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

Item 9 on our agenda this afternoon is the Plaid Cymru debate, NHS pay review. I call on Rhun ap Iorwerth to move the motion. Rhun.

Motion NDM7655 Siân Gwenllian

To propose that the Senedd:

1. Condemns the UK Government’s recommendation to the NHS Pay Review Body for a wholly inadequate 1 per cent pay rise to nurses and other NHS staff which would amount to a real terms cut in their wages.

2. Calls on the Welsh Government to make further representations to the NHS Pay Review Body supporting the specific calls of the trade unions and other bodies representing health and social care staff in Wales for a fair and well deserved pay rise to reflect the sacrifices made during the pandemic.

3. Calls on the next Welsh Government to deliver a reformed pay and retention settlement for health and social care staff, including a guaranteed minimum of £10 an hour for care workers to end the current disparity between health and care.

Motion moved.

Thank you very much, Deputy Presiding Officer. It's my pleasure to open this debate and to formally move the motion in the name of Siân Gwenllian. How many of us have said 'thank you' over the past 12 months? How many of us have stood on our doorsteps clapping?

How many of us have remembered over the past year the importance of saying 'thank you' to those who work so selflessly across the health and care sectors to look after us? How many of us have stopped to think and realise that care doesn't just happen? We're cared for because people—our friends and neighbours, people we grew up with, went to school with—decided to commit their professional lives to caring as nurses and as physios and domiciliary carers and doctors and speech and language therapists, and it's such a long list, I couldn't possibly name them all; a whole host of health professions.

But saying 'thank you' has to be so much more than a passing act. And so, we're here today talking about something that should be a given. It should be a constant: fair financial reward for the commitment, the hard work, the dedication, the graft, and as I said, the sheer selflessness shown by health and care workers at any time, let alone during this extraordinary past COVID year.

Can I say here how pleased I am with the remarkably coincidental announcements earlier today from Welsh Government about (a), making money available to support the continuation of the payment of the real living wage across the NHS—again, something that should be a given; and (b), the funding of a bonus for all NHS and care staff, a net payment of around £500 for most, and of course, I welcome any reward shown for their work. They deserve every penny. But let me be clear that fair financial rewards should be firmly embedded in the culture of our health and care services at all times, and not settled through one-off bonuses. And though grateful for the announcement, there'll be a rather bitter taste left by the fact that this has been done, frankly, because Welsh Government was put in a corner—by a Plaid Cymru Senedd motion, as it happens—and so, felt compelled to do something.

The Llywydd took the Chair.

I don't need to explain too much about the content of the motion itself. We condemn the UK Government's proposal to give a tiny pay increase of 1 per cent for nurses—and I see the Minister laughing; perhaps he can explain why he's laughing in just a moment. We condemn the UK Government's proposal to give a totally inadequate 1 per cent pay rise to nurses and other NHS staff, which would amount to a real-terms cut in their wages, in order to make it entirely clear that we wouldn't accept a settlement such as that here. We are calling on the Welsh Government to make further representations to the NHS pay review body, supporting a fair wage for staff. We're also expanding the motion to include care staff. Plaid Cymru wants to integrate health and care by having a national health and care service. You will have heard me talking about that in the past, and I'll be doing so again over the next few weeks as the election approaches. One of the upshots of that would be to bring care staff into the same pay grades as health staff over time, and this motion calls for the delivery of the first stage of that, with a minimum of £10 an hour immediately for care workers to start to deal with that disparity.

So, the aim here is very simple. You will have all, I think, received an e-mail from the Royal College of Nursing today saying that they welcome this afternoon's debate, so I'd like to thank them for working with me throughout my time as a Plaid Cymru health spokesperson. I'd like to thank all of their members for their work throughout the recent pandemic. That e-mail asks us all as Members what we're going to do in order to show our real appreciation and to show our support for a proper and fair pay settlement for our health and care staff. One thing that you could do is to support this motion this afternoon. Thank you.

I have selected the three amendments to the motion. If amendment 2 is agreed, amendment 3 will be deselected. I call on Angela Burns to move amendments 1 and 3, tabled in the name of Mark Isherwood. Angela Burns.

Amendment 1—Mark Isherwood

Delete point 1 and replace with:

Recognises that NHS pay is devolved and welcomes the additional £2.1 billion increase in the Welsh Government budget for 2021-2022.

Amendment 3—Mark Isherwood

In point 3, delete all after 'next Welsh Government' and insert:

'to:

a) implement the recommendations of the pay review body;

b) introduce a reformed pay and retention settlement for health and social care staff; and

c) create a substantial mental health support package for health and social care staff suffering from the impact of the pandemic.

