§ Ms Julia Drown (South Swindon)I am pleased to have the opportunity to raise the issue of pay for non-pay review body national health service staff. It is particularly appropriate that the issue should be discussed in the House today, when many Members are receiving visits from constituents as part of the lobby of Parliament by MSF—the Manufacturing Science and Finance Union—for fair pay for all NHS professionals.
By way of introduction, I should explain who is covered by the label "non-pay review body staff." When the NHS is mentioned, people mostly think of the important work of doctors and nurses, without which the NHS could not function. Those and many other direct patient clinical professions are covered by pay review bodies, which independently review salaries each year and make recommendations to Government, but in addition to the 600,000 staff who are covered by pay review bodies, there are another 300,000 to 400,000 staff without whom the NHS could not function.
Those staff are not covered by pay review bodies and do not receive the same recognition as is given to those who are traditionally seen as front-line staff. They include laboratory technicians who analyse specimens, pharmacists, hospital physicists, speech and language therapists, as well as ambulance, estates, domestic and administrative staff and others. All those people together make up the NHS. All of them are vital to the end product of quality patient care.
It is only through all those groups of people working together that we produce good-quality patient care, yet successive Governments have failed to regard all NHS staff as full members of one team, pulling together for patient care. Instead, staff have been divided into the categories of pay review and non-pay review bodies, leading the latter group to feel like second-class citizens in the NHS. There should be an end to that division, which has a particularly negative impact on pay and morale for those staff.
The debate follows recent ones led by the hon. Members for Twickenham (Dr. Cable) and for Winchester (Mr. Oaten), who raised issues on biomedical scientists and pathology services. However, I should like to address the issue of pay as it affects all non-pay review body staff: the pharmacists without whom we could not use medicines in the NHS, the estates and domestic staff who keep patients fed and housed in as good an environment as possible and, yes, those often maligned administrative staff in the NHS, without whom it could not function either.
Doctors and nurses together are the biggest group of staff in the NHS and do a fantastic job, but the NHS is much more than doctors and nurses. I hope that the debate goes some way towards recognising that.
The Government deserves congratulation on the work that they have already done on pay. They have recognised many of the problems. They have awarded significant pay rises to many staff in the NHS and are addressing many of the issues that lead to a decline in morale. In its pay strategy "Agenda for Change" the Government set out their vision for replacing the incredibly complex current pay system.
260WH With the current system, suitcases would be needed to carry all the books covering the terms and conditions of staff. The Government want to replace that system with three national pay spines: one for doctors and dentists, one for staff currently covered by the nurses pay review body and one for other staff not covered by pay review bodies.
That simplification is welcome and must be the way forward, but the three pay spines still leave non-pay review body staff vulnerable to continuing to be left behind, with the consequent loss in recognition, pay and morale. I hope that we will hear from the Government today a guarantee that that will not happen.
The concerns of non-pay review body staff are real. Since 1984, pay increases for staff covered by PRBs have been around 30 per cent. higher than awards to non-pay review body staff.
That has left, even after this year's pay offer, a graduate trainee medical laboratory scientific officer starting work on £9,400, compared with a nurse starting on £14,400. The comparisons with graduate salaries outside the NHS are even starker, but it is not only graduates who receive low pay. Many in the NHS work tirelessly for patients, both in direct patient care and behind the scenes, for very low pay. The Government need to take action to ensure that all NHS staff feel supported and rewarded in their roles.
The current division into pay review body and non-pay review body staff demoralises staff in the second group. It adds to the bad feeling created under the previous Government. Under their proposals for private finance initiative schemes, staff were divided into core and non-core staff. The latter were offered out to private sector contractors, giving the staff affected a feeling that they were peripheral to the NHS, when they clearly were not.
Again, the Government are to be congratulated on the fact that, while getting on and building hospitals under the PFI to see what they can deliver for patients, they have found a way to ensure that future PFIs do not have to classify staff as either core or non-core staff in that divisive way. However, I urge the Government to go further.
