The Bishop of London spoke to a group of amendments related to health services during a debate on the Strikes (Minimum Service Levels) Bill on 9th March 2023, raising concerns of the effect of the bill on individual health service staff, pressure on staff levels, and low morale in the healthcare service:
The Lord Bishop of London: My Lords, I rise to speak to this group of amendments on the inclusion of health services in the Bill. I am sorry that I have not been able to speak before. I declare my interests as set out in the register.
I have been a union member. I joined as a nurse—and as an NHS manager and a civil servant in the Department of Health—because I wanted protection. The relationship with unions was critical; it was the way in which we improved patient care. One of my overall concerns about the Bill is that it has the potential to break down the relationship which is so vital for patient care, as the noble Baroness, Lady Noakes, said.
I am grateful to the Royal College of Nursing, which has helped me in considering the Bill. I am sure that it will not surprise noble Lords to know that it does not support the Bill, for what I see as some good reasons: not least because it curtails the freedom to participate in what otherwise is lawful action.
My right reverend friend the Bishop of Manchester regrets that he cannot be here, but he shares my concern that far too much power is given to the Secretary of State in what we have already heard is only a skeleton Bill, and that there is a complete lack of clarity about how it could be used. It is open to abuse. I am surprised that, as many others have said, the detailed policy that becomes legislation is not there. I am concerned that those who work in the health service probably cannot see whether they are in there or not.
I support the noble Lord, Lord Allan, and the noble Baroness, Lady Chakrabarti, regarding the definition of health services. It is such a wide definition that leaves it to the imagination whether you are covered by it or not. I do not believe that this is for the professional groups, but for the individual. I am also very conscious that we have talked a lot about trade unions, but the health service is about individual nurses, doctors, health visitors and midwives who seek to do their best for patients. One of my great concerns is that the Bill could lead to the sacking of staff for taking what otherwise would be seen as lawful strike action. They are the nurses, midwives and doctors whom we can ill afford to lose.
As has already been said, the reality is that those who work in the NHS do not take strike action easily. They choose to do it only because they are frustrated that their voices are not being heard when they express their concerns about patient standards, workforce levels, recruitment and retention, and the role that fair pay plays in this. In September, the Nuffield Trust reported that 40,000 nurses left the profession last year, and we are still waiting to see the arrival of the workforce plan. Meanwhile, healthcare workers are spread more thinly, at the expense of their mental health and well-being.
It is amazing that the legislation talks about minimum service levels, yet this Government resist setting minimum standards for nursing and other health professions. If we want to ensure standards of patient care throughout the 365 days of the year, the focus should be not on banning strikes but on getting in place minimum staffing levels to ensure that quality patient care is given. For the Government to fire anyone using strike action when they try to raise a concern about the conditions set by the Government is ridiculous and undermines the dedication of staff in the NHS.
I have a question. Rather than passing the Bill, should the Government not be spending more time listening to and addressing the concerns of healthcare staff, to hear the solutions they believe they have to ensure that patients get the care that they require?
Finally, the other concern that has been raised is around trust and staff morale. The reason staff in the health service are striking partly relates to morale, and also to trust. I am concerned that the Bill will undermine the trust that is there and further undermine morale. We saw something of that trust undermined when this Government were seeking for healthcare professionals to be double-vaccinated against Covid. Although I am a great supporter of vaccination, we were heading for disaster. I am concerned that the Bill undermines trust and morale. What risk assessment has been made of the effect of passing this Bill on staffing levels of the NHS in particular?
Extracts from the speeches that followed:
Lord Markham (Con): I will try to answer the questions raised by the right reverend Prelate the Bishop of London, the noble Lord, Lord Prentis, and others, about trying to undermine the trust between the hospitals, in this instance, and employees. I go back to the position that it is for the trust to work with local unions to work out what the best level is, in the hope and knowledge that this will probably never be needed. It is just enabling legislation because we can see that there are circumstances, as I mentioned before, where it might be needed.
