To ask His Majesty’s Government what assessment they have made of the effects of upcoming industrial action in the NHS.

My Lords, strikes are disruptive and costly. The strikes in July cost around £240 million. Thanks to the heroic efforts of other NHS staff during the recent November strikes, the NHS was able to maintain 95% of planned care, while still maintaining critical services. I urge the BMA to reconsider its plans for more damaging strikes before Christmas, and to work with the Government to improve the working lives of resident doctors and to rebuild the NHS in partnership.

My Lords, I thank the Minister for that Answer and also pay tribute to those hard-working doctors who kept going, despite the feeling for industrial action by many in the BMA. The timing of the BMA’s announcement is surely no coincidence. Is it not the case that last week’s Budget, which displayed the Chancellor’s readiness to increase the burden on taxpayers in order to fund public spending, will have sent a clear signal to the BMA that there is scope for it to squeeze even more money out of the Treasury than it did last year, with the 29% pay rise that was awarded? Will the Minister take this opportunity to confirm the Government’s position? Do they agree that a further massive pay rise for resident doctors at this time is completely unaffordable?

Quite frankly, I do not think any Secretary of State could have been clearer in his repeated words that he cannot increase the pay of resident doctors. They have received an average pay rise of 28.9% compared with three years ago: the highest settlement in the public sector. His door is open to discuss conditions, deal with the bureaucracy that they face and improve the conditions for resident doctors. The Secretary of State could not have been any stronger than he has been about his intentions on this.

My Lords, in light of that, have the Government learned the lesson that giving resident doctors a nearly 30% increase in future, when pay increases come, should be linked to reform, not just a blank cheque?

The reform plan for change has been very clear from the outset of this Government. There has been a clear recognition that things need to change, which has driven the efforts to do everything possible to improve conditions both for the workforce and for those in receipt of care. It has not been good enough; we have a huge job to do to improve the NHS, to make it fit for purpose and to continue to deliver excellent care for people up and down the country.

My Lords, the fundamental issue here is that many previously professional organisations now seem intent on acting not as trade unions but as parodies of the trade unions of the 1950s. Underlying that are the appallingly low turnouts in the election for executives; they are normally in single figures. What are the Ministers in this department, and others, doing to try to win the battle for hearts and minds, to increase turnout to get more representative leadership?

I agree that it is essential that we move forward to modernise industrial relations, which is exactly what this Government are doing. We know that strong trade unions are essential for tackling insecurity, inequality, discrimination, enforcement and low pay, but we have to move to a situation where there is more communication, negotiation and space for collaboration in order to deliver our objectives and take people with us.

My Lords, during the doctors’ strike in 2023, I was left to die, with untreated gallstones and sepsis, in an NHS hospital. The only thing they offered me during that time was, “Do not resuscitate”. I am here today only because my friends and family managed to get me transferred to a private hospital for emergency surgery, just in time. I thank all of them for everything they did. But I know that, sadly, many others would not be able to do that, so when will enough be enough and what will the Government do to ensure that doctors fulfil their duty to patients? They exist only to do that and to serve.

I am very sorry to hear of the noble Baroness’s unfortunate experience and pleased to see her back on the Benches, fighting her corner. This is absolutely the backbone of what this Government intend to do. We knew when we came into government that standards had slipped. The pressures on medical staff have been enormous and it is our job to transform the service. That is what we have put in place.

My Lords, I listened very carefully to the excellent question from the noble Lord, Lord Spellar, but I was astounded by the Minister’s answer. I think I heard correctly that she talked about modernising the trade union regime. In the Employment Rights Bill, the Government are going to make it easier—less difficult—for trade unions to call strikes on a lower turnout. That is going to make the situation worse, not better.

We beg to differ completely with the noble Lord. We believe our Employment Rights Bill is the way forward. It will improve industrial relations and make sure that we have workplaces that are fit for purpose as we move forward through this century.

My Lords, will my noble friend tell us what proportion of resident doctors are taking action and what are the consequences for individuals when they do? You hear stories of individuals deciding to take a long weekend and in practice it is leave rather than anything else.

I have the figures in front of me. The data we have received reported an average of 17,200 resident doctors absent from work in each of the November rounds, which is slightly higher than the 16,200 average during the last set of strikes in July. Resident doctors make up about 50% of the workforce of around 150,000 NHS doctors in England. I think that gives a pretty clear sense. Of course, our sympathies go to all the other doctors, medical staff and other staff in hospitals who performed so admirably during those strikes. We will continue to support them and make sure that they can deliver for the patients in their care.

