§ 2.56 p.m.
§ Lord MacKenzie of Culkeinasked Her Majesty's Government:
What is the reason for the delay in reaching agreement on the new National Health Service pay system.
§ Lord Hunt of Kings HeathMy Lords, final decisions on pay modernisation need to take account of the recent settlement for NHS funding. Considerable progress has been made in developing the new system. We aim to reach agreement as quickly as possible this year.
§ Lord MacKenzie of CulkeinMy Lords, I thank my noble friend the Minister for that encouraging Answer. I am sure that he is aware that negotiations have been going on for a very long time, in response to ideas put forward by UNISON in late 1996. I declare an interest as a nurse and a former general secretary of the Confederation of Health Service Employees. In the 1980s, together with the late Trevor Clay of the Royal College of Nursing, I bore the scars of negotiating and trying to sell the new clinical grading structure.
§ Lord MacKenzie of CulkeinMy Lords, as my old sergeant used to say when I anticipated an order, "Wait for it. Wait for it".
Does my noble friend agree that it is important that we do not replicate the mistake that seriously damaged that clinical grading structure, when the Treasury refused to provide sufficient funding to secure the change in flexibility that was negotiated by the NHS management, CoHSE and the RCN? Instead, nurse was set against nurse. Does my noble friend agree that it is necessary that sufficient funding is available on this occasion to secure the completion of these negotiations in Agenda for Change? Does he further 140 agree that it is vital that nurses and other health professionals are encouraged and supported if professional barriers are to be brought down as part of the investment and reform so needed by the National Health Service?
§ Lord Hunt of Kings HeathMy Lords, that was well worth waiting for. There are many lessons to be learnt from the debacle over the clinical grading restructuring that my noble friend referred to. It was a remarkable achievement some years ago to require the health service to undertake such a massive exercise, to put more money in and at the end to demoralise the whole nursing staff. It is clearly very important that we get the negotiations right and end up with a pay system that enables us to reward innovation and encourages staff to take on extra responsibility. I confirm that my right honourable friend the Secretary of State for Health told the RCN conference in Harrogate a few weeks ago that he is fully committed to Agenda for Change. He said:
we now want to move to conclude the negotiations".That remains our intent. Financially, it has to be a something for something agreement. Of course, we shall ensure that pay awards are appropriately funded on the back of the agreement that we reach on Agenda for Change.
§ Lord Astor of HeverMy Lords, following on from the Minister's last point, what proportion of the annual increase in NHS expenditure announced in the Budget does he expect to be spent on increased staff costs?
§ Lord Hunt of Kings HeathMy Lords, the noble Lord cannot possibly expect me to answer that question at the moment. We are negotiating on taking the Agenda for Change proposals forward. For me to state to your Lordships' House how much money we intend to budget for such a proposition would be ridiculous. The noble Lord cannot expect me to do so.
§ The Earl of OnslowMy Lords, if the Minister does not know the answer to that question, he cannot possibly do a budget for the health service. If that is so, it may be why the National Health Service is in such a mess. They cannot get their sums right.
§ Lord Hunt of Kings HeathMy Lords, I fail to follow the logic of the noble Earl's argument. Only three or four weeks ago, we received the Budget settlement which sets out the resources that the NHS is to receive over a five-year period. We put the negotiations on Agenda for Change on hold until we knew the outcome of the spending review settlement. Currently, we are engaged on working through the potential costs of Agenda for Change. Later in the year, we shall be able to start negotiation. The noble Earl is asking me to reveal my negotiating hand in front of your Lordships. However tempting that may be, I shall not do it.
§ Lord AveburyMy Lords, in costing Agenda for Change, is the Minister taking into account the 141 potential savings which would arise if the NHS were able to dispense with the use of large numbers of agency personnel, who not only cost much more than nurses and other staff who are regularly employed, but impose substantial overheads in administration of the system to get them into position?
§ Lord Hunt of Kings HeathMy Lords, I could not agree more with the noble Lord; we spend too much money on agency staff. In November, we launched a strategy for NHS professionals which is designed as a nation-wide service to bring much greater coordination and consistency to the use of temporary staff inside the NHS. We are also urging NHS employers to become much more flexible in their employment practices so that they can offer some of the flexibility that agency nurse agencies offer in addition to the rewards of being a full member of staff in an NHS organisation.
§ Lord Stoddart of SwindonMy Lords, does the Minister agree that one of the problems we still have with the health service is the deplorable wages and salaries that have been paid in it for very many years, with the result that properly qualified staff are not attracted to the service? That in turn has had an effect on productivity and, therefore, on the efficiency and availability of the health service which the people of this country expect.
§ Lord Hunt of Kings HeathMy Lords, of course pay is an issue in recruiting and retaining staff, but it is not the only issue. Other matters are important as well, including flexible working and support for staff to continue their development and professional training. It is worth reporting to the House that, since 1997, pay for nurses, midwives and health visitors has increased by at least 26 per cent in cash terms. We have also introduced new consultant nurse grades which give opportunities for earning up to just less than £47,000 per year. As the Agenda for Change negotiations culminate, we expect the result to be a much more sensible arrangement for pay which enables proper comparisons to be made across the NHS professions, encourages people to take on greater responsibility, and enables us to deliver the NHS Plan.
§ Baroness Finlay of LlandaffMy Lords, will the Minister please outline his plans to ensure that physiotherapists, occupational therapists and other highly skilled people, of whom there is currently a shortage in the NHS, are encouraged to continue working within the new structures of the NHS?
§ Lord Hunt of Kings HeathMy Lords, they will be covered by our general discussions on the way in which pay and other matters are dealt with in the National Health Service. There is no doubt that the staff groups which the noble Baroness mentioned have a vital role to play not only in the new health service, but in taking 142 on greater responsibility from doctors. We are keenly aware of the need to ensure that the NHS remains an attractive place for those professionals to work.
§ Lord TebbitMy Lords, in his answer to my noble friend Lord Onslow, was the Minister saying that in the negotiations between the Secretary of State and the Chief Secretary to the Treasury, the Treasury d id not secure undertakings on how much of the money being granted would be spent on staff salaries? Or is he just saying that he knows how much they are prepared to spend, but is not prepared to say it because he does not want his noble friend on the Back Benches there and the other members of the unions to know?
§ Lord Hunt of Kings HeathMy Lords, the noble Lord will know from his wide experience in government that many discussions take place between spending departments and the Treasury, and issues to do with the cost of pay of NHS staff is of course one of the factors. However, the noble Earl seemed to suggest that because I was not prepared here and now to say the exact sum to be spent on NHS staff—
§ The Earl of OnslowNo.
§ Lord Hunt of Kings HeathWith the greatest respect, my Lords, he was. He was saying that if I was not prepared to do that, then we were not competent to run the National Health Service. If I were to come here today and say, "This is the exact amount of money that we have reserved for the cost of NHS salaries", when we have not yet completed the final negotiations, I would not be fit to run the health service.