NHS Industrial Action: Government Preparations

Commons Urgent Question

The following Answer to an Urgent Question was given in the House of Commons on Monday 12 December.

“I am grateful to the honourable Member for his Question, which I am taking on behalf of the department as the Secretary of State is attending a COBRA meeting on contingency planning for industrial action in the NHS. He also came before the House on the subject twice last week: at departmental Questions and for the Opposition Day debate.

We are all hugely grateful for the hard work and dedication of NHS staff, so we deeply regret that some union members have voted for industrial action. Our priority must be to keep patients safe. That begins with keeping the door open. The Secretary of State wrote to the Royal College of Nursing on Saturday asking for further discussions as a matter of urgency. At the same time, we are working with the NHS to minimise the disruption to patients if the strikes do go ahead. We are engaged with providers, professional bodies and trade unions to agree safe levels of cover should any action take place.

In addition, this afternoon, Ministers—including the Secretary of State—are attending a COBRA meeting focused on our contingency plans. Our plans draw on extra support from a range of places, including service personnel and the private sector. While we aim to minimise disruption, with the NHS already under significant pressure from the Covid pandemic and winter pressures, we remain deeply concerned about the risk that strikes pose to patients.

I want to be clear that, even at this moment of uncertainty, people must keep coming forward to get the care that they need. People should continue to use NHS 111 if they need medical help and dial 999 in the event of an emergency. For more routine treatment, hospitals will do everything they can to ensure that planned procedures go ahead, but it is inevitable that any strike would mean some patients would have their treatment delayed. People will be contacted if their appointments need to be changed.

It is our hope that patients can be spared unnecessary and unjustified strikes. Industrial action is in no one’s best interests, especially in this difficult winter. We have had constructive meetings with the leadership of several unions, including the RCN, UNISON, Unite and the GMB, and we look forward to further discussions to find a way forward together that is in the best interests of the patients we all serve.”

My Lords, the Royal College of Nursing and UNISON have said that they are prepared to call off strikes if the Government will negotiate with them seriously regarding pay. So the key question to the Minister is whether his Government will confirm whether they are prepared to do this in order to avoid disruption to patients in the NHS. As today’s devastating King’s Fund report on the state of the NHS, which was commissioned by the Government, so clearly shows, these strikes are not just about pay. Can the Minister give his view on the wider factors that have led to the strikes and give some commentary as to why the Government have not taken preventive action?

I thank the noble Baroness. On the other actions, so to speak, we have already met a couple of times with the union and are very happy to meet to talk about other things we can do on terms and conditions. As regards the main element around pay, we are following the results of the independent pay review body, which, as the House will be aware, has been in existence since 1984. Parties from each side have taken its expert advice and followed it, and that is what the Government have done in this situation.

My Lords, patients will naturally feel very anxious whenever there is disruption to services that they need, but this anxiety can be mitigated by effective communication. Many of us will have had experiences of great communication by the NHS, such as during the Covid-19 vaccination programme, but also of frustrations, where letters are lost or delayed or we are playing telephone tag with hospital administrative staff. What steps will the Government be taking to ensure that patients receive clear, timely and relevant information during the forth- coming industrial actions?

I thank the noble Lord for the question. Clearly, we want to ensure that there is as little disruption as possible, and appointments will go on as normal where possible. The general advice is that, if you have not been communicated with, you should turn up to your appointment as normal. As ever, there is a bit of fluidity in the situation, because, as I am sure noble Lords are aware, a nurse does not have to give notice of whether they are going to be attending work that day, so there needs to be some fluidity. But the expectation is that, if you have not heard from us already, you should turn up to your appointment and, in all likelihood, you will receive your planned treatment .

My Lords, if the military personnel are going to drive ambulances, for which they are paid less than the ambulance drivers and paramedics, will my noble friend ensure that all military personnel get paid a bonus for the work they do?