Amendments 1 and 3 moved.

Thank you, Presiding Officer. I move amendments 1 and 3, tabled in the name of my colleague Mark Isherwood. The staff of our national health service, and those who provide social care to the people of Wales, have been at the forefront of the fight against the spread of COVID-19. They have kept vital services running, held hands that families could not reach, seen death and suffering on a scale usually associated with conflict, and supported patients and colleagues whilst being under the most intense pressure. I recognise their hard work.

I also recognise that Welsh Government do have the levers to reward health and social care staff appropriately, which is why I find the opening premise of this debate extraordinary from Plaid Cymru, a party whose mantra begins and ends with demanding independence from the UK whilst refusing to take fiscal responsibility. They should accept our first amendment, and recognise that NHS pay in Wales is a devolved matter, and that the Welsh Government have received an additional £2.1 billion increase in their budget for 2021-22, and that same Government have the ability to spend it how they wish. Indeed, earlier today, I heard the Minister for finance loudly proclaiming that the Welsh Government were not a postbox for the UK Government's spending decisions. £2.1 billion is a lot of pounds, and I urge the Welsh Labour Government to use it to support an increase in nurses' pay. Remember, £5.85 billion has been given to the Welsh Government since March last year, with another £602 million yet to be allocated. That's a lot of money, and there is money to rebalance the pay of health professionals.

The Welsh Conservatives have already stated that we would implement in full the recommendations of the pay review body as an absolute minimum, but for those who refuse to hear, let me say it again: if we form the next Welsh Government, the Welsh Conservatives will implement the recommendation of the pay review as a minimum. That would be in tandem with our commitment to introduce a reformed pay and retention settlement for health and social care staff, including on a recruit, retain and retrain policy, and a minimum salary of £10 an hour for care staff.

I note the proposed bonus for staff today and rejoice that Welsh Government have finally learned how to calculate tax. Any chance domiciliary care workers, short-changed by Labour, will receive a top-up? And has the Welsh Government published their response to the pay review board yet? This is vital, because a bonus is welcome, but does not embed a pay uplift on a year-to-year basis.

At the beginning of my contribution, I spoke of the extraordinary service performed by so many, but that extraordinary service has caused untold stress, and mental health has been impacted. We recognise that, and we will work with the staff, employers, unions and royal colleges to create a substantial mental health support package for health and social care staff suffering from the impact of the pandemic.

I commend our amendments to the Chamber, and, Presiding Officer, if I may, as this will be my last debate, probably, on this health subject, I just want to say to those staff out there in health and social care, thank you. I do recognise your commitment and your hard work, and I want to say a truly heartfelt 'thank you' from me, from the people I love who you have helped this year, from my colleagues in the Welsh Conservatives and from my constituents in Carmarthen West and South Pembrokeshire. Thank you.

Dai Lloyd. I apologise. The Minister to formally move the amendment in the name of Rebecca Evans. 

Amendment 2—Rebecca Evans

Delete all after point 1 and replace with:

Acknowledges that the Welsh Government has noted the different position from the NHS trade union on what they believe is a fair and affordable pay uplift and has made further representations to the NHS Pay Review Body to confirm that no arbitrary cap has been set.

Believes that the pay review bodies should report independently on a pay that is both fair and affordable.

Recognises that NHS Wales pays the Real Living Wage, that the Welsh Government supports the Real Living Wage as the minimum rate of pay for social care workers and has established the Social Care Fair Work Forum which is looking at how to improve terms and conditions in the sector.

Acknowledges that one of the key themes of 'A Healthier Wales: Our Workforce Strategy for Health and Social Care' focusses on fair rewards and recognition for staff.

Amendment 2 moved.

Formally, Llywydd. 

Thank you. Dai Lloyd next. 

Diolch, Llywydd. I rise in support of the Plaid Cymru motion—no surprise there—in particular point 1:

'Condemns the UK Government’s recommendation to the NHS Pay Review Body for a wholly inadequate 1 per cent pay rise to nurses and other NHS staff which would amount to a real terms cut in their wages.'

That is point 1 of the Plaid Cymru motion, and I wholeheartedly agree with it. And furthermore, I wholeheartedly condemn the Conservative and unionist amendment here today that seeks to delete this point 1 altogether. Clearly, Llywydd, you will be aware of my medical background—I may have mentioned it once or twice over the years—and I have family members working in the NHS today. Colleagues in the British Medical Association, the Royal College of General Practitioners and the Royal College of Nursing have all voiced huge concerns about this derisory pay rise, also huge concerns about a UK Government budget announcement that disinvests in public services and ignores social care. 