Lord Patel (CB): My Lords, I will speak to my Amendment 18. Much of what I have to say will resonate with what the right reverend Prelate the Bishop of London and the noble Baroness, Lady O’Grady of Upper Holloway, had to say. I am also grateful to my noble friend Lord Kakkar for adding his name to it. My amendment seeks to explore the logic of defining minimum staff service levels in healthcare, without first having a benchmark of what is an appropriate level of staffing that fulfils the needs of patient care and patient safety.
While this Bill is not about rights and wrongs of strike action, I will express my personal view that, as a doctor, I would never have withheld my service, no matter the circumstances. This Bill grants the Secretary of State powers to make minimum service regulations during a strike across several sectors, including health services. I will speak only regarding health services, as “health services” are not defined in the Bill, which makes the legislation very broad in scope. “Minimum service levels” are also not defined in the Bill but will be defined by the Business Secretary after consultation.
The focus of my amendment is patient safety. Legislation that imposes minimum service levels inevitably means a reduced number of staff expected to provide the same level of care. How can that not compromise patient safety? We seem to have forgotten the lessons from the Francis report, the Kirkup report and the Ockenden review—to mention some—all of which commented on patient harm caused by lack of staff. We are all aware that the health and care service is currently under immense pressure, as has been mentioned several times. There are unprecedented levels of workforce shortfall—around 10% of the total workforce—leading to 130,000 vacancies with over 50,000 vacancies in nursing alone. Staff are exhausted, morale is low and employers are having to pay out huge sums of money in agency fees.
My amendment prevents the Government introducing minimum service levels for health, unless they have, via primary legislation, first set out the appropriate legally enforceable staffing levels for health services on non-strike days. Without this, how can the service or, importantly, the patients know that care with reduced services at a minimum level is safe and will not result in patient harm? Daily, patient safety is compromised as a result of staffing problems. The NHS should be safely staffed every day of the week, as has been mentioned.
The Lord Bishop of London: My Lords, I shall speak to Amendment 18 in the names of the noble Lords, Lord Patel and Lord Kakkar, and add my voice to many of the points already raised. I thank the Minister for being much more specific around health. I hope that we can define it much more clearly, rather than having that very broad category, as well as the issue around life and limb.
I remind the Government that, in this Chamber, they have resisted introducing legislation for minimum staffing levels on a number of occasions. It seems incredible that they now want to put in levels of minimum service, which clearly require minimum staffing levels, but are willing to do it only on strike days.
As I indicated earlier, this amendment goes to the heart of one of the key issues with the Bill; namely, that people in the health service who strike do so partly because safe staffing levels are not in place on non-strike days. We have already heard that the healthcare system is under huge pressure, trying to provide quality care with fewer staff, and there are workforce problems. The most recent statistic I have shows that there are 124,000 vacancies across the NHS—that is 13,000 more than this time last year. The Royal College of Nursing published a survey in May 2022 showing that only 25% of shifts have the planned number of registered nurses and 83% of respondents said that there were not enough nursing staff to meet all patient needs safely and effectively on their most recent shift.
Staff on non-strike days are thinly stretched and cannot provide the level of care that they would want to, which puts huge pressure on their health and well-being. The distress that they experience is causing an increase in illness to them. Reporting on the past year, the Healthcare Safety Investigation Branch noted that the additional pressure that staff were under was causing sickness. As a new student nurse put it, “I no longer want the career as it is. The reality feels as though I must sacrifice my own health and well-being for less than satisfactory pay.”
The notion that the Government could legislate to require minimum service levels in healthcare settings, which are already committed to safe strikes, while there is a lack of investment and workforce planning—which is the reason for the action—is unfathomable. I would welcome the Government legislating to ensure appropriate staffing levels on non-strike days that are greater than the strike day cover. That would be welcomed by nurses, because it would mean more resources and more workforce planning than the health service has seen for years. It would also resolve one of the reasons why nurses are taking strike action. I have spoken about trust, as have a number of noble Lords. Accepting this amendment would go some way towards to rebuilding the trust that has been eroded, and will be eroded further by this Bill.
Amendment 13 in the name of the noble Lord, Lord Fox, seeks to make a similar point but through a different route. Along with my right reverend friend the Bishop of Manchester, who is unable to be here, I express my support for that amendment as well.
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