NORTHERN IRELAND ASSEMBLY

COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY

OFFICIAL REPORT
(Hansard)

Nurses’ Pay Award 2007

Thursday 7 June 2007

Members present for all or part of the proceedings:

Mrs Iris Robinson (Chairperson)
Mrs Michelle O’Neill (Deputy Chairperson)
Mr Thomas Buchanan
Rev Dr Robert Coulter
Dr Kieran Deeny
Mr Alex Easton
Mr Tommy Gallagher
Mrs Carmel Hanna
Ms Carál Ní Chuilín
Ms Sue Ramsey

Witnesses:

Dr Peter Carter } Royal College of Nursing
Ms Mary Hinds } Royal College of Nursing Northern Ireland
Ms Janice Smyth } Royal College of Nursing Northern Ireland

The Chairperson (Mrs I Robinson):
I welcome Mary Hinds and Janice Smyth of the Royal College of Nursing Northern Ireland (RCN Northern Ireland). The normal procedure is that witnesses — either or both of you — speak for about 10 minutes, after which the discussion is opened up to Committee members. We have watched with interest the recent headlines about nurses’ pay, so we are keen to have your organisation’s views on the subject.

Ms Mary Hinds (Royal College of Nursing Northern Ireland):
I thank the Committee for inviting us. First, I must offer apologies on behalf of Dr Peter Carter. He is en route from Luton Airport but has been significantly delayed in the air. He is probably rushing here as we speak, and I hope that he will join us. Janice Smyth is the deputy director of RCN Northern Ireland. I am Mary Hinds, and I am its director. It is a great privilege to be here.

I am here to speak on behalf of Northern Ireland’s nurses about their pay. For the sake of brevity, and as it will probably be more useful, I will trot quickly through the briefing paper that we sent to the Committee.

To give some background information, Members should be aware that the Review Body for Nursing and Other Health Professions (NOHPRB) is an independent body through which the pay of public-sector health workers, including nurses, is negotiated. Much like the independent body that reviews the pay of Assembly Members, the review body takes evidence from staff and Government and then reaches an independent decision. The body is renowned for its integrity. Although staff do not always agree with the outcome — that is, the value — of the decision that is reached, we appreciate the integrity of that decision.

This year, the NOHPRB proposed a 2·5% pay award. Unfortunately — and, to a degree, in an unprecedented way — the Secretary of State for Health, Patricia Hewitt, staged that award in two parts. That meant that nurses and other health professionals received a total award of only 1·9% instead of 2·5%. At the same time, the then Scottish Minister for Health and Community Care, Andy Kerr, said that the Scottish Executive valued nurses and nursing in Scotland and would therefore implement the pay award in full. That is very significant.

One of the last actions of direct rule Minister Mr Goggins was to announce that nurses would receive a staged pay award only. He announced that measure on 26 April 2007 — right on the cusp of the restoration of devolution — and that was a slap in the face to nurses and other health professionals in Northern Ireland.

One might ask why we are bringing a submission to the Committee, and why we are doing so now. We wish to draw the Committee’s attention to the injustice of the situation. We entered into the same process of pay negotiations as the Government, and we expected both sides to honour the deal that was reached. The restored Executive have the wonderful authority to make their own decisions; that is what devolved Government is all about.

For the first time ever, the possibility of industrial action was voted on at this year’s RCN congress. Janice Smyth and I are nurses, and that discussion did not sit lightly or easily with us. There was a groundswell of feelings of upset, betrayal, hurt and of being undervalued throughout the profession. Despite the rhetoric contained in the Government’s Agenda for Change policy — the new NHS pay deal — about nurses being involved, nothing was delivered. The upshot of the RCN vote is that there will be two ballots. The first ballot will ask nurses what type of industrial action they want to engage in, and will gauge the strength of feeling on industrial action. I do not know one nurse who wants to take industrial action — I do not want to do it, and neither does Janice. The second ballot, which will happen later, will determine whether industrial action will be taken. We do not want industrial action. We see other places in which that is happening, but it is not constructive. We want to work in partnership with people.