After the pandemic year we have all had, care staff and NHS staff are exhausted, burnt out, angry and hurt. They bear huge responsibilities daily over matters of life and death, and it's difficult to grasp that level of responsibility unless you have felt personally yourself that total terror that engulfs you when your medical decision—your decision—has resulted in something going wrong, damaging another person even to loss of life. And it's so overwhelmingly busy now, you cannot plan carefully or ask your seniors if they're not available; you've got no control over what's happening. Health services were overstretched before the pandemic. Nurses and doctors are driven by a deep sense of service and duty to their patients, but motivation can really be tested by an occupational disease like COVID. Hundreds of NHS and care staff have died UK wide, hundreds more floored by long COVID. 

And personal protective equipment was totally inadequate in the early days, and staff wore bin bags for protection, risking their lives and the lives of patients. When staff die because of catching COVID in the workplace as an occupational disease, their families cannot claim their funeral costs. And a derisory pay offer on top of all that. While UK Government stockpiled tens of millions of unusable PPE items made by companies who had no experience in the field, with contracts worth millions handed to Government chums without scrutiny and without experience in PPE, the High Court found the UK Conservative and unionist Government broke the law here, all while ignoring companies with experience and capacity to provide PPE. 

And the £37 billion spent on a UK test and trace system, set up in parallel to what we've got already and private in the middle of a pandemic, from scratch using people with no health or care experience. I mean, what could possibly go wrong? The £37 billion system has made no difference according to Members of Parliament recently. A new £2.6 million press briefing room has just been unveiled in Downing Street, and don't get me going on care staff pay and conditions, because I'm coming to the end, Llywydd—I see you anxiously there—because that's point 3 of our motion.

Finally, health staff see all this that I've outlined. They know all this. They are not taken in by Ministers' insincere claps, and the 1 per cent proposed pay rise shows staff just how much their unbelievable sacrifices are valued by the UK Conservative Government. Do not dismiss the justifiable anger—agree a proper pay rise. 

My previous life as a Unison official in Wales is well known, and I remain very proud of the fact that I was part of the negotiating team working in partnership with the Welsh Labour Government that delivered the living wage into the NHS in Wales, ahead of the rest of the UK, and at a time when NHS colleagues in England were taking strike action against an intransigent UK Tory Government who would not honour the recommendations of the pay review body. I'm also old enough to remember why the NHS Pay Review Body was set up. It followed the bitter pay dispute of the early 1980s and was an attempt to look at pay independently and to take politics out of it. And that worked well, until, again, the UK Tory Government decided on policies of austerity and brought politics back into the game by interfering with the PRB's independence, insisting that they offered no more than 1 per cent, regardless of the evidence that could lead them to a different conclusion. Well, it's history repeating itself, isn't it, because, once again, the Tory UK Government has said it's only prepared to fund a 1 per cent increase, regardless of what evidence is presented to the PRB and what it recommends. This is a disgrace, given what NHS and other front-line workers have been through over the last year, so I'm pleased that this Welsh Labour Government have set out very clearly in evidence to the pay review body that there should be no arbitrary cap on the offer made to NHS workers; it should be an offer that reflects their worth to the country, and the UK Government must fully fund it. They have, after all, as Dai Lloyd has already been telling us, found money during this pandemic for many other things: billions for a privatised but largely failed track and trace system; a significant pay rise for Dominic Cummings; and is it still three official photographers for the Prime Minister? And, of course, £2 million for that press room in Downing Street. And at that time, NHS workers were working far beyond the normal call of duty to save lives and to keep us safe. They even saved the Prime Minister Boris Johnson's life, and he clapped and then he slammed the door on them. A 1 per cent pay offer brings shame on those who made that decision, but I hope that they will be shamed into doing better, because we can do better, as our Welsh Government has today shown with the announcement of a £500 bonus to all NHS and social care staff, in recognition of their efforts during the pandemic. 

Llywydd, can I also say that I'm pleased that, unlike the UK Government, the Welsh Government has not forgotten the social care workforce and is working with trade unions and the sector to deliver improvements to people who look after our nearest and dearest when they're at their most vulnerable? From my own experience, I know that this Welsh Labour Government, the health Minister and the trade unions will work together to show that Wales is a fairer nation, a nation that will reward those who helped us through the darkest of recent times. But let us not for one minute let the UK Government off the hook. They hold the purse strings for this, and they must be held to account and pay up. Actions will speak far louder than any words.

