HC Deb 25 March 1952 vol 498 cc209-13
The Minister of Health (Mr. Harry Crookshank)

I think the House should be informed at once of the result of the claim by general medical practitioners for increased remuneration in the National Health Service.

As the House is aware, the late Government agreed to refer the doctors' claim to an adjudicator on the understanding that his award would be binding on both parties, subject to agreement being reached on an improved method of distributing doctors' incomes. The present Government continued these arrangements and Mr. Justice Danckwerts was appointed to act as adjudicator.

The Secretary of State for Scotland and I have now received the adjudicator's award. Its precise effect can be determined only after more detailed study, but, broadly, it amounts to the award of an additional £9¾ million remuneration for the year 1950–51 (the year on which the award is based) with corresponding increases for previous and subsequent years.

While, as I say, the full calculations have yet to be made, I feel I should inform the House that—in very approxi- mate terms—this may involve an additional charge on the Exchequer of as much as £40 million in the coming financial year to cover the period back to 5th July, 1948. This means that in spite of the serious measures of economy which have already been proposed to restrain Health Service expenditure within a ceiling of £400 million, it will be necessary to seek a Supplementary Vote for this additional amount.

Mr. H. A. Marquand

The right hon. Gentleman has reminded us that there were two parts to this agreement to refer this matter to arbitration. Will he now confirm that there is no intention whatsoever of departing from the understanding that this involved a redistribution of incomes, including some reduction in the size of the larger lists, and a better opportunity for younger men to enter into practice—possibly also some encouragement of the establishment of group practices? May I ask the right hon. Gentleman whether, before he asks Parliament to vote the very large sum here involved, he will make available to this House the evidence which he laid before the learned adjudicator as to the size of the present earnings of doctors in the Health Service?

Mr. Crookshank

I will certainly consider that. Of course, there is no intention of asking for a Vote until the next financial year begins. We are too late this year for the matter to arise.

As regards the first question which the right hon. Gentleman asked me, it is true that there is what is called a working party now, consisting of representatives of the profession and of my Department and of the Scottish Health Department, looking into the points which he made, which were part of the reference.

Mr. Marquand

Do I understand that the working party is actually in session now?

Mr. Crookshank

I am advised that it has already started working.

Mrs. Eveline Hill

Can my right hon. Friend say what relation this award has to the recommendations in the Spens Report?

Mr. Crookshank

As I understand it, the late Government accepted the principles of the Spens Report, and what the adjudicator has now to decide is the sum of money which he considers necessary to give retrospective effect to the Report, as accepted by the Labour Government.

Mr. Somerville Hastings

Are we right in assuming that these increases in salary apply only to general practitioners?

Mr. Crookshank

That was all that was referred to the adjudicator.

Mr. Ralph Assheton

Without wishing to make any observation on the particular matter in hand, may I ask my right hon. Friend whether he does not consider this a matter which gives rise to very serious consideration; and whether there is not a growing tendency for Parliament to abandon its responsibility for controlling expenditure and placing it in the hands of other bodies?

Mr. Crookshank

My right hon. Friend will realise that all this was decided before I came into office.

Mr. A. Blenkinsop

Are we to understand from that last remark that the right hon. Gentleman disagrees with the whole conception of an independent adjudicator?

Mr. Crookshank

No, Sir, not at all. This was an honourable obligation into which I naturally had to enter. I was not, of course, concerned with what happened before, or the presumably abortive negotiations ever since 1948 which made such an adjudication necessary.

Mr. H. Hynd

As the right hon. Gentleman mentioned the "ceiling" of the Health Service, does this increased pay for doctors mean that there will be more cuts necessary in the Health Service?

Mr. Godfrey Nicholson

Can my right hon. Friend put the affair into truer perspective by giving any indication of what the ultimate burden on the taxpayer will be after recovery of taxes?

Mr. Crookshank

No, Sir, I am afraid that it is a calculation I could not make on the spur of the moment.

Mr. George Porter

In view of what the right hon. Gentleman has had to say today about the amount of extra money he is giving to medical practitioners, ought he not now to cease in his endeavour to take further money off the working class for the same Health Service?

Mr. H. Hynd

May I have a reply to my question?

Mr. Herbert Morrison

Might I press the right hon. Gentleman to answer my hon. Friend's question? This is a substantial addition, and what my hon. Friend wants to know, and what the House ought to know, is whether this sum is now to be taken within the "ceiling" with the consequence that other expenditure is to be cut. Is this to be added to the "ceiling" which has been fixed before this additional claim came along? The House really ought to know.

Mr. Crookshank

I should have thought it stood to reason that this was additional expenditure to which we shall eventually be committed, but it does not arise at the moment because it can only be covered by a Supplementary Estimate. It is too late in this financial year to discuss any further Supplementary Estimate. Therefore, it will no doubt fall to be discussed next year. That does not detract from the fact that it will still be an extra burden, one way and another, upon the Health Service, unless other steps are subsequently taken.

Mr. Morrison

The expenditure will fall, presumably, in the financial year 1952–53, which is about to begin—next week to be precise. Can we take it from the rather lengthy and complicated statement the right hon. Gentleman has just made, that the short answer is that this will be additional expenditure and will not require corresponding cuts in the Health Service? That is what I am understanding him to mean.

Mr. Crookshank

I really cannot possibly be drawn upon what the financial policy of the Government may be at some undefined date next year. The present position, if I can make it clear to the right hon. Gentleman, is that we have tried, on the Estimates before us now, to keep next year's National Health Service expenditure below the "ceiling" set by his own Government of £400 million, and in order to achieve that certain charges are to be put before the House during the debate on the National Health Service Bill. Since that decision was taken we have had an adjudication by a judge, the effect of which may be an increased cost of something like £40 million, of which a proportion, but of course not all, is concerned with next year. Some of it is back pay, as I have already indicated in my reply. What the policy of Her Majesty's Government will be with regard to that will fall to be discussed and settled when the time comes.

Mr. Marquand

Is it not a fact that the right hon. Gentleman's Estimates are pretty substantially below he "ceiling" of £400 million, and that the additional £9¾ million, though it might raise expenditure slightly above the "ceiling," would not raise it very much; and would it not be wrong to include the retrospective part, which nobody ever anticipated, as coming within the "ceiling" for the current year?

Mr. Speaker

It seems to me that the House is now anticipating a subsequent debate.