.
It is an honour to be the first ever Labour MP for this historic constituency, in a city that, throughout its history, has punched above its weight. It is the home of the Royal Navy and our nation’s new carriers, and the birthplace of British authors, world-leading engineers, the greatest football club in the land, in my opinion, and the occasional Labour Prime Minister—but one step at a time.
The constituency is made up of communities united by a sense of pride in Portsmouth. It is the home of world-class businesses built on the tradition of creativity and innovation that drove Britain’s industrial revolution. Portsmouth’s success gave Britain a competitive advantage that has persisted into the modern era. We are a city of doers and a city of makers. Indeed, I would go as far as to say that the success of the UK has been intrinsically linked to the success of my great city.
The spirit of this innovation is driving success in Portsmouth’s modern economy. Through my conversations with business leaders, I know that there is the potential to build an economy that creates well-paid jobs for the many, not just the few.
Portsmouth continues to leave an imprint on our world. We welcome hundreds of thousands of visitors each year, who take with them an understanding of British naval history and an affection for a modern British city that has an unrivalled waterfront and world-class events.
Maybe it is our military reserve that means the people of Portsmouth do not shout about our military success; they just get on with the job. It is this spirit that has fortified the city in the most testing of times. During wars and emergencies, my city has gone and done the job. In the two world wars, it played a key role in delivering victory and winning the peace we all enjoy today. My own family, like millions of other families across our nation, played a role in the second world war, fighting against tyranny—my grandfather leaving Southsea seafront on his 17th birthday to liberate mainland Europe on D-day. I am hugely proud of the strength and courage shown by all communities across Portsmouth during Europe’s darkest hour. The city has a spirit and a determination that is second to none, and that is why I love it.
The sadness for me, though, is that far too many people in Portsmouth are continuing to fight their own battles, whether it is the daily battle to earn enough money to make ends meet, the battle to find a good school for their child or the battle for a property they can call their home. These are the challenges, plus so many more, that people up and down this land face every day. I want Portsmouth and our nation to tackle these individual challenges head-on. I want our society and our economy to be vibrant and diverse, so that we can tackle these individual battles that ordinary people are facing, and make it our collective responsibility to resolve them together.
I want to help create a future that is better than the present, where hope replaces division, and where everyone—and I mean everyone—is better off. We know from our history that there is no challenge that we cannot face by working together, so this is my call to every Member of this House: unite to tackle the everyday challenges of the many. If we do this, I know that Portsmouth’s and Britain’s best is yet to come.
Most disturbing for me, though, is that the generation that literally fought for our country is now facing new battles. With adult social care and our NHS in crisis, the elderly are uncertain in their old age. This is not the world that we promised them. We promised them homes fit for heroes, and we are letting them down. We are not providing them with the level of public services they deserve, due to the current funding and staffing crisis, where years of pay freezes have created challenges for recruitment and retention.
I want the people who keep our communities safe, who educate our children, who defend our great nation and who save lives to be shown that people in this place understand, value and respect them. That is why I was proud to stand with Portsmouth nurses last week in the lobby of Parliament, and why I am particularly pleased to be making my maiden speech in today’s debate.
My own sister will be relying on the care of these nurses at my local hospital, the Queen Alexandra, in the next few days. She will be giving birth to her first child. Sadly, she cannot be here today, but I am personally delighted, because I fear she may give birth in this place—not another first I would want to see.
As I said at the start of my speech, it was public sector workers who gave me hope and who taught me never to accept it when someone said to a Pompey boy, “You can’t do that.” What motivates me now is one simple notion: to ensure that the opportunities of a good education, a good home or a job are not limited to the privileged few, but can be enjoyed by all our citizens, regardless of where they are born.
For as long as I continue to enjoy the privilege of representing the people of Portsmouth South, I will fight for a future in which power, wealth and opportunity are in the hands of the many, not just the privileged few. Every day, when I—a Fratton lad—arrive in this grand place, I will not forget who sent me here. I will be a local campaigner and a strong national voice committed to serving their interests.
So, to all those young people growing up in Portsmouth, as I once did, my message today is this: aim high and work hard, and you will achieve. Never, ever accept anyone telling you that you cannot achieve.
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.
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.
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.
I congratulate my hon. Friend Stephen Morgan on an excellent maiden speech. Modesty prevented him from telling the House that he more than doubled the Labour vote, going from third to first and winning the seat for Labour for the first time since the seat’s creation in 1918. He has a bright future in the House, I think, and I look forward to him being joined by many, many more Labour MPs from the south of England after the next election.
I should declare an interest in speaking in this debate, not registerable but important none the less, which is that generations of my family have worked in the national health service. My grandmother, great-aunts, aunts and cousins were and are nurses and midwives, and my mother has worked in the NHS for over 30 years.
I am very rarely accused of modesty, so I shall certainly take that compliment. I did have one occasion to act as midwife when our daughter arrived slightly more quickly than expected. As I said to her godmother, my hon. Friend Vicky Foxcroft, it is not something that I intend to repeat, and I certainly would not recommend it to the untrained.
It was in tribute to my own family’s NHS pedigree, but most importantly out of necessity to properly value the nurses and midwives of today, that I tabled an early-day motion to end the public sector pay cap in the NHS. I thank the 67 hon. Members from every Opposition party—and indeed from the Government party on the Opposition side of the House, represented by Emma Little Pengelly—who signed the motion to scrap the cap. I also pay tribute to my hon. Friend Jonathan Ashworth, who has relentlessly campaigned on the issue of fair pay for NHS staff, and who has brought this motion before the House today.
In my local NHS trust, St Helens and Knowsley Teaching Hospitals NHS Trust, there are over 1,000 nurses who do a magnificent job caring for patients in often incredibly difficult circumstances. I am very proud that the trust has been recognised as the best NHS acute trust in England in the latest patient-led assessments, achieving top marks in the country in every area of inspection.
The context in which NHS staff are showing such dedication and commitment to providing high-quality care makes it all the more remarkable. As we have heard, while working hard to meet increasing demands, nurses have seen seven years’ worth of frozen or capped pay. The rate of inflation has exceeded the pay cap of 1% in five of those seven years. That means less money at the end of the month for nurses—a 14% pay cut in real terms since 2010, according to the Royal College of Nursing, which has campaigned with great tenacity and passion on this issue, alongside many other organisations, including my colleagues in Unison.
For seven long years, Ministers have refused to introduce a fair pay package for nurses that reflects the skill set and dedication in the profession. They ignored the clarion call for the pay cap to be scrapped—until last night. In an act of cynicism, knowing they faced defeat in the House today, Ministers appear to have suddenly changed their minds—not because the Conservative party suddenly believed the pay cap was wrong, but because the Government might lose a vote in Parliament. What a morally and intellectually bankrupt Government this is, and what a disgraceful way to treat NHS staff—as a tool for seven years of ideologically driven austerity, and now as a tool of political expediency.
The announcement that the pay cap is to be scrapped is long overdue. Anyone in this House who believes that it should go needs to vote with us tonight, if indeed the Government decide to divide the House. But it is not enough: we need to see action. Thousands of nurses and NHS staff will be waiting eagerly to see what the Government offer above 1%, and millions more people across the country will be waiting to see when this Government are finally going to end their cuts to our public services and start properly funding our NHS.
I join other Members in congratulating Stephen Morgan on his maiden speech. I am sure that he will make many fine contributions to this House, and I look forward to debating with him in the months to come.
I think we agree across the House that doctors, nurses and all NHS staff are fundamental to the foundation of the NHS, which the Secretary of State referred to as a world-class health system. It is, on a number of measures, such a system. Since 2010, the Government have been determined, despite the pressures we have faced, to maintain and increase funding for the NHS. We made a commitment in 2010—we could have made a different choice, given all the difficult choices we had to make—to continue funding our NHS, and we pledged in the 2015 election campaign to increase NHS funding further.
I know the vital work that frontline staff do in the hospitals that serve my constituency, such as Russells Hall hospital, Sandwell general hospital and Rowley Regis hospital, where the staff work extraordinary hours and do exceptional work for my constituents. Of course, pay is an important part of incentivising a high-performance workforce, and I welcome the Treasury’s announcement on public sector pay, which indicates that we will look at giving Departments more flexibility. I think that that is important.
I want to highlight one aspect of the workforce challenge that the NHS faces. I have campaigned on mental health for the last decade or more. Over the summer, Government announced their ambition to increase the workforce for mental health by 20,000 by 2020. There are particular challenges around the recruitment and retention of those who work in mental health in the NHS. If the Government are to have any chance of delivering on their aspirations and objectives as outlined in the five year forward view, which they have committed to implementing, they have to get the workforce challenge right. Not enough people want to go into psychiatry or mental health nursing, and we need to find ways of incentivising people to fill those positions. The stretch ambition to get 20,000 additional people working in mental health is a considerable challenge.
