The next item is a statement by the Minister for Health and Social Services, an update on meeting with the NHS trade unions, and I call on the Minister to make the statement—Eluned Morgan. 

Diolch yn fawr, Llywydd. I'd like to take this opportunity to update Members following my meeting on 12 January with the NHS trade unions. I wrote to the unions on 6 January in advance of the meeting, inviting them to discuss a package of measures aiming to find a way to offer some additional reward to the workforce so they felt able to call off their industrial action. I suggested that the discussion could include a potential package including: on pay, a non-consolidated award funded through this year’s Welsh Government budget; ways in which we can move forward on the issues highlighted in the staff welfare project and reducing agency spend; and ways in which we can work together to restore confidence in the pay review body process.

Hard choices have been required to find the money for the proposed one-off cash payment. We will have to draw on our reserves and reorder spend from across Government if trade unions want to take up this opportunity. If we use this money now to increase pay, it means we can’t use it for other purposes, but we are confident that this is the right thing to do and would put more money into the pockets of NHS workers this winter, many of whom are struggling with the cost-of-living crisis.

The autumn statement was a missed opportunity for the UK Government to give hard-working public sector workers a pay rise in 2022-23, and to prevent widespread disruptive industrial action across the United Kingdom. The 2022-23 'Agenda for Change' pay award, which has been implemented, provided a 7.5 per cent pay rise on average for the lowest-paid staff—those on bands 1 to 4—which make up nearly half of the 'Agenda for Change' workforce. For staff at the top of bands 6 and 7, the award was equivalent to a 4 per cent pay rise. Unfortunately, our financial settlement falls far short of what is needed to provide the consolidated pay awards that the unions have been campaigning for on behalf of their members. So, we're not in a position to increase the consolidated pay award already given.

Last week’s meeting was attended by representatives of the Royal College of Nursing, GMB, Unite, Unison, the British Association of Occupational Therapists, the Chartered Society of Physiotherapists, the Society of Radiographers, the Royal College of Midwives and the British Medical Association. I'd like to give thanks to those who attended the meeting. There was a great deal of recognition in that meeting of the position that we find ourselves in in Wales, and an acknowledgement that we are making efforts to end this dispute, unlike the approach being taken in England.

I was realistic in terms of my expectations for that meeting, and whilst the trade unions felt that a one off non-consolidated payment was not enough to stop industrial action, the trade unions agreed to go away, and, as a collective, consider next steps. Whilst I have heard back from the chair of the health trade unions this morning, we agreed, as a collective, to not give a running commentary on the discussions, and I will respect that agreement. I will continue to engage with trade unions.

Unlike the UK Government, we are not responding to the strikes by bringing forward new, draconian laws that would trample over the devolution settlement and restrict workers' rights further.

There are currently strikes planned in the Welsh NHS. The RCN and GMB—the Welsh ambulance service—have already taken industrial action, and the Royal College of Midwives and the Chartered Society of Physiotherapy have a mandate for strike action, but have not yet announced dates. Unite—the Welsh ambulance service—will be striking this week and next, on 19 and 23 January. The RCN have now also announced two additional days of strike action on 6 and 7 February. We are committed to working with our trade unions, with a view to ending this industrial action within the means available to us.

We recognise and respect the strength of feeling demonstrated by NHS staff members in these ballots, and through the industrial action taken, but we are committed to working in social partnership with unions to explore a way to resolve the current dispute over pay. I reminded the unions in the meeting that the clock is ticking on this matter. In order to get the money into NHS pay packets this financial year, we must come to an agreement by around the mid to the end of February. Diolch.

Can I thank you, Minister, for your statement this afternoon? You are in a very difficult position; that's something I would accept. And I appreciate how tough these negotiations are for you, Minister; it's not easy at all. And it is regrettable, as you will agree as well—and as the RCN will agree—it is regrettable that we've got a further announcement of strike action in February. 

You mention in your statement, Minister, ways in which we can work together to restore confidence in the pay review body process. So, can I ask you for your assessment of that? What is your assessment of the pay review body process, please?

You also mentioned payments—the one-off payments—and I appreciate that you said you worked across Government to look where you could find that additional funding. But that won't do anything, I would suggest, to stabilise the workforce, or attract people into the profession, which is a large part of the issues that we're talking about. Or do you think I'm wrong in making that assessment?

You said in your statement, Minister, this afternoon, that,

'Unlike the UK Government, we are not responding to the strikes by bringing forward new, draconian laws that would trample over the devolution settlement and restrict workers' rights further.'

