§ 6.35 p.m.
§ Mr. Kenneth Robinson (St. Pancras, North)
In the National Health Service today staff morale is at its lowest ebb. Staff shortages seem to be endemic at almost every level. Health Service Whitleyism is virtually dead, killed by the Minister, and resentment in the Service at the Minister's conduct is intense. It is for these reasons that my hon. and right hon. Friends have chosen to debate first on this Motion for the Third Reading of the Bill the problems of Health Service staff.
I want at the outset to say a word—and it will be a very brief word—about the shortage of doctors. I have a great deal of ground to cover and I hope that the House will appreciate that the importance of this subject merits a great deal more time than I can give to it this afternoon. I shall have to compress my remarks in this part of my speech.
All the evidence points to the fact that there is already a serious shortage of doctors throughout the Health Service, in the hospital service and in general practice, that this shortage is growing, and that it will soon become critical. It is not a shortage, like the others we shall be discussing, due to pay. The doctors are perhaps one of the few categories of staff in the National Health Service who are adequately remunerated. It is a shortage which arises primarily out of a failure of planning not perhaps so much by the Minister of Health as by his predecessors. It was a failure of planning which arose out of statistical misinformation as particularly exemplified in the Report of the Willink Committee and acceptance of the Willink 1082 Committee's recommendations by the Government.
The House will recall that that Committee advised a reduction of 10 per cent. in the intake of medical students. One distinguished member of that Committee, in a speech not long ago in another place, admitted that the Committee had based its conclusions on no fewer than four false assumptions. He also admitted that the Committee was wrong in the advice which it gave to the Minister. To do the Minister justice, he has now reversed the decision that his predecessor took and has agreed that the cut of 10 per cent. should be restored.
I think that the best estimate is that we need at the moment not fewer than 250 more doctors a year coming into the Service than we are now getting. It is quite clear that an accretion like this cannot be squeezed into the existing medical schools. I submit that the one essential step that the Government must take—and take now—is to ensure the immediate establishment of two, probably three, new medical schools. Even if they take that decision now, it will be eight or ten years before those new schools can make any real contribution to the medical staffing of the Health Service.
If there appears to be any difficulty—although I do not think that there will be—in getting enough medical students, I suggest that medical students might in future be drawn from a somewhat wider social class than has been the practice in the past. Much propaganda has been made in recent months about the emigration of doctors, and suggestions have been made that this has been the prime cause of the shortage of medical staff in our Health Service. It has been suggested that about one-third of the doctors who qualify in each year find themselves, within a very short time, emigrating either to Commonwealth countries or to the United States of America.
Papers have been published—and very much attention has been given to them by the medical Press—by persons who might be described as amateur statisticians, making this case with some cogency. It is not a case that I accept. I do not believe that the emigration figures are anything like those suggested. But the fact is that credence has been 1083 given to these papers, and this allegation has been used not ineffectively by the enemies of the Service to try to persuade people that doctors in the Service are very "fed up", and that they can obtain decent conditions of work only in other countries.
Credence is given to these papers because the right hon. Gentleman cannot or will not produce any official figures to refute them. All I want to say now is that it is the Minister's plain duty to discover the facts about medical emigration. It is not an impossibility. If he cannot do it within his own Department there are university departments which would undertake a survey. I suggest that he should forthwith institute a survey to find out how many doctors are emigrating every year, and if it is a substantial number—although I do not think that it is anything like one third—there should be a searching inquiry into the causes.
In the meantime, there is one other way in which we can mitigate the effect upon the patient of this doctor shortage in the Service. That way is to build up the strength of the other members of the therapeutic team, and, in particular, the professions supplementary to medicine. There is little doubt that the effective use of medical auxiliaries—people like psychotherapists, and psychiatric social workers—can enable a doctor to concentrate better upon that part of the therapeutic job which only he can do. It would make possible the more efficient use of our scarce and highly skilled medical manpower.
But we find that, in terms of numbers, there are shortages perhaps even more serious among the professions supplementary to medicine than there are among the doctors. Among physiotherapists, occupational therapists, radiographers and other similar professions, the shortage is acute. I have no time to go into detail on the matter, but, taking the country as a whole, these professions are 25 per cent. under establishment. In other words, out of every four posts which are considered by the authorities to be necessary to give an adequate service to the patient, one is vacant and is likely to remain vacant.
It is no answer for the right hon. Gentleman to tell the House that things 1084 were worse in 1948. We know that, and we expect them to be very much better today, after fourteen years' development and expansion of the Service. But is it surprising that we cannot get these professional workers? The starting salary for a physiotherapist is just over £10 a week, and for a radiographer it is substantially under £10 a week. Both scales rise to about £12 a week, but this is the limit, unless members of these professions become heads of departments. These are the salaries that we are paying to professional workers who have good educational qualifications and up to three years' specialised training. I could quote similar examples for comparable professions in the Service.
This is pitiful remuneration, which has been inherited largely from the days before the Health Service came into being. Experience has shown that the Whitley Council system has been quite impotent to bring about any basic revaluation of the services of these skilled, devoted and hard-working people.
I should like the Minister to tell us why the whole professional salary structure, aside from that of the doctors and dentists, cannot be examined with a fresh eye by an independent committee. I made this suggestion from this Dispatch Box last November, and it was turned down by the Minister from that Dispatch Box. It is, broadly, the proposal contained in an early-day Motion on the Order Paper, signed by about 220 hon. Members of all parties.
This is not a job to be done by the Whitley Councils. I do not think that it would be even if they were relatively unfettered in their operations. Still less is it a job to be done by bodies which have been so subjected to Ministerial direction as the Health Service Whitley Councils have been in recent months. Let these services be evaluated objectively, say, in relation to the remuneration of doctors and dentists. They had their Royal Commission. They have now been given their review body. As far as I can see, they seem to have opted out of the Whitley Council system altogether. I do not suggest that this need happen in the case of these other professions, but what is the difference in principle between the kind of independent committee the House is asking for and the Royal Commission which was granted for the doctors?
1085 The right hon. Gentleman has produced two reasons, which apparently satisfy him, for turning down this proposal. The first is that such an inquiry could not be confined to those professions which are seeking it. Perhaps the Minister was thinking of the nurses. Why not include them? Their trade union has already asked for a Royal Commission on nursing, and I imagine that after their bitter experiences of the last few months nurses as a whole would welcome being included in such an inquiry.
The Minister's second objection is almost ironical. He has said that it would be wrong to by-pass, and thus to weaken, the existing Whitley Council machinery. I have only two questions to ask about that. First, why were these considerations not valid in the case of the doctors? There was a medical Whitley Council, but that did not prevent the right hon. Gentleman's predecessor from agreeing to a Royal Commission. Was it not merely that the pressure exercised by the doctors was far greater than can be exercised by these smaller and weaker professions? My second question arising out of this objection of the Minister's is: could such an independent committee possibly weaken the Whitley Council system to anything like the same extent that his own actions have debilitated it during the past six months or so?
Confidence in the Whitley Council system was dying before all this started. Ever since the system began claims for more pay have almost invariably been settled not by the Whitley Council themselves but by arbitration. I have one or two rather interesting figures about this aspect of the matter. Since the Councils started, in about 1948, 58 arbitrations have been completed and five arbitrations are pending in respect of non-manual workers in the Health Service—that is, 63 arbitrations in all. Over the same period there have been three arbitrations in respect of local government workers, one arbitration in the electricity industry, and none at all in the gas industry. Does not the right hon. Gentleman think that this at least suggests that the system has not been working as happily as he would wish?
Even before the pay pause, delays in dealing with claims were excessive and, in many cases, quite inexcusable. It has long been clear to all those who 1086 take part in the system that there is no proper negotiation, in the accepted sense of the word, between the management and the staff side. When a case goes to arbitration—and most cases do—the farcical nature of the structure becomes apparent for all to see, because the management side plays no part whatever in the arbitration.
I am informed that it does not even see the case that is presented to the arbitration court in its own name. These are all handled, I am told, by the Minister's own representatives, who have been the "bear leaders" for many years on the management side of the Whitley Council. This is the tottering edifice that the right hon. Gentleman has been still further undermining in recent weeks.
I should like to look in some detail at a couple of recent pay claims before the Whitley Council. The first concerns almoners and psychiatric social workers. This claim was submitted on 31st May, nearly two months before the Chancellor's first pay pause statement. Matters proceeded at the normal snail's pace. Finally, a full Whitley Council was summoned for 16th January, seven and a half months after the claim was submitted, for proposals to be made to the staff side.
It is generally believed—if I am wrong, perhaps the Minister will correct me—that the agreed figure was an increase of 8 per cent. and that this had been actually approved by the Treasury. What happened? A few moments before the opening of this meeting, the chairman of the Whitley Council received an urgent telephone message from the Permanent Secretary of the Ministry of Health telling her that no offer could be made. So she had no option but to tell the members, who had come from far and wide to attend the Whitley Council meeting, that they had better just go home again, which they did.
It has never been satisfactorily explained, so far as I know, how it came about that a pay offer, which had received the approval both of the Ministry of Health and of the Treasury, was withdrawn at the eleventh hour and fifty-ninth minute. Perhaps the right hon. Gentleman will explain to us today what happened. Needless to say, in the end, a 2½ per cent. offer was made, was 1087 rejected by the staff side, and is now the subject of arbitration.
I want to devote most of the rest of my remarks to the case of the nurses and midwives. The House will not expect me to dwell for long on the critical situation in the nursing service. There are about 25,000 vacancies for nurses in the Health Service. Nearly 10,000 beds have been closed for lack of nursing staff, according to the Ministry's Annual Report. The shortage of midwives is even more acute, both in local government service and in the hospital service. Of course, the Minister will again produce figures to show that nurses are more numerous than they were in 1949. That, too, is only to be expected. The fact is that there are not nearly enough of them, as everyone in the hospital service knows. It is becoming increasingly difficult to recruit student nurses.
The intake last year was 1,259 down on the previous year. In one hospital region last year, every conceivable effort was made to stimulate the recruitment of student nurses, by innumerable school visits to about 40 secondary schools, by lectures, by open days, by inviting the schools to the hospitals, by mobile exhibitions, films, leaflets, and, of course, Press advertising. Everything possible was done. What was the result?
The number of student nurses recruited in the region as a result of this special effort was 4,387, which was 11 fewer than the previous year and one more than in 1959. All that really happened was that this effort staved off a very substantial reduction that would otherwise have taken place. The wastage rate among student nurses is running at about 30 per cent. and I am told that in psychiatric nursing the figure is nearly 50 per cent. These are girls who start their training and who fail to complete it for one reason or another.
Why has this situation arisen? It has arisen, I think, largely because the nursing service is failing to compete today, especially in terms of pay and working conditions, with other comparable occupations open to young women and, indeed, to young men. Nursing, as the House well knows, is a hard, responsible and skilled job. The hours 1088 are still long. There is night duty and weekend duty without any extra pay. A qualified staff nurse, after three years' training, and aged at least 21, starts at about £10 per week. No doubt other of my hon. Friends will be able to give further examples of salary levels in the nursing service. It is largely for these reasons that the nurses' representatives decided to put forward a claim which embodied a complete overhaul of the salary structure. The claim was for an increase generally of about 10 per cent., but in some cases, particularly where there was a dangerously acute shortage, an increase rising to about 30 per cent.
I want to deal in some detail with the history of this claim. The claim was submitted on 11th August last. The day before, on 10th August, a letter had been sent on behalf of the Minister to all chairmen of Whitley Councils. That was following the Chancellor's statement about the pay pause in this House. The letter to the chairmen included the following sentence:Claims will be considered on their merits, but during the period of the pause any offer of increased pay which it may be thought reasonable to make will generally be for future implementation when circumstances permit.The letter went on to say that the actual timing of awards, if made through arbitration, would be withdrawn from the scope of arbitration.
In November, the staff side was told by the management side of the nurses and midwives Whitley Council that it was not ready. So another meeting was called for December, but again it was not ready. In January it was not ready. On 13th February, six months after the original submission of the claim, the first response from the management side was forthcoming. A meeting was held and a prepared statement was read by the secretary to the management side. This is what he told the Council:We have received advice of the Ministers concerned and have considered the Staff Side claim. We have taken cognizance of the statement made by the Chancellor of the Exchequer in the House of Commons in December, 1961. You are aware of the letter sent to the Management Side Chairman on 6th February. 1962, and of the White Paper on Personal Incomes. The Management Side have considered the claim in the context and are prepared to offer 2½ per cent. increase as from 1st April, 1962.When it was asked why the claim had not been considered on its merits, in 1089 accordance with the previous instructions from the Minister, the management side had to reply that circumstances had changed. They went on to say thatcurrent consideration had been given to the claim in the light of the White Paper".But that is a White Paper published on 2nd February, and the claim had been submitted six months earlier and deliberately stalled by the Ministry representatives on the Whitley Council.
In a Question I asked the right hon. Gentleman what was the advice which he had given to the management side, and he replied that he had asked them to have regard to the White Paper, to which he had drawn their attention at the beginning of February. Would the Minister like to tell the House what happened on 9th January, three weeks before the White Paper was published? Did he not then do something rather extraordinary—something which, I believe, no other Minister of Health had ever done before him? Did he not go in person to a meeting of the management side of the Nurses and Midwives Whitley Council and tell them on 9th January that the nurses must not be offered more than 2½ per cent.?
Action like this finally destroys the myth of the Whitley Council as an independent negotiating body. The only thing that surprises me is that the management did not resign en bloc. To add insult to injury, the right hon. Gentleman said in the House that his advice—perhaps he would have done better to use the word "instructions"—did not preclude the consideration of the claim on its merits.
The nurses were offered 2½ per cent. from 1st April. The almoners were offered 2½ per cent., the psychiatric social workers were offered 2½ per cent., the physiotherapists were offered 2½ per cent. and the biochemists and physicists, who had asked that their salaries should be equated to those of their opposite numbers in the Government scientific service, have been offered 2½ per cent. Must we take it that the merits of all these claims happen to be identical? This is humbug.
Today, nurses are furious and utterly disgusted with the treatment which they have had at the Minister's hands. Through their representatives they rejected this offer unanimously and with 1090 contempt. They resubmitted the claim, only to be met with a blank refusal on the part of the management side to discuss the matter further. That is where the matter rests for the present.
I wish to register, on behalf of my right hon. and hon. Friends, the strongest protest at the Minister's breach of faith and double dealing with a section of the community which cannot hit back without injuring the patients in their care. Is it surprising, after all this, that demands are being made for an independent inquiry into the Health Service Whitley system? Is it surprising that the Minister had a letter only last week from the chairman of the staff side of the National Whitley Council protesting at his frustration of the whole working of the Council, and at what the writer of the letter called the scandalous inefficiency of the Minister's Department?
This letter appeared in the Press, and I want to quote one sentence from it:For both sides of the council Health Service Whitleyism has become a complete farce and I cannot express too strongly the anger and resentment felt by the staff side and by the professional staffs its represents.The letter was in harsh terms, but I suggest that very word was justified by experience.
Something odd has been happening to the right hon. Gentleman lately. It seems that he has been at some pains to change his public image. Perhaps the Conservative Central Office and the public relations "boys" have had something to do with what may well have been a policy decision. One can see them reflecting on the right hon. Gentleman, pondering his Treasury past, his resignation from the Government over their refusal to cut expenditure by £50 million, his savage cuts as Minister of Health a year ago, and perhaps his general air of colourless austerity.
One can see them asking themselves whether this is not rather bad for the Tory image in general and perhaps particularly bad for the right hon. Gentleman if, as may be the case, he is being groomed for promotion. They probably decided that something had to be done, that somehow it must be shown that underneath this arid exterior a human heart was beating after all. No other satisfactory explanation has occurred to me for the somewhat 1091 uncharacteristic cavortings of the Minister in public recently. Why else should he happen to have been bouncing round Eaton Square on a pogo stick just as the Daily Express cameraman was passing by? Why should he choose this time to appear in a Channel 9 "Face to Face" programme, or what I suppose we could call "Mug to Mug with Muggeridge"?
Why, above all, as a Minister of Cabinet rank, did he decide to take part, somewhat disastrously I might add, in a television guessing panel shortly after that, especially when what the panel was trying to guess was the result of the Orpington by-election half-an-hour before it was announced? I can assure the right hon. Gentleman and the Conservative Central Office that it will take a good deal more than this to erase the right hon. Gentleman's Ministerial past.
In a speech which he made last week to a gathering of manufacturers, the Minister asked his audience whether they thought that he had found it easy to limit nurses to a 2½ per cent. increase, or to refuse an independent inquiry into the salaries of physiotherapists. The answer to what was clearly intended as a rhetorical question is that the right Gentleman probably did not find it so very difficult. If he wants to alter his brand image, let him, for a change, begin fighting within the Government for, and not against, the devoted men and women who are carrying the burden of the Health Service and who have to look to him for support.
At present these people are bitterly aware that, because of the relative weakness of their bargaining position, and their reluctance to lake strike action, they have been singled out as the guinea pigs of the pay pause. They are angry, resentful and utterly sick of the Government and their policies.
§ 7.7 p.m.
§ The Minister of Health (Mr. Enoch Powell)
It is a very good thing that the House should have an opportunity to consider in a broad context recruitment to the National Health Service, because, as the hon. Member for St. Pancras, North (Mr. K. Robinson) said, there has been a good deal of misrepresentation about the trends of recruitment in the Health Service, and the per- 1092 petuation of this misrepresentation cannot do other than harm the future of the Service. I want, therefore, to take this opportunity to put the facts of recruitment to the Health Service clearly before the House of Commons and the public.
There are broadly three groups of professions involved, which I will deal with in the same order as did the hon. Gentleman—the doctors, the professions supplementary to medicine and the nurses and midwives. In each of these three great fields the experience of the Health Service right up to the present time has been of a steady improvement in staffing and a continuous increase in the staff at work in the Health Service. I shall proceed to demonstrate this by taking each of those three groups in succession.
First, I will take the doctors. Roughly speaking, one may think of approximately half the doctors in the Health Service as being in general practice and half in service in the hospitals. In fact, it is slightly more than half in general practice and slightly less than half in the hospitals. The hospital doctors, in turn, fall roughly half-and-half between the senior and the junior grades. In all those three groups within the profession, there has been a steady increase year by year right up to the present time. For example, in general practice there has been an annual increase over the last seven years, averaging just under 200 per annum. Every year there has been an increase, and particularly in principals, i.e. in the number of doctors giving unrestricted service in the General Medical Service.
In the hospitals there has equally been a steady manning up both of the senior and of the junior grades. There was, of course, a good deal of reclassification in the early years of the Service, but that has nothing to do with the continued increase in the number of consultants and senior hospital medical officers year by year up to the present time, averaging over the last four years about 100 additional senior doctors in the hospital service every year. The increase has been equally steady in the junior ranks, running between 200 and 300 on average per annum over the last four or five years. Here, as in every branch of the medical service in the National Health Service, is a steady manning up of the service. This is a picture which is 1093 absolutely inconsistent with that which some—not the hon. Gentleman, but some—have sought to paint of a Service—particularly of general practice—which, because it offered little to attract and to satisfy the doctors, they were leaving in large numbers. This is a Service in which the doctors are serving in increasing numbers, and in every part of it.
There has been one argument to the contrary still advanced. It is said that this manning up of the Service, at any rate in the hospitals, is largely or entirely due to an increase in the number of overseas doctors who are serving in our hospitals. I think I should say, in using this phrase "overseas doctors", it includes several hundred doctors who studied and qualified in this country. It means quite literally doctors, wherever qualified, who were born outside the British Isles. But this increase—and an increase there has been—is far from accounting for the total strengthening of the medical staff of the hospitals.
If we take, for instance, the last 10 years, we find that in the hospital service there has been an increase of no fewer than 4,000 doctors, while at the end of the 10-year period, running from 1950 to 1960, there were approximately 3,000 overseas doctors in all in the junior ranks—and they nearly all are in the junior ranks—in the hospital service. In other words, the increase in the total medical staff of the hospitals was much greater than not only the increase in the number of overseas doctors but the total number of overseas doctors. Therefore, even on the ludicrously extreme assumption—which, of course, is not true—that there had been no overseas doctors at all at the beginning of the 10 years, there would still have been a substantial and steady increase in the number of British doctors in the hospital service.
These are figures which completely refute the notion that service in the National Health Service is somehow not attractive to the graduates of our British medical schools. It is attractive to them, and they are coming into it. Their numbers in every branch of this Service are increasing, and it is right that these facts should be placed upon the record and should be widely known.
1094 What of the immediate future? We know that the number of medical students who graduated last autumn and who correspond, broadly speaking, to the 1956 entry. The following few years will be years of graduation which correspond to the entry in the year of the Willink Report and the years immediately following it. It is important to note that in the estimates made by the deans of the medical schools they expect to see over the next three years at least an increase in the number of students graduating. Here I am talking about British graduates of British birth, not students from overseas who may serve a year or two and then go home. They expect an increase year by year over at least three years in the number of British medical students who are graduating. Therefore, even without the addition to the intake of the medical schools which, as the hon. Gentleman mentioned, is in contemplation, we can look forward to the movement which I have described being sustained by an increasing number of British graduates leaving our medical schools. The House will, I know, appreciate that the number of graduates in any one year or in any brief series of years is only a small factor and one of many factors which determine the size of the profession at work in the National Health Service.
I pass from this favourable and expanding position in the medical service inside and outside the hospitals to consider the professions supplementary to medicine. For many of these professions virtually a new field of work has come into existence since the Health Service. I quite agree with the hon. Gentleman that the comparison with the year 1948 is practically meaningless since the possibilities and scope of so many of these professions have been part of the development of medicine during these past twelve to fourteen years. So rapidly has the appreciation of the scope for these disciplines expanded that it would have been impracticable, consistently with the maintenance of the necessary quality and training, for the numbers to expand at that rate and in that proportion; but the important fact is that, with one exception which I will come to instantly, in each of these professions there has been a steady annual growth. Naturally, we should have liked 1095 to have seen a faster growth, but it is the trend which matters, and the trend throughout all but one of these professions—I shall mention the exception in a moment—has been a steady upward trend continuing right into the present time.
The exception which I have in mind is the position in the profession of physiotherapy. It is individually the largest of these professions supplementary to medicine. There the figures of the staff in post, after rising quite sharply in the early years of the Service, have remained more or less stationary for some six or seven years past.
There is, however, another feature of the situation which is very important, and that is that in the last three or four years the number of students has shown a very marked increase, so that it is running on average around 300 higher than it was three or four years ago. The effect of this quite marked increase in the numbers of students of physiotherapy in our hospitals could not yet for chronological reasons, be reflected even in the latest staffing figures, but it provides a basis for the firm expectation that we shall very shortly see physiotherapy joining the other professions supplementary to medicine in this common upward trend.
§ Mr. A. Fenner Brockway (Eton and Slough)
Does the right hon. Gentleman expect to get recruits among physiotherapists unless he increases the appalling rate of pay which they now receive?
§ Mr. Powell
Well, the fact is that there is an increase in the numbers who are coming forward as students, and indeed we could train more—and this was the point I was coming to—
§ Mr. Powell
They will stop for a number of years and do service there, otherwise they would not be coming forward in these increasing numbers. Indeed, we could train more if we had more teaching staff, and this in fact is the limiting factor at the present time in the expansion of our physiotherapy service. The figures I have mentioned of the increased numbers of students are themselves evidence of expansion of training facili- 1096 ties, and I think the House knows that there have been emergency measures and shortened courses instituted for the training of additional teachers; but I must say that I feel the situation would be further helped if, on reconsideration, the Chartered Society came to the conclusion that it would be possible to train at any rate physiotherapists as teachers in a shorter than the normal two-year course.
As long as we are limited in numbers in the professions supplementary to medicine, and above all in physiotherapy, we must be absolutely sure that we do not waste their services.
§ Dame Irene Ward (Tynemouth)
My right hon. Friend referred to the Chartered Society. I have to declare an interest, because I sit on the Council of the Chartered Society. Has it ever occurred to my right hon. Friend that when he asks something from the Chartered Society it would be a good thing to give something which the Chartered Society wants? There should be reciprocity, not a dogmatic assertion that what is wanted in the Health Service by the Minister is so-and-so. It should be a co-operative effort. If he would give, perhaps they would give.
§ Mr. Powell
The suggestion I was making was not for my benefit. It was for the benefit of the profession and the service. I am sure that knowing and seeing it to be so the Society wild give it its best consideration.
I come back to the question of the effective use of these trained people in the Health Service. There is evidence that we could be more effectively using them, and that there could be reduction in waste or under-use of physiotherapy services in the hospital service. I am today sending to hospital authorities advice, based upon a report of my Standing Medical Advisory Committee, for a much more careful conservation of our physiotherapy services. In particular, there should be a regular review of patients who are under physiotherapy treatment so that we may be absolutely sure that we are not wasting a speciality which is in such demand.
I come now to the third group of professional staff in the Health Service, namely, the nurses. Here again, there is precisely the same picture of a steady 1097 increase in staff which has continued right up to the present time, so that the numbers of nurses are today at the highest level at which they have ever stood.
§ Mr. Richard Marsh (Greenwich)
Is the Minister also prepared to say that the number of qualified nurses in the service is at the highest level it has ever been?
§ Mr. Powell
Yes, it is. I will not trouble the House with the almost infinite variety of figures which one can take to illustrate this. I will take merely two series. Over the last five years there has been an increase of 10 per cent. in whole-time and of 70 per cent. in part-time nurses in general hospitals. Over the same period there has been an increase of 10 per cent. in full-time and of 33 per cent. in part-time midwives.
The House will note that this increase is most marked in the case of part-time staff. This is a very important and, indeed, a very welcome feature, because we shall, as the years go on—this is a part of a very general social change—find that we need to bring into the Health Service—perhaps this applies not only to the Health Service—a great many who have served in it in early life, have left and are able to return.
I am glad to say that the hospital service is learning ever better so to arrange its work that there is an increasing scope for the part-time nurse and, I add, for the part-time midwife. That is why it is so misleading when the expression "wastage" is used in relation to trained nurses Who leave the hospitals—for example, upon getting married. It would be much truer to see these trained people as a reservoir and as a reserve from which we shall be able to draw increasingily in future years. After all, the student nurse and the pupil nurse, while they are receiving their training, are also serving and working in our hospitals. I do not begrudge it for an instant that many of them, after their training or after a comparatively brief period of service, should pass out of the hospitals.
§ Mr. K. Robinson
Would not the Minister agree that wastage during training, which was the only wastage to which I referred, is a very serious and disturbing matter?
§ Mr. Powell
Yes. I was not criticising the hon. Gentleman's use of the word "wastage" in that context, but people often speak as though the departure from the service of trained nurses was somehow a permanent dead loss. We must learn to recognise that it can be very much the reverse.
§ Mr. Llewelyn Williams (Abertillery)
Is the Minister satisfied that the total number of nurses is fairly and equitably distributed throughout the country? Some areas have a sufficient number of nurses, but other areas are steadily depleted.
§ Mr. Powell
I am dealing with the total national position, as I did with the other categories. I am showing—this is my theme—an increase which is bound to redound to the benefit of all parts of the country. I am saying that there is a continued upward trend here and in the other professional services in the National Health Service.
