HC Deb 26 February 1962 vol 654 cc1091-102

Motion made, and Question proposed. That this House do now adjourn.—[Mr. Finlay.]

10.57 p.m.

Dr. A. D. D. Broughton (Batley and Morley)

I am very grateful to Mr. Speaker, and to you, Mt. Deputy-Speaker, for allowing me this opportunity of speaking about Oakwell Hospital, a small hospital in my constituency. It has been in the news recently, because it is the hospital where the Yorkshire smallpox cases have been isolated and treated. It is an old hospital, built well away from other buildings on a hill top in Birstall. It was put there for the isolation and treatment of infectious cases. The larger part of the hospital used to take in the more common infectious diseases such as diphtheria and scarlet fever, which were prevalent as recently as thirty years ago. A small section, set apart from the rest, was for smallpox cases.

In recent years, the astonishing decline in the incidence of infectious diseases caused the wards to be empty, and the beds were then brought into use for geriatric cases. According to The Hospital Year Book, the hospital has ninety beds for geriatric patients. I have had the pleasure of visiting the place on several occasions, and I have been delighted to see the old people being cared for efficiently and tenderly. Since 1948, when the National Health Service came into operation, the hospital has been under the management of the Dewsbury, Batley and Mirfield Hospital Management Committee, which is under the direction of the Leeds Regional Hospital Board. So much by way of introduction to Oakwell Hospital.

When the first smallpox cases occurred recently in Bradford, the Leeds Regional Hospital Board decided to use this hospital for the isolation and treatment of the patients. I think that this was a very sensible decision, because the hospital is conveniently situated and suitably constructed for that purpose. The geriatric patients were speedily transferred to other hospitals, a volunteer staff was recruited and the smallpox cases were brought the few miles from Bradford.

I am very pleased that this hospital in my constituency should have been chosen to play such a vitally important part in the recent battle against this deadly disease. I shall have something to say about the staff in a moment but, at this point, I think that it would not be out of place to pay tribute to the hospital management committee and to the Leeds Regional Hospital Board for their part in this grim fight against disease and death.

My pride and my interest in this hospital prompted me to ask the Minister of Health some Questions, and I wish to thank him for answering them. I asked him first what staff was being employed and whether all were volunteers. I was informed that thirty-one medical, nursing and ancillary staff were working in the hospital and I was pleased to learn that all were volunteers. I am sure that I can express the grateful thanks of all my constituents to every member of that staff for their courage, patience and skill in carrying out the exacting and dangerous duties for which they volunteered.

Let it be remembered also that not only must the smallpox cases be isolated but all the staff must necessarily be confined to the hospital lest they spread this highly infectious disease. They have had to endure what amounts to imprisonment for weeks in a small hospital on the top of a bleak hill. We all owe them a debt of gratitude.

I thought that thanks alone were not enough, that something more tangible was required, and I asked the Minister whether any additional remuneration would be forthcoming. Following the publication of this Question of mine, I was pleased to read an announcement in the Press that there would be additional pay for the staff during their period of isolation. When I received the Minister's official reply I was told that there would be additional pay for the nursing and ancillary staff. I want to ask, why not for the medical staff?

I learned from the Minister's Answer to a subsequent Question of mine that one doctor was being employed at the hospital, and I now ask: how comes it that whereas 30 out of 31 receive additional pay, one member of the staff and one only must be content with his normal salary—and he the one who carries the heaviest burden of responsibility? Surely this is an injustice. What is the explanation of this discrimination, and why pick on the one member of the medical profession?

The Minister has been good enough to give me a list of personnel, arranged according to grades, employed in the hospital. I refer to the OFFICIAL REPORT of 5th February, 1962, col. 8 of Written Answers. At the head of the list is the doctor whose grade in the service is that of senior hospital medical officer. As I have already explained, he appears to have been singled out for ingratitude and injustice. The grades in the nursing profession are: matron, ward sister, charge nurse, staff nurse, State enrolled nurse, student nurse, pupil nurse and nursing auxiliaries.

The weekly normal rate of pay for each of these different grades is also given in the Minister's Answer to which I have just referred. We see, for example, that a matron receives about £20 a week, a ward sister about £15 a week, and, at the other end of the scale, a pupil nurse about £6 a week. These are the usual rates of pay under normal circumstances.

The ancillary grades comprise ward orderly, cleaner, porters, gardener, boiler stokers, head cook, cook and assistant cook. Their normal weekly rates of pay vary from just under £7 for a cleaner to just over £11 for a head cook.

