Trade Union Bill

– in a Public Bill Committee at on 13 October 2015.

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[Sir Alan Meale in the Chair]

Photo of Alan Meale Alan Meale Labour, Mansfield 2:00, 13 October 2015

Order. We will now hear oral evidence from 2020 Health. Ms Manning, Members on either side of the room will be asking questions, but please give us a brief introduction first. We have to finish at 2.30 pm.

Julia Manning: Thank you for the invitation. My name is Julia Manning, chief exec of 2020 Health. We are a think-tank whose mission is to make health personal. That is very much about information, education, understanding and confidence for individuals to make decisions for themselves.

My background is that I served in the NHS for 19 years as an optometrist, firstly in the high street and then in hospital, in research practice and finally with people who are housebound, disabled, end-of-life care and also working in prisons with people who are sectioned under the Mental Health Act. So I have an NHS background and I continue to be involved in research. I am a research associate at UCL in medical anthropology looking at the impact of digital health technologies on behaviour and wellbeing.

Q 9191

Photo of Stephen Doughty Stephen Doughty Shadow Minister (Business, Innovation and Skills)

Thank you Sir Alan. I welcome you to the Chair and hope that you will enjoy proceedings with us over the coming weeks.

Julia, I was not aware of your organisation before seeing you were giving evidence today. Could you clarify if you have ever had any associations with any political party in the past? Does your organisation or anybody in a senior position or present directors have any political affiliations?

Julia Manning: Yes. After 10 years in the NHS I was very frustrated that a lot of what I did was influenced and dictated by politicians. I had no prior engagement in party politics at all. I looked at what the different political parties were doing in health inequalities, and at that time, under the leadership of William Hague, the Tories were doing more than any party, so I joined the Conservative party.

I stood as a councillor and stood in the 2005 general election. During that period I became increasingly concerned that the front line of the NHS—whether managerial, clinical, research—did not have a voice when it came to policy formation, so I gave up my parliamentary ambitions and set up 2020 Health, which is about having vision for the future and not our sell-by-date.

Q 92

Photo of Stephen Doughty Stephen Doughty Shadow Minister (Business, Innovation and Skills)

Am I correct that your current president is a former Conservative MP as well? Is that right?

Julia Manning: Are you referring to Dr Thomas Stuttaford?

Julia Manning: He has been ill for some time, so we have not had any contact with him for some years.

Q 93

Julia Manning: Yes, he is notionally still our president.

Q 94

Julia Manning: Yes.

Q 95

Photo of Stephen Doughty Stephen Doughty Shadow Minister (Business, Innovation and Skills)

Why do you think this Bill is necessary, particularly given the lack of industrial action in the health sector? The RCM has obviously not authorised industrial action before; it was the first time the RCM had gone on strike in its 134-year history. Given that, why is this Bill so needed in the health sector?

Julia Manning: I think you are right that the health sector is part of the public sector that has set a very impressive record of not taking industrial action. You cannot speak for everyone—there is over a million employees—but the ethos has been very much one of focusing on caring for the individual and doing everything possible to keep that as your primary focus. That is the perspective that I am coming from.

Q 96

Photo of Stephen Doughty Stephen Doughty Shadow Minister (Business, Innovation and Skills)

I am interested in that because you are talking about the relationships that exist in the health service and that ethos of patient care and so on. I am well aware that concerns about the Bill have been expressed to Ministers in writing and submissions from senior figures in the NHS, who have made a point of emphasising their strong partnership arrangements with trade unions and the fact that they are worried that the Bill is going to put that at risk—in jeopardy. In one letter that I have seen they say that it will make us less able to agree solutions locally to manage any potential impacts of any actions in the future. Would you agree that there is a serious risk that the Bill will put at risk those type of partnership arrangements that have ensured that patient care is the focus, even when there are industrial disputes?

Julia Manning: No, I do not agree, and I do not really see where that concern comes from. My understanding is that the Bill ensures that everything possible has been done in terms of sorting out issues at the front line and that it ensures that there is a large majority of opinion that action needs to be taken, rather than a few vocal proponents of action being allowed to have their head.

