The following amendments have been selected: amendment 1 in the name of Rebecca Evans, and amendments 2, 3 and 4 in the name of Darren Milllar. If amendment 1 is agreed, amendments 2, 3 and 4 will be deselected.

The next item, therefore, is the Plaid Cymru debate on NHS pay and conditions, and I call on Llyr Gruffydd to move the motion.

Motion NDM7138 Rhun ap Iorwerth

To propose that the National Assembly for Wales:

1. Regrets Betsi Cadwaladr University Health Board’s proposals to extend nursing shifts without pay for more than 4,000 nurses and health care support workers.

2. Fears the loss of goodwill among staff who already regularly work through their breaks or are on call on their wards or units.

3. Calls on the Welsh Government to protect frontline workers’ pay and conditions within the NHS by ensuring that this regressive proposal is scrapped.

Motion moved.

Diolch, Llywydd. Yesterday, a consultation into changes in nursing rotas at Betsi Cadwaladr health board came to an end. The proposal, ostensibly, to standardise and simplify nurses’ breaks and handovers is actually trying to save money for the health board, at a time, of course, when its chair is admitting that it’s having trouble meeting targets to reduce its £42 million deficit. Now, it’s within this context—a desperate attempt to save money—that this plan has been dreamed up. And that desperation may explain why the proposal has led senior management at the board to come up with this hair-brained idea to save cash. Put in a nutshell, it’s extending nurses' shifts by an extra half-hour without pay. It would mean a nurse currently working a 12.5-hour shift, which includes a half-hour unpaid break, is expected to work the same shift but only get paid for 11.5 hours.

I think it’s important that we recognise that many nurses currently take their breaks on their wards or units, and are effectively on call in an emergency. Now, this is purely down to the goodwill of hardworking staff, and this proposal is aiming to take advantage of that goodwill. What management fails to understand is that—[Interruption.] No, I won't, I'm afraid—I need to get this—. You can speak in the debate. It’s a very short debate. What management fails to understand is that the proposal threatens to totally undermine nursing morale and goodwill. The changes will effectively mean full-time nurses having to work an extra shift a month to make up the unpaid hours.

Now, these aren’t minor changes—if implemented it will affect over 4,000 nurses and healthcare support workers across my region in north Wales. Nurses that we have spoken to anonymously say that if the plan goes ahead, they will consider reducing their hours, some will consider quitting completely, some say that they’ll be taking their breaks off their unit or ward, and some will be taking annual leave rather than work extra shifts.

Similar changes have been imposed in English hospitals, but this is quite possibly one of the first times, although there may be ABMU—they may have done something similar. But I feel strongly that we have to challenge these proposals, and as a representative of north Wales, clearly I have the interest of our nurses in north Wales at heart.

Now, underlying the proposal is the need, in law, of course, to ensure safe staffing on every ward, while reducing agency nursing costs, by ensuring that Betsi Cadwaladr nursing and healthcare support worker staff make up the numbers. Poor management also means that there is a huge variety in staff breaks, from no breaks to 75-minute paid breaks. Standardising these shouldn’t mean enforcing an unfair extra burden on nurses.

The health board, of course, has been in special measures due to a variety of clinical failures since 2015. It’s entering its fifth year of direct Government control, yet shows no sign of dealing with the workforce challenges that underpin much of its problems. There are acute shortages of doctors and nurses, as we know, and at the last count, there were 500 nursing vacancies in the north—one in 10 of the workforce. So, you can understand why the staff who are there are already under pressure, and why the health board is looking to cut its huge agency nursing bill. Now, a freedom of information response to me last week revealed that Betsi Cadwaladr University Health Board is currently spending over £1 million a month on agency nursing alone. Indeed, at one time, it was spending £3 million a month on locums and agency staff. Now, these nurses are filling gaps, but employing agency staff, of course, costs more, and they are unable to carry out some of the duties that staff nurses routinely do.

So, how much will this proposal save? Well, according to the health board itself, they expect to save £25,000 a month from their agency nursing bill. That’s around 2 per cent—2 per cent of the monthly bill. I'm sure the health board will argue that when you're facing such a mountain of debt you have to count the pennies, and I wouldn't disagree with that, but I fear that they've lost sight of how this has been received at ward level. The gap between board and ward has never been greater, judging by the response. 