My Lords—

My Lords—

My Lords, it is the turn of the Cross Benches.

My Lords, yesterday, the Chief Secretary to the Treasury gave an interesting report, repeated here, and we had a 40-minute debate. The Chancellor had four objectives, one of which was to reduce waiting lists, not to increase anybody’s pay. Doctors going on strike will increase waiting lists. What will the Government do, knowing that the Chancellor cannot, under her fiscal rules, spend unbudgeted expenditure? Who will persuade the doctors that theirs is a lost cause?

The noble and right reverend Lord is right that communication and talking are critical. That is why the Secretary of State has repeatedly made it clear that the door is open to have those conversations, recognising the challenges that doctors have faced, whether that is bottlenecks in training or money being taken out by compulsory payments for joining the Royal College of Physicians, and all those things. As we have heard, our absolute priority is to reduce waiting lists, putting the patient at the centre of the NHS. That is the mission we are on, and we are determined to deliver it.

As the Minister will be aware, pay is only one part of what I understand the resident doctors are looking for. As I understand it, they are actually quite senior doctors—registrars, one step below consultants—often in their late 20s or early 30s, looking to form relationships, start families and put down roots. Yet they are given security of tenure of only something like six to 10 months in each posting. That is not acceptable to give them a sense of permanency and value. The Government need to look at this as a matter of urgency. Will they?

The noble Baroness and I have discussed this in another forum in this House. It is critical that we work with those doctors to find out what their priorities are and how we can work with them to give them more security and to make sure that the training posts are available. I am pleased to say that consultation is on offer around all these points. We have to move forward; the door is open, and we want to discuss how we can make improvements to the contracts.

My Lords, obviously, it goes without saying that the industrial action just before Christmas is completely unacceptable, but I would be remiss not to observe that at the time that the 28.9% pay award was made, the Health Secretary attributed problems of industrial relations with resident doctors to the former Government, rather than recognising that it is an ongoing problem. That is a matter of record. I ask the Minister: what estimate is the department making of the impact on other aspects of the NHS, particularly elective operations and primary care, of this completely unreasonable and uncalled-for industrial action?

As I said earlier, we have done some analysis of the strikes that took place in July, and we are working on the data for November. Obviously, we will take the learning from that through to how we deal with the strikes. I repeat that everyone in the health service has stepped up to the plate to make sure that the impact on patients is as low as possible. We will not shy away from the fact that we think strikes in the week running up to Christmas are completely unacceptable, and I am pleased to say that we have the leadership in the Department of Health from the Secretary of State, who has made his views on this exceptionally plain.

My Lords, is it not the case that under the last Government, the health service was wrecked, and doctors’ salaries were controlled to such a level that they fell behind previous years? We have made a substantial increase in pay; should that not mean that doctors think we are committed to the NHS and that they should help us to deliver our aims and objectives?

My noble friend puts his finger right on it. The facts speak for themselves, and I make no apology for repeating that resident doctors have had the highest pay award of the entire public sector this year: an average of 28.9% compared with three years ago. That is an enormous commitment. It is a recognition of the work they have done and of the fact that their situation had slipped behind. We call upon them now to get round the table and work it out, recognising that there is not more pay on the table at the moment but that there are other ways we can work together to improve their conditions and to make sure that we can all start delivering at full strength.

My Lords, in response to the previous question from the Benches opposite, I refer the noble Lord, Lord Watts, to a programme on Radio 4 this morning, which made it clear that, since 2015, junior doctors have had sufficient pay rises compared with other parts of the public sector—whether or not that is fair is another matter. Can the Minister tell the House how much the Government have saved on pension contributions that we will not be making to pensions forgone by the strike, as well as on employers’ contributions in relation to holiday pay? If she does not have those figures to hand, I would be grateful if she could write to me and put a copy of the letter in the Library.

The noble Lord has pre-empted my answer: I am very happy to write to him to give him the details he requested.

Like everyone else, I think that this strike is unacceptable. Nevertheless, instead of consultation, would it not be possible for the Government to organise extra jobs with the NHS? That is one of the problems that I gather the resident doctors are so concerned about.

The initial offer would have increased the number of training places by 1,000 over three years. The offer has since gone up to 2,000. We recognise that there are shortfalls—it is very patchy and there are differences between departments—which is why we need to have detailed consultations to make sure that the vacancies are in the places that need them. I absolutely agree that we need to increase the number of places available for those doctors.