HC Deb 05 December 1960 vol 631 cc1011-24

Motion made, and Question proposed, That a Supplementary sum, not exceeding £5,212,000, be granted to Her Majesty, to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1961, for the provision of national health services for Scotland and other services connected therewith, including medical services for pensioners, etc., disabled as a result of war, or of service in the Armed Forces after the 2nd day of September, 1939, certain training arrangements, the purchase of appliances, equipment, stores, etc., necessary for the services, certain expenses in connection with civil defence, and sundry other services.

10.30 p.m.

The Joint Under-Secretary of State for Scotland (Mr. T. G. D. Galbraith)

In introducing this Supplementary Estimate, the first thing I want to say is that it covers the same ground for Scotland as that covered by the debate we have just had on the National Health Service in England and Wales.

The money we are asking for tonight is required for additional remuneration to Health Service staff. The total additional gross cost amounts to £5,912,000 and, as it is estimated that additional superannuation contributions amounting to £700,000 will become due on this, the net cost is £5,212,000.

The main item in this sum is what is required to implement the Royal Commission's recommendations on doctors' remuneration, which will cost us this year £5,124,000. There is also required a sum of £788,000 to meet Whitley awards.

The money required to cover the Royal Commission's settlement is almost equally divided between the medical staff employed in the hospital service and the general medical practitioners. The cost this year is about £2.2 million.

The settlement also provides for retrospective payments to cover the period from 1st March, 1957, when the Royal Commission was appointed, to 31st December, 1959.

A sum of £2.9 million is required to meet these retrospective payments and, again, this amount is divided more or less equally between the hospital medical staff and general medical practitioners.

The sum required for Whitley Awards, as my right hon. Friend has already explained in the case of England and Wales, represents the amount required to meet some dozen or more agreements, some covering technical and works staff employed in the Health Service and certain technical and clerical grades where the numbers employed are very small.

The major award included in this, requiring nearly half the total sum, is an award to domestic and ancillary staffs.

As the Committee will appreciate, the number and variety of staff employed in the Health Service covers a very wide range and the rates of pay are revised from time to time in the light of agreements made in the Health Service Whitley Councils.

In total this requires, in respect of agreements reached since the original Estimate was presented, £788,200.

The original Estimate for the National Health Service in Scotland was just over £64 million and, adding the increases to cover the settlement flowing from the Royal Commission recommendations and these other salary awards, the total now required is close on £70 million.

With this explanation, I trust that the Committee will approve the Supplementary Estimate for Scotland.

Miss Margaret Herbison (Lanarkshire, North)

Can the Minister give us a further explanation of Subhead J.2 "Scottish Dental Estimates Board, £8,500"?

Mr. Galbraith

I shall be delighted to do that. The additional sum of £8,500 required is in respect of clerks and other administrative units. It is not in respect of dentists themselves.

10.36 p.m.

Miss Herbison

The Joint Under-Secretary has at least given a more detailed explanation of these Estimates than we had in the previous debate. It is quite clear that the largest sum in them is in respect of the Pilkington Report, and I would like to stress the point which has already been mentioned by my right hon. Friend. There is a feeling among doctors in hospitals that there has been a tardiness in deciding how soon they were to have their increases paid to them. I know that the Minister tried to explain this away, but I would ask the Joint Under-Secretary to ensure that everything possible is done to award those increases very soon. Many of the doctors concerned are very much worse off than the majority of general practitioners in Scotland, and that makes it all the more necessary to give them their increase.

I am glad that the general practitioners are getting this increase, because they form the backbone of the Health Service. A good general practitioner service should mean a good Health Service. Although there are many criticisms I could make on various points, I cannot do so in this debate, but it seems to me that it is not sufficient for the Minister to say that they accepted the Report as it stood and as a whole. He seemed to think that that was a good enough answer for not trying to get agreement between the doctors and the Ministry, or the doctors and the Scottish Health Department, on what might be done, as a result of these awards, to improve the service considerably. Those of us who are asked to pass these Supplementary Estimates feel that we cannot merely accept a statement made by the Minister.

The lists of some doctors are far too large, especially in areas where it is of the greatest importance that doctors ought not to have too many people on their lists. That question should have been discussed in a very friendly way with the doctors, and I should have thought that it might have led to an agreement for a reduction in the permitted number on a list.

Time and time again we have raised the question of group practice. Before the Minister came clean in this debate our English colleagues had to raise a number of questions on this matter. The Minister has not yet said that not a penny of this £1 million is included in the Scottish, English or Welsh Estimates. He just said, "Well, it is not all included." I want to take it for granted that perhaps some is included, and the Minister ought to tell us if it is not. If it is, I have the same right as may hon. Friends who represent English constituencies to raise certain questions.