Q 97

Photo of Stephen Doughty Stephen Doughty Shadow Minister (Business, Innovation and Skills)

Even though there has not been such action, as you have accepted, in terms of the RCN and the RCM and many other bodies?

Julia Manning: The RCM, I believe, was going to take action in 2014, and then at the last minute—

Q 98

Julia Manning: Absolutely. Prior to that, there was some action in 2001, and in 1982. It has been rare in health.

Q 99

Photo of Stephen Doughty Stephen Doughty Shadow Minister (Business, Innovation and Skills)

Okay. I have a specific question about devolution. Do you operate just in England, or do you operate across the UK?

Julia Manning: We operate across the UK.

Q 100

Photo of Stephen Doughty Stephen Doughty Shadow Minister (Business, Innovation and Skills)

What do you make of the position of the Welsh Government, and, I believe, the Scottish Government as well, that significant parts of the Bill cut across the devolution settlement? These are fully devolved matters—health is a fully devolved matter, and yet the Bill effectively interferes in relationships that the devolved Governments have with the health sector.

Julia Manning: I am not an expert in devolution, but I think that the general direction of travel is a greater emphasis on local relationships and local negotiations, and the Bill reflects that.

Q 101

Photo of Stephen Doughty Stephen Doughty Shadow Minister (Business, Innovation and Skills)

So you would agree that the Welsh Government and the Scottish Government should have the freedom to be able to determine those local relationships, rather than being interfered in by the Bill?

Julia Manning: I think it is a conversation that needs to take place across the country—across the devolved nations.

Q 102

Photo of John Howell John Howell Conservative, Henley

The health service would be subject to the 40% threshold for strikes. Do you think that that has been drawn widely enough, and would you like to see any other bits of the health service included in that?

Julia Manning: In terms of detail, I have not clocked all the amendments, and one of my concerns was that certain areas would be excluded. Maybe you can tell me, for instance, what the terms are for some of the critical services, such as intensive care and emergency services, and whether they are different.

Q 103

Photo of John Howell John Howell Conservative, Henley

So you would like to see those included.

Julia Manning: I would like to see them excluded. I do not think, if you are working in intensive care or emergency services, you should have the right to strike.

Q 104

Photo of John Howell John Howell Conservative, Henley

What do you think the effect of the Bill will be on patients seeking healthcare?

Julia Manning: Thinking about the Bill, the wider context is really interesting in terms looking at the trends for our ageing population, the greater proportion of people who will have long-term conditions, who will be dependent on interventions and who will have been lined up potentially seeking to have treatment and then feel that that might be jeopardised by industrial action. There is a volume issue here.

For me, the Bill raises the discussion that I feel we should be having around the changing nature of the workplace for the NHS as a whole, because of the impact and influence of technology, which is changing many of the duties and roles that people have and the opportunities for the public to look after themselves. It feels to me as though we are still talking about skills and the workforce as it is now, but what is it going to look like in five or 10 years’ time? It could be very different.

Q 105

Photo of John Howell John Howell Conservative, Henley

Would you like to give us a view of what you think it will look like, and how the Bill would affect that in five to 10 years’ time?

Julia Manning: Again, I will try not to get too technical or philosophical. The Bill does not go into the detail of the many different NHS roles and responsibilities, but those are going to change. As patients, as the public and as what we call “participatients”, we will have information and access to all sorts of things that we currently do not have access to, which have been the preserve of the NHS. Down the line, the impact of action could be quite different because of what we as the public will have access to, which will no longer be within the control of NHS professionals. That is something we should be mindful of.

Q 106

Photo of Chris Stephens Chris Stephens Scottish National Party, Glasgow South West

It is a privilege to serve under your chairmanship, Sir Alan.

I would first like to ask: are you aware that the current law in terms of trade unions participating in industrial action is that they must provide life and limb cover? If so, does that assuage your fears? In addition, what surveys have you taken of the members in your organisation? You did intimate to Mr Doughty that you are organised across the UK. Also, do you believe that, with any changes at all within any of the health services across the UK, there has to be a negotiated change and a mutual partnership arrangement between employers and the trade unions?