I welcome the announcement about flexibility, because I think it will open up opportunities to address the particular skill challenge that we face in mental health. We must try to find innovative ways to incentivise people to come into the NHS to work in mental health, whether it is in psychiatry or psychological therapies, to fill that skills gap. Unless we address those issues, there is no way that we will be able to build the kind of mental health services that we desperately need in our NHS. We have made a lot of progress, but this particular workforce challenge lends itself to innovative thinking about pay and incentives.
I hope that the flexibility that the Government have announced will allow the Department of Health to look at its workforce plan and think in even more detail about how it might develop the incentives necessary to create the mental health workforce that we desperately need. That might mean looking at pay and incentive structures as well as training and other ways of getting people into the profession. I very much welcome the Government’s decision to allow Departments more flexibility on public sector pay. It has been a long road, and the decisions that we had to make at the beginning of 2010 about public spending have meant sacrifices for public sector workers. Everybody agrees that we have particular challenges in the NHS workforce, and we need to find innovative and flexible ways to deliver that workforce, particularly in mental health.
I must take the time to declare an interest: I am a junior doctor at St George’s hospital in Tooting.
When the Conservative Government began their programme of ideological austerity, they imposed the pay cap to secure our nation’s finances. It quite simply has not worked. We were told that the Government could not increase public sector pay beyond 1% because to do so would harm our financial security, but capping public sector pay has harmed us. It has put stress fractures in the foundations of our society—our public services. After seven years of austerity, this Government have borrowed more than all other Labour Governments in history combined. The Government have not paid off the budget deficit, and they lack any credible economic direction. Instead, they are attempting to drive our economy off the Brexit cliff like a lemming.
A decade on from a global financial crisis and seven years after the Government’s austerity programme began, our nurses, refuse collectors and teaching assistants are still paying the price. The stability of our society—the foundation on which we live our lives—depends on these vital services, from healthcare to our security, our children’s education and our local government. Since 2010, our nurses have suffered a real-terms pay cut of 14%. A hospital porter is £7,000 worse off, and a midwife has been left £18,000 short. These real-terms pay cuts have hit so hard that some of those who choose to stay in the profession are forced to use food banks, take on a second job and rack up personal debt, all because public sector pay rises have consistently failed to keep up with the rising cost of living.
The bravery of our emergency service personnel has been highlighted in recent months, following some truly tragic events, but when the media spotlight goes away they perform the very same duties, at the same risk and with the same courage. The Government absolutely do not value the people who put their lives on the line every single day to save ours.
I am grateful to the hon. Lady for giving way, but I think she should take back what she has just said. Whatever divides us when it comes to pay and financing, the one thing that cannot be said about any hon. or right hon. Member of this House, whichever party they may support, is that they do not care about the workers in the NHS. We certainly do, and we value and respect them.
I thank the right hon. Lady for her intervention, but I have to say that a future Labour Government will not just talk the talk; we will walk the walk. A Labour Government will be on the side of ordinary people—those serving on Britain’s frontline. It is not right that in 2017 Britain, those at the top of our civil service can receive golden handshakes, taking home more than a quarter of a million pounds a year, while those on the frontline are stuck on the breadline.
In response to the comments from Anna Soubry, does my hon. Friend agree that instead of just saying that we respect our public sector workers, we want to show them that respect? The cap has affected morale and retention. To say otherwise, when we can see that what is being done is harming people, is to be much like the people in the story of the emperor’s new clothes who said to the emperor, “You are not naked.”
I agree 100% with my hon. Friend’s argument, which was most eloquently put. While those on the frontline work so hard, they are on the breadline. Our firefighters, teaching assistants, council officers, nurses, policemen and women, prison guards and hospital porters—the list is endless—are the glue that binds our country together. The services in which they work are vital, because they allow people in every part of the country to live their lives, feel safe and have opportunity. Those workers—I have the pleasure of working alongside many of them at St George’s hospital in Tooting—do not seek recognition; they serve our country selflessly on a daily basis. They are simply seeking a decent day’s pay for a decent, hard day’s work. That is why the Labour party would scrap the NHS pay cap and give our hard-working NHS staff pay that recognises the skill and dedication that they bring to their working lives.
No, I am going to make some progress.
The quality of NHS services depends on the skill and talent of the people in them. Those in our NHS facing the everyday challenge of treating our most vulnerable should not be worrying about how they will put food on the table for their children—the very children who are having to accompany them to food banks.
Let us be clear: lifting the pay cap is not about recognition. It is about removing a cap that actively degrades our public services, weakening the foundations under our feet. Let us stop this demonisation of a workforce who hold this country together. We need an independent pay body to negotiate public service pay. Our services have been gutted by seven years of ideological austerity.
I am listening carefully to what the hon. Lady says. She speaks with passion and from chalk-face experience. I was interested to hear her make an open-ended pledge that her party would raise public sector pay in the national health service, but she has not said by how much, at what rate, on what timetable or how it would be funded. Can we have some detail?
The hon. Gentleman heard the eloquent contribution from the Opposition spokesman today, and I would ask him where the £350 million a week is that we expected to see as a result of leaving the European Union. If his party has its way, we will have even less money for the NHS, so we will not only lose our valuable workforce who have come here from Europe but we will be further underfunded.
Lifting the public service pay cap would enhance the capacity and skill of each of our public services. In such high-pressure, stressful places of work, we demand that our nurses, police officers and firefighters make life or death decisions with a clear mind. How will they do that if, at the back of their mind they are worrying about how they will be able to feed their children or care for their parents? They will burn out—it is a recipe for disaster, and we are already seeing it happen. How long do we expect those public sector workers to carry on like that?
There are times when we in the House divide and times when we unite. This debate reaches far beyond a percentage increase on a payslip. It is about not just pay but the knock-on effect on lives. I implore the Government to look at the issue again and pay our public service heroes a decent wage.
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 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.
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?
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.
Does my hon. Friend agree that with the Labour years having led to far less recruitment and training of nurses and doctors than the country needed, we are now in an international labour market for those important workers? It is therefore important that pay rates are high enough to attract them to this country.
I start by acknowledging just how long the constraints on pay in the NHS and across the public sector more generally have applied, and I say that fully recognising that I was a member of the coalition Government. I understood and accepted the reason why constraint was necessary at that time, because public sector pay had run quite a long way ahead of private sector pay, but the situation is very different now. Ultimately, we cannot justify year-on-year real-terms pay cuts for workers in the public sector as a way of sustaining our vital public services, but that is what they are facing and we have to face up to it.
Alongside the moral case is the fact that the cap simply will not work. The Royal College of Nursing says that the NHS in England is some 40,000 nurses short, and that has consequences. Among the doctor workforce, rota gaps are endemic—I suspect Dr Allin-Khan recognises that. It is particularly bad in some parts of the country and in some specialties. James Morris spoke about psychiatry. According to the survey published by the Royal College of Psychiatrists earlier this week, the numbers of psychiatrists vary significantly around the country, with some areas disturbingly short.
We often talk about doctors and nurses in this House, but so many other people work in the NHS. Allied health professionals, caretakers, orderlies and all sorts of other people are affected by the cap, many of whom are on very low pay. I want to give a particular shout-out to paramedics in the east of England, many of whom regularly work very long shifts and often get home utterly exhausted after dealing with traumatic events. I pay particular tribute to the 70 staff from the East of England Ambulance Service NHS Trust who have signed up to become blue light champions to highlight the importance of mental health among that organisation’s workforce. That has been done with the support of Unison and the involvement of Mind, which does really important work with frontline workers.
When we talk about pay levels in the NHS, we should also think about pay levels in social care. Non-payment of the minimum wage is endemic in many parts of the social care system, which is intolerable. Too many workers who provide care in people’s homes are still not properly paid for travel time. Information I got from Her Majesty’s Revenue and Customs recently showed that millions of pounds of unpaid wages had been recovered following an exercise in social care. When we talk about the need for a fair deal for NHS workers, we also need to talk about a fair deal for people working in social care, who do often very unattractive but vital work.
The right hon. Gentleman mentioned public sector workers more widely. In Scotland, despite voting not to scrap the cap in May, the Scottish National party Government have now listened and done so. However, public sector workers in UK bodies in my constituency and across Scotland are still left out, and will continue to be left out by the recent Tory announcement to lift the cap selectively. Will he join me in urging the Government to value and properly pay all public sector workers across the UK and ensure that none are left behind?