There are a few suggestions I should like to make regarding ways and means of spending this money. There was a fund set up to help doctors to form group practices. Where such practices have been formed it has led to a much better service. I can think of many areas in Scotland where a group practice would give the people a much better service than exists at present. If some of the £1 million is contained in the Estimate, will it be possible to get agreement that part of it might be used to set up group practices? I should like the Joint Under-Secretary to consider that.

I understand that the Working Party is to have representatives from the Department of Health for Scotland, the Ministry of Education and the general practitioners. I hope that forward-looking ideas will be proposed by the representatives of the Ministries. One of my hon. Friends mentioned the need for better facilities for those patients who have to wait in waiting rooms at surgeries, and there are many other ways in which improvements could be made in the Service.

I know that the increase in salaries is included in the Estimate. I have had discussions with a number of assistant doctors who are very worried about the position. Many of these assistants do the night work and have proved themselves invaluable to the doctors with whom they work. They believe that as a result of the way in which the Pilkington Report has been accepted and the money paid out they will not get the share they ought to receive. Will it be left to the doctors to decide whether any of this money is given to the assistants? They are the people for whom we have to speak because of the important work which they do.

I wish to turn to the Scottish Dental Estimate where the Minister is asking for £8,500. He states that this is money for the increase in the wages of clerks and members of the administrative staff and so on, and that it is not for the dentists. No doubt the Minister will have seen the statements in the Press only last week about the state of the teeth of Scottish children. I am certain that these statements came as a great shock to the Scottish people. I would not take responsibility away from parents. As with so many things, in the first instance parents have a real responsibility for their children in this matter, but, since we have the Scottish Dental Estimates Board, it seems that a certain degree of responsibility rests on that board. What is it doing to try to get as much propaganda as possible over to parents, particularly, about the need to conserve children's teeth? I want the Minister to look at that, because not only is there a responsibility for the parents but for anyone who has anything to do with the Dental Health Service. Also, does the Minister think that there are enough dentists in the schools?

The Temporary Chairman (Mr. John Diamond)

I am sorry to interrupt the hon. Lady, but I think she is now going a little wide of the subject. The Supplementary Estimate must not be dealt with in that detail. I heard the Joint Under-Secretary say that this item referred to clerical services only.

Miss Herbison

I am sorry, Mr. Diamond; I thought that propaganda could come under these Estimates and that I could ask if these clerks were doing their job. One of the jobs I want the Scottish Dental Board to do is to ensure that everyone realises the importance of conserving teeth. I thought I might chance it and get in a word about the school dental service. I think the Joint Under-Secretary will be as concerned as I am about the shocking reports about the condition of the teeth of Scottish children.

I turn to the ambulance service. The Joint Under-Secretary will be aware of the number of questions which have boon raised in the House on this subject from time to time. We are being asked for an extra £14,000 for this service. We find that is because of the cost of contract services. Perhaps he will give a little explanation on that. When going into the cost of contract services, what steps does he take to ensure that ambulances are in good condition before they are used? There have been many complaints from this side of the Committee on that. What steps does he take to ensure that ambulances used under contract are properly manned? We should like to have that information before we decide that another £14,000 of public money from the taxpayer is spent on this service. In the main, the ambulance service in Scotland is a good one. I would not seek to denigrate it in any way, but there have been glaring instances of where it was not nearly as good as it should be.

I hope the Minister will reply to the points I have raised. Like hon. Members who spoke in the earlier debate, I think we should debate fully how this £1 million each year—for it is not just £1 million once and for all—is to be spent to improve the general practitioner service. It would be a most worthwhile debate with many good ideas coming from both sides of the Committee.

10.49 p.m.

Mr. William Ross (Kilmarnock)

I do not think any of us will vote against this Supplementary Estimate.

Mr. E. G. Willis (Edinburgh, East)

Why not?

Mr. Ross

I think we can assure the Joint Under-Secretary in regard to that. It may be that there will be "winds of change" and revolt from Edinburgh; I do not know. I urge that in future if we have a Supplementary Estimate which so changes the character of, say, Subhead B, the Minister will take the opportunity of revising the appendix which we had in the original Estimates to give us a far better idea exactly how the hospital service is affected. I recollect that on page 157 of the original Estimates there was an appendix giving fairly full details about the hospital service, and if the amended information had been given with this Supplementary Estimate, we need not have been questioning the Under-Secretary tonight. Subhead B refers to Additional provision for increased remuneration". How much of that is for nurses? In Scotland we are very concerned about the fact that nurses are far from satisfied with their salaries, and those who are interested would like to know how much of this money is in respect of increased salaries for nurses.