One might argue that a 2·5% pay award is generous, compared to what others are offered, but it is not: it does not even keep pace with inflation. The most recent workforce census in Northern Ireland showed that there were almost 600 vacancies in nursing. Therefore, although progress is being made in some areas, we have not reached the end point. The age profile of nursing staff in some areas, particularly mental-health nursing, suggests that there will be a problem in achieving adequate staffing levels in a few years’ time. Rather than being reactive, an opportunity exists for the devolved Ministers and Government to be proactive and to manage those situations before they start to become a problem.

There is already a shortage of nurses in such areas as mental-health nursing. Janice reminded me that the Assembly debated nurse shortages and the closing of beds in specialist acute services such as neurology. Nurses are not the best-paid professional group, but they routinely work unpaid hours and do not get paid overtime. They do that because they do not want their patients or colleagues to suffer.

A pay award of 1·9% is a pay cut — it cannot be tarted up as anything else. We have, I hope, the beginnings of the Minister’s vision for the future of the health and social care services in Northern Ireland in respect of long-term disease management, and the reform of services and trusts. However, a skilled, well-motivated, innovative staff will be required to deliver much of that agenda. Staff represent the oil that makes the engine work. Without them, nothing changes and nothing happens; therefore, motivation is important, and pay is part of that motivation. People have mortgages to pay, children to care for and families to rear.

There are some myths surrounding the pay review body’s recommended pay award. It has been said that the Government cannot afford to pay it and that jobs and services will have to go if the full award is made. That is not a good enough reason for not awarding it, because services to patients will not be appropriate or correct if there are not enough nurses on the ward to deliver care.

One could argue that the previous Administration manipulated the goodwill of nurses — that is strong language from me. The Government know that nurses do not wish to harm patients. That is in our code, and, at its essence, the RCN has a charter to protect patients’ safety from any action that nurses might take. That goodwill has been abused.

The previous direct rule Administration said that they have implemented the pay review body’s recommendations, but they have not. They have staged them. The pay review body did not recommend staging the pay award.

We estimate that to stage the pay award, and not to give nurses that 2·5%, would save only £2·5 million. In response to a recent question for written answer from Mr Mervyn Storey MLA, the Minister of Health, Social Services and Public Safety stated that the annual cost of unused medicines in Northern Ireland amounts to £2·5 million. Money is there for nurses if the Government are minded to find it.

Money is not the motivation for nurses. If it were, there would be a lot more than 600 vacancies. Nursing is a vocation; nurses are motivated by trust and a legacy of devotion to patients and communities. Nurses and other professionals feel that their vocation and trust have been abused.

We ask that the Committee support us when we raise the issue. We are not naïve — we recognise that times are difficult for the Assembly and that there is no golden pot that will allow everyone to get everything that they want. However, we have asked the Minister, and will approach the Executive, to reach a decision that will enable nurses in Northern Ireland to receive the pay award that the pay review body said they were entitled to. I am happy to answer any questions.

The Chairperson:
Thank you. I am sorry that you were delayed coming across from the mainland, Peter. You are very welcome. Do you or Janice wish to make any comments? I do not think that you have used your allotted 10 minutes.

Dr Peter Carter (Royal College of Nursing):
I have been at Luton Airport since 9.00 am, which was frustrating. Luton Airport is not a great place to be at the best of times. I am sorry that I missed the beginning, because this is important to us. I am sure that my colleagues have already said this, but thank you for giving us this opportunity. It might be better if members of the Committee asked questions.

The Chairperson:
The Committee fully appreciates what nursing staff do in the Province; they are the backbone of our Health Service. I am not being patronising — I am very aware of the dedication that exists in the nursing fraternity.

Why is it that the Scottish Executive appear to be so far ahead of England and Northern Ireland in how they deal with their health issues?

Ms Hinds:
I am not sure of the ingredients for their success. I believe that the Scottish Executive have grasped the independence that devolution brings to decision-making. They have gone at it with gusto, and not been afraid to draw a line and say, “That may be all right for you, but this is Scotland and it is not all right for us.” As I have said, this is not only about pay. Overall, the Scottish Executive have been prepared to step up to the mark.

Furthermore, communities differ. Northern Ireland has different health and social care needs. We are a health and social care service, which is different from the rest of the NHS. That is our strength, and something of which we should be making more. The Scots have had the courage and commitment to do the job.

The Chairperson:
In the press this morning, you spoke of the numbers of nurses that have required counselling. Although not related to pay, it is important to highlight that fact. Can you expand on those pressures?