The Minister also stated in his Answer: All grades except the Senior Hospital Medical Officer received a 50 per cent. addition to pay while on smallpox duties and the ancillary grades are also eligible for other additions to pay e.g. overtime."—(OFFICIAL REPORT, 5th February, 1962; Vol. 653, c. 8.] So now we see that whilst on smallpox duties the matron will be receiving £30 a week; a ward sister something in the region of £20 a week, and, at the bottom of the scale for nursing staff, a pupil nurse probably less than £9 a week.

I wanted to know also what the 50 per cent. addition to pay and the other additions such as overtime amounted to for the ancillary grades. I asked the Minister, and on 13th February he told me that The gross weekly pay of the ancillary grades has ranged from £30 15s 5d. to £51 1s. 6d."—[OFFICIAL REPORT, 13th February, 1962; Vol. 653, c. 141.] This reveals a very strange and disturbing state of affairs. It exposes the fact that porters, boiler stokers and probably all the ancillary grades receive more pay than the matron, which is ridiculous. Unless the doctor has risen to the highest level of pay in his grade, some of the ancillaries draw more pay than he does, which is preposterous. Does the Minister think it right that cleaners and porters should receive more than £20 a week above the pay of nurses? The nursing staff must know that the ancillary grades receive more pay than they do. What are their feelings about it?

At this juncture, I want to make two points absolutely clear. First, I do not seek to belittle the importance of the ancillary grades. Their work is valuable and, indeed, essential. I include them when I pay my tribute to the hospital staff. I appreciate the services rendered by all the staff, and I speak in admiration of them all. But I suggest that the Minister insults and offends the nurses by paying them much less than he pays the ancillary staff.

Secondly, if this policy for salaries and wages is wrong—and I myself consider it completely cockeyed—no blame whatever attaches to either the hospital management committee or the regional hospital board. They pay the salaries and wages laid down in instructions from the Ministry, and the responsibility for this fantastic pay policy rests entirely on the Minister and the Government. Will the Parliamentary Secretary undertake to look into this unfair wages policy? It is ridiculous and disgraceful and urgently needs alteration.

We have had a Tory Government for ten years. As a result, the country is in a mess. Now, the Government are to adopt as their own a part of Labour Party policy. I understand that there is to be a planned policy for salaries, wages and dividends. I respectfully suggest that an early start be made towards a fair and sensible scale of salaries and wages in the National Health Service.

I have spoken of Oakwell Hospital. I have praised the staff. I have been strongly critical of the wages policy. In conclusion, I must mention the most important of all, the patients. I should not like this occasion to pass without expressing deep sympathy to those who had the misfortune to suffer from smallpox and to the relatives of those who died of the disease. I am sure that in those concluding words I carry the whole House with me.

11.8 p.m.

Mr. Kenneth Robinson (St. Pancras, North)

We all echo the tribute which my hon. Friend the Member for Batley and Morley (Dr. Broughton) paid to the entire staff of Oakwell Hospital during these very difficult weeks. It is quite impossible to measure this kind of devotion and courage in monetary terms, but, although we are very glad that the staff did receive some recognition in monetary terms, I think that my hon. Friend has brought out certain curious anomalies which have arisen from the method of making the payments. I hope that the Minister will be able to set at rest some of my hon. Friend's anxieties.

We do not know—we are waiting to hear—what discretion the Minister has in these matters. If the hon. Lady says that he has no discretion at all, and that all these matters are governed by the Whitley Council, then I think that the experience in this case justifies a reference to the Council of this odd position. If she cannot do anything else, I hope that she will ask her right hon. Friend to get his representatives on the Council to make these representations.

11.10 p.m.

The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)

In the Adjournment debate of 15th February on the recent smallpox outbreak, I described the fine work that had been done in Bradford. I am very glad that both hon. Members opposite who have spoken have paid their triubutes also tonight. We are discussing the service given by the staff of the hospital in the constituency of the hon. Member for Batley and Morley (Dr. Broughton)—Oakwell Hospital, Birstall—who treated those in the area who were found to be victims of smallpox, as well as patients who were suspected to have contracted the disease. The staff of the hospital were all volunteers, as the hon. Gentleman said, and I should like at once to join with him in the tribute he has paid to them for the fine work they did.

Mr. Arthur Tiley (Bradford, West)

I am very grateful to my hon. Friend for allowing me to intervene, because it would be most unfitting if the report of these proceedings were compiled without my also joining in the tributes, as a Bradford Member, to those who, with such devotion, served our city and Yorkshire in these troublesome days.