The appendix in the original Estimates informed us that the increased remuneration was for specialist services and nursing services and so on, and I should like the figure to be broken down so that we could find out how far our male and female nurses—whose conditions we cannot now discuss—are enjoying the benefit of this increased remuneration. I hope that we shall not be told that all the extra money is for the doctors, or that, if we are, we will be told that something is to be done for the other services.

The question about Subhead F is whether the Under-Secretary has, or is about to, come clean. I have a feeling that this matter has already been thrashed out and I believe that to expand upon it would be out of order.

The Under-Secretary will remember that in the original Estimates £484,000 was provided as an additional contribution to the supplementary superannuation contribution. It was not an appropriation in aid, but a special employers' contribution, and I want to know whether, and if so how much, this Supplementary Estimate is in respect of the 1½ per cent. which was to cover the deficiency discovered in 1955.

10.55 p.m.

Mrs. Judith Hart (Lanark)

I want first to refer to the £14,000 which, we are told, is the cost of the contract ambulance services. The condition of the ambulances has already been mentioned, but I wonder whether the Under-Secretary can tell us how far, in allocating the money and making the contracts which are necessary to many of the ambulance services in Scotland, particularly in the West, he insists that the administration of the services should be as efficient as possible, to save patients unnecessary suffering.

I have had a number of cases in my constituency, and I have raised one or two cases with the hon. Gentleman and with the Western Regional Hospital Board. I must say that in each case I have had satisfactory answers that the matter is being looked at and reforms, where necessary, made. Nevertheless, the number of cases that occur leaves room for doubting the efficiency of the administration of the ambulance service, although it may well be that it is particularly in these services on contract that inefficiencies arise. I hope that in allocating moneys for these services, we can ask the Minister to pay particular attention during the remainder of the year to the effectiveness with which the ambulance services are organised.

We are also concerned about patients who are gravely ill—who are, perhaps, being transferred from hospital to home because they are so gravely ill that the hospitals can do little more for them. We are concerned to find that it takes four or five hours to get them home because a gravely-ill patient is first picked up from a hospital, and the ambulance then circumnavigates Glasgow, for example, calling at other hospitals—and other towns—before taking that first patient home.

That will not do. It is surely appropriate that the Minister should make certain, when contracting for these ambulance services, that a guarantee is given that the comfort of the patient will be placed first, that the interests of the patient will be safeguarded, and that inefficiency which causes suffering will be eliminated.

My second complaint has been referred to by my hon. Friend the Member for Kilmarnock (Mr. Ross), and it concerns nurses' conditions and pay. We are told that some part of the advance under Subhead B is on account of Whitley Council awards, and that some part of it is to go to assistant nurses and midwives.

As the Minister knows, there has recently been a good deal of reference to nurses' conditions in the Scottish Press—in particular, in the Daily Record—and I have written to him on the matter. It seems to me that there is particular cause for concern if there should prove to be any grounds whatever for some of the complaints now being publicised. Several years ago there was set up a Government Working Party on conditions of work and the recruitment of nurses, and another on conditions for midwives.

One had hoped that as a result of the subsequent discussions of those Working Party Reports many of the matters—and many of them are financial matters—that are now being criticised and questioned, apparently, by nursing staffs in Scotland, had been ended. One had thought that conditions were satisfactory enough now for these complaints to be unnecessary, but perhaps I could just mention three or four of the complaints that seem to be recurring, and which are confirmed by letters I have had from constituents who are connected with women in the nursing profession.

For example, can the Minister find out whether nurses must pay for their transport when they are going to examination centres? There are allegations that they must. How generally is that true? Another very minor matter—but a very effective irritant to a nurse on duty, I should imagine—is the rule that she must pay for some of the items of her equipment that she uses in her work—scissors, for example. Again, State-registered nurses, after becoming State-registered, do not receive—

The Deputy-Chairman (Major Sir William Anstruther-Gray)

Order. I am reluctant to interrupt the hon. Lady, but it is difficult to see how the points she is now making can come within the Supplementary Estimate.

Mrs. Hart

I am sorry, Sir William. I had hoped that the matter of the administration by the regional boards would cover some of the costs under which this kind of reference might be made. But, of course, I at once accept your Ruling.

I hope that in administering the money that we are voting, the Minister will ensure that the spending of it is, generally, as efficient as possible; and, as efficiency includes creating conditions in which nursing staffs may work, I hope that he will consider all these points as carefully and as effectively as possible.

