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NHS Strikes
17 April 2023
Lead MP
Steve Barclay
Debate Type
Ministerial Statement
Tags
NHSEmployment
Other Contributors: 25
At a Glance
Steve Barclay raised concerns about nhs strikes in the House of Commons. A government minister responded. Other MPs also contributed.
How the Debate Unfolded
MPs spoke in turn to share their views and ask questions. Here's what each person said:
Government Statement
The Secretary of State for Health and Social Care, Steve Barclay, addressed the House regarding the impact of the junior doctors' strike. He reported that an estimated 285,000 patient appointments were rescheduled following the previous three-day strike, involving 175,000 hospital appointments disrupted and 28,000 staff absent. The exact figures for the current week-long strike are yet to be determined but may affect a similar number of patients. He highlighted the Government's commitment to address the significant pressures on junior doctors due to pandemic-related backlogs and offered a deal with the NHS Staff Council which includes an increase in pay by 10.75%, compared to Wales' offer of 7.75%. The Minister emphasised the need for the BMA committee to move from their 35% demand, which he deemed unaffordable.
Wes Streeting
Lab
Ilford North
Question
The shadow Health Secretary criticised the Secretary of State for his absence during the strikes, questioning whether he is willing to bring in ACAS and mediate an end to the dispute. He also questioned the government's approach and its effect on patient safety.
Minister reply
The Minister acknowledged that a deal with NHS Staff Council has been recommended to members by unions including the RCN, which had voted in favour of it. However, he noted disappointment with the RCN’s rejection of derogations for emergency care, posing risks to patient safety. The deal offers 10.75% pay rise compared to Wales' offer of 7.75%. He emphasised that a fair and reasonable agreement is on the table.
Question
Concerned about the position chief executives find themselves in due to BMA asking members not to engage with trusts, Steve Brine asked what more could be done by the government to mitigate this.
Minister reply
The Minister expressed surprise at BMA’s instructions and urged junior doctors committee to allow its members to liaise with NHS management on sensible contingency measures. He also thanked staff who provided cover during Easter strikes but warned it increases pressure on other staff if such liaison is not allowed.
Rachael Maskell
Lab Co-op
York Central
Question
The bigger dereliction of duty by the Secretary of State is not addressing the retention crisis among junior doctors, who have the choice of going to New Zealand or Australia, to be paid more than double what they receive now, or to move over to work as locums, where they will not carry the stress levels they currently do. What is he doing to address the retention crisis of junior doctors in the NHS?
Minister reply
In part, that is why my door is open and I am keen to discuss with junior doctors the pressure they face not just on pay, but on non-pay issues. There is the issue of support for the number of doctors and the workforce plan we have committed to bring forward to boost recruitment, but other non-pay issues are also frequently raised by junior doctors, such as booking annual leave and rostering. I am keen to work constructively with junior doctors to address those, but for us to do so they need to move from an unrealistic and unaffordable 35%, which the Leader of the Opposition himself has recognised is an unreasonable position.
Question
The Secretary of State is right to say that the pay offer that has been put on the table, notwithstanding the junior doctors, is fair and reasonable. What should drive all parties in this situation is putting patients first, moving forward to address the serious challenges of recovering from covid and seeking to address the issues within the NHS. Everyone should be focused on patients first as this situation moves to a resolution.
Minister reply
I very much agree with my hon. Friend that this is a fair and reasonable settlement. As I say, it is more than £5,000 at band 5, and the NHS Staff Council has recommended it. The majority of trade unions, including the RCN, recommended this deal to their membership. That is why we should respect the NHS Staff Council process, respect the ballot that is still live and allow those votes to continue.
Jon Trickett
Lab
Normanton and Hemsworth
Question
Has the Secretary of State seen the recent report on the BBC that billions of pounds—my words, not the BBC’s—are being squandered on agency labour from private providers, with huge profits being generated? Is it right that one doctor alone received £5,200 for a single shift, as was reported by the BBC? What does the Secretary of State think the impact of that would be on his own staff? How can it be right for him to use bellicose language about the staff associations and unions while larding money into the pockets of the private agency providers?
Minister reply
One of the concerns at the moment is the BMA rate card, which is significantly increasing the cost of providing the required cover for the strikes, and in turn taking money away from things NHS staff have raised with me, such as improving our tech offer, improving the NHS estate and the many other priorities on which money could be spent. I am keen, as I am sure the hon. Gentleman is, to bring down the cost of agency workers. That is why we have the commitment to the NHS workforce plan and why I am keen to sit down constructively with the junior doctors committee, in the same way that I did with the NHS Staff Council.
Question
When union bosses open their pay demands at 19% for nurses and 35% for junior doctors, is it any wonder that some ordinary members feel let down when they have been asked to settle for a generous and fair 5%? Would it not be far better if the BMA junior doctors committee revised its ludicrous demand for 35%, got around the table and did its members some service by negotiating for a fair and reasonable pay offer?