Ms Hinds:
We cannot underestimate the pressures under which nurses and other healthcare professionals work. The pace of life is infinitely different from when I worked on the wards as a young nurse many years ago. Our expectations of nurses are significant, and the uncertainty due to the review of public administration is also a factor. Although change must happen, it is not easy to live through when it applies to a person’s own job and career. Therefore those anxieties are real.

Pay is one of the main causes of stress. The issue is about reward and value. For a ward sister, the pay rise equates to about £10 to £13 each week, which is not a lot of money. However, as I have said, the issue is over how valued people feel. In these times of change, as members will notice from the article in today’s ‘Irish News’, much of the stress is hitting middle managers, ward sisters and others on whom we depend to make our service work. They try to support their staff in wards and in district teams, but they also feel the pressure of targets. As a result, they are being sandwiched. That causes significant stress, which manifests itself in many ways. For example, people take time off due to stress. However, they become more stressed when sitting at home because they know that their patients are not getting the care that they want them to have. The range of problems also includes alcohol abuse, smoking, marital difficulties and physical ill health.

I am conscious that the meeting is public. Therefore I want to stress that nursing is a wonderful career. It is hard work but good work. The RCN wants to make it better and more productive. The Committee’s job is to scrutinise nursing and decide whether it gives value for money. One way in which to do that is to reward nurses so that they can play their part in the reform agenda.

Mr Easton:
Thank you for your presentation. My sister is a nurse, so I am interested in the topic. Otherwise, I might get a slap when I get home.

The Committee has identified retention of nurses as one area that it wants to examine. It will be a major issue for the Committee in the weeks and months ahead. How does the pay rise compare to other health-sector groups at present? Does the RCN believe that nursing has fallen behind other public-sector bodies?

Ms Hinds:
Yes. The pay review body’s evidence, which is a significant tome, as well as independent papers, such as those of the Office of Manpower Economics and the annual survey of hours and earnings (ASHE), all demonstrate that nursing has slipped behind over several years. Although there has been progress in some areas, nurses’ average pay has slipped behind compared to that of other professionals. I do not want to point the finger at other professionals: if they have done well, it is because they have needed that resource. However, nurses have slipped behind. Although it will not bridge the gap or fix the problem, the opportunity exists to take a little step forward, at least.

Dr Carter:
On average, nurses are the lowest paid of all public-sector workers in the UK. The figures demonstrate that. However, the RCN has been careful not to be caught up in comparisons with other disciplines. For example, the pay scales for consultant surgeons or physicians start at £75,000, but the RCN does not believe that they are overpaid — they have completed 12 years’ training. There has been much publicity about GPs being paid up to £100,000. Those who negotiated that figure on behalf of GPs were surprised that they got that deal. That is what they asked for and that is what they got. Who would not take that pay offer? The RCN does not consider GPs to be overpaid for the amount of work that they do. However, we do consider an average of £24,000 for qualified nurses to be a gross underpayment. The RCN wants nurses’ pay to reflect how much they are valued.

Mrs Hanna:
I am on record as supporting nurses’ plea that they receive their reward in full and immediately. I have already put that in writing. I hope that colleagues will do so, too.

When the Minister last attended the Committee, I asked him how the Department would retain and motivate nurses. I am concerned that nurses are getting stuck at lower grades because of a lack of training opportunities. The RCN has explained that that will become a more pressing issue.

 

We were also led to believe that the nursing shortage had been dealt with. What is your view on that matter?

 

Ms Hinds:

I shall ask Janice to answer those questions.

 

Ms Janice Smyth (Royal College of Nursing Northern Ireland):

We are in a better place today than we were two or three years ago, Carmel. However, shortages still exist in the areas of mental health and learning disability. There are also shortages in some specialist disciplines, although those are not as marked as they have previously been. Moreover, as Mary said earlier, the workforce in areas such as mental health is ageing. As the Assembly — when we were fortunate enough to have it in its first mandate — and the RCN discovered, it takes about five years to plug that gap and solve the problem. It takes three years to train a nurse, and that is followed by specialist programmes and workplace development to hone the necessary skills to deliver specialist care.