I agree that we have to treat people with justice across the public sector to ensure that they are not unfairly and unreasonably left behind.
On the comments made by Dr Wollaston, behind this issue is the inescapable issue of the amount of money that we are putting into health and care services, because that ultimately determines how much we can pay and how many people we can employ. The bottom line is that we cannot carry on as we are; it is not sustainable. We are not being honest with the British people. The truth is that, at the last election, none of the political parties had a solution for the NHS and the care system. I was challenged earlier about the fact that the Lib Dems argued for a 1p increase in income tax. I absolutely acknowledge that that is not a panacea and would not solve all the problems, but it would provide an immediate £6 billion, which would have a big impact on the sustainability of the system.
The bottom line is that we need to work together across the party divide. If we do not, we will be letting down the people of this country. We can continue to shout at each other, but that does not help the family whose loved one is let down by failures of care because the NHS and the care system do not have sufficient resources. More than 1 million older people have care needs that are not being met because of the underfunding in social care. As the independent Age UK survey showed, well over 80% of Members of Parliament, on both sides of the House, agree that we need to work together to come up with a long-term, sustainable solution. Please, Government, get on with it.
It is a great honour to have been called in this serious debate. I am pleased by the way in which it has been conducted, as we have heard some very good speeches, in particular the maiden speech by Stephen Morgan. It was an amusing, entertaining, heartfelt and serious speech, and I have no doubt that the hon. Gentleman will make valuable contributions in this Parliament and in years to come. It was a salutary speech because it gave one faith in the House of Commons.
Having been a Member for seven years, I have seen many debates—and some yah-boo politics—in which people apportioned blame for the crisis. Labour says that the Tories cut too much and that it was all the bankers’ fault that we had a deficit of £160 billion—the largest peace-time deficit in our history. Norman Lamb, who was a Front-Bench member of the coalition Government for their full five years, will remember clearly the context in which we came up with the difficult policy of the pay cap. It was not a whimsy, and we did not do it for the hell of it to put people under pressure. The pay cap was a serious response to a difficult and chronic problem—the deficit.
I do not want to apportion blame, and I echo my right hon. Friend the Secretary of State in recognising that the global crash was not entirely Labour’s fault—I am willing to give it that—but the history of the public finances from 2001, eight years before the financial crisis happened, shows that we ran a deficit in every single one of those years. To borrow a phrase—a mantra—from a departed colleague, Labour did not fix the roof while the sun was shining. The Labour party had a record of fiscal incompetence, and it was against that backdrop that public sector pay restraint became an issue. It is important to look at the history to explain why the pay cap was instituted in 2011.
I would like to allow the hon. Lady to speak early on, and there is nothing wrong with intervening, but we do need short interventions. That would be great. I need to know if Members will be giving way, too. I would like to get all speakers in, but the more interventions we have the less chance there is that I will be able to do that.
That was a fair intervention, but I completely disagree with the hon. Lady’s point. The deficit had nothing to do with the then Secretary of State for Health. It was not the previous Secretary of State for Health who caused the £160 billion deficit the Government inherited in 2010. Naturally, when running a huge deficit—I think it was something like 12% of GDP—one has to find savings in the budget. The question I pose to Labour Members is, how would they find the extra money? There are only two ways to do that: the Government can either raise the money through taxation, or the Chancellor has to borrow the money. It is very unclear to me what the Labour party proposes to do to increase the pay of public sector workers. No doubt it will have a plan to increase it by 5% or 10%—I do not know by exactly how much it wants to put up public sector pay—but it would have to fund that. I looked at the Labour election manifesto and I think it spent the tax on people earning over £80,000 about 10 times over to fund their various projects and policies.
We cannot go on kidding ourselves and kidding the British people. I very much like the point made by the right hon. Member for North Norfolk about the fact that we have to be serious about how we are going to fund the NHS and social care provision. He described current model as—his word—unsustainable. I do not share that view—I think we can fund the NHS adequately for the rest of the Parliament—but his general message was right. It does not make any sense for Labour Members to scream, holler and shout about Tory cuts without having a serious proposal.
To work together in a constructive, rational and mature way requires the Government to agree to do it. We are still waiting. I met the Prime Minister in February. Please make a decision.
I am not privy to the conversations the right hon. Gentleman has had with the Prime Minister—that is something he might wish to take up with her—but this is a serious debate. As he said, we cannot be honest with people on this issue if we are simply screaming and shouting across the Dispatch Box.
Conservative and Opposition Members have made the point that we have extremely impressive professionals across the public services. The level of public service provision here in Britain is right at the top of the global rankings. I have spent time in Europe, Africa and across the middle east. The public services we have in Britain are really world class and we must never lose sight of that in these discussions. The nature of the debate has been very fruitful and we have had a measure of courtesy, but it does not make sense simply to holler “Tory cuts.” That is what I have heard in seven years of trying to address what are very serious problems.
I start by saying it was a joy to be in the Chamber to listen to the maiden speech by my hon. Friend Stephen Morgan. I am confident he will be a strong advocate for his area. I would also like to take this opportunity to recognise my hon. Friend Jonathan Ashworth. NHS workers must take some reassurance in knowing that they have a champion in him.
As I have mentioned many times in this House, my constituency lies between two hospitals: Dewsbury and District hospital, which has recently seen a significant downgrade; and Huddersfield Royal Infirmary, which is earmarked for future downgrade and closure. Sadly, and probably as a consequence of these NHS cuts, I receive a large number of hospital complaints from constituents covering a variety of different issues. There is, however, one common theme in all the letters and emails: no one wants to point the finger of blame at NHS staff, because they can see how hard they are working, often in unsafe conditions mainly due to chronic understaffing issues.
In March this year, it was reported that there were over 30,000 vacant full-time positions across the NHS. There are nearly 200 vacancies at just one of my local hospital trusts alone. This means that in many hospital wards across the country, staff are having to do the work of two or even three people. We have all heard the stories of NHS staff working 12 hour shifts without food, water or even toilet breaks, where staff are close to breaking point mentally due to the undue stresses of their everyday working life. Yet they are consistently ignored when they ask for what should be their basic right: a decent pay rise to reflect the work that they put in on a daily basis in circumstances some of us in this House can only imagine in our worst nightmares. They are, frankly, heroes.
As we have heard from many of my colleagues today, NHS workers have reported having to: cut back on food shopping; miss meals in order to feed their children; use debt services, taking out payday loans or even approaching loan sharks; and even resort to food banks when the money runs out at the end of the month. Many are leaving the profession to take alternative work in different sectors. Some tell me they choose to work in supermarkets, where the pay is broadly similar but without the stresses and strains of working in a stretched industry where many workers are left feeling undervalued and burnt out from trying to keep up with the unprecedented demand for care. Many worry about the future of their registration, given the pressures they are having to work under.
By undervaluing our NHS workers to this extent, the Government are presiding over what could be the worst staffing crisis ever seen in the NHS since its inception in 1948. NHS bursaries have been slashed, and we hear that nurse staff recruitment from EU countries is down 96% on last year, mainly because of uncertainty over Brexit. In addition, a huge proportion of the existing workforce is due for retirement in the early 2020s. Instead of looking for solutions to this problem, the Government have chosen to inflict a seven-year, real-terms pay cut on our NHS staff. Yesterday, they came out and offered nothing more than a sticking plaster, with no offer of new money, saying that one group of public sector workers were more valued than another, and a vague promise that maybe in the future there could be a little bit more money made available, but no details on for whom or how much.
Those of us on the Labour Benches know how those on the Government Benches feel about our public sector heroes. We heard that loud and clear in June this year when they voted to keep the public sector pay cap and then cheered in celebration at their “triumph”. That will stay with me for the rest of my life. These are people who often put their lives on hold for us and put their lives at risk for us. They clearly deserve a pay rise to reflect their dedication and commitment.
I declare an interest as a nurse who has worked for over 20 years in the NHS, and who still works as a nurse on my hospital bank. I worked through 2010 to 2015, when the pay freeze and then the pay cap was introduced, so I know exactly how difficult it is to manage on a nurse’s wage and not see an increase. Inflation is now close to 3%, so it is becoming increasingly difficult. Seven years is enough for anyone to have lived with a pay cap or a pay freeze, so I support the RCN’s campaign to scrap the cap.
No political party comes out of this unscathed. There was a recognition among colleagues back in 2010 that we in the public sector had to tighten our belt if we were to protect jobs and frontline services. We recognised that we had to step up to the plate and play our part, and we did. However, we were promised by those on the Government Benches that that would be for roughly a five-year period. The Government have to take responsibility for not having tackled the deficit completely and for keeping the pay cap going. It is not fair on frontline staff that they are the ones still picking up the pieces of the mess the last Labour Government left the country in.
