HL Deb 15 February 1990 vol 515 cc1508-30

6.8 p.m.

Lord Stallard rose to ask Her Majesty's Government what steps they propose to take to resolve the current dispute in the ambulance service.

The noble Lord said: My Lords, my Unstarred Question asks what proposals the Government have to resolve this dispute which is now in its 23rd week. The dispute is now approaching six months' duration. Clearly there is widespread sympathy and support for the ambulance staff's claim. A recent poll found that 85 per cent. of the general public support the ambulance men and women and that only 6 per cent. support the Government stance. Some 4.6 million supporters signed a petition. That was a record number of signatures for such a petition and I understand that that statistic is soon to be included in the Guinness Book of Records.

Most informed and professional staff in the National Health Service also support the ambulance men and women's claim for more money, yet the Government who are effectively running this dispute in everyone's eyes refuse to intervene to bring it to an end. What is the current situation? There are two elements of the current claim still outstanding. The first is the claim for a pay mechanism that would maintain the value of ambulance staff earnings. The staff's preferred option is for a mechanism like the fire and police pay formula. Union negotiators have repeatedly said on that point that they are prepared to negotiate almost any other pay mechanism that would lift the ambulance service out of the annual scramble and disruption. The second outstanding element of the claim is for an increase of 11.4 per cent. in the hourly rate.

The pay of ambulance staff has been deteriorating in relation to earnings throughout the economy, and more particularly in relation to the other emergency services, since 1975. At that time the ambulance staff's earnings were about 7 per cent. above the average for all male workers. By 1978 they were 3 per cent. below the average, a decrease of 10 per cent. The Clegg award restored the position and earnings rose to approximately 3 per cent. above the average. Since then the position has deteriorated dramatically. By 1988 ambulance staff's earnings were 16 per cent. below the average male worker's pay. In that context, therefore, the initial claim for 11.4 per cent. is not unjustified or excessive.

Nevertheless the unions have indicated that they are prepared to negotiate on that 11.14 per cent. and if necessary to lower their sights. However, clearly —and in the view of millions of people throughout the country —in the light of all the circumstances, 6.5 per cent. is unacceptable. The offer of 9 per cent. over 18 months is much the same as 6.5 per cent. over 12 months. It only sounds better, and probably satisfied some government supporters. It fooled nobody else.

The unions have always been prepared to discuss enhanced pay rates for those with extra training. However, the fact that overtime is paid at standard rates remains a major grievance. Extra training needs additional resources. Those resources have never been forthcoming from the Government. There is a dire lack of training in some areas of the ambulance service.

In addition, last November, in order to facilitate negotiations, the unions dropped several other key points from their April 1989 claim. Those points included an increase in the stand-by allowance, an increase in annual leave, a reduction in the working week and the introduction of long service pay. Those were all elements of the original claim and legitimate elements of any pay claim. The unions dropped those points in the hope of facilitating negotiations. I believe that that is a perfectly reasonable thing to do, having had a great deal of experience of trade union negotiations. I see nothing unreasonable in it. On the contrary, I believe that throughout the period to which I have referred the trade union side has been very responsible and amenable.

What is the Government's position? Speaking in the Opposition debate on the ambulance dispute in another place on 11th January the Secretary of State for Health said that he had three points to make. The first was that the claim was excessive and not justified by comparison with other health service staff who had not taken industrial action.

Perhaps I may mention a few more figures in relation to that point. I apologise for quoting so many figures but they are important when talking about wages. At the moment ambulance staff receive £7,340 on entry, rising to £10,093 on qualification. The management's offer, with government approval, would raise the pay of a recruit to £8,000 and that of a qualified worker to £11,000. However, across the health service as a whole there have been many different settlements. The public sector pay awards announced on 1st February last will give doctors, nurses, midwives and others a 7 per cent. increase in April 1990. That is to be staggered so that in January next year increases will average 9 per cent. for nurses and midwives, 9.5 per cent. for hospital doctors and 11.5 per cent. for family doctors. I also understand that the chief executive himself is to receive an annual increase at that time of £4,750, which represents more than half the total annual pay of an ambulance recruit if the claim is settled.

With inflation running at above 7 per cent., is a claim above 6.5 per cent. excessive? There are millions of people in the country who think not. That was before the dramatic increase in mortgages and in other prices. Many people would agree with me that it is not, as the Secretary of State said, excessive.

A Daily Telegraph opinion poll on 7th February found that 71 per cent. of National Health Service staff thought that the offer made to ambulance staff should be increased. A mere 16 per cent. did not. How did the Secretary of State reach the conclusion that other National Health Service staff are opposed to the ambulance claim? That is just not true. All of the polls and petitions have proved that.

The Government have also argued that the ambulance service is not an emergency service. The Secretary of State's remarks about the vast majority of crews being no more than professional drivers is so contemptible that it does not merit serious consideration. The fact is that 70 per cent. of ambulance staff are on emergency duties. In my view an emergency service is one which answers emergency calls. The ambulance service answers more emergency calls than the police and fire service together. That is not to denigrate either of those two great services in any way.

If I needed any further support for that point I could quote a letter, which has been quoted before, dated August 1978 from the office of the right honourable Mrs. Margaret Thatcher, MP. The letter is in reply to one received from a trade union. It reads: In all the comments she made during the Fireman's strike, Mrs. Thatcher linked her remarks not just to the firemen but to what she, and you, call 'the Emergency services'. All three deserve to have their pay negotiation put outside the arena of industrial dispute by being given firm and automatic linkage to national price or wage rises. Mrs. Thatcher agrees with you about this".

The letter is signed: Matthew Parris, Private Office of the Leader of the Opposition".

That is quite hefty support. I do not know what has changed or whether the Prime Minister is still of the same view. However, we have not heard her speak on the issue for a long time.

The Secretary of State's second point was that the management's offer is fair and generous and should be accepted. I think that I have done enough to show why I believe that it is unfair and far from generous. Even so, a further small comparison with the other emergency services underlines the point. At present an ambulance recruit receives £8,000, rising to £11,000. A fireman receives £11,505 on entry rising to £13,180 and eventually to £13,763. On entry a policeman receives £10,587, rising to £12,756 and ultimately to £16,521. I do not believe that anyone can deny on the basis of those figures and the work of the emergency services —I shall not go into the tremendous work that they do daily, and more particularly in national incidents —that the ambulance service is not underpaid.