 

We are doing better, but now is not the time to pat ourselves on the back and tell ourselves that we do not need to worry; our problems are far from over. We began to implement the Government’s Agenda for Change policy in December 2004 for vacancies and staff retention, but it remains unfinished. That causes great concern for nurses, who still do not know which band they will go on in the new pay system. To add insult to that injury, the Secretary of State for Health, Patricia Hewitt, among others, has bandied about the figure of a 6% pay rise. It was also the subject of a question for written answer in the Assembly.

 

I want the Committee to know what that is about. When the Agenda for Change pay policy was collectively negotiated and agreed, it was designed to address well-proven inequalities in the pay of healthcare professionals who were not receiving their proper entitlement. It was also designed to alleviate the problem of staff retention in the nursing profession. Under the existing Whitley Council scheme, most of the nurses employed by health and personal social services (HPSS) were working at grades D or E — the lowest-grade posts. I have that in writing, and I will happily leave that document with the Committee. To exacerbate that situation further, 37·5% of nurses were employed in those D-grade posts in 2001. In England and Wales, that figure was 24%, and in Scotland it was 28%. Northern Ireland has a history of keeping nurses’ pay at a lower rate than that in the rest of the UK.

When the collective agreement was made, it was accepted by all that the majority of D-grade and E-grade nurses would go into band 5 of the new Agenda for Change pay system. There are two additional increments at the end of band 5. They do not amount to much, but they are there. The implementation of the agreement began in 2004, so nurses who are in the top band of the E-grade salary will not receive an incremental rise this year. A small number of nurses still has room at the top of that band to move up an increment.

It is absolutely disingenuous, after we had negotiated a pay agreement, that the Secretary of State for Health should now undermine that agreement by staging a pay award and giving nurses pay rises below the rate of inflation. That will undo everything that we have done and will result in a totally demoralised profession voting with its feet.

The Chairperson:
Thank you, Janice. That was a very comprehensive response. I am sure that Members will not need to return to that issue; there is no doubt that everything was well and truly answered.

Dr Deeny:
I welcome Mary, Janice and Peter. It is nice to have fellow health professionals in the Building.

Ms S Ramsey:
Kieran feels lonely.

Dr Deeny:I agree that many nurses in general practice are suffering from stress and feel guilty that they are unable to do their work. We depend more and more on foreign nurses; we are grateful for their contribution, and, only for them, the Health Service in Northern Ireland would collapse. Many nurses have left our shores to work in the USA and elsewhere because better pay is available. I agree with Peter that the rate of pay is very low for professionals who put so much time into the job.

Is a figure available for how many nurses are leaving Northern Ireland each year? GPs and their negotiators have fought to obtain a reasonable deal for their work, yet nurses are falling behind in a big way. I see that only contributing further to —

Ms Smyth:
Yes.

Dr Deeny:
I have a second question as well. Overseas nurses are welcome, but we would like to keep our own nurses, too.

I agree that Scotland has led the way in many areas, as the Chairperson has said. I presume that the £2·5 million that you mentioned represents the savings made by staging the pay award across the UK. What would that amount to in Northern Ireland? We should show by example that we are thinking of our own nurses.

Ms Hinds:
The £2·5 million is the figure for Northern Ireland — it is £60 million for the whole of the UK. However, remember that £2·5 million-worth drugs are going unused in Northern Ireland each year. Therefore it would not be a huge management task to find £2·5 million needed to implement the pay award in full.

We do not want to lose our nurses, whom we currently lose in several ways. You will have seen the figures that show the increase in numbers of nurses entering training; however, they do not all come out the other side. Stress is a major factor among young people who go into nursing, only to drop out. They are lost to the Province and to the HPSS workforce. It is hard to gauge how many nurses leave the Province, but it is probably in the region of 10% to 15%.

Ms Smyth:
We know that the most recent HPSS workforce census — from 2006 — revealed that 1,000 people left the Health Service in 2005. We do not know how many of those were of retirement age. We have a lot of work to do on data collection and workforce planning.

Dr Carter:
I have one statistic that might help. It is ironic that the Westminster Government, who are so obsessed with targets and totals, have been responsible for more than doubling one figure: the number of people recruited in the UK by nursing recruitment agencies. That has gone from 3,000 in 1997 to more than 7,000 last year. That is just the figure from recruitment agencies, and all the indicators are that it will increase.

Three weeks ago, the last five pages of ‘Nursing Standard’ — the journal most widely read by nurses throughout the UK — were full of advertisements from Australia, Canada, New Zealand, South Africa, the Cayman Islands, and so on. At our annual conference a few weeks ago, a recruitment agency from Australia could not cope with the volume of people requesting information about nursing abroad.