Minister reply
I agree with my hon. Friend. The fact that even the Labour party does not support 35%—the Leader of the Opposition himself says that is not affordable —indicates how out of step the junior doctors committee co-chairs are on what is realistic to get the balance right in bringing down inflation and on the wider economic pressures we face. We stand ready to engage constructively with the junior doctors committee but, as my hon. Friend says, that has to be on the basis of a meaningful opening position.
Daisy Cooper
Lib Dem
St Albans
Question
On 5 July, the British public will want to celebrate 75 years of our amazing NHS, but if they are still feeling the brunt of NHS strikes at that time, does the Secretary of State think it would still be right for him to be at the Dispatch Box?
Minister reply
We have agreed an offer with the Agenda for Change staff council. That is something that the staff council and the majority of trade unions have recommended to their own members, and that the largest health union has voted in favour of. I think we should allow that ballot to take place; it reflects meaningful and constructive engagement. That was reflected in the fact that trade union leaders themselves recommended the deal to their members. I hope that, when we come to the 75th anniversary, we can celebrate that.
Question
What actions are senior NHS managers taking to resolve non-pay issues for which they could offer better work experiences to doctors? What use can they make of flexibilities over pay increments, promotions and gradings so that good staff can be better rewarded?
Minister reply
As ever, my right hon. Friend raises an extremely important point. As part of the negotiation with the AfC staff council, a number of non-pay issues were discussed. Job evaluation is one such issue. Likewise, for junior doctors, areas such as e-rostering are extremely important. I share his desire for investment in technology, and to look at the time spent by clinicians that could be spent by others in the skills mix or through better use of artificial intelligence technology and a better estates programme.
Zarah Sultana
Lab
Coventry South
Question
Nurses, junior doctors and paramedics do not take strike action lightly; it is a last resort after more than a decade of working harder and longer for less and less. The Secretary of State will say that there is no money for a fair pay deal, but that is not true: it can be paid for by taxing the richest and redistributing the wealth. Ending non-dom status would raise £3 billion; introducing a 1% tax on assets worth over £10 million would raise £10 billion; and equalising the capital gains and income tax rates would raise £14 billion. What do the Secretary of State and Conservative Members prefer: nurses having to use food banks, or taxing the richest and making them pay their fair share?
Minister reply
The odd thing is that the hon. Lady seems to be disagreeing with the trade union leadership, which is not her usual position. Unison described it as a “decisive outcome” when 74% of its members voted in favour of the deal. It is odd that she wants to deny the GMB and other trade unions the space to vote on what their leaders have recommended—the GMB leadership has also recommended the deal to its members. Even the RCN leadership recommended the deal to its members.
Question
It is ironic to hear the British Medical Association complain about staff shortages when it has in the past resisted the expansion of training places for doctors. When there have been disputes in the health service, those involved have always taken steps to ensure that lives were not endangered by the dispute. That appears to be no longer the case. That is, to my mind, a dereliction of professional duty. Will my right hon. Friend send the strong message to those involved that preserving life is a professional duty that must be maintained?
Minister reply
My right hon. Friend is absolutely right to focus on patient safety and the duty that all involved have to safeguard it. Indeed, I have previously given the Royal College of Nursing’s leadership credit and praise for granting strike exemptions, known as derogations—notwithstanding our disputes, I was happy to recognise that on the record. Given that less than a third of the RCN’s total membership has voted against the deal, and that the RCN’s leadership recommended it, it is very odd that it has now hardened its position and removed those exemptions.
Richard Burgon
Lab
Leeds East
Question
We need to be clear: junior doctors have had a 26% real-terms pay cut. Restoring their pay would cost around £1 billion a year. That is less than half the giveaway handed to the super-rich through the non-dom tax avoidance scheme. Is it not the case that a proper pay rise for junior doctors is affordable—it is just that the Government have the wrong priorities?
Minister reply
It perhaps will not surprise the House to hear that the hon. Gentleman disagrees with his party’s leader on that, because the Leader of the Opposition says: “I don’t think 35% is affordable”. The hon. Member for Leeds East (Richard Burgon) is also wrong on the quantum, because the cost would be £2 billion, not £1 billion as he says.
Julian Lewis
Con
New Forest East
Question
Given that the terms “emergency care” and “intensive care” imply that the life of those who need them is at risk, does my right hon. Friend share my dismay that people in that predicament are now clearly being targeted by strikers? Will he—and hopefully his Opposition counterpart—represent to the medical unions that whatever other strike action they take, they should not endanger the life of people in emergency or intensive care?
Minister reply
My right hon. Friend makes an extremely important point. Patient safety should come first for all parties in this dispute. That is why I urge the Royal College of Nursing to wait for the NHS Staff Council decision on the offer. Voting is still ongoing, and it would be premature to announce strike action ahead of that decision.