§ Mrs. E. M. Braddock (Liverpool, Exchange)
Are the Minister's figures in relation to the establishment in each hospital? Hospitals have had to supply an establishment—the number of nurses they want. I agree that there has been an increase in the number of nurses, but is it in relation to the full national establishment, if the Minister says that we are not short of nurses?
§ Mr. Powell
I have not said that we are not short of nurses. I am inviting the House to take note that the nursing service is constantly expanding and increasing. This is virtually common to all parts of the nursing service.
I want to mention two minor exceptions. In the last year or two there has been a slight drop in the number of student nurses from the peak of 1958 and 1959. There are a number of causes at work here, one of which—this has relevance to wastage in the sense in which the hon. Member for St. Pancras, North referred to it—is the undoubted fact that in many hospitals higher educational standards have now been voluntarily adopted, which will bring their advantage probably in a lower rate of true wastage during the student years.
Another point is that the number of pupil nurses has continued to increase very rapidly, and I am sure that the 1099 relative importance of the roll is destined, and rightly destined, to increase in the nursing staff of the hospitals.
Finally I am glad to say that the latest figures from the schools of nursing indicate that there has been just recently a resumption of the previous upward trend, but I remind the House that the figure which we are about 2 per cent. below—namely the 1958–59 figure—was itself a very high peak and the highest number of students who had ever been under training.
There is one other branch, and it is the only other branch, in which we are otherwise than absolutely at the top at the moment. In the staffing of psychiatric hospitals we are also a little below the peak figures reached in 1959. I want to come back to that point later, but meanwhile I should like to sum up the whole picture of staffing and recruitment in the Service as I have put it to the House. The picture is that in every one of the branches of the Service—in medical staffs, in professions supplementary to medicine, and in nursing—there has been a steady expansion which has been going on up to the present day. These are facts which entirely refute any suggestion—it is a suggestion which can only harm the service—that service in the National Health Service is unattractive to the young men and women who are equipped for it.
I believe that the publication at the beginning of this year of the hospital plan will itself be a great asset to further recruitment in the service. It can do nothing but good. It can exercise nothing but a strong attraction if the public and all who are thinking about service in hospitals can see before them the prospect of the development over the next ten or fifteen years of a service where the buildings and the pattern will be fundamentally modernised.
Here I would like to say a few words particularly about the prospects that modernisation and the new pattern open up for psychiatric nursing. I think that there has been an impression, and I would like to do all I can to correct it, that the prospective reduction in the number of beds for mental illness carries with it the implication that there will be less need for trained mental nurses. 1100 I believe that it carries with it the quite opposite implication—that there will be a need for them in a calling which will be much more attractive and rewarding than that which previous generations in our mental hospitals have ever enjoyed. Therefore I believe that, when this is seen, the brief halt in the recruitment for psychiatric nursing will quickly be overcome and we shall go forward there as on other fronts.
Among the factors which influence and which are at the root of this steady and continuing expansion, pay is one, but it is only one, and in many cases it may not in itself be the most influential or important. But this brings me to speak of pay, particularly in the nursing service and of the current controversy.
§ Mr. George Brown (Belper)
The right hon. Gentleman is leaving that section of his speech in which he has been discussing the staff situation in the various sectors of the Service. May I draw his attention to the fact that he has spoken for over twenty minutes and has not made a single reference to there being any shortage anywhere in the Service, or to there being any difficulties anywhere in it? Does the right hon. Gentleman intend to leave that passage of his speech and to leave everybody, outside and in the Service, who know it to be untrue, to believe that he thinks that there is no desperate shortage anywhere in the Service?
§ Mr. Powell
I hope that I have given the House the impression that I want and expect the trend which I have proved to exist to continue, but what I am not going to do is to attempt to quantify for years ahead the number of staff who, under rapidly changing and developing conditions and medical methods, will be needed in the different branches.
The overwhelmingly important fact is that in every sector we see expansion. In every direction we are pushing ahead, and there is certainly no direction in which I am saying to the hospital authorities that they have reached the limit of their endeavour and that the requirements are fully met. But the important thing is the trend. The important thing is the spirit. The important thing is the direction in which we are moving.
1101 I was about to refer to what was the major subject of the speech of the hon. Member for St. Pancras, North, the current pay negotiations and the Government's incomes policy. It is from the incomes policy of the Government, stemming from the Chancellor's announcement in July last, that this must set out. For this is not a partial policy. The incomes policy is not a policy for one section of the community. It is a policy for the nation as a whole, and it is a policy which could not be carried through and could not succeed if the Government, where the Government themselves have the responsibility, authority or influence, did not act and were not seen to be acting in accordance with their own policy.
Therefore, when I exercised what is my duty of advising the management side of the Nurses' and Midwives' Whitley Council, I drew their attention, as in duty bound, to the incomes policy set out by the Government. The nurses and all the other sections in the National Health Service are not being called upon to take part in a policy which does not apply to the nation at large. They are only being asked to accept the same common sense of the incomes policy as the whole of the nation is being asked to accept. [HON. MEMBERS: "Surtax payers."] They are not in any sense being singled out.
The day after tomorrow I am to see a deputation from the professions concerned. I very much welcome this, for it will give me the opportunity of setting the issue of nurses' pay where it belongs—in the nationwide context of incomes policy. I do not, therefore, in advance of that meeting, want to argue the details, but it is only right that I should point out to the House and should place on record the fact that the salaries and the grading structure of the nursing profession were thoroughly reviewed three years ago, with increases in pay ranging up to 25 per cent., and that there was an increase of 5 per cent. only just over a year ago.
There is one other very germane consideration, and that is that no one has more to gain from the success of this national incomes policy than the professions themselves, for in the race against inflation it is always the profess- 1102 sions who will be left behind. They therefore have the greatest interest in the success of a policy which will prevent it.
Almost the whole of my speech has been occupied with figures. I make no apology for that, because the figures which I have put on the record decisively disprove some misconceptions which were contrary to the interests of the Health Service. But I do not want to end upon the note of statistics, for, whatever the shortages of today, it would be wrong and narrow-minded to envisage the future of the Service and its future improvement exclusively or even mainly in terms of a continual increase in mere numbers. The staff, their quality, and particularly the effectiveness with which the Service uses them, is by far the greatest source to which we have to look for the improvement of the Service.
The professions, and above all the nurses, have in recent months made the most striking response to the movement—indeed they have been the leaders of the movement—towards improving all the human aspects of the Health Service. I believe that they will continue to be in the van of that movement, but we must see that in the Health Service, whatever numbers we are able to recruit and however this expanding trend continues, we make more and more effective use of those who give their skill and devotion to the Service.
This will come about by improvement in organisation. It will come about by relieving nurses and trained staff of tasks which those less trained or untrained can perform. It will come about by setting the staff in the context of all the technical improvements which the advance of medical science is bringing about, and by giving them a modern hospital service, modern in buildings and modern in pattern in which to serve. It is by these means, much more than by the continuation, important though that may be, of the rising trend of recruitment, that they will be able to perform an ever greater service to their patients.
§ 7.40 p.m.
§ Mr. Eric Lubbock (Orpington)
I understand, Mr. Deputy-Speaker, that there are two conventions which are generally followed by hon. Members in 1103 making their maiden speeches. The first of these is that they should make some general references to their constituency. In view of the fact that a great many things have been written in the national Press about my constituency which hon. Members may have had an opportunity of reading, I think that I need not deal with that subject. Indeed, several hon. Members have paid visits to my constituency within the last few weeks. Some of them came away with some curious ideas.
The right hon. Gentleman the Leader of the House, from his researches, concludes that there are—and I think that I have the figure correct—22,846 people out of an adult population of 55,000 who do not possess features. I happen to be an example of them, but I have, as you can see, Mr. Deputy-Speaker, a perfectly good nose and ears and I have, not only in the literal sense but also in the metaphorical sense, teeth—as the right hon. Gentleman may discover.
The second convention which is generally followed by maiden speakers is that they should say nothing controversial. But we are speaking about nurses' pay, which is a subject on which I feel very strongly—as, indeed, do many of my constituents—and, therefore, if it is necessary to transgress this rule slightly I am sure that hon. Members will understand.
There is another factor, which is that I have already been attacked from the Treasury Bench before I had an opportunity of speaking and when I did not have an opportunity to reply. But this is a thing which I welcome. I hope that it will happen on many future occasions, because it proves conclusively to me that I have been saying the right things.
In speaking about nurses' pay, I would like to refer to a reply given on 12th March by the Parliamentary Secretary to the Ministry of Health to the hon. Member for Stoke-on-Trent, Central (Dr. Stross). The hon. Lady told him that it was mistaken to compare the salaries and conditions of nurses with those of ancillaries. It may be mistaken, but that is what I intend to begin by doing today.
A male ward orderly in the London area receives £10 0s. 8d. basic pay for 1104 a 42-hour week, which was the figure the hon. Lady gave. He also gets 100 per cent. extra for Sundays; 25 per cent. extra for nights; 50 per cent. extra for Saturday afternoons; 100 per cent. extra for Bank Holidays, and, of course, if he works on a Bank Holiday, he has another day off in lieu as well. He also gets overtime for all hours over 42.
A State enrolled nurse at the top of the scale receives £11 13s. 3d. for a basic week which is two hours longer, and does not receive one penny extra, no matter if he or she works round the clock.
§ Mr. Lubbock
Two pay slips have been shown to me by a constituent, and they have been sent to the Parliamentary Secretary. I hope that she will have seen them by now. They were sent to her by a nurse in Orpington Hospital. One of them was the pay slip of the nurse. He received the maximum figure of £11 13s. 3d.—and he is a man with twenty-five years' service in the profession. Also sent to the hon. Lady was the pay slip of a ward orderly who had been in the hospital five weeks, who worked for two hours less and who received £13.
The hon. Lady also said that we should not compare these two because the nurses receive better conditions of service—among other things, better holidays. I can prove that that statement is false, because they work a greater number of hours in the course of the year than do the ancillaries. The nurse, indeed, has five weeks holiday. But if my arithmetic is correct, he or she is working 47 weeks at 44 hours a week. Multiply these, and the total is 2,068 hours. The ward orderly works 50 weeks of 42 hours, but he gets five Bank Holidays, each of eight hours, so that his total comes to 2,060 hours. In fact, there is hardly any difference, in spite of the fact that, on the face of it, nurses get longer holidays.
In one respect, indeed, there should be no comparison between trained nurses and ward orderlies. The ward orderly has no responsibility whatever, whereas the trained nurse has the greatest responsibility which any person can possibly undertake—that of protecting human life.
1105 The consequences of this situation are much more grave than the Minister would lead us to suppose. I must talk about my own constituency in this because, obviously, I know more about it than I do about other parts of the country. But I think that the situation which we have in Orpington is a microcosm of the whole country, and many of the aspects of our situation are repeated in other places, as the hon. Member for Abertillery (Mr. L1. Williams) has already said.
We have trained nurses who are leaving the service in Orpington and are going to industry—to Morphy Richards, or to Tip Top Bakeries, or whatever we have in Orpington—and there are nearly as many trained nurses in Orpington's factories as there are in Orpington Hospital. This is because we have presumed on the spirit and devotion of the nurses for far too long. But if we want to look at this not from the point of view of equity, but from the point of view of how public money is spent, then the present policy is entirely wrong because public money is being spent on training these people. They take several years to acquire their skills and then leave to work at a factory bench.
The hon. Member for St. Pancras, North (Mr. K. Robinson) said that 30 per cent. of those who enrol in the nursing profession fail to complete the course, but the Guardian of 12th October last gave the figure of 40 per cent., and in the same article said that 50 per cent. of the nurses who had completed their training had left for other work.
The students are already doing a shorter week, and they spend less time in the wards nowadays than they used to because there are more lectures in the course. Therefore, it becomes all the more important that those who enrol remain in the profession, because the ward sisters have less time to give attention to the students in the wards, because there is a more rapid turnover of patients, and because there is a shortage of ward sisters. It is extremely important for those who enrol in the profession to complete the course and stay with it.
What inducements are there? I have already quoted the figure of the maximum which a State enrolled nurse can attain. Also of interest is that a staff nurse's maximum is £656 and a ward 1106 sister's £840. This maximum of a State enrolled nurse of £578 per annum is after two years' training and six years of qualified service.
When one considers that this is £1 a week less, roughly, than a shorthand typist gets right at the beginning of her professional career, one can see how ridiculous these salary scales are. The Minister has been unwarrantably complacent about the staffing situation in hospitals. He sees the situation as being adequately covered in the nation as a whole. I can tell him that, in Orpington Hospital, there are 58 vacancies in its establishment of 168 trained people. In the country as a whole, there are 25,000 such vacancies.
This is borne out by looking through the pages of journals such as the Nursing Mirror. I was looking through its issue for 23rd March, and I counted 56 pages of situations vacant. Someone asked the Parliamentary Secretary the other day how much money was being spent on advertising vacancies in the National Health Service. I therefore did a little sum and I found that the Nursing Mirror was receiving £150,000 a year in advertising revenue for nursing situations vacant—and this is not the only journal in which these vacancies are advertised.
I have spoken of shortages of staff and the danger particularly as it refers to Orpington Hospital, which has three night sisters on duty for 23 wards, in which there are between 500 and 530 patients. As a result of this situation, first-year students are in charge of the wards after only nine months' training and in other cases, nursing auxiliaries are in charge of the wards.
That is not a situation about which the hospital authorities can do anything. They would like to be able to get the extra trained staff to which their establishment entitles them, but there are 74 part-time and 30 full-time auxiliaries working in the hospital and it would be impossible to function without them. They are not trained, however, to recognise an acute condition when it occurs. Moreover, even if they recognise it, they have to summon help in a crisis, because, obviously, they are not themselves allowed to give treatment. This constitutes a danger to human life.
1107 The danger is increased by the expansion of the geriatric side of the general hospitals. To ease overcrowding in the mental hospitals—this is an arrangement which dates back some years—a great many senile dementia cases were diverted to the general hospitals which took geriatrics and were rechristened cerebral arteriosclerosis cases. In Orpington Hospital, there are 350 geriatric patients in a total of 510, many of whom are totally incapable and require constant skilled attention. It may well be imagined that in these circumstances superhuman efforts are necessary to cope with any emergency.
During the summer, accident cases are brought in nearly every weekend and this happens frequently even in the winter and spring. Nurses have to be recalled to duty in their time off and from their beds. I should like to quote an instance of this which happened on Sunday, 11th March. A particularly serious motor accident occurred at Badger's Mount and the casualties were brought into Orpington Hospital. The theatre sister had already done two spells of duty that Sunday, from 7.45 a.m. to 1.15 p.m. and from 4.30 to 8.15 p.m. She was summoned back to the hospital, where she attended from 10 p.m. until 7 a.m. next day, having assisted at two major operations.
That is not the end of the story. Monday is a busy day in Orpington Hospital and it was not possible to allow that sister to go home. She then had to do another spell of duty from 9 a.m. until 1.15 p.m., at the end of which time she had been on duty on and off for 22½ hours without sleep. How many professions or occupations are there in which people would not only stand for this kind of treatment, but would do so without asking for a penny extra?
The 2½ per cent. which has been offered to those in nursing is an outrageous insult and is presuming on the noble ideals of service of the profession. The Minister knows of the reluctance of these people to take positive action by striking in defence of their legitimate rights. Perhaps he thinks, like the Minister of Aviation, that striking terror into the hearts of a potential enemy is a mission which should be fulfilled at 1108 the expense of those sections of the community who are least able to protest.
§ 7.54 p.m.
§ Mr. John Wells (Maidstone)
It is a great pleasure and privilege to be able to congratulate one of one's neighbours on making his maiden speech. Not only do I have the good fortune to have the hon. Member for Orpington (Mr. Lubbock) as my fairly near neighbour, but we have all enjoyed the fund of information on this subject which he has brought to the House and the charm and humour with which he introduced his speech. I therefore congratulate him most warmly.
The hon. Member for St. Pancras, North (Mr. K. Robinson) said towards the end of his speech that it was a pity that my right hon. Friend the Minister was not fighting for, but fighting against, the excellent people who work in the Health Service. The hon. Member was completely wrong, because to my mind my right hon. Friend, with his hospital building and modernisation programmes, is fighting many battles on behalf of the people who will work in the Health Service. We welcome all that he does for them.
On the matter of salaries and the salary structure, however, I hope that we may have some rethinking. The national income policy which allows an average of 2½ per cent. to workers of one sort and another should, in my view, be breached in respect of nurses and other workers in the professions supplementary to medicine, for the reason that it is essential to improve the social status of the people in these professions. They are, as has been said, a devoted band who do great service to the nation.
The fact is, however, that certain sections of the community must get greater status and others lose status if a society is to be flexible. We do not wish to see society stay exactly put. We want a flexible society. I suggest to my right hon. Friend that at some future date, which, I hope, will not be too far off, there should be scope for giving a greater share of the national income to the nursing, midwifery and other professions supplementary to medicine.
Last year, I had the privilege of visiting Finland on an Inter-Parliamentary Union delegation and I asked about the conditions of the nursing services. It was 1109 clear that nurses were contented, plentiful and enjoying their work. I made specific inquiries about the rates of pay and was told that they were by no means excessive. The rates of pay of nurses in that country were quite moderate. The fact remained, however, that throughout society in Finland, nursing was regarded as an excellent job from the community's point of view. In that country, nurses are held in high esteem.
There is no disputing that in this country of ours, nurses are held in high regard, but I should like to see the day when they are held in higher regard still, not only for the goodness of heart, their good looks and all the other many virtues that one associates with the nursing profession, but because they should have plenty of money in their pockets to spend. They should be a highly-educated section of the community, spending their money wisely and well. For this reason, I should like to see them enjoying a better standard of living than they do today.
All of us who have visited hospitals and nurses' homes must have noticed the great efforts that management committees have made in recent years to make nurses' homes more attractive. My right hon. Friend is partly responsible for this. The fact remains, however, that for a young woman, living in a nurses' home is not like living in her own home. There should be compensation in pay for the absence from her own home. I therefore ask that something specifically should be done for nurses.
The hon. Member for Orpington drew attention to the relative difference in pay between a ward orderly and a fully-qualified nurse. The fact remains that a male ward orderly is drawing only 6s. 6d. a week less, before overtime, than a fully qualified nurse. The fact also remains that my right hon. Friend, in an Answer to me yesterday, disclosed that he had no knowledge of the net earnings in the nursing, ward orderly and similar sections of this profession. Therefore, if he has no knowledge of the net earnings, the fact clearly emerges by implication that, as the hon. Member for Orpington said, ward orderlies are in many cases earning considerably more than nurses. I have no objection to ward orderlies earning high money. I think that we all appreciate the terrific amount of work they do. They 1110 earn big money through overtime, working at weekends and—
§ Mr. Wells
I do not think that the hon. Gentleman could have been listening to what I said. I said, together with overtime and the other money they pick up. We do not know what the net earnings are, and that was part of my complaint, was it not? Indeed, they are higher than those of nurses, and that is the burden of my complaint.
It has been represented from time to time that my right hon. Friend is too conditioned in his thinking by the activities of the great London hospitals.
§ Mr. Charles Loughlin (Gloucestershire, West)
Before the hon. Gentleman leaves the point about comparative earnings, can he say precisely what he wants to see being done? He made the comparison between orderlies and nurses, but he did not say whether he wanted to see nurses get a substantial increase in wages. Will he deal with that point?
§ Mr. Wells
I feel that the hon. Member must have been "miles away" when I said, at least twice, that I hope that the nursing profession will have a substantial increase. I have also said that I hope that they will have a substantial increase relative to other sections of the community. Surely it is that which is important.
If I may be allowed to go on to the conditioning of the mind of my right hon. Friend, it has been brought to my notice by various opinions that he thinks too much of what goes on in the great London hospitals. To find out precisely the degree of knowledge that he and my hon. Friend the Parliamentary Secretary have of provincial hospitals, I asked them yesterday how many visits they have paid recently. I was extremely impressed, as I am sure all hon. Members who read the OFFICIAL REPORT yesterday will have been impressed, by the assiduous attendance of both my right hon. Friend and the Parliamentary Secretary in visiting provincial hospitals. We therefore see and understand that they have visited these hospitals.
Where, I should like to ask, when they have been visiting provincial hospitals, 1111 have they seen this great increase in nurses? That is the problem to me. My right hon. Friend says that there are these big increases in nursing staff, and I believe his figure. I am sure that it is a national statistic, and that it is true, but in my own constituency, which, after all, is the only place from which I can draw conclusions, just as the hon. Member for Orpington drew conclusions from his constituency, I say that the major hospitals are facing considerable staff shortages.
In the West Kent General Hospital, Which is the principal general hospital in my constituency, we are at present enjoying a very substantial rebuilding programme, which we all welcome. As a result of this rebuilding programme, 85 beds are vacant, but, at the same time, 13 beds are vacant now because of lack of staff.
Again, next door to the general hospital, there is a much smaller, highly-specialised ophthalmic hospital—the leading E.N.T. hospital for our part of south-eastern England—Greater London, Kent and other areas in our part of the country. This hospital is permanently working on about 60 per cent. occupancy because of shortage of staff. The right hon. Gentleman has given his figures, saying that there are plenty of staff in the nation as a whole, but they do not appear to be readily available in my constituency. The shortage of as few as seven members of the staff can cause a very big upset on the availability of the programme and the work of a small specialist hospital.
Again, in a large geriatric hospital, the Linton Hospital, in my constituency, Which, I am sorry to say, is an old-fashioned hospital, but one on which considerable sums of money are being spent, we have quite a different picture of staff shortages. This brings me straight back to the point about ward orderlies. The establishment of ward orderlies in this hospital is 17½. I never quite know where to find these half-persons, but that is the proper establishment in that hospital. Last month, the figure for ward orderlies there was 42. There are far more ward orderlies than the establishment allows. Why? It is because they are doing the work of other 1112 people, and it is this fact which is extremely worrying.
Also in my constituency there is a large mental hospital. Here, there is a somewhat different pattern. A far greater emphasis is placed on the requirements of male nurses. The male nurses are a most devoted body of men, but to a man with a wife and family and all the rest of it to support, the salaries they receive are totally inadequate.
The fact that we have been able to maintain so large a staff as we have in Oakwood Hospital is a great tribute to the ability of the senior staff there to keep their junior staff. It is on this point that I would ask the Minister to bear in mind, when there is a review of salaries, that the senior staff, the people carrying the weight of responsibility, should have some "weight of responsibility allowance" in their salaries.
A young nurse who has finished her training is looking to nursing as a career, and not just as a "dead-end" job. Those setting out on a career must surely look for substantial rewards later. They may fully realise that in the early years they are still, as it were, undergoing training, although they may just have qualified. They are still learning and adding to their own volume of experience, but they want to see that there are substantial rewards available to them if they stay in or go back to the service.
My right hon. Friend has quite rightly dealt with the valuable work of part-time service in mental hospitals such as Oakwood. Female staff part-time service is invaluable. If we cannot offer these ladies real rewards if they stay in the service, if we cannot offer incentives to them to stay on for the higher posts, I think that the wastage will be much more real than it has been in the past. With male nurses, this matter of money seems of importance, but with female staff, the ability of the seniors, the quality of the building, and so on, may have a considerable bearing on the retention of the staff in the hospital. No matter how good the matron is, or how good the senior staff, unless there are good buildings and a lively hospital atmosphere we shall invariably get wastage.
Young nurses do not like the small specialist hospital. They prefer 1113 the hubbub of a general and larger hospital. Would it not be possible for my right hon. Friend to see whether a method of exchange could be arranged to enable nurses for a period to go to the smaller specialist hospitals before returning to their main hospitals? This is a matter of some importance if the smaller hospitals are to continue to be staffed as we would like.
Reference has been made to overseas personnel, and especially to doctors. In my own constituency applications have been received for nursing appointments from overseas personnel, but the hospital authorities now always insist on the prospective nurses applying in their own handwriting, because there seems to be a total lack of screening of prospective nurses in their own country. It might not be beyond the bounds of possibility for the United Kingdom representatives in various Commonwealth countries which send us prospective nurses to organise some form of screening for literacy and personal health. It is clearly foolish to bring into our great hospitals people who can scarcely read and write and who may not measure up to the requisite standards of personal health.
In the country areas we are all very much aware of the great burden which is being placed on rural mid wives. The rural midwife works long hours and has to drive her own car. Her work comes in spates. It always seems that there is a great number of babies when there is snow on the ground. Life for these ladies can be very trying at times, but they are most devoted. In view of the present trend for more and more young married women to seek to have their babies in hospital rather than at home, there is great difficulty especially for rural midwives who work at too great a pressure, because the mothers-to-be are told that they have to have their babies at home because of the shortage of beds. They then have a somewhat belligerent outlook and feel that they are getting second-best.
That is by no means the case and I would be grateful if my right hon. Friend would go out of his way not only to see that the rural midwife gets an increase in pay when the general increases come along, but is also commended for her work. I would also like him to see that the supply of maternity 1114 beds in hospitals is increased so that there are no more unwilling confinements at home. Hon. Members will have seen the various items which appeared in The Times last week and, in particular, the article, published on 22nd March, about the acute shortage of maternity beds.
My right hon. Friend has already said that there is a great increase in the number of physiotherapists, but the demand still outstrips the supply. That is surely because of the new skills and the new use made of physiotherapists and similar practitioners. The fact remains that they are on a salary scale belonging to a previous generation. If it is possible, they should be put on a salary scale which has a more realistic appreciation of their service to the community. They, too, work long hours.
There is no point in going on about the long hours which everybody in the hospital service appears to work. Hon. Members and my right hon. Friend are all clearly aware of the effort and good will in the Health Service. My right hon. Friend said that the national income policy would benefit the professions most. I appreciate his point, but when the Government are formulating that national income policy I hope that they will bear in mind that the various professions centred around medicine have not had a fair deal in the past. Before they are subjected to any 2½ per cent. rule, they should be given a fair and square 1962 basis from which any further 2½ per cent. may be taken.
I ask for a fair deal for these people at the earliest opportunity—I am not being unrealistic and asking for it tomorrow—so that they can enjoy the same standard of living as their neighbours in other trades and professions.
§ 8.15 p.m.
§ Mr. Frank McLeavy (Bradford, East)
I am very glad to have the opportunity of following the hon. Member for Maidstone (Mr. J. Wells). As a member of the delegation to Finland, to which he referred, I should like to endorse his tribute to the Finnish people for their nursing standards. As he said, the nursing profession throughout that country is held in very high regard.
The Minister of Health has given little pleasure to our nurses. The Government's policy towards nurses has been 1115 shocking. Even the community generally has always been prepared to allow the nursing profession to be exploited. My mind goes back to the time when we used to have collection boxes and flag days to maintain our hospitals. We are proud to feel that it was the first majority Labour Party, in that historic period of 1945 to 1950, which put an end to that nonsense and provided this country with a National Health Service which is the envy of the world. There can be no greater monument to the memory of Aneurin Bevan than our National Health Service.
When one reads of the difficulties of the people in the United States of America, that great capitalist nation, when they are ill and when they have to pay hospital and doctors' fees, we can be proud that, in a period when the nation had lost so much of its financial resources during the war, the Labour Government introduced the Health Service. If by some misfortune a Tory Government had been returned, all kinds of excuses would have been used to show why it was not then possible to introduce the Service.
But having destroyed the voluntary hospital system, it is our duty to make our hospitals the finest in the world and to see that those who are employed in them, medical, nursing and other staff, receive financial rewards which are reasonable and just.