The Secretary of State has said that it is not his place to intervene. It was he who decided and announced that no more money was available. That is intervention. He said that quite clearly and has repeated it and made other statements which may be construed in any negotiations as being interfering. He said that the £6 million to be spent on ambulance men's pay is fair and reasonable, but in the view of millions of people the Government's offer is clearly unfair and is certainly not generous.

We are bound to ask for how long the Government intend to ignore public opinion, if nothing else. What other government would ignore the opinion of millions of people? One could have expected the support to have dwindled, but public support is now as strong as it was in the first week and in some areas even stronger. The ambulance men could not have been sustained otherwise. Does that count for nothing in the eyes of the people who are supposed to be running the dispute for the Government?

The Secretary of State said that there was no more money available, but he has made available millions of pounds to prolong the dispute. Parliamentary Questions in another place have elicited the information that the basic rate charged by the police for ambulance duties is £16.60 per hour in the West Midlands and £16.20 in London. Overtime rates range between £25 and £35 an hour. That does not include vehicle, administration or pension costs.

Those are the basic charges for the service. A qualified ambulance man or woman earns £4.96 per hour and no overtime premium. How can one say that that is generous, excessive and unjustifiable? The facts do not bear that out.

Up to two weeks ago the Government had spent an estimated £20 million —that is an underestimate —on police and army costs in the dispute. That is £10 million more than would have been needed to meet the union claim in full. Surely that is madness, not management. No one can justify that course of action.

We understand that, in addition, £241,000 of public money has been spent on an advertising campaign to inform the staff of the management's offer. That is a gross misuse of public funds. A total of 22,000 staff have had to be informed at a cost of £241,000. That works out at £10.90 per head. That money could have purchased, for example, 12,000 defibrillators which are not currently supplied by the NHS, although I understood that they were part of the ambulance equipment and were supplied by the NHS, funded by the Government. However, they are currently obtained through charity work undertaken by ambulance staff in their own time. That is how they obtain their defibrillators. The advertising campaign cost £10.90 per head. On a per capita basis, that must surely be the most expensive campaign on any issue. I suggest that it is one more for the Guinness Book of Records.

The Secretary of State's third point in the debate was that industrial action organised and taken by the unions concerned is against the interests of patients and patient services. There is an element of truth in that argument. It would be impossible to take any kind of action that did not affect patients and patient services. However, we must look deeper into the matter because the truth is that the unions and their members would prefer not to be in that position. They have offered many alternatives. That is why they have kept their legitimate protest action to a minimum and have continued to answer emergency calls, despite wildcat management and government action to prevent them from doing so. The Secretary of State called in the police and the army and continues to pursue that course of action even though those services are quite inadequate for the task, although the people concerned are doing their best in the circumstances.

The chairman of the metropolitan branch of the Police Federation said: At the end of the day apart from being totally unqualified to run an efficient service, we are using vehicles which really any self-respecting prisoner would complain about, let alone a patient".

He said that they have a standing instruction not to convey people with head injuries in police vehicles, yet that is what they are doing. The vehicles are not designed for that purpose; they are designed to carry goods, not people. If the money is there, he asked, why cannot it be used to solve the dispute? That is a perfectly reasonable question from a perfectly reasonable man. I echo his statement.

It is clearly not in the patient's interests to have a protracted dispute when the Government have it in their power to take constructive steps to end it. The Secretary of State should be prepared to meet the union negotiators face to face. There is no point in television or radio broadcasts and press comment. He should meet the negotiators face to face. If there is a disagreement, they should proceed to arbitration. Before someone tells me that there is no room for arbitration, I should point out that it has been said to me before in this Chamber that there is no arbitration procedure under the Whitley Council. That is not true; I checked it. There must be some discussion about the arbitration procedure. Section 21 of Appendix 1 of the revised main constitution of January 1984 sets out the procedure that could be followed to permit arbitration even under the Whitley Council.

No case has therefore been made out as to why the Government have refused the unions' repeated demands and requests for arbitration and to accept the results of arbitration. Neither I nor anyone in the trade union movement can understand that. So far as I know, there is no other example of a case in which an employer has refused in those circumstances, after 23 weeks, to accept unbinding arbitration. That must be another record.

The case is justifiable. It is not excessive. Given that the unions are prepared to negotiate and to go to binding arbitration if necessary, I suggest that that is what the Government should do.

6.27 p.m.

The Earl of Longford

My Lords, my noble friend Lord Stallard has made a powerful speech full of knowledge, experience and warmth. Mine is a small voice compared with his. I have few working rules in this House, but one is to support any Motion brought forward by my noble friend. That has not got me into trouble yet. No doubt it will do so one day, but not this evening. Now I come to think of it, another of my rules is never to refer to the noble Lord, Lord Boyd-Carpenter, without preparing myself to meet a formidable intervention. I do not know whether that rule will be proved right immediately. I see that it will be discarded in future.

The popularity of the ambulance men is beyond dispute. Everyone is aware of that. My noble friend Lord Stallard brought that point home to us. It is strange for me to be associated with a popular cause. I have not quite got the feel of it. People sometimes decline to support me in an enterprise because they believe that my side is likely to lose, but that is not so here.

Lord Stallard

My noble friend has backed a winner this time.

The Earl of Longford

That is right. The arguments have been set out so clearly and decisively by my noble friend Lord Stallard that I need not go over the facts again. There has been a decline in the relative position of the ambulance men. The Government have offered them a pay increase which does not keep up with inflation and therefore represents a decrease in real terms. Those facts are beyond dispute. I do not think that any fair-minded person could possibly believe that the Government were being worthy of what one expects from a British Government if they make no move towards the ambulance men.

In the few minutes at my disposal I should like to touch on a rather wider aspect of this Question which is perhaps controversial but nevertheless relevant. It seems that the Government call on the ambulance men —indeed, expect and demand them —to show more concern for the public interest. The Minister concerned said that industrial action in an essential industry is in any case wrong, but it seems that, speaking broadly, the Government expect the ambulance men to be more public spirited and more unselfish than others. That is the Govenment speaking with one of their voices.