Staff pay can be affected by whether the service that they provide is done in-house or by a private contractor. Although the Government say that doctors and nurses are safeguarded from being transferred to private contractors, the Minister of State, Department of Health, my hon. Friend the Member for Southampton, Itchen (Mr. Denham), tells me that the Government are not dogmatic when it comes to support services, and that pay and conditions for those staff could be set by private contractors, who would be able to take over contracts for support services where they can offer greater value to patients. That again sounds like one rule and one lot of pay and conditions for one lot of NHS staff, and another rule for another group of staff.
Someone once described the NHS to me as a perfect illustration of the British class system, where groups are divided into categories whose members ostensibly live and work in the same world, but which actually do much to ensure that the dividing lines between them remain in place. Doctors defend their separate dining rooms with the utmost vigour and porters do not feel that they can make suggestions for improvements to services because 261WH they will not be listened to. Those attitudes are changing, but they can still be found in parts of the NHS. It is only by changing those attitudes that we will maximise the benefits for patients.
I turn to some specifics of this year's and next year's pay rounds. Although the Government improved their original offer, the 3.25 per cent. award, with a pledge for next year of at least 0.5 per cent. above inflation, will not solve the problems of recruitment and retention for some groups of scientific and laboratory workers in particular.
I recognise that some of the worst paid staff benefited from much higher increases, but they affect only a small number of non-pay review body staff and still do not go far enough towards solving the significant recruitment and morale problems.
In my constituency of South Swindon, our hospital has 12 vacancies out of a complement of 50 lab staff. The resulting pressure on the remaining staff is unsustainable in the long term. The Government must therefore not allow pay awards for non-pay review body staff to fall further behind those of the review bodies.
Swindon is not unusual in that respect. The pressure in its labs exists in many other areas. That is why the MSF is lobbying Parliament today. It thinks that the proposed pay awards are inadequate and will not have a big enough impact on those problems. Those concerns are shared by many Members. There are 92 signatories to early-day motion 461 on the issue.
The Government must listen. A further deterioration in the situation must be prevented. In a sense, it seems unfair that, in three years, the Government are being asked to put right 18 years of the knocking down of public services by their Tory predecessors—it is unrealistic to ask for all the problems to be solved overnight, but the issue of low pay in particular for non-pay review body staff is a real one. There is a risk that, unless more can be done, the Government will alienate a loyal and long-serving staff from the NHS for good, with the consequent reduction in quality services for patients.
NHS staff who are not visible in the delivery of front-line care find it harder to attract media attention and to generate public sympathy for their cause. Their position is not as well understood. Subsequently, the pressure on Government to deliver change is considerably less, but pay awards should be decided on their own merits, not on staff's ability to command a high public profile, or to attract media attention. That is unlikely to be achieved if all NHS staff are not covered by the same pay review arrangements.
I recognise that the Government are working with the National Advisory Group for Scientists and Technicians to develop an employment environment that is attractive to and supportive of these staff, but that is a promise of jam tomorrow for them. Until more is delivered, many non-pay review body staff will not have the confidence that their needs will be met.
The recruitment and retention problems to which low pay contributes have serious implications in terms of costs to the NHS. Not only are vital services understaffed and overstretched, but an exorbitant amount is spent on agency staff. For example, a medical laboratory scientific officer at the top of the scale receives £360 a week, and a locum to fill a vacancy at 262WH that level costs £603 a week—a difference of about £13,000 a year. Such figures show that if a larger pay award were made to NHS staff, the NHS would have to rely less on agency staff, and that a larger award would be cheaper for the NHS than a lower one.
I know that in my constituency the spending on agency staff in laboratories is high, and hard-working NHS staff cannot understand why greater funds cannot go into recruiting and retaining NHS staff. They also find it ironic that while all UK staff have to be registered, overseas agency staff do not go through that process, so more is being spent on possibly less well-trained staff. It cannot make sense for so many trusts to be relying on agency staff to run labs when a better pay award would attract more NHS staff to the profession as trainees and full-time staff.
As the Government rightly point out when announcing pay awards, in the face of what sometimes seems like opposition by the Tories, there is not a straight trade-off between paying staff less and having more money for patient services. Of course there may be an element of that, but there is also a win-win element because paying staff fairly reaps huge benefits in increased commitment and less stress and sickness, and that leads to better patient services.
