Health and Social Care Bill

My Lords, I rise to support Amendment 45 and to follow on from my noble friend Lady Wheeler. I have spent quite a lot of my working life negotiating pay and conditions for staff in the National Health Service. I sat on four NHS Whitley councils for a very long time—one of them for 21 years. As a nurse, I was privileged to lead negotiations on behalf of Britain’s nurses and midwives for quite a few years as chairman of the staff side of the Nursing and Midwifery Staffs Negotiating Council. So I know a little about the subject of this amendment and the possible consequences of any breakdown in national pay and conditions of service for National Health Service staff. We have had nationally agreed pay and conditions ever since the inception of the National Health Service, with occasional attempts to break this down, particularly in the late 1980s. The Government of the day thought better of it and backed away. The old Whitley system stood the National Health Service in good stead for many years, but it was far from perfect and there was not always peace and harmony. There were problems in some years, going back, for example, to 1972 for ancillary staff, 1974 particularly for nurses and 1982 for most staff groups. The most recent that lingers in my memory was the ambulance dispute, which I think was in 1990. Not all staff unions in 1983 agreed that the Government should set up a pay review body for nurses and midwives and professions allied to medicine. However, it was in my view an entirely sensible move, which by and large took a lot of heat out of relations between management and staff organisations for these two groups of staff. Why was the pay review body the right solution? The review body was independent and the staff unions were forced to undertake very detailed research into their pay claims. We used to spend many months getting that evidence right. The management side and government put in evidence as well. The Office of Manpower Economics, which provides the secretariat to the review body to this day, also carried out its own research. The review body took oral evidence from all of the parties. I led that for a number of years on behalf of the staff side. The members of the review body—academics and professionals—put us through the hoops, and any half-baked evidence would have been very quickly exposed. There was no question of any staff side taking inflation, doubling it and—metaphorically at least—banging the table. That clearly would not work. The pay review body provided, for the most part, fair uplifts in pay. Sometimes we were disappointed but often the real anger from nurses and professions allied to medicine was more often directed at Governments, who had a habit of staging pay awards—except of course in election years. Other pay groups were brought into the purview of the review body in 2004 following the very long and detailed work to bring in the new pay structure, Agenda for Change, to which my noble friend Lady Wheeler referred. In 2007, all the remaining groups of NHS staff except doctors and dentists were brought into the National Health Service review body. The plethora of NHS Whitley councils—I think there were 10 when I was involved—has now been reduced to one. Staff unions, NHS employers and the Department of Health have invested very heavily in making Agenda for Change work. The structure is underwritten by comprehensive job evaluation, a knowledge and skills framework and the national pay scales. Particularly importantly, it is equality-proofed. It provides some built-in local freedoms for employers, one example being to allow for recruitment and retention payments. It is supported, as my noble friend Lady Wheeler said, by staff, employers and trade unions. The worry is that we have already seen some efforts by some foundation trusts to impose alterations to Agenda for Change outside of the agreed local freedoms. Instead of the relative harmony that has existed over many years now, we have had unnecessary local hotspots with the inevitable problems of distrust and effects on morale. The pressures on National Health Service staff over the next few years are going to be enormous. The most important focus should be—must be—on improving quality and driving efficiencies. We do not need that focus upset by employers and unions doing battle over local pay and rations. The last thing we need is fragmented and inconsistent systems of pay and conditions of service. The ratcheting up or down—probably mostly down—would in my opinion lead to equal pay litigation issues if the equality-proofed Agenda for Change structure breaks down. This amendment will ensure that clinical commissioning groups and foundation trusts are not able to break down the systems so painstakingly put together in the past few years. Let us not move away from that tried and tested system where staff unions and employers can put their energies into giving evidence to an independent pay review body rather than expend these energies on local bargaining, which could create disharmony, industrial disputes and issues of morale. I hope we hear from the Minister that we will continue to have national pay bargaining in the National Health Service.