Now, in your oral statement last week, you stated that the impact on capacity as a result of recent industrial action has placed additional pressures on our system. So, you must therefore agree with the International Labour Organization, which the TUC subscribes to, that minimum service levels are a proportionate way of balancing the right to strike with the need to maintain vital services, such as health services.

Minister, the other issue, of course, is taking the pressure off our Welsh NHS, and we've seen how successful surgical hubs are in England. Where they've been introduced, we've seen the two-year wait virtually being eliminated in England, yet, in Wales, we've still got tens of thousands of people waiting for over two years for treatment. Now, I think that, last week, you almost lost your temper with me, Minister, saying, 'Look, you keep banging on about surgical hubs; well, we've got them, they exist.' But the reason I'm asking is because that's your response yourself—you've been saying that for some months to me—'They exist, they exist.' But in freedom of information requests, in a written response to Andrew R.T. Davies at the end of November, just less than eight weeks ago, you responded to him,

'At present, there are no dedicated surgical hubs across Wales.'

So, this is why I keep raising this with you, Minister, because we do get different answers on that point.

And my final question to you, Minister, is, quite simply: do you think you will resolve the pay dispute any time soon?

The Deputy Presiding Officer (David Rees) took the Chair.

Thanks very much, Russell, and thanks for your understanding that this is a very tough negotiation and a very difficult time for all of those working in the NHS.

You asked about the confidence in the pay review body process. I think there are things that can change. I'm obviously very keen to hear what the NHS unions think in terms of what could be improved, but one thing that is very clear to me is that, when the pay review body took the temperature of inflation, they took it at the beginning of the year. And that was at a time when inflation was at about 6 per cent or so, and it was just after the war started in Ukraine, so we hadn't seen the impact that early in the year. So, I think there is a really good case to be made for making sure that you can somehow perhaps have some kind of mechanism whereby if it goes above a certain thing, you can revisit. So, I think there is room for us to think around some very practical issues like that.

In terms of stabilising the workforce, you'll be aware that more people work in the NHS today than have ever worked before. We are still recruiting and, tomorrow, I will be issuing a statement in terms of how Health Education and Improvement Wales will be training the future workforce, in terms of what they have planned in the next years.

In terms of the minimum service levels, I think we've got to be absolutely clear what we're talking about here. The people who go into the NHS are not irresponsible people; they are people who are committed to public service, and they are the ones who help to determine what the derogations are. So, you won't see people, irrespective of what's going on in the strikes, walking out of the ITU service, or those areas that are absolutely critical for care. So, effectively, those derogations are the minimum levels of service. But I think it's absolutely right to make sure that people understand that the right to strike is something that has been hard fought for, and something that we as a Labour Party certainly sign up to.

In terms of surgical hubs, I think there is a bit of confusion around this, because the definitions are slightly different. So, you could argue, for example, that Abergele, which is a ring-fenced place, where it's not knocked out by what happens in relation to A&E, is a surgical hub. We haven't labelled it as such, but that, effectively, is what it is. We now have the Vanguard centre in Cardiff, which is a new centre, and is definitely ring-fenced and won't be knocked out by A&E. So, that's my definition of what a surgical hub is. I'm not quite sure what yours is, but that's mine—is it going to be knocked out by things just flowing through the doors, and will it knock out the planned care? And obviously, there's a new facility in Llanelli, which is really up and running, and only just opened. So, we are doing things, and we've got, again, a ring-fenced facility that won't be knocked out by the urgent care that comes through the door.

I think you've got to be really careful here as well, though, Russell, just to understand that it is so much easier if you live in a big city to have two hospitals, where one is A&E and the other one you can have as separate, then it doesn't get knocked out by what comes through the front door. We're already doing that. In Cardiff, we can do it. You've got the Heath, but then you've got Llandough, where they can just get on with things. In Swansea, they've effectively got three hospitals and now they're starting to say, 'Look, I'll tell you what, most of the orthopaedic we'll put into Neath, so we'll keep it away.' There are always going to be complex cases where you're going to need—. For example, if you've got somebody who needs a hip operation, but they've also got a heart problem, you can't do that in a ring-fenced hub because you need somebody who's an expert in hearts quite near. So, the complex cases are always going to have to be in the big hospitals. The problem we have in Wales is that we've got lots—it's not a problem, it's a good thing—we've got lots and lots of hospitals, but because of the geography of the area you can't have more than one. So, if you want more planned care centres, we would have to switch off some of the A&E. That's very difficult when you live in such a spread-out area. In England, because populations tend to live in big cities and big urban centres, it's much easier for them to whip through things with those separations. That is much more difficult in Wales.

