This pandemic has asked so much of our health and care system. The whole country recognises how our NHS workforce have performed with distinction and gone the extra mile throughout this crisis, which has also had a huge impact on our economy. It has been and still is a tough time for businesses and all those who work in them.
As hon. Members will be aware, most of the public sector is having a pay freeze. However, even against that backdrop, we will continue to provide pay rises for NHS workers, as the Chancellor set out at the spending review. This follows a multi-year pay deal, which over a million NHS staff have benefited from and which includes a pay rise of over 12% for newly qualified nurses. We are also ramping up our investment in our NHS, with a £6.2 billion increase for 2021-22, as part of our £34 billion commitment by 2024-25, and £3 billion for supporting recovery and reducing waiting lists. As part of that, we are increasing the number of staff in the NHS, with over 6,500 more doctors, almost 10,600 more nurses, and over 18,700 more health support workers in the NHS now than a year ago. We are also on track to have 50,000 more nurses in the NHS by the end of the Parliament.
Last week, we submitted our evidence to the NHS pay review bodies, which are independent advisory bodies made up of industry experts. Their recommendations are based on an assessment of evidence from a range of stakeholders, including trade unions. They will report their recommendations in late spring, and we will carefully consider their recommendations when we receive them.
I can assure the House that we are committed to the NHS and to the amazing people who work in it. Just as they have been so vital throughout this pandemic, they will continue to be the very essence of our health service, together with all those who work in social care, as we come through this pandemic and build a health and care system for the future.
I am grateful to the Minister, but where is the Secretary of State? Why is the Secretary of State not here to defend a Budget that puts up tax for hard-working families and cuts pay for hard-working nurses? The Secretary of State has stood at that Dispatch Box repeatedly, waxing lyrical, describing NHS staff as heroes, saying they are the very best of us, and now he is cutting nurses’ pay.
Last summer, when asked by Andrew Marr if nurses deserved a real-terms pay rise, the Secretary of State replied:
“Well, of course I want to see people properly rewarded, absolutely.”
Yet now he is cutting nurses’ pay.
Last year, the Secretary of State brought to this House legislation to put into law the NHS long-term plan. He said from that Dispatch Box that his legislation represented
“certainty for the NHS about a minimum funding level over the next four years and certainty for the 1.4 million colleagues who work in our health service”.—[Official Report,
The Minister talked about the Budget. Where is the Chancellor? Where are his glossy tweets? Where is his video? Why did he not mention in the Budget that he was cutting nurses’ pay? Why did he sneak it out the day before in the small print?
This is happening at a time when our NHS staff are more pressured than ever before. In the midst of the biggest health crisis for a century, when there are 100,000 shortages, what does the Minister think cutting the pay of NHS staff will do the vacancy rates? Perhaps she can tell us.
The Minister talked about the pay review body, but she did not guarantee that the Government will implement any real-terms pay rise that the pay review body recommends. Why is that? It is because Ministers have already made up their minds to cut, in real terms, NHS pay in a pandemic. Our NHS staff deserve so much better. If this Government do not deliver a pay rise, it shows once again that you simply can’t trust the Tories with the NHS.
My apologies, Mr Speaker.
I do not think that we should play politics with these very serious questions as we come through a pandemic that has hit us and the world so hard, when people have lost their lives, people have lost their jobs, and we as a Government have had to spend so much to support the economy, individuals and, indeed, the NHS. I have been speaking to staff on the frontline of health and social care throughout this pandemic, and I and the Government are grateful to them and thank them from the bottom of our hearts for what they have done and are still doing. While so much of the public sector is having a pay freeze, NHS staff will get a pay rise.
In these difficult times, the Government have submitted their evidence to the pay review bodies and, as I said in my opening statement, they will report back to us. They will look at a wide range of evidence, including, for instance, evidence from trade unions, inflation, and the wider situation with the economy and pay levels, and we will of course look at their recommendations carefully.
The right hon. Gentleman talked about the vote that we had on the NHS Funding Act and, yes, we absolutely did vote for it. We are fulfilling our commitment to record investment in the NHS—£34 billion more. He also referred to the long-term plan and, although not something we voted on, the 2.1% increase within it will be invested in the NHS workforce this year. That will include not only these pay rises, but pay progression and further investment in the NHS workforce.