It is time now to scrap the cap. Nursing has changed dramatically over the last 20 years. It is now a graduate-only-entry profession. Nurses are taking more advanced roles, including nurse prescribing, and extended roles, such as biopsies and minor ops. Today is National Sepsis day. In A&E, it is often a nurse who sees a patient and, if they suspect sepsis, cannulates, takes blood, does the blood cultures and, if they have done their prescribing course, starts the first line antibiotics. That is done long before the doctor ever sees the patient. That is not because nurses are becoming mini-doctors; it is because they are extending their role, improving outcomes for patients and improving patient experience.
I want to send a message to Ministers: there are two myths doing the rounds at the moment about nurses’ wages. The first is that nurses are on an average of £43,000 or even £37,000. That is completely untrue. Most nurses are in bands 5 or 6, the average wage for which is £27,000—for an experienced nurse—and the starting salary roughly £21,000. The banding system is used to downgrade nurses and pay them as little as possible. When I do a hospital bank shift, I am on the lowest band 5 wage—after 20 years of working as an experienced cancer nurse who is chemo and intravenous-trained.
The incremental rise we hear about is also a myth. The banding system is used to start nurses on the lowest-possible salary. They have to wait seven years—each year going up a little bit—till they reach the top of their banding. In no other profession would that happen. We do not see MPs in the 2017 intake being paid less than those in the 2015 intake because they are less experienced or new to the role, but that is exactly what we do to nurses, and then we tell them they should be grateful for that incremental rise. They should be paid what is due for that job, not wait seven years to get the actual pay the job is worth. We do not say to the editor of the Evening Standard, “You’ve never been a journalist before, so you should be paid less than any other journalist in this country.”
This is about fair pay for a fair day’s work. We are asking people to save lives or put their own lives on the line to save the lives of others. The time has come to end the public sector pay cap, and I welcome the moves by the Government. As for the motion, I hear that the Labour party wants to scrap the cap, but there is not the money to do it across the board, although there are ways to give nurses, public sector workers and other NHS staff a pay rise. If we focus that pay rise on bands 1 to 7 and help those in high-cost areas with high-cost living allowances, we can make a difference, but using this as a political football will not score any goals. It is incumbent on all of us from all parties to work together.
When Ministers stand up at the Dispatch Box and say, “More schools than ever are good or outstanding”, “More patients are being treated than ever before” or “There is less crime than ever before”, they should remember it is because of the hard work of public sector workers. We need to reward them for their hard work and effort.
The Government’s public sector pay policy can best be described by the Glasgow word “guddle”. Translation: a tangled mess. The Government, seeking to deflect criticism, and no doubt as a direct result of tricky doorstep conversations in the election, yesterday announced a policy that was spun as ending the public sector pay cap. It was no such thing, however, and instantly attracted criticism from the very set of workers they were hoping to silence. The Prison Officers Association correctly pointed out that the so-called increase on offer would amount to a real-terms pay cut since inflation had just hit 2.9 %.
The title of this Opposition day debate is “NHS Pay”, and it is right that today there is a focus on a vital set of workers providing life-saving services, but I feel that the whole subject of public sector pay cannot be debated in a silo and in the context of one particular set of workers without reference to others. This week at the TUC conference, all the public sector unions came together in a collective call for parity and fairness in pay awards, not selective cherry picking.
I come from a public sector background and a trade union, Unison, that has always recognised that not rewarding and supporting public service workers properly is a political choice. It is a choice that the Government are trying to avoid being called out on, as from time to time token efforts are made to imply they understand and value public service. The Prime Minister told the Tory party conference last year:
“Our economy should work for everyone, but if your pay has stagnated for several years in a row and fixed items of spending keep going up, it doesn’t feel like it’s working for you.”
That sounds good, but it is at odds with the very heart of Conservatism and the shareholder mentality that puts pounds and profits before a public sector ethos. The privatisation of public services is a case in point. Turning public assets into private shareholdings, rather than investing in quality, and targeting public sector pay for quick savings is a hallmark of every Tory Government. I was a public sector worker under John Major’s Government when they, too, had a public sector pay cap.
We would not be having this debate if the Government really valued public service workers and recognised that although many could earn more in the private sector, they have chosen to contribute their skills to helping others. The systematic punishment inflicted on them year on year by a Government who have chosen to make public sector workers pay the price for the failings of the private sector when the economy crashed in 2008 is morally unjust and unfair and has tested their patience to the limit.
I strongly believe that cuts to public sector pay is an issue that affects everyone—not just the workers, their families and service users but the wider community and local businesses. Local economies suffer when wages are held down and jobs are lost, and given the scale of the money involved, this is also a national economic issue. The TUC has produced an excellent report, “Lift the Cap”, that outlines in detail the knock-on economic impact on local economies through wages being systematically depressed.
How can the national economic picture be anything other than bleak if hundreds of thousands of people are on a low-pay subsistence existence and struggling to afford the basics, never mind boost consumer spending, without plunging even further into debt? All the time the cost of living is rising and hitting low-paid workers hardest, especially on energy and transport costs. The question is not: can we afford it? I advocate turning that miserable ideological argument on its head to say that we cannot not afford it. Paying public sector workers properly works for everyone: it generates tax revenues, reduces social security spending and creates jobs in the private and voluntary sectors.
I am concerned about the Government’s direction of travel in making announcements on police and prison officer pay over that of other public sector jobs. There is a danger that they are targeting professions dominated by men and not dealing with those public services where employment is dominated by women. I would like to hear from the Minister how they plan to tackle that issue. There is a risk of the gender pay gap increasing if the Government do not get their public sector pay policy correct.
I agree with the hon. Gentleman’s comments about the Government seeking to divide public services between those with more men and those with more women. That said, regarding the increase in police pay, an officer in my constituency wrote to me that it was only a 1% increase with a 1% bonus and that they did not get it on their overtime or shift allowances, and that it felt like another kick in the teeth, because it was being sold as 2%.
That is a fair point. Two years ago, three months after I was elected, I received a 10% pay increase followed by another uplift of 1.3% last year. As a trade unionist, I believe in a rate for the job and in accepting independent pay review processes, so I donated to local charities following the pay rise. It sticks in my craw, however, that there appears to be one rule for MPs and another for public servants. How much more must it offend my constituents?
Every Member who has spoken today against raising public sector pay while having accepted their own increase must have a different set of values, and they are entitled to their views. Equally, however, their low-paid public sector constituents are entitled to pass judgement on them, and no doubt they will draw their own conclusions. I say: lift the cap, lift it now and fund it properly.
I welcome the opportunity to address the House on the subject of NHS pay. Let me start by praising the excellent work that nurses and other NHS staff perform on a day-to-day basis. In my constituency, the excellent Southport Hospital, part of the Southport and Ormskirk Hospital NHS Trust, is a shining example of how a hospital that has had difficulties can turn itself around with the right leadership. It was commended for being the most improved hospital in the first quarter of this year, and I was grateful to my right hon. Friend the Secretary of State for visiting it, talking to staff and listening to their concerns.
The Government have continued to listen to the public sector pay boards’ recommendations, and I am particularly pleased that they have announced this level of flexibility, which I hope that will extend to those at the lower end of the pay scale. Opposition Members, who did not sort out our economy when they had the opportunity to do so, should bear in mind that we did not introduce the pay cap to penalise nurses; we did it because of the economic situation that existed at the time. For many years, because of the Labour Government’s policies, the economy was like a patient itself—it was sick, and yes, there was some bitter medicine to take—but now, thankfully, the patient is on the road to recovery.
We know that the only route towards the building of strong public services is through the building of a strong economy, and that is exactly what the Government are doing. The Opposition have made some egregious claims about the situation of NHS staff, and have even tried to claim that there is a nurse recruitment crisis owing to poor pay, although the NHS Pay Review Body recently emphasised that that was not the case, stating:
“We do not see significant short-term nationwide recruitment and retention issues that are linked to pay”.
I urge the Opposition to welcome the fact that 52,000 nurses are currently in training, and to celebrate the recent announcement that funds have been set aside for a further 10,000 training places by 2020.
Let me conclude by making a recommendation to Labour Members. If they are genuinely serious about raising public sector pay, they should consider supporting sensible economic policies that will lead to the nation’s increased prosperity and to rising wages for everyone, not just those in the NHS.
Let me join in the congratulations to my hon. Friend Stephen Morgan on his maiden speech. He was able to demonstrate what Parliament is at its very best, when members of communities come here to give a voice to those communities. It was a fantastic speech.