Over the next 10 years, 180,000 nurses in the UK will retire. That is an irrefutable figure. We predict that, four or five years from now, we will be back to doing what the NHS has done in the past, which is to recruit nurses from Africa, India, the Philippines and other poor countries that can ill afford to lose their nurses. We have made clear to the Secretary of State for Health and others that we disapprove of that. We see it as plainly as that, and we hope that the Committee will support our views.

Ms S Ramsey:
Thank you for your presentation. Your briefing paper helps the Committee to deal with some of the myths and realities. In response to a question from the Chairperson, you said that Scotland values its nurses and pays them well. You said that the Scottish Executive are willing to put their money where their mouth is. I would go further and say that it goes back to William Wallace’s line about delivering their own destiny, and we could learn from that. There was an article in ‘The Irish News’ this morning that quoted the Minister of Health, Social Services and Public Safety:

“Nurses are at the front line and while delivering targets for patients is important there is also the emotional cost for nurses — we don’t want them to be treated as targets.”

That referred to nurses who are taking time off through sick leave and counselling.

You mentioned that between 10% and 15% of nurses leave the profession. It would be useful to get a more definite figure, particularly to compare it with the 600 vacancies. How much do the Department and the trusts spend on outside recruitment? The cost of such recruitment should be compared to the cost of the 2·5% pay increase. What is the cost per annum? The nitty-gritty of various issues is being debated in the Assembly, and it would be useful to know the figures, as Members are only being told that things will cost money.

Members of the Royal College of Nursing said that they are not happy with the 2·5% pay increase but that they are willing to accept it. When will the ballots on the pay award be sent out? If there were to be strike action, when it would happen?

An independent pay body recommended that further education lecturers were not entitled to a pay award; however, employers, employees and the Health Department said that nurses are entitled to a pay award. What is the feeling among your members about the fact that the pay review body recommended that nurses are entitled to a 2·5% pay increase that they are not receiving?

Ms Hinds:
I do not know how much the Health Service in Northern Ireland spends on outside recruitment; however, it is too much. It is not just a question of staff leaving and the resultant vacancies; there is also the question of the level of sick absence among staff due to stress that accompany those figures. Added to that is the pressure of meeting targets. Nurses are working in a cauldron that will boil over. I cannot give you exact figures, although I will try to obtain them. However, I am sure that the Committee, with its authority, will get them much quicker than I can. Can you remind me of your last point?

Ms S Ramsey:
How much will the pay award cost per annum?

Ms Hinds:
It is 2·5%, which is not enough. The retail price index is about 4·6% or 4·8%. Last night, the ‘Belfast Telegraph’ reported a drop in the number of first-time house buyers. On a salary of £20,000 a year, staff nurses will not be able to afford mortgages that are four or five times their salaries. The average house price in Northern Ireland is about £216,000. That is terrifying. However, the Royal College of Nursing has entered into negotiations and, due to our integrity, we have kept to our side of the deal. All that we ask is for that to be reciprocated.

With regard to further education lecturers, if the Assembly or the Executive decide that the pay award is too low and make a decision on it, more power to your elbow because that is what devolved government is about — valuing people. Independent pay review bodies exist to guide Government and staff. It is unprecedented for a pay award to be decreased, and I thank you for acknowledging that. It is unprecedented for an award to be less, but that is what nurses, and other Health Service professionals, are being asked to accept. The veneer is that 2·5% is being offered. Let me disabuse the Committee of that notion: it is not; it is 1·9% in real terms.

Dr Carter:
I will answer the ballot question and will try to complement some of Mary’s points briefly, as I know that the Committee is pressed for time. The financial crisis in the NHS is said to affect the whole Health Service, whereas it chiefly affects England, and the Royal College of Nursing feels that that is not properly recognised. That is why Andy Kerr, the Scottish Health Minister, said that because Scotland was managing its tight finances well, money was available to implement the 2·5% award in full. I was in the room when he made that announcement. The case is similar in Northern Ireland: money may be tight, but there is enough to implement the award.