I'll begin in a constructive way with those areas where I agree with the Minister. On non-pay issues, I'm pleased that there's serious focus on staff welfare and that reducing agency costs is a part of what Government sees as the way forward, although I couldn't quite get the First Minister's attitude today, when he seemed to be defending the structures through which agency working currently happens. What we're saying is take the private profit out of it, so that that money can be fed back into the health service. I also very much agree with the Minister in condemning the actions of the UK Government regarding the legislation that's been brought in to limit the right to strike.

But, as much as I agree also with Welsh Government's opinions about the level of public spending from UK Government—we need to see that level increase—Welsh Government cannot hide away from its own responsibilities to resolve the problem that we face currently, which is that we have thousands upon thousands of public workers in the health sector, and elsewhere too now, that are taking industrial action because they feel that they have no other option. They gave opportunities to resolve this sooner.

In terms of the offer of a one-off, non-consolidated payment, it's clear that's not going to be accepted by the unions. The GMB are making it clear that their members would not accept a one-off payment, the RCN are also saying that it's not good enough. In real terms, cuts have been consolidated, real-term cuts in pay have been consolidated and reinforced for a decade and more, and we've got to break that cycle. You know what? This isn't happening at a very good time. Government finances are tight. But the truth is that the finances of our health workers are tight too, and they've been getting tighter and tighter. There was an opportunity in recent years to break that cycle when there was a little bit more flexibility in the system.

A few weeks ago, before Christmas, we were told there was no flexibility at all, no reserves, no unallocated money. We know that's not true, and now we have an admission that there is an offer that can be made. But that offer has to be increased. That is the bottom line. We, as a party, have spelt out how we believe it can be increased, and increased to a point where we believe a deal, hopefully, can be struck. There's a feeling that I'm getting very clearly from the unions that Government isn't negotiating seriously enough. The Minister said today:

'we are making efforts to end this dispute, unlike the approach being taken in England.'

We were here for weeks and weeks, asking Welsh Government to negotiate and they were refusing to negotiate with the unions. Whilst in Scotland, again, strike action has been paused—it was paused initially, put back on the agenda, and now it's been paused again. And here, the Welsh Government was refusing to even negotiate, whilst we were seeing health workers out on the picket lines. We've spelt out how we believe it can be done, but the bottom line is it simply has to be done, and there is a way.

Thanks very much. First of all, on the issue of agency workers, I think it's really important we put this into a context. So, 65 per cent of what we spend in the NHS is spent directly on staffing, and, of that, about 6 per cent is spent on agency workers. That's too much, and we need to bring it down. But what was clear to me—. I spent a bit of time in Withybush hospital on the weekend. Friday night, I was in Withybush with nurses, looking at what they're doing, and it was really interesting, because 50 per cent of the nurses on duty there—50 per cent—were agency nurses. So, we can take that away, but you'd have to shut the hospital; let's be absolutely clear. The interesting thing for me was that actually most of those agency workers had come from outside of Wales. So we're not talking generally about people who are NHS workers in Wales who go to an expensive agency; these were people who were coming in. I think it's really important that people understand that this is not something that is easy, because I'm not in the business of shutting hospitals, and if we try and go too quickly on this, that's going to be the consequence. I can't be doing that. 

This is a time when we've got 7 per cent of NHS workers off sick, so we have to backfill that. These are not things that you can plan in advance. We didn't know we were going to have flu and COVID and everything else. We can plan to an extent, but actually there's just not enough people who are on bank to fill those spaces. [Interruption.] We have got an agency; it's called the bank. That's what it's called. You need to go and look at how the actual system works. We have banks. So we do use people from banks, but there's not enough of them. And don't talk to me about hiding from our responsibilities. We know that we have choices, and we have made choices.

I'm going to ask you to write these figures down, because it's really important that you understand how difficult it is to get to the amounts of money that you would want to put on the table to get to a consolidated—. Don't forget, this is not a one-off payment. This is not money that you can find this year—. But if you want to increase the pay of NHS workers by 1 per cent, you have to find £55 million, okay? So, in Wales, the number of people who pay the additional rate is 9,000. It's 9,000 people. If you put that up by 1p, you'd make £3 million. That's how much you'd get. So, you're miles away from the £55 million that you would need to get to a 1 per cent increase. So, you look then at the people who earn between £50,000—[Interruption.] Stop moaning; listen to me. If you look at the people who earn between £50,000 and £150,000, and you put their income tax up by 1p, you'd get to £33 million. Again, miles away from the £55 million for 1 per cent. So the only place you've got to go to get anywhere near—anywhere near—the 1 per cent, let alone the 17 per cent that the RCN are asking for, is the basic rate taxpayers. If you raised it by 1p, you'd get to £237 million, so that would be an increase of about 4.5 per cent. Asking the poorest members in Wales, who are up against it at the moment—. That's your approach; that's what you want to do. And, yes, we are making some political decisions, because we think people are struggling with the cost of living crisis at the moment. So, I think it's really important that people understand quite how difficult this is, because we have made a political decision, and we are not going to raise income tax for the poorest people in Wales at the moment. 