I also pay tribute to the members of our Front Bench for the fight that they have put up today, and, indeed, before today. They have ensured that the case has been made—for instance, when representatives of the Royal College of Nursing were across the road campaigning for the cap to be scrapped.
There is no doubt that we are still in very difficult times. The economy has not grown in the way that people intended; despite the setting of repeated targets, every one of them has been missed, and tax revenues have not been coming in. But, of course, there is always money for priorities, and this situation comes down to that question of priorities. Is the Government’s priority to give money to the wealthiest through corporation tax cuts and personal tax advantages, or is it to establish a foundation of decent public services? Collectively we know that if we are to achieve the type of society that we want, grassroots investment is vital.
Tomorrow is quite an important day for our country. It will be a decade since the financial crisis began, and queues of Northern Rock customers were forming at the cash machines. Now, our doctors and nurses are experiencing a real-terms pay cut. That is where the axe has fallen. Let us consider the Royal Bank of Scotland, a majority public institution, 73% of which is owned by the taxpayer. Last year it made a £2 billion loss. Let us forget the casino banking that brought our country to its financial knees. A majority publicly owned bank in which the Government had a significant interest, and which had made a £2 billion loss, managed to pay £17 million worth of bonuses. Where is the pay restraint when it matters? It is OK to be tough when that means talking down our doctors, nurses and other public sector workers. Where is that toughness when it comes to sticking it to the banks? The people who caused the financial crisis in 2010 have been allowed to get away with it, and the stress and the strain have fallen on our public sector workers.
The NHS does not sit in isolation. It is part of a very delicate public service ecosystem. It relies on other public sector agencies to be strong, robust and well resourced to ensure that that pressure is managed. In the north-west, more than 100,000 workers have been taken away from our local authorities and other public sector bodies, which means that there is more pressure on the NHS to deal with matters that ought to be dealt with in the community. Social services departments are under such strain that some are nearly falling over, but rather than dealing with that by paying people a decent amount for a hard day’s work, the Government seem to want to put their fingers in their ears, hum to themselves, and believe that everything is OK.
I am not fooled, and I do not believe that Conservative Back Benchers are fooled. When they stand up to defend their Government, there is a veneer of support because they have to toe the party line, but they know—they absolutely know—the real impact that their Government are having. [Interruption.] That is the truth. Listen: I know my feelings about the NHS, and they are not just about words. This is about action, about deeds, and about showing genuine support.
We are sent here to represent our constituents. Can any Conservative Members tell me how continuing to suppress the pay of hard-working public sector workers is to the benefit of any one of their constituents, when at the same time a publicly owned bank is getting away with paying £17 million in bonuses? Let them tell me where the pay restraint is when it really comes to it. Words are one thing, but facts—evidence—another thing entirely.
This comes down to stark choices. The choice on our side means having decent public services there when they are needed. The choice on the other side means sticking up for the rich at the cost of public services.
I was going to say that it was a great pleasure to follow Jim McMahon, but I truly struggle to do so. If we are to do our job as politicians, the first thing that we must do is drop the rhetoric, drop the slogans and stop the insults. They do not help, they do not achieve anything, and they are insulting. Let me tell the hon. Gentleman, and other Opposition Members, that some of us on this side of the House are getting a little sick and tired of, one, the way that the Labour party continues to run down our NHS, and two, the perpetuation of the stereotype that we do not use it, and, indeed, that we do not have families. In fact, our families have long roots in the NHS.
I am very proud of four generations of Soubrys all of whom are working, or have worked, in the NHS. My niece is training to be a paramedic, and I am sure that my mentioning that in Parliament in the presence of my right hon. Friend the Secretary of State will advance her career. Of course it will not! Her mother, my sister-in-law, works in a GP’s surgery, and my brother Charlie works at the Queen’s Medical Centre in Nottingham. My mother was a radiographer all her working life; she proudly worked in the NHS for 40 years, finally retiring, long after she should have done, at Doncaster Royal Infirmary. Her mother-in-law—my grandmother—was a nurse, as was my great aunt. I am therefore one of many Members on this side of the House with long, firm roots in the NHS. We get it, we love it, we have a passion for it, and that is why we continue to support it and fund it.
What the hon. Member for Oldham West and Royton just does not understand, like, sadly, so many of his colleagues, is that the way we achieve the great public services we all agree we want is to have a good, firm, sound economy, and we achieve that through the sort of sensible Conservative policies that we on these Benches have advocated, and have achieved—or we wreck it and destroy that strong economy with the sort of socialism that strangles our economy now being advocated by Labour’s current Front-Bench. The choice for the British people is absolutely clear: if they want a strong NHS delivering those fantastic services, they should support the Conservative party, because it us who deliver the economy to pay for those services.
I also take grave exception to anybody telling me that I follow the party line; I can think of a few on the Conservative Benches who would take grave issue with that. I make it very clear that there are undoubtedly problems and huge challenges, and all is not well within our great NHS, but, please, we must not talk it down in the way we have done.
By way of example, a very dear friend of mine died only the other week; he had a terminal illness. Even in her deepest grief, my friend, Dick Benson’s widow, when she called to tell me of his demise, told me of the remarkable care that he had had thanks to the GP in Nottingham who had provided his end-of-life care support. That is just one example of the hundreds of thousands of people who are receiving world-class treatment every day, thanks to our NHS.
As I have said, however, all is not well. Too many of our NHS workers are working overly long shifts with short breaks. I know of consultant friends of mine having to pay for their lanyards when they are broken at Nottingham University Hospitals NHS Trust, and there are many other examples.
Finally, let me give an outstanding example from my clinical commissioning group, Nottingham West. It has said that six of the 12 GP surgeries are outstanding. There is much more to be done, but make no mistake: the way we achieve a great NHS and make it even better is to have the strong economy that only the Conservatives can deliver.
It is a pleasure to follow Anna Soubry.
As a nurse of 40 years, I can say that the issue we are debating today is close to my heart. I, like many other NHS staff, struggled to make ends meet with the 1% pay cap, which acted as a pay cut. Since 2010, NHS staff who have decided to stay in the profession have experienced a real-terms pay cut of 14%. They are overstretched and undervalued, which is making patient care in the NHS a real concern. The 1% cap is forcing many experienced staff out of the profession, putting strain on those left. Others are pushed into the arms of agencies where they could earn many times their normal hourly rate, and others pursue a second job to make ends meet, working extra hours to increase their earnings. This puts a strain not only on their financial life, but on their family too.
In my constituency of Wolverhampton South West, I have constituents who work as nurses telling me they are leaving the NHS because of increasing workloads, which has caused them great stress, and years of pay restraint that has left them feeling undervalued and demoralised. Many hard-working nurses are turning to food banks, facing missing meals and struggling to pay their bills. Pay has not increased, but utility and grocery bills have. The Royal Wolverhampton NHS Trust employs over 8,000, and 7,297 are non-medical staff. Another constituent who is a ward manager at a local rehabilitation hospital in Wolverhampton contacted me explaining how she had been fortunate to train with an NHS bursary and to then be employed there as a staff nurse since 2001.
In response to a recent question by my hon. Friend Grahame Morris, the relevant Health Minister said that the Government changed the funding system for pre-registration tuition and bursaries to the standard student support system. This change means we have moved away from centrally imposed number controls and financial limitations, and therefore the artificial cap has been removed. That is not the case, as the latest UCAS figures show that applications for midwifery and nursing have fallen by 23% this year as health students are put off under this Government. Under this Government, it is difficult to train and to make a living as a nurse. That is why I am proud to have stood and been elected in the 2017 general election on Labour’s pledge, in a fully costed manifesto, to scrap the NHS pay cap and reinstate bursaries—unlike the Tories, who have given out massive tax giveaways worth £70 billion over five years.
It is a pleasure to speak in this debate. I will not try to compete with my right hon. Friend Anna Soubry, but one reason why I am speaking today—and why I often speak on healthcare matters in this place—is that I, too, come from a family of doctors and nurses who work in the NHS. It was wanting to make the NHS better that first got me involved in politics, and I care very deeply about our national health service.
I welcome the Government’s decision to lift the pay cap, and to do it in a responsible way, but it has served a purpose. Back in 2010, the pay cap was necessary. Indeed, there was a pay cap in the Labour party’s 2010 manifesto as well. Labour also recognised that a level of pay restraint was necessary because of the financial situation in which the country found itself. Pay restraint was urgently needed, because wages are a significant driver of costs in the NHS and the wider public sector, and the public finances were running totally out of control. The pay cap was part of the restoration of financial discipline, of confidence in our economy and of growth, which we are now enjoying. Thanks to that growth, millions more people are now in work.