I have already mentioned the positive improvements to the pay system that the Government set out in "Agenda for Change". They state that
modern forms of health care rely on flexible teams of staff working across traditional skill boundaries.That strengthens the argument for going further than the document outlines and creating a single pay spine and a single pay review body for all NHS staff, facilitating and encompassing that extra flexibility.Progress on pay should be matched by progress on harmonisation of conditions of service; it is illogical to address one without the other. One example would be to reduce the working week of ancillary staff.
It is essential that avoidable divisions in the work force do not undermine the Government's vision for a united, modern NHS. Different pay arrangements for different groups of workers cannot achieve that as effectively. NHS staff should not be made to feel that some are more important than others and some more dispensable than others. Every cog, however small, is necessary to ensure that this huge machine works well. I remember Frank Dobson describing the NHS as an oil tanker that needed to be turned around. Well, it is the staff who will turn that tanker around, and they are doing so. However, unless they pull together we will not turn it around quickly. Staff should not be set one against the other so that they pull in different directions and fight among themselves.
In spite of the divisions in the pay structure, there are many examples of staff in the NHS working well together in teams, and it is those smooth-running teams that produce the best patient care. However, to get those teams working better and to replicate that work throughout the NHS, we need an end to the divisive pay structure in the NHS.
Ultimately the aim is to deliver high-quality patient care, and that is what the Government want to achieve. Good progress has been made on NHS pay. The Labour Government are putting right many of the problems 263WH created by the Tories, and staff and unions recognise and welcome that. However, as negotiations for new pay levels draw to a conclusion in the coming months, it is essential that the Government demonstrate their commitment to the vital staff outside the scope of the pay review bodies.
We know that problems cannot be solved overnight, but we need to know what steps will be taken to tackle the problems of recruitment, retention, low morale and inadequate pay, now and in the future. One united system bringing together all the staff in the NHS would send out the clear message of admiration and respect that all NHS workers deserve.
§ Mr. Deputy Speaker (Mr. John McWilliam)Order. I did not want to break the hon. Lady's flow, but, before I call the Minister, I must point out that the former Secretary of State for Health should be referred to in this Chamber as the right hon. Member for Holborn and St. Pancras (Mr. Dobson).
§ The Minister of State, Department of Health (Mr. John Denham)I congratulate my hon. Friend the Member for South Swindon (Ms Drown) on being successful in the ballot for this debate and on deciding to raise the matter of remuneration for non-review body staff in the NHS. As my hon. Friend said, this is a very important group of staff, numbering more than 300,000.
NHS staff whose pay is not determined by the doctors and dentists review body or the nurses review body are a diverse and wide-ranging group covering many different occupations. As my hon. Friend said, it is often too easy to give the impression that it is only doctors and nurses who run the NHS. Non-review body staff play a vital role in delivering high quality health care to patients.
The largest of those groups is administrative and clerical staffs who provide essential secretarial and management support and look after medical records and computers. Ancillary workers including cooks, cleaners, porters and maintenance staff such as electricians are essential to the successful running of every hospital. Ambulance staff, including paramedics and those working in the control room, directly contribute to saving countless lives each year.
Clinical psychologists, speech and language therapists and health care pharmacists directly provide specialised patient care. NHS scientists and other scientific and technical staff make a crucial contribution to patient care through their work on diagnostic techniques and treatment, playing vital roles in the treatment of people with life-threatening conditions such as cancer and coronary heart disease. I, too, want to begin by emphasising the importance of the work done by those different staff groups, all of whom deserve fair and affordable pay awards.
As my hon. Friend recognised, we have made a strong commitment to all non-review body staff groups. For the first time in the history of the NHS, we have been able to guarantee above-inflation rises not just for one year, but for three years.
264WH In January, we offered all non-review body staff an innovative above-inflation three-year deal that gives special help to the lowest paid. We have made some progress, at least, because from this year no adult worker in the NHS on a national contract will earn less than £4 an hour. That is the first longer-term deal of its kind in the public sector. I believe that it does give staff the security of real-terms increases for the whole of that period. Last year's increase has resulted in a real-terms increase of 1.4 per cent. We project that by the end of our three-year deal, pay increases will amount to at least 9.25 per cent. against projected inflation of 6.5 per cent.