We will continue to invest in more doctors and more nurses for the NHS, and I wish that the right hon. Gentleman would welcome that. We will continue to support the recovery of our economy and restore our public finances, so that we can fund our NHS not just through the pandemic, but into the future.
The long-term plan budgeted for a 2.1% increase in salaries, which has now gone down to 1%, but an even bigger gap in last week’s Budget was identified by the Office for Budget Responsibility as a lack of funding from next year for annual covid vaccinations, for Test and Trace, for long covid and for millions of catch-up operations delayed by the pandemic. What discussions has the Health Secretary had with the Chancellor about that gap in funding, and where will that money come from?
I thank my right hon. Friend for his question. He mentions the 2.1% increase within the long-term plan. That figure covers not only this pay rise for the NHS workforce, but the pay deals that have been agreed for staff in other multi-year pay deals, pay progression, and other investment in the workforce. As for his question on funding for the broader extra covid costs, that is not in the main NHS budget. Just as we had £63 billion invested in those costs throughout this year, there is an extra £22 billion set aside for covid costs outside the NHS budget and also £3 billion specifically for recovery and bringing down waiting lists.
The proposal for a mere 1% pay rise suggests this Government do not value the risks taken and sacrifices made by health and care staff throughout the pandemic, nor the challenge that they will face to clear the backlog. Like their initial refusal to extend free school meals, it also shows the Government are out of touch with the public.
With a workforce crisis before the pandemic, does the Minister really believe that such a mean award will help recruit and retain healthcare staff? Senior band 5 nurses in England already earn up to £1,000 less than their Scottish counterparts, while the removal of the nursing bursary and imposition of tuition fees has saddled recently qualified nurses with up to £50,000 of debt. I am sure the Minister knows that shops do not accept claps instead of cash. Will this Government not give health and social care staff a decent pay rise and consider a one-off thank you payment, as in Scotland?
I am somewhat surprised by the language the hon. Lady used around 1%, because a 1% pay rise for this large number of staff will cost around three quarters of a billion pounds. She should remember that this all has to be paid for in the context of, sadly, around three quarters of a million people losing their jobs through the pandemic, while others are seeing pay cuts or reduced hours. We are in a time of huge economic uncertainty, but while much of the public sector is going to have a pay freeze, the NHS workforce is going to have a pay rise.
I acknowledge the very difficult decisions that the Government have had to take as a result of the pandemic, with the majority of public sector salaries being frozen this year. Will my hon. Friend confirm that our amazing NHS staff being the exception to that in part acknowledges their hard work, and that we should now await the outcome from the pay review bodies?
My hon. Friend is absolutely right. The NHS workforce is the exception to the pay freeze for the wider public sector, recognising the huge amount of work done and the lengths they have gone to in looking after us all during covid. He is absolutely right that we will wait for the response from the independent pay review bodies before we announce the pay settlement.
The Test and Trace programme, which the Scientific Advisory Group for Emergencies considers has had only a marginal impact on covid-19 transmission, will have had an almost 150% increase on its original £15 billion price tag following the small print buried in the Chancellor’s Budget last week. Is this Government’s claim that the 1% pay offer to NHS staff is all they can afford actually serious?
The first thing I would say to the hon. Member is that the Test and Trace programme is doing a truly phenomenal job. The other thing I would say is that in the pandemic what we absolutely need is an effective test and trace programme, so I make no apologies for the fact that we are making sure it is funded.
Although everyone in this Chamber would really like to give nurses a decent pay rise as much as possible, may I ask the Minister how that equates with equivalent grades in the police, the fire service and the armed forces, particularly given that, as she has already mentioned, they are on a pay freeze at the moment?
As my right hon. Friend says, most of the public sector—and that includes the police—is regrettably under a pay freeze for the coming year because of the challenging times we find ourselves in and in recognition that across the economy there are people who have lost their jobs and that we are having to spend a huge amount of money to support people’s incomes. It is against that backdrop that we are giving NHS staff a pay rise, but indeed these are difficult times that we are living through.