Question
Nurses and junior doctors are being pushed to breaking point, because there simply are not enough of them, and the Government have failed to plan the workforce properly. Why are we still waiting for the NHS workforce plan, which the Government promised? Can the Secretary of State tell us on what date we can expect to hear a statement on it?
Minister reply
The Chancellor committed to publishing the NHS workforce plan in the autumn statement, and we will publish it shortly.
Question
What urgent action will he take to address the social care crisis?
Minister reply
In the autumn statement, the Chancellor put additional funding of up to £7.5 billion over two years into adult social care and I announced a £250 million package for supporting greater discharge in January.
Question
Does my right hon. Friend agree that the BMA pay demands are over four times the average private sector pay increase?
Minister reply
I do agree with my hon. Friend, and point out that agreeing to a 35% demand would mean some junior doctors receiving a pay rise of over £20,000.
Question
The BMA has made it crystal clear that it is willing to enter into negotiations. Will the Secretary of State commit right now to asking ACAS to negotiate and mediate?
Minister reply
We need to see meaningful movement from the BMA, as a 35% demand is not affordable.
Question
I welcome the Secretary of State’s acknowledgement that junior doctors deserve a pay rise. Is it not the case that so long as the BMA leadership maintain that their starting point is 35%, there is no point in going to ACAS, because the BMA is not prepared to negotiate?
Minister reply
The previous negotiation with the junior doctors included setting up a higher pay band and targeted action such as a £1,000 a year allowance for junior doctors who work less than full time.
Question
My constituents are absolutely furious with the Government’s stewardship of the NHS. When will the Secretary of State start to put patients first? Will he get ACAS involved so that we can get the junior doctors back at work?
Minister reply
We have a larger cash offer on the table for 2022-23 than the Labour Government in Wales, and we stand ready to have similar meaningful and constructive engagement with the junior doctors once they move from what is an unrealistic position.
Question
None of us has any idea what their policy is. Does the Secretary of State share my difficulty that, in respect of this urgent question, none of us has any idea what their policy is?
Minister reply
The position of the shadow Health Secretary seems to be to deny the vote of his own union, Unison, and unravel meaningful and constructive engagement with the NHS staff council.
Question
I have two significant worries about the long-term future of the NHS. One is seeing so many people using all their life savings to buy an operation because there is such a long backlog, and secondly, terrible problems with recruitment and retention, with more than 110,000 vacancies in the NHS.
Minister reply
The workforce plan is critical, and I have referred to that already. We are rolling out the programme of diagnostic centres and surgical hubs, redesigning patient pathways to streamline those journeys.
Question
We all recognise how hard junior doctors work, but if we are to have successful negotiations, we need honesty and integrity in them. Does the Secretary of State share my concern that the BMA’s figure of £14-an-hour pay for junior doctors has been shown to be misleading?
Minister reply
I do share my hon. Friend’s concern. Full Fact has shown that the figure is inaccurate.
Jim Shannon
DUP
Strangford
Question
Acknowledging the Secretary of State's efforts to find a pay settlement, Jim Shannon raises concerns about the stress and pressure on NHS staff, particularly those in foundation year 1, who are overwhelmed by their responsibilities. He asks how the Secretary of State’s proposals will ensure adequate support for these staff members.
Minister reply
Steve Barclay acknowledges the importance of addressing the skills mix in the NHS to ensure that staff operate at the top of their licence and receive proper training. He mentions looking into roles such as physician associates, medical examiners, pharmacists within primary care, and continuing professional development to improve career progression and reduce financial penalties for pursuing apprenticeships.
Question
James Daly criticises the actions of two trade unions that are causing risks to people's lives by striking. He questions what measures the Secretary of State will take to address this issue and hold these unions accountable.
Minister reply
Steve Barclay expresses his concern about the situation and highlights ongoing constructive work with the Royal College of Nursing, acknowledging the exemptions granted previously. He suggests waiting for other trade unions' decisions before taking further actions.
Caroline Johnson
Con
Sleaford and North Hykeham
Question
Drawing attention to her financial interests, Caroline Johnson describes cancellations due to strikes and the verbal abuse faced by staff. She thanks those who continue to work despite the strikes and asks for progress on minimum service guarantees legislation.
Minister reply
Steve Barclay joins in thanking the dedicated NHS staff who provide cover during strikes. He agrees with the need to reflect on recent events concerning minimum service legislation and highlights regret over cancellations due to doctors' non-notification of strike status.
Shadow Comment
Wes Streeting
Shadow Comment
The Shadow Secretary of State, Wes Streeting, criticised the Government's handling of the junior doctors' strike as an 'abdication of leadership'. He pointed out that over 350,000 patients had appointments and operations cancelled in the most recent strikes. He urged the Minister to admit his failure and bring ACAS in for mediation. Further, he questioned the Secretary of State's plan to mitigate risks to patient safety following new strike dates announced by the RCN with no derogations.
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