I was moved by a letter I read in the Bradford Telegraph and Argus on Friday, 23rd March. It was written by a student nurse and was in clear terms—far clearer than I could express. She spoke of the problems confronting student nurses, and I am grateful to this evening newspaper for having given the letter this publicity so that the public can know precisely what this problem means. This young lady, who signs herself "Just a Nurse", writesI am a student nurse at one of our local teaching hospitals and am at present doing a spell of night duty. I work 10i hours each night, and although only 18 I have been left in sole charge of a whole ward of sick people all night. The work is exacting, both mentally and physically, yet despite all this and the responsibility of having other people's lives in one's hands, I receive at the end of the month the magnificent sum of £10. Out of this I had to pay nearly £3 this month for entrance 1116 examination fees, and before long shall need to spend several pounds on books for my training.Her letter continues:I like nursing and don't want to have to give it up, but if something isn't done soon in the way of increased remuneration I shall be reluctantly compelled to join the rest of the girls who went into training when I did but have left for jobs with better hours, far less responsibility as well as twice the amount of money.Do I see the Minister smiling? It may amuse him, but these are the words of a sincere young student nurse which, I am submitting, should receive not the laughter and sneers of the right hon. Gentleman but—
§ Mr. Powell
The hon. Gentleman should have been in this House long enough not to play that silly game.
§ Mr. McLeavy
I was not playing a silly game. I was referring to the Minister having grinned when I was reading that letter.
§ Mr. Powell
If the hon. Gentleman thinks that I was laughing or smiling about what he was saying he is mistaken, and he knows it.
§ Mr. McLeavy
If so, I apologise for suggesting that the right hon. Gentleman was laughing. I took it from the Minister's attitude that he was amused by my remarks. I thought it was necessary to bring the facts contained in this letter to the right hon. Gentleman's attention.
§ Mr. McLeavy
We are discussing a service which is invaluable and which will undoubtedly increase in its scope in the years to come. It is evident from what the Minister has said that, although recruitment is increasing in various sectors of the service, there is a considerable shortage of nurses in certain parts of the country. The warning which is so clearly stated in the letter from which I have quoted—that people cannot be retained in the service if they do not receive a reasonable remuneration—should receive the Government's immediate attention.
The nursing profession has been exploited for far too long by the community at large. Nurses are dedicated and responsible people who are inspired 1117 by a desire to serve rather than to exploit their fellow citizens, and they should be given every possible encouragement. It is a "shocker" when we are told that a student nurse is expected to pay £3 for examination fees out of her paltry wage of £10 a month. The Minister should look at the whole matter to ensure that student nurses, when going through their examinations, are not called upon to pay examination fees out of their meagre salaries. Surely the books which are essential to enable them to qualify can be made readily available in the hospital libraries? Our whole attitude towards the nursing profession must be changed.
I can understand the Minister being bound by Cabinet decisions regarding the wage freeze. It was a deplorable decision, but I appeal to the Government to go into the whole question again at the earliest possible moment and to re-examine the wages and conditions structure for nurses. Let us ensure that their conditions of employment and salaries bear a relationship to other responsible jobs. All I am asking is for the Minister to re-examine the position and to make a comparison between the salaries paid to nurses and those paid to other responsible people.
Whatever the results of an investigation made by an impartial committee on this matter, I am sure that all hon. Members would be willing to accept those results on which, we would hope, the Minister would act. Unless we provide a proper salary for the job and encourage these dedicated young women to continue in the service—and enrol in greater numbers—our aims will be defeated. We must let them feel that we are not putting obstructions in their way or placing undue hurdles before them in order that they may enter the profession. The training facilities must be better than they are today and the awards for qualifying and continued service must be commensurate with those existing elsewhere. We have a great responsibility to see that justice is done.
The Government have failed lamentably in this matter. I ask the Minister to go into it once again and to see whether we cannot provide for the musing profession a standard and conditions of employment which will ensure that they are treated at least as reason- 1118 ably as other professional people with similar responsibilities.
§ 8.30 p.m.
§ Dame Irene Ward (Tynemouth)
Before I launch my broadsides, which will be quite numerous, I wish to say of my right hon. Friend that I think the Minisitry of Health is very lucky indeed to get a Minister who is dedicated to making it effective and efficient and to helping it to develop the Service which is so essential to the nation as a whole.
Although I often find myself in conflict with my right hon. Friend and expect that by the time I have finished my speech he will feel I am very much more in conflict with him, I feel that when one argues a case with him he is full of interest and determined to make the best possible Health Service we can have. We should be very wrong if we did not recognise that that is his objective, as well as the objective of my hon. Friend the Parliamentary Secretary. I follow that by saying that I agreed very much indeed with the speech of the hon. Member for St. Pancras, North (Mr. K. Robinson). He expressed very well indeed many of the thoughts and experiences of those who are in the Health Service. He put forward a case which, I regret to say, my right hon. Friend made no attempt whatever to answer.
It would not serve any useful purpose to go over all the ground which has been covered. On the point about recruitment figures, however, my right hon. Friend dealt with the whole national picture. I have not at my finger-tips all the information he has in his Department. Therefore I am bound to accept the figures he has given. That does not relieve individual Members of Parliament of the anxieties and difficulties they feel in individual regions and hospital management committee areas. My right hon. Friend could give the necessary information which would be satisfactory to all of us only if he were to publish details of the hospitals with their establishments and their situations. If necessary, I should be delighted to put a Question on the Order Paper so that this information may be obtained. I do not want to get out of the train of my theme, but I give one example to emphasise the point I am trying to make.
Not long ago I asked my right hon. Friend a Question about physiotherapists 1119 in the Newcastle region, particularly in the physiotherapists' school in the Royal Victoria Infirmary, which is our teaching hospital. A considerable sum of money was expended a short time ago in extending the school. My notice had been drawn to the fact that it would have to close one of the courses. The course which was in operation when I asked the Question was carried on only through the good services and good offices of experienced personnel in the Royal Victoria Infirmary who were not actually part of the staff of the physiotherapists' school. My right hon. Friend gave me an Answer, which on the face of it seemed completely satisfactory, that a shortened course would enable people in training to complete their course and there would be some additional teachers to be used for training personnel in other physiotherapists' schools.
When one got down to an examination of what my right hon. Friend had said, however, one found that each of the personnel who would emerge from that course would take up an appointment in another part of the country and none would be available in future for training in that physiotherapists' school under the Newcastle Regional Hospital Board. The school would fail to provide any additional physiotherapists for the hospital management committees working under the Newcastle Regional Hospital Board.
I say frankly to my right hon. Friend, although I hardly like to say it was deliberate—I never know whether the facts presented to him are accurate or inaccurate—that it looked to me as if he had deliberately tried to put me off the trail. In the area of the Newcastle Regional Hospital Board his Answer was very badly received. I suggest to my right hon. Friend that when he is asked Questions by hon. Members who have a legitimate interest in these matters he should give the true picture and not a national picture which is of no use to those within a particular region. I very much resented that Answer.
That brings me to another point. I might as well deal first with this problem of the professions supplementary to medicine. I cannot understand the objection to having a general inquiry into the pay, the recruitment and con- 1120 ditions of service. My right hon. Friend is to receive a deputation. He said that there were difficulties about physiotherapy personnel and what can be provided, but I cannot see, when a great deal of trouble, hardship and anxiety has infiltrated to the whole of the Health Service because of the pay pause, why my right hon. Friend has to maintain this rigid—and I think quite untenable—refusal of such a general inquiry.
I feel as many other hon. Members do about doctors and dentists. I do not blame my right hon. Friend, because he has not been long at the Ministry.
§ Dame Irene Ward
I do not believe that he has been there too long. I am glad to have a Minister who will at any rate listen to me, even if he does not always take my advice. But it is most deplorable that he cannot have this inquiry and obtain the facts from these professions, which are very worried about their future development.
The Minister would go a long way towards establishing his own position as an individual if he would cease adopting this terribly rigid approach to those who are qualified to appeal to him on behalf of their profession. I hope that before the end of the debate he will be able to reconsider the position. No harm would result from having an inquiry. There is no doubt that the doctors and the dentists have exercised a great influence on my right hon. Friend's Department in the past. He would be well advised to redress the balance now by listening to the cases put forward by those who are devoted, through their own services, to the National Health Service. We might then be able to make some progress, at any rate within the professions supplementary to medicine.
I do not need to go into all the details of their difficulties, because many other hon. Members can speak with real knowledge of their problems. I have risen merely to say, in my own small way, how unwise my right hon. Friend is. I think nothing of his speech tonight. He gave no answer whatever to the points raised by the hon. Member for St. Pancras, North. My right hon. Friend talked in generalities, and I am sick of generalities. I want details. I want to know exactly where we are, 1121 where we are going, and what we are doing. However brilliantly expressed it was, and however forceful its terms were, my right hon. Friend's speech conveyed nothing at all to me, and I am certain that it would convey nothing to the nursing profession or to those professions supplementary to medicine.
Having heard my broadside, I hope that my right hon. Friend will think again. I have always understood that when trying to deal with problems which are causing acute anxiety—and these must be doing so in the National Health Service—if it is possible to investigate all the facts it is possible to make a wiser judgment and to lay better foundations for future policy. My right hon. Friend has failed lamentably on this score.
§ Lord Balniel (Hertford) rose—
§ Dame Irene Ward
I am sorry, but I have not finished. It was extremely nice of my hon. Friend to try to intervene between my right hon. Friend and myself, but I cannot give him an opportunity to do so at the moment because I have a lot of other broadsides to deliver.
I want to say something about the nursing profession. I always feel privileged to speak as a friend of the Royal College of Nurses. The other day the Minister for Science was talking about language and what it meant. He said that Ministers should always be quite certain that when they spoke everybody understood what they were saying. I know that the Minister for Science would not approve of me, because my grammar is appalling and my sentences leave much to be desired. But I want my right hon. Friend to answer one question. On 12th March this year, in answer to a Question asked by the hon. Member for St. Pancras, North, the Minister said:Early in February I asked the management side to have regard to the terms of Command Paper 1626. I do not accept that this precludes consideration of the claim on merits."—[Official Report, 12th March, 1962; Vol. 655, c. 873.]He was referring to the claim of the nurses. Will he explain to the House in language which is crystal clear how, if he has already decided that no pay award over 2½ per cent. can be offered by the management side—and has issued an instruction to this effect—the case can be considered on its merits? In my 1122 opinion, it was again a most ridiculous statement to make. Of course my right hon. Friend may use different language from mine. I never mind people disagreeing with me, because half the time people do disagree with me, but I like things to be stated quite definitely and to know what they mean. I cannot for the life of me see, when my right hon. Friend says that there was nothing to preclude the case being considered on its merits, how, if he had already taken the steps which the hon. Member for St. Pancras, North said he had, the case could be considered on its merits.
Another thing that I want to know is this. Of course it is possible for the nursing profession to go to arbitration. The White Paper "Incomes Policy: The Next Step" is the most namby-pamby paper I have ever read. I am afraid that my right hon. Friend has not measured up to the language in accordance with the instructions of the Minister for Science. How on earth can anybody in his senses know what he means in his statement on page 5 of the White Paper on negotiation and arbitration? I want to know whether if any of the bodies which we are discussing tonight take their grievances to arbitration, it will be real arbitration. It is all very well to keep saying that they can talk and that they should have regard for this and regard for that, but that is not the kind of language which I prefer. I want to be down to earth. I am not suggesting that if the nursing profession goes to arbitration and is given a substantial award it should immediately be implemented.
What my right hon. Friend does not seem to understand is that the nursing profession feels very bitterly that it is being restricted to a 2½ per cent. pay award which certainly in no sense meets the claim made for a 25 per cent. to 49 per cent. increase. The nursing profession, [...]s very bitterly about that, and I feel very bitterly for the nursing profession. It also asked for a reconsideration of the structure of its service. If I remember rightly, my right hon. Friend in his speech said that there had been an examination of the structure of the nursing service not so very long ago. It still thinks—and I think that this has been admirably brought out tonight by my hon. Friend the Member for Maidstone (Mr. J. Wells) and the hon. Member for Orpington (Mr. Lubbock)—that 1123 whatever was looked at a few years, months or days ago was about as useless as the piece of paper on which this White Paper is written. In my opinion, it is of no use whatever.
My right hon. Friend is taking part in a circus. He is trying to ride two horses at the same time, and he is a very bad performer. I cannot find out from the White Paper what will happen if any of these bodies go to arbitration—and that is what I want to know. Will there be interference with the amount which the arbitrators may award? Has some secret instruction been sent round to the arbitrators? When we have another debate will such information be made available to the House by hon. Members opposite so that we find that on this side of the House we have been sold a pup? I do not like Ministers who sell me pups. I want a straight, down-to-earth statement of what the White Paper means on arbitration.
I was staggered by what the hon. Member for St. Pancras, North said about the Whitley Council. I always understood that he and all other hon. Members opposite were wedded to the Whitley Council procedure, but today he seemed to abandon any idea that it can be effective. I believe in negotiating machinery. But my right hon. Friend has broken the negotiating machinery. That is how I read what he said and what is written in the White Paper. The negotiating machinery is as dead as a dodo, and that is very regrettable. I see the difficulty about the management committee, but I should feel much happier if we were told how the arbitrators assessed this position.
I am delighted that the hospital almoners intend to go to arbitration. When their claim is considered on arbitration, no one can possibly say that hospital almoners are in plentiful supply; that flimsy excuse will not hold water for a moment. When that arbitration award is announced I shall be interested to know all the facts behind it.
Undoubtedly there is a great shortage of maternity beds, but the Minister did not tell us whether this is because the hospital services cannot provide the beds, because there is a shortage of midwives or because there is a shortage of nurses. The Royal College of Midwives feels as 1124 strongly as does the National Association of State Enrolled Assistant Nurses about the whole of the Minister's action. Having been in the House for a long time, I assess character quite differently, perhaps, from the way in which many of my colleagues do.
I know very well that there are some Ministers who do not like to go to argue with the Treasury. All my life I have been an arguer. I am not saying this about my right hon. Friend, because I believe that he is a man of very great integrity, but during the war—it cannot be attributed to any of the present From Bench—I was told by a Minister that it did a Minister no good to go to the Treasury. That is not my idea of a Minister. I like a Minister to go to the Treasury as Lord Woolton did, to bang on the table and to say, "This is what I intend to have"—and to get it.
The difficulty about the whole problem is that I do not know whether the Minister is acting on the instructions of the Cabinet. I do not think that any of the members of the Cabinet who instruct my right hon. Friend have ever been round a hospital or discussed the hospital situation. My right hon. Friend came to the north of England and looked at some of our hospitals there, and one or two very good results ensued from his visit. But when he goes to the Cabinet to talk about the Health Service, how many Ministers there know what they are talking about in the dicussion? I do not think that they know anything about it at all.
It is very obvious to the nurses and to the midwives and to the professions supplementary to medicine that when the railway men wanted something they went to the Prime Minister and managed to get something fixed up. Of course, nobody quite knows what they got fixed up because when that sort of thing happens it is private, so that nobody ever knows. One cannot have documents published for 50 years in case one quotes a member of the Cabinet—very awkward, indeed. What we do know is that the railway men got to the Prime Minister and came out of the interview quite happy, apparently. That is all right. I am devoted to the railway men.
What I want to know is, why cannot my right hon. Friend the Minister of Health take the members of the Royal 1125 College of Nursing and the Royal College of Midwives and of the National Association of State Enrolled Assistant Nurses and all the professions supplementary to medicine to the Prime Minister? The Prime Minister wrote to me when I made that sort of suggestion—
§ Mr. Marsh
I am glad the hon. Lady has mentioned that. One of the organisations concerned, the Confederation of Health Service Employees, has sent a telegram to the Prime Minister on that point. I think I may read the the reply in full. It was:The management side of the Whitley Council have been acting in accordance with the Government's policy as set out in the recent White Paper. Yours sincerely ".
§ Dame Irene Ward
All I can say is that the hon. Gentleman does not know how to deal with the Prime Minister.
§ Dame Irene Ward
Although I would not necessarily get good results, what I can say is that sometimes one can have an effect. If we do not get something in relation to this matter, and if I can get a Question on the Order Paper, I shall start badgering the Prime Minister. When I go into a battle, I go into a battle. That is part of the trouble about my right hon. Friends. They are so namby-pamby in their language that no one understands what they are talking about. In my part of the world—I cannot speak for Orpington, but I can speak for my part of the world—in the north of England if you call a spade a spade they may disagree with you and fight you to the death, but at least they understand you and they respect you. Nobody can respect this ridiculous White Paper.
The Royal College of Nursing feels that for many years the nursing profession was at the bottom of the salaries scales because all of us accepted far too much from the nursing profession without asking what were its conditions of service.
I want to ask my right hon. Friend another question. He says that they have had these salary increases. If he says that, let us have circulated in the OFFICIAL REPORT details of all the salaries and wages of all sections of the community so that we can see where 1126 these nurses stand. I thought that my right hon. Friend was a really good digger for information, but, my goodness, he is not nearly such a good digger as I could be. There are thousands of permutations—I think that is the right word—which I should like to see set out in the OFFICIAL REPORT. I think my right hon. Friend might let us know these things.
The Royal College does feel that for very many years nurses have been—and indeed they have—far too low in the salaries scales, and now they have just begun to climb up my right hon. Friend talks about their having got this and having got that. That may be, but that does not necessarily make that finally just. I saw a documentary film, "The Judgment of Nuremberg", and one of the lawyers said, "This is logical", and the other lawyer said, "Yes, but it does not necessarily make it right". I kept on thinking about that as I listened to my right hon. Friend today—it does not make it right. I stand for justice, but not a word has been said about justice. All those figures really did not mean a thing.
I want to make another suggestion. I fully agree with my right hon. Friend that we have to see that we get value for money, but I never think that the Treasury knows how to spend money to save. I am sure that it does not. I do not think that the men in the Treasury have a clue about how to spend money to save, and I am very surprised that my right hon. Friend has never given his assessment of the value, in human terms, of the Health Service.
A very well-loved, highly-respected and very competent general practitioner in my part of the world said to me that before the introduction of the Service the very rich were all right and the very poor were all right—because we always provided for the very poor in very many ways—but that the bulk of the people just above the poverty line, the great bulk of people who were earning their living—often when they should have been in hospital—had no service at all.
I agree with that view. I think that the National Health Service has been of great benefit to the nation. Why, therefore, when we are talking about spending money, and when we are talking about the Health Service, are we not told 1127 of what value that Service has been to the nation? Not a word did we get from my right hon. Friend on that subject, though some of the money spent has had a brilliant result on the health of the nation.
We want increased productivity; surely, we can see that a really efficient, well-paid and happy Health Service would help to increase productivity. But part of the weakness of the Government is that there is absolutely no co-ordination between one Department and another. We deal with the Health Service in isolation. We deal with transport in isolation. We deal with the Prime Minister in isolation—[HON. MEMBERS: "Good."] No, I do not want to isolate my right hon. Friend; I think he is one of the best Prime Ministers we have ever had. Let me say to hon. Members opposite—and I hope that the hon. Member for St. Pan-eras, North will not get a swollen head because a Tory said she liked his speech—that I would not have them running the Health Service because there would then be even less money and less justice available to those in it.
§ 9.4 p.m.
§ Mr. Charles Grey (Durham)
I hope that the hon. Lady the Member for Tyne-mouth (Dame Irene Ward) will forgive me for not following her argument too far, but I cannot help but comment on the fact that she began by praising the Minister, telling us what a good fellow he is, but, by the end of her speech, was telling us how bad he is. I agreed with her when she said that he had made a terribly bad speech, and had not given any consolation to the great Health Service in which we all believe.
The hon. Lady praised the Service, but we on this side cannot help remembering that one of the greatest political crimes ever committed in 1948 was when the party opposite voted against it—
§ Mr. Grey
It is true.
I share the view of the hon. Lady that the Minister's speech was a miserable effort. It did not face the facts. The right hon. Gentleman referred to an ex- 1128 panding Health Service. We are wondering what part of the Service is expanding. It seems that everyone except the Minister knows that there is a shortage of doctors. If he realised that, he would have told us about plans for the building of new medical schools. He did not say anything about the present overcrowding in medical schools. In short, he did not give us any facts on things about which we are concerned. The Government should tell us what plans there are for building new medical schools. This is a vital and important matter for the future. The country needs more doctors, and, therefore, needs more schools in which to train them.
I wish to mention one aspect of the Health Service which, to my knowledge, has not been mentioned. I refer to orthoptists. The Minister did not mention a word about the fact that there is a great shortage of orthoptists I do not single these people out because they have been treated any worse than anyone else, but I think that the House will agree that they have been treated as badly as anyone else. There is an acute shortage of orthoptists in the North-East in particular, and there is grave misapprehension that the Minister is doing nothing to remedy the situation, and if the present trend continues, there will be a serious crisis.
I want to give three examples of what I mean. In the Sunderland Eye Infirmary there was a training school which had to close because of a lack of staff. A clinic in Middlesbrough suffered the same fate. In Dryburn Hospital, in Durham, an orthoptist is working single-handed in a clinic which is far from adequate to meet the large demands of patients over a widely scattered area. Patients are travelling many miles to this clinic. They are travelling for treatment from Birtley, about eight miles away, from Tow Law, about 12 miles away, from Woolsingham, about 16 to 18 miles away and even from Saltburn, which is as many as 20 or thirty miles away. The reason they have to travel such distances is that there are no clinics near to them because of a shortage of suitable staff. In fact, there is a shortage of staff all over the country Surely we cannot be complacent about this desperate state of affairs, for which the Minister of Health is responsible?
1129 Reference has been made to the emoluments of orthoptists. The Health Service could not be run if these people did not work overtime, and even their pay for working overtime is not particularly good. There is something wrong if starvation wages have to be supplemented by working overtime. It is bad for the Service if we have to tire some people to death to keep others alive. This is no way to run the Health Service.
Orthoptists are shockingly underpaid. They regard themselves as forgotten people. Students are not being attracted to the profession. This is because those already in the profession are uncertain about their future and unhappy in their work because they are insufficiently paid, and this sense of insecurity has an effect on potential recruits. Students are not prepared to work and study hard to pass difficult examinations only to find, when they are fully qualified, that they receive little more than clerks who have little or no responsibility and who have done no training for the work they do. It is not possible to get the best from skilled people if they are not paid the money that they are worth.
I have every reason to believe that there is now more discontent in the Service than ever before. I am not talking only about orthoptists. I find disgruntled people in every part of the Service. These are the people who have a vocation in life and provide a good service to humanity. They are the people who normally are not discontented with their lot.
People in the Health Service consider that they could follow an occupation outside the Service and get more money for accepting less responsibility. I understand that an orthoptist is paid between £520 and £630 per annum. If this is true, it is no wonder that there is a shortage of them. They are doing a great service to mankind—as are all the other people in the Health Service, nurses, midwives, doctors, physiotherapists, and so on—and we should ensure that they are paid wages which are commensurate with the value of their work.
These people do not want to strike. They are not like workers in other industry who sometimes decide to go on strike. They detest the use of the strike weapon and do not want to be forced 1130 to use it. But, because they do not go on strike, they should not be denied fair play and justice. I believe that it is up to the Government and the Minister of Health to see that they get them.
§ 9.15 p.m.
§ Lord Balniel (Hertford)
There were large parts of the speech made by the hon. Members for Durham (Mr. Grey) and for St. Pancras, North (Mr. K. Robinson) with which I found myself in complete agreement. Without attempting to be in any sense disparaging, the parts of the speech of the hon. Member for Durham with which I was in agreement were the emotional parts, because, like him and the hon. Member for St. Pancras, North, I am of the opinion that in parts of the nursing profession and in the midwifery service there are under-staffing, over-work and under-payment. The remuneration which the people in these professions receive is not commensurate with the service they render to the community.
I also agree with my hon. Friend the Member for Tynemouth (Dame Irene Ward), who described these services as under-valued—not under-valued in any way in the hearts of the community, but under-valued in the cash return which they obtain from the community. We as a Government and we in Parliament owe them a debt of gratitude, and, indeed, a debt of honour, to ensure that the remuneration they receive is commensurate with the service that they render to the community.
So far, I agree with the hon. Member for St. Pancras, North, but he seemed to me to leave out completely the heart of the problem which we are now facing. The heart of the problem is surely that there is no single factor which has been more damaging to the interests of the nursing and midwifery profession than inflation. No single section of the community stands to gain greater benefits than nurses, midwives and the other professional bodies if we can curb inflationary pressures.
The fault rests with both political parties. During all the post-war years we have seen the wage-price spiral go twisting upwards. The wage-earning community, as a result of the strong representation which they have behind them, has been able to contract out of the impact of inflation, but those living 1131 on fixed incomes and those working in the professions which we are discussing have undergone a relative decline in their position in the community.
§ Lord Balniel
We have seen professional salaries lag behind the wage-earning increases.
No Government in this inflationary period has been at one and the same time able, on the one hand, to meet the wage demands and, on the other, to honour the obligations which we as a community owe to the professions. Therefore, it seems to me that just as no single factor has been more damaging to the interests of these professions, so there is no single economic achievement which will be of greater benefit to nurses and to midwives than the curbing and ultimately the elimination of inflation from our economy.
§ Mr. Loughlin
On the question of salaries lagging behind, could the noble Lord explain why it is that industry has been able to take from the Civil Service and many other Government services many people at increased salaries? Are those the kind of salaries he is talking about in this respect?
§ Lord Balniel
The hon. Member is really reinforcing my argument that industry is able to pay higher wages whereas the salaries of professional people have not kept pace with the wage increases. It is to achieve this objective of eliminating inflation, which is directly beneficial to the nurses and mid-wives, that the Government have addressed to the nation as a whole a call for restraint. Surely by now, after all these post-war years, there must be some measure of agreement in the country about the steps which are necessary to eliminate inflation. Surely by now there is also universal agreement that if wages, salaries, and dividends outrun production we are moving along the road to inflation.
§ Dr. Horace King (Southampton, Itchen)
The noble Lord is arguing that there are unjust differentials between professionals and wage earners. How, then, can he defend a policy which is 1132 freezing the present position and maintaining the preferentials which he claims are unjust?
§ Lord Balniel
If the hon. Member will allow me to continue my speech, I am trying to point out that we at this stage are trying to eliminate inflation. Elimination at this stage is, surely without any question—and I doubt whether he would question this—the greatest benefit that we can render to such professional persons as nurses and midwives. There is, of course, a later stage beyond the elimination of inflation to which I hope to be able to turn.
There is also, so far, fairly universal acceptance of the fact that the gross national product in recent years has increased by only between 2 per cent. and 2½ per cent. There is also universal agreement that this is not enough and that we should strive with all our efforts to increase the gross national product beyond this rate. But it must also be agreed that until this is achieved, nothing beyond a limited increase in wages and salaries and dividends is beneficial to the nation as a whole. This argument seems to me to be fairly generally accepted. [HON. MEMBERS: "Nonsense."] I thought that it was.
The question which we have to discuss today is whether there is a unique case for excluding nurses and midwives from this call for restraint, which has been addressed to the nation as a whole. If they are excluded, and if their case is not absolutely unique, we as a Government, in a field for which we are directly responsible, and as a Government who are expected to set an example, will be punching a hole in our economic policies through which, later, a whole multitude of professions and other occupations will pour. Then we will see that our aim to eliminate inflation will have been a failure. The wage-price spiral will once again be resumed and we shall once more see this dismal picture of the professions tagging a long way behind wage increases.