Concerned nurses have contacted us because this proposal will backfire badly on the health board. The loss of goodwill among thousands of nurses who are already working under immense pressures will make matters worse, not better. It's no way to treat skilled, experienced and specialist staff. I want the health board to reconsider this proposal. It's causing anxiety amongst staff who don't need further stress in their working lives. Staff morale is already low and this could be the straw that breaks the camel's back. The health board, yes, they may save £25,000 a month, but you can't put a price on the goodwill of over 4,000 nurses.

Now, I hope the health Minister, whose department has, of course, direct oversight of Betsi Cadwaladr, will understand this. I hope—. Well, I understand that his colleague the Crewe and Nantwich MP Laura Smith has been very forthright in opposing similar changes that have been imposed on nurses at Leighton Hospital in her constituency. So, if he doesn't listen to Plaid Cymru, I wonder whether he'd listen to her argument.

Is he listening to the unions, such as Unite, and the Royal College of Nursing, who are both opposing these changes in the strongest possible terms? I would urge him to step in and ensure that this policy is abandoned before it causes real problems with the workforce, and ultimately, of course, with the NHS across north Wales.

Will he listen to the over 6,000 people, many of whom are nurses and their families, who have signed petitions to scrap this change? Nurses and healthcare support workers are at the front line of delivering a fantastic service across the north. Nurses work damned hard and don't need more pressure being put on them by management, who of course can leave their offices at 5 p.m. come what may. So, does senior management really think that this move is going to help retention and recruitment?

I close my opening contribution with a quote from a staff nurse who signed our petition and who left this message on the message board:

'This will be the final nail in the coffin for nurses working for Betsi. We already work on an understaffed ward so we are lucky if we take a break. This will mean lots of nurses moving away from the nursing profession and I will be one of them. I absolutely love being a nurse but will not have my health threatened by the trust putting more pressures on me. Betsi are showing their true colours in my opinion. They care more for finances than patient or staff well-being. Maybe if they put money into their frontline staff by making wards safely staffed and not paying companies to come up with stupid ideas then they might save money in the long run.'

Those were her words. Now, I urge the Assembly to support the Plaid Cymru motion and to support our nurses this afternoon.

The Deputy Presiding Officer took the Chair.

Thank you. I have selected the four amendments to the motion. If amendment 1 is agreed, amendments 2, 3 and 4 will be deselected. Can I ask the Minister for Health and Social Services to move formally amendment 1, tabled in the name of Rebecca Evans?

Amendment 1—Rebecca Evans

Delete all and replace with:

To propose that the National Assembly for Wales:

Values the NHS workforce and our social partnership working arrangements.

Expects all NHS bodies to work with, engage and consult with staff, their trades unions and other representative bodies on operational changes that impact upon staff.

Amendment 1 moved.

Formally.

Thank you. I call on Angela Burns to move amendments 2, 3 and 4, tabled in the name of Darren Millar. 

Amendment 2—Darren Millar

Insert as new point 2 and renumber accordingly:

Further regrets that the number of working days lost due to stress and mental health related issues within the health board has increased by 20 per cent since 2014.

Amendment 3—Darren Millar

Delete point 3 and replace with:

Expresses concern that this proposal will be unhelpful to staff morale and will place additional expectations on nurses and health care workers to sacrifice their contractual break periods.

Amendment 4—Darren Millar

In point 3, delete ‘by ensuring’ and replace with:

‘and for the Minister for Health and Social Services to intervene to ensure’

Amendments 2, 3 and 4 moved.

Thank you, Deputy Presiding Officer. I formally move those amendments. But I'm afraid that my colleague over the Chamber here, Llyr Huws Gruffydd, has said exceptionally eloquently pretty much everything I wanted to say. Because we  have an NHS that is under an immense amount of pressure. We have staff who work over and above the call of duty. They work longer hours and they don't chase overtime payments, which they very, very seldom would get anyway. They stay and don't have the breaks they should have, because there's always somebody who needs a bit of help, somebody who needs lifting, somebody who needs feeding, and a drug to administer, a handover to undertake. They don't ask for that extra money; they just get on and do it. The RCN has been very clear about if every single nurse in the Welsh NHS worked to time we would have some shocking shortfall of nurses throughout Wales—in the order of 3,500 to 4,000 personnel.