But what is their attitude to the pursuit of wealth in other areas? To pursue wealth is regarded by our present rulers as a great virtue. I have not heard the Government criticise the doubling of the salary of the chairman of British Rail. A booking clerk who has to work seven days a week in order to keep going will criticise it but, so far as I know, the Government have not said that there is anything wrong about it. But what can be right about doubling the salary of the chairman of British Rail? Is it suggested that the last chairman was not quite up to the job, or that this one is so superlative that he should be paid twice the salary that anyone else would normally be paid? The argument for the pursuit of wealth which seems to appeal to the Government is the one which says: if you can get the money, then go for it and good luck to you.

I should like to deal for a moment with an article by the former Chancellor of the Exchequer which appeared last Tuesday in The Times. He is a man of brilliant gifts. I have the greatest admiration for him. When I was his tutor for a short time at Oxford he was thought to be the best philosophy student of his year. I did not teach him philosophy or economics. I taught him politics and whether he is seen as successful in that area only time and history will decide. At any rate he is a brilliant man.

Now that he is no longer the Chancellor he earns fabulous money. It led even a royal chaplain to criticise him for greed. It must be quite unusual for a former Chancellor to be criticised by a royal chaplain for greed. He has been attacked for being about to receive what most people would regard as enormous sums of money for relatively little work. I gather that he will be doing as much as some of the less active Members of this House. However, he will be paid an enormous sum.

In his article in The Times he said: The idea of noblesse oblige in government" — and noble Lords may think that in this House noblesse oblige would be well regarded, but it is not highly regarded by Mr. Lawson — automatically creates a civil service ethos which is hostile to wealth". So there is the idea that if any noble Lords in considering the poor and disadvantaged feel that they are greatly privileged —and that is what is usually meant by noblesse oblige—then there is about them a smell of the Civil Service and their whole attitude is inimical to wealth.

The article goes on to say: If you say nobility is associated with low pay"— and some of us in this House would think that it was — then it is a very easy transition to say that those who are on large salaries, those who do what they are doing for the money, are ignoble". I would not say that they are ignoble, but the pursuit of money for money's sake can be overdone, and they are doing it for money.

To return to the ambulance workers, the Government say that they have to think of the public. Of course Mr. Lawson is not the Government, and to be fair —and possibly I anticipate something which might have occurred to the noble Baroness who is to reply to this Question —I understand that Mrs. Thatcher has renounced part of her salary. I think that she might give a few instructions in public spiritedness to the former Chancellor. However, I do not think that that was the reason why he left the Government.

At any rate, those are the two voices of the Government. On the one hand they call on the ambulance men, who are receiving less than the average wage at this present time, to restrain themselves and not to take advantage of their position. On the other hand they encourage the pursuit of wealth without restraint and the collection of whatever rewards, however vast, that come one's way. Those are the two voices that we hear. I am afraid that the second voice expresses a terrible message at this time.

We are all human. Even the Tories are human. Anyway, one cannot prove the opposite. The heading today in the Evening Standard is: "Tories Beg for Budget Boost". That is what our Tory friends are begging for; they want a Budget boost. They are thinking of their pockets. Up to a point we all think of our pockets. No one can pretend that one goes through life ignoring the need to earn one's living and the necessity to look after one's family. However, it is a question of degree and emphasis. The emphasis of the present Government is on making money by every possible means and picking up whatever rewards come one's way, however vast they may be. It is quite contradictory to any message that could possibly be of any use to settle this dispute.

6.36 p.m.

Lord Monkswell

My Lords, first I must apologise to the House for coming without any warning into the middle of this debate. I was a little late getting to the House.

The reason that I rise to take part in the debate is that I should like to say a few words about what I see as the wider implications of this dispute. I thank the noble Lord, Lord Stallard, for a very good exposition of the ambulance workers' side of the dispute and their very good case for being given what they are asking for, as well as putting the case for arbitration and some mechanism to prevent such a dispute happening again in the future. No doubt we shall hear the Government's side and their reasons why they feel that they have to stick to their position.

I look at the dispute almost impartially, dare I say, as someone who has seen both sides of industrial dispute negotiations as an ordinary worker and a shop steward but also as a manager in industry. I have had the experience of seeing both sides. That experience tells me that usually the cause of an industrial dispute is effectively mismanagement of the situation.

I readily admit that mismanagement of the situation comes from both sides, but usually and more often it is, unfortunately, the result of bad management by the management side. In that context, when faced with a long running dispute in industry, one seeks to resolve it not by giving in to every demand that the workers or unions may make, but by seeking an agreement that is fair to both sides. I believe that one of the essentials of the British psyche, if I may put it like that, is the concept of fairness. British people do not like unfairness. That is one of the problems with which we are faced in this dispute: it appears that the Government are being unfair and that the ambulance workers are being unfairly treated.

The way out is for management effectively to take some action. That action may be in terms of changing their negotiating stance. In some situations I have known a change in personnel make a significant difference. I am trying to find some opening for the Government to use to save face, because obviously that is one of the big stumbling blocks at the moment. I agree with the noble Lord, Lord Stallard, that a change of government would probably resolve the dispute very quickly, but unfortunately it does not look as though we shall have a change of government as rapidly as the East Europeans are obtaining a change in their governments these days.

It strikes me that the Secretary of State in some respects is the managing director of the health service. The chairman of the company is obviously the Prime Minister. I am not sure that it is necessary to involve the chairman of the company. It is very rare that chairmen of companies become involved in industrial disputes. They usually leave it to the managing director to respond. However, I would hope that the Secretary of State would take a personal interest in this by meeting the other side personally. That is very important. Personal contact, personal discussions, can make an immense amount of difference in industrial disputes in understanding the thinking of the other side, to come to agreements and to change the situation.

One of the problems that unfortunately we have with the Government is their apparent lack of understanding of the industrial relations scene. We saw an immensely long and damaging dispute with the teaching profession which, curiously enough, ended up with the teachers being paid more at the end of two years than they would have settled for within a couple of months at the beginning of the dispute. The longer the dispute goes on, not only does the cost mount in terms of providing and maintaining the service, but it escalates with regard to the final solution. I implore the Government, not only for the sake of the dedicated ambulance workers but for all the people of this country, to resolve the dispute. It is in their hands to resolve it and they should take steps to do so as soon as possible.