I have received literally hundreds of emails from constituents and from the Royal College of Nursing. The Democratic Unionist party and I support the campaign for a fair wage increase for NHS staff, because they have been at the forefront of the war against covid-19. They put their lives on the line day by day in defence of this great nation of the United Kingdom of Great Britain and Northern Ireland. Since 2010, average weekly pay in the private sector has grown by 22%, compared with only 17% in the public sector, so I ask the Minister, very gently and kindly, whether she will in the name of justice and for moral reasons consider reviewing the decision and deliver for NHS staff.
The Government have submitted our evidence to the pay review body of what we can afford for NHS pay, but the review bodies will look at a wide range of evidence on what is the right level to set and will make recommendations over the spring.
I am proud to play a small role on the NHS frontline, and this last, most recent wave has been particularly brutal on nurses, healthcare assistants and, especially this time round, ambulance crews. May I urge her, during this period while the review body is considering the matter, to open up discussions with the Treasury to look at what more we can do for our NHS staff, be that a one-off additional payment or other support, such as just giving people more rest and recuperation time? We should do everything we can and make every effort to go further than what has so far been recommended.
I thank my hon. Friend; I know that he does tremendous work on the frontline. He makes a really important point: beyond pay, the question of what other support we are giving to the NHS workforce is really important. Through the pandemic, there has been lots of extra support for the workforce, whether that is with practicalities such as hot food and drink—things that make work and long hours more manageable—or mental health support, which is so crucial for those who have had really traumatic experiences. We are absolutely looking at what continued support we can put in place in the months ahead.
“We absolutely want to reward NHS staff for what they have done.”
As I say, this discussion is against the backdrop of many people receiving a pay cut in parts of our economy, people losing their jobs and a wider pay freeze in the public sector. Against that backdrop, we recognise the enormous work that the NHS workforce have done, and that is why they are exempt from the pay freeze and will be getting a pay rise.
I thank the Chancellor for the scale of economic intervention that he has provided for businesses and livelihoods in these unprecedented times, and I join others in paying tribute to our incredible NHS staff; the nation owes them a debt of gratitude for what they have done and continue to do. I understand that no decision on NHS pay will be made until May. Will the Minister wait for and heed the advice of the independent pay review body before confirming the scale of the pay rise that NHS staff can expect?
Absolutely. We submitted our evidence to the pay review body last week, which included the affordable pay envelope from the Government. The Pay Review Body will look at a wide range of evidence, and we will look at its response when it comes back to us.
This pay proposal for NHS staff has managed to be both wrong and unpopular. Over two thirds of those surveyed, including nearly 60% of Conservative voters, think that a 1% pay rise is less than our NHS staff deserve, and I believe that the Secretary of State should be in the Chamber answering this urgent question about it. Does the Minister agree that NHS staff are worth a real-terms pay increase? Does she consider that the billions wasted on ineffective or undelivered personal protective equipment could have been better spent on giving our NHS heroes a pay rise?
It is absolutely right that we invested in ensuring that we could supply PPE to the NHS and the social care workforce during this extremely challenging time. There was a global shortage of PPE, so it is right that we spent money on that. As we look ahead at the pay deal for the next year, it is right that we exempt NHS staff from the wider pay freeze for the public sector and ensure that they get the recognition they deserve for what they have done and are still doing.
I thank my hon. Friend for the answers she has given thus far. Clearly we have to await the results of the independent pay review body, but can she explain to the House the basis on which the Government have put forward the proposal of 1% and how that compares with the commitments that were made to dramatically increase salaries, particularly for nurses at the start of their careers?
We have delivered on the commitments in the multi-year pay deal for “Agenda for Change” staff, including nurses. That includes the 12% pay rise for newly qualified nurses, bringing the starting salary for a new nurse to almost £25,000. We are now going into a new pay settlement for the forthcoming year. As part of the spending review, the Budget will set the envelope to cover pay costs for that pay settlement, but there are extra pay costs for the growing number of staff as we increase our staff in the NHS, particularly nurses—as I said, we are on track to have 50,000 more nurses in the NHS by the end of this Parliament.
Together with my right hon. Friend Liam Byrne, I met nurses—members of the Royal College of Nursing—in the west midlands, and Catherine, a young intensive care nurse told, with tears in her eyes, how she had worked for months to save lives. She told how she went off for a week’s holiday because she was exhausted, and when she came back, three of the four people she had been caring for had died and a member of staff had died. Does the Minister not begin to understand the dismay and despair on the part of tens of thousands of nurses like Catherine that, having endured purgatory to save lives, their reward now is effectively a pay cut?
