My Lords, I rise to support Amendments 3 and 4 in the names of the noble Lord, Lord Collins, and the noble Baroness, Lady O’Grady. First, looking at Amendment 3, which seeks to exclude health services altogether, I think the key question remains: who wants this legislation? As the noble Lord, Lord Balfe, who is not in his place, asked in relation to Amendment 1: who is asking for this power that the Government are legislating to grant them? We have the Health Minister in the Minister’s place. I hope he can inform the Committee which bodies within the National Health Service have been knocking on his door, asking to be given the powers that are set out in this legislation.
The noble Baroness, Lady O’Grady, quoted to us from the note that has been sent out by NHS Providers, which represents all the trusts in England, and it could not be clearer that not only is the legislation unwanted but it sees it as actively counterproductive to its efforts to work with the staff that it employs in order to deliver the service both on a day-to-day basis and during industrial action. We seem to be in a situation where the employers are saying that they do not want this, and the employees certainly do not want it, yet the Government are determined to stick their oar in and make a difficult situation worse. This potentially has significant short-term and long-term disadvantages that will be to the detriment of the health service.
I am sure the Government will say that this is about delivering health services to people in the United Kingdom, and we would agree that it is about that. The question is: what framework means that we are most likely to get those health services delivered effectively? It is one in which employers and employees are working hand in hand to deliver health services to people. It is not one in which we create artificial tensions between employers and employees, and it is not one in which we pass legislation and seek to impose measures that will increase those tensions and make things worse.
As well as NHS Providers, I have been contacted by a consultant who works in the health service, who said to me:
“Instead of focusing on minimum service levels on striking days, the Government should be taking action to ensure the NHS is safely staffed 365 days a year.”
We will come to amendments later on where we will talk specifically about that, but that is the prize—a 365-day-a-year service. That depends, crucially, on staff morale, staff recruitment—we all know that we have huge gaps right across the health service—and staff retention, which means making them feel valued. It certainly does not mean press-ganging them into working at times when they have exercised their legitimate right to withhold their labour because of an industrial dispute.
The consultant goes on to say:
“Instead of threatening workers and unions with heavy-handed tactics that put workers’ right to strike at risk, this means ensuring that there is meaningful engagement on pay and a commitment to enshrining and funding safe staffing. This would help stem the tide of doctors leaving the NHS every year for better jobs at home and abroad, in the best interests of the NHS and patient care.”
My Lords, the noble Lord, Lord Allan, says “Who asks for this Bill?” He then tries to portray that as a binary thing—either workers and unions, or employers, claiming that neither of those groups wants it. However, he and others who oppose this Bill are missing out on a crucial third group: the users of services. This is the Government acting on behalf of the users of services generally. By taking the power to create minimum service levels, they are giving themselves the power to act for the users of services if the need ever arises. Broad terms are used to allow the detailed minimum service levels to be devised within that. Obviously, when regulations are produced they must be very precise, because they will affect whether individual workers will have to comply with work notices.
I should also say that no employer is ever forced under this legislation to issue a work notice; it remains entirely voluntary. Noble Lords should start to see the Bill in a much broader sense, rather than that of trying to create yet more disharmony between employers and their workers.
My Lords, I rise to speak to this group of amendments on the inclusion of health services in the Bill. I am sorry that I have not been able to speak before. I declare my interests as set out in the register.
I have been a union member. I joined as a nurse—and as an NHS manager and a civil servant in the Department of Health—because I wanted protection. The relationship with unions was critical; it was the way in which we improved patient care. One of my overall concerns about the Bill is that it has the potential to break down the relationship which is so vital for patient care, as the noble Baroness, Lady Noakes, said.
I am grateful to the Royal College of Nursing, which has helped me in considering the Bill. I am sure that it will not surprise noble Lords to know that it does not support the Bill, for what I see as some good reasons: not least because it curtails the freedom to participate in what otherwise is lawful action.
My right reverend friend the Bishop of Manchester regrets that he cannot be here, but he shares my concern that far too much power is given to the Secretary of State in what we have already heard is only a skeleton Bill, and that there is a complete lack of clarity about how it could be used. It is open to abuse. I am surprised that, as many others have said, the detailed policy that becomes legislation is not there. I am concerned that those who work in the health service probably cannot see whether they are in there or not.