Lord McColl of Dulwich

My Lords, before the noble Lord sits down perhaps I may ask this question. Does he not realise that there have been some benefits from this industrial dispute? What has come to light is that only 10 per cent. of the so-called emergency service is in fact emergency. What is happening is very interesting. Instead of little old ladies in Lewisham going by ambulance to Roehampton for the fitting of their artificial limb, a journey of four hours on average, they are being taken in great comfort by limousine at a fraction of the price and in half an hour. There are therefore some benefits from the dispute.

Another benefit is this. When one has any industrial action of health care workers one finds that mortality tends to fall, not rise. The attempted suicide rate also falls. Perhaps I should not tell your Lordships this, but when doctors strike, mortality falls.

Lord Monkswell

My Lords, I am grateful for the intervention. It does not surprise me that mortality falls when doctors go on strike. I have felt that they are a rather over-blown profession at the best of times; but I leave that to one side.

The point that the noble Lord mentions about the way that the ambulance service is being provided now, indicating interesting new ways of delivery, is very important. It is a hidden agenda behind the front of this dispute. But surely we do not need a long drawn out, horrendous dispute of this nature to show us ways in which services can be changed and the delivery of services improved. That should surely be a task of management anyhow.

If the Government believe that changes which may or may not be beneficial —that will depend on the negotiation and proper development of new aspects of the service —will be introduced more easily as a result of their supposedly winning the dispute, I have to advise them that that will not be the case. Effectively, if change which may be beneficial is imposed in the direction that the noble Lord suggested, that change will be beneficial only if it is done by agreement and negotiation. If it is imposed, we shall end up with more problems.

Viscount Slim

My Lords, perhaps I may intervene. I am sorry to harass the noble Lord. Many noble Lords have been on both sides of the negotiating table. It strikes me that the weakness from the ambulancemen's side stems from the fact that they are offering little or nothing. Surely we should see some approach with regard to better response time and better productivity, and higher levels of skill and training demanded by the ambulancemen. Is it not a fact that the management on the ambulance side may be good on television but not necessarily very good at negotiating.

Lord Monkswell

My Lords, I am rapidly becoming a jack-in-the-box. When I finish this time, I shall sit down and take no more interventions.

The point that the noble Lord was trying to make is that the ambulance men are not responsive to the possibility of change. My understanding is that the ambulance workers are a dedicated group of men and women who want to do the best they can for their patients —for the people who call on their services. I am sure that they will co-operate with management to the utmost to introduce the necessary changes that have to be made in the light of new technology and new methods of working. That is the point that I was making earlier about negotiation: agreement, enthusiastic support and encouragement by the ambulance workers will come only if the changes are introduced through a framework of negotiation. They will not come if the changes are imposed in ways that reduce the ability of ambulance workers to provide the service.

6.48 p.m.

Lord Rea

My Lords, I also apologise for not putting my name down to speak. I had thought that this Unstarred Question would be discussed at a later time when I would be unable to take part in the debate.

Perhaps I may first make a remark in response to the noble Lord, Lord McColl. I should like him to produce the figures which show that the mortality rate has gone down since the dispute. I should like him to be able to prove that that is because of the ambulance dispute.

Lord McColl of Dulwich

My Lords, I did not say that in this dispute mortality had gone down. I said that when health care workers go on strike, the tendency is for mortality to go down. I do not think that the noble Lord should be fooled by newspaper and television reports stating that because of the delay in the arrival of the ambulance of one hour Mr. So-and-So died as a result. I have gone into some of these cases and that it not so. One has a man of, say 83, there is an alleged delay of one hour, but in fact he died of pneumonia, not a heart attack as alleged. One therefore has to examine all these shroud-waving reports.

Lord Rea

My Lords, I quite agree. I would not wish to go down that line.

I wish very briefly to give noble Lords an anecdote to show that one reason why the mortality rate has not gone up is that emergency services are still being carried out by ambulance drivers, some of whom are not receiving any pay. They have been suspended. I wish to report an incident at which I was present about a month ago. I was called to see an old lady of about 80 who had fallen at home during the previous night and fractured her femur. She was in a lot of pain. An ambulance team came extremely quickly. It dealt with her very skilfully. It administered gas and air analgesia, splinted her leg, and moved her with extreme care onto the stretcher, at the same time carrying on a stream of cheerful and humorous conversation with the old lady to keep up her courage. She responded to words which were chosen exactly to suit her social background. She responded saying, "Oh thanks, that's better. You can squeeze me a bit more there, darling".

I choose that example to show that ambulance people are a dedicated group and some of them are providing services even though they are not being paid. I was able to witness professionalism in the entire trio. It was not just the leader of the team with the paramedical qualifications; the other two were co-operating in a skilful and sympathetic way to put the elderly lady comfortably into the ambulance. It is that type of sensitivity and skill that the ambulance service shows, and for which it has a deserved reputation, which explains why the British public are prepared to see a slightly larger slice of taxpayers' money going to equalise the pay of ambulance workers with other public service workers who are doing worthwhile and vital jobs.

6.51 p.m.

Lord Rochester

My Lords, in this short debate I am anxious to say nothing that might make it harder for a settlement of this unhappy dispute to be reached. I would go further and say respectfully that in my experience it is rarely, if ever, helpful for people without close knowledge of all the factors involved to intervene in industrial disputes. That goes for politicians such as ourselves as much as anyone else, and the course the discussion has taken tonight supports my view.

However, since the debate is taking place —I am sure that in initiating it the noble Lord, Lord Stallard, sincerely wishes the dispute to be brought to an end as soon as possible —I shall confine what little I have to say to a few observations designed to facilitate rather than hinder a settlement.

On 23rd Janaury last I asked the noble Baroness, Lady Hooper, to confirm that the Chief Executive of the NHS has proposed that the management and staff sides should undertake a joint review of the ambulance service salary structure under which no preconditions would be set. I went on to ask whether that meant, for example, that if arbitration or a review body were ruled out, at least some flexible system such as that now being introduced in parts of the Civil Service might be used in future to determine the pay of ambulance workers.