I disagree with the hon. Member about what he just said—as I said, we are committed to giving NHS staff a pay rise—but he actually made a really important point when he talked about Catherine and other frontline staff, who have been through incredibly difficult times. I speak to nurses and other healthcare workers all the time, and one of the things I have heard many times in recent weeks and months is how badly staff need time off, and many staff have not been able to take holiday because they have been putting in extra hours to help with the pandemic response. It is absolutely vital in the weeks and months ahead that staff get the annual leave they need to rest and recuperate, and I am working with the NHS to make sure that happens.
Hundreds of thousands of people have lost their jobs during this pandemic and will be looking to the Government to support them so they can start earning again for their families. Millions of people in this country are on furlough and are living with pay cuts of 10% or 20% and will be looking to the Government to continue to support their businesses through extension of the furlough programme. Thousands and thousands of small businesses have seen the value of their businesses evaporate over the last 12 months and will be looking to the Government to support the economy to rebuild their businesses. So will my hon. Friend remind us that it is the Government’s job to balance all of those calls on the taxpayer, and it is the job of the pay review body to come back with a recommendation?
My hon. Friend is absolutely right. So many businesses have been so hard hit by the pandemic, and it is vital that we support not only the livelihoods of individuals who work in the businesses that have been hit, but those businesses themselves, because they are what will help us come through this and recover from the economic pain of the pandemic. He is right that the Government are having to balance these enormous demands on the public finances, and we also need to take steps ourselves to recover those finances so that we have a strong economy for the future.
Does the Minister realise that there is a sense of the most enormous anger all across the country? Nurses have seen us through this crisis and have saved many lives, yet they are offered a pay cut as a result of it. Some are already having to resort to food banks to survive, and a third are thinking of leaving the profession unless they get a decent pay rise. Surely to goodness, if £37 billion can be found to pay Serco for a failed track and trace system, the money must be available to pay NHS staff properly. You cannot clap for them, and cut their pay at the same time. Surely we should just pay them properly, so that we can have a national health service that we can all be proud of and all rely on for all time in the future.
Actually, talking of anger, it is probably not very helpful for many of those on the Opposition Benches to be fuelling a level of anger by calling a pay rise a pay cut. We are being absolutely clear that NHS staff are getting a pay rise. I also say to the right hon. Member that we need an NHS Test and Trace system to control the virus and we need NHS staff.
I draw the attention of the House to my entry in the Register of Members’ Financial Interests and to the fact that my wife works in the NHS. NHS staff pay is and always will be a highly contentious issue—it was contentious during the junior doctor contract debate and we do not need the back end of a pandemic for it to be so at the moment—because of the mere existence of national pay contracts, pay awards and review bodies. As part of the implementation of the changes proposed in the future of health and care White Paper, will my hon. Friend view alternative models that allow decisions on individual staff pay to be set by local employers, such as NHS trusts themselves, so that they can be best suited to the employees and the services they work for?
I thank my hon. Friend, who makes a really important point. The balance between nationally set pay and local pay has been a point of much debate over the years. There are pros and cons to both ways. We do not want to have trusts competing directly all the time for workforce, but on the other hand there are higher costs of living, for instance, in some areas. That is why there is some flexibility in the system for different levels of pay according to different areas, as he will well know, and some extra support in areas where it is hard to retain staff. I always to listen to his expertise, which I really value.
Earlier this year, Baroness Harding defended giving £1,000 per day to private sector consultants on the failing test and trace programme. Now, the Minister says we cannot afford to give our NHS heroes a real-terms pay rise. Given that covid will be with us for years to come, given the outstanding non-covid backlog in treatment, and given the incredible pressure on NHS staff, the existing 100,000 NHS vacancies and the resulting reliance on expensive agency staff, can we really afford not to?
