The following amendments have been selected: amendment 1 in the name of Darren Millar, and amendment 2 in the name of Lesley Griffiths. If amendment 1 is agreed, amendment 2 will be deselected.

The next item is the Plaid Cymru debate on healthcare workers' pay. I call on Rhun ap Iorwerth to move the motion.

Motion NDM7791 Siân Gwenllian

To propose that the Senedd:

1. Supports Unite, Unison and the Royal College of Nursing’s efforts to achieve fair pay for all healthcare workers.

2. Calls on the Welsh Government, in its current discussions with the healthcare unions, to commit to a real terms pay rise above that proposed by the NHS pay review body.

Motion moved.

Diolch yn fawr iawn, Dirprwy Lywydd. We've thanked them; we've clapped for them; we've come to appreciate them perhaps more than ever over the past 18 months. But after sacrificing so much, our NHS health and care workers across Wales deserve now to be properly and fairly rewarded through their pay. The least we think Welsh Government could do is stand alongside healthcare workers in Wales and commit to a rise above that proposed by the NHS pay review body, which, of course, doesn't even keep up with inflation. That’s why we’re holding this debate today.

Experiences of the pandemic, of course, only reinforced what was already known about the NHS and the health and care workforce—one that was suffering from staff shortages and low morale, which operated in an environment deprived of investment and resources. Now add to that a real-terms pay cut, it’s no wonder so many health and care workers have voted through their unions and representative bodies to express their anger at what they have been given.

Since when is the Welsh Government in the business of matching what we have seen from UK Government, which of course, first of all, offered up that derisory 1 per cent only to then increase to 3 per cent? We do not believe that Welsh Government should be merely matching that. 'Money doesn’t grow on trees', said the First Minister. Of course he’s right, but a failure, I think, to invest in, to support, to attract and to retain staff—the best staff, who we need—within health and care risks taking a big swinging axe to any hope of growth, of morale within health and care and of nurturing the staff that we should be treasuring.

In a recent survey, members of the Welsh NHS Confederation identified recruitment and retention of the workforce as one of the main challenges facing the NHS in Wales. To ensure NHS careers remain an attractive proposition, to keep the workforce wanting to provide care within the NHS, and being able to afford to, the workforce need to know that they are appreciated, and fair pay is at the heart of that.

During the pandemic, the nursing workforce in Wales provided clinically complex care day in, day out—leadership shown; compassionate support shown for colleagues, for patients and their families. It’s always been the case though that healthcare workers provide that level of care and dedication 24/7, 365 days a year. But we can’t just take that for granted. We need to recognise that Wales has a chronic workforce shortage. It’s failing to attract sufficient individuals into the healthcare professions; failing to encourage healthcare staff to stay. The Welsh Government has to tackle these existing workforce shortages and ensure that the healthcare professions are an attractive career option—well-paid and meaningfully supported. Fair pay is at the heart of that.

The Royal College of Nursing in Wales have, of course, led the charge to ensure that nurses in Wales get a salary that recognises their contribution to society, not just to the NHS. Throughout the pandemic, we have all witnessed the most impressive—deeply impressive—demonstration of nursing, seeing it as the highly skilled profession it is, deserving of fair pay and we owe so much to the nursing profession, as we do to other workers right across the health and care system. But now, they feel unappreciated, and who can blame them?

Unions and representative bodies have held pay consultations. A pay consultation by Unison Cymru found that 87 per cent of healthcare workers voted to oppose the offer; Unite Wales's NHS members have voted to reject their 3 per cent pay increase; 93.9 per cent of RCN Wales members who voted said that they think that the pay award is unacceptable, with only 6.1 per cent saying that it is acceptable. The RCN has decided this afternoon to move to an indicative ballot on industrial action in England, with a decision for Wales expected to be announced soon.