The noble Baroness said that part of the final offer which was made on 5th December included a complete review of the 1986 arrangements which aimed at maximum flexibility. On this occasion I should like to develop that theme a little. As the dispute has dragged on, attitudes on both sides have hardened. The unions are seeking a pay increase in excess of the latest offer and the promise for the future of some form of pay formula. The Government are unwilling to accept either of those claims and that refusal has been underlined by their recent decision to withdraw the automatic pay mechanism enjoyed by firefighters employed by the Ministry of Defence.

The Government are of course able to stand absolutely firm on their present position, but in my opinion they would be unwise to do so. If they do, it will be at the cost of ambulance crews eventually returning to work in bitter mood at considerable cost to the service. There is need, as I see it, for some movement on both sides. The recent suggestion made by chief ambulance officers that there should be a 16 per cent. pay increase to cover a period of two years from April 1989 to April 1991 and that the question of a pay mechanism should be left for future talks seems to me to provide a possible basis for further negotiation.

That the question of a pay mechanism should be left open amounts to much the same thing as Mr. Duncan Nichol's offer of a joint review of the 1986 salary structure under which there would be no preconditions. The Government thus have nothing to lose from such an agreement, and on the same point the door is not slammed in the faces of the unions. As for the immediate pay award, the Government have already authorised, as I understand it, an increase over a period of 18 months, and the extension of the period to two years would involve no surrender of principle on their part and might just be sufficient to enable the unions to recommend a return to work while negotiations proceeded. I therefore express the hope that the proposal put forward by the chief ambulance officers will be followed up.

In this brief contribution to the debate I have deliberately refrained from proffering any view on such difficult questions as to whether, when negotiations in disputes affecting emergency services result in a failure to agree, there should be resort to some form of independent arbitration, possibly matched by no-strike agreements; to what extent future pay negotiations should be conducted on a regional basis to take account of differing labour market pressures; how far a distinction should be drawn between trained paramedical staff and others, and so on. That is because in trying to solve industrial problems one has to start from where people are and not from where one thinks they should be. In what little I have seen fit to say, I have tried hard to bear that thought in mind, for in this dispute room for manoeuvre in seeking a settlement which the parties involved can accept without humiliation is small.

6.58 p.m.

Lord Ennals

My Lords, the House will be grateful to my noble friend Lord Stallard for having raised the debate on an urgent issue. He said that there is great respect, and indeed admiration, for the way in which ambulance staff do their duty and often far more than their duty. He put the ambulance workers' case fairly. In this debate we are clearly not able to produce a solution, but it gives us the opportunity, as the noble Lord, Lord Rochester, has done, to put forward some ideas for consideration and, as some of my noble friends have done, to draw attention to the disgraceful way in which the ambulance workers have been treated.

Apart from the fact that the ambulance workers have now been out for 22 weeks without any significant proposals from the Government, they have also been the victims of a campaign of distortion by the Government, and principally by the Secretary of State. He has misled the public in a number of respects. He has claimed that union leaders recommended acceptance of 6.5 per cent. before the dispute turned into industrial action. That is simply not true. The national officers clearly stated that 6.5 per cent. was the best which could be achieved without industrial action. There was no acceptable recommendation to make. Therefore, I believe that that is very unfair on the ambulance officers who have been representing their unions in this dispute.

As my noble friend said, there has been a distortion about the actual offer made. The offer of 9 per cent. over 18 months amounts, as my noble friend said, to 6.5 per cent. over 12 months. It is no more than that but simply looks better. London staffs are frequently presented as having been offered more than that sum. That is also not true. London weighting is added on to 6.5 per cent. so that it becomes a 9 per cent. offer to make it appear more substantial. The 18 months' time extension also makes the offer look more substantial than it is.

As my noble friend also said, as part of the distortion the Government have spent an estimated £20 million on police and army costs in the dispute. That is twice as much as would have been needed to settle the dispute. He also referred to the advertising campaign. I too wish to refer to that because I believe that it is absolutely wrong that money which should have been used for patient care or for the pay of ambulance men should be used on that excessive scale, as has been said, to inform the staff of the management offer. I believe that that was a piece of propaganda which should not have been paid for from the public purse.

We also know of lives being put at risk. I heard what the noble Lord, Lord McColl, said, but he knows that there have been substantial increases in deaths on arrival. The noble Lord shakes his head. Of course it is too early for nationwide statistics but it was revealed by Ministers in another place last week that the number of deaths on arrival had increased by 30 per cent. in South Yorkshire during the dispute. There has been an increase of 100 per cent. in Sheffield.

Lord McColl of Dulwich

It was winter-time and the mortality rate increases then.

Lord Ennals

But this was compared with other similar times. Therefore, such figures as are available suggest that there has been an increase. When the time comes no doubt the Government will give their figures to prove that that is not the case if it is not so. However, I believe that it is the case.

My noble friend Lord Stallard and other noble friends who supported him have shown that there is massive support in this country for the stand taken by the ambulance workers. The opinion poll published in the Telegraph last week showed that 85 per cent. supported the ambulance staff, with only 6 per cent. backing the Government. Ambulance workers are very highly respected, along with the police and the fire service. A few days ago the Prime Minister said that the Government had, a duty to others in the health service". Interestingly, the opinion poll showed that the strongest support for the claims of the ambulance men comes from others employed in the National Health Service. According to that Gallup poll, some 82 per cent. of ancillary workers, porters and cleaners, supported the claim and said that they would not use a new offer to the ambulance men as a bargaining counter. The nursing staff, by seven to one, said the same. Apparently, according to that poll, the highest support for an improved offer came from those declaring themselves to be Conservative supporters. It is certainly not a party issue.

On 29th November, 12 weeks into the dispute, 15 Peers from all parties wrote to the Secretary of State asking him to take action to bring the dispute to an end either by renewed negotiations or by arbitration. They did not take sides on the dispute or put forward positive proposals as to what the settlement should be. Five weeks later Mr. Clarke replied saying that the dispute was for management and not for Ministers to decide and that the final offer had been made. We have heard before about final offers, but all the evidence is that that final offer has not been and will not be accepted. He also turned down a request of the all-party group of Peers, all with great experience of the National Health Service, to meet with him to express their concern. I must say that in my view his refusal was an act of some discourtesy.