There are many matters of great concern in the Health Service in Scotland upon which we cannot touch this evening, restricted as we are by the rules of order. It is, however, highly necessary that in view of those great problems, those which can be covered by efficiency of administration and the efficient spending of money to its most effective purpose, should be met as carefully and as fully as possible by the Minister.

11.0 p.m.

Mr. Harry Gourlay (Kirkcaldy Burghs)

I should like to follow my hon. Friends the Members for Lanarkshire, North (Miss Herbison) and Kilmarnock (Mr. Ross) in dealing with Subhead B, "Advances to regional hospital boards: Revenue Account", and to stress that there is no detailed provision in respect of nurses. I should like to know how much of this £3,039,000 is in respect either of additional nursing services or of increases in nurses' pay. When I was chairman of a hospital management committee, we found great difficulty in implementing the recommendation to reduce nurses' hours from 48 to 44 per week, because the Minister's Department would not sufficiently increase the Estimate to cover the increased cost of providing additional nursing services when it was possible to recruit nurses.

I, too, have had representations made to me by constituents regarding the conditions that were publicised in the Daily Record. I also know that, while some of those complaints may be justified in certain areas, they are of a general rather than specific character. On a previous occasion, I had the opportunity to raise complaints about conditions in the East Fife area and had them remedied.

I ask the Minister, if I am within the rules of order in suggesting this—

The Deputy-Chairman

The hon. Member is in great danger of getting outside the rules of order.

Mr. Gourlay

I have tried, as a new Member, to keep within the rules. I ask the Minister whether he would consider issuing a directive to the various hospital boards of management asking them to set up machinery whereby those grievances, if they exist, can be rectified without victimisation of the persons concerned.

My second point concerns Subhead J.2, the Scottish Dental Estimates Board. I should like to know whether this £8,500 includes the provision of a regional dental officer for the Fife area. Some time ago. I understand, when patients required special examination by regional officers, the officer had to travel all the way from Aberdeen to certain parts of Fife to examine patients. I should like the Joint Under-Secretary also to consider whether economy could be effected by arranging that once a patient has had an examination by a regional officer, if subsequent treatment is required the patient should not have to wait three weeks for a subsequent examination before the dentist can proceed with the necessary treatment.

I should like an assurance from the Minister that, while he is asking for a fair amount of additional money on account of regional hospital boards, there is no intention whatever of asking hospital patients to pay for their food while they are in hospital.

11.5 p.m.

Mr. Galbraith

We have had a fairly full debate on this Supplementary Estimate and I will do my best to answer the various points which have been raised, although this will mean that my speech is rather piecemeal. The hon. Lady the Member for Lanarkshire, North (Miss Herbison) regretted what she regarded as the tardiness in coming to a settlement on the outstanding money due to the profession. I assure the hon. Lady that it is the desire both of my right hon. Friend and of myself that we should come to a settlement on that as soon as possible.

I noted with interest the various suggestions which she made of ways in which the service could be improved, and, of course, it is just points like that which will be considered by the Working Party to which my right hon. Friend referred in discussing the Supplementary Estimate on the England and Wales Vote. In that respect what he said for England and Wales also applies to Scotland.

Miss Herbison

On this question of the salaries of doctors in hospitals, we in Scotland have many fewer doctors and hospitals. Surely it does not take the same time, therefore, to make the settlement in Scotland? Surely, they can be paid soon?

Mr. Galbraith

I will certainly look into that aspect to which the hon. Lady has just drawn my attention.

Another matter to which she referred was one in which I have a good deal of personal interest. She spoke of the shock she suffered on reading about the condition of children's teeth in Scotland. I am glad she suffered that shock, because everybody in Scotland was intended to suffer that shock and to realise the appalling condition of children's teeth in Scotland today.

Because it would be out of order I do not want to discuss the school dental service, but I agree with the hon. Lady that a certain amount of the trouble is due to parents allowing their children to eat far too many sweets.

Miss Herbison

Before the hon. Gentleman leaves that matter—

Mr. Galbraith

Allow me to go on.

Miss Herbison

Still on dentists?

Mr. Galbraith

Yes, I have not finished with dentists. The hon. Lady may not think it follows directly, but her hon. Friend the Member for Kirkcaldy Burghs (Mr. Gourlay) also referred to this matter, and he asked whether or not there would be provision within this Supplementary Estimate for a local dental officer in Fife and whether these figures would provide for his salary. In fact they do not do that. These are purely administrative figures. I am sorry that, for the time being, his worry will not be got over by these figures in this Supplementary Estimate.