We hear that the Government is in talks with the unions, and I hope that the unions are successful in those discussions for the sake of the workers, for the sake of their members. And perhaps the Minister can confirm today that those talks do include a substantive pay increase—that the possibility of a substantive pay increase is on the table. There's been huge frustration in the RCN and its members at suggestions that they have somehow been pulling out of discussions with Government; it's the Government that's been saying, 'You will not discuss a substantive pay increase across the board'. I understand that a meeting is to take place perhaps as early as tomorrow, and again, perhaps the Minister can confirm that a substantive pay increase is on the table.

Other measures considered when looking at pay and conditions, measures such as increased annual leave and holiday pay are, of course, welcome, but surely the Government can accept that, at the end of the day, to really show gratitude and appreciation and recognition of the work done by our health and care workers, that has to include now a real-terms pay increase. It is time to reward our health and care workers with a new fair pay deal.

I have selected the two amendments to the motion. If amendment 1 is agreed, amendment 2 will be de-selected. I call on Russell George to move amendment 1, tabled in the name of Darren Millar.

Amendment 1—Darren Millar

Delete all and replace with:

To propose that the Senedd:

1. Recognises the dedication and sacrifice of all staff in the health and social care workforce in Wales.

2. Welcomes the historic levels of funding by Her Majesty’s Government to all regions and nations of the UK, including Wales, in successive budgets and in the fight against COVID-19.

3. Notes the recommendations from the independent NHS pay review body in Wales and the Welsh Government’s decision to award NHS staff a 3 per cent pay rise.

4. Calls on the Welsh Government to urgently tackle working conditions such as mental health support, retention, upskilling and filling staffing gaps within the NHS, to ensure we have a workforce fit for the future.

Amendment 1 moved.

Diolch, Deputy Presiding Officer. Can I firstly thank Plaid Cymru for bringing forward this debate today and also add my own thanks to healthcare workers who have kept Wales safe and fought, I think, so hard during the course of the pandemic in the fight against coronavirus?

I move amendment 1, Deputy Presiding Officer, in the name of my colleague Darren Millar, and I firmly believe, as all Welsh Conservatives do here in the Senedd, that the Welsh Government should specifically recognise the dedication of all staff in the health and social care workforce in Wales. We wouldn't be in this position today if it wasn't for the huge efforts given by our healthcare workers. I think there'll be no doubt across this Chamber, Deputy Presiding Officer, that the NHS has been under immense pressure over the last 18 months to two years, and I think it's pleasing that the UK Government has provided, of course, that additional funding during that time, including £8.6 billion to fight coronavirus, the £2 billion for the 2021-22 financial year, and, of course, the £1.9 billion of additional funding that the Welsh Government can then spend on the NHS over the course of the next three years.

I think, from my perspective, what I would like to say in this contribution is that looking after our healthcare workers isn't just about pay. That's an important element, but I also think it’s important that the Welsh Government tackles working conditions; mental health support—this follows, of course, the previous debate led by us as Welsh Conservatives; retention; and upskilling of staffing gaps within the NHS to ensure that the workforce is fit for the future. I think what we should be doing is looking to support the pressure, taking the pressure off our healthcare workers by making sure that adequate staffing is provided. This is one of the reasons why I’ve put forward an NHS covenant Wales Bill in the recent Members’ ballot. This Bill would guarantee the NHS remains in public hands, free at the point of use, and it would guarantee NHS staff always receive the pay recommended by the independent NHS pay review body. And not only this, it would strive to, of course, improve staff well-being with more flexible working hours, increased holiday, greater access to childcare and mental health support. These are concrete plans for a duty to support NHS staff during their careers.

My colleagues and I have said that front-line workers should be treated differently within the pay award. We have previously argued that the Welsh Government must provide pay commitments to the nursing profession, which is separate from other NHS staff, and it should also be the role of the Welsh Government to talk to unions and the independent pay review body to discuss these possibilities. Diolch, Deputy Presiding Officer.

I call on the Minister for Health and Social Services, Eluned Morgan, to formally move amendment 2 tabled in the name of Lesley Griffiths.