Therefore, we reached the conclusion that if this was a matter for management, it might be helpful if we could have a meeting with Mr. Duncan Nichol, who is the National Health Service Chief Executive, together with Mr. Roger Poole and other union negotiators. They were invited to attend a meeting of Peers in your Lordships' House. Today I received a letter from Mr. Duncan Nichol in which he rejected the offer. His letter said: I do appreciate your concern and your offer to arrange a meeting but I have to say that at the moment I do not believe such a meeting would serve any useful purpose … It is now six weeks since I wrote to Roger Poole telling him I would be willing to hold further talks, but only if there was some indication of a significant change in position. I am still waiting for his reply and am forced to conclude that he is not willing to consider any change. In these circumstances the kind of meeting you suggest would not, I regret, take us any further down the road towards a resolution". Perhaps such a meeting would not achieve a resolution. I do not pretend for a moment that a meeting without the privacy of negotiations could ever produce a solution.

However, what is very interesting is the reply which I received from the unions. A letter which has been approved by the five unions and endorsed by Mr. Roger Poole said that Mr. Duncan Nichol has refused further talks unless the unions revealed their precise negotiating position before a meeting was called. The unions cannot be expected to do that because they believe that it would undermine their whole bargaining process. However, they have made it clear that the figure of 11.14 per cent., which is their proposal, is not their last word. It is a negotiating gambit if the Government would only take it as the basis of talks, which of course might produce something else.

The unions have said: the unions are willing to negotiate because their aim is to achieve the best possible pay deal for their low paid members, not to score political points or to 'win' a victory over the Health Secretary, Mr. Kenneth Clarke". Their attitude and that of Mr. Duncan Nichol suggests to me that there would be advantage in their meeting. Perhaps they should not meet together in your Lordships' House but perhaps they should meet if the Secretary of State was prepared to do so.

I am extremely critical of the way in which the Secretary of State, after 22 weeks and a clear willingness on both sides to find a basis of agreement, is simply not prepared to bring them together. I hope that one lesson which may come from the debate in this House is that the Secretary of State should be prepared to bring together the two sides. Of course management has its important role, as well as the representatives of the unions. However, it is the Secretary of State who holds the money bag. Mr. Duncan Nichol cannot move forward unless the Secretary of State gives him his approval. I believe that that is for the Secretary of State to decide.

There are other reasons to think that the time is now propitious. In the Financial Times on 13th February, Mr. David Rennie, chairman of the management side of the Whitley Council ambulance negotiating body, said that he felt confident that the recommendations made by the Select Committee to the Whitley Council that an arbitration mechanism ought to be built in was the way forward. He said that the Government had acknowledged that that should be discussed. He said: It is the civilised way of dealing with disputes". I do not know whether that proposal has been put to the unions, but it seems to me that the moment has now been reached, with sensible suggestions not only from the management side but also by the Association of Chief Ambulance Officers, for the Secretary of State to intervene and to try to find the basis for a settlement and to stop the dispute. I hope that we shall hear from the Minister as to what the Government are doing to bring this dispute to an end.

7.10 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)

My Lords, the House is grateful to the noble Lord, Lord Stallard, for having introduced this debate and for the way in which he did so. It gives me the opportunity to pay tribute to the skilled and dedicated service of ambulance staff in caring for the sick and injured, often in stressful and hazardous circumstances. This is an acknowledgement that has frequently been made by the Government in the course of the dispute, and indeed before, and perhaps in particular by my right honourable friend the Prime Minister and my right honourable friend the Secretary of State.

It is very sad that many of these ambulance staff have felt obliged to take action which can only hurt patients in pursuance of a pay claim. Because of this I should like to give my special thanks to the chief ambulance officers and their staff, the voluntary organisations and the police and the army who are struggling to maintain an acceptable level of services.

Since this dispute started much has been written and said about the way forward and the way out of this dispute. I think we have to acknowledge, as indeed some of your Lordships already have, that we have heard nothing new in the course of this debate. Indeed, I myself have no new information or initiatives to announce, but what I can say today will, I hope, be helpful in setting the facts in their proper context.

Perhaps I may start by referring to the final offer made by the management side on 5th December last year. Much has been made of the idea that the offer of 9 per cent. over 18 months is really only 6.5 per cent. over 12 months in disguise. But I must say to your Lordships that if ambulance staff were to accept this final offer they would then receive increases of at least 9 per cent. on their basic pay rates backdated to April. That is a good deal more than the 6.5 per cent. rejected by the unions after they had initially recommend it to their members.

I can quote from a letter of 8th May last year written by Mr. Roger Poole which said that after giving detailed consideration to the pay offer and hearing from those members of the committee that sit on the ambulance council they had decided to recommend acceptance of the offer. But times have changed.

Lord Ennals

My Lords, would the noble Baroness put that letter in the Library? It would be helpful to others who are interested. She has referred only to an excerpt from the letter.

Baroness Hooper

My Lords, the letter is probably readily available and I see no reason why it should not be placed in the Library for the convenience of your Lordships.

Returning to the terms of this final offer, I would add that staff in the London ambulance service had been offered additional money —that is over and above the 9 per cent. backdated to April —which would increase their basic pay by as much as 12 per cent. and their overtime rates by over 20 per cent. In addition, fully trained paramedics would receive an additional £500 per annum, again backdated to 1st April 1989.

Those with intermediate skills have also been promised increases yet to be determined, but again they would be backdated to April of last year. All this has meant that £6 million of new money has been added to the cost of the 6.5 per cent. original offer in the current financial year. This fact is not generally understood or appreciated, and so I have tried to say it once again as clearly as possible because it shows how much the original 6.5 per cent. offer has been improved.

Lord Monkswell

My Lords, I am sorry to intervene, but the Minister has said that the money would be backdated and paid from 1st April. The problem I have is that I believe that a number of ambulance workers have been suspended and they have not been paid. Are the Government effectively saying that all those who have had pay withheld from them during this dispute will be paid fully, including the increase that the Government are talking about?

