DOCTORS' AND DENTISTS' REMUNERATION (INTERIM ADJUSTMENT)

HC Deb 16 April 1957 vol 568 cc1753-7

The Prime Minister (Mr. Harold Macmillan)

With your permission, Mr. Speaker, I will make a statement on the remuneration of doctors and dentists.

Before the Royal Commission was appointed I explained that its appointment did not preclude an interim adjustment in advance of and without prejudice to its recommendations. An adjustment was made in the remuneration of the junior hospital staff, both medical and dental, at the beginning of this month, when their remuneration was increased by 10 per cent. In announcing this increase, I said that we were considering what should be done by way of an interim adjustment for the other doctors and dentists covered by the Commission's terms of reference.

The Government have now decided to increase the basic remuneration of senior hospital medical and dental staff including consultants and specialists and all dentists engaged in general dental services by 5 per cent. from 1st May next, and from the same date to add 5 per cent. to the aggregate net remuneration of general practitioners—that is, remuneration after the deduction of practice expenses. We propose to consult representatives of the profession as to the best method of distributing this sum between individual practitioners.

In the meantime, the Royal Commission has been asked to regard its work as a matter of urgency and has, in fact, already, I understand, held six meetings. I hope that the letters I have exchanged with the then President of the Royal College of Physicians, together with the statement issued by the Chairman of the Royal Commission will reassure those who have expressed concern about the terms of reference.

I hope now that all concerned will turn their thoughts to the task of working out a satisfactory basis for future remuneration, and for keeping it under review.

Dr. Summerskill

May I ask the Prime Minister four short questions? First, what was the basis used to arrive at this award? Secondly, why has this decision been made in an arbitrary fashion without negotiation with the doctors? Thirdly, why has the decision been made without any consideration of the findings of the Royal Commission? Fourthly, will the right hon. Gentleman say whether the distribution from the central pool will be similar to that made in 1952?

The Prime Minister

It was always stated by the Government that we intended to make an interim award while the Commission was sitting. The 10 per cent. was given to the junior staff and now 5 per cent. is given to the general body. The reason this procedure is adopted is that the present dispute is on a matter of the interpretation of the Spens Report. Therefore, there could riot be any agreed basis for negotiation in the ordinary way. The object of the Commission, which is really an independent body, is to find and recommend what should be the basis of remuneration both now and in the future. As to the method of calculation, I do not know whether it is similar to that in 1952. In the case of the 10 per cent., it is as I have already stated. In the case of the 5 per cent. to certain senior hospital medical and dental staffs and the dentists engaged in the general service, and of the doctors in ordinary practice, it is by adding to the aggregate net remuneration; and then we propose to consult the doctors' organisations as to the best method of distributing this money.

Mr. Gaitskell

Can the Prime Minister say how much this will cost?

The Prime Minister

The whole?

Mr. Gaitskell

Yes.

The Prime Minister

The senior medical staff, about £1,200,000. The junior medical practitioners, £2,500,000. The general dental practitioners, £1,200,000, to which I should add a 10 per cent. increase to the junior hospital staff, which is £900,000.

Mrs. Jeger

Cannot the Prime Minister give us a better explanation of the basis of these calculations? Is he saying that he thought up 10 per cent. in his sleep one night, and that on another night he thought up 5 per cent.? What is the arithmetic behind a suggestion which provides the same increase for highly paid consultants as for the humbler and overworked general practitioners?

The Prime Minister

As I have explained, we appointed a Royal Commission because, in this case, there is a disagreement as to what should be the whole basis for calculating remuneration both now and in the future. I hope that this independent body, with terms of reference which I have explained to be very wide, will reach that basis. Meanwhile, since the Commission must take a considerable time—a substantial time—to make its report, it was thought right to make this advance. I hope and believe that it will be regarded on the whole as equitable and reasonable.