I began by saying that the Health Service is under-staffed, is over-worked and is under-paid. Nevertheless, the picture which the Service presents, as was most forcefully shown by my right hon. Friend the Minister, is one of very steady 1133 improvement in every section. It is true that there are geographical areas where there are serious shortages. No one attempts to disguise that that is the case. But if we look, be it at the midwifery service, or be it at the general practitioner service, or be it at the general nursing service, we see that the trend is towards an increasingly well-manned service. We have a general picture where never before in the history of the Health Service have there been so many part-time or whole-time nurses and mid-wives.
This steady improvement is a step in the right direction, and it now makes it difficult to sustain a claim that nurses and mid wives must be treated as being completely unique, and that they should be absolved from the call for restraint which has been addressed to the whole nation. My fear is that, were they absolved from this call, we would see the battle against inflation imperilled—that we would see this particular section, which stands to gain greater benefits than any other in the community, harmed once again, as it has been in the past, by inflation.
None the less, I agree entirely with the remarks of my hon. Friend the Member for Maidstone (Mr. J. Wells) and other hon. Members, that in this Service there are real grievances and problems. The wastage in the midwifery service is a serious problem. So are the anomalies, mentioned by the hon. Member for Orpington (Mr. Lubbock), in the nursing service, where untrained ward orderlies, can receive greater remuneration than nurses with twenty-five years' service. These are anomalies and problems which it is obligatory upon my right hon. Friend to solve. I believe that his decision to receive a deputation of representatives of the nursing profession will be very warmly welcomed throughout the profession.
The steps which my right hon. Friend has to take must be taken within the broad framework of the Government's economic policy, with the purpose of destroying, once and for all, the disastrous wage-price spiral. If and when this can be achieved, the nation will win a certain amount of elbow room. I want to see that elbow room used to increase the salaries of nurses and 1134 midwives and the members of the other professions which we are discussing.
I also want to see our economic policies used as a springboard to achieve a relative improvement in the position of nurses and midwives in the community. It is in the hope that the Government are now working upon the next stage of their economic policy, using the success which has attended their efforts so far as a springboard to achieve a relative improvement in the position of these professions, that I support them tonight.
§ 9.28 p.m.
§ Mr. George Brown (Belper)
I do not rise now to close this debate. This is one of those occasions when it can go on, as is shown by the number of hon. Members on both sides who wish it to go on. But at this stage, something else might well be said from the Opposition Front Bench about the way in which the debate has gone so far.
I listened very carefully to the noble Lord the Member for Hertford (Lord Balniel), who followed faithfully a large part of the pattern which the Minister set for him. The noble Lord began by declaring that nurses, and those who work in these other professions ancillary to medicine, are over-worked, under-staffed and under-paid. He repeated that declaration at intervals. He said that there were great grievances.
Then I understood him to say that, because the country has had a long period of inflation—lasting, I gather, during the whole of the twelve years of his Government—and because he did not know where else to stop it, he felt that it was right to hold back these very people who are under-paid and make them bear the whole burden of the inflation he regrets. He thus denied the justice of their claim.
I must accept that the noble Lord was sincere, but I find it very hard to understand how he could persuade himself of the justice of what he was saying to these people.
§ Lord Balniel
The right hon. Gentleman has put into my mouth words to the effect that I had said that this profession should bear the whole burden of inflation. The whole tenor of my speech was that the appeal for restraint was addressed to the nation as a whole.
§ Mr. Brown
The noble Lord's economic lecture was addressed to the nation as a whole, but large sections of the nation, either because they have power to arrange it or because the Government refuse to take steps with them, are able to win increases for themselves in their income. They have been doing it since the start of the pay pause policy, they are doing it now, and they will go on doing it.
What the hon. Member is justifying is what the Minister sought to justify—a deliberate decision to impose it upon the only place where it can be imposed, which happens to be cases, like this, of small people who are quite hard hit and who have considerable grievances and injustices. It is imposed upon them just because they are small, because they cannot win a way out for themselves, because they cannot fight back without injuring their patients, and because the Minister, in this respect, has power that he does not have elsewhere. Without going into the details of the economic lecture, I do not see how one can possibly defend such a course, either as good economics, as a way out of inflation or as justice to the people we are considering.
The Minister made an appalling speech. There were three parts to it. He gave us a long, tendentious, distorted and quite meaningless dissertation on staffing. That occupied twenty-five minutes of his whole speech, which lasted for about thirty-five minutes. He then gave us a party version of the economic lecture, of which we have just heard a rather longer version and which, I gather, the Minister intends to repeat to the deputation in a few days' time. He wound up with a peroration about the glorious future that will come about for these devoted people, more and more of whom, I gather, are to be part-time rather than whole-time, in the grand new buildings which they are to have.
That was all there was to the Minister's speech. There was not at any stage a word about whether the claim was justified. There was no examination of whether the salaries were relatively out of line with comparable grades. There was not even a word of sympathy for these people and there was no examination of the shortages that exist side by side with the figures given 1136 by the Minister. There was no word about his own gross continual interference with the negotiating machinery and the conclusion which he expects to be drawn from it, nor was there a single word about why he was not prepared to accept the claim for an independent inquiry into the whole structure of the problems associated with staffing the service.
The things that the Minister did not discuss are what the debate is about. The things that he did discuss are not—or, if they are, they are only peripherally—concerned with it. Let me deal with the question of staffing. I do not know what the Minister, or the hon. Member for Hertford, who also took the point, sought to draw as a conclusion. The only real conclusion of what they said when they have proved that people axe still dedicated enough to want to serve their fellow citizens in the Service is that the Minister regards that as a reason for not raising the salary, but that if the people were walking out he might regard that as a case for raising the salary.
That could be the only purpose of the argument. I ask the Minister quite frankly if he thinks that, in putting that forward as the case—"You cannot have it because these people are so devoted, and because lots of young girls still feel the call for this service"—he thinks that he is living up to the devotion of the very people he is talking about? Does he think that he is making any contribution to raising the ethics in our materialist age?
Does the right hon. Gentleman think that he is making any contribution at all to anything other than conflict and dispute, because even these people, with all their devotion, will at some stage draw the conclusion which the Minister was trying to teach them, and at some stage somebody will learn that they need power and will have to exercise it, whatever the consequences, when they are met with this kind of approach from the Minister? Therefore, I do not see what he has achieved by his argument, even if it had been true.
Even if the Minister's figures show that there is a steady expansion in the numbers coming into the Service, the right hon. Gentleman glossed over some very interesting exceptions to that—the student teachers, the physiotherapists, and others. He knows as well as I 1137 do that the general picture of those coming into the service does not justify drawing the conclusion, which he left to be drawn, that this is a Service in which we are getting more and more and better and better manning, and in which we are expanding the provision. Side by side with the figures he gave are the figures that he did not give—for hospitals cutting down wards, hospitals shutting down only recently-built operating theatres, like the ones which his predecessor opened with such a fanfare of trumpets not so very long ago, but which now have had to be shut for want of staff to operate them.
The right hon. Gentleman knows as well as I do, because other people have told him, that side by side with his figures comes a picture of enormous dilution by people who are not skilled trying to cover the jobs of skilled people who are not there. He knows that, side by side with these cases, goes the kind of story, such as the hon. Member for Orpington (Mr. Lubbock) told in his maiden speech, of devoted women working enormously long hours to make up for the absence of others.
These figures are also relevant, and they show the situation at the moment. They show not a Health Service that is giving more and more facilities, but a Service that is not keeping up with the demands that our people are making on it, and which is not keeping up with the need that has grown up over these years. That is the side of the story that ought to worry the right hon. Gentleman.
Although the case for more pay for these people is not wholly made, and is not being made, by them on the grounds of the need to attract more people into the Service, or to retain the people already in it, it is relevant to it, and if the Minister rests, as he did, most of his refusal to grant an increase on the ground that it is not necessary, because people are coming in, I tell him that he is misreading the figures. He is reading only the figures that suit him, but he is leaving out the others, when any impartial examination of the situation in the Service would lead one to conclude that there is ground, even in that limited area, for doing something about salaries. He ought also to do something about conditions and hours 1138 of work in order to encourage people into the Service and to retain them there when they are in.
I thought that the right hon. Gentleman was very complacent about the whole thing. Obviously, he does know the other side of the picture. Why did he choose not to put the two pictures side by side? I do not understand. I had the terrifying feeling at the end that he was as complacent as he looked, and was not merely putting up one side of the argument to score a little debating point, but because that was how it looked to him. He was complacent, he did think that the Service was expanding, that the men and women situation was getting better, and that there was no need to do anything about it.
The Minister said that physiotherapists were one of those groups in which things were not as rosy as he seemed to think they were in all the others. He made two proposals to put that side of the picture right. Again, I was horrified, because the man is shown by his outlook. The right hon. Gentleman and I have crossed swords on this before and he knows that I have a great respect for him, more than I have for some of his colleagues. I understand him and his outlook and he always courageously stands by it.
One of the two proposals was to reduce the quality of the teachers by asking the Chartered Society to cut the two-year period, and the other was to cut the service by having patients much more carefully examined to see whether they should be receiving physiotherapeutic treatment. One proposal was to reduce the quality and the other to reduce the service. On that basis, one could solve a shortage of anything.
Although many Tories hide it from themselves, I believe that this is a fundamental Tory doctrine. It is what the right hon. Member for Woodford (Sir W. Churchill) meant when, in an election, he said that under the Tories the social services would be used as an ambulance service, a safety net catching those who fell through everything else, but only those. That is what was behind the Minister's thought today when he was talking about cutting the service and reducing the quality He had in mind something for what the hon. 1139 Lady the Member for Tynemouth (Dame Irene Ward) called the very poor, while others would provide privately for themselves elsewhere. This is the attitude which has gone along with all the developments of the idea of more and more private provision through insurance companies, and so on. It is that which terrifies me.
§ Dr. Alan Glyn (Clapham)
My right hon. Friend spoke of the necessity for physiotherapists. I am sure that he was not referring to those who could get that service privately, but to those who, through medical necessity, needed physiotherapy. The service should be reserved for them and not wasted.
§ Mr. Powell
It is wrong to waste the services of physiotherapists upon cases who can no longer benefit from them.
§ Mr. Brown
This is the politician deciding that the medical people are wasting services by treating people whom they ought not to treat. This is the Minister saying that he will solve the problem of the shortage of physiotherapists by interfering with the freedom of the medical profession to decide whom to treat.
The right hon. Gentleman has decided that the treatment is being wasted on some people and that he will issue guidance, or advice, or instructions—it comes to the same thing—to tighten up the medical test and to make it narrower and stricter. Anybody who does not get through that net will not have the treatment. [HON. MEMBERS: "No."] That is clearly what is meant, or it means nothing. That is all it can mean.
Anybody who fails to get through that narrower and stricter test shall not have the treatment. By that means the Minister will cut out what he calls waste. Patients who are now being treated will not be treated and he will be able to tell us that he has enough physiotherapists and that that problem has been solved. That is the attitude the Minister took and is the only deduction that can be drawn from what he said then or from his frank statement just now. It will be noted carefully outside the House.
1140 We then received from the right hon. Gentleman a short economic lecture—the sort of lecture that has been repeated time and again. Surely we are entitled to protest at this. At a time when dividends are not restricted by Government action, when rents have gone up because of Government action, when the cost of living is rising in all directions and at a time when people generally are having their incomes increased, the Minister had a bit of a cheek to answer the case that has been made with the kind of arid economic lecture to which we were subjected.
The right hon. Gentleman's argument was quite irrelevant. The nurses have not caused the inflation. They are the victims of it. To say to the victims, "The best thing we can do for you is to make sure that you suffer your hurts without any balm" seems to be adding insult to injury. If the Government want to tackle our economic problems and have an incomes policy they must do many things in many fields which they are not now doing. Merely to take individual groups of people—the poorest, relatively speaking; the minor civil servants, the teachers and now the nurses—and deal with them in this way will do nothing that is adequate to tackle our economic problems. Unless the Government do something constructive for these people they will not alter our methods of production, improve the exports position and obtain the co-operation of management and labour in a national plan.
I urge the Secretary of State for Scotland to deal with the major issues. Is the claim of these workers justified? Do they have a case? I will not go into the figures now, because I am sure that the right hon. Gentleman must be just as aware of them as I am. I urge him to consider their wage scales. The salaries of physiotherapists and all the other ancillary grades should be compared with any like group outside. If the right hon. Gentleman makes that comparison with people who must give up the time required for training and have the limited opportunities for promotion and extra payment, he will then be in a position to say whether or not he thinks that they have a claim.
I do not see how anyone can deny that they have. After all, we are talking about salaries in the £500 to £600 a year 1141 range for the sort of training, work and conditions that apply to these people. I would have thought that they are marked out as being under-paid in relation to any other comparable group.
Will the Secretary of State for Scotland do what his right hon. Friend would not do and say whether he accepts what I have said? If he does not, will he frankly say so? We should know the answer. Until the Government frankly declare their attitude towards this subject all the rest of what they are saying is shadow boxing. It seems that the people about whom I am speaking have a very considerable case, and that the 2½ per cent. does nothing to meet more than the tiniest fraction of that case. That figure is ludicrous when compared with the degree and justice of their claim.
If he feels that although they have a case, and are under-paid, he cannot himself do justice to it, why does be resist the independent inquiry which has been asked for? As was put so cogently by my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson), this has been done for many other groups of people. The doctors had their inquiry. What is it that makes it proper in their case, but improper for other people whose hardship is a great deal greater than those for whom the Minister's predecessor granted an inquiry? The Secretary of State for Scotland ought to be frank to the House and tell us what it is.
Is it anything other than a fear on the part of the Minister that the decision would be bound to lead to a different salary structure that now exists and a very considerable increase in parts of it? Is that the only thing which prevents him setting up an inquiry? In other words, has he made a judgment already that his refusal is wrong but is unwilling to let someone else pass judgment on him? If that is not the answer, I ask the Secretary of State to be frank with us and to tell us what it is.
Will the Secretary of State complete the picture, which the Minister only half finished, about the situation in the Service? Will he set frankly alongside his right hon. Friend's figures the figures for shortages of staff which now exist? Will he tell us what they are? We all have had material from various bodies con- 1142 cerned. There is no reason to think that the Chartered Society of Physiotherapy would be deliberately misleading in the memoranda it sends round. I have a list of the shortages in the ancillary professions. They vary from 21 per cent. under establishment in the case of physiotherapists to 42 per cent. in the case of therapeutic dieticians. There is 23 per cent. in the case of occupational therapists, 20 per cent. in the case of orthoptists and 24.6 per cent. in the case of remedial gymnasts. Are those figures right? If they are right, what effect does that have on the case the Minister built up? They hide and cloak more serious shortages, particularly of male entrants to these professions.
What is true of this is also true about nurses. There is a great shortage of nurses. We are able to find that by the evidence of our own eyes when we go to hospitals and also by evidence from matrons and sisters in hospitals. It is evident in my constituency as it is in others. It is published in documents issued by bodies which know the position and tell the truth, the General Nursing Council, for example, and the Sheffield Hospital Board, covering my region. There is a long list of places which are being closed. Does the Secretary of State accept, or is he denying, all this information? If he accepts it, it destroys the case which his right hon. Friend relied upon.
I have asked the right hon. Gentleman to tell us frankly what he thinks is the justice of his claim and to tell us why he will not submit it to an independent inquiry. I now ask: if the shortages do exist and are of this kind of gravity at a time when we know that waiting lists are growing and will go on growing, and there will be more and more people to use the service—a factor which the Minister left out of consideration—how does the right hon. Gentleman propose to deal with it, short of cutting the Service down? How does he propose to attract people into it—or does not he want to?
The right hon. Gentleman seemed to think that so long as we went more and more over to part-time working we could get by, and that where we did not we could reduce the Service. Does the Secretary of State accept that interpretation? If not, and if he does not intend 1143 to do anything about salaries, how will he close the gap?
There are many other matters to which I should have liked to refer, but many have already been referred to, and what have not will be referred to by my hon. Friends. I leave it there, except to say that the nurses, who are already worried and upset, will be staggered when they read reports of the Minister's speech, as will the members of the ancillary professions. I want to tell them that the problem arises from none of the things which the Government have been discussing this afternoon. The real problem is concerned with social priorities, and the Government's approach to communal spending. The nurses, physiotherapists and others will have their claims met only when we are running a society in which justice is the prior consideration, and are prepared to find the money from our communal productive effort for those services that we deem to be of the highest order of importance.
This materialistic, so-called affluent society—this society that the Conservative Government has so sedulously cosseted and built up, with the, "Pull up the ladder Jack, I'm all right" mentality; with the encouragement of selfishness, and of putting oneself right regardless of what is happening to other people—is what creates the problem for the nurses and the others of whom we have been talking. No real way out of this situation can be found until a different attitude has been created in society, and there will be no different attitude while the Government, by their actions, and by speeches such as we have heard today, deliberately teach the lesson that power tells, and that unless a person has it and can exercise it regardless of the comfort of other people he can expect to be held back at the end of the queue.
We shall not create a new attitude while the Government teach that lesson. We shall merely see more and more people tumbling to the fact that they must look after themselves, and that the jungle law will apply in the jungle world for which the Government are responsible. We should continue, both in this House and outside it, pressing the Government to change their attitude 1144 to nurses and to the other people in the Health Service.
We need a much vaster change than this. When the Health Service was brought in it was a wonderful conception. It was really meant to be a free Service. It was meant to be available to people when they needed it. When I heard the Minister denying that this afternoon—as he has done before—I wondered why he applied that argument to the Health Service and not to water. Why is it right to have some things on tap, regardless of what it costs, but not other things? Why is not health regarded as an essential service?
The Health Service was a wonderful Service to begin with, and it must be made one again. We must return to the original conception. Until we do, successive Ministers will try to hold down what they call the cost and they will be forced again and again to do one or other of the only two things they can do—either to cut the Service or to impose hardship upon those who work in it and make them pay for their devotion. That is the action that the Minister seeks to justify.
§ 10.0 p.m.
§ Mr. John Farr (Harborough)
The right hon. Gentleman the Member for Belper (Mr. G. Brown) when intervening in the debate said that he thought that it might be of some benefit if he made a few remarks. I have found nothing of any benefit whatever in what he said. I feel that I could well have waited another few hours before I had the benefit of his advice, delivered in his usual moralising manner which becomes quite nauseating on this side of the House after the first twenty minutes or so.
Before the right hon. Gentleman chipped in, we had some very interesting speeches, particularly from this side of the House. I should like to reinforce the plea made by my hon. Friend the Member for Tynemouth (Dame Irene Ward) to the Minister. She called his attention to the Motion on the Order Paper relating to the Review of Remuneration of Professions Supplementary to Medicine. She also called the Minister's attention to the need, in her own words, of calling a spade a spade, of speaking as Geordies do and of trying to say what one means. May I fully 1145 support what she said. She put it in far more able words than I could ever expect to do.
My hon. Friend the Member for Hertford (Lord Balniel) had a clear and cogent argument. So far as I could follow it, he seemed to say that the pay pause should continue, but I disagree with him in so much as he said that the professions we are talking about—the nursing and medical professions—are at the bottom of the ladder and are frozen in this pay pause at the bottom. I think they are in a position far lower down the ladder than can possibly be allowed to continue.
I welcome the initiative of the Opposition tonight in introducing this subject for debate. It enables us to focus a spotlight on a profession which is quite unable to support its pay claim by the threat of industrial action. I say that advisedly, although I read in the Evening Standard tonight a heading, "Hospital strike threat". It went on to say that the union leaders of Britain's 200,000 nurses may meet to decide whether or not to take industrial action. I say to the House quite sincerely that that is nonsense.
§ Mr. Farr
I am not an authority on the total number of nurses, but I quote exactly what the paper states:Calls for hospital strike were made at meeting of union leaders of Britain's 200,000 nurses and midwives today.To develop my theme, I think it is nonsense to say that the medical profession would ever threaten to strike. [HON. MEMBERS: "Oh."] It would never do so. We have many people employed at all scales and all levels in the medical profession. They realise that whether they want to strike—and I have no doubt that with the treatment which they are receiving at the moment many would like to strike—it is absolutely impossible. How can they strike and leave the hospitals full of sick patients to fend for themselves? How can they possibly strike—even though some hon. Members opposite seem to think that they could.
§ Mr. Farr
How could they possibly strike and leave a mental hospital full of 1146 mental patients to fend for themselves? Nobody with any sense of obligation could contemplate it for a moment. There are certain professions in the country to whom the moral obligation to remain at work is perhaps nearly as strong—for example, the police, who are virtually forbidden, morally, to strike; but they are on a far different rate of payment from the people whom we are discussing tonight. The police constable starts at £12 a week and receives 42s. a week rent allowance. Hon. Members should compare that with the starting wage of a male nurse of £8 13s. 4d. a week. There are many other occupations and employments for which the word "strike" means very little. The Armed Forces are forbidden to strike because they are governed by Queen's Regulations or other regulations in similar terms. But I challenge any hon. Member to tell me of an occupation the members of which as a whole are paid less and yet who have a higher obligation to remain at work than the members of the medical profession.
I emphasise this moral obligation to remain at work because we all know that in wage negotiations the strong union, representing a strong body of employees, always has the strike ace up its sleeve, perhaps to play after it has laid its other cards on the table. This is a significant factor in wringing out of management or employers the extra 2s. to 3s. a week. But the use of the strike cannot possibly apply to the medical profession.
I turn to a fairly narrow aspect of this subject—the problems of mental nurses and, particularly, male nurses in mental hospitals. Yesterday, in response to a lot of correspondence which I have received and many telephone messages. I visited the biggest mental home in Leicestershire, Carlton Hayes, near Narborough, in my constituency. I had received many letters before I went there, and I went to interview the people who had written to me. Unfortunately, my right hon. Friend is not in his place at the moment. I wanted to tell him exactly what these people want and why this major mental hospital, with a staff complement of 104 male nurses, is having to stagger along with only 56 male nurses on its staff.
When I spoke to the deputy chief male nurse, who took me round and gave 1147 me the opportunity to speak to many other male nurses, he told me that out of the 56, in a complement of 104 male nurses, three were leaving this month to take up occupations outside the nursing profession with far more remuneration. The chief male nurse and the whole of the male nursing staff in this hospital are desperately worried men. My right hon. Friend should be worried, too. Certainly the relatives of the patients in this mental hospital are desperately worried, because they know that their relatives in the hospital cannot possibly receive the treatment which we or they would like them to receive and to which they are entitled. That is because of the shortage of staff. I trust that my right hon. Friend will read my speech in HANSARD. I wish to tell him, following the interviews which I had with members of the nursing profession, what is wrong in Carlton Hayes, because in this he may find a pattern for other mental hospitals in the country.
First and foremost we have the burning topic of wages. A male nurse engaged at this big, major mental hospital operating under the new Mental Health Act with all that that means starts there at £8 13s. 4d. for a 44-hour week or an 88-hour fortnight, which is what they work. That £8 13s. 4d. is quite a long way below the scales which the right hon. Gentleman the Member for Belper mentioned when he referred to various branches of the medical service where there were shortages of staff and where there were income categories of £500 and £600 per annum. This category of male nurses get only £400 or so a year. From that £8 13s. 4d. there is a deduction for all meals taken while on duty. The male nurses have to pay for that. There is a deduction for superannuation and a deduction for National Insurance; and, if they qualify for it, which is doubtful, they have to pay Income Tax. Many of them, the chief male nurse tells me, take home something like only £7 10s. a week. I remind my right hon. Friend that we are not talking about some young girl working in a hospital however able and qualified she may be. I am talking about a man who may well have the responsibility of providing for a family and of running a home, and to expect him to do so on 1148 such an income as I have mentioned is to my mind ridiculous.
A traffic warden—and what on earth is the good of a traffic warden? I got a ticket—
§ Mr. Farr
No, not for the Cup Final, but I got a ticket from one of the traffic wardens the other day. Even before I got the ticket from the traffic warden I really thought, with all due respect to my right hon. Friend the Minister of Transport, that there was very little justification for their existence, and I still do think that there is no justification whatsoever for a traffic warden's receiving far more pay in a week than a male nurse does.
§ Mr. Farr
Exactly. The hon. Member has put the words into my own mouth, and I thank him very much.
What chance has the chief male nurse at this hospital of recruiting new staff when two or three miles away there is a thriving engineering firm offering full employment and employing over a thousand people making special grinding machines, a firm offering full overtime for anybody who wants it? What chance has the chief male nurse of getting replacements for his missing staff when the hospital is situated only six miles away from the thriving, busy and bustling City of Leicester?
One might think that there must be some hidden emolument for the nursing staff at Carlton Hayes to make up for the apparently pitiful figure of £7 or £8 a week they are receiving. It might be thought that perhaps they got something else in a hole and corner manner, that perhaps they had subsidised rents for the hospital houses in which they live. Indeed, that was one of the questions which I specifically asked. The answer I got was that, unlike the police, who receive a rent allowance, they receive no rent allowance whatsoever.
Moreover, the rents for the 60 hospital houses owned by Carlton Hayes to house the hospital staff, nursing and otherwise, and which used to be rented favourably for hospital employees living there, so that they paid slightly less rent than 1149 they otherwise would have done, have been increased in the last few years by direction of my right hon. Friend the Minister of Health, and now the rents of those houses compare more or less exactly with the rents of similar council houses to let round about.
Moreover, the chronic shortage of staff prevents the chief male nurse from being as selective as he should be in choosing staff. He gets very few applications in response to his Press advertisements. A position in a mental hospital like this does not require anybody; it requires someone with goodness knows how many qualities of skill, patience, understanding and tact. The chief male nurse is unable to sieve the candidates as he would wish, with the result that the general calibre of the male nursing staff is slowly going downhill.
The chronic shortage of staff in this hospital also acts as a discouragement to advancement. The chief male nurse finds that he cannot release for special training for S.R.N, the younger members of the profession who want to get on, because he just does not have the staff to do the jobs in their absence. One finds men—and I was at the hospital only yesterday—in their early 'twenties, newly-married and anxious to get on but finding that in this branch of the Service they are more or less at a dead end. To become a qualified male nurse involves three years' training, and a further two years' training for a general certificate, and it is tragic to see these qualified and dedicated people being forced to leave the profession on purely economic grounds.
As I believe that this debate is to continue all night, I venture to read extracts from the letters of two or three members of the male nursing profession which I think are particularly relevant. They are short extracts, and I am quite sure that hon. Members opposite, being as desperately interested and concerned in this matter as I am, will pay every attention to them—
§ Mr. Julian Snow (Lichfield and Tamworth)
The hon. Gentleman says that the Opposition are just as interested in the subject as he is. Is he under any delusion at all that it is the Opposition that are taking the initiative in this debate? Vol. 656
§ Mr. Farr
I said at the beginning that I was grateful to the Opposition.