The hon. Lady talks about the NHS workforce. One of the fabulous things we have seen throughout the pandemic—I am really grateful to all those who work in the NHS for this—is a reduction in the leaver rates, so more people are staying and sticking with the NHS, which is truly phenomenal. We have to make sure we look after those people, and I talked earlier about some of the support for the NHS workforce as we recover. It is also fabulous to see such extra interest in careers in the NHS; for instance, over a third more people are applying to become nursing students this year compared with last year. I also want to make this point on the test and trace question: it is not either test and trace or the NHS workforce. We need to have a test and trace system, and, of course, pay our NHS workforce.
I had several bits of correspondence about NHS pay over the weekend. Can my hon. Friend confirm whether any decision has been made specifically about nurses’ pay and what the total allocation for NHS pay rises is in the Budget? Will she ensure that those on lower pay bands are prioritised in any pay awards?
I thank my hon. Friend very much for her question. Nurses are just a part of the workforce being considered in the pay review, which involves over 1 million staff. About 300,000 of those are nurses. The cost of a 1% pay rise is about three quarters of a billion pounds, but we will absolutely look at the recommendations from the pay review bodies when they come through later in the spring.
The Minister has today said that she is grateful to NHS staff for their hard work during the pandemic, yet the reward the Government have suggested is a real-terms pay cut. Does the Minister feel that that is the right response, both morally and economically?
In our submission to the pay review bodies we said we have a funding envelope to enable a 1% pay rise for NHS staff. As I have said to other Members, the pay review bodies will look at a wide range of evidence and at factors including inflation. They will also look at what is happening to pay levels across the economy.
My hon. Friend will be aware of the heroic efforts made by NHS staff at the Princess Alexandra Hospital and across Harlow during the pandemic; they put their health and lives at risk looking after Harlow residents. While absolutely recognising the economic constraints and the £2 trillion debt that our country owes, will she reconsider and at least propose a larger increase for lower-paid NHS workers?
I completely agree with my right hon. Friend about the heroic efforts of NHS staff at hospitals and primary care and community trusts across the country, including the Princess Alexandra Hospital. As I have said, we have submitted to the pay review body our envelope for funding—the 1% that the Government say they can afford—and we will look at its recommendations when they come back. I should also say that there was a commitment in the spending review to ensure that lower-paid staff would get at least a £250 pay rise, and that applies to those in the NHS as well.
We heard this weekend about nurses in particular wishing to leave the profession, so does the Minister have any figures on departures in recent years? Does she agree that the elephant in the room is not pay across the board but low pay in the NHS? Even a 10% pay rise on not very much is not very much. Do we not really need a grown-up conversation about what we pay those who do some of the least glamorous jobs across health and social care day in, day out, every single year?
My hon. Friend is absolutely right that we should be thinking about the whole workforce. As the Minister with oversight of social care, I have many conversations with that sector about the pay levels for people working in social care. I want to see us appropriately rewarding and recognising staff across our whole health and social care system, not only in pay terms but in the wider package of support that people get, and making sure that each day at work is a good day. That is something that I will continue to work on in this role.
It has not taken the Conservatives long to revert to type and forget the contribution that our NHS staff have made to fighting this pandemic over the last year. Since 2010, “Agenda for Change” staff have seen their pay cut in excess of 10% on most of the spine points on the column. What assessment has the Minister made of the effect that this pay increase will have on the retention and attraction of high-quality staff into the NHS? Surely, we need to attract those people into the NHS, and this will not do it.
The hon. Gentleman makes a really important point about the retention of staff. I am working to make sure that we have another 50,000 nurses in the NHS by the end of this Parliament. On one hand, that is about making sure that we have more newly qualified nurses graduating with nursing degrees; on the other, it is about making sure that we keep the nurses and the other NHS workforce that we have. We have seen an improvement in retention, but I want that to be maintained. That is why I am working with NHS England on making sure that we have the greatest possible package of support, including mental health support, for staff who have been through a really tough time.
May I first wish the House a happy Commonwealth Day and International Women’s Day? Will my hon. Friend outline how many pay rises we expect to see through pay progression by raising pay bands?
My hon. Friend is absolutely right that, in addition to the pay settlement that we will reach through this pay review process, there are many staff who will be eligible for pay progression. About 40% of the staff we are talking about are eligible for pay progression, so many of those will get a pay rise in addition to the figure that we get to through this process.