Those figures should be compared with the increases awarded by the previous Government. During their last five years in office, rises ranged from below the rate of inflation to a meagre 0.4 per cent. above inflation.
In January, staff were offered increases of 3 per cent. or £250, whichever was greater, from April 1999, 3.25 per cent. or £300 from April 2000 and a minimum of the underlying rate of inflation plus 0.5 per cent. for next year. As a result some 75,000 of the lowest-paid staff working in the NHS will benefit, including porters, messengers, storekeepers and domestic staff. They will receive an average 3.2 per cent. in year 1 and 3.7 per cent. in year 2.
In addition, as part of the long-term deal, our pay offer for April 1999–2000 makes special provision for some of the scientific, professional and technical groups. Junior health care pharmacists received increases of up to 12 per cent. All scientists have been offered at least 3 per cent., and about half of all biomedical scientists—some 6,000 in the lower grades—have been offered 7 per cent. to address special recruitment problems.
Trainee biomedical scientists have been offered a particular deal, too. There are about 1,000 of them altogether, and around 100 at the bottom end of the scale have been offered 26 per cent., and we have offered the rest increases ranging from 7 to 22 per cent. by restructuring their pay scale. In addition, we have offered to increase London weighting by 13.5 per cent. to restore it to 1995 values.
I do think that that is a fair offer in the current circumstances. We needed to target funds where the need was demonstrably greatest—to address recruitment and retention problems that would have damaged patient care. There is a problem in recruiting staff at the bottom end of the biomedical scientist scale, including medical laboratory scientific officers and path lab staff. We recognised that, and have offered larger increases to staff in that part of the profession. That means that some pathology staff will be getting more than many review body staff; biomedical scientists are receiving a rise of up to 7 per cent., and trainees up to 26 per cent. That compares favourably with the 4.7 per cent. awarded to most nurses in 1999-2000.
The current position is that unions representing about 75 per cent. of non-review body staff have now accepted our offer. Advance letters instructing employers to implement the pay increases have now been issued for administrative, clerical, ancillary and ambulance staff. I look forward to the remaining groups being able to benefit from this long-awaited award in the near future.
The offers have been made within the context of the current pay system, and it is worth pointing out that that system allows considerable flexibility to address the 265WH needs of key groups of staff. There is, for instance, the provision within Whitley to restructure on-call and call-out payments to suit local service organisation. This and similar action has been taken by a number of NHS employers in order to pay staff more attractively to ensure that key services are provided when they are needed. One example that is local to my constituency is the Winchester and Eastleigh Healthcare Trust, where staff working in biochemistry and haematology may have their annual pay increased by £3,744 for providing on-call services twice a month.
More widely, there is also provision to offer local pay supplements of up to 30 per cent. in the London area and 20 per cent. elsewhere, specifically to address recruitment and retention issues where management considers that proven problems could be redressed by pay enhancement. That is one way of addressing the reliance on agency staff to which my hon. Friend referred.
I have set out the current offer and the flexibility that exists, but everyone accepts the need to modernise the NHS pay system, which is outdated and has become a barrier to modernising working practices. Too often, services have to be organised around the barriers created by the pay system rather than around the needs of patients. My hon. Friend rightly spoke of the importance of teamwork in the NHS involving different professional and occupational groups and across traditional barriers.
As part of its modernisation, we intend to make a substantial investment in the NHS to enable services to be more patient-centred. Staffs need to be encouraged to work effectively in fluid and flexible teams to provide seamless care. They need to break down professional demarcation lines and work in partnership across professional and other occupational groups.
The problem with the current pay system is that it reinforces the barriers and the inflexible ways of working that the current system promotes by tying staff incomes to ways of working that go against team working and patient-centred care. It is also frustrating for staff because it is not always clear to them how the responsibilities of their jobs and the competences that they develop are actually rewarded in their pay at present.
Over the next five years, the Government intend to modernise the care system—health and social care alike—from head to toe. Modernisation of the system is necessary to secure a lasting improvement in people's health and to tackle inequalities.