I support the noble Lord, Lord Allan, and the noble Baroness, Lady Chakrabarti, regarding the definition of health services. It is such a wide definition that leaves it to the imagination whether you are covered by it or not. I do not believe that this is for the professional groups, but for the individual. I am also very conscious that we have talked a lot about trade unions, but the health service is about individual nurses, doctors, health visitors and midwives who seek to do their best for patients. One of my great concerns is that the Bill could lead to the sacking of staff for taking what otherwise would be seen as lawful strike action. They are the nurses, midwives and doctors whom we can ill afford to lose.
My Lords, I have the honour to serve on your Lordships’ Delegated Powers and Regulatory Reform Committee. As noble Lords will know, in our 27th report we dealt with this particular Bill.
There is an issue which arises in relation to these two amendments. I would like to read to your Lordships just three paragraphs from our report. Paragraph 17 says that
“the Government are ‘of the view that the detail required to set the level of service for each relevant service is not appropriate for primary legislation’. But the Memorandum does not explain why setting out any detail on the face of the Bill would be inappropriate. Parliament is not allergic to matters of detail, particularly where it relates to an important matter such as the right to strike.”
Paragraph 19 says:
“The Government have chosen to put no detail in the Bill in relation to minimum service levels, leaving the matter entirely to regulations. Important matters of detail should be included on the face of the Bill, perhaps with a power to supplement those matters in regulations.”
At paragraph 23, in conclusion on this aspect—there are other aspects to be dealt with—we say:
“Given the absence of an exhaustive or non-exhaustive list in the Bill of the matters that can be included in regulations, the unconvincing reasons for this power in the Memorandum, and the absence of indicative draft regulations illustrating how the power might be exercised, the House may wish to press the Minister to provide an explanation of how the power to set minimum service levels in new section 234B(1) of the 1992 Act is likely to be exercised. In the absence of a satisfactory explanation, we regard the power as inappropriate.”
I looked at the consultation paper that emerged in relation to health services, which has already been remarked upon. It is confined simply to the ambulance service. I looked to see what the criteria for setting minimum service levels might be. I can see that, right at the end, there is half a page suggesting to consultees that they might wish to specify category 1 and/or category 2, and that in respect of one service they might be favourable to a percentage of the ambulance service being carried out. But there is nothing, as far as I can see—the Minister will correct me if I am wrong—to indicate what the metrics are. What are the factors to be taken into account in setting minimum service levels?
My Lords, I support Amendments 3 and 4 in the names of my noble friends Lord Collins and Lady O’Grady. Noble Lords will know that I have already expressed my opposition to the Bill and, in particular, my opposition to skeleton legislation such as this, which gives Ministers unfettered powers to amend, repeal or revoke, calling into question parliamentary scrutiny, which matters.
Amendments 3 and 4 relate to health and would remove health services from the Bill. Quite simply, this Bill has the potential to wreck the partnership working that has been the bedrock of industrial relations in our NHS over 70 years. The workforce is 75% women, as we have heard, and 29% ethnic minority. In relation to health, the Bill is rushed. It is deficient to its core. It weakens protections against unfair dismissal. It flies in the face of ILO labour standards, and it could violate the Human Rights Act. Much of the Government’s argument rests on the ambulance service, which has just been mentioned.
In November, the Government praised the NHS, stating that important factors exist to mitigate the impact of industrial action in that sector. It was put forward as a really good way of working when it comes to industrial action. But by January, the same Government said that ambulance workers had refused to provide a national safety net. What an about-face in only six weeks. Why did it happen? What had been discovered that was not there before? Nothing could be further from the truth. Unions and staff representatives reach direct agreement with their employers. They do it before any action is taken, not on the day. It includes call volumes, rapid mechanisms to bring staff in if needed and constant contact with management. They reflect local circumstances. I do not know how many people have seen the folders of procedures—I would love to give a copy to the Minister—but they are not just two or three pieces of paper; they are whole folders of procedures. The Minister said that a number of ambulance trusts stated that they were not getting agreements to enable them to be satisfied. Where are those trusts? We asked employers which trusts are not happy, and said that we would talk to them, and we were told in no uncertain terms that they did not know where the information had come from.
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I turn to the evidence of NHS Providers, which has already been mentioned. I state very clearly that NHS Providers represents all the NHS trusts. It represents the ambulance trusts and mental health trusts—it is the employers’ organisation. If any organisation were to be saying that we needed minimum standards, clearly this Government would be listening to it. I shall read out one or two of the many things that NHS Providers is saying:
“NHS Providers has a number of concerns about this legislation. It will not resolve or address the fundamental issues underpinning the current industrial action, and risks worsening current and future industrial relations, and potentially local relationships between trusts as employers and their staff … Existing legislation and mechanisms are already in place to ensure ‘life and limb’ cover during periods of strike action, with trusts also having the option to invoke a section 240 under existing legislation.”