One issue that has particularly angered nurses throughout the United Kingdom — and Scottish nurses agree with the rest of the UK — is that Westminster has spent £500 million on management consultants in the past 18 months. The 0·6% that was mentioned earlier represents £60 million. People are therefore cynically suggesting that £440 should be spent on management consultants next year and that nurses should receive the remaining £60 million.

That type of inequality exists. Consultants from blue-chip companies receive exorbitant amounts of money, which nurses think could have added as much as £7 a week net to their wages. That is why nurses want to have an indicative ballot to consider industrial action. I cannot give a firm date for that ballot, but it will be either at the end of July or after the summer holidays.

Ms S Ramsey:
I support you in that.

Ms Ní Chuilín:
I also support you, and I thank Janice, Mary and Peter for their attendance today.

It is ironic that Agenda for Change was introduced to address significant inequalities but has, in fact, added to them. Two and a half million pounds is a great deal of money, but it will be money well spent. However, if members of the RCN decide to ballot, the cost to the NHS of trying to plug the gap will be huge. What would the cost be to the NHS if the RCN decides to ballot?

Ms Hinds:
It is difficult to put a cost on industrial action. The greatest cost will be in patient care and services and the impact on the waiting times that everyone has worked so hard to address. Patients sitting on trolleys in accident and emergency departments will feel that cost. Elderly people in nursing homes will lose out. The cost will be professional and human, and nurses want to avoid that.

Ms Smyth:
Surveys carried out by the RCN consistently tell us that, on average, nurses, out of a sense of goodwill, work two and a half hours’ unpaid overtime a week to ensure that patients and their relatives are cared for properly. When those nurses are supposed to be off duty, they chat to patients and their relatives, maintain important records in order to report to the nurse coming on duty, and sometimes call in on elderly people in their own homes. That is why the Government’s proposals are the ultimate insult. If nurses stopped working unpaid overtime, the Health Service could not cope and patients would suffer. That creates more stress for nurses and adds to the problems to which today’s ‘Irish News’ refers. It is a catch-22 situation.

Ms Ní Chuilín:
I am sure that morale is very low among nurses, and the human cost of that is immeasurable. People appreciate that nurses’ work does not stop when their shift ends; that may always be the case. However, it is important that the Committee has figures, even if they are only crude estimates, so that it can understand the financial cost. Nurses have been the backbone of the Health Service and have provided care from the cradle to the grave, but their case is not being heard. We need figures in order to draw attention to the issue.

Rev Dr Robert Coulter:
It is good to have representatives from the RCN here today; I look forward to seeing you again tonight.

Is the grading system satisfactory or is the pay scale too long? Could the money that was spent on management consultants have been better spent elsewhere?

Ms Smyth:
Agenda for Change is the Government’s policy. It was collectively agreed and the implementation date was October 2004. The Royal College of Nursing commenced that process in December 2004. Members were balloted, and 83% voted in favour of the new system. It was sold to members as a pay system that would provide a career structure and deal with the problems caused by so many of our workforce being held in lower-grade posts.

Unfortunately, there have been a few difficulties. The RCN has some concerns about the implementation of the pay system. One is the time that it has taken to get the job done. The RCN has only 90% of the Health Service staff in Northern Ireland, and Agenda for Change covers all Health Service staff, with the exception of doctors and dentists. Therefore 90% of workers have been matched to a new profile in the new system; however, after three years, only 60% of them have been transferred to that system and know what pay they will receive.

Many of our nursing colleagues and RCN members feel that they are not doing as well from Agenda for Change as had been hoped. As a result of the system not having been fully implemented and because we cannot yet make comparisons with the rest of the United Kingdom, the RCN cannot answer all the questions.

However, undermining the new system by stating that some nurses are getting a 6% pay rise is disingenuous and is the ultimate insult. That issue will be revisited. If the new pay system is implemented — as was written and agreed — with all the benefits of continual professional development for nurses, we hope that we can work with it and that it will support our members in looking after patients.

Dr Carter:
A recently published report by the National Audit Office on management consultants found no appreciable benefit to the NHS from such a high expenditure. The views of the Royal College of Nursing on the matter might have been expected; however, the National Audit Office, which is an independent body, came to the same conclusions.

Mr Buchanan:
The Royal College of Nursing said recently that up to 30% of nurses will leave the profession if the proposed pay award is unsatisfactory. That is an alarming statistic, as nurses have had to be brought in from overseas in recent years. How realistic is that figure?