Julia Manning: On the first point, in terms of like for like—

Photo of Chris Stephens Chris Stephens Scottish National Party, Glasgow South West

Sorry, it is life and limb cover. Trade unions are legally obliged to provide life and limb cover in any industrial action.

Julia Manning: Sorry, could you repeat the question?

Photo of Chris Stephens Chris Stephens Scottish National Party, Glasgow South West

Basically, are you aware that trade unions have to provide life and limb cover in an industrial dispute? Does that assuage your fears of what is currently taking place in the workplace? Are you more relaxed that because a trade union under current law has to provide life and limb cover that you are comfortable with that? You have raised a lot of points on some of the earlier questions about the impact on patients.

Julia Manning: My concern with that is about the projected increase in the number of patients and, therefore, the workforce we will potentially need. We already have shortages in skill sets in all sorts of areas. If I understand you correctly, the opportunity to provide cover is going to be harder.

Q 107

Photo of Chris Stephens Chris Stephens Scottish National Party, Glasgow South West

Do you know what life and limb cover actually is?

Julia Manning: Give me your definition.

Q 108

Photo of Chris Stephens Chris Stephens Scottish National Party, Glasgow South West

In an industrial dispute a trade union is obliged to maintain services while workers are on strike, and to provide cover in case of emergencies: health and safety emergencies, for example. In the NHS, there would have to be some sort of provision for those who are critically ill. Have you considered the life and limb cover issues that are in existing trade union legislation?

Julia Manning: As an organisation, no we have not.

Q 109

Photo of Victoria Prentis Victoria Prentis Conservative, Banbury

Going back to devolution, on which I recognise you are avowedly not an expert, take it from me that health is a devolved issue. I think my colleague mentioned that. Do you view the Bill as being concerned more with employment and industrial relations than health? Obviously, you look at it from a health perspective, but in your mind, what is the Bill concerned with?

Julia Manning: The Bill from my perspective and the interest I have in it is how patient experience would be affected by the Bill and has been affected by strikes. When we already have a scenario of shortages in the workforce and treatment being curtailed and postponed for other reasons, it is another consideration for us that would mean that people are not seen when they expect or need to be. That is my interest in the Bill.

Q 110

Photo of Jo Stevens Jo Stevens Labour, Cardiff Central

Can I ask you about clauses 12 and 13? They propose to change the current arrangements for facility time, and facility time operates within the NHS. What do you know about the current arrangements and what do you consider their benefits?

Julia Manning: Of facility time? I do not know about that.

Q 111

Photo of Jo Stevens Jo Stevens Labour, Cardiff Central

You do not know anything about facility time?

Julia Manning: No.

Q 112

Photo of Rishi Sunak Rishi Sunak Conservative, Richmond (Yorks)

Concerning patients’ access to healthcare, as you mentioned, when there are strikes in other sectors outside healthcare, for example, in transport or schools, presumably that impacts a lot of people who are employed by the NHS or other healthcare operators. Do you have any thoughts on the disruption that strikes in those sectors have caused in healthcare and in the NHS, and do you think that this Bill will at all improve patients’ access to healthcare in those circumstances?

Julia Manning: That is an interesting question, particularly in the light of the recent strikes that we have experienced in London and on London transport, which we know have had a significant impact on the ability to run clinics in hospitals across the capital. That is the extent of our interest. Again, I take that back to the patient experience and either their managing to get there and then not being able to be seen, or their being told that they cannot be seen because of that action—the influence that has on someone who requires urgent treatment for sight loss or on someone who is isolated, has had a fall and then had their hip replacement postponed again.

Our interest is very much at that personal patient level, but the repercussions go beyond that individual’s experience, because of those around them and the other circumstances that have had to be arranged. Your point is very valid in terms of the influence of other industrial action on the ability of the health service to do its job and, quite practically, for staff to be able to be on site.

Q 113

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Climate Justice)

I wonder what your views are on the opinions of the Royal College of Nursing, the Royal College of Midwives, the British Medical Association and the Society of Radiographers, which all state that  there are aspects of this Bill that are deeply concerning to them with regard to patient care. What would your response be in that regard?