The first short extract is from a letter written by George Slough, a male nurse at this hospital. The consensus of his letter is contained in these three lines:Is it possible that the Minister of Health does not realise that he is not only dealing with single girls of 18 years but also married men with a family to support? I am a male staff nurse with eight years' experience "—and let hon. Members listen to this:and I take home, after deductions, a meagre £9 odd to support a wife and two young, growing, sons. As you can imagine this does not stretch very far.Another male nurse at the hospital—H. A. Taylor, R.M.N.—writes:In the sphere of mental nursing, it is an accepted fact that male nurses have to supplement their income with part-time work in order to obtain a decent living wage. Can this be truly said to be what your Prime Minister meant when he said his aim was to double the standard of living?Here is a further extract:The contributory pension scheme asks for 3 per cent. to 6 per cent. of the nurse's wages, no rent allowance, and £5 per year towards the cost of providing uniform. These conditions for police, fire brigade, etc., were obtained after promises of militant action being taken if they were not forthcoming.I have another letter from a male nurse with fifteen years' experience in this hospital. He is a disillusioned man, who states:When I joined the most noble of all professions fifteen years ago, the flame of Florence Nightingale shone bright before my eyes. Since then, the flame has dimmed to nearly the point of extinction, as it has with quite a number of good and dedicated men and women who have left the profession in recent years to earn worthwhile salaries inother occupations.
I have files and shoals of letters on similar lines. With the permission of my hon. Friend the Parliamentary Secretary, I will send them to her so that she may study them at her leisure.
§ Mr. Farr
I ask my right hon. Friend to act quickly and to instruct the management side to increase its offer of 2½ per cent. I warn him that if it is not substantially increased the chronic situation in this big mental hospital will become worse. Even with an increase of 2½ per cent., the present serious situation will not be contained.
1151 I have confined my remarks to mental hospitals, but I believe that all medical, nursing and professional staffs are underpaid. I have among these papers an official table for England and Wales issued by my right hon. Friend. It refers to the recruitment of hospital staffs from 1955 to 1961. The trend is that since 1955 the percentage of hospital whole-time nurses has increased, the number of hospital part-time nurses has increased, the number of certificated whole-time midwives has increased and the number of certificated part-time midwives has considerably increased.
I tried to relate this table to the information which I obtained yesterday, and it was not until then that I noticed a little note at the bottom of the table saying that these figures did not include mental hospitals. What is the trend in the staffing of mental hospitals? 1152 Does it show the same satisfactory increase that the recruiting figures for other types of hospital show? Does it show the same satisfactory trend in staff increases which are shown for mid-wives in my right hon. Friend's table? If it does show that there has been an increase in the staffs of mental hospitals, will my right hon. Friend tell me why the staff of this large hospital in Leicestershire, Carlton Hayes, is so desperately under strength?
Finally, however hard and uncompromising the Chancellor of the Exchequer may be in demanding wage limitations, I ask my right hon. Friend the Minister of Health to deal with this very difficult problem in the Mental Health Service and not to brush it aside with a general answer. I assure him that at Carlton Hayes there is a real, chronic and tragically serious problem which needs investigation and action on his part.
§ 10.25 p.m.
§ Mrs. Barbara Castle (Blackburn)
I apologise to the House for appearing in a somewhat unusual garb. I also apologise for the fact that I have not been able to take part in the earlier stages of this debate on nurses' salaries. I sat in the House from 3.30 to 7 p.m. hoping that this debate would begin, and then I had to go away to take part in one of those occasions of Parliamentary hospitality to foreign visitors, which it is the duty of us all to perform from time to time. I hurried back to the Chamber because I was anxious to fulfil a solemn promise that I made to the nurses in my constituency that I would take part in this debate under whatever circumstances or at whatever hour of the day or night it was necessary to do so.
The hon. Member for Harborough (Mr. Farr), who made a most impressive speech on behalf of the efforts which we are making on this side of the House, said that it was inconceivable that nurses would ever strike. But one of the things which has surprised me about their reaction to the contemptible salary offer made by the Government is that they are in a more militant mood than any of us have ever known them, and I suggest to the hon. Member for Harborough that it would be unwise of him, and indeed of any of us, to go on assuming that we can trade indefinitely upon the public spirit and vocational dedication of the nursing profession of this country, because the nurses have just about had enough.
Indeed, one of the things that has inspired me to take part in this debate is the fact that 44 nurses of the Royal Infirmary in Blackburn have been so goaded into an expression of opinion by the Government's policy that they have burst into verse. I have here a long poem signed by 44 nurses from one of the key hospitals in Blackburn. It touches on this very point, and is, I think, symbolic of an entirely new mood in the nursing profession.
I know that there is not time to read the whole poem. [HON. MEMBERS: "Read it all."] Very well, but at the 1154 moment I want to quote only two verses as a kind of warning to the hon. Member for Harborough:With other professionsOur pay doesn't compare,And we feel that thisIs most unfairBetween us we workRound the clock every day,Who else would do thisFor our meagre pay?If we all went on strikeIt would be quite a blow,In fact, there'd be chaosIf we only went slow.We don't want to do eitherFor, of ourselves we must give,But we are only humanAnd, we too have to live.I am not suggesting that the nurses of Blackburn have to be positively frantic before they can burst into poetry, but I suggest that this long poem is a remarkable phenonemon because nurses as a profession are usually fairly reserved people reluctant to push this kind of militancy.
There is another remarkable phenomenon about the present situation to which I think the Government would be well advised to pay careful attention. It is that this reaction is not limited to one small section of the profession, to one sex, or to one rank, or to one branch. It spreads through them all, and, just as I have had this explosion of feeling from 44 nurses at the Royal Infirmary in Blackburn, so I have been deeply impressed to receive by the same post a letter from the matron at St. Asaph's Hospital.
The matron has written to me because she says she is an ex-citizen of my constituency. For about 20 years she was principal tutor at the Royal Infirmary. She has moved on from that Blackburn hospital and is now a matron in a responsible position. She writes:May I appeal to you on behalf of the countless nurses whom I have been privileged to train that something be done forthwith to safeguard their status and to recognise the serious load of responsibility which devolves upon them?".It must be rare for the matron of a busy hospital to write to the Member of Parliament of her former constituency in this strain. I should have thought that matrons on the whole were the last 1155 people to write letters to Members of Parliament or newspapers or in any other way to break out of the conventional mode. But this matron has done so, obviously deeply inspired by a sense of public duty.
This matron makes very constructive contributions to our debate which I should like to bring to the attention of the House. She writes:In this hospital the following factors pertain:There we have from the matron of one hospital an appalling catalogue of disabilities under which the nursing profession labours. The situation that we face tonight is that nursing itself has got into a vicious circle, and the lamentable decision of the Government to impose an arbitrary figure of salary increase unrelated to any of these difficulties or the merits of the case will make the position very much worse.
- (1) Decrease in the available number of enrolled nurses—between 1st April and 30th September, 1961, the number fell from 20 to eight. These persons state that they cannot afford to practise the art of nursing; and some have gone into industry.
- (2) Poor recruitment of State-registered nurses who prefer to seek employment in (a) foreign countries, with higher pay, (b) domiciliary fields. The high and early marriage rate aggravates the problem: many nurses find the hours of duty more suited to their domestic responsibilities (often entailing care of dependent and aged relatives).
- (3) Discontinuation of travelling allowances has increased the financial burden on both skilled and unskilled staff, and has, consequently, affected recruitment. You will also appreciate the difficulty of maintaining a 24-hour service with infrequent public transport.
- (4) Institution of a 42-hour week for ancillary staff and increased holidays for nurses and midwives has greatly aggravated an already intolerable administrative enigma.
- (5) Housing and residential accommodation—this is a chronic and insoluble problem whereby the nursing and administrative officers resolve themselves into a 'housing bureau'."
The shortage of nurses is leading to very long hours of work for which the nurses get no overtime. What is more, we are now in the ironical situation that not only do they not get any overtime by the nature of their salary contract but they cannot be allowed time off in lieu because of the very fact of the shortage of nurses, which these conditions are helping to perpetuate.
1156 Therefore, we have this farcical situation, which is demonstrated, for example, in a hospital in Doncaster, a case which my hon. Friend the Member for Barking (Mr. Driberg) drew to my attention as he was not able to be here tonight. He was written to, as many of us have been, by nurses from hospitals in all parts of the country. This is almost a volcano of emotion that is bursting out of constituency boundaries. Nurses are writing to any Member of Parliament whom they think will make a noise about their situation in the House of Commons.
My hon. Friend had a letter from a former constituent working in a Don-caster hospital, who said:I know that most of the trouble is the staff shortage but if they carry on much longer as they are doing, they will have no staff at all. I am a first-year student nurse doing my turn on night duty. This is a 110-hour fortnight for which we get paid for 88 hours. Therefore, this means that I and the rest of the night staff are working 22 hours for just plain nothing. Is this right in this day and age?… If we were paid for the hours we work or had days off in lieu, it would be something. I like my work, but I would like it a lot more if better working conditions were made.My hon. Friend took this up with the hon. Lady the Parliamentary Secretary to tine Ministry of Health and he received the following reply:Nurses in general, as opposed to psychiatric, hospitals have never been entitled to payment for excess hours worked, and there is clearly no question here of giving time off in lieu of excess duty as this would simply transfer the burden from one set of nurses to another.Can one have a more classic example of the bureaucratic mind faced with a human problem? There is a shortage of nurses because of the working conditions and the salary conditions, and when the nurses say, "You cannot get recruits because of the conditions", they are told that the conditions must continue because there are no recruits. Is it beyond human wit or the humanity of the hon. Lady to break through this vicious circle? This, surely, is the Civil Service mind at its worst.
I do not have to go to Doncaster for evidence of the effect which this kind of bureaucratic attitude is having on recruitment. Like other hon. Members, I have had a shoal of letters on this subject, some from outside and some from inside my constituency. Someone who 1157 describes herself as a former student nurse at the Royal Infirmary in Blackburn writes:When I commenced training seven years ago I was one of twenty-four. Now I am one of two left, working in hospital."—It is a different hospital—she has moved elsewhere.The rest are working in hospital abroad or doing private nursing. I am sure that if we had a salary that was comparable with other professions more nurses would qualify and practice in their own country.And so this salary decision of the Minister is declared by nurses and matrons throughout the country to be directly responsible for the chronic and dangerous shortage of nurses.
I am sure that the hon. Lady the Parliamentary Secretary would be the first to agree that we, in my sex and hers, are used to being exploited. I would have hoped that she would be a better ally with me against the exploitation of my sex and hers which the nursing profession has suffered for so long. We have been used to being cast against our will in the rôle of underpaid ministering angels when what we would really like is a living wage.
As the hon. Member for Harborough has pointed out, however, more than the exploited sex is involved. Men are involved, too, married men with families who are, as the hon. Member pointed out, engaged in mental nursing. I shall not say that that makes the case more serious. I am against exploitation in all its forms. I am against particularly the exploitation of my sex on the assumption that the little women will remain single anyhow and, therefore, be fair game to do the dirty, underpaid work of the world.
I point out to hon. Members, in case this is an argument that has more weight with them, that involved in this decision are married men with families, who are being expected to keep a vital service going on what every hon. Member would contemptibly dismiss as being nothing approaching a living wage.
A massive amount of evidence has been brought to my attention in the letters which I have received. I quote one of them:I am a charge nurse at Brockhall Hospital, Langho, near Blackburn, the staffing problem of which is so acute on account of the small number of trained nurses available, and in the 1158 ensuing years there are not going to be sufficient trained staff to take charge of the wards. Only a monetary increase in salaries as forwarded by the Staff Side of the Whitley Council will bring in the nurses to run our hospitals, which are at present in a state of breakdown.I plead with you to use your strong influence in the House of Commons "—he is obviously somebody who knows me well—and press the Health Minister to implement a satisfactory salary scale to ease the tension of an exhausted nursing staff who are doing more than their fair share to keep the hospital service from complete breakdown.I would add that in the mental field of hospital nursing, the majority of our trained nurses are married men who are denied any overtime by virtue of becoming trained nurses and are existing on meagre wages after superannuation, National Health and Income Tax have been deducted.Many hon. Members can repeat that kind of plea many times over. It is not peculiar to one constituency or one locality. It is endemic in the whole nursing service. This evening we have to ask what we are to do about it. I am sure that we all agree that those who have written to us are not firebrands by nature, or by inclination, are not greedy, not lazy, not clock-watchers, not people who are seeking an easy time in life. They are some of the hardest working people in our community and some of the most reasonable.
Because of that, we have traded upon their spirit. We cannot trade on it indefinitely. Typical of their attitude was that which was reflected in a letter which I received from the Royal College of Midwives. They wrote, "We do not want more than our fair share of what is available; we are not asking for something extra; we are just asking for a fair deal." By the very definition of his policy, the Minister has set out to refuse it to them.
That is intolerable. I do not like the assumption that underlies the Government's whole attitude in this debate—"We can drive these people further still; they are not the sort of people who will hit back, for they care too much about their patients." That is true, but if there is any decency in British political life, the people who are not ready to take it out of their patients should be the first to have the consideration of the House.
1159 I conclude by quoting again from the admirable poem sent to me, most unpredictably, by the 44 nurses of the Royal Infirmary in Blackburn:We try to comfort the weary,Ease those in pain,Struggle with life—Though, sometimes in vain;The very best we can giveOn our patients we heap,Doesn't this seem important.Or is life so cheap?So cheap—that theyWho serve in this way,Are barely consideredWhen they ask for more pay.The recently offered rise ofTwo and a half per cent.,We take as an insult,Is that, how it was meant?So please, Mrs. Castle,Though you're busy it's true,Speak to the Government,We're relying on you.Explain to the MembersSo that each understands,And perhaps finish by saying,'Your life's in their hands '.
§ 10.50 p.m.
§ Mr. Geoffrey Johnson Smith (Holborn and St. Pancras, South)
I see that the hon. Lady the Member for Blackburn (Mrs. Castle) has been supping, as is her custom, with her usual relish at a table groaning with grievances. I have never heard a more one-sided account of a fantastically good service as the National Health Service as she has delivered tonight.
I shall not dispute the details, but what she said was a one-sided account. It is a pity that she went to her dinner and did not wait to hear what my night hon. Friend had to say about certain aspects of the Health Service. If she had, perhaps she would not have put us in the position of listening to such a dismal story of a pathetic Service. [An HON. MEMBER: "Did you hear him?"] I heard him very well indeed. Perhaps the hon. Lady and some hon. Members who were not here at the time might be reminded of some of the facts. They would not, I think, suppose from the information we had from the hon. Lady that in point of fact for the last ten years of this "miserable nursing profession" whose conditions are so poor that no one wishes to work for it, recruiting in the nursing and midwifery services increased by 16½ per cent. full-time and 132 per cent. part-time, excluding that 1160 in the mental hospitals, and 10 per cent. nursing and 62 per cent. midwifery staff in hospitals.
This is the other side of the picture which the hon. Lady chose to ignore. Other hon. Members who took part in the debate very rightly drew attention to the fact that salary scales in the nursing profession do not bear very fair comparison with certain other professions. This is one reason why I want to take part in the debate. We might also remember though that in the last decade there have been six general salary increases for the nursing profession which have been put into effect by the present Government, the last as recently as December, 1960, which was a percentage increase of 5 per cent. That, incidentally, followed a salary increase which dated from 1st March, 1959.
Another fact I have not noticed mentioned by my right hon. Friend, or indeed any hon. Member in the debate, is that the nurses' own pension scheme was last year reported to have run into the red to the tune of £80 million. What was the action of this "parsimonious" Government? It was to help to pull the nurses out of their pension difficulties to the tune of £40 million. I look at the salaries prevailing in the nursing profession ten years ago with those prevailing today, and one knows that with the six general increases there has been a considerable increase in the level.
§ Mr. Johnson Smith
I do not see the exact relevance of what the hon. Member says. I am making a simple statement. The hon. Member knows my salary scale as well as his. I do not know whether I would liken my responsibilities with those of a matron responsible for 1,500 beds who at the time when the hon. Member's party was in power could enjoy a salary of £930 to £1,000 and in 1961 finds that her salary scale has gone up to £1,391 to £1,643. Perhaps it would be an impertinence on my part to compare my responsibilities with hers. Nevertheless, if we are in the comparing mood, some people might not think it a particularly adverse comparison.
1161 In any case, I am sure the hon. Member realises that that is the sort of irrelevant interruption which contributes very little to the debate when he knows that the point of my remark was that it has been consistently ignored on his side of the House that in the last decade there have been six general increases in salary for the nursing profession. Compared with the time when the present Opposition went out of power there has been a significant increase even taking into account the rise in the cost of living. There has been a significant improvement. It is not correct to suggest by any implication that under his Administration the nursing profession did better then. They did not; they did worse, as did practically every profession I can think of.
I thought my right hon. Friend made a number of interesting points about the recruitment, but his speech left me with a sense of anxiety. Obviously, one has to accept the facts which my right hon. Friend gave. The trend of recruitment is one of expansion. If conditions in the nursing profession were so miserable, one would have expected that, far from there being an increase, there would have been a decline in recruitment. My right hon. Friend proved quite conclusively to me at least that this was very encouraging news. It was a trend in the right direction. On the other hand, during the debate one has heard far too many stories of shortages in different parts of the country.
In some parts of the country, there are no shortages. Nevertheless, I have the impression that there are too many shortages in too many hospitals in too many parts of the country. I ask myself, therefore, whether recruitment is going fast enough and whether the quality of those recruited is high enough. It seems to me that there are one or two steps which the Government might consider taking in the coming months. I shall come to those shortly. Before I do so, I shall quote from a letter I have received which, I believe, gives a clue to at least one of the two major disappointments which the nursing profession has experienced recently.
The first of those disappointments was over the way the negotiations have been conducted. I have here a letter from a nurse at a hospital in my constituency 1162 —hon. Members will know that I have in my constituency more hospitals, perhaps, than are to be found in most—who is a member of the Royal College of Nursing and who represented the Royal College on behalf of ward sisters and the pediatric branch on the staff side in the recent negotiations. She says:We understood that the negotiations should continue despite the pay pause and the awards could be made although the operative date would have to await the Chancellor's decision to modify or lift the pay pause".I suppose that this nurse had in mind the sort of award recently made to some members of the Armed Services. Tonight, for instance, we read in one of the London evening newspapers that certain members of the Armed Services have received half of their pay award. The rest, we are told, will come later when we have moved out of the period of wage restraint—if it can be said that we can ever move out of a period of wage restraint. The impression was that, as the pay pause was working at present, they could not expect to have all the pay award. This is obviously what the nurses felt when they were told that their pay claims would be considered on their merits. They thought that people would go into the matter and say, "All right. You deserve x per cent. more, but, because the pay pause is at present operating, you must unfortunately forgo a certain percentage of the increase". The fact that it was not put in this way accounts to a large extent for the anger which has been expressed. That is certainly what I gather from the correspondence which I have received.
The second disappointment lies in the fact that the financial inducements to stay on in the service do not appear to them to be good enough. I can best illustrate this by giving the salary of a ward sister, a nurse of some training and experience. I believe that the most she can earn is about £12 to £16 a week. The interesting thing which crosses my mind and which, I assume, has crossed the minds of many ward sisters, is that at the very beginning of her work as a ward sister she receives the same amount of money as a three-year trained non-graduate teacher, but when she reaches her thirties she receives £300 to £400 less than a three-year trained non-graduate teacher of the same age.
1163 That is just the time when anyone who has taken on a responsible job and has gained some experience at it feels that he ought to have some sort of tangible reward, which at least compares with the tangible rewards which other people in similar professions are getting. The feeling that higher wages do not match higher responsibilities is very strongly felt by the professions supplementary to medicine. Some hon. Members have talked of physiotherapists. I have the Moorfields Eye Hospital in my constituency, and I paid the orthoptists a visit recently. The main point they made to me was that after seven years, when they were holding responsible posts, they reached a dead end financially. This is what causes resentment to set in.
The resentment stems from the fact that some people feel tempted to leave their occupations. One hears from time to time that this is the point in a person's career when she says, "I will chuck it. I do not feel that I am getting on in the way I should. I will leave it and get a job outside the profession". This makes a dedicated member of the profession resentful and almost ashamed because she gives way to this temptation. It makes her feel angry with authority, because she feels that authority undervalues her experience at that time in life when she wants to make a little extra and put something aside for old age.
Members of these professions are also angry because they feel that society has presumed too much on their public spirit. This is the impression I formed from the correspondence I have received. It seems to me that if, at bottom, theirs is a financial grievance, the right way to tackle it is to have a look at the wage structure. I am sure that this applies just as much to the teachers' problem that we faced last year. It is not so much an all-round wage increase that we want in the nursing professions and similar professions as that selective groups within those professions, particularly those who have got some position of authority, feel the need for extra financial assistance.
I can see how difficult it is to determine what is or is not a fair wage for professions like the nursing profession. 1164 The Government White Paper on "Incomes Policy: The Next Step" made it clear that comparability cannot always provide a fair yardstick on which to base a wage claim. I can see that it is attractive to say that because such-and-such a group receives £X hundred a year another similar group should also receive £X hundred. But there are cases when that yardstick must not be used
I can appreciate the difficulties in the nursing profession, especially when using productivity as a basis on which to demand an increase in salaries, although it is true that in 1960, 500 fewer midwives delivered 100,000 more babies than in 1955. I know that the infant mortality rate has gone down, so that we can assume that midwives do their job properly. But there are other parts of the nursing profession where productivity is no guide. The truth is that the services of too many groups like nurses have, in a sense, been monetarily undervalued for too long.
Despite this, people have been willing to come forward, but whether they will be so willing to come forward, or to stay in posts of responsibility so readily, in the future I beg leave to doubt. One reason why they stuck at these jobs for so long and for such a pittance—far less than they receive today—was that professions like nursing had an aura of security around them which did not apply to other jobs. But with full employment in most areas of the country, other jobs have security to offer. This great advantage of the nursing profession, therefore, no longer exists. Nursing and similar professions no longer have a monopoly of security, and they are caught up in a vicious wage-cost inflation which makes their position particularly poignant.
An all-round wage increase is not necessarily the answer. Too often people have assumed that the present wage scales are a deterrent to recruitment. My right hon. Friend showed that apparently they have not acted as a deterrent. Too often we underestimate the fact that in this and other similar professions there are other features which are an attraction. An example is that of people who become Members of Parliament. Salary could be an attraction but not the primary attraction. One of the great features of 1165 nursing is that those who enter the profession do so of their own volition because they want to do that job and are happy to do it. To be doing a job which one wants to do and enjoys doing is a great satisfaction which is often denied people.
§ The question of trying to relate the wage levels of professions such as nursing to the national economy is basically a question to which the National Economic Development Council should give close attention. We certainly want guidance on it. In the meantime, I and many of my hon. Friends hope that my right hon. Friend will institute an inquiry. He said that there had been an inquiry some years ago, but it appears that another is necessary into the wage structure of the nursing profession. There is no doubt that at a certain level in the profession there is dissatisfaction and discontent with the present structure.
§ 11.07 p.m.
§ Mr. H. Boardman (Leigh)
As we discuss this question tonight there are men and women throughout the country who are waiting with patience and, unfortunately, in many cases with pain for a bed in a hospital. There are many vacant hospital beds simply because we have not the nurses to tend them.
How does this anomaly arise? It arises because we are dealing with another facet of full employment. It will be increasingly difficult to get girls to take up nursing when other girls, with far lower educational qualifications, can go into comfortable five-day week jobs and get much more money than a nurse can ever get.
We must pay attention to this. Hon. Members have said time and time again in the debate that the wage paid is not everything, and that is true, but it counts for a good deal. If the wage is not everything, let us look at one or two other problems. Nursing must go on for twenty-four hours a day and 365 days a year. Nurses must work when other people are sleeping and when other people are playing. If we add the fact that they are relatively ill-paid, we have the answer to the question, why are we so short of recruits and why are hospital beds empty when so many people are suffering?
1166 The hon. Member for Holborn and St. Pancras, South (Mr. G. Johnson Smith) said that girls go into the nursing profession because they want to do nursing. We talk about the dedication of nurses. I am beginning to find this a sickening phrase. We pay the nurses lip-service—and we refuse to pay them.
I was talking to a hospital matron some time ago when this question of the dedication of nurses arose. She went rather further; she was very blunt about it. She said, "If a nurse comes to me and shows the slightest interest in salary I have no interest in having that nurse in my hospital, because a nurse must, of course, be absolutely dedicated." What a lot of arrant nonsense this is. Is it pretended that somebody will be less dedicated because we recognise her worth and pay her accordingly? It is really time we got away from this sort of hypocrisy.
This is tied up with the Government's policy on wages. I think the Government were wrong in that policy, and I think they acted rather stupidly over the pay pause. If it was right for the Government to intervene in the wages question, was it right to make a one-way street of it? If it was right to intervene on the wages question and say, "If wages increase that will injure the economy", is it not equally right to intervene when wages are low, as they are in the Health Service, so that it suffers in consequence, because it cannot get the people it needs? This 2½ per cent. was a terrible insult to all the people engaged in the Service. The hon. Member for Holborn and St. Pancras, South said the superannuation fund was in the red. Having regard to that, and having regard to the higher salaries and non-contributory pensions of the higher Civil Service, it was an outrage that those people should call upon nurses to accept a salary increase not exceeding 2½ per cent.
I hope the Minister is not going to say in reply that we cannot afford to give nurses more. I must anticipate him, and I say to him that I do not think we can afford not to. I think we must afford in any circumstances to see to it that these nurses have an increase. They should not wait for another commission; they should not wait for another committee of inquiry. This should be 1167 treated as a matter of extreme urgency, and they should be given an increase now.
I believe—and I speak now as a trade union official—that if this pay pause were to be broken by the Government for the nurses none of the trade unions would exploit that breach. They would accept it, I think, as fair and just to people who have been long suffering. I also believe that if the Government were to breach their own pay pause the Government would receive acclaim from the public.
The Government propose to spend £500 million to £700 million in the next 10 years on hospitals. That is a sizeable sum by any standards, and I think it is laudable that they do it, but how ironical it would be if, having the modern buildings and modern equipment, we were still to have inside the hospitals the Victorian attitude towards the people who staff them. If we are to have the hospitals staffed properly we have certainly got to alter our attitude towards the nurses' pay and conditions.
What a tragedy and an irony it would be, if we are expecting the hospitals to continue with the blood transfusion from colonial and Commonwealth nurses, and we could not get these people. How many more beds would be empty? The Minister in an answer the other day said it would be about 7 per cent. Surely to goodness what we ought to do is to recognise the problem for what it is? We talk about standards, and I do not object to that, since these standards affect human life, but really there is only one standard.
To me, it seems to be very wrong indeed that even under our present hospital system those with the ability and the willingness to pay can get beds without much delay, whereas the ordinary individual, unless the case is very urgent, has to wait weeks and months for a bed because we cannot decide whether or not we mean what we say when we talk about our dedicated nurses. For heaven's sake, let us stop this exploitation, let us pay the nurses properly, and let us do something about it quickly.
§ 11.15 p.m.
§ Mr. Stanley R. McMaster (Belfast, East)
Of the many contributions to 1168 this debate I do not think there has been one in which there has not been the suggestion of a review of the pay of either the whole of the nursing staff or, as was said by my hon. Friend the Member for Holborn and St. Pancras, South (Mr. G. Johnson Smith), of the senior part of it.
The debate has been divided into three parts. In the first part, doctors were referred to. There is frustration among many members of the medical profession who choose to stay in this country and specialise. Many of those people study for a number of years after taking their degrees, and after spending a time as house surgeons in hospitals. They go on to acquire fellowship of the Royal College of Surgeons or membership of the Royal College of Physicians, but they often have to wait until they are in their forties before getting a part-time or full-time consultant appointment. Even when they get the appointment, it often means moving very far from their homes, from their friends, and from the hospitals in which they trained. The Minister should look into the genuine shortage of senior hospital appointments if he wishes to encourage those in the top end of the profession—those who specialise—to use their skills in the United Kingdom.