The Minister was right when she talked about the amazing people who work in the NHS who have, in her words, “gone the extra mile” for the country. Does she understand why they will see this real-terms pay cut as a kick in the teeth? She justified it by reference to the pay freeze for other key workers, but that was a decision of this Government. Should they not recognise that they have got it wrong on both counts, review the pay freeze and give NHS staff the pay rise they deserve?
I must remind the hon. Gentleman of the difficult times that we are living in: many thousands of people have, sadly, lost their jobs through covid and others have had pay cuts. We are in times of great economic uncertainty, and against that backdrop the Government have to make very difficult decisions. They have made the decision that there will be a pay freeze for much of the public sector, exempting those on the lowest pay and the NHS from that pay freeze—so the NHS workforce will get a pay rise.
Every 1% increase will cost the taxpayer £750 million, but I did not hear the shadow Health Secretary say by how much he would increase pay or indeed which taxes he would increase to pay for that. Does my hon. Friend the Minister agree that one way to increase resources for health and social care and remuneration for our care workers is by means of a German-style social care premium?
I thank my hon. Friend for his question. I am smiling, because it is not the first time that he has mentioned to me a German-style social care system. I absolutely appreciate the work he has done to look into that and say to him, as I have before, that we will bring forward proposals for social care reform. He is absolutely right that we also need to look at the whole health and social care system as we consider these difficult questions.
The efforts of NHS staff during the pandemic have been nothing short of heroic, and, although deserved, recognition and good will are no substitute for proper pay and investment. Given the current level of vacancies and the fact that the use of agency staff in Welsh health boards costs nearly £70 million a year, does the Minister not agree that a substantial pay award would not only be fair but would constitute an investment in the NHS workforce that could help recruitment and retention of staff, thereby reducing reliance on agency staff?
I am absolutely committed to increasing the NHS workforce. As I mentioned in my statement, we already have 10,000 more nurses than a year ago; and 6,500 more doctors and over 18,000 more health support workers. We saw fantastic growth in the number of students starting nursing degrees last autumn—nearly 30,000—and nearly 50,000 have applied to study nursing this autumn. I am absolutely determined that we will continue to increase the size of our NHS workforce to meet the healthcare needs of the population.
The process begins with the Secretary of State sending the pay review body a letter to set up its remit, which was done in December. We then submitted our evidence to the pay review body last week, which covered the point about the pay envelope as well as a whole load of information about, for instance, retention and staff levels and support for the workforce. The pay review body will consider that, along with other evidence from the NHS, trade unions and others, and will report back to us in late spring. We will carefully consider its recommendations and come to a decision.
By the end of the year, £37 billion of taxpayers’ money will have been spent on the Serco Test and Trace programme, which is not even fit for purpose. That is on top of the Government spending £10 billion more on PPE contracts than they should have spent. Given that waste, how do the Government justify the view that most of the 300,000 NHS nurses are worth only a £250 a year pay rise?
The pay conversation that we are having at the moment is indeed about nurses—who are a fabulous part of our NHS workforce, and I cannot thank them enough—but it is also about the wider NHS workforce, which includes paramedics and health support workers, and this pay settlement will also include some doctors. More than 1 million staff are being considered in this process, and that is why the cost is closer to £1 billion than the figure the hon. Lady mentioned; it is around £750 million. The Government were absolutely right to invest in PPE to protect staff in health and social care during the pandemic at a time when there was a global shortage of PPE, and we are absolutely right to have invested in a world-beating test and trace service, which is doing a phenomenal job and is essential to our country’s recovery from this pandemic.
We now come to the final question, from Nigel Mills.
Will the Minister confirm that the public sector pay review body can take into account the exceptional service and sacrifice of our nurses and medical staff over the last year, and that if it recommends a higher pay rise than 1%, the Government will look at funding that from new resources and not have to scrimp and save elsewhere in NHS to fund the difference?
I agree: our NHS workforce—in fact, our whole health and social care workforce—have done a phenomenal job through the pandemic and, we should not forget, continue to do so. I will not pre-empt the recommendations that we will receive from the pay review body, but I assure my hon. Friend that we will absolutely consider them carefully before coming to a decision.
I will now suspend the House for three minutes to enable the necessary arrangements for the next business to be made.