Amendment 2—Lesley Griffiths

Delete point 2 and replace with:

Calls on the Welsh Government to continue to engage with NHS Wales trade unions including on NHS pay.

Amendment 2 moved.

Formally.

Diolch. Hefin David.

I recall the statement during the debate on the social partnership Bill that Joel James made, and it was quite a strong statement. The words he used, I’ve got them on the screen here:

‘this Government is chiefly concerned with looking after their trade union paymasters.'

And, 'Surely the Deputy Minister can see that there is a clear issue in how trade unions will now have undue influence over policy'.

Those are words used by a Member of the Conservative benches, and at the time I had grave concerns about what was said, and there was a lot of concerns raised in this Chamber about that. But we need to remember the trade unions are the most effective representation of the workforce that has been seen in this country. I’ve had conversations with my own trade union, Unison, about this issue, and I’m very glad to have had that conversation, particularly as chair of the Unison Senedd Members group, and I enable links between Senedd Members and Unison to have those discussions.

If there is a criticism of the Government on this, and I feel there is a criticism, it's that the trade unions—. I’ve said this to the Minister myself privately, that I feel that the trade unions could have been involved more comprehensively and more deeply earlier on in this process. I think that is an issue that I would hope the Minister would recognise. And I know that there’s a system, an independent body that recommends NHS pay that is set up for that purpose, but nonetheless, we are nothing if we do not listen to the workforce, and the body that achieves that are those trade unions. So, I do feel that I’d like the Minister to respond on that issue.

But nonetheless, yesterday in the response to the leader of Plaid Cymru, the First Minister made clear that there is a limited pot of funding and many demands on it, and that is exactly why the Welsh Government is looking to introduce constitutional reform and see this concept of radical federalism that would free up the Welsh Government to do exactly as Rhun ap Iorwerth has said in his speech. One of the things that I would like to see, for example, is a Holtham levy, but we must have a different distribution of powers across this United Kingdom if that Holtham levy was to be levied for social care.

Councillor Carol Andrews is a Labour councillor in Bargoed, but also a nurse at Ysbyty Ystrad Fawr. She has raised with me the heroic efforts that she and other nurses are making there, particularly through COVID. Her daughter, Megan, has just graduated with a first-class honours degree in nursing, and will be a fantastic nurse in the future.

NHS workers do deserve a better pay deal, and I’m glad to hear that that discussion is ongoing with Welsh Government. And Unison, rather than meet with the leader of Plaid Cymru, I’d say to Unison they were right instead to meet with the Welsh Government, and continue those discussions, because my concern is when negotiations are held with opposition parties, and those points are then made to score party political points in First Minister’s questions, it detracts entirely from the seriousness of this issue. What needs to be done, as the Minister is doing, is for that constructive conversation to continue. And I know that that is what's happening with responsible unions, like mine, Unison, and we look forward to hearing the result and the outcome of that. We know that there's a potential for industrial action; I urge the Minister and the unions to work together to do all they can to avoid that.

Perhaps I should begin by declaring an interest: my wife was a nurse throughout her life until she had to retire recently, and many of the nurses who worked with her continue to be close friends to us as a family. And, as a result of that, I have seen, I have been an eyewitness to, the impact of the pandemic on them as nurses over the past 18 months. On a personal level, I've seen the strain that they've suffered, the challenges that they've had to face, and the fatigue that they are now feeling. And the things that I have seen have been confirmed by the recent survey by the RCN, which demonstrates that 38 per cent of nurses are considering leaving the profession because of difficult working conditions and huge work pressures, with 58 per cent of them believing that an entirely insufficient wage is the root of their discontent.

The failure to retain and recruit staff, as we've already heard, and the fact that so many are away from their posts because of illness, has exacerbated the situation, which means that there is now a crisis in the health and care field. And there's no doubt in my mind that giving a pay increase greater than the 3 per cent recommended would be a way of retaining experienced staff and would demonstrate that they are respected, and would attract younger people into the profession.