Miss Pitt

They did very fine work, as I was saying, and it was a very arduous duty. Tonight's debate has been mainly about their pay, but I doubt very much whether the question of the pay they would receive was uppermost in their minds when they volunteered for this work. Before the first smallpox case was confirmed in Bradford, the Leeds Regional Hospital Board had, early in January, following the alert given by my Department, taken preliminary steps to bring the 16-bedded smallpox hospital at Oakwell into use.

Preliminary plans were also made to evacuate the neighbouring and larger Oakwell geriatric hospital, which was itself originally an infectious diseases hospital, and to use it for smallpox patients. When it became clear on 11th January that there were probable smallpox cases in Bradford, immediate instructions were given for the opening of the smallpox hospital, and it was opened and staffed that evening.

During the night, six patients were admitted. Next morning the geriatric hospital was evacuated, and in the afternoon the smallpox patients were transferred to the geriatric hospital, and from then on it was that hospital which was used. I should like to congratulate all concerned on this speedy and efficient operation. During the outbreak Oakwell Hospital has treated eighteen patients, eleven of whom were confirmed as smallpox cases.

As the hon. Member for Batley and Morley said, it was the duty of the Dews-bury, Batley and Mirfield Hospital Management Committee to arrange the staffing of Oakwell Hospital, and their arrangements were based on the general principle that there should be a team—and I emphasise the team work in this operation—which should be large enough and efficient enough to be able to do the work it had to do, and yet be no larger than it need be.

There are obviously some special reasons for keeping to the minimum the staff of a smallpox hospital—to reduce the number exposed to infection and to simplify the security arrangements needed to prevent spread of the disease from the hospital. As the hon. Member said, they were confined to the hospital. There were also limits to the accommodation. The infectious diseases consultant paid regular visits and supervised the treatment of patients.

At first, the resident staff consisted of a senior hospital medical officer, a nursing staff of seven drawn from a list of volunteers maintained by the regional hospital board, and nine domestic staff selected by the hospital management committee. I use the word "domestic" where the hon. Member used the word "ancillary". I chose "domestic" only in order to make quite clear the type of staff I refer to. It is a different word for the same people. We are both talking about ancillary workers.

As time went on the nursing staff was increased until at the end of the month there were seventeen—including two ward orderlies—and five more domestic staff—two assistant cooks, two cleaners and a porter—making a total of fourteen domestic staff. At the beginning of this month, three nurses came in as replacements, and the number of staff then began to be reduced, and at the moment there are 12.

For a period two ambulance attendants employed by the West Riding County Council were also stationed at the hospital, and for the same reason-to confine the risk—it was thought better and wiser to use only one ambulance and two attendants who remained on duty for the whole of the time rather than having a number of ambulances needing to be disinfected and a number of men at risk.

The female staff were housed in the nurses' home, the doctor in part of a ward and the other male staff in the physiotherapy department, which was converted into use as a dormitory, and in make-shift accommodation in the gate office.

I am informed that for the first two weeks the hours of work for nursing and domestic staff alike were eighty-four hours a week. These may seem excessive hours particularly for the nurses, but as the staff was being reinforced by no means all of them worked these long hours for two weeks. I have no doubt that had the strain seemed too great some way would have been found—though accommodation was limited—to increase the nursing staff. Thereafter they have worked a 44-hour week.

As regards the domestic staff, their hours of work began to be reduced on 12th February. It may be questioned whether the domestic staff had work to do for an 84-hour week. I am assured that they worked 12-hour shifts seven days a week. This has had to be a self-supporting hospital with rigid security. There had to be a constant and effective guard at the gate: all the laundry had to be done in the hospital: all equipment had to be maintained with special care to avoid breakdowns: and special precautions were essential at all times as regards cleanliness and disinfection. There was special responsibility on the domestic staff to keep the services of the hospital going without help from outside. The hon. Member for St. Paneras, North (Mr. K. Robinson) in particular will appreciate that if any machine had gone wrong there would have been risk if outside contractors had had to be brought in.

The management committee had to select a team—again I emphasise the word—of domestic staff who knew the hospital, its equipment and machinery, and who could relieve on other jobs. I do not think that in this operation there was much hesitation about lending a hand on any job that had to be done. All the domestic staff except for one assistant cook, one porter and one cleaner were, in fact, employed at the hospital before the outbreak and so "knew it well.

If the domestic staff had been increased there would have been less payment of overtime—but, on the other hand, more staff would have been exposed to infection, security risks would have been greater and, in some grades at least, staffing difficulties at other hospitals where compensating overtime might have had to be paid.