Hon. Members will be aware that last week's Budget announced substantial injections of funding into the NHS—an extra £1.4 billion for the NHS in England plus additional revenue from taxation on tobacco. Those extra resources represent a huge opportunity to modernise the NHS and improve patient care. We must not waste that opportunity. No one should be in any doubt about what the public expect us to do with the money. If we fail to produce improvements in patient care where they are most needed to tackle ill health and inequalities in health care, we will be judged to have failed to deliver the changes the public and NHS staff expect and deserve.
266WH We need to make sure that we can continue to make fair and affordable pay offers, to address recruitment and retention and—fundamentally—to invest in a pay system which rewards new and better ways of working. That is why on 15 February last year we published "Agenda for Change", which outlines our proposals for modernising the NHS pay system. We want a new system that is based on efficiency, fairness, flexibility and partnership and gives all staff better career progression and fairer rewards for taking on extended roles, widening their skills and working in teams. We want to give all staff modern conditions of service. My hon. Friend mentioned working hours and other issues that will inevitably arise in negotiations.
We also want to provide a fair basis for pay rises in the security of a national pay system. That will entail substantial changes to the current system in which staff are often defined by a combination of their titles, their pay and how they are trained rather than by what they do for patients. It means changing the existing conditions of service, with their range of arcane allowances which too often distort working patterns.
Over the past year, we have had positive and constructive discussions with trade unions, NHS health professionals and NHS staff on the proposals set out in "Agenda for Change". I genuinely believe that we are working in a real partnership with all the recognised unions to make sure that the concerns of all staff groups are properly represented.
"Agenda for Change" proposes three pay spines for doctors and dentists, an expanded healthcare professional group and a single negotiating council for staff groups whose skills are attractive to employers outside the NHS. Although we propose different mechanisms for pay uplift for those three groups, it is essential—and it is recognised in the agreements that we have reached so far—that there should be a means to ensure that future pay increases on the three spines do not result in different rates of pay for jobs of equal value which could not be justified under the relevant legislation.
We also recognise that, for various reasons—often rooted in history—some smaller groups of highly qualified health professionals are outside the remit of the nursing pay review body. Those groups could well be included, although it is not intended that there should be any change to the fundamentally professional character of the coverage of the NPRB. As I have said in several debates over the past two or three months, it is too early in the negotiations to be specific about proposals for particular staff groups, but the matter is under discussion. I am confident that pay modernisation will bring benefits to all NHS staff, whether or not they are covered by a review body.
We have the opportunity to change the pay system for the better so that staff can be rewarded fairly for the work that they do rather than the title that they hold. We need the flexibility to design jobs within the security of a national pay system, to offer better career progression and modern terms and conditions for all staff and crucially, to allow managers and staff to deliver the quality of services that everyone wants. A national 267WH system of job evaluation will allow creative approaches to job design to match exactly the redesigned care processes that are so important to patients. If our negotiations continue to be successful, I hope that we will have an agreed package by the summer so that we can move ahead to implement locally and nationally to an agreed time scale over the coming years.
Although pay is important, it is not the only thing that matters to NHS staff. The quality of their working lives is also important. My hon. Friend mentioned people not being listened to and feeling that their views were not of value because they did not belong to the right profession or group of staff. She will know that, over the past year or so, we have undertaken an extensive exercise on staff participation within the NHS and I hope that we shall be able to publish a report and the Government's response to the staff participation proposals in the very near future.
268WH We recognised from the outset that it is important that all staff in the NHS should have the ability to contribute their views about how services should be run and the right to expect those views to be listened to and taken seriously.
We are not prepared to leave good employment practice to chance. We are developing more supportive, flexible and family-friendly working practices; we are extending and improving investment in lifelong learning and professional development: we are tackling violence and racism in the workplace and we are insisting that employers make those changes happen by setting clear priorities and targets to improve employment practice.
My hon. Friend has raised some important issues, some of which we have been able to address in the offers that we have made recently and others which we shall need to address in the context of wider change, but I am sure that we shall continue to make progress.
§ Question put and agreed to.
§ Adjourned accordingly at Two o'clock.