As has already been said, the proposal of a 3 per cent wage increase means a real-terms cut in their wages, on top of the 1.25 per cent increase in national insurance contributions, as well as the significant increase in living costs.

Dirprwy Lywydd, I spoke last night to a senior nursing sister, who has given nearly 40 years of her life to the NHS. She told me very movingly that never during her long career has she felt so low, so burnt out and so undervalued. She was telling me how, during the early days of the pandemic as a community nurse, she and her colleagues visited patients without adequate personal protective equipment, not knowing whether those patients who had often been discharged from hospitals had COVID, and how they felt terribly vulnerable. And yet, through all of this, they carried on and never flinched in their obligations to the patients in their care. These brave health workers put their own lives at risk in order to save the lives of others and worked long, tiring hours, over and above what was expected from them, to look after those who utterly depended on them. And what we saw across the country were countless examples of selfless sacrifice, and, in circumstances worse than we've ever seen since the second world war, our health workers showed a stoicism and conviction that was as unstinting as it was inspiring.

Will the Member conclude now, please?

I'm coming to the end.

And when we clapped, as we heard earlier on, they were given hope that, at last, Governments would give them a decent wage in recognition of the challenging tasks they carry out day in, day out. But, unfortunately, that has turned into dismay. For them, the thunderous clapping on our doorsteps has become a distant echo as despair and disillusionment has returned in heaps, because the clapping never paid for bills and their mortgage and food on the table.

So—and I finish with this—things don't have to be this way. One decision by the Government to give that wage that they deserve would change the situation entirely and would give them their dues. Thank you very much.

Well, I would've had four and a half minutes if I'd known I'd be allowed it.

[Inaudible.]—Members to respect the Chair. Altaf Hussain.

Thank you very much. I've worked all my life with nurses, and it is right that we recognise the contribution of all our healthcare workers across the NHS and social care. We know that the past 18 months have been the most challenging. Like so many others in our public services, those on the front line of care have witnessed the human tragedy of the pandemic. The NHS pay review body report, published in July, is an exceptionally detailed report relying on a significant body of evidence, submissions and analysis. The document contains a range of points made by Welsh Ministers, and noted that a decision as to whether or not any additional money required would come from existing budgets in due course. 

We all recognise that Welsh Ministers now adding any further uplift in staff pay would need to find that money from existing budgets, and, in their evidence to the review, the Welsh Government said that, the higher the pay award, the more difficult the choices would be on how to find it and other priority ambitions for the Welsh NHS. I am pleased that the UK Conservative Government has not only provided £8.6 billion to Wales in the effort to fight coronavirus, on top of more than £2.1 billion for the 2021-22 financial year, but has announced it will also be investing an extra £1.9 billion into the Welsh NHS over the next three years. In my view, if the Welsh Government wants to pay for further increases, then it can hardly say that it is short of money. I acknowledge how difficult this is for many staff who believe that their contribution should be rewarded.

Deputy Presiding Officer, I feel the same for our social care staff too. In the pandemic, the media and the political narrative largely overlooked the work of those caring for many older people whose lives were coming to an end because of COVID-19, experiencing the trauma in the residential and nursing home sector, where residents were dying at a faster rate, and where those staff members became surrogate family members in those final hours, comforting them at the end. The pandemic exposed how poorly we have recognised the contribution of our social care staff. We must put this right. And whilst I welcome the proposals to address pay as a part of new commissioning arrangements for the social care services, we need to be robust in driving more money towards supporting this crucial part of our health and care sector. Thank you very much.

Already, in this Senedd, we have discussed the principle of UBI and the importance of giving dignity to people by giving them an income that they can live on. It was the Labour Government, of course, that introduced the minimum wage in order to give some level of dignity and assurance to the workforce. That fundamental principle of a fair wage for the work that you do, giving people dignity, is way gone. But, here we are, again, in 2021, having to argue for giving fair salaries to workers that reflects their work, their commitment and their ability, and, indeed, a salary that will attract people to a career in care.