Why bring health into this Bill? NHS Providers continues:
“Emergency cover provisions have been in place for all recent strike action in the NHS, drawn up by each trust through local planning processes and derogation negotiations with unions, drawing on local experience and expertise. This gives the ability to make decisions based on a detailed understanding of the day-to-day operational needs of their services.”
It is all in place—in fact, it is better than all in place. It is a far better system of local people talking to local employers, looking at the local circumstances, and all being of one opinion: that there must be minimum standards to ensure the safety of our communities if industrial action is ever taken. How often is it taken? What we are seeing now is something that we have not seen in many decades—indeed, in our lifetimes.
It is not just NHS Providers or myself saying that the Bill is going too far, that there is no need for it, and that it is vindictive. As has been mentioned today in this Chamber, the report by the Regulatory Policy Committee was absolutely damning, saying that the Bill is not fit for purpose or backed up by evidence, with no assessment of how the Bill could make strikes worse, and that it is full of assumptions.
Something else that has been mentioned—put it all together and you see what kind of picture you get of what has been proposed and the opposition to it—is the report by the Joint Committee on Human Rights. I will not go into the detail of it, but it concludes:
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I asked the Minister this question at Second Reading; I will ask it again: is there anything in this legislation that the Minister can say, hand on heart, will help him and his department recruit more staff to the NHS and stem that flow away from the service?
On the specific consultations that the Government have put out, we now have one on the ambulance service; again, I have been talking to people who work in that service. First, I have to say that the consultation is one of those classics: if you ask people, “Do you want more or less service?”, who votes for less service? When the Government ask, “Do you want category 1 and category 2 or just category 1?”, I think we can reasonably predict the answer. But the consultation does not ask, “Do you want the Government to come to a fair settlement with ambulance workers so that you can have categories 1 and 2 all year round, delivered to a level of performance that would be a significant improvement on today’s level?” I think the Government would freely admit that they are failing on both categories today; again, we have to ask whether anything in this legislation will improve the service delivered by the ambulance service. There is nothing there.
The ambulance service points out that, if you include categories 1 and 2, that covers pretty much the entire service. It is pretty much business as usual that the Government are consulting on. In essence, they are asking, “Should we prevent ambulance workers going on strike?” That is the net effect of saying that the minimum service level is the entire service. Again, I think that there is some confusion there.
The ambulance service also points out that the Government are, in part, driven by the fact that they are failing to meet their targets. Now they are consulting on what should be in categories 1 and 2, so we may end up consulting on a minimum service that will itself have to change as the Government change their definition of what constitutes categories 1 and 2 because of the pressures on the ambulance service; for example, there are suggestions that some people may no longer be categorised as category 2 until a further assessment of their needs has been made. Again, we are consulting on something that may move as the consultation progresses. We have a problem both with the generality of the health service being included and around the specifics on the ambulance service.
I want to raise one further issue, which relates to the speed with which the legislation has been introduced. I am not a civil claims lawyer but I know that their job is to pursue all possible angles in favour of their clients. We also know that the NHS is already paying out more than £2 billion a year in compensation claims, including claims made for failures to deliver on the agreed levels of service for ambulances and emergency care.
This legislation could change that landscape in several ways. First, if the minimum service level has been defined yet there is still a failure, there will potentially be a claim against the Government who set that minimum service level. If I am a claimant lawyer, I am going to go for every angle; one of the angles is to say, “The minimum service level was insufficient so I am going to try to drag the Government into the case”.
If the minimum service level was set but the work notices were insufficient, I would go after the trust and try to bring it into the case, saying that the only reason my claimant suffered was because the hospital trust failed to deliver sufficient work notices. Even the existence of this law could fundamentally change the landscape for those claims. If you fail to exercise that law, which the Government keep saying is a measure of last resort, claims could come in to the effect, “You had a law for minimum service. I suffered at the hands of the NHS because there was no minimum service level in place, but the Government could have done something because the legislation was there”. I see the noble Baroness, Lady Chakrabarti, nodding, which is encouraging given her legal experience.