Mr. Woodburn

Can the right hon. Gentleman say what steps are to be taken to see that fairness is done to the assistants? In some parts of the country quite a lot of empire building is going on among doctors and assistants. The public would like to know that the assistants were to get proper treatment under these arrangements.

The Prime Minister

No doubt my colleague the Minister of Health will take that point into account in consultation with the doctors' representatives as to the methods of distribution. We shall certainly take account of the point that the right hon. Gentleman has made.

Mr. Lipton

How does the Prime Minister expect employers and workers to accept the principle of collective bargaining if he ignores this principle in dealing with the doctors' increment of pay? Is he aware that this contempt for established machinery is regarded as a very grave injustice by the medical profession?

The Prime Minister

I do not think that that is really quite fair. It is a prerequisite of any arbitration that there should be common agreement on what the arbitration has to be about. The difficulty here is disagreement about the interpretation of the Spens Report. The most practical way—I think there is general opinion in the country supporting this—is to get the most independent body we can—and I think we have in the Royal Commission a very good independent body—to try to reach an agreed basis from which, in future, these adjustments can be made without difficulty.

Mr. Shinwell

Now that the Prime Minister is in a generous mood, will he give consideration to the plight of hon. Members?

Mr. Speaker

Dr. Johnson.

Mr. Shinwell

May I have an answer to my question?

The Prime Minister

I will, of course, take note of what the right hon. Gentleman has said.

Dr. Johnson

At the risk of being repetitious, may I ask the Prime Minister whether he will press, or ask the Minister of Health to press, upon the medical organisation the necessity of bearing in made, in distributing this 5 per cent., that there is quite serious concern at the differences in remuneration among various practitioners within the same service, and that it will give this point very serious attention in the distribution of the extra sum?

The Prime Minister

Yes, Sir. No. doubt my hon. Friend will, if necessary communicate with my right hon. Friend himself.

Mr. Blenkinsop

Can the Prime Minister assure us that at last the Minister of Health will have real power to carry out negotiations in this matter, and that he will not only take account of the position of assistants but of the position of doctors with smaller lists and will try to make a constructive settlement that will help to reduce the large lists of the richer practitioners?

The Prime Minister

It is not a question of negotiation but of consultation, and of how this interim award had better be distributed and applied. When we get the Royal Commission's Report I hope that we shall have a permanent solution of how the whole service will work in the future.

Dr. Stross

As a very important factor will be the speed at which the Royal Commission reports, can we have an assurance that its deliberations will not take more than eight or nine months from now?

The Prime Minister

I am glad that the hon. Gentleman has asked that question. I have asked the Royal Commission to do its work speedily. I have every confidence in the chairman and the members. The Commission has already had six meetings, and I hope that every possible assistance will be given to the Royal Commission to conclude its task speedily.

Mr. Ramsden

In view of the businesslike way in which the Commission is proceeding—[HON. MEMBERS: "How do you know? "]—as is shown by the fact that it has already met six times in a very short time—has my right hon. Friend some hope that the doctors will, in these changed circumstances, modify their attitude towards the Commission? Will he make it quite clear, once and for all, that it will be within the competence of the Commission to have regard to the general relevance of the Spens Report in its consideration of the matter?

The Prime Minister

All these points of the competence of the Commission were cleared in the exchange of letters which took place. I think that this has been generally regarded as wise and satisfactory. On the question of the acceptance of the Commission, I can only repeat that I very much hope that everyone concerned will now turn his labours to the work of creating a satisfactory basis for the future remuneration and future management of the Health Service.

Mr. Lee

Now that the Prime Minister has pointed out that before one can have a successful arbitration it is necessary to have some sort of offer about which to arbitrate, will he make sure that a copy of his statement goes to the shipbuilding and engineering employers?

The Prime Minister

I did not say that we had to have some kind of offer, but some kind of basis. In this case, there was one interpretation which the doctors made and which the Government felt that they could not accept. Therefore, it was felt better to have an independent body to deal with the matter.