I'm pleased to take part in this really important debate. I will begin by doing something I don't usually do, and that is to quote the words of another person, and I'm going to quote the words of Helen, who is a nurse from Llanelli. I've known her and her work for a very long time. She has e-mailed me about a number of healthcare issues, but I want to just quote briefly some of the things she says about nurses' pay: 'As for nurses pay, the misinformation and manipulation of the facts about previous pay increases and that the vast majority of nurses are on salaries of over £30,000 peddled by the Westminster Government needs to be challenged. Many nurses are the main breadwinners in their family, and their income is not secondary to a husband's.' 'It's not just during the COVID crisis that those who provide health and social care in primary, secondary and independent services have been serving our community' she says. 'To stand outside and clap and then offer a below-inflation pay increase is an insult. The retention of health and care staff will be vital to meet the needs of those who have had delays in diagnostics and treatment, and a paltry 1 per cent does not offer much incentive to remain in nursing.' She then says, 'My apologies for the rant, but in 40 years I have never seen morale so low and I personally have never felt more patronised and insulted.'

Now, as I've said, I know Helen, and her commitment and dedication have been inspirational, and it makes me furious to hear how patronised and insulted she feels. And there are hundreds of Helens in all our constituencies—thousands of them in all our constituencies and regions across Wales. Nurse recruitment, of course, has never been a very major issue. There are so many people who are willing to serve and are willing to train, though there are challenges. But nurse retention has been an issue for a very long time, and there are a number of reasons for this. Lack of flexibility is one of them; limited opportunities for career progression another. But low wages are part of this picture. Adding to the almost unbearable strain of working under COVID conditions, I am really genuinely concerned that we will see a haemorrhage of these nurses and other skilled professionals out of our NHS to agency work, or out of health and care altogether, precipitated by unbearable working conditions and just ended up by this gross insult of a pay offer. That leaves me with real concern about the long-term sustainability of services. We know that we need to provide more services close to people's homes, but, if we don't have the professionals, how can we keep hospitals like Prince Philip Hospital in Llanelli or Withybush Hospital in Pembrokeshire going and providing the excellent services that they do?

So, what is the Welsh Government response to this? Well, the bonus—very welcome, but none of the health and care staff that I've spoken to in the region I represent want just an occasional pat on the back. What they want and need is a fair day's pay for a fair day's work, week in, week out. And the Government's response to our motion? Well, it's the usual, 'delete almost everything, and everything we're doing is fine'. Well, it's not fine. To me, Llywydd, this is yet another example of why devolution may be better than nothing, but why it isn't enough. I firmly believe that the majority of Welsh people want to see our health and care staff properly and consistently rewarded.

But our health and care workers, despite health and care being devolved, are still subject to and distressed by the insulting rhetoric of a Conservative Government that we didn't vote for. And even if the Welsh Government wants to provide a more generous pay settlement, they may struggle to afford to do so. Angela Burns is right to say, of course, that this is a devolved matter, but there are questions of resource. Our health and care staff and those who use their services—all of us, Llywydd—deserve better. Sooner rather than later, we need to be an independent nation with a Government that can really and completely reflect our values and our priorities—decisions that affect us made by us. 

In the meantime, we must do all we can, including paying a minimum of £10 an hour to all care workers. After May, a Plaid Cymru Government will do just that. I commend the motion, unamended, to the Senedd.

I call on the Minister for Health and Social Services to contribute to the debate—Vaughan Gething.

Thank you, Llywydd, and I move the Welsh Government amendment in the name of Rebecca Evans. I'd like to thank Plaid Cymru for choosing this topic for a brief debate today, as it allows me to reiterate the clear view of the Welsh Government on NHS pay, and the direct contrast between ourselves and the UK Conservative Government.

As many of you have said, we regularly say how much we value our NHS staff for their dedication and their compassion, especially in the face of this terrible, unforgiving virus. The last year has been relentless. The pandemic continues to have a significant impact on patients and staff. I recognise the incredible physical and emotional demands faced by our workforce as a result. They have put themselves in harm's way to keep all of us safe. We painted rainbows, we gave thanks and we clapped in the streets. And the response from the UK Conservative Government to recognise that extraordinary service is an attempt to limit the NHS pay rise to 1 per cent. It beggars belief. The UK Conservative Government can find taxpayers' money to spray over private consultants on test and trace in England; the unanswered questions on PPE and the VIP lane; a team of photographers for the Prime Minister; and the new media briefing room we've already heard about today. Yet, when it comes to the NHS, the coffers are bare. Nobody should underestimate the sense of anger and betrayal from our NHS staff. It is a kick in the teeth from the Tories. I understand the strength of feeling from staff and their trade union representatives. I met trade unions, as I regularly do, on the Friday after the UK Government's announcement, and I heard first hand their unified dismay, hurt and disappointment.