I am not satisfied with the statistics about the number of doctors going abroad. Various figures have been quoted today, but the Ministry does not seem to have adequate knowledge of the number of doctors who go abroad, how many stay abroad and how many return. I know that a large number of men who were at university with me have had to emigrate in order to find the jobs and the rates of pay they expect as professional men. I therefore ask my right hon. Friend to look particularly at the statistical side of the matter.
Not a lot has been said about the professions supplementary to medicine but here, again, there is a case for a particular or special review. The other day I received a letter from a physiotherapist. He was an Army officer who was blinded during the landings at Salerno. He stayed on for three years' training as a physiotherapist, only to be offered a salary of £550 a year, rising, after a number of years in practice, to £650. It has already been pointed out 1169 that a London parking meter attendant gets £600 or £700 a year. One hesitates to draw comparisons with other professions, but is it right that that physiotherapist, in a full-time, responsible position cannot, as he told me, afford to give his two children a professional education if he wishes to?
The major part of the debate has been spent in discussing the situation of our nurses. It is freely admitted that many provincial hospitals are under-staffed. I have heard complaints about this from hospitals in this country and in Northern Ireland. The hours of work for nurses have been reduced recently from 48 to 44. But the nurses work a longer week than many other people connected with the hospital service. Nurses work on day and night shifts without any extra pay, and they work on Sundays and public holidays. They receive only four weeks holiday a year, and the pay scale in this country is much lower than in most other countries.
The International Council of Nurses publishes reports from about 30 or 40 countries giving the terms of service and the hours of work of nurses. Throughout the world there has been a general rise in the pay for nurses. It is most marked in Scandinavia. In Denmark there has been a 70 per cent. rise since 1957. In Sweden the figure is 45 per cent. In the United Kingdom it is only 25 per cent. The reports give many other figures of hours and rates of pay. In Belgium and Finland the rates of pay are about £600 or £650. In Denmark the figure is £700 and in Sweden £800. In Britain it is only £525. In the Scandinavian countries nurses are paid extra for night work and Sunday work and their salaries are tied to the cost of living. In those countries the salary scales rise more sharply than in this country.
So far as they can be compared with this country, the salary scales in Canada and the United States rise from £900 for a newly trained nurse to £2,800 for a hospital matron. I suggest that these figures reveal how far Britain is lagging behind in respect of pay for these very important people. Hospital sisters with three or four years' training who enter the service of an oil company, such as Shell, and go to Borneo or Singapore, are offered £2,000 a year. There may 1170 be certain disadvantages in going abroad, but the rate of £600 or £700 offered in this country cannot be compared with a salary of £2,000. Some students qualify and then decide to specialise in some branch of nursing such as midwifery which has been mentioned during the debate.
In order to take the two-year training as midwives, nurses have to revert to student grades of salary, that is to say, they revert to a third-year grade, the salary for which is £336 per annum from which is deducted £128 for board and lodging. Is it right that trained nurses who decide to become midwives and who have already done three or four years in the nursing service should have to revert to this very low salary scale which leaves them with barely £200 a year after they have paid for board and lodging? I believe that it is in these poor salary scales that one finds the reason for the shortage of nurses, particularly in such specialised fields of the service such as midwifery.
Much has been made today on both sides of the House, and particularly by my right hon. Friend the Minister of Health, of the White Paper on "Incomes Policy: The Next Step". If it is true that in this country we are going to have to wait until the wage pause and the following steps have taken effect before there is a general rise in the pay of nurses, we might have to wait a very long time.
Surely the whole policy of the Government at the moment is one of continuing wage control. It is not just a one, two, three or even five-year policy. It is a policy which along with the National Economic Development Council is intended permanently to fix wages in this country and to relate them to rises in productivity. Paragraph 3 of the White Paper quotes the speech made by the Chancellor of the Exchequer in the House on 18th December, 1961. It says:He explained, however, that, given the complexities of the problem, a long-term incomes policy of this sort would inevitably take a considerable time to work out. The Government hoped, however, to make steady progress towards that end.As part of this complex long-term in-comes policy, I would suggest to my right hon. Friends on the Front Bench that they should look particularly at the special circumstances of nurses. The 1171 Government admit in paragraph 5 of the White Paper that there may be particular circumstances in particular cases. They say that arguments based on increases in the cost of living and on the shortage of labour should not apply.
I say to my right hon. Friend the Minister of Health most sincerely that if he is going to argue that because there is a shortage of labour in one field the income of those engaged in it should not rise out of keeping with the rise in productivity in the rest of the community then the corollary must also be true. Even though one admits that the number of student recruits to nursing has risen, if the corollary is true simply because the number applying has risen, it does not show that their incomes should not rise or should stay in step with other incomes where special reasons attach to the case.
The Government cannot have it both ways. They cannot say, on the one hand, that because there is a scarcity of labour in a certain field of activity that incomes can rise sharply and, at the same time, not admit the truth of the other case. I wish to press this most strongly on my right hon. Friends.
As a number of hon. Members wish to speak even though the hour is late, I will conclude by saying that after studying all the rates of pay which I have quoted to the House tonight and which are to be found in the official reports, one is left with the feeling that because of the dedication and the responsibility of the nursing and medical professions their members are being exploited by the public and by the State as a whole. They are exploited by the public as well as by the Government, because the public foot the bill in the end. It is all very well for the right hon. Member for Belper (Mr. G. Brown) to say that the Government should pay or do this or that. It is not the Government but the country that must pay.
I say most sincerely that we have had our medical services on the cheap for far too long. Any hon. Member who has been to France or the United States and faced the possibility of being ill there will know what one has to pay for medical services abroad. The fact that members of the nursing profession undertake 1172 that they will not strike because they are dedicated to their profession is no reason why the rest of the public should exploit that position.
Even if it means an increase in the National Health stamp in order to pay the nurses and other professions supplementary to nursing and the doctors reasonable remuneration, the Government should put this fairly and squarely to the public. The Government cannot build, as they are suggesting, a wages policy which is based on an unsound foundation. There is a very special case here, particularly for nurses and the other medical professions that I have mentioned. There is an urgent need to get the basis right here and now. It should not be put off to an unknown date. The Government should start now on a fair and firm foundation and admit freely and frankly that nurses and other medical professions are underpaid. They should agree to have a thorough and complete revision of the salary scales, and start on that basis with the national policy.
§ 11.32 p.m.
§ Mr. Richard Marsh (Greenwich)
Whenever one hears the hon. Member for Belfast, East (Mr. McMaster) one becomes more and more surprised to find him sitting on the Government side of the House and not on the Opposition benches. Judging by most of the speeches I have heard him make and the Divisions in which I have seen him take part, he always seems to be on this side spiritually and frequently physically. Presumably, one can explain this only by the fact that he is an Irishman and feels that, although he is with us, he must sit on the other side of the House in order not to be conventional.
In the case of the speeches made by some other hon. Members opposite, it would take far more effort to be courteous and chivalrous than one can muster at this time of the night. However, one is pleased to see that the Secretary of State is enabling us to continue this debate, because this is a subject on which there is a great deal of feeling on this side of the House and a number of hon. Members want to make brief, snappy speeches in the time that remains.
1173 I regret very much that the hon. Member for Holborn and St. Pancras, South (Mr. G. Johnson Smith) is not at the moment in his place. He made a particularly offensive attack on one of my hon. Friends in a speech which I thought was in large part insulting to nursing staff in general. One thing which must be made clear is that hospital staff do not want sympathy. They are fed up with slushy sentimental references to Florence Nightingale. With the greatest respect to that deceased lady, I think that the memory of Florence Nightingale has done more damage to the living standard of staff in the National Health Service than anything else. Every time they ask for the sort of standard of living which is accepted as normal for any other section of the community, there is always someone, as we have seen tonight, with the insufferable arrogance to tell them that they have no right to mess about with ordinary wage negotiations because they have chosen a vocation. Nurses take up nursing for exactly the same reason that other people become shorthand typists or work in factories or go on the stage—because they have to sell their labour to obtain the means to live and they prefer to nurse rather than to do other jobs.
The fact that they perform a service and work in an industry which is essential to the community and do a job for which all of us are extremely grateful is no excuse at all for using this against them to dodge what is their night to have a decent living. There is too much of this business that they choose to go into their jobs. Of course they do. The hon. Member for Holborn and St. Pancras, South chose to come into this House, as we all do. [An HON. MEMBER: "Not for long"] There is evidence that there are a great many people who will choose to put him outside next time. They will not be Liberals. As we discovered this afternoon, their spurt of enthusiasm has been short-lived. We had four of them here earlier and they have now, as I believe is the colloquial expression, "knocked-off" for the night. Apparently we are not to be honoured with their presence any more. But British democracy has functioned effectively without their help for years past and probably will be able to do so in the future.
1174 Hon. Members have made contributions to this debate which have either been naive to an unbelievable extreme or have been sheer unadulterated humbug I do not know which. Several hon. Members said, with voices quivering with emotion that they thought the Minister should examine the possibility of setting up a committee. They do not want a committee. One cannot keep a family with a committee. One does not achieve anything specific with a committee. The Chancellor of the Exchequer set up a committee to examine the economic problems which faced the country and he came here a week afterwards to say that we were millions further into debt than we were before. Committees do not achieve anything.
We on this side of the House do not care very much whether the Minister sets up a committee or not. As he explained earlier, he has already made up his mind. He knows what the answer is. We know his policy towards people in the National Health Service. We know why the right hon. Gentleman came into office. He came in not as a great Minister of Health, not as a person with a great background of reforming social zeal but as a person who had an enormous and justifiable reputation for being severe and being able to regulate the finances of the State. His purpose in coming into the Ministry was not to assist and expand the Ministry but to control expenditure within the Service, and that is the task with which he finds himself faced.
There is another comment which I want to make, because it was objected to earlier by the hon. Member for Holborn and St. Pancras, North, whom I am glad to see is now present. When he was comparing the salaries of nursing staff under the Labour Government and salaries under the Conservative Government, I asked the simple question whether he would go one step further and compare these with his own salary. I think that that was a perfectly relevant point to make. By what right does the hon. Member arrogate to himself a salary which no nurse in the National Health Service could ever hope to obtain? Why does he think that the nurses are not too badly off? When a matron in charge of a hospital with 2,000 mental patients could not hope to 1175 get the basic salary which he gets as a Member of Parliament, why should he think that that is the way things ought to be? He is entitled to express the belief that some of us are entitled to higher levels than others.
If one says that these people in the Health Service are not entitled to the same standards as other people and that they are a sort of industrial coolie group who should be on that kind of salary level, it is a fair argument. It would be interesting to know how many hon. Members opposite would have the courage to make it on their platforms, but it is the only argument that the hon. Member can substantiate if he says that the nurses are not too badly off when the most eminent members of their profession can never hope to attain a salary anywhere near his own.
A number of other hon. Members came in and made similar contributions. Over and over again, they made the point that the Government should look at the situation. As I mentioned in an intervention, the general secretary of one of the trade unions within the National Health Service sent a telegram to the Prime Minister. He got a reply, dated 26th March, not from the Prime Minister, but from somebody whose signature I cannot even decipher. [An HON. MEMBER: "The Prime Minister has gone to Stockton."] He may have gone to Stockton, but it will not do him much good.
The reply stated:The Prime Minister has asked me to reply to your telegram about the nurses' and midwives' pay claim, and to say that in following the guidance of the Minister of Health and limiting their offer to an increase of 2½ per cent."—then came the simple answer to an organisation representing 50,000 hospital workers—the Management Side of the Whitley Council were acting in accordance with the Government's policy in incomes as set out in the recent White Paper.Do hon. Members opposite, including the hon. Lady the Member for Tynemouth (Dame Irene Ward), want us to have another committee so that it will tell us the same after meeting at public expense for some months? This business of standing up on the back benches and saying, "And 1176 I want the Minister to know that we are not prepared to be satisfied with this is attractive for the local paper, but we all know that everything about which we complain, on both sides of the House, in this issue this evening does not just happen. It is the direct result of Government policy.
Hon. Members opposite cannot have it both ways. They cannot come along in righteous indignation all over the place with bags of moral fervour. The hon. Member for Harborough (Mr. Farr) objected to my right hon. Friend the Member for Belper (Mr. G. Brown) bringing morality into the question. I understand the hon. Member's objections. As soon as one talks about morality, the benches opposite are immediately occupied with people who are obviously physically and mentally uncomfortable at such references.
§ Mr. Marsh
Far be it from me to go into too much detail about whether any lady Members are comfortable or uncomfortable at this stage in the proceedings. The important point is that hon. Members cannot attack what is happening in the National Health Service without attacking the Government, because this is a Government decision.
Staff in the National Health Service—and I know a lot of them—need to wake up to the fact that it is no good writing indignant letters to Tory Members of Parliament and voting Conservative at the next General Election, because the political reality is that this sort of thing is the inevitable result of a Conservative Government, who see people in different groupings and have a different attitude to these things.
The Minister of Health, in one of those revealing asides which he makes from time to time, mentioned his views about physiotherapists. I hope that I do not misquote him, but I understood him to say that physiotherapists should not be wasted on those who can no longer benefit from them. That was what I understood him to say.
§ Mr. Powell indicated assent.
§ Mr. Marsh
What we like about the right hon. Gentleman is his honesty in these matters. On that philosophy there 1177 are many old-age pensioners who could not benefit from physiotherapy. There are many people who in the long run could not benefit from physiotherapy because they are going to die and cannot be saved. It makes their last years more comfortable, but it does not cure them.
We believe that a comprehensive National Health Service should be available to any person who can get a doctor's certificate saying that he needs it. There are people who are found to be in need of medical treatment which they cannot get precisely because the right hon. Gentleman, who should have been defending the Service, has been running it down.
He came out with some very interesting arguments. To listen to the right hon. Gentleman one would think that there was nothing wrong with the Service. He asked why there should be all this fuss about the shortage of staff. He said that he did not want to quantify the situation for the years ahead. Of course not, but we are asking him to look at the situation now. Let us take the example of radiographers, whom the right hon. Gentleman does not regard as being scarce because he did not include them in the exceptions. There are two commercial firms in London offering a 24-hour radiography service. As the right hon. Gentleman knows, there are hospitals in London which cannot guarantee to carry on a 24-hour radiography service. If his State hospital service has to call in a commercial firm to do this essential service, there is something wrong with the administration.
The right hon. Gentleman spoke of nurses and gave the apparently attractive answer that we wanted to encourage more married women to return to nursing. He got many cheers from hon. Members behind him who said that this was a good policy. But it is the worst possible policy which could be applied to the nursing profession, because married women clearly want the most convenient hours. That is understandable. Married women want to work from eight in the morning to five in the afternoon and they want week-ends and bank holidays and no night duty and no split shifts.
§ Mr. J. Wells
I have in my hand a letter from the physician superintendent 1178 of the leading mental hospital in my constituency and the final paragraph says:It is felt that more use could be made of part-time trained nurses in Mental Hospitals, particularly female staff that have married".That is the opinion of a very wise and capable medical man.
§ Mr. Marsh
The hon. Member has a faculty for missing the point. If there is a serious shortage of nurses, of course one is keen to get nurses from any quarter, and in some cases married women are the only hope for people who are trying to keep the hospitals going. But the hon. Member and other hon. Members with the same attitude should have a chat with full-time nurses and should ask them if they are happy about the influx of married women with families who, quite naturally, cannot work the uncomfortable hours. It merely makes the position that much worse for the staff who are already there. It is not only salary which makes it difficult to fill nursing and other hospital posts. It is the matter of the awkward and unpleasant and difficult hours which have to be worked. If many married women are brought in, the situation is intensified. The hon. Member's medical superintendent may be left in the position of having no alternative but to bring in married women, but I am saying that if the Government produce a situation which deliberately encourages that, in the long run it does more harm to nursing recruitment than does anything else.
The hon. Member for Harborough made great point of the fact that doctors and the medical profession generally do not take part in strike action. There was a particularly unscrupulous general secretary of the British Medical Association who, when we were eating our breakfast cereals, could be heard inciting doctors all over the country to take action. There was most blatant political propaganda from him. He may not get his reward in another place, but he has had it here in this House. If the hon. Member thinks that doctors are happy and content with the present position, I would be prepared to arrange a meeting, in pleasant surroundings, of the Greenwich Branch of the British Medical Association with the right hon. Gentleman and the hon. Member, who can tell them that on the whole there is no 1179 serious trouble about the doctors. One gets the impression that although the right hon. Gentleman and the Parliamentary Secretary know the position—
§ Mr. Farr
The hon. Member will know, being a master of the art, that there is a great difference between the fact and drum banging and bluff, a great difference between the fact and what one intends to do. I was referring to medical staff, student nurses male and female, who have told me that no matter what some militant drum banger may say they have no intention whatever of going on strike because they feel morally quite unable to do so.
§ Mr. Marsh
I accept that from the hon. Member. I do not think that the nurses would strike. That is one of the things which upsets me, because if there were any danger that they would, the right hon. Gentleman would not have the guts to implement the policies he is bringing in. The whole debate is not just an argument about whether nurses ought to have a 2½ per cent. increase or not, or a question of whether a particular rate of pay is reasonable or not. This is a major debate on a major issue of principle. As the hon. Member inferred, it is a question of whether we kick the weak because they are weak and for no other reason. No hon. Member has suggested that the social contribution of these people is anything other than first-rate. No hon. Member on either side of the House would suggest that the rates of pay are reasonable. Only one argument can be put to justify the present situation. That is that the Government can get away with it. That in itself is appalling.
Another issue involved is whether employers and employees should be allowed to settle their salaries between themselves. How can the Minister or anyone else expect employees to have faith in collective bargaining machinery when the results of that bargaining machinery are implemented only if they are satisfactory to the Minister? I know that he could say that this has always been the situation in the Health Service and obviously the Government must have some right of intervention when Government money is being spent. From a purely personal point of view which 1180 does not involve anyone else, I should like to see a situation, if the Government are to intervene directly, in which they have representatives on the Whitley Councils representing the Minister. Let us not have this situation where, when there is negotiation and the management side agree with the staff side, the Minister steps in and says that, on second thoughts, he will not pay.
The whole future of the hospital service is involved. The Government may produce all sorts of glossy figures and arguments to show that the position is really very good, but there is no one in the Health Service who is not worried at the gradual decline of standards on the nursing side of the Service. There are hospitals where the situation is now becoming positively dangerous for the patients because of lack of qualified staff. On the figures alone—and this is a situation which the Minister apparently does not find particularly worrying—we are at the moment short of 25,453 nurses. I should have thought that that was something to worry about, but the whole burden of the right hon. Gentleman's speech was that there was no real need to be worried. But the actual shortage of nurses in numbers is only part of the story.
The General Nursing Council has for a long time been talking about education standards in nursing, and from 1st July next, or 1st June—I am not sure of the date—it is to allow certain minimum education qualifications, two O-level passes in the G.C.E. and certain undefined standards of competence in five other subjects. This is the best we can do—two O-level G.C.E. passes-but the Minister has had to intervene and say that even that standard cannot be introduced in mental hospitals. If patients in this country are to be nursed by people of whom it is too much to ask that they should have two O-level G.C.E. passes, this is something which hon. Members opposite who think seriously about nursing cannot regard with complacency.
The short answer is that, if it were not for unskilled staff and completely untrained staff in hospitals assisting the nurses, the whole of our National Health Service would collapse. If there were a ban upon immigration of the kind with 1181 which some of the more enthusiastic hon. Members opposite toy—
§ Mr. Marsh
That is so. The Prime Minister's successor has been very good at keeping them quiet.—[HON. MEMBERS: "Who?"]—I should have thought that the Leader of the House was steadily becoming a one-man Cabinet. He is spokesman on the Metropolitan Police Force, he is the one who deals with Central African Affairs, and with the Common Market—
§ Mr. Denis Howell
It is the only job he has not got. Reverting to my hon. Friend's remark about the Prime Minister's successor, may I point out that my right hon. Friend the Member for Leeds, South (Mr. Gaitskell) has not intervened in the matter at all?
§ Mr. Marsh
I shall leave that point because I am being drawn away from the path of righteousness.
If hon. Members opposite were successful in banning immigration to the extent which some of them want, our hospitals could not continue. We welcome into this country girls who wish to take up nursing training.
§ Mr. Leslie Hale (Oldham, West)
I do not think that my hon. Friend has been very generous to the right hon. Gentleman the Home Secretary. He has forgotten to say that the whole of the vast arrangements for Civil Defence have been primarily his responsibility and his work, and that he has been responsible for the digging and the construction.
§ Mr. Marsh
I believe it was a Socialist economist who first set the principle for digging holes and then filling them up again. This looks like another field in which we might find the right hon. Gentleman.
Nobody minds, and everybody is pleased, when girls from the Commonwealth or our colonial territories come to this country to train as nurses.
One of the problems which face the nursing profession and the poor British taxpayer—and the hon. Member for Tynemouth made a valid point about the need to avoid wasting money at a time when it is thought that money is being saved—is that an enormous number of people are trained by the National Health Service for professions which they have no intention of following within the Service. Many girls from our overseas territories come here for training, and we are pleased to have them, but they do not intend to stay here. We see many coloured student nurses, but seldom a coloured sister, because a coloured sister can go back to her own country and get a good job. Over 5,000 people in this country are in industrial nursing. Industry finds no difficulty in getting qualified nurses, because it outbids the National Health Service. The Service trains laboratory technicians, but Glaxo, I.C.I, and Oxo take them afterwards. We are training people to use elsewhere the abilities they acquire.
I am worried about the number of people who come into nursing—not as professional nurses but as ward nurses—straight from the local labour exchange, without any qualifications at all. We are pleased to have them; we could not function without them, but it is a sad state of affairs. As for professional nurses, there are more unqualified and non-qualified ones than trained ones.
The students are the biggest group of nurses in the profession. Therefore, the situation as it affects students is important. It is no good saying that we are not doing so badly in nursing recruitment when, at the same time, we are doing badly in student nursing. At 20 years of age a third-year student nurse collects £259 a year, after paying board and lodging. After paying National Insurance and superannuation in addition, she if left with about £4 a week, for a 44-hour week—if she is lucky.
1183 This evening's Evening News contains an advertisement from Barclays Bank, offering a number of clerical vacancies for single or married women up to 27 years of age. The commencing remuneration depends upon age and experience, but at 16 years of age the minimum salary would be £385 a year, rising to £650 a year at the age of 27, with a non-contributory pension scheme, sports and social facilities, and a generous marriage gratuity. There is another advertisement for a secretary at £16 a week—W.C.I, contact Museum 8090.—[HON. MEMBERS: "Oh."] The trouble is that one is joined by the bawdy-minded after midnight. The same paper advertises vacancies for clerk-typists at £15 a week. Does the Minister think that a girl, after three years' training, will work for £4 a week when she can pick up a newspaper and have a selection of jobs, with much more pleasant conditions, much shorter hours and no awkward hours, which offer not a few pounds more but three or four times as much?
§ Mr. Marsh
If the hon. Member had had his priorities differently organised 1184 and had placed his interest in nurses before his interest in his dinner, he would have heard that point made several time;, and answered. Of the nurses, 30,000 are men. They have families, and they cannot keep their families on the hon. Member's patronising remarks about a vocation. They want to buy clothes for their families and they want to go on holiday, as the hon. Member does. They would love to be in a position in which to talk about holidays can be as amusing as it is to the hon. Member. They would like to have as much money in a month as he has in a week. They want a decent standard of living. If the hon. Member can understand that point, then the debate will have been worth while, because at least one sinner will have returned to the fold.
§ Mr. Marsh
The hon. Member, who came into the debate late, should not have intervened from a sitting position if he had not wanted me to answer and he should not have made insulting remarks about those who cannot speak here for themselves if he had been frightened of someone being unkind to him.
The fully qualified staff nurse, with three years' training, joins at a salary of £525 a year, and after six years she can rise to £656. Out of habit I refer to "she", but this is probably the only profession in which men were assimilated on to women's rates of pay. The equal pay award meant that men went on to rates of pay formerly designed for women. These are male rates, paid to males and females.
Let us look at the position in Government Departments. Let us look at the Services, which are controlled by the same people, by the Government and the Cabinet. If the same girl with the same qualifications, a State-registered nurse, joins one of the three Services, she is on a salary scale of £584, rising to £666 in four years. The position is even worse than that because in the National Health Service they are not given board and lodging, whereas in the Armed Services board and lodging are provided. The comparison is with the £239 a year extra which a person with exactly the same qualifications and also working in the public service gets in the Forces, 1185 and the reason, of course, for this is, that the Services are regarded as key services which have got to attract nurses. I should like the right hon. Gentleman when he winds up—
§ Mr. Marsh
—much later to tell us why it is that in the Services a State-registered nurse, trained in a civilian hospital, can get £239 a year more for doing precisely the same job she would do if she were in a civilian hospital
To give another example of this sort of meanness of the Government in dealing with medical people—and we must not forget that this is not a matter of nurses only but of others, too, in the National Health Service. Here is an example which I passed to the hon. Lady the Parliamentary Secretary recently. It was raised with me by members of the B.M.A. in my own constituency. In the recent smallpox scare doctors worked very long hours giving vaccinations. After some negotiation it was decided they should get 5s for each successful vaccination. Then they discovered to their horror and surprise that the 5s. for each successful vaccination was to be taken out of the doctors' salary pool. So the doctors were to pay themselves for the extra hours they put in doing vaocinations.
§ Mr. Charles Loughlin (Gloucestershire. West)
I am not quite sure that my hon. Friend's information is quite correct. Perhaps the Minister will verify it.
§ Mr. Loughlin
As I understand it, my doctors were complaining that they received no fee at all for vaccination of adult persons. If that is true, the statement made by the hon. Member is not quite correct.
§ Mr. Laurence Pavitt (Willesden, West)
The position is this. The doctor does not get paid for a vaccination but is paid 5 s. for filling up a form. A local 1186 health authority doctor does the vaccination, while an industrial doctor fills up the form. So it is an industrial doctor who gets the 5s.
§ Mr. Marsh
This seems to me to get more Gilbentian as we go on. We should like to know from the right hon. Gentleman all about this issue, because it has been raised with us by constituents and we should like to know the answer to these questions. Is it possible for a person who is not giving the vaccination to receive the payment for it? Even if it is possible, and whoever gets the 5s., where does it come from? Does it come from the doctors' pool and are the doctors paying themselves? Not all hon. Gentlemen opposite are as bad as they sound, and some of them at least would agree that in common justice, if the medical profession is to have some recompense for what were very long hours—I think we have all seen the queues outside the vaccination centres at midnight and after—that recompense should not come from the doctors' salary pool and ought to be provided by the Government, and that the doctors should not be fiddled in this way. We look forward—much later, as my hon. Friend said—to hearing the Minister dealing with these points.