So, when you're under that immense pressure, to—as you have said, Llyr—have people tinkering around the edges and making those kinds of changes actually just makes you feel incredibly unloved, unworthy, undervalued. I think what goes against the grain is that the parliamentary review was really clear about the importance, going forward, that the vision for health was going to put on staff and on patients that we were going to become a much more people-centric NHS. 

Because I'll ask you this, Members—the NHS, if nothing else, is a people business. It is all about people—the people who are patients, the people who are the people who work in it, who make people well, who send them back out into the world. It's about human interactions, it's about communication, it's about skill, it's about one person helping another person or being part of another person's life for a very brief moment, and you have to feel good about yourself to do it. And I want to just do a quick comparison, and I hold my hands up to this: on the days when I don't feel great, when I'm tired, when I'm knackered, when I'm fed up, when I'm reading 450 committee papers in a very short space of time, I'm pretty short with my husband, I'm pretty short with my kids, I'm pretty you know, because I feel under pressure, I feel under stress. It's how human beings react. So, what are we doing to all these NHS staff who are working their socks off for us? We're putting them under even more pressure, but expecting them to be sunshine and light, to do their job the best they can with that passion in their heart.

Now, it is all about cost saving, and Betsi does need to trim some of its sails, but there are better places to trim those sails. And I would suggest that PricewaterhouseCoopers, who have helped them to do this little exercise, are probably very good at looking at the numbers and very good at looking at the books, but I really challenge them to walk through those wards in the dead of night and get on and do and see what these staff do. 

We absolutely support your motion. We've made a few amendments, but it was an effort to try to just tidy it up and to make it sharper, because the one thing we do call for, Minister, is for you personally, directly, to intervene in this, to have a long, hard look, because you've already in earlier debates today said that you react and make things go directive because health boards aren't performing. Betsi is not performing, and this latest thing is just going to upset so many people and cause morale—. I've run out of time, but I just want to make one final point. Staff sickness absence for mental health issues within Betsi Cadwaladr has risen year on year on year, and in 2018-19—and these are little figures, and I couldn't believe it when I read them—full-time days lost, over 72,000. You get those days back into Betsi Cadwaladr, back into the NHS and you'd have a completely different NHS. You can only do it with happy, healthy staff who feel rewarded and feel that people are committed to them. 

I also commend what Llyr and Angela have just said. Often in this Chamber we refer to 'our health service', 'our hard-working health service staff' and I think this is a way of saying that we value beyond measure the services we receive and the people we receive them from.

The health service provides vital services—many people rely on them very heavily at times and when they are vulnerable, ill and upset. We all know that nursing or caring is a vocation that not everyone wants to do and not everyone can nurse someone back to health, comfort the bereaved or deal with a medical emergency. We know that, when you put your heart and soul into your job, when it is a vocation, you will give more, do more, unrewarded and unrecognised.

But that is sort of okay when you feel valued by your patients and by your employer. The Betsi Cadwaladr health board remains in special measures. This means that the level of quality of service that is being experienced by people across north Wales is not as good as that they enjoy in other parts of the country. Despite being directly supervised in certain areas by you, health Minister, there is no end date in sight for the cessation of these measures and may I venture that this sorry state of affairs leads me to think that perhaps there are structural deficiencies in the whole set-up that need to be addressed?

Now, it seems to me that the strength of any organisation is its people, and, considering the amount of e-mails that I've had on this health board subject, it is now in the process of eroding the goodwill of its staff by seeking to change terms and conditions and, effectively, make staff work one extra shift per month for free. This is not on. I see that they talk about standardising and rationalising shift patterns—well, fine, but not to the detriment of staff who are already overstretched, overstressed and working beyond their own capacity. 

A couple of questions spring to mind, and I'd be grateful to get your thoughts on this. If the health board has been in existence since 2009, why has it only realised in 2019 that rationalisation needs to take place? And we all know how cynical consultations can be. Will the health Minister please do everything he can to make sure that consultation responses are truly taken into account?

Finally, someone who is not affected by these proposed changes, as they have moved roles, has actually written to me, and I quote, 'We need to look after our nurses and healthcare assistants, and show them how valued and appreciated they really are, and stop these changes being put into effect'. I could not have put that better myself. Thank you.