Baroness Hooper

My Lords, I would have thought that that was most unlikely. If the terms of their suspension are that they are not paid during that period, obviously backdating covers only the period when they were working and not when they were suspended.

The plain fact is that the unions themselves have not changed the essence of their claim over the last few months. Their bottom line still appears to be a substantial increase in basic rates in the current financial year, plus some form of pay formula for the future, as the noble Lord, Lord Stallard, reiterated. Small wonder therefore that the National Health Service Chief Executive, Duncan Nichol, has told the unions that until they indicate that they are prepared to change their position significantly there is little point in further talks.

This of course was the point made by the chief executive to the noble Lord, Lord Ennals, in his letter. I had not had the benefit of hearing the union's response to the noble Lord's offer and was interested to hear it. I understand, however, that a number of Members of another place have also made similar offers to mediate. Therefore, there appears to be no shortage of volunteers.

Lord Ennals

I have not offered to mediate. I hope that the noble Baroness was not referring to me.

Baroness Hooper

I understood that the tenor of the offer made by the noble Lord, Lord Ennals, and the other Peers involved was that they would.

Lord Ennals

No, my Lords. There was no such suggestion. It would be absolutely inappropriate. We wanted the opportunity of hearing the views of both sides. If there was then common ground, they could go away and talk about it; but I do not think that any of us would say either individually or collectively that we had a mediatory role.

Baroness Hooper

I am glad to have that point clarified. If the noble Lord had felt that it would be of any value, I had been about to say that I would be happy to see him and the other Peers who had volunteered to discuss the matter if he wished.

The unions offer nothing in return for their demand for high basic increases. Therefore we have to return to the fact that over 96 per cent. of all National Health Service staff have already settled their pay for this year —that is, from April 1989 to March 1990 —without recourse to industrial action, and many at rates of increase around 6.5 per cent.

The noble Lord, Lord Monkswell, talks of fairness, but I think he should bear this in mind. Those that have been given more than this are to be subject to major pay restructuring, have agreed to local pay flexibility or have serious problems of recruitment or retention, which we all acknowledge have to be dealt with.

Lord Monkswell

My Lords, I am sorry to intervene, but fairness, like beauty, is in the eye of the beholder, and the British public behold the Government not to be fair to the ambulance workers.

Baroness Hooper

I regret to say that the British public are probably influenced by some of the rather inaccurate statements made in the British press.

Ambulance staff themselves received much higher than average increases in 1986 —we have talked about this before —when the new salaried structure was introduced. And in the current offer London staff have been offered higher increases because of recruitment problems in the London area which, as I said, we all acknowledge.

It was the 1986 salaried structure which raised the myth about pay parity with the fire service and the call for a pay formula. Pay accounts for over 70 per cent. of National Health Service current expenditure. It would be a rash management indeed that did not want some control over the amounts paid out for such a high percentage of total costs.

I remind your Lordships that the total pay bill for the National Health Service amounted to about £13 billion last year. Some commentators advocate a mere 1 or 2 per cent. addition to pay offers to secure a quick settlement. That is an attractive argument in newspaper headline terms, but each "mere 1 per cent." costs the National Health Service over £100 million. Indeed 1 per cent. for all Whitley Council staff adds up to about £40 million, which in fact is the equivalent of the entire budget of a major teaching hospital.

If pay control is lost —and that is the effect of introducing pay formulas which automatically trigger increases or handing over responsibility to a pay review body or independent arbitrator —then resources might have to be diverted from patient care into the pay budget. Next year total resources for the National Health Service in the UK will increase by £2.7 billion. We do not want to spend a large part of that on pay increases instead of on patient care. That is where our priorities lie.

I should like to quote in support of that one of your Lordships who said in another place (at cols. 28–29 of Hansard on 22nd January 1979): I must make it clear to the House that this Government cannot and will not abdicate their responsibility and let wages rip. That is the road to disaster. The only results would be a return to mounting inflation, cuts in public services, high taxes and more on the dole. Those who will suffer most from all this will be the low paid and those on fixed incomes, such as pensioners. This is the law of the pay jungle". The person I am quoting is none other than the noble Lord, Lord Ennals, who made this jolly good speech almost 10 years ago as the then Secretary of State. That is very helpful to the Government's case today.

Lord Ennals

My Lords, the noble Baroness looked as if she was expecting me to ask her to give way. She accepts, does she not, that the ambulance dispute in the winter of discontent —to save her the use of those words —was brought to an end by a modest increase in what had previously been offered and rejected and that the Secretary of State played a considerable part in that?

Baroness Hooper

My Lords, of course I am happy to acknowledge that and also happy to return again to the 1986 salaried structure argument which was intended to set this on a sensible basis and which, indeed, was acknowledged by the Government so to do. That 1986 salaried structure was a good deal for ambulance staff. We should not be misled into believing that the basis of the deal has been undermined since 1986. Not only has the value of the salaries accepted then been more than maintained in real terms, but in 1988 the standard working week was reduced by one hour to 39 hours. That is an overall real improvement of over eight percentage points. When comparisons are made with the pay of firefighters, we should remember that they work a 42-hour week.

A very important aspect of the final pay offer is the review of the 1986 salaried structure. This would have a wide agenda and will include flexible local pay arrangements linked with productivity, recruitment and retention; but so far, I am sorry to report, the unions have shown no interest.

The noble Lord, Lord Stallard, quoted figures on pay. I return to the fray with some other figures. These are based on the ambulance crews' weekly earnings as opposed to the average gross weekly earnings. We do not record centrally gross earnings of individual ambulance staff, but because we are always being asked we have made an assumption that ambulance men and women work an average of two hours' overtime each week. In some areas of course they work far more than that and in others they work less. The gross weekly pay of a qualified ambulance person, including the final pay offer but without the addition for paramedic skills, would be almost £222 outside London; on an annual basis that is around £11,565. In London the figure would be almost £250, which on an annual basis is around £13,000. In the most recent Department of Employment new earnings survey published at the end of 1989 the gross average weekly earnings of full-time male manual workers on adult rates was £217.80, which again on an annual basis is £11,325. In that context the offer made to the ambulance men bears favourable comparison.