It is right to lift the pay cap now, but it must be done with caution because this country still has a sizeable deficit and increasing levels of debt. We are still paying off large amounts of debt interest. We therefore have to be responsible in the way we make commitments on public sector spending. I am very concerned about Labour’s plans for the pay increases that they would be willing to fund. They seem to involve an open promise and a potentially bottomless pit. Labour Members will not tell us how much the pay increases would be, but we know that the proposals in their manifesto would have cost between £6 billion and £9 billion extra. It was not clear where that money was to come from. Time and again, we heard that it would come from corporation tax, but we know that when we put up corporation tax we reduce the tax take, so that policy would not have funded the increases. I am concerned that Labour Members are making an irresponsible promise that they would not be able to deliver, were they in a position to try.
I welcome the more responsible approach taken by this Government. It will not involve a blanket pay rise; rather, it will draw on the guidance of the next pay review body for the health service and make pay rises where they are most necessary. In my constituency in the south-east, for example, I am aware that the high cost of living affects the people on the lowest pay in the public sector, and I hope that they will be recognised in the pay review. We should definitely draw on the expertise of that body when making proposals for public sector pay, rather than just trying to score debating points and get the right headlines.
In my experience of about a decade working in many parts of the NHS, including hospitals, and as an MP, I have spoken to people working in the NHS and found that pay is rarely, if ever, the No. 1 concern. The issues that come up much more frequently include having time to care—
I thank the hon. Lady for allowing me to intervene. She clearly wishes to champion nurses and their selfless desire to serve the public, but does she acknowledge that nurses in my constituency have to visit a food bank after a long shift at the hospital? Should not their selflessness in wanting to serve the public be recognised by their being paid what they deserve so that they can fund their families and their livelihoods?
I genuinely believe that all members of the public sector should be paid a fair amount, and that is exactly what the pay review body will report on in its next report.
I was making the important point that pay has not been the No. 1 issue among nurses and other healthcare professionals when I have asked them what worries them most. Instead, they mentioned having time to care; being part of a stable team rather than having a high turnover of staff and lots of temporary staff; being listened to by the people they work with, particularly the senior people in the institution; and being valued. Being valued is not all to do with pay; it is much more to do with the way they are treated. In fact, I remember very well talking to one nurse whose line manager had not talked to her since the previous appraisal. To me, that is an extraordinary way of not valuing a member of staff; everyone should have regular conversations with their manager about how they are progressing.
Part of the problem in some NHS institutions is, therefore, in my view, not good enough management practices. If they were improved, we would have a much better environment for staff to work in, and I would very much like to see more attention paid to creating the right environment for healthcare workers, as well as ensuring that there is a fair and sensible pay settlement.
I have already alluded to the fact that I am delighted that the Labour party secured this afternoon’s debate. We will support the motion if this matter goes to a vote tonight, but it will be interesting to see whether we actually reach that point. Maybe the House will agree that the points that have been raised today are such that we should send out a clarion call from this House that we agree with what has been said on both sides of the Chamber today, despite some of the party political divisions that might have informed some of the debate.
I too declare that, like many Members, I have members of the family in the health service. My wife was a nurse in the Royal Victoria Hospital in Belfast, my daughter is a nurse in the Craigavon Area Hospital, my niece is a junior doctor in a hospital in Belfast, and my nephew is a trainee doctor. Many of us therefore see at first hand and hear about the needs of our health service from our relatives. From time to time we hear churlish points made to the effect that people do not care. I think all Members throughout the House know that at any moment they will know someone who works for or is being cared for in the NHS, and it is important to state that it is a brilliant service and that that service needs to be supported.
I want to raise two points. The first relates to the number of nursing staff vacancies that currently pertain in the NHS. I quote from a letter from Janice Smyth, a director of the Royal College of Nursing in Northern Ireland, in which she has indicated to me:
“The use of agency staff in Northern Ireland and associated agency costs have almost doubled” over the past few years, and that of course puts significant pressure on budgets. Also, it is unfair on regular staff in the service when they see the difference in pay that sometimes accrues. That is not to deny bank staff their right to that pay, but it does have an impact on people’s morale.
We have 1,300 vacant posts for nurses in Northern Ireland, and about the same again in the private sector. That needs to be addressed, and Northern Ireland has tried to address it by way of ensuring that the bursary remains in place. I believe that has been beneficial, but that is not the only answer. I also believe that the pay difference in Northern Ireland is dramatic and significant. It is important that I put this on the record. A care assistant in Northern Ireland earns about £17,500. Without the pay cap, they would be earning almost £20,000. A newly qualified nurse earns about £21,000. Without the pay cap, they would be earning about £25,000—a shortfall of £3,500 per year. For an experienced staff nurse, there is a significant difference: whereas they currently earn about £28,500, without the pay cap they would be earning £32,000—a shortfall of over £4,000 per annum. A highly qualified, experienced specialist nurse in Northern Ireland earns about £41,000; without the pay cap they should be earning £47,500—a shortfall of a staggering £6,500. That gap must be addressed, and addressed radically if we are to change things.
I would say to those members of the Labour party who chide us about the £1 billion deal: your party would have quite happily covered a deal that would probably have been better for us—those are the discussions we had in advance of the last election. In chiding us, you only hurt the public servants in Northern Ireland who are benefiting from that £1 billion deal that will allow us to allocate this money to relieve these costs.
I will not take that personally, Mr Deputy Speaker.
I thank the Labour party for giving the Conservative side of the House, and me in particular, the opportunity to put on the record the grateful thanks of all our constituents to public sector workers for their fantastic work in hospitals in places such as Blandford, Shaftesbury, Poole, Dorchester, Salisbury, Southampton and Bournemouth, all of which will have served my constituents over the years. We are all grateful to them.
I want to make two points to the Labour party. I entirely endorse what my right hon. Friend Anna Soubry had to say, because this is not a bidding war over which party loves the NHS more; it is about all of us trying to come together to ensure that the NHS is fit for purpose for the next 70 years, delivering quality care that is free at the point of use in the face of ever-increasing demand in the ever-more competitive space of medical advancement. At the heart of that, I am afraid to say, is cruelty from the Labour party, which makes huge promises about raising this, doing that or scrapping the other without saying how, by how much, or how it is going to be paid for. Labour raises expectations only for them to be dashed, as always, on the rocks of what would ultimately be the folly of a Labour Government. Labour’s childish approach to economic management defines what it is to be a Conservative. Broadly, being a Conservative in public life is to be the man or woman with the bucket, the brush and the shovel following behind the horse of Labour Government and picking up the mess.
I wonder whether the hon. Gentleman is aware of how his Government are reducing supply in the national health service, creating demand for private healthcare. People outside the Chamber are fully aware of the Conservative Government’s privatisation agenda and their agenda of selling off buildings—
Order. It is not normal to intervene just after coming into the Chamber. The fact is that Members who have been here all day are desperate to get in, and I am worried that they may not.
The hon. Lady has burnished her reselection credentials among the Corbynistas in Momentum as Labour approaches its party conference, and she will be grateful for that.
There is another great elephant that needs to be put out of its misery. It has been perpetuated by socialists down the decades, usually at public meetings and the like, that my party wants to privatise the national health service. Let me say in all candour that the Labour party misses the fundamental fact that the Conservatives have been in government for longer than Labour during the existence of the NHS. We have had majorities in three figures and two figures and we have had minorities, so if it was a deep-rooted Tory secret that we wanted to privatise the NHS, having privatised everything else we would have jolly well done it by now. We have no intention of doing so. I was born in an NHS hospital, as were my three daughters.
My right hon. Friend is correct, but the Labour party does not like truth spoken unto opposition. Let us hope that we never have to speak truth unto Labour in power, because that would be even worse.
There is a false debate where GPs and pharmacists are in essence private businesses delivering healthcare and advice to our constituents free at the point of use. I think the mindset in the national debate has moved on beyond the cosy intellectual rigour of north Islington, and most people are just keen to enjoy a quality service that is delivered by motivated people in a safe and secure environment. That is at the heart of our policies.
There is clearly fluidity and movement on the pay cap, which is welcome. I used the word “cruelty” a moment ago. When its economy came under pressure, Ireland coped with the management of its health budget by making a vast number of health service workers unemployed. That is one way of dealing with it, but it is not the right way. We have done it the right way, and we are grateful for the forbearance of those at the sharp end. It has not been done out of cruelty or out of intellectual or ideological purity; it has been done out of financial and economic necessity.
As our economy grows, so will the pay packets of those working in our vital public services. I know it is boring, and I know it is an inconvenient truth for the Opposition, but without a strong economy, without people in work, without business confidence and without people paying taxes, it would be an absolute sham to continue funding unsustainable pay increases and the like through borrowing, because that would just lead to cuts and further ruin.