Can I now call the Minister for Health and Social Services, Vaughan Gething?

Thank you, Deputy Presiding Officer, and thank you to Members for their contributions in the debate. I'll start by making it clear that staff rotas are an operational matter and the responsibility of individual organisations. They should ensure that all of their rotas take into consideration compliance with the Nurse Staffing Levels (Wales) Act 2016, are designed to meet the needs of staff, service delivery, and place patient need at the centre of the management of the workforce.

I expect all NHS employers to work closely with trade unions on the staff side on proposed changes, to consider and respond appropriately to all comments and concerns. The current proposal being consulted on by Betsi Cadwaladr University Health Board does seek to standardise shift patterns, handover durations and break durations across all divisions, and the whole consultation has not concluded yet; they're still engaging and consulting on the proposal.

I understand that, in response to a request from trade union partners, the consultation period has been extended to ensure adequate time for all staff potentially affected to consider information and take part in the consultation. I also understand that trade union representatives have raised concerns about the potential impact, including work-life balance, potentially increased childcare costs, and travel, laundry and food costs. I do expect the health board management to consider any equality impact and all feedback before any decision is made. So, the motion does not reflect the reality that local consultation processes have not yet been completed—that is ongoing and no decision has yet been taken.

The motion also refers to protecting front-line workers' pay and conditions within the NHS. The rota proposals are about shift design and wouldn't affect contractual pay, terms and conditions that are set out under the collectively agreed 'Agenda for Change'. 

In opposing the motion, I've also moved amendments to reiterate the value that we place on the NHS workforce and social partnership working arrangements here in Wales, and that we continue to expect all NHS bodies to work with and engage and consult with staff, their trade unions and other representative bodies on any operational change that does impact upon staff.

The social partnership and trade union engagement are normal arrangements here in Wales. Our arrangements in Wales are understandably viewed with some envy by trade union colleagues in England, where there is a radically different approach. I am happy to say that data quality in recording absences is improving, and this will help to identify and address specific themes and areas to focus on.

Work is ongoing throughout Wales, following the 'Agenda for Change' agreement, to reduce sickness absence in every health board and trust. NHS organisations are engaged in a range of initiatives to support both the physical and emotional health and well-being of their staff. Like all colleagues, I am also concerned about stress and mental health-related issues that affect our health and care staff. Employers do have to fully consider their employees' health and well-being. It's actually—that discussion about how to reduce sickness absence has been taken forward jointly by trade unions and by employers, and has been supported by additional resource from the Government. So, we'll not be supporting the amendments proposed by Darren Millar. As I've said before, these proposals are rightly subject to engagement and consultation with staff, trade unions and representative bodies.

I do want to make it clear that I have the best interests of our staff and the public that we serve in mind with every decision that I take. I know that that is something that other Members would say—that they too have that in mind when they make contributions in this Chamber. But I expect NHS employers to take a similar approach in listening to and working with our staff and their elected representatives on the trade union side. 

That does not, of course, mean that employers and trade unions agree on every proposal made. We do, though, in Wales, however, have a track record of finding a way to reach agreement on a way forward. I expect that constructive and grown-up approach that we have fostered, encouraged and embedded through social partnership to find a way forward in this case, and I will, of course, take continued interest in the progress of that in this matter once the consultation responses have been concluded. Then the health board will have to consider any proposal they still have at that point, or to revise it, discuss it and, I hope, agree in the partnership that we have fostered and, I'm proud to say, delivered here in Wales.  

Thank you. Can I call on Dai Lloyd to reply to the debate? 

Thank you very much, Deputy Presiding Officer. I only have a brief amount of time. Could I congratulate everybody who has taken part in this important debate, specifically Llyr Gruffydd and Angela Burns who have set out what is in front of us—the challenges? Of course, nursing is a calling, and that means that people go the extra mile for their patients, and nurses, like doctors, are seen sometimes by administrators as a soft touch, because we will stay on and do whatever it takes because our patient is there, sick or ill, and we have to show respect to that attitude and that nurses have a calling. We have to show that its due respect, and support this motion. Thank you very much.

Thank you very much. The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Object. Therefore, we defer voting on this item until voting time. 

Voting deferred until voting time.

We have now reached voting time on the agenda, so unless three Members wish for the bell to be rung, I'm going to proceed to the vote.