Comparisons were made between ambulance staff and firefighters but I believe that realistically they cannot be directly compared. The settlement date for ambulance staff is April and for firefighers it is November. As I have already said, ambulance staff work a 39-hour basic week and firefighters work 42 hours. Comparisons are made with fifth year qualified firefighters; ambulance staff can in fact become qualified after 15 months.

With regard to the funding of extended training, in 1984 the Department of Health endorsed extended training of emergency ambulance crews in certain immediate care techniques. In doing so we recognised that ambulance staff had a vital role to play in immediate patient care. We also endorsed the NHSTA's extended training package. Most health authorities have taken the opportunity to use that package. However, we believe it is for health authorities to make arrangements for extended training and in doing that they need to take account of local circumstances and resources.

I believe that the noble Lord, Lord Stallard, also referred to arbitration. There is no provision for independent arbitration in National Health Service pay agreements. The same arguments against arbitration apply as those against pay formulas and review bodies; those points I have already made. We believe that the management cannot hand over control of the amount to be spent on salaries and wages to outsiders who have no responsibility for the provision of patient care.

Reference was also made to standby allowances. An increase in standby allowances is included in the management side's offer of 5th December. Increases for pay review bodies staff are for next year's settlement, which will be from 1st April in the next financial year. Management side's offer is backdated to 1st April last year.

The noble Lord, Lord Stallard, sought to resurrect a 1978 letter —if I recollect correctly —in aid of the Labour Party's support of the ambulance staff action. As regards the Government's commitment, the 1979 Conservative manifesto was very clear on public sector pay. It was on the basis of our policy in that manifesto that we were, after all, elected and re-elected to government. Among the commitments we accepted in taking up office was the implementation of the recommendations of the independent Clegg Commission which provided for very generous pay increases for the ambulance service which, as I have already said, we met in full.

I was asked whether the ambulance service is an emergency service and whether the Government really recognise that. Successive Secretaries of State have acknowledged that a proportion of ambulance service work is of an emergency nature. That proportion is approximately 10 per cent. Urgent work, which is subject to a limited time specified by a GP or a consultant, constitutes 5 per cent. of ambulance work; the balance of 85 per cent. is of a non-emergency nature. Approximately 70 per cent. of the total cost of the service is devoted to that 15 per cent. of emergency and urgent services.

Lord Ennals

My Lords, I am grateful to the noble Baroness for giving way. Does she not accept that the amount of time spent by ambulance workers on emergency work is higher than that of the police and the fire service?

Baroness Hooper

My Lords, I cannot accept that because I do not know the detailed figures. I shall certainly look into that matter. I believe it was suggested by the noble Lord, Lord Monkswell, that there was a hidden agenda in the way the service is delivered. That is not so. I believe that it is often forgotten that in April 1984 we published a scrutiny report on a non-emergency sector of the ambulance service in which we said that it was open to district health authorities to buy in part of the ambulance service from the private sector if that was more cost-effective and provided that the quality of service was maintained.

As a result, many National Health Service ambulance authorities already use private contractors; namely, the hospital car service and the voluntary aid societies which transport appropriate National Health Service patients. That has been the case for many years. It helps to ensure that skilled ambulance crews and specialist vehicles are used for those who really need the special care and attention which they can provide. There is no hidden agenda.

My noble friend Lord McColl said that there are some benefits which have come from this dispute.

He quoted some very telling examples for which I am most grateful. In my view, if any good has come out of this dispute, it is that a number of longstanding shortcomings in the ambulance service have been brought sharply into focus, not least the fact that there is a greater realisation of the enormous benefits to be gained by splitting the accident and emergency services from more routine work as already happens in some services. We were going in that direction, but I believe that movement has been stimulated as a result of the dispute.

Lord Stallard

My Lords, will the noble Baroness accept that so far her reply has been very disappointing? She has simply repeated what her right honourable friend the Secretary of State has said, much of which has been rebutted. The rest can be the subject of negotiation. The noble Baroness has still not replied to the Question —or is she saying that the simple answer to the Question is "none"?

Baroness Hooper

My Lords, I believe that I made it quite clear at the outset that nothing new had arisen on either side so far as I was aware. Therefore, it would be very difficult for me to use new arguments in responding to old questions. I turn to a point which the noble Lord, Lord Rochester, raised about a meeting of chief ambulance officers which took place yesterday with the National Health Service Chief Executive, Duncan Nichol. The chief ambulance officers agreed with him that a pay formula was inconsistent with local pay flexibility and the right to manage. They also agreed that a two-year deal was likely to play a part in settling the dispute.

Apart from that I was glad to hear the open-minded views of the noble Lord, Lord Rochester, on the future of the service. There is no doubt where the future lies. That has again been spelt out very clearly by my right honourable friend the Secretary of State. Again, I regret that I am not saying anything that will be new to the noble Lord, Lord Stallard. We want a better accident and emergency service which lays greater emphasis on developing paramedic skills and which at the same time provides an efficient and caring service on the routine transport side. We are intent on raising the standards of the accident and emergency service to the best now operating. Some services operate very efficiently in that respect.

We see it as a service with a minimum requirement of one paramedic to each front line ambulance. That raises a number of issues about the provision of paramedic training and equipment. We are giving these matters our full consideration. We want local productivity deals which will release resources to pay staff more through locally agreed flexibility deals. Above all, we want a settlement of the present dispute so that the prospect of an ambulance service fit for the 1990s and providing the level of service which the public has the right to expect can become a reality.

The only way to achieve that is for the ambulance staff to recognise that the final offer made by the management side is a fair one, which I believe I have been able to make quite clear this evening. They should accept it and return to normal working. It may be that we have not found a new solution in the course of this debate, but we are all grateful to the noble Lord, Lord Stallard, for giving us the opportunity to make our positions perfectly clear.

Lord Rochester

My Lords, the noble Baroness was kind enough to refer to what I said about the chief ambulance officers. Would she be prepared to go so far as to say that there may be some merit in the suggestion that I put forward that the management side might be willing to leave for future talks the whole question of a pay formula?

Baroness Hooper

My Lords, I think I have made our position perfectly clear on the question of how we view a possible pay formula. It is a subject which will always be considered. It forms no part of the proposals and the arrangements we are making in relation to the current dispute.