Over a half of the NHS workforce are the main wage earners in their households. Tens of thousands of households in Wales are reliant on nurses' wages in order to live, to keep a roof over their heads and food on the table. More shockingly still, one in five of the workforce has to have other employment in addition to working for the NHS. Isn't this alone enough to show the importance of wage levels in the NHS, and that the current salaries aren't sufficient for many people?

According to thorough research by the Royal Society for Arts, Manufactures and Commerce, almost 60 per cent of the NHS workforce can't strike a good work-life balance, because they work more hours than they are paid for, and often work unsociable hours. Indeed, three quarters of the nursing workforce say that they work overtime, leading to an increase in levels of stress and mental health problems, as well as other problems. This, in turn, is costly to the health service. An FOI request to the north Wales health board prior to the pandemic showed that 77,000 staff days had been lost as a result of stress, which amounted to £5.5 million lost to the service. It's no surprise, therefore, that a high level of people are leaving the NHS workforce. The money's there, but it's being put in the wrong places, and this, in turn, leads to a reliance on agency nurses and far higher costs for the health service—tens of millions of pounds per annum, and that's increasing annually.

A fortnight ago, there was a debate here on the ambulance service, and everyone was agreed that the shortage of beds in hospitals was a core part of the problem. In order to resolve that, of course, we need more nurses, and it is well known now, for a decade and more, that there is a shortage in nursing staff. The work of Anne Marie Rafferty shows that, irrefutably, a shortage of nurses leads to an increase in mortality rates among patients. A shortage of nurses leads to more accidents, mistakes and an increase in infections. Do we truly expect to meet the nursing needs without giving nurses a fair wage? And who are the people suffering most from this economic uncertainty?

The Member will have to come to a conclusion, please.

I am coming to a close. It's women and people from black, Asian and minority ethnic communities that make up the most of the nursing workforce, and this is the same cohort of people that is at the bottom of every league in terms of equality and fairness, and these are the people who are suffering because of this policy of not paying them properly. These are the people who support our health service, and without them the service would collapse. We must show our thanks not by clapping, but by giving them a fair salary for their work. Thank you, Dirprwy Lywydd.

Can I remind Members that when we have a 30-minute debate, it is three-minute contributions? And particularly when your party produces that debate for 30 minutes, please keep to that so that everyone has an opportunity to speak.

I call on the Minister for Health and Social Services, Eluned Morgan.

Diolch yn fawr, Dirprwy Lywydd. I'd like to thank Plaid Cymru for choosing this topic for debate today, because it allows me to reiterate the view of the Welsh Government on this important topic. Now, the last 18 months have been relentless. The pandemic continues to have a significant impact on patients and staff, and I would today like to pay tribute and ask Members to recognise the incredible physical and emotional demands faced by our workforce as a result of trying to keep us all safe.

Now, in order to determine increases in pay, an independent pay review process was established. Governments, trade unions and employers submit evidence to the pay review body for them to consider before making their recommendations. The Welsh Government truly values their independence, which was made clear this year after the UK Tory Government, in submitting their evidence, imposed an arbitrary cap of 1 per cent on what they said they would pay NHS workers. The pay review body made their independent assessment and recommended a 3 per cent uplift for this year. The pay review body recommendation of 3 per cent was met here in Wales from existing health department Welsh Government funding. No additional consequential or money was given from the Tory UK Government to fund NHS pay.

I fully support the need for fair and affordable pay for NHS workers, but, unfortunately, I'm unable to do this without additional funding from the Tory UK Government, because to increase the basic rate of pay—

Will you take an intervention?

I will.