The hon. Lady referred, as did her hon. Friend the Member for Lanark (Mrs. Hart), to the ambulance services. I think they were worried—

Miss Herbison

Has the hon. Gentleman finished with the dentists? We just cannot leave the matter by saying that the children eat too many sweets. I think they are eating far too many sweets, and I hope that the parents will take warning, but I feel that the Government have a responsibility and that the Dental Estimates Board has a responsibility to ensure that much more propaganda and teaching are given, propaganda to the parents, and teaching in the schools, on this matter.

Mr. Galbraith

That is why I am so grateful to the hon. Lady for the forceful way in which she referred to this matter tonight, because what we say here in this Chamber is a form of propaganda, and I am sure that she, and her hon. Friends, and my hon. Friends, too, will do everything they can to bring this problem to the notice of the parents. I myself believe that at least as much can be done in the home as can be done elsewhere.

I should like to turn now to the ambulance services which the hon. Lady the Member for Lanarkshire, North and the hon. Lady the Member for Lanark referred to. I think they were worried by the reference to the cost of the contract services. As they both know, the ambulance services in Scotland are provided by the Red Cross and the St. John Ambulance Brigade on a contract basis to the regional hospital boards, but the money referred to in the Supplementary Estimate is going—as the result of a Whitley award—to the men who are running the services. I shall certainly look into the point which the hon. Lady the Member for Lanark raised about the quality of the services in her area.

The hon. Member for Kilmarnock (Mr. Ross) made the very reasonable point that perhaps we had not printed this Supplementary Estimate as fully and as well as we had printed the original Estimates. I shall certainly bear that point in mind far a future occasion. I have the figures of which he spoke, but I do not think that the Committee would wish me to read them all out. I can tell the hon. Member, however, that out of this £3 million odd the amount which will go to nurses is £82,000. Perhaps, however, I should "come clean" on this—as my right hon. Friend the Minister of Health has already come clean this evening—and say that this is in respect of part-time nursing staff. Therefore, I do not think that it really deals with the point raised by the hon. Lady the Member for Lanark when she referred to the recent series of articles in the Daily Record. I assure her, however, that I am having that matter investigated and will write to her when my investigations are completed.

Mr. Ross

Surely it is very bad for the House of Commons to be presented with a Supplementary Estimate in which we are told that everything in a certain Subhead relates purely to the Pilkington Committee. This was what we were led to believe. No reference was made in connection with Subhead B to the fact that there was any additional provision for nurses. If we had been told that, we might have had an entirely different debate.

Mr. Galbraith

All I can do is to apologise to the hon. Member. If he had listened to my explanation he would have found that I said that the bulk of it was in respect of the Pilkington Report, but I also said that "There is a sum of £788,000 required to meet Whitley awards". This is one of those awards.

Mr. Gourlay

The hon. Gentleman mentioned £82,000 for nursing staff and particularly for part-time nurses. Can he give an assurance that, with the employment of part-time nurses, there are no nurses in Scotland working more than the normal 44-hour working week?

Mr. Galbraith

I should not like to give that assurance without notice. I will certainly look into the point.

The hon. Member for Kilmarnock asked also whether the 1½ per cent. was included for superannuation. The answer is that it is.

Mr. Ross

How much?

Mr. Galbraith

It costs some £200,000.

I think that I have more or less covered all the points raised in the debate. Those which I have not I will note and try to answer later. I am glad that the Supplementary Estimate has been welcomed by the Committee, in spite of various matters to which, naturally, attention has been drawn. I hope that the Committee will now allow us to have the Estimate.

Mr. James McInnes (Glasgow, Central)

Considerable play has been made about the dental service. Assuming that the public respond to the appeal made by the hon. Gentleman and by my hon. Friend the Member for Lanarkshire, North (Miss Herbison), does the hon. Gentleman regard a Supplementary Estimate of £6,500 as adequate to meet the situation that would arise?

Mr. Galbraith

No, because the dental side of the Pilkington Report is not dealt with in this Supplementary Estimate. This is purely an administrative increase.

Question put and agreed to.

Resolved, That a Supplementary sum, not exceeding £5,212,000, be granted to Her Majesty, to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1961, for the provision of national health services for Scotland and other services connected therewith, including medical services for pensioners, etc., disabled as a result of war, or of service in the Armed Forces after the 2nd day of September, 1939, certain training arrangements, the purchase of appliances, equipment, stores, etc., necessary for the services, certain expenses in connection with civil defence, and sundry other services.

Resolutions to be reported.

Report to be received Tomorrow; Committee to sit again Tomorrow.