Health and Social Care Bill

My Lords, by now it will be no surprise to the Opposition that I do not support this amendment. It seems to be an extraordinary pedalling-backwards amendment. I ought to remind colleagues that foundation trusts already have the ability to negotiate local terms and conditions of service, so at least two-thirds of mental health trusts and half of all acute trusts already have it. They have not used those freedoms for very sound reasons, but there will come a time when gradually they will want to do so. It seems extraordinary that we would seek to remove those freedoms. I say to those who are anxious about pushing pay downwards that that has not happened at all with consultant grades of pay, where freedoms have led to much greater flexibility and a real and genuine recognition of the rarity of some consultant specialties in some areas, so it is not a good idea to remove that pay bargaining and that flexibility locally. I do not see the Agenda for Change as being successful. Yes, it was better than the Whitley Council, which had 250 different scales and you did not know where you were; it was pretty grim. However, Agenda for Change has not been implemented with the learning and skills framework alongside in any more than 50 per cent of trusts. It has not led to productivity gains. It led to an uplift of pay but did not actually deliver what employers wanted it to deliver. In my view, a good employment framework for local organisations must take account of local economic circumstances, the social demographic mix and the skills available in the local communities. Therefore, it must give local employers greater flexibility, as part of the autonomy of those organisations, and the ability to move away gradually from the situation that we have at the moment of profound skill shortages of nurses in some areas and an oversupply of some skills in other areas. If we could be more sensitive to local circumstances, we would get better values and rewards for staff in the NHS. I therefore very much support the Government’s approach to this and do not support this amendment.