What are the effects of all this? The right hon. Gentleman seemed to suggest that there was really nothing much wrong with the set-up at present, but the plain fact is that there are ten thousand empty hospital beds. To take a comparatively local example, about two years ago the poor, suffering taxpayer paid out £160,000 for a new wing at Sutton and Cheam Hospital. Since then, every bed in that wing has been empty because of lack of staff. Again, in Leicester, it was decided to make a special attempt to get nurses conditioned to a 44-hour week—incidentally, many nurses still have not got a 44-hour working week—but the Leicester authorities found that that could be achieved only by leaving empty 183 beds—and that, in an area in which there are 6,786 people on the hospital in-patient waiting-list.
Those are not theoretical things; they are not abstract arguments. We are talking about people, measured in their thousands, who are sick, but deprived 1187 of medical treatment because of Governmental policy. We have talked about hospital staff, and we feel full sympathy for them, but we are not now talking of staff but of patients who are suffering.
All along, the Government's attitude to salaries calls for much question. Leaving out of account whatever views there may be on the merits of the nurses' salary claim, we are entitled to ask the Minister why it took him from 11th August of last year to 13th February of this year to give the nurses a proper answer to their claim. He may well have decided that the claim was not justified—that is another matter—or he may well have thought that it was not the time to give them salary increases, but would any Minister keep the miners waiting for six months in similar circumstances? Would any Government be prepared to tell the dockers "We shall not even give you an answer for six months"? Would they tell the engineers, when they put forward a claim, not only mat they would not grant an increase—that can sometimes be justified—but would not even treat them as having a right to negotiate for a period of six months?
Regardless of the amount involved, and views as to whether this is the right economic time to give a salary increase to a large section of the community, we are entitled to ask whether there has not been a deliberate devaluation of the negotiating machinery; and whether the Minister has not taken advantage of the comparative industrial and political weakness of these people in order to treat them with a contempt that he would not dare to apply to more strongly organised sections of the community.
The secretary of the Middlewood and Wharncliffe group of mental hospitals recently reported that that important group was 20 per cent. understaffed, and he made the specific point—and I have given the name of the group, and the statement can be checked; it has been published—that mental patients who were going to work outside the hospitals were earning more money per week than were the nurses who looked after them inside. That was not put as a joke; it was a serious statement made by that group secretary. It is impossible to 1188 justify that state of affairs. It is not moral or sensible. It is certainly a completely demoralising state of affairs for any section of the community. But it is the sort of situation which is bound to exist in the state to which the Minister has brought the National Health Service.
We are now faced with a situation in which the same staff works in two hospitals. People come off night duty and then take a part-time job during the day time in another hospital to try to make up their money. The Minister will be aware of this, examples have been quoted, and it is not something new which has just burst on the country. These people have a vocation. They love the job, and that is why they stay and put up with that state of affairs. But why should they have to go to these lengths just because they love the job?
It is not only a question of nurses. There are other people in the National Health Service besides nurses. We have heard a great deal about the manual workers who earn more than the nurses, and that is true. But it would be a great mistake to delude ourselves into believing that manual workers in the National Health Service receive a reasonable rate of pay. They are paid abominably. Take the porters as an example. These people are unskilled, but they are doing an important job of work which has to be done. We pay them £9 5s. 8d. a week, that is, the State—not some terrible hard-faced private employer. It is the responsibility of the community. After they have paid their National Insurance and their superannuation, these men, some of whom have families, take home £8 10s. a week.
Of course, they can work on Sundays and at nights on double shifts. They can work a 60-hour week, and if they do, they may even be able to afford to take their families on holiday. But why the devil should a man have to work like that in order to be able to take home more than £8 10s. a week? No one should be expected to keep house on £8 10s. a week. No hon. Member has the right to suggest that £8 10s. is a reasonable wage for anyone in public employment.
One could argue that these people are not trained. Their work could be described as humping, carrying, pushing 1189 and pulling. But let us consider the case of a head porter, a man who may control a staff of over seventy. That is a reasonably responsible job. His gross rate of pay is £12 18s. After he has paid his National Insurance and superannuation, he takes home less than £12 a week. Is it seriously suggested that such a man is not entitled to more than £12 a week?
Take the case of a head cook, a person who is doing a skilled job. I cannot cook. The Minister of Transport can. But on the other hand he cannot run the transport services. Ever since the right hon. Gentleman has been Minister of Transport we have had less transport and now we have reached the stage where the right hon. Gentleman pays someone £24,000 to do his job for him. A head male cook responsible for a staff and for the preparation of 9,000 meals a day, gets £13 10s. a week gross. These are manual workers.
Consider the case of the professional workers, for example, dark room technicians, the people responsible for assisting the radiographers. Without their help the radiographers could not develop their prints. If he makes a mistake when the right hon. Gentleman goes for his annual check-up and suddenly comes back with a plate showing him to have a heart, all sorts of things could result from that—merely from not having a properly trained person to do the job. What does such a man get? After all, he is doing a good job.
§ Mr. Marsh
I think that is unkind. The right hon. Gentleman obviously has a heart. It is merely that he mislays it for much of his political life.
The rate of pay of a dark-room technician at the age of 25—a man of that age could be married and have a family—is less than £8 a week. The absolute maximum rate of pay for a dark-room technician aged 29—the great horizon, the Shangri-la to which he looks forward—is £535 gross a year. In the face of these facts, are we really entitled to say that the only answer we have is to set up a committee, that we think the position is serious, that we ought to do something about it but that we cannot do anything about it at present 1190 because there is an economic crisis and that the Chancellor is grappling with economic difficulties? Every time the Chancellor grapples with an economic difficulty he comes back six months later with a bigger one. I believe that a lot of people on both sides of the House wish that the right hon. and learned Gentleman would stop grappling because the country is getting into a terrible state because of it.
How much do we spend—taking up the point made by the hon. Lady the Member for Tynemouth—on hidden expenditure and how much does it cost us? Can the Minister tell us how much we spend on advertising for staff which we cannot get because we will not pay them properly? This is a major piece of expenditure, and the problem arises directly out of Government policy. A lot of public money is involved, so we are entitled to ask specifically how much we spend on advertising throughout the country.
The hon. Member for Kidderminster (Mr. Nabarro) believes that we should look at this sort of expenditure very closely. I can quote one hospital in the London area which last year spent £4,000 on advertising for staff. The hon. Member who spoke on behalf of the Liberal Party when its members were here earlier in the day before it got dark and cold, whereupon they all went home, mentioned the fantastic figure of something like £100,000 being spent with the Nursing Mirror alone. I must say that that figure struck me as a rather large one, but the cost of advertising these vacancies in the National Health Service at the moment is certainly astronomical.
This is not only a matter of advertising vacancies. There is a new service growing up. People are finding commercial profit out of the National Health Service, out of the public exchequer, by providing services which the National Health Service cannot provide for itself. An agency operates to provide medical secretaries, and the National Health Service pays twice the price that it would pay to its own secretaries to medical entrepreneurs to got them from outside.
There are private commercial concerns providing a 24-hour radiography service. There are catering services, contract gardening and cleaning services, essential 1191 services which the Minister of Health cannot provide for himself. Private concerns are providing these essential services and are lining their pockets in the process because of the meanness of the Ministry in not paying its own staff properly.
I do not want to speak for long in this debate, but I thought that some sort of introduction to the subject was essential. To be serious, it would be agreed on all sides that the recent smallpox outbreak frightened everybody. It frightened all who had children. No doubt it frightened hon. Members opposite. It frightened me, and it frightened my constituents. There is something almost obscene about death by this insidious disease. There is something about it which frightens even the bravest man who in other circumstances might well perform acts of gallantry.
But we should not lose sight of the fact that every one of those smallpox cases was looked after by volunteers prepared to risk their lives in the service of the community. At least one died as a result of a cold-blooded decision voluntarily to take this risk. They were not all nurses. We make a mistake if we confine this to nurses. There were old ladies who scrubbed floors, porters who pushed patients, laboratory technicians who carried out tests, and nurses. In every section there was no shortage of staff to nurse the patients, and the staff did the job well. They underwent the risks because they had a vocation and felt that they had a responsibility to society. For that reason society has a responsibility to them.
I do not believe there is a possibility of widespread strike action in the hospital service. I have worked in this sphere and cannot imagine widespread industrial action in it. We can all feel secure; if our children are taken seriously ill, they will get devoted care. These people will not let us down. Precisely because they cannot fight for themselves, we believe that the House has an obligation to fight for them. It is time hon. Members opposite stopped talking about their vocation and what they might do in the future and got down to the realisation that if only they will apply political pressure to their own Front Bench, they have it in their power 1192 —and they know it—to change the situation which they have said they find so distressing.
§ 12.32 a.m.
§ Dr. Alan Glyn (Clapham)
I wish to take up a few points made by the hon. Member for Greenwich (Mr. Marsh). Forgetting what he said at the end, if he looks at HANSARD tomorrow he will find that at the beginning of his speech he said that the spirit of Florence Nightingale is dead and that people enter the nursing profession simply as a matter of finding employment and the highest paid job.
§ Dr. Glyn
The hon. Member went on to say that people enter the profession nowadays simply because it is something in the labour market which offers an attraction. That is quite wrong. People enter nursing because they believe it is a vocation. I am not suggesting that this is an excuse for not paying them, but the reason why most people enter nursing is that they like it and because they realise that it is a service. That is not what the hon. Member said at the beginning, as he will see from HANSARD tomorrow.
The hon. Member went on to make some pertinent remarks about pay. He criticised my hon. Friend the Member for Holborn and St. Pancras, North (Mr. G. Johnson Smith) on pay. He compared £1,600 a year for a matron, quite rightly and reasonably, with the hon. Member's salary of £1,760, but he forgot to say that my hon. Friend has expenses out of that for secretaries and various other matters. I do not believe that one can make comparisons of that nature between the two types of salary. I am 1193 sure that many hon. Members on both sides of the House would agree with me.
The hon. Member also criticised what my hon. Friend the Minister said about physiotherapists when he remarked that there came a time when perhaps in a patient's treatment the physiotherapist could render no further service. I agree that if a time comes when he can no longer give beneficial service it should not be given. There are cases of people who go the round of hospitals for treatment. I had a case the other day of a man who had been at no fewer than nine hospitals endeavouring to receive treatment. That man had nothing wrong with him, to the best of my knowledge, and I investigated his case pretty thoroughly.
§ Mr. Loughlin
I appreciate and accept what the hon. Member says, but the point made by the Minister, to which we objected, was that he implied that members of the medical profession were treating patients who do not require treatment and that the politicians would take the decision.
§ Dr. Glyn
With the greatest respect, I do not consider that that was what my right hon. Friend either meant or said. That is why I interrupted the right hon. Member for Belper (Mr. G. Brown) when he made that remark.
I should like to take up a point which the hon. Member for Greenwich made about smallpox. I hope that it will be mentioned when my right hon. Friend the Secretary of State for Scotland winds up the debate. The country has been extremely worried about it. I ask my right hon. Friend to confirm that the Labour Government abolished compulsory vaccination with the result that though vaccination itself is a free service the giving of a certificate is not a free service. I hope that my right hon. Friend will clear up this point. There 1194 has been a great deal of misunderstanding throughout the country about it.
Nobody in his senses would suggest that the Health Service is perfect. There are difficulties and shortages of staff and there are points where I am certain the Service could be improved. But my right hon. Friend has done a great deal. He has not by any means been a destroyer of the Service. He has done what has been possible to build up both the hospital building programme and other spheres.
The hon. Member for Greenwich made a valid point about certain shortages. He spoke quite rightly about the shortage of radiological staff. There is a firm in London which carries out that service because of shortage of hospital staff. I am sure that if my right hon. Friend's attention had been drawn to it at an earlier stage he would have put it right. I am sure that he will now do so, but it is expensive.
§ Dr. Glyn
I think that the hon. Member will agree that hospitals have been allowed to have this work done by private contract if they have not been able to provide the service themselves.
The hon. Lady the Member for Blackburn (Mrs. Castle) spoke about strike action. We all appreciate that any suggestion of strike action from the nursing profession would not be well received. Some quarters may have discussed the possibility of strike action, but in principle the medical profession, nursing and the professions supplementary to medicine would be opposed to that form of action. I say this for one reason. We have all said, on both sides, that these professions deserve good treatment. They provide a special service, and they know that if they resorted to strike action they would forfeit their right and the attitude which the country has towards them.
There are difficulties in the National Health Service. The number of letters that we have all received from constituents illustrates, not only the feeling in the nursing profession, but the great lobbying power of an organised force when it gets into motion. I have spent 1195 the last two days answering a large number of these letters.
The fact is that there is a shortage in certain directions. One of the difficulties, however, is that no overtime is provided for in the Service and salaries have lagged behind those of other services. One must realise that salaried workers always lag behind weekly wage earners. An important matter which has not yet been mentioned is that the status of the professions supplementary to medicine and of the nursing profession has to be revised. The nursing profession finds difficulty in accepting the odd hours that it is called upon to serve.
My right hon. Friend said that the number of nurses was increasing. We must consider, not so much the increase in the number of nurses entering the profession, but, far more, the requirements of the Service. One cannot say that we need an increase of 2, 5 or 8 per cent. on the previous year. What we can do is to set the requirements for the next year against the numbers actually in the Service. The position should be viewed simply in terms of the requirements of the Service and not in percentages.
One of the matters which many people have power to alter is the hours and working conditions of the nurses. I refer particularly to many of the young nurses. This is a matter to which, I hope, my right hon. Friend the Minister will give thought. Many young people who join the Service are made to work hours which are quite wrong, not because of their length, but because of the times of going on or off duty. Nurses are human, like anybody else. No nurse wants to go on duty at 7, 8 or 9 p.m. This means that the whole evening is spoilt and a nurse cannot go to the cinema or anywhere else. I am sorry that some of the senior staff in hospitals do not co-operate to stagger the hours, so that the younger people could enjoy social life. I know that this is one of the penalties of nursing, but a great deal could be done by senior members of the nursing profession to make life easier in terms, not of work, but of hours, to make the work more attractive for the younger, newly-joined members of the profession.
1196 I have been one of those who have always maintained that there is far too great a barrier in status between doctors and nurses and the professions supplementary to medicine. People do three or four years' training, and doctors seven years, but in principle there is far too great a distinction in the terms of service and the conditions of the two sides of the profession. There is a case for the structure of the physiotherapists and of the other auxiliary professions to be reviewed in this light. We must look upon the nursing profession, physiotherapists and the doctors as one team and consider their wage structure accordingly. In radiology the doctor can work for private fees outside the National Health Service, but the radiographer who is working inside the Service and doing the job cannot get remuneration for the private work which he or she does. That is quite wrong. I disagree with the attitude that nurses and radiographers and physiotherapists and others should not enjoy the same sort of privileges as doctors. If there were a review of the structure of status within the Service of the various people who work in it, then they would work more as a team. Fewer distinctions of the sort which I have mentioned would go a long way towards solving the problem which these people have rightly posed to us.
Mention has been made of the shortage of beds for midwifery cases. Many of us are concerned about this and feel that women should be able to have at any rate their first baby in hospital, if they wish. But I am certain that the increased building programme which my right hon. Friend is encouraging will solve that problem in the future.
One of the great reasons for the shortage of beds and shortages in the medical profession in general is that diagnosis of disease is improving more and more, and many diseases which would not have been recognised only twenty years ago are now being treated. That is especially true of mental diseases. The need for beds is thus increasing. But it is nevertheless true that there are people who, if they are not battening on the Service, are getting treatment which is overloading the Service and which they do not need. 1197 I am sure that many hon. Members will agree that doctors throughout the country are frightened of refusing to give a certificate for an illness. They know that if they do not give it, the patient will cause trouble with the Ministry and kick up a fuss.
I think that many general practitioners will agree that there are many people who do not need their services but who cause the doctors to give them. I do not say that it is a great number, but there are these cases. It should be our policy to give the best possible treatment to the patient, but when we have reached the stage of knowing that he cannot benefit from any further form of treatment, we should think very carefully about whether he should be given further treatment.
There is no question but that there is a shortage, but we should look round the Service not to cut it but to see whether we can economise slightly. We have also to take a much longer view than we now do. Every hon. Member is sorry that this pay claim was made at an unfortunate time when there was a wage freeze. I should like the whole structure of the medical profession and the professions subsidiary to it to be reviewed and put in the same context as the National Economic Development Council. I cannot see any difference between those people who work with their brains and those who work with their hands. Their conditions should all be considered together as part of a national wages structure. I hope that that will be taken into account when the N.E.D.C. gets going. I hope that the Council will consider not only the workers and managements in the factories, but somehow be able to correlate the wage earner with the salary earner. One cannot always measure responsibility by the amount of pay, but the rewards of the industrial wage earner and the salary earner and those in the professions should all be taken together in an effort to gear wage and salary increases to the national economy and the national production level.
§ 12.50 a.m.
§ Dr. J. Dickson Mabon (Greenock)
The hon. Member for Clapham (Dr. Glyn), with whom I was once abroad, is an excellent companion and a very 1198 loyal one. If I were in a fight I cannot think of anyone else I would choose to have with me, but tonight his loyalty to the Minister has tended to overthrow his professional judgment.
Take, for example, the unhappy man he described as going round the hospitals. The very fact that he went there was proof positive that there was something essentially wrong with the man. We have all had patients with whom we could find nothing physically wrong, but their continual complaints and psychological attitude showed that there was something wrong. Such a person would lead me to think that he needed some advice and attention. I admit that my general reaction if I had a massive surgery and a heavy visiting round, perhaps fifty or sixty people waiting for me to see them, would be to give the poor wretch a bottle of medicine. That may not be good medical practice, but it does not alter the fact that the fellow would be in need of some medical assistance.
This is what is wrong with the Health Service, despite the much vaunted claim of the Minister today. Any Martian Colonel Glenn listening to what the Minister said would believe that he was talking about a miraculous Health Service which exists really in the Minister's imagination only. The remark which the Minister made about physiotherapists has got to be answered. I hope that the Secretary of State for Scotland will answer it. He probably has more responsibility in these matters, for he sits in the Cabinet which imposes Treasury strictures on the Service, while the Minister has to accept orders from the Cabinet. The Minister should be in the forefront of any argument to promote and expand the Health Service, but from what we hear there is not much of a fight put up.
The Minister has to justify his remark about physiotherapists. Are there people in the Service ordering physiotherapy for those who do not need it? I suppose that it is on the basis of some doctors ordering the treatment for some patients for whom allegedly it is of no medical value. I could not accept the other interpretation that we should stop physiotherapy and write off patients as dead ducks anyway. I could not accept that Dracula4ike interpretation even 1199 from the Minister. I prefer the other, that the Minister believes that some doctors are incompetent to the extent of ordering the treatment unnecessarily. The Minister has to answer this point because when members of the profession read his statement they will want the point answered to their satisfaction and the satisfaction of those of us who loyally try to practise medicine and think that we are doing our best in extremely trying conditions. It is all very well for him to make these statements in a soft comfortable office, but people are working hard in medicine and they do not like these taunts made by those whom they regards as ignorant politicians. Allegations have to be justified. When some ignorant criticisms were made by hon. Members opposite about doctors over-prescribing, there had to be two committees set up to prove ultimately that doctors were not over-prescribing. It is in the records of the House that apologies were made by Ministers and that that criticism as a general attack was shown to be ignorant and unfounded.
Let the Minister now answer this one. When the medical Press prints his speech at the weekend, it will blazon abroad that we are now accused of a new sin. I hope to see some sort of justification attempted by the right hon. Gentleman.
The Minister was a great man with his party in 1956. There are many cans tied to his tail, and perhaps this will be another one. He tied one can to his tail in 1956 when, at the Ministry of Housing and Local Government, he said that in twelve months, that is, by November 1957, the equation of demand and supply of houses would be solved. He said that when he was trying to promote the Rent Bill. We know that that was a grossly untrue remark. Only the most ill-informed and incompetent statistician could possibly arrive at such a conclusion. The right hon. Gentleman is without doubt—we have had some experience of his like in Scottish history—the James VI of this Administration. He is easily the cleverest of them but at the same time he is the most foolish. In making remarks of this kind he puts up an incredible performance.
1200 In 1957, the right hon. Gentleman gave us the miserable story about old-age pensioners cheating the nation out of 2s. 4d. on the tobacco concession. What a mean mind this man had to imagine that that can be a sound argument for withdrawing a concession. I remember that day very well and the three words, "or did they?". I remember the late Hugh Dalton taunting the Minister for arguing about the pennies and halfpennies of the elderly. What an attitude to take!
We can expect more of the same kind because this is the way the Minister's mind works. This is the approach of the Ministry. One can hardly expect the Secretary of State for Scotland to try to compensate in any way for the failings of the Minister of Health. Perhaps the previous one, perhaps a Labour Secretary of State I can think of, but not this one. The present Secretary of State is trailing behind the Minister of Health in everything he does.
In 1945, the Scottish Hospital Surveys which were completed then—it took sixteen years for the Ministry to make a survey at all, despite many pleas from this side—said:The first aim of the hospital service must be to ensure that every patient requiring hospital treatment can obtain it without delay.Have we at any time since 1945 had a situation where that was true? Is it true today? Of course not.
I remember a pathetic man coming to me on the day of the General Election in 1959 and telling him that he would vote for me. He said he was sorry that he had not been to see me earlier—[Laughter]. I will tell the House what he told me, and then perhaps hon. Members will not laugh. He said he had been prevented from coming to see me earlier because he had been very busy at home, and he then handed me a letter he had received informing his wife that she was to go into the local hospital for an operation. He told me that she had been on the waiting list for two years. I said, "I am glad that she has at last got a bed. I hope everything goes well and the operation is successful ". It was then that he told me that she had died six months before.
This is the whole point. There are many people—I do not know how many—who have been waiting for admission to hospital for a long time who are not 1201 yet in sight of being admitted. Some waited too long and are no longer with us. What a commentary on our situation today! It is quite wrong for the Minister, with his equations of demand and supply, to make speeches about the rising number of nurses—we have never had more, he says—and about the tremendous number of doctors, as if all our problems are solved. What nonsense! The Minister, with his equations of supply and demand, should tell us what is the present equation of demand and supply in relation to the waiting lists, the beds, and the nurses.
The fact is that we have closed many beds. I do not need to point out to The Ministers, with their White Paper, Hospital Plan for Scotland, that in every item relating to the number of beds to be estimated for 1975 there is this pathetic footnote:This table omits convalescent and general practitioner beds, and unclassified, unstaffed beds".We know that there are many hospitals with large blocks of wards which have been completely unserviced for many years. We know that this is entirely due to the fact that we cannot attract young women into the nursing profession as we used to be able to do. Before the war it was said that unemployment was the best recruiting sergeant for the Army. No one has more respect for nurses than I have. They have been my helpmates all my working life, and many of my profession marry nurses, as proof of their tremendous admiration for them though I have not paid that tribute yet. But that does not weaken my argument that many nurses coming into the profession before the war came in because it was a reasonably good job, and a respectable and constant job.
Now, full employment has changed all that, and despite the fact that there are many trained nurses, there is a considerable shortage. This is a challenge to the Minister, who made one of the most complacent speeches that any Minister of Health has made since the National Health Service came into being. It was an incredible speech. I can only hope that he made it purely for propaganda purposes, to deceive his hon. Friends and the country. It would be incredible if he were so incompetent as to believe that what he said today presented a true picture of the present situation.
1202 The introduction to the White Paper refers to the 1945 surveys of the hospital service in Scotland and defines three aims of the ideal service. I have referred to the first—that every patient requiring hospital treatment can obtain it without delay in the hospital most suited to his needs. The second is that the hospitals axe provided with accommodation, equipment and staff sufficient for this purpose, and the third that the efficiency of the service and the standard of treatment will be maintained and enhanced.
Let us examine the White Paper further. A large section is devoted to what is meant by those three aims, in relation to medical practice. Since the hospital surveys were written in 1945 medicine has been revolutionised. First, we have drugs that are able to combat successfully many respiratory diseases that used to bring life to an end in the sixth and seventh decades. In other words, many of our old people who would have been carried off by pneumonias and other chest diseases are now with us. Because of that, and because of the increase in population, we have a larger number of people to deal with, and a different kind of pattern of disease.
Not only have drugs saved many people from an earlier death; we have now entered into the realm of having to treat on a large scale the diseases of old age. We are faced with an entirely new problem in specialisation—the challenge of a large and a growing population is equalled only by the challenge of specialisation in medicine, and from the subject of specialisation in medicine I am driven back to the subject of nursing.
Paragraph 46 of the White Paper says:So far as nurses are concerned, a general hospital must contain a considerable range of specialties if it is to offer the variety of nursing experience required by the General Nursing Council for recognition as a training school for the General Register.… For the same reason, the highly specialised units in, for example, neurosurgery, which make exceptional demands on trained staff must wherever possible be located at the hospitals with training schools.… An increasing number of hospitals are beginning to have training schools both for the General Register and for enrolled nurses, which adds to the demand for facilities.That is an excellent idea, but there is a strange remark later in the White Paper. 1203 It is pointed out that there was only one major teaching hospital built in Scotland since 1914, which was in Aberdeen.
That is the whole point of my criticism. Instead of grubbing around in this way and treating nurses as some section of the great industrial army which must bear the brunt of the battle, as hon. Members opposite see it; instead of referring, as the hon. Member for Hertford (Lord Balniel) did, to a loophole through which all the other professions will stream, we ought to realise that the time is long overdue for a complete and radical review of the financial structure not only of the nursing profession but of the entire Health Service.
I can never understand how doctors have acquired such influence with the Conservative Party. Certainly they have the assistance of the Minister of Housing and Local Government, but I do not think that he pays much attention to organised medicine nowadays. Whatever the reason, the doctors had the Royal Commission, the Pilkington Commission, set up in 1957, which has done a lot to try to improve the doctors' position in this country. The Minister skated over the recent article in the British Medical Journal by Dr. Seale, but he has not disproved what was said in that article. He must give us more facts. I hope that the article is wrong, because I do not want to think that members of my profession are leaving the country in such numbers. Irrespective of the party in power, this will be a colossal problem if we are to have a chronic shortage of doctors. If we have a chronic shortage for the ordinary service, what chance shall we have of getting doctors in the specialised services for which we need men more and more?
The fact is nevertheless that we are losing doctors. Perhaps we do not know the exact numbers, but if we are losing them it must be for a good reason. Let us try to find out what it is and why doctors want to leave the country. Has the Minister asked himself why most doctors take out insurance policies for hospital treatment instead of having it in the N.H.S. hospitals? Has he ever asked himself why a medical man makes sure that his own family is not treated 1204 in an N.H.S. hospital? Certainly that is so with many medical men. We have had an article in a paper pointing out that Ministers are not treated in N.H.S. hospitals. I am not complaining that people wish to have a free choice not to be treated in an N.H.S. hospital, but if I were the Minister of Health—and I hope that the present Minister has the same thoughts—I should want to know why the Service is so unpopular with the principal people working in it. I should ask myself those questions—and I might get some not so surprising answers. Part of the answer lies in the shortage of staff in the hospitals, and part of the reason for that shortage is that the remuneration is not good enough. It is a very simple point.
The Conservative Party has made no case on this issue in the debate. I have listened to every speech, and not one hon. Member opposite has failed in some way to pay tribute to the nurses or to admit that they have a good case. One hon. Member suggested that they ought to have a salary award similar to that made to the Services—an award which would be paid in instalments, with back pay. Hon. Members opposite are falling over each other to make the case that some consideration should be given to the nurses' pay. It is difficult for hon. Members opposite. But, as Jimmy Maxton once said, if one cannot ride two horses at the same time one should not be in a circus.