I have been very clear since that Tory announcement that this Welsh Labour-led Government has not set an arbitrary cap on NHS pay. I wrote to the NHS pay review bodies on 11 March to confirm that we have not set a cap on NHS pay. We want independent advice from pay review bodies on a fair and affordable uplift for NHS workers here in Wales, in line with the remit that I set in January. The pay review bodies are due to report in May, and NHS staff and the public will have to decide if they want to endorse Tory contempt for our NHS at the ballot box. The contrast with Welsh Labour priorities and action could not be clearer. And the bonus payments announced today are in addition to, not instead of, a fair pay award. I was proud to confirm this payment today after weeks of work with our stakeholders, and it is plainly laughable to suggest that the bonus was somehow a last-minute response to this motion.

I'm equally proud that NHS Wales is a living-wage employer, and Dawn Bowden outlined her role as a trade union officer in negotiating that with a Welsh Labour-led Government, and I have recently decided to implement the new real living wage rate of £9.50 an hour for our NHS staff from 1 April. Welsh Government funding to achieve this is an interim measure whilst we wait on the new pay review body recommendations. We have a long-established commitment to the real living wage as the minimum rate of pay for our social care workforce. Yesterday, I set out our work on paying for care and our priority for raising the pay of social care staff. We're committed to bringing about long-term improvements to the sector that includes pay progression and that goes beyond this minimum.

Social care is complex, with over 1,000 employers and services across the private, third and public sector. Introducing long-term improvements means that we do need to work in partnership, and that's why we established the social care fair work forum. Pay is a key consideration for social care, but so too are good contractual arrangements, terms and conditions, in creating a stable sector where people feel valued. We don't want improved pay to be introduced that is then offset by poorer terms and conditions. The majority of care and support is commissioned, and the current arrangements tend to result in low, minimum wages for our front-line workforce. That's why we propose a new approach in our 'Rebalancing care and support' White Paper. And in that we set out how a new national framework will ensure that quality and value, rather than price, should become the key determinants of success in a market of care provision.

I ask Members to support the Government amendment today and to send a clear message of how much we value our staff, and a clear message to the Conservative Party as well.

Rhun ap Iorwerth to reply to the debate. Rhun ap Iorwerth.

Thank you very much, Llywydd. I thank the Minister for his response to this debate and everyone who's participated—to Dai and Helen for reinforcing what's contained within this motion before us today. I'd like to thank Members of all parties and of the Government who have declared, as a matter of principle, how important it is that we reward our staff properly and pay them properly within health and care. But it's what we do that's ultimately important, rather than what we say. I welcome the words of the Conservative spokesperson, again, supporting fair wages. But I also agree with Dawn Bowden on the disgraceful track record of the Conservatives in Westminster in terms of health and care staff pay and conditions, and offering that derisory 1 per cent for staff in England is the background for the motion that we're discussing this afternoon.

Whilst referring to comments by Angela Burns, you also managed to turn this into an issue of constitution and independence, stating that we were seeking independence for Wales but weren't willing to take fiscal responsibility. If I could correct you and say that we are literally asking for fiscal responsibility by insisting on independence for Wales, so that we can put health and care and all the other crucial public services in Wales on more robust foundations.

As we say, it's what we do that's important here, and of course an act such as providing a bonus for health and care staff is something that the Government can do as a one-off, and it certainly will be appreciated by staff that are tired across health and social care. But as the RCN said this afternoon:

'Let’s be clear: a one-off COVID-19 bonus is not the significant and substantive pay rise that we have been calling for for our nursing staff. What we want from the Welsh Government is a commitment to ensuring fair pay for nursing, fair pay that addresses the 1,600+ vacancies in Wales, fair pay that encourages nurses to stay in the profession and fair pay that ensures the delivery of excellent patient care.'

That's what we want to deliver within health and care in Wales, and we want to ensure that our care staff are rewarded for their work. The Government's amendment withdraws that from this motion this afternoon. The Government says that it wants to pay a real living wage, but removes from our motion what we want to do in Government, in providing a minimum of £10 per hour for care staff. So, Labour Members, don't vote for your own amendment this afternoon. After all, in welcoming statements of principle from Members of all parties in the Senedd this afternoon on pushing for better pay and conditions for health and care staff, I invite you to support a motion that insists on that. So, I invite you once again to support this motion today.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] There are objections, and therefore we will defer voting on this item until voting time.

Voting deferred until voting time.

And that brings us to voting time, but we'll take a short break before we move to the votes to prepare the technology. A short break.

Plenary was suspended at 17:01.

The Senedd reconvened at 17:06, with the Llywydd in the Chair.