Julia Manning: Can you give me an example of one of their concerns?

Q 114

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Climate Justice)

Yes. For example, the RCM has spoken about the use of agency workers, which it describes as being potentially detrimental to patient care, in relation to those workers’ ability to understand patient care regulations within the workplace and so on.

Julia Manning: I agree that use of agency workers is always sub-optimal, but it happens all the time for other reasons. There are bigger issues, and issues that occur more frequently, which create the need for agency workers to be brought in. Those issues need to be addressed outside of this.

Q 115

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Climate Justice)

The RCN opposes the Bill. If the Bill is enacted, the RCN says, it

“could have serious consequences for productivity and morale in the NHS”,

and therefore it poses a threat to patient care.

Julia Manning: That has to be looked at while considering the balance between the ability to take action and other factors, so you could argue from both sides that patient care will be affected if action is taken or if it is made more difficult to take action. Patient care is a concern that needs to be at the forefront of all decision making. Looking at the RCM in particular, it was very much at the heart of the call for action a couple of years ago but then stepped back, and I think that it did absolutely the right thing.

Q 116

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Climate Justice)

But you have no concerns that your views appear to be in opposition to all these bodies, which represent medical and nursing staff and which are concerned about patient care, as well as the impact on it?

Julia Manning: I do not see it as being in opposition. I am as concerned as they are about agency workers, but there are many more issues that require agency workers to come in.

Q 117

Photo of James Cartlidge James Cartlidge Conservative, South Suffolk

It is a pleasure to serve under you for the first time, Sir Alan.

Thank you, Julia, for coming in. I have read many of your organisation’s reports; they are incredibly authoritative and look at many wider issues of health, including stress. The nub of this Bill—the biggest issue—is when cities and economies are paralysed by major strikes that are called on a low turnout. I think that is the biggest issue out there for the man or woman in the street. Those days are incredibly stressful for people who have to reorganise their childcare and who cannot get a train, so that they have to stand in a rugby scrum to get on a bus. But it is a serious point—commuting is one of the most stressful activities that we now do—and so I would like to have your thoughts on whether we can make life easier for people and have less stress by having fewer such disturbances.

Julia Manning: Yes, I agree with you, and that stress applies not only to those who are working in the system, but to those who expect to be treated on that particular  day. There are known risks already. I can draw from my own experience of people who have been referred, for instance, for cataract operations for sight loss and have had them postponed again, either because the staff cannot get there or because other staff—usually not directly the doctors, but those who facilitate the care—have taken action.

I recognise that that has been the exception rather than the rule in the NHS. I see that the repercussions of action taken by others, for instance in the transport sector, have a greater knock-on effect and a more direct impact than any action taken by the health service personnel themselves. But the scenario in which someone does not get treated for whatever reason and then has a fall—the worst-case scenario being that which results in their death—can be prevented. If we can put something in place so that that is less likely to happen, I would welcome that.

Q 118

Photo of Tom Blenkinsop Tom Blenkinsop Labour, Middlesbrough South and East Cleveland

I was going to ask a question, but you actually answered it in your previous response about the exception to the rule in relation to how industrial action might affect access to services for patients. How often, in your opinion, do the exceptional circumstances that you are coming out with actually happen?

Julia Manning: I only looked back to 1982, I think; so for prior to 1982, I could not tell you.

Q 119

Photo of Stephen Doughty Stephen Doughty Shadow Minister (Business, Innovation and Skills)

Going back to the fundamentals of why you are appearing and giving evidence today, why did you think you were called to give evidence on the Bill? Why were you asked as a Government witness? Has your organisation lobbied for the Bill and the measures in it? Have you been meeting with Ministers arguing for the measures in the Bill?

Julia Manning: No, but we have a strong record on representing patient interests, talking about the patient experience and considering the wider landscape of change in legislation in terms of trends in population—

Q 120

Photo of Stephen Doughty Stephen Doughty Shadow Minister (Business, Innovation and Skills)

Sorry, but just to clarify, you did not ask for the Bill before it was published? Your organisation has not published a report or given a submission?