As my right hon. Friend the Member for Belper (Mr. G. Brown) said in an excellent speech, there is not much point in having a national wages policy if we start on a rotten foundation. The foundation on which salaries in the Health Service are laid is a charity foundation. It is fundamentally so. The Labour Government had a lot to do in their time and they could not do everything. Hon. Gentlemen opposite imagine we ought to have done it and seek to compare the Labour Government's term of office with the Conservative Government's term as though the years when the Labour Government were in office were comparable with the years of the Conservative Government. They imagine all those years were comparable and that a reasonable comparison can be made between them.
1205 Even putting that aside, the fact is that a complete reformation of the structure of staff remuneration in the Health Service could not take place in its early years but wait until its later years. Now the Government, by their wages policy, are hitting hardest a profession which can least bear it. I have had more letters from Edinburgh—of all places—this week than from any other part of Scotland about this subject. Edinburgh is Scotland's only Tory city. Edinburgh is the most anglicised and middle-class city in the whole of Scotland, and yet I have had the most angry and militant letters from Edinburgh—from matrons of hospitals even. I would never have dreamed when I was a young impecunious houseman that a matron would write to me about her salary. I never dreamed this day would come, yet here it is. I sympathise with them, everyone. I know how hard they work. I have been in practice and I have been in a good many hospitals, and hospitals in Edinburgh, and I can visualise how uphappy these women must feel. And most of them would never dream of voting Labour. In a daring moment they might think of voting Liberal, but usually they would for respectability's sake vote for the Conservative Party. And yet these women are writing to me and to hon. Members on both sides of the House asking for their consideration.
But in relation to this matter of the remuneration of nurses and midwives the only people who can change this decision are not on the Whitley Council or on the Government Front Bench, for they have made up their minds and they have got to stick to this policy it is the hon. Gentlemen behind them. In this regard the Government will not listen to us on this side at all. Hon. Gentlemen opposite are really the only ones who can do anything for the nurses and midwives in this country. If they do not exert sufficient pressure on the Minister to make his life a perfect hell, if they do not nag and push him, the nurses will be left with the 2½ per cent. award, this miserable pittance which everyone of the hon.& Members opposite behind the Government Front Banch has said ought to be higher.
If hon. Gentlemen opposite want to table a Motion calling for a committee of inquiry to reform the wage structure 1206 of the professions supplementary to medicine and of the nurses and all the rest, I for one will sign it, and I hope that my hon. Friends will, too. If we get sufficient signatures from both sides perhaps that will oblige the Minister to change his policy. I am not referring to the Motion already down on the Notice Paper, but to something much more specific, and demanding what the award should be—and a much higher one than that presently offered. If such a Motion is put down the debate may have done some good, but if hon. Gentlemen opposite, who tonight think they have done their best, do not put it down, in spite of their speeches tonight, then those same speeches will have been so much humbug. The Parliamentary Secretary says, "Hear, hear." She has not made a speech yet. No doubt she will make one later in response to the many questions my hon. Friends have asked and wish to ask about this matter.
But it is a very grave matter that the nursing profession has reached the stage of objecting to this as they have. It shows that the Government have managed to antagonise them as they have, indeed, also antagonised the teachers, the police, the firemen—antagonised practically every one of all the respectable professions and trades in the land who in many cases are not at all identified with the trade union movement or with militant trades unionism. They have managed to do it. Is it any wonder they have their Orpingtons? Is it any wonder that people who think they are middle class, in attitude if not in income, are revolting, and turning to other liberators? Of course, they do not for the moment accept us in the Labour Party. That time will come, because I think people will ultimately realise that the only way in which we can have a larger Consolidated Fund from which we can spend more money on awards of this kind, and a larger proportion on the Health Service and on education, is by having a growing volume of wealth.
I recently re-read the General Election speeches of the right hon. Gentleman the Secretary of State for Scotland—a form of masochism on my part—and found that his one great, astounding dialectical argument, which he thought felled every Labour man in the vicinity, was to ask where the Socialists were to 1207 get that £1,000 million to finance their programme. Little did he know that two years later his own Government would have to find £600 million of that £1,000 million. Where did that come from?
Our only choice is in the rate at which we encourage the growth of the Health Service. We have no alternative. I hope that the time will come in this House when we no longer argue between parties by saying, on the one side, that we spent so much in 1950-something and, on the other, that we spent so much more at another date, but that we will talk in terms of a rising percentage of the national income. When we spend more on social services than on defence and the like, a really good Government will be in office. Instead, we get this indirect pat on the back for the Labour Party, when the party opposite say that when Labour did anything good all they must do is keep up with it and all will be well.
I suggest that that is the point about the nurses. I know that hon. Members opposite, particularly when they or their relatives have been ill, have every admiration for the nurses, and would be delighted to see them treated as they should be, but the nurses cannot be properly paid if we do not allocate money from the national "kitty." We have a wrong climate of opinion at the present time, and an entirely wrong approach by a Minister entirely unsuited for his task. He ought to be known as a rebellious Minister and one in favour of spending money, because he has the agony of health priorities to go to bed with at night. He knows that he has to spread his money over a Service where he can never have enough. It would be better if he had a treasury full and overflowing rather than have that constant agony of priorities.
But that is not the Minister we have. That is neither his nature, nor does his political record exhibit it. That is why we all feel so sad about things in the National Health Service, so understaffed, so under-paid. One would not imagine that that is what we are arguing about tonight, but rather that if the Minister had his way all was well with the Health Service. We have never had a chance to debate these two new 1208 hospital plans. We are to embark on a national hospital plan; indeed, that is part of the present-day Tory propaganda for the 1963 General Election—"Pie in the sky."
I do not know how many roads we have had built in Scotland—on paper. I remember that in one year alone we had no less than three road programmes. They all added to the same thing, of course, but they were given three tremendous splashes of publicity. My own constituency, which has for some months had an unemployment rate of 7 per cent., and where the average has not dropped below 5 per cent. in the last ten years, has had its problems solved by the Secretary of State at least once—on paper. Hon. Members can imagine what the unemployed said when I told them the good news on paper.
A lot of bureaucratic errors have been made—
§ Dr. Mabon
I am obliged to my hon. Friend. I shall look forward to hearing him speak later. I see that he has come well-armed.
I was saying that the crux of this hospital plan, irrespective of whether it is put into operation by hon. Gentlemen opposite or hon. Members on this side of the House, depends on getting staff, and not just ward orderlies. I have a great regard for those men and women who act as ward orderlies and who come into the hospitals to do the chores. Nothing is more disgusting than some of the jobs which have to be done in a hospital. But at the same time there is a mountain of difference between ward orderlies and fully-trained nurses.
Perhaps that is part of the reason why the insurance organisation set up to provide private nursing homes is so popular. Is it because some doctors do not disregard the talent of other doctors in the National Health Service but whose services may be available privately wish to have better nursing than is provided in the Health Service? I suggest that the Minister ought to be concerned 1209 about this. He should be able to say that any treatment which is provided in a private nursing home can be improved on by the National Health Service. But can he say that?
§ Dr. Mabon
The Minister says that it is far better. I suggest that he should give some examples to prove that. He had better prove to the private organisations that they are wasting the money of the public, and that doctors are badly informed about the facilities in the hospitals. They should be discouraged from taking out insurance when the treatment is so much better in the National Health Service. It may be interesting to know how many Ministers of Health have been treated under the National Health Service. I do not like to hear critical things said about the National Health Service, and I think that these things should be looked into.
But, to get back to my point. Unless we are able as a nation to raise the standing of the nursing profession in its own eyes by paying the nurses properly. Let us not have Sisters finding at the age of 27 that they have reached the top of their profession; or a matron getting less money than many other people in less demanding and responsible positions. We cannot continue to have this state of affairs. Until we can revolutionise the financial conditions we shall never get the staff which is needed, or wipe out the waiting lists of patients or have a sufficient number of doctors in the hospitals. I think that the Government have failed, and they will continue to fail unless they change their system of priorities and realise how vitally important it is that much more money should be spent on the National Health Service, with nurses and midwives given first priority when salaries are raised.
§ 1.25 a.m.
§ The Secretary of State for Scotland (Mr. John Maclay)
A long time ago I thought that I should be making my speech at about seven o'clock in the evening. But I have found the debate of such intense interest that I have held back until 1.25 a.m., I think, however, that it will be for the convenience of hon. Members if I speak now.
§ Mr. Loughlin
On a point of order, Mr. Deputy-Speaker. May I take it that the speech of the Under-Secretary of State for Scotland—[HON. MEMBERS: "The Secretary of State"]—I am sorry, the Secretary of State for Scotland—
§ Mr. Deputy-Speaker (Sir William Anstruther-Gray)
As far as I am concerned, the Secretary of State for Scotland rose to speak and he caught my eye. I called the Secretary of State for Scotland. That is all.
§ Mr. Marsh
Can the Secretary of State for Scotland tell us whether the Parliamentary Secretary to the Ministry of Health will be making a contribution later on, before lunch, so that she may respond to the comments which will be made between now and later? Obviously there are a number of hon. Members who wish to speak. If we could have a contribution from the hon. Lady it would be of benefit, because she could answer the many questions which are to be raised.
§ Mr. Maclay
The right hon. Member for Belper (Mr. G. Brown) spoke a very long time ago and I thought that we were Box and Cox on the thing, but it did not seem a very sensible dung to me if, indeed, as long ago as that—
§ Mr. Hale
If the right hon. Gentleman was on a point of order, perhaps he would say what it is. He was, in fact, replying to a point of order and he has no right to do so. There must be some limit, Mr. Deputy-Speaker, to the abuse of the House by Ministers. My hon. Friend raised a point of order, and no Minister is allowed to reply to it. That is the prerogative of the Chair alone. I desire to put a point to the Chair. In the course of seventeen years in the House I recall an unhappy night when the closure was moved on the Third 1211 Reading. I am sorry to say that it was moved by a Labour Chief Whip, and some of us voted against it. Later we were given an assurance that it was a misunderstanding. We get to know the procedure of the House rather rarely. Unless the closure is moved, it is surely obvious that the Minister should not rise to reply before the observations have been made.
If the good fortune of the Minister in catching your eye, Mr. Deputy-Speaker, on the first time that he rose to his feet—[HON. MEMBERS: "Order."]—I do not know to whom the cries of "Order" are addressed, but I am glad to know that I am in order. If the good fortune of the right hon. Gentleman in catching your eye, Mr. Deputy-Speaker, at the first moment that he rose to his feet is fortuitous, then I rise on a point of order to suggest that, on reflection, it is inconvenient. If, on the other hand—
§ Mr. Deputy-Speaker
I hope that the hon. Member is not criticising the Chair in its right to select speakers. The right hon. Gentleman caught my eye and I called him. I go no further than that. Mr. Maclay.
§ Mr. Hale
On a point of order. I was saying that, on reflection, I have known cases where Mr. Speaker has called a Member and then when it has been pointed out that there has been a misunderstanding Mr. Speaker has corrected himself and has expressed regret that there was some misunderstanding. This has happened at Question Time and in debate. I am suggesting that on the Third Reading of the Consolidated Fund Bill, when hon. Members are still rising to speak—hon. Members who have been here all day—it would be deeply to be deplored if the calling of the Secretary of State became misunderstood or misinterpreted. That is why I wonder if you, Mr. Deputy-Speaker, would permit the hon. Lady the Parliamentary Secretary, who has sat here patiently all day, to intimate that she will take advantage of the opportunity which remains to her and reply to other speeches if the Secretary of State persists in his intention of speaking now.
I beg the Secretary of State to reconsider speaking now, because the reason which he gave was that the debate had 1212 taken a long time. He said it was so long since my right hon. Friend the Member for Belper (Mr. G. Brown) spoke that he thought he should speak. He also said that he had hoped to speak at about 7 o'clock and that he thought six hours later was a bit of a do. In point of fact, the debate did not open until 6.30 p.m.
This is a matter of the liberty of the House. There are some hon. Members who have been sitting here hour after hour since 3 p.m. in the hope of taking part in the debate, which we all regard as important. I gave notice to the Minister twelve hours ago that I wanted to raise—
§ Mr. Deputy-Speaker
I am seized of the hon. Member's point. As far as the point of order which he raises is concerned, it is perfectly in order for the Chair to call the right hon. Gentleman to speak. That is what the Chair has done. No doubt the hon. Member's remarks have been heard in all parts of the House, but the Chair has called the right hon. Gentleman the Secretary of State for Scotland to speak, and I call Mr. Maclay.
§ Mr. Maclay
Far be it from me ever to argue with the hon. Member for Oldham, West (Mr. Hale), but it seems to me that we have sorted this out fairly sensibly. This seems an appropriate moment for me to speak.
I congratulate the hon. Member for Orpington (Mr. Lubbock) upon his interesting speech. He said he would not follow two of what he understood to be the customs of the House, first about talking very much about his constituency, and secondly about remaining entirely uncontroversial. I shall not follow one of the conventions—which is to say that we hope we shall hear a lot more of the hon. Member. I do not say that to be rude to the hon. Member, but only last week I was reminded by the hon. Member for Kilmarnock (Mr. Ross) that 14 years ago I said those very words to him and have been regretting it ever since. I repeat that no reflection is meant upon the hon. Member for Orpington.
1213 The hon. Member for Greenock (Dr. Dickson Mabon) spent a good deal of time in an extraordinary attack on the Minister of Health, particularly in relation to physiotherapy in hospitals. He reproved the Minister, and so did the right hon. Member for Belper (Mr. G. Brown) and the hon. Member for Greenwich (Mr. Marsh), over what he said about physiotherapy. The accusation was that the Minister was being a politician and telling the doctors how to prescribe physiotherapy for patients. If the hon. Member for Greenock, a doctor himself, is so wrong over this, perhaps a number of his other charges can be taken to fall, too.
What the Minister has done is to commend to hospitals advice given by the independent Standing Medical Advisory Committee which, as the hon. Member knows, consists wholly of doctors. The following is the advice to which my right hon. Friend was referring, which went out under cover of a note from the Department:The Standing Medical Advisory Committee has prepared a note on the provision of physiotherapy in hospitals. After reviewing recent changes in the application of physiotherapy, it emphasises the need to make the best possible use of physiotherapy services and advises:It goes on in paragraph II (ii):
- (i) the avoidance of unnecessary treatment;
- (ii) the precision in the prescription of physiotherapy;
- (iii) the periodical review by a doctor of all cases, normally not less frequently than once a month."Investigation of the patients attending physiotherapy departments will often show that a proportion have been under treatment for long periods and with infrequent review by doctors. This is more apt to occur in departments without adequate consultant supervision of the day-to-day work within the department and there may be a variety of reasons for it.It goes on:Patients suffering with chronic disorders … may be referred by consultants in the first instance and reviewed by them in the early stages but sooner or later this type of patient tends to be transferred to the review clinics of less experienced and junior staff who may come and go at short intervals. Thus in time these patients tend to look to physiotherapists rather than doctors for continuity of advice and treatment.This was what my night hon. Friend was referring to. It was advice produced not by a politician but by a committee composed wholly of doctors.
§ Dr. Dickson Mabon
I congratulate the right hon. Gentleman on his excellent smokescreen. He is loyal. That is not what the Minister said. The Minister is on record three times. He said something entirely different. His interpolation to my hon. Friend the Member for Greenwich (Mr. Marsh) and my night hon. Friend the Member for Belper (Mr. G. Brown) is on the record. His words were that physiotherapy will not be made available to patients who cannot profit from it. I am trying to be absolutely fair to the Minister of Health, but he has made a serious blunder and the sooner he apologises for it the better.
§ Mr. Maclay
I will not pursue it any further: If the hon. Member will look at what I said and get hold of the documents and look at what my right hon. Friend said he will see that there is no inconsistency of any kind.
A number of other detailed points have been made and it will be difficult for me to pick up more than a few of them. I should like to clear one in particular straight away. It is the question of vaccination. There was some confusion about it. The position is quite clear. Vaccination is free for the patient. There is a registration fee paid by the local authority. It is true that that is part of the pool but that in turn is completely in conformity with the Pilkington Report on which the pool is based. I think that dears that point.
Throughout the debate people have spoken with a great deal of emotion on both sides of the House. My hon. Friend the Member for Harborough (Mr. Farr), my hon. Friend the Member for Maidstone (Mr. J. Wells) and my hon. Friend the Member for Belfast, East (Mr. McMaster) spoke with equal conviction, some of them attacking the Government's general policy in certain respects and others not. Hon. Members opposite, of course, have steadily criticised what the Government are doing, but common to my night hon. Friend and myself and to our hon. Friends is our intense admiration for the nursing and related professions.
§ Mr. Maclay
The hon. Member moans and makes sad noises and says "The same old stuff". I admit that many 1215 of their speeches are sincere, but hon. Members opposite try to pose the whole time as the sole champions of certain sections of the community. This is utter nonsense.
Throughout the debate there has run a good deal of emotion. The hon. Lady the Member for Blackburn (Mrs. Castle), who spoke earlier and now has come back to us in another manifestation, talked of a volcano of emotion. That is the trouble with the debate. There has been a steady attack—
§ Mr. Maclay
It has been an emotional attack, because it has not got down to thinking of what the Government are doing. If we get into another inflationary spiral, the people who will suffer most are members of the professions, and nurses above all. The object of what we are all doing is to see that the value of money is maintained and the country remains solvent and effective and that we have adequate production in the long run to do what we all want, which is to make the adjustments to salaries in many of the professions which I personally would like to see better than they are. But it would be folly, knowingly and wickedly, because one's emotions are touched by one or two professions, to take action in relation to them which would bring down everything we are trying to do, above all for those very professions.
§ Mr. McMaster
My right hon. Friend has referred to my speech and I have also been attacked by the hon. Member for Greenwich (Mr. Marsh).
§ Mr. McMaster
He misunderstood my speech. I was not attacking the Government. I approve of the Government's pay pause and wages policy. What I suggested was that within the policy a special case could be made for nurses.
§ Mr. Maclay
I was not criticising. My hon. Friend made an extremely interesting speech. I was interested in what he said.
1216 What I now have to say may be dull and hon. Members may say that it is not relevant to what they said, but I want to have on record, and I want the House to hear, some of the facts of the situation, such as the dates of the last salary awards and decisions in the various sections of the profession. For the nurses, a revaluation by the Whitley Council was carried out in 1959 which worked out, I think, at an average of about a 15 per cent. increase, with a further increase of 5 per cent. from 1st December, 1960. Physiotherapists, occupational therapists and radiographers had new scales effective from 1st January, 1961; dieticians, 1st March, 1961; almoners and psychiatric social workers, 1st November, 1959; and pharmacists, 1st January, 1960. Medical laboratory technicians have had one recently.
It is only right that that should be appreciated when all this emotion has been engendered today—and I understand it—without anybody checking back to see what has happened and the dates when it happened. My right hon. Friend the Minister gave figures of recruitment and the growth in the services, but that was discounted by all hon. Members opposite as if it was irrelevant to the situation.
§ Mr. Maclay
I will answer. I have never been aware of any salary claim in which I have been involved, on one side or the other, whether as a Member of Parliament or a businessman, when I have not been quite convinced that there was an extremely good case for the people asking for the increase.
§ Mr. Maclay
Of course, I have great sympathy with the claims. The question is whether it would be in anybody's interest, above all the people themselves, if the claims were granted, with the consequences that that could have.
Two lines of criticism have run through the debate. One is that the National Health Service is not getting and will not get, the numbers and 1217 quality of people that it requires, that the situation is bad and that the Government's incomes policy will make it worse. That about sums up what has been said. My right hon. Friend quoted figures—hon. Members opposite criticised him for doing so—which show that the numbers in post in nearly every grade have been, and are, increasing. I make no apology for returning to the figures, because in a matter of this kind we must argue from the facts.
§ Mr. Maclay
I take nurses first as the largest group. The numbers of whole-time nurses have risen in the last ten years in England and Wales by 20 per cent. and in Scotland, I am glad to say, by 25 per cent.
§ Mr. Maclay
I will come to that. To an increasing extent in both countries, with the earlier age of marriage, we will have to depend on part-time nurses as an essential part of the nursing service and not merely as a useful supplement. I appreciate what the hon. Member for Greenwich said, but I see this question in too wide a range over all my responsibilities as Secretary of State.
We are dealing with what still is such a narrow band that is available for all these jobs that I hope that attacks will not be made on the possibility of people coming back who can give invaluable service on a part-time basis. That will be necessary not only in nursing, but in teaching and among doctors. Over the whole range, if we are to staff all the critically important posts, they must be staffed in this modern society, which is getting more and more complex and requires the whole time a higher standard of training and basic ability.
What has happened with the part-time nurses? In England, the numbers have risen by almost 100 per cent., and in Scotland by about the same. It is a gross over-simplification to suggest that pay is the only element in the whole problem of getting nurses.
§ Mr. Maclay
It sounded very much like it all through the debate, although I agree that most hon. Members qualified it when they thought about it.
1218 Working conditions are also involved in a very big way. Despite the increasing pressure of the work in hospitals, it has been possible to come down to the 44-hour week, or rather, the 88-hour fortnight. I appreciate that some problems arise from that, but that has been a vary important move. A good deal of the drudgery has been taken out of nursing by the revision of procedures and the initroduction of work study. Not a single hon. Member opposite touched on that critical part of what is going on in the nursing profession—the immense amount of work which is being done to try to improve the conditions of work, something which everyone wants to see. It has been tragic that for years qualified nurses have had to do duty which, with proper organisation and management, they should not have to do. They are now able to give more time to their essential job. It is largely a question of organisation.
Another point on the staffing figures which we have to remember is that we have had a slowing down, in Scotland at any rate, in the intake. That has coincided with one of the periods in the war when the birth rate was low. We are just beginning to move into the proper bulge which will be leaving school fairly soon.
§ Mr. Maclay
The night hon. Gentleman should not ask what a proper bulge is. There is every reason to hope that nursing will continue to attract its full snare of recruits and my right hon. Friend and I and the hospital authorities will make every effort to ensure that that is so.
The right hon. Member for Belper asked what we were doing to encourage recruiting. All that I have been saying is part of the programme for the encouragement of recruiting—new buildings and methods of work and so on.
The trend of numbers of medical auxiliaries was upwards in almost every case in the last year and the numbers of student radiographers has been much more satisfactory than it was a year or two ago. As my right hon. Friend said, the one ancillary profession in Which the number has remained relatively stable has been physiotherapy, and there has been a special problem with the shortage 1219 of teachers. However, with the help of the Chartered Society, a special course has been started to provide more teachers quickly.
In Scotland we were satisfied that it was not a question of the shortage of recruits but that the main problem was shortage of schools. I am glad to say that we are opening a new school in Aberdeen next autumn and making plans for yet another in Dundee. Because of the rather wide range of my duties as Secretary of State, I constantly come up against many of these problems of recruitment and training—teachers, social workers, probation officers and so on, as well as professions within the Health Service.
We have to face the fact that there is a relatively limited number of people with the basic education and the inclination to take up one or other of these various kinds of professional work. The same applies to almost every other country and there would be no point in believing that we would solve the problem in the professions which I have mentioned simply by attracting recruits from one into another. One merely adds to the inflationary spiral when one does that, and it is the old story of robbing Peter to pay Paul. We believe that the problem is best approached by having an education policy which is generally aimed at increasing the number of people with the higher education which will enable them to go into these professions. I can assure hon. Members opposite that almost every civilised country has a shortage in the band of people equipped for this kind of job.
I want now to refer to the shortage of doctors and doctors going overseas. I do not want to go into detailed statistics, although I agree that the statistics are not as good as they might be. In Scotland we are trying to get some figures and my right hon. Friend is trying to get some better statistics to show what is going on. Scottish doctors have always gone overseas.
§ Mr. Maclay
Quite a lot of them have gone to the South as well, and the South is a great deal better for that. If what hon. Members have said about the shortage of doctors were wholly true, a 1220 great many are coming back to Scotland because in the last ten years the number of registrars has increased by 70 per cent., the number of senior medical staff by 60 per cent. and the number of consultants by 40 per cent. We have figures for house officers only since 1953, but the increase there has been 20 per cent. and in the same ten years the number of doctors in general practice in Scotland has increased by 15 per cent.
The hon. Member for Greenock made a fuss and tried to convey the idea that the National Health Service was in a pretty bad way. I do not think he did any service by that. He seemed to think that it was slowing down and coming to a stop. I am sorry to give more Scottish figures, but they are indicative of what is happening south of the Border. The total staff beds are up from 58,000 in 1948—a convenient date because statistics started then—to 63,500 in 1960. Senior staff consultants are up from 646 to 977, nursing staff from 20,550 to 29,442, patients discharged 383,000 to 561,000, first attendances by new out patients 1,262,500 in 1948 to 2,228,922. This shows an immensely vigorous expanding and effective Service.
§ Mr. Maclay
Of course, there is an expanding demand. As hon. Members opposite must know, it is extremely difficult to get an accurate figure for shortages because the nurse-patient ratios are changing the whole time, there are different methods of treatment and differences in the handling of the work in hospitals. We can get general figures, but I do not think they mean a great deal. I am not for a moment pretending that we do not need more nurses, but the whole tendency is for the figures to improve and increase over the years and there is no sign at the moment that that process has been set back seriously.
§ Dr. Mabon
The right hon. Gentleman promised us that he would deal with vacancies. He has not reached it yet and I do not mind how long he goes on speaking, because it will be interesting to hear about the vacancies. Is it not true that nurse-patient ratios are constantly changing upwards and recruitment of nursing is not going up with them? One of the major arguments of 1221 G.P.s, who after all are the backbone of the Service, is that we cannot each treat 3,500 patients. It ought to be 2,500.
§ Mr. Maclay
The hon. Member is making a good case. We do need a bigger and better Health Service. I entirely agree with him and my right hon. Friend is doing more than any Minister of Health has done for many years to achieve it. I remember a speech—I am afraid that I do not remember who made it—in this House about ten years ago in which it was pointed out that there could never be a moment when we had everything we wanted in the way of a National Health Service. Practices are changing, one method of treatment goes out and another comes in, one illness disappears and new ones come. The real question is whether we are setting about in the right way to build up the Service. I submit that we are. If we were not doing all that we are doing in relation to pay and salaries in the pay pause, with the full knowledge of how hard it may seem to many people, we would be doing the greatest disservice.
§ Mr. Maclay
Where would the hon. Member stop? He does not mind whether money loses its value, the overseas balance of payments goes wrong and productivity goes down. We have heard the emotional approach. No one has a greater admiration for the nursing profession than I have, but I think it wrong not to realise that we are working in the way which we believe to be the best to secure everything they want.
§ Mr. K. Robinson
The right hon. Gentleman has listened to a great deal of the debate. Did he hear the speech of my hon. Friend the Member for Leigh (Mr. Broadman) who, speaking from his background of considerable trade union experience, said what almost every hon. Member has said, that the nurses' case is a special case, adding that he was quite certain that the Government could breach their own pay pause in this limited field, if they wanted to, without any repercussions from industrial workers whatever?
§ Mr. Maclay
I can tell the hon. Gentleman of at least five other special 1222 cases straight off. The probation officers have a special case. The teachers have a special case. The firemen have a special case. So I could go on. There are many others. It is no use trying to ride that one out in that way. We believe that we are working in the way which can help them better than any other.
§ Mr. Harold Davies
We have not yet been told what this figure is. