Debate contribution: Junior Doctors’ Pay

Debate contribution by Mr Robin Swann on 21 May 2024.

MLA: Mr Robin Swann
Party at the time: Ulster Unionist Party
Date: 21 May 2024
Type: Debate contribution (made as a minister)
Business: Private Members' Business
Heading: Junior Doctors’ Pay
Assembly identifier: Official Report component 4491928

Text

Thank you very much, Madam Principal Deputy Speaker. I am grateful to the Alliance Party for bringing this issue to the Floor of the Assembly today, because I want to acknowledge the vital contribution of our junior doctors to the health service, their commitment and expertise and the long hours that their jobs have long involved. It has always been a tough and demanding job, and the current extreme pressures on our hospitals have, undoubtedly, significantly exacerbated that. I fully understand the frustration behind the latest phase of industrial action, and I respect the mandate that the BMA junior doctors committee has received from its members. However, I deeply regret the decision to strike again, because it will cause serious disruption to patient care at a time of already significant and prolonged stresses on the service. Therefore, I again question what the industrial action can hope to achieve in a Northern Ireland context. This is a national dispute that will only be resolved at a national level. For reasons that I will set out, it is beyond the Executive's remit and the resources that have been provided to us to provide a unilateral solution. I begin by correcting a factual inaccuracy in today's motion, because, as things stand, no agreement has been reached in Wales on junior doctors' pay. Indeed, the 5% pay increase for 2023-24 that has been implemented in Wales was lower than the corresponding uplift in Northern Ireland. Wales has not yet matched the 2023-24 recommendations of the DDRB, the national review pay body for doctors in Northern Ireland. While that situation may yet be updated, that is the current factual position. I am sure that Members will want to correct the record in that regard, because I know that a number of them mentioned Wales. Let me assure the Assembly that, as far as I and my Department are concerned, my Department's negotiations with the BMA junior doctors committee have not closed down. The talks have not collapsed. Indeed, there are important issues of real substance to be progressed. Our doors remain open. I had a very open and amicable engagement with members of the junior doctors committee earlier today, and I reiterated that point to them. On taking up office, I met the BMA central committee on the matter. Officials from the Department have met the BMA junior doctors committee on a number of occasions and will continue to do so. While the negotiations are, quite properly, led on my Department's side by our workforce negotiating team, I remain across the detail and will continue to do all in my power to facilitate progress. That has been detailed in my letters to the junior doctors committee in which I set out my Department's position and offered independent arbitration in the talks. To date, that offer, which I made again this morning, has not been taken up. What I will not do is make promises that cannot be fulfilled. Populist gestures might be good for headlines and photo opportunities on picket lines or, indeed, in social media videos, but they do not help to resolve the situation. The reality is that, at the heart of what is a national dispute, there is a demand for pay restoration for what would be a landmark pay settlement that reverses the below-inflation increases from over the past decade and more. I am sure that many in the House have sympathy with that cause, but it must be remembered that public-sector pay restraint has been a core element of UK Government policy for 10 years and more. It has been a centrepiece of austerity and, inevitably, has impacted on all public-sector pay awards in Northern Ireland over time. It was reflected in public-sector pay policy, which the Department of Finance actually set and, indeed, in pay awards that were given by previous Northern Ireland Health Ministers, some of whom are still in the House today, and by Ministers in other Departments. All our public-sector workers were impacted by pay restraint, so pay restoration spans our entire public sector. I want to set that in context. If we had that mythical, magical money tree to shake and if I were able to commit to the BMA's request for a 32% uplift for our junior doctors, even over a longer term, that would require a further £52 million per annum before any other pay awards were considered. Amending the public-sector pay policy, which was adopted UK wide for all our employed doctors and dentists, would require an additional sum of over £210 million each year before pay awards. I do not believe that the House would want me to make an exception just for junior doctors in that regard. I could not turn to nurses, paramedics, social workers and social care workers and say, "Sorry, this special pay uplift is not for you". If we gave that tree another shake, we could maybe dislodge another £1 billion, which Agenda for Change staff would seek to restore their pay levels. Likewise, other Ministers would not relish delivering the same message to teachers, police officers, civil servants, public transport workers and all the other workers in key services. That, in a nutshell, is why pay restoration is not just a cross-cutting issue for the Executive but an issue that they cannot resolve, given their limited fiscal headroom and current acute budgetary pressures. Therefore, we must realise those hard realities. Members have asked about business cases. I advise the House that I have written to the Finance Minister to propose a comprehensive independent review of public-sector pay in Northern Ireland that will look at a range of issues, including comparisons with neighbouring jurisdictions and recruitment and retention considerations. I have asked that that include not just the estimated costs of full pay restoration but the potential cost to public services, if pay erosion is not addressed. Therefore, I fully accept that that is an important issue, but I stress again that the responsibility rests with those whose policies created the situation, namely, the Westminster Government. That is not to say that progress in other areas cannot be made between my Department and the BMA junior doctors committee. Some