I am pleased to speak in this Opposition day debate on the public sector pay cap. I was elected as a Labour MP for Lincoln on a fully costed manifesto, and I am proud to be a member of the shadow Treasury team.
Our NHS is chronically understaffed, and there are not enough nurses, doctors, midwives, healthcare support workers, housekeepers, occupational therapists or physios—I could go on and on. Taking a leaf out of Jeremy’s book, I spoke to some of my colleagues. I spoke to Rachel, a senior occupational therapist. OTs focus on how to support and enable people to live well at home. They empower people to be as independent as possible and to access jobs and education. We simply do not have enough OTs in our hospitals, which might be a clue as to why we have such long waiting lists for social care assessments and why we have delayed discharges.
I also spoke to Sue and Maz, who are both healthcare support workers. They wash our patients, take them to the toilet and give them back their dignity when they feel at their lowest ebb, and much, much more. Nurses cannot deliver holistic patient care without the support of a healthcare support worker. Maz told me that her family have had to cut back considerably because her wages have not gone up with the cost of living. She is on leave in a couple of weeks, and she will be working bank shifts to pay for basic household items that she cannot afford out of her regular wages. Her son is at university, and he gets a grant because the family are on a low income despite both Maz and her husband having jobs. Her son’s grant is not enough, so he is working part time alongside his studies. Next year, Maz and her husband will have to help to support him so that he can cut back on the hours he works so that he is able to study more in his final year at uni.
Another healthcare support worker, Sue, with whom I worked for 12 years, told me that she has had to cut back on her spending every single day. After working for the NHS for 20 years, her hourly rate is £1.75 above the current legal minimum wage. Again, both she and her husband have jobs and cannot make ends meet.
Gail is a housekeeper, and she told me that she has to work extra bank shifts just to make ends meet. She has not had a holiday since 2009 and, after paying her bills, she has £20 left each month. She has to do bank shifts if she wants to buy anything for her grandchildren or take them out. Again, she and her husband both have jobs.
Those women, like me, are in their 50s and will not be able to retire until they are 67. The one thing that they all told me is that they love their job. They love the patients and the people they work with, and they would not do anything else. I used to be part of that team, and I know that nurses feel the same. The trouble is that this Government have taken advantage of that hard work and loyalty for far too long, and some people just cannot afford to stay in the NHS. People cannot afford to train without a bursary, let alone stay in the NHS. To quote Gail:
“You can earn more…at Lidl than I get.”
The Government simply must pay all public sector workers what they are worth and what they deserve. They must reinstate bursaries—
Like everyone who has spoken, I completely welcome the hard work that is done by NHS staff up and down the country, but please let me bring some context to the debate. In representing Walsall North, I represent the 31st most deprived constituency in the country and the 17th most deprived in England by income. The average income in my constituency is £440 a week, which is approximately £23,000 a year. Across Willenhall and Bloxwich in my constituency the average property price is £122,000. My constituency is the complete embodiment of the hard-working, just about managing, and the people there, after 38 years, decided to elect a Conservative MP to advocate on their behalf. I intend to advocate on behalf of all my constituents, not just those who work in the public sector. Why is that? Well, the average salary in my constituency is £23,000, which is about the same as a qualified nurse starts on in the NHS.
Many workers in my constituency are employed as hairdressers, plumbers or carpenters, and what pay rise do they get every year on an incremental basis? They do not get one. They have had to work hard every year for their pay, and when we make the comparison using other factors, such as pension schemes, we see that in order to earn the same sort of pension a plumber would need to be putting away 43% of their salary. What have this Government done instead? Since 2010, we have increased the national minimum wage from £5.93 to £7.50, an increase of 26%; and we have increased the basic rate above which people pay tax from £6,500 to £11,500, putting an extra £1,000 in the pay packets of the people in my constituency. When the average salary is £23,000 a year, that money goes a long way to helping them buy a property. So, yes, I completely endorse the arguments I have heard and, yes, we value the public sector in this country, but the Conservatives value all the workers in this country, which is why I will be advocating that we continue with a Conservative Government in the future.
The first order of business should be congratulating the Scottish Government on removing the cap on public sector pay rises. We should note, too, that, as my hon. Friend Dr Whitford said, Scotland’s nurses get paid more than England’s, by between £300 and £1,100 each, and that wages for nurses in Wales and in Northern Ireland are even lower than in England. It is time that the English, Welsh and Northern Irish Governments opened up the cash tin and started paying nurses more—
Those Governments must give nurses the cash to bridge that gap with Scottish nurses and then match the pay rises from the Scottish Government—and make it new money. This has to be new investment, not current resources and not freed-up efficiency savings—those infamous, mythical beasts. It must be new money that is put into the service to keep it viable. Squeezing current resources simply starves the whole service. Please, let us also have no more of the pretence that paying workers a decent wage would bankrupt the economy or that a couple of per cent. on the wages of the lowest-paid would be some sort of spiral of economic doom.
Will the hon. Lady join me in asking why the Welsh Labour Government have not raised the pay cap where they could in Wales? That would have cost £60 million and would have relieved the situation for 30,000 nurses.
I thank the hon. lady for that important intervention. Austerity, wage cuts and in-work poverty are political choices—this is policy not necessity. The poverty facing public sector workers, including NHS workers, is a choice made by the Government—a choice made by millionaires, making ordinary workers poorer. An “increase” of 1% in someone’s wage while Brexit takes food prices through the roof, heating bills rocket, public transport fares are up by a quarter—more in some cases—the costs of childcare grow faster than the children, and rents soar is simply a pay cut. That makes the effects of the Government’s inhumane austerity policy worse. These workers are suffering the effects of cuts to public services.
“Britain in which work pays” and a mental health Bill
“to put parity of esteem at the heart of treatment”.
Last year, the Mental Health Foundation found a causal link between poverty and poor mental health, just like dozens of studies have shown before. That means that Tory Government austerity is increasing the incidence of mental health problems while promising to make it better. That increases the pressure on the NHS and betrays the patients who need the help. We cannot solve the problem in England’s NHS with new laws; it needs new cash. A responsible Government would be finding that new cash and funnelling it into the NHS and other public services.
English police forces have been saying that they cannot afford pay rises without additional funding. Some forces have clearly already reached and exceeded capacity, judging by the stories of crimes being ignored because no officers are available. For some unfathomable reason, the Government have let police numbers drop by around 20,000 since 2010. That is not a public service in a serviceable condition; that is a public sector breaking down.
If austerity continues, England’s public sector will cannibalise itself, and when that happens, Scotland’s public services will be damaged as well. Tied to this place, Scotland gets damaged time and again, but public services in England have reached fracture-point and are disintegrating. At this point, England’s NHS is not struggling but dying, and it is being helped on its merry way by Ministers who would rather it was gone. Breaking down the fabric of public services renders them irreparable, and breaking down the workers who deliver them does the same. Decent pay for decent work is not an outrageous demand, and decent funding for society’s infrastructure is a matter of respecting one’s own self-interest as well.
Regrettably, I do not have much time to go through Members’ speeches, but I want to draw attention to the maiden speech by my hon. Friend Stephen Morgan—a Pompey boy. There are two victories in Portsmouth: HMS Victory and my hon. Friend’s victory, for which I thank him. He mentioned Arthur Conan Doyle’s time as a doctor in Southsea; if the Tories had their way, this country would be going back to Victorian times.
Some 5.4 million people work in the public sector—including members of my family; my wife and daughter work in the NHS, as I did for many years—and they provide services that are crucial to the good running and, literally, the order of the country. They provide the armed services that protect our country and the protection that this House enjoys day in, day out; they provide the services that educate and look after our children; and they provide the services that care for our disabled citizens and senior citizens. They provide services that we barely notice until things go wrong, such as traffic problems, floods, weather damage, public health emergencies and much more. Some 1.6 million of those people work in the NHS, providing the services that look after the physical and mental health of our—yes, our—constituents.
I will come back to the hon. Lady in a moment.
NHS workers are the subject of today’s debate, but we must not forget workers in the rest of the public sector. In fact, I believe that NHS workers would be dismayed if we focused only on their pay situation. Why would they be? Because they spend their professional lives looking after others. I take NHS workers’ commitment incredibly seriously, unlike that hon. Member on the Government Benches who laughs at nurses, doctors and allied professionals. That is the sort of thing we get from the Tories.
If we were to take that as an example, I could give many other examples of people on both sides pointing and certainly not being courteous to Members in the way one would expect. The right hon. Lady has a good track record of being able to give a bit out; she ought to be able to take it.