The position as to the pay of the nursing and domestic staffs is governed, as the hon. Member for St. Pancras, North surmised, by agreements of the respective Whitley Council. I agree that the figures of earnings of the domestic staff are somewhat startling, but they are due to the wholly exceptional circumstances in which the normal conditions of employment of domestic staff had to be applied. It has been the rule for a long time—since 1948, in fact—that nurses and domestic staff who are isolated to look after smallpox patients should receive an increase of 50 per cent. in their pay during the period they are so engaged. The rule is the same for both categories of staff. What gives rise to the different results is the determination of the pay on which the 50 per cent. addition is calculated.

The salaries of nurses, as professional people, are not subject to any enhancement on account of the number of hours they work or the way in which they have to work. Their conditions of service do not provide for extra payments for extra hours worked or for working at weekends. But when comparisons are made, particularly by people who have not close knowledge of the pay and working conditions of nursing and other staff, it should be remembered that nurses enjoy a progressive salary scale, that they have longer paid holidays, and better sick pay conditions than the domestic staff. Their salary is the rate for the job.

Provision is, however, made for them to have compensatory time off for long hours worked in a period of emergency, such as an outbreak of smallpox, and I understand that such arrangements have been made for the nurses at Oakwell Hospital.

Domestic staff are on a different foot-ting. They are employed on industrial-type conditions. This means that they are entitled to various additions to their basic pay according to the total number of hours worked and the way in which they are worked.

Domestic staff are the only category of hospital staff who are entitled to these enhancements, and it means that their actual earnings are almost invariably greater than their basic pay. The extent to which they are greater depends on the factors which I have already mentioned.

Under normal conditions the effect of these enhancements on the total pay packet would not have been remarkable, but in the exceptional working conditions prevailing in Oakwell Hospital they operated in such a way as to magnify the result to very large proportions.

As I have already said, domestic staff were working eighty-four hours a week in seven shifts of twelve hours each. Their standard working week is forty-two hours, so that they were working twice as many hours as usual. Moreover, the fact that they were on duty seven days a week meant that they were working on Saturday and Sunday and on the day that would normally have been their rest day. This is where the enhancements come in.

The hours making up the standard 42-hour week are paid for at plain time, except those worked on Saturday afternoon and on Sunday, which attract time and a half and double time respectively. Hours outside the standard week are paid for at double time if worked on the rest day or on Sunday, and at time and a half if worked on Saturday after twelve noon. If worked on other days they are paid for at time and a quarter on the first three hours in the week, and at time and a half on the remainder.

I do not have details as to the composition of the earnings of the domestic staff at Oakwell, and I am only concerned to give a general idea of how the conditions of employment operate. But the effect of the enhanced payments I have described must have been to produce earnings equivalent to at least 120 hours at plain time rate for the staff on the day shift. Those on the night shift would get more. This means that the earnings would have been at least three times the basic rate of pay, for there may have been other enhancements for which the staff would have been eligible in the particular circumstances.

What must be kept in mind is that the domestic staff would have drawn the same earnings if they had worked the same number of hours in the same manner in an ordinary hospital. These hours were most exceptional. That is why I said earlier that we were dealing with a wholly exceptional set of circumstances which produced a wholly exceptional result. And, of course, the agreed 50 per cent. addition had to be made to that result, making the total earnings even greater. So we have the combined effect of the total hours worked, the Whitley enhancements, and the smallpox addition.

Clearly everything stemmed from the fact that the staff were working a total of eighty-four hours a week. I have already explained why this was necessary. It would be most unfortunate if the result in terms of earnings was thought in any way to reflect the value placed on the services rendered by the domestic staff compared with the services given by the nurses.

Nothing could be further from reality. All of them—nurses and domestics—were volunteers for this duty, and they are all deserving of the highest praise. In saying that, I include the doctor in charge of the unit.

The hon. Gentleman asked me why there was discrimination against him. There was no discrimination, but his conditions of service permitted no salary enhancement whatever. Far from being singled out for ingratitude and injustice—to quote the hon. Member's words—he, like the public health medical officers, worked in the highest traditions of the profession.

I have already explained that the pay and conditions of service of the hospital staff are all governed by Whitley agreements. The hon. Member will appreciate, therefore, that it is quite impossible for me to say that any changes will or should be made in the arrangements for paying staff in the circumstances of what has happened at Oak well. Nor would I say that the arrangements for staffing the hospital were in any way wrong. We must bear in mind that we are concerned with a short period in which emergency provision is required. But I accept that we must seek to learn what lessons we can from experience, and my right hon. Friend will be looking into the position generally, to see whether there is any advice or guidance which he ought to give to hospital authorities faced with a similar situation.

Question put and agreed to.

Adjourned accordingly at twenty-five minutes past Eleven o'clock.