Ms Hinds:
That figure came from independent research that was carried out by the RCN throughout the United Kingdom. Similar research by our colleagues in UNISON produced a figure of 45%. Those figures reflect the hurt felt by nurses. That is in part due to nurses being told constantly that pay will be sorted out soon; however, no date has been given, and no specific numbers have been produced. It is an alarming statistic but a reasonable one.

Dr Carter:
Thirty per cent of nurses will not be able to leave because they need to earn a living. Over the past 10 years, investment in the NHS has — supposedly — doubled. Therefore it is a shocking indictment that more than 30% of the workforce say that they are prepared to leave. If that investment had reached the pockets of the people who are doing the work, a feel-good factor would have been expected by now. It was helpful that our colleagues in UNISON carried out a survey that showed the figure to be more than 40%. It is sad that so many people feel so disaffected with their situation.

Mr Gallagher:
The pay award was handled disgracefully after the pay review. I hope that what was agreed is received, and from the agreed date in April. How bad is the situation? Will the next stage of the payment — the 1·9% — be paid in three months’ time or in a year’s time? How was the payment offered?

Dr Carter:
The pay review body said that the pay award should be 2·5%, which the Government decided to pay in stages. We therefore rejected the entire pay award, and no nurses have received anything from 1 April. Our line is that we agreed, long before the pay review body published its report, that we would accept the independent analysis of what was affordable. Traditionally, the Government have done the same. Therefore when the offer was 2·5%, which, as Mary pointed out, is well below the rate of inflation, we were still prepared to accept it because we knew the Government’s precarious financial situation.

However, we will not accept payment in stages. We have drawn a line in the sand and are saying that 2·5% should be paid. That is why the Royal College of Nursing, the Royal College of Midwives, Unison, and all our colleagues, such as physiotherapists, in other unions say that it is time for industrial action. It is a depressing state of affairs.

Dr Deeny:
Dr Carter said that there are far too many managers, and I hope that the review of public administration (RPA) will address that point in Northern Ireland. He also mentioned drug wastage, which must also be addressed. Many Members, myself included, are very uncomfortable with funding health services through private finance initiatives (PFIs). Could savings in those areas not fund the pay rise? I want to put on record that I support Dr Carter’s demand for a 2·5% pay rise

Ms Hinds:
The Committee will shortly meet our colleagues, who will set out our position on PFI. Dr Deeny is absolutely right: efficient and prudent management of taxpayers’ money is required, and health services must be delivered on a best-value basis. There appears to have been instances in Northern Ireland, specifically associated with PFI, where that has not been the case. I will stop now rather than steal the thunder of my colleagues who will be speaking after us.

Dr Carter:
I guarantee that in 10 to 20 years’ time, many PFI contracts will be seen to have been very poor value for the public purse. Unfortunately, by that stage, the people who put them in place will have long since moved on and will not be accountable.

Dr Deeny:
Would it help if there were fewer managers?

Dr Carter:
The NHS needs managers. However, the exponential rise in the number of managers has not been met by a commensurate increase in the number of clinical staff. To broaden the issue from nursing, because we do not want to be parochial, this year, 70% of newly qualified physiotherapists in the UK will not get jobs. That is shocking. People said that there were too many physiotherapists. I did not realise that one of the Committee members is a GP; however, he will not find that there are too many physiotherapists when he has to refer patients for physiotherapy.

Ms Hinds:
Today, in Belfast, there is a ward sister who is responsible for 32 patients, 24 hours a day. She is also responsible for 50 staff, care, treatment, compassion, standards, co-ordination of care, and a salaries and wages budget of £566,960. The public gets all that for £27,000 a year — that is good value for money. All we are asking for is £13 a week.

The Chairperson:
It would be more cost-effective to pay our nurses the appropriate salary rather than lose them to other parts of the world after their years of training in the Province.

Thank you for your excellent presentation. I will ask members of the Committee to approve a letter to the Minister asking him to state the cost of filling posts with agency nurses and whether he will reconsider the decision to implement the pay award in stages.

Ms Hinds:
Thank you. May I say, with our general secretary sitting here, that the Committee makes me very proud to be a citizen of Northern Ireland.

Dr Carter:
It is good to be here.

The Chairperson:
Do members agree to the Committee sending a letter to the Minister?

Members indicated assent.