I say again that I know for a fact that NHS workers take the view that this debate is not just about them but about the public sector generally.In proxy terms, this debate is about all public sector workers. Many of the arguments about the health sector apply to other parts of the public sector as well.
No, I will not.
This debate has come at a stark time for our public sector workers. We have had the hardest summer that many of us can remember—our emergency workers and other public sector workers have faced the horror of terror attacks and the outrage of Grenfell.
No, I will not.
As the country suffered, those workers stepped forward. Will we step forward for them? Labour says, yes, it will. We know what those workers provide for our communities and for our country. What do we provide for them—or, rather, what do the Tories provide for them? First, they provide huge amounts of patronising claptrap—we have seen loads of that today—backslapping and warm words. Those workers do not need our tributes; they need our action. The Tories tell them how much they are valued and what a great job they do. The Prime Minister tells us virtually on a daily basis how wonderful our public services are—it usually happens after a national emergency in which people are murdered, maimed or, in the case of Grenfell, asphyxiated or burned to death. Yes, in the week of the Grenfell public inquiry, it is as stark as that, so let us not shilly-shally around this issue.
Those public sector workers are the people we turn to when no one else is available. They are the people who save lives, help to bring life into the world and are there when we leave the world. While they gave their all for us over these hard months, they knew that the Conservative Government remained committed to capping their pay and to continuing with the real-terms pay cut they have faced since 2010. Ever since the election, they have faced mixed messages about their pay from the Conservatives.
The problem is not just about pay, but about the funding of the NHS. York’s hospitals are in this capped expenditure process due to the debts they have accrued because of massive underfunding. Can we ensure that this money comes from the Treasury and not out of the coffers of the NHS?
I will come to that point in a minute.
In the election, Labour promised to end the public sector pay cap and to free the pay review bodies to do their work properly without the artificial encumbrance of a 1% cap. Meanwhile, the Tories have spent the period since the election putting the heads of public sector workers in a spin—will they or won’t they. Yesterday, No. 10 was briefing that the pay cap was over. The Chief Secretary to the Treasury was on the radio announcing derisory offers to police and prison staff, rather than coming to this House to explain what was going on. We had to have this debate today to get the Government here to explain their actions. Members on the Government Front Bench would do well to remember these words of wisdom:
“It is better that you should not vow than that you should vow and not pay.”
We will hold them to that. When the reality of this supposed U-turn emerged, there was nothing tangible. In the case of the police, it was just an unconsolidated 1% bonus on top of what they were due to get. Prison officers were offered just 1.7%. In effect, less than 4% of public sector workers were covered by the proposals announced yesterday. In the meantime, the other 96% can whistle. The nasty party simply cannot help itself. What is its tactic? It is the same old one, regurgitated time and again, of divide and rule. As ever, it tries to pit one group of workers against the other—the public sector against the private sector, doctor against manager, admin against manual workers, British workers against foreign workers, and the north against the south. Yes, it is the same old hackneyed tactic, but this time it has not worked. If the Government had focused on dealing with this matter and on sorting out the tax dodgers, we might not have been in this situation in the first place.
This is over. Even as the Government conceded the need for a thaw in the pay cap, Tory Front-Bench Members were briefing the media to raise the issue of wonderful contracts and pensions in the public sector. The Prime Minister attacked our public servants for having progression pay as they gain experience. The Government just could not accept that fairness required a change in direction. They still had to have that streak of resentment when they were announcing the policy change. As Anne Bronte said:
“There is always a ‘but’ in this imperfect world”.
With the Tories, it is always an industrial-sized ‘but’, visible from space.
The police and prison officers will have to pay for their pay rise themselves. There is no new money and no new resource. It is an announcement without substance. If and when the public sector pay cap is lifted across the rest of the public sector—namely the other 96% I referred to earlier and, in particular, the NHS—will the Minister be asking them to pay for their own pay rise by sacking more NHS staff? Will she provide new resources? Does she expect waiting times to get longer, and operations to be delayed or deferred? Who will be first on the sacking list—the porter, the radiographer, the medical secretary, the nurse, the doctor or an allied professional? Perhaps none of these redundancies will be needed because jobs in nursing, medicine and other allied health professions cannot be filled in large parts of the country.
This is a betrayal of public sector workers and it has to end. The Tories do have something in common with nurses and doctors, but for wholly different reasons. Nurses and doctors in the medical profession stitch people up for the benefit of the patient. The Tories stitch people up for their own benefit.
We have had an important debate, in which it is fair to say that both sides of the House have recognised the importance and hard work of workers across the NHS. I saw this hard work in action on the Becket ward of Worthing Hospital a few weeks ago, where deputy sister, Sue Grace, and her team were in an improvement huddle, where every day they look at how they can make life better for their patients. That goes on right across our NHS. Because of the hard work of NHS workers across the country, there have been 1 million more operations and cancer clear-up rates have improved.
The Health Secretary recognised in his opening comments that there are challenges to address. We need to ensure that we retain those hard-working staff, that we can recruit the next generation into the service and, as my hon. Friend Dr Wollaston pointed out, that we are able to recruit people in specialisms. We need to look at making jobs more flexible so that people have a good work-life balance and we need to look at banding, as my hon. Friend Maria Caulfield pointed out. That is why the Government announced yesterday that we are moving from a blanket approach of having a 1% public sector pay cap to greater flexibility in each workforce across the public sector.
Just to be clear—because there seems to be some confusion on the part of Opposition Members—the prison officers and police settlements were for 2017-18. Our new policy is for 2018-19. There is already a clear process in place for that. The Health Secretary will submit evidence to the independent pay review body. It will look at issues such as recruitment, retention and affordability, and will then come back with a recommendation. That is the way we should do it; we should look at the evidence. Rather than shouting out numbers in the debate, we need to look at the circumstances. We need to ensure that pay is fair for people in the NHS, but that it is also fair for the taxpayers who fund those services.
OECD figures show that we spend 9.8% of our GDP on health and social care. That is above the European Union average of 8.6%. We are able to do that because we have run a strong economy. Today we announced record levels of employment. We have not heard any concrete proposals from Labour Members this afternoon. We have just heard reckless pledges that they will spend more money without looking at how they are spending it. As my hon. Friends the Members for South West Bedfordshire (Andrew Selous) and for Copeland (Trudy Harrison) pointed out, the Conservatives do not just spend more money. We actually make sure that the money goes to the frontline, that it helps and empowers people there to do their jobs, and that it makes those jobs more fulfilling.
It is not just about spending more money; it is also about the way we spend it. If we followed the Labour party’s advice, we would end up crashing our economy in exactly the same way the Greeks did with their economy. What was the result of that? They ended up cutting health service spending by 36%.
We have recognised that there are challenges in the national health service and in other parts of our public sector, and this policy applies right across the public sector. We have reflected on that situation, and we have moved to a more flexible policy that looks at issues of recruitment and retention.
However, it is important, as my hon. Friend Eddie Hughes pointed out in an excellent speech, that we also look at fairness for the people who pay for our public services. It is only by having a strong economy and by being disciplined in our approach to debt that we can get the great public services that we all want.
Question put and agreed to.
That this House
notes that in 2017-18 NHS pay rises have been capped at one per cent and that this represents another below-inflation pay settlement;
further notes that applications for nursing degrees have fallen 23 per cent this year;
notes that the number of nurses and midwives joining the Nursing and Midwifery Council register has been in decline since March 2016 and that in 2016-17 45 per cent more UK registrants left the register than joined it;
and calls on the Government to end the public sector pay cap in the NHS and give NHS workers a fair pay rise.
On a point of order, Mr Deputy Speaker. Is it not now clear that the House has been unanimous in saying that we should end the pay cap in the NHS and give health workers a fair pay rise? Is it not also clear that the reason the Government did not divide on this motion is that they knew they would lose?
The point of order is well made. It is not for me to judge, but I am sure many people will make a judgment, whatever side of the House they may be on.
On a point of order, Mr Deputy Speaker. You may be aware of press reports that have circulated during the day that the Government are abandoning their manifesto commitment to ensure that private schools take concrete steps to earn their charitable status. Once again, this appears to be an announcement made to the media rather than this House, and with only one sitting day remaining for us to pursue it. One of the ways you may advise us that we can do that is through an urgent question, but given that the Secretary of State should be here for the next debate, would it be helpful to you and the House for her to respond to this point of order, clarifying whether these reports are accurate and whether we can expect a statement to be made?
What I can say is that Mr Speaker has always made it very clear that any announcements should be made to this House first. That is a clear line that is still held, and nothing has changed from that. I am sure that Ministers will have taken that on board, and the point is well made.