Julia Manning: No.

Julia Manning: No.

Q 121

Photo of Julie Elliott Julie Elliott Labour, Sunderland Central

You just said that your organisation has a strong record on representing patient interests. In what way do you engage with patients? How representative are you? Are you represented across the country? How do you conduct that information-gathering exercise? How can you validate what you are saying in terms of representing people? Representation is a strong word.

Julia Manning: I agree, and right from the start it was something that we thought seriously about in terms of engaging not just with the front-line people who are doing the job and delivering services, but with those who receive them as well. The way in which we engage in all the research we do is that we have steering groups.  We engage with the relevant charities. We do polling. We do a lot of one-to-one interviews with people who are either on the receiving end of services or involved in delivery. There is a lot of dialogue with people who know what they are talking about, either from a position of being at the front line of delivering services or of having received treatment.

Q 122

Photo of Julie Elliott Julie Elliott Labour, Sunderland Central

To follow up on that, I represent a constituency in the north-east of England. I am not aware of anything you have done with patient interest in the north-east of England. You might have done something. How have you looked at things in the north-east, for instance, in terms of engaging with representing patients? Not speaking to charities or anything else, but representing patients, which is the term you used.

Julia Manning: The one thing we did in your area was to hold a workshop looking at the emergence of health and wellbeing boards and how they would engage with the local population.

Q 123

Julia Manning: About 30.

Q 124

Photo of Julie Elliott Julie Elliott Labour, Sunderland Central

About 30 out of a population of 4 million? Out of a population of 4 million in the north-east, about 30 people attended a workshop about one specific thing. Would you say that that represents patient interest?

Julia Manning: What I would say to you is that we are a small organisation focusing on particular areas of research. When we undertake research we make every effort to make people aware that we are doing it and encourage people to get involved.

Q 125

Photo of Julie Elliott Julie Elliott Labour, Sunderland Central

I totally accept that, but you said you represent patient interest. Would you like to amend that? Is it still your view that a workshop of 30 people out of a population of four million—

Julia Manning: That was my answer in response to your question about what we have done in your area. Let me give you another example. We did a piece of work that came out last year, looking at people with HIV in the population. We worked alongside all the major HIV patient charities and we specifically looked at the needs of older people, because more than half the people in the country now who have HIV are aged 50 or older and services are still organised for 25-year-olds. That is the kind of work we do, where we are thinking about the needs of under-served populations whose concerns have not been represented. This is the kind of thing that we will pull together and put into a policy document to present to those who are commissioning services and campaigning for improvement on behalf of patients.

Q 126

Photo of Julie Elliott Julie Elliott Labour, Sunderland Central

That is absolutely fine, but I question whether that is actually representing patient interest, which is what you said your organisation does. I struggle with the concept that your organisation is a representative body of patient interest. That is the point I am getting at. I am not having a go at any of the work you have done or how you have done it, but I struggle to reconcile what you said your organisation is there for—representing patient interest—with what you outlined that your organisation actually does.

Julia Manning: I welcome you to look at the reports on our website and see the work we have done over the past eight years.

Photo of Alan Meale Alan Meale Labour, Mansfield

This will be the last question: we are running out of time.

Q 127

Photo of Edward Argar Edward Argar Conservative, Charnwood

Clearly it is in patient interests not to have treatment disrupted by action taken in respect of stoppages with a very small turnout. We heard this morning, and I think we all agree, that it would be useful if there were statistics—and we are not aware of any—that quantified the indirect consequence of stoppages in terms of days lost and disruption. In your experience, and recognising that we have not got those figures, would you assess, from your research, your conversations and the work you have done, that the impact on patients has been significant in the past?

Julia Manning: I think it has been incredibly significant to every individual who has been affected by this. The figures I have show that in 2011, when action took place, about 7,000 people had their operations cancelled and tens of thousands of people had an appointment cancelled. I think that for every one of those, it was significant.

Photo of Alan Meale Alan Meale Labour, Mansfield

Thank you, Ms Manning, for giving evidence to the Committee.