of those issues have been raised here today, and real progress has been made since the Executive returned. When the ballot for industrial action was launched, junior doctors, like those in the rest of the health service, had received no pay award for 2023-24. We have put that right, implementing in full the recommendations of the pay review body — the independent DDRB. That award will be paid in the June pay run, landing in pay packets next month. The reason for that timeline is that I had to wait to receive that money from the Department of Finance, which had to wait to receive it from Westminster as part of the restoration package. It was not the case that we, the Department of Finance or, indeed, the Business Services Organisation (BSO), as the paying authority, were sitting on that money and not moving. It is a fact that we moved as quickly as we could once we received it. It is misleading to look solely at basic pay rates when making comparisons with other jurisdictions. Junior doctors in England have a different contract that involves a higher basic pay rate than that in Northern Ireland, but they have lower additional payments, such as banding allowances, which are paid as an additional percentage of basic pay and which vary according to the rota that an individual doctor works. Again, that is why my Department and I are putting so much emphasis on that contract renegotiation with the junior doctors committee in Northern Ireland. It was indicated at the meeting that we had this morning that that would be a first for Northern Ireland.
We have delivered a new contract for our GPs under the GMS, which we talked about during Question Time. It has stepped outside the bounds of what would normally have been done. I firmly believe that, by engaging with our junior doctors committee, my departmental officials can do that again for Northern Ireland to address the other issues that have been raised today. I recognise that the junior doctors committee's mandate is on pay. This morning, I asked the committee whether we could look at a dual-track approach, looking at the contract while continuing the conversations about pay. The vast majority of our doctors work in rotas, which attracts that conversation and that additional payment that was mentioned earlier. That is the construct of the current Northern Ireland contract, and we are willing to engage on it. Comparisons with Scotland have been made, but those are complicated by a different income tax rate there. As always, it is not about the headline but about the take-home pay. I will conclude with two points. First, I urge the BMA junior doctors committee to continue to engage, notwithstanding the wholly unacceptable Budget settlement for Health. There are real issues of substance to discuss and make progress on. My Department is clear that implementing the DDRB-recommended package will not bring an end to pay discussions with the BMA. For example, a set moment is ongoing in the junior doctors' dispute in England that could result in further funding becoming available to Northern Ireland through a Barnett consequential. It would, of course, be a matter for the Executive to decide how such funding would be allocated. My argument and my position are that, if funding comes through a settlement in England, it should be allocated to my Department so that we can recognise our junior doctors and implement the funding for them here. I would look for support from the other Executive parties to secure that. Secondly, ahead of national DDRB recommendations for 2024-25, discussions on contract reform and non-pay terms and conditions can still be progressed. That is the route to making real improvements in the working conditions that were recognised and talked about today in what I firmly believe is an out-of-date contract. With respect to Members, I conclude by emphasising that the Budget that the Assembly is poised to endorse next week will make progress on pay much more difficult, not just for junior doctors but for all health service workers. It is not me who says that; it is the Northern Ireland Fiscal Council, which referred to that in its last report on pay awards and the pressures that they will bring. It is not uncommon for some in the House to brush aside concerns about budget cuts with bland and grand pronouncements about efficiency savings, but the budget that the Executive are handing Health for this year places even more severe limits on what can be done on junior doctors' pay. Do not take my word on that; in a statement issued on Thursday 25 April 2024, the BMA said that the allocation:
"is simply not enough to sustain a health service that is struggling to function effectively".
Yet here we are. The party that tabled the motion and proclaimed to the world how much it supports junior doctors actually supports the Budget. You could not make it up.
As the conversations with the BMA are ongoing and have not concluded, I think that there is an opportunity for the Executive to look again at the Budget that has been presented. I recognise the welcome work that the Minister of Finance has completed recently on the fiscal framework and the fact that she is in Westminster today to engage further. I do not know why we would shackle ourselves to a Budget that was previously presented when there is still an opportunity for more money to come forward before we have to take an Executive decision.
The Chair of the Committee will know that I have recognised that this job is tough, but being Finance Minister in Northern Ireland at this time is on a comparable footing. I therefore commend her for the work that she is doing. What I do not agree with, however, is the allocation, agreed by the other Executive parties, that has been given to Health. The BMA statement of that date also went on to say that the Northern Ireland Executive need:
"to be absolutely honest with the public about what health service they can expect as a result of this budget as it is clear it will be impossible to match any expectation."
I, for one, am being totally honest about the Budget. It is still, as I have said, not too late for others to join me. As a parent, I sometimes worry about how best to explain the meaning of irony to my children, so I am grateful to Members for providing an excellent example that I can bring to their attention in the future.

2,140 words. Text as published by the Northern Ireland Assembly.

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