It's really important also that people understand—. I'm not going to give a running commentary on the discussions, but you will understand that what we get in Wales in terms of increases in health is directly proportionate to what happens in England. What was really interesting is that, in 2008, we'd got to a point where we had met the EU average of the 14—. So, we compared ourselves to the 14 richest parts of the EU, and we'd met the EU average. But, between 2010 and 2019, in Britain, we saw an increase of 15 per cent. In the EU, it rose by 21 per cent. In Germany, it was by 39 per cent. The UK spent £40 billion less on healthcare than the European average. That meant that money didn't come to us, which means we couldn't put up the payments. And the answer is that, actually, austerity is a deliberate policy of the Tory Government over 10 years, and that is why nurses are so frustrated. And we understand that. We understand that. Because it's not today; it's an accumulation of 10 years of austerity, and that is your responsibility.

I talked to nurses on the picket line, because I wanted to hear their views as well, and they did say to me that it's not just about money, but it's also about work-life pressures as well. Many are doing 12-hour shifts. And there's a lack of flexibility as well, with childcare et cetera. They did also mention agency costs, and it upsets them if they know they're working with somebody who's paid more. They haven't got the experience on that ward as well, because you don't have the same people on the ward that they have, so they have to fill in for them as well.

I was really interested to hear about having a nationally owned bank, not just for nurses—I know you've mentioned it as well, actually, Eluned, before—but for social care workers and for teachers. You know, with austerity, all these strikes that are happening now, it would be really interesting. I'd love to hear more about your going on the night shift at Withybush hospital, because I think it's really interesting hearing the views of the nurses and to hear about what did you learn while you with there.

And this one-off payment—I know it's not what's needed, but, because we've got this current cost-of-living crisis and a lot of newly qualified nurses, that one-off payment would be really welcome. Talking to nurses, they would really welcome that, until we can get something sorted with the UK Government, to ensure that everybody, all these people working in public services, are properly paid and there's an end to austerity. So, I'd like to just hear your views on that, please. Thank you.

Thanks very much, Carolyn. Certainly, we're very aware that it's not just about pay; there are lots of other issues around this, which is why I was really pleased to have been presented with the staff welfare project on Monday, by representatives of the trade union movement, just setting out the kinds of things where they'd really like to see us make some movement. And so, obviously, I'll be looking at that in detail, just to see how much further we can go with that.

On agency costs, we are determined to try and bear down on certainly the most expensive agencies. And, as you say, all of the health boards have their own banks. To what extent we could have a Welsh bank—. I mean, I don't think that's rocket science; it's something we could probably try and move towards.

In terms of the night shift in Withybush, I can't tell you how fascinating it was. It's really important not just to get a sense of it through reading about what the situation is and listening to people. When you actually see the pressure on the ground, when you actually see the number of in particular older people who shouldn't really be in hospital, because they've had their treatment and there are real issues with delayed transfers of care, it really makes a difference and hits home. Some of that information in relation to agency workers I found really very useful. I had no idea we had quite so many people coming in en masse from England, but of course it's a real issue of how we staff, especially hospitals that are perhaps further away from the big centres. So, it's a real challenge and it's not going to be easy to fix.

The other thing is, on the one-off payment, I think it's really important for people to understand, first of all, that this is money where we've asked all around Cabinet for people to slow down their spending this year. If we ask them to, if we get an agreement on this, we'll ask them to slow down spending and maybe push it into next year. So, this is not money that is easy to come by, this is not underspends; this is money that has already been allocated and we're asking a big favour of the rest of the Cabinet. And it's about reserves as well. There's a big risk with going into reserves. We don't know if we're going to get a new COVID variant that is going to bypass our vaccines next year. We would be taking a risk with this. So, this is really high-risk politics, but it's something we're prepared to do because we actually want to stand by our NHS workers. So, this would be a one-off payment, and it's not going to be on the table for very long, because the end of the financial year is coming very, very quickly, and if they want it in their pay packets, we've got to get it in at the start of March, which means that an agreement has to be made before that. So, the clock is ticking here. And, of course, we haven't taken the money away from anybody yet. Obviously, people would be more than happy to hold on to that. We're asking a really, really big favour of people, and taking a risk on reserves. So, we'd have to have a very good reason to be doing that, and obviously this is a negotiation.

I thank the Minister.