I hope that the Minister can say in response, “We’ve worked all this out, don’t worry. When we drafted the legislation, we figured out the effect of having law on minimum service levels, questions around work notices of minimum service levels and how the responsibility of the Government, the trust and others would factor into the landscape of compensation claims once all this has occurred.” I fear that the Minister may not have all that to hand and, frankly, that it has not been done. This is another example of what happens when you rush legislation. There are all kinds of consequences to this Bill because it was not introduced in a thoughtful, careful manner but to fill a government communications grid: “We have strikes; we want to show that we are doing something for the public; we will bring this in.” The health service element creates more questions than answers. I appreciate that the Labour Front Bench has tabled amendments that would remove that.
Amendment 4, which lists the different professions that might be expected to be included, is also interesting. The noble Baroness, Lady Chakrabarti, mentioned earlier that we need foreseeability. The fact that there is no foreseeability in a phrase such “health services” makes it hard for any of us, and certainly for those professions, to understand whether they are in or out. I suspect that the Government will say that where the Opposition would exclude a list of professions, they would include it. Even that would be better than what we have today. If they do intend to include physiotherapists, pharmacists and other workers in the legislation, they should list them in the Bill.
It is not acceptable to use a phrase such as “health services”, which does not inform those hard-working professionals. There is not one profession on that list that does not have a staff shortage right now. We have this list of professionals, but we do not even have the decency to say to them in the legislation, “By the way, at some point you may be subject to minimum service levels being imposed and work notices being sent to you as an individual professional in that job.” We leave it open. We leave it for them to guess.
Both amendments make sense, in that they test the Government’s rationale for including health services and they have thought through the implications for health services in the longer term and try to get more predictability and certainty. If a particular group of professionals are to be included, let us see them in the Bill rather than just saying, “Well, ambulance workers, yes, they’re clear; but for the rest, maybe, maybe not.” That is not good enough when we are talking about people’s essential rights and things which may affect them personally, as they will be press-ganged into coming to work against their wishes at some unknown future date.
As has already been said, the reality is that those who work in the NHS do not take strike action easily. They choose to do it only because they are frustrated that their voices are not being heard when they express their concerns about patient standards, workforce levels, recruitment and retention, and the role that fair pay plays in this. In September, the Nuffield Trust reported that 40,000 nurses left the profession last year, and we are still waiting to see the arrival of the workforce plan. Meanwhile, healthcare workers are spread more thinly, at the expense of their mental health and well-being.
It is amazing that the legislation talks about minimum service levels, yet this Government resist setting minimum standards for nursing and other health professions. If we want to ensure standards of patient care throughout the 365 days of the year, the focus should be not on banning strikes but on getting in place minimum staffing levels to ensure that quality patient care is given. For the Government to fire anyone using strike action when they try to raise a concern about the conditions set by the Government is ridiculous and undermines the dedication of staff in the NHS.
I have a question. Rather than passing the Bill, should the Government not be spending more time listening to and addressing the concerns of healthcare staff, to hear the solutions they believe they have to ensure that patients get the care that they require?
Finally, the other concern that has been raised is around trust and staff morale. The reason staff in the health service are striking partly relates to morale, and also to trust. I am concerned that the Bill will undermine the trust that is there and further undermine morale. We saw something of that trust undermined when this Government were seeking for healthcare professionals to be double-vaccinated against Covid. Although I am a great supporter of vaccination, we were heading for disaster. I am concerned that the Bill undermines trust and morale. What risk assessment has been made of the effect of passing this Bill on staffing levels of the NHS in particular?
This is not just for the ambulance service. As has already been remarked, in Amendment 4, my noble friends set out a whole list of potential categories of worker in the health service—and very diverse it is too. What is it that the Government have got in mind to formulate the way in which the minimum service levels will be articulated in respect of each of these trades, professions and subcategories of worker? That is my question to the noble Lord.
Looking at, say, the ambulance service, and at whether it needs this additional restriction on taking industrial action, I am not too certain why this should be the case. The Government criticised ambulance workers for guaranteeing only category 1 999 calls. This is misleading. Calls in category 2 are answered if the call has been put through by a clinician, and usually only half of category 2 calls are an emergency. The Government have run two successful pilots where category 2 calls have been directed to alternative services rather than being dealt with by the 999 system. So why does this Bill call for 100% answering of 999 calls—the so-called minimum standard—when in 2022 the figure answered on a normal day was 77% and in 2017 was only 76%?