Thank you, I'm very grateful for that. Do you acknowledge that, as a result of the current settlement with the UK Government, Wales receives around £1.20 for every £1 for the devolved health service? That gives you the capacity, if you wanted to, to give another 20 per cent on top of what you're currently paying members of staff. Do you accept—[Interruption.] Do you accept that that is the—[Interruption.] Do you accept—[Interruption.] I can hear the heckling. I can see the First Minister smiling. He's the guy that struck the deal with the Treasury in order to get that compensation. That is the case, they are the facts, do you accept that you do have more resources than the UK Government to pay your staff?

I absolutely don't. What I do know is that people in the NHS who have been working hard throughout this pandemic deserve their 3 per cent pay award and it should have come from the UK Government. Instead, what we've had to do is to find that money from within the budgets we had here already. That effectively means that we've had to cut other areas because we wanted to make sure that we rewarded these people who have been working so hard throughout this pandemic. And I'll tell you how much it would cost. For us to find 1 per cent, it'll cost us £50 million a year. To go further than 3 per cent is going to be incredibly difficult. And unfortunately, unlike Plaid Cymru, we don't have a magic money tree to address that issue, and it would be very interesting to hear from Plaid Cymru exactly what they would cut in order to find that additional funding that they say they would pay, because it's got to come from the NHS budget. So, what would you cut? You have to be serious about politics. You are not serious. It's about the language of priorities. That's what Aneurin Bevan talked about. We know about that. We make those tough decisions, you never do. Tell us what you would cut instead. You are not doing that. 

I understand, definitely, the strength of feeling from staff and their trade unions. We continue to meet regularly with trade union representatives from the majority of NHS unions. And yes, I'll be meeting them again tomorrow. And they, and we, agree that despite these really difficult circumstances, our social partnership approach provides the best possible mechanism for finding the best possible solution. And they continue to push really hard on behalf of their members for additional benefits and enhancements to supplement the 3 per cent pay offer for our hard-working and committed NHS staff.

And whilst I am committed to fair pay for NHS Wales, social care workers have also provided a significant contribution to keeping us safe during the pandemic, and we're desperate to recruit more people to this valuable service, which will take the pressure off NHS staff. And unlike NHS Wales staff, many social care workers are paid below the real living wage, and their pay must also be a priority.

I won't take any lessons from the Tories on this subject. They have not given us the additional funding that we should have had. The talks continue. They're tough, they're robust, and we'll continue to work with our partners to reach a fair outcome for all. And of course, we all want to avoid an industrial dispute. NHS workers absolutely deserve to be recognised for their work at this most challenging time, and we'll do our very best to meet their aspirations within the means that are available to us.

I call on Rhun ap Iorwerth to reply to the debate. 

Thanks for all your contributions, starting with Russell George starting in a measured way, paying tribute to our health workers. But the issue here is this isn't about showing commitment, warm words towards the workforce; this is about paying them properly. And I will stand shoulder by shoulder with the health Minister in criticising UK Government for its actions in terms of its unwillingness to invest in public services through the Welsh settlement. And frankly a schoolboy contribution from Darren Millar in suggesting that, somehow, additional money coming to Wales through the Barnett formula was available to spend. Has he not heard of needs—needs in Wales entrenched by the actions of his Conservative Government?

Will you take an intervention?

Of course. 

Thank you. It's been acknowledged by the Welsh Government that not every part of the £1.20 for every £1 that comes is actually spent on the health service. The health service does not receive in Wales the £1.20 for every £1 that is spent, therefore there is capacity within the Welsh Government's budget to invest in our NHS and to reward, if the Welsh Government was so minded, the NHS staff differently.

But your argument is to knock Wales and it's to knock devolution, so we cannot take it seriously in this context.

The Minister told us that Plaid Cymru should be prioritising. The privilege of being in Government is being able to budget to prioritise, is it not? And surely now, investing in our most prized asset, our workforce in health and care, has to be a real priority. The Minister invited us all to pay tribute to health and care workers; this is about a fair pay tribute. And thanks to our workforce for their work, but now they need a fair pay deal.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Yes. Therefore I will defer voting on the motion until voting time. 

Voting deferred until voting time.