First, I will take the opportunity to thank the Armed Forces and anyone else who will be helping at this difficult time. I appreciate that that might cut into some of their plans for Christmas and I appreciate what they are doing in the circumstances. I cannot speak beyond that in terms of any financial support that they might be given, but they will definitely have our undoubted thanks.

My Lords, does the Minister accept that many working families are much worse off because of inflation? The image given by the Government is that they have no coherent strategy. We seem to be in a sort of playground situation of shouting at each other, whereas what we need is understanding from the Government as to how they are going to tackle the inevitable fall in the standard of living caused by the excesses that happened during Covid. Will the Government try to get their act together, because the sympathy of the general public is not with the Government? It is not against the strikers. At best it is neutral and at worst it is moving the other way as we get nearer to Christmas.

We appreciate of course that these are difficult times. Unprecedented circumstances have caused the current inflationary environment, which we appreciate provides challenges to many people. We are trying our best to help them navigate through that. Obviously, the energy support package was a good example of where we are trying to make sure that probably the biggest component of inflation—the increased energy bills—is covered. We will seek to act and do what we can in all circumstances to help people through the crisis.

My Lords, even prior to the strikes, agency nurses were being brought in to ensure that shifts were safely staffed. I should be grateful if the Minister would set out what assessment the Government have made of the cost to the NHS of employing agency staff, compared with that of a pay rise that would work towards an arguably better and more stable workforce?

I do not have those figures to hand, but I believe there is a Question on this subject tomorrow, when we will be talking very much about the use of agency staff and bank staff. From memory—the right reverend Prelate will get the exact figures when I have done a bit more swotting up overnight—I think the cost of agency and bank staff work this year is around £3 billion. Clearly, the workforce strategy will be all about making sure we can recruit staff to minimise that.

My noble friend referred to the NHS Pay Review Body. As Secretary of State, I thought it was rather important that I did not determine the pay of nurses, for example; the pay review body made recommendations and I adhered to them. Will the Government continue to explain that they are not refusing to negotiate on pay with the trade unions but adhering to a long-established principle? The trade unions appear to be seeking somehow to overturn last April’s pay award, when they should be providing evidence to the pay review body on what the pay award should be next April, with the remit letter already published.

I thank my noble friend for his question. He is quite right. As mentioned before, this body was set up in 1984 and extended to other areas of the health service in 2007. Since then, Governments of all colours have followed its recommendations because, after all, it is the expert in this field. We have honoured that in full because it is right that the experts determine it. Working towards making sure that the next settlement in April—which, let us face it, is only three or four months away—covers the latest situation would be a good way ahead.

Is not the total silence of all members of the pay review body since it delivered its report to the Government remarkable? Has anyone asked them, bearing in mind that they delivered their report when inflation was about 3% or 4%, whether they believe the figures in their report are still relevant today? Forget last April or next April—we are talking about today. The pay review body has been loaded up with a responsibility by the Government which in a way is not solely its responsibility. The Government do not have to accept its recommendations, as the Scottish Government have not. Has anybody asked it whether, in the present circumstances and with inflation so high, it still stands by the report it delivered in the middle of last year?

My understanding, based on the long time that this has been in place, is that this is an annual review. April is now quite close; for that April review, it can take into account all the factors, including what happened to inflation during the year. I expect it will take all that into account, quite rightly, in what it comes up with for that next pay review. It is a long-established principle that it is there to do this. I trust it to get the right answer in time for April.

Will my noble friend be very careful to stick by the case being put forward? We know that those arguing it want to hide behind some discussion of the mechanisms in order not to say what they really think about the pay rises. The Government have a responsibility to stick by the system. If we lose that, it will be the Minister who makes decisions always, which is what we have tried to avoid since the 1980s.

I agree. Clearly, there are difficult choices; if we changed the position, we would have to take money away from other parts of the system, such as the elective care fund and other front-line services, which we clearly do not want to do. It is absolutely right that we let the experts guide us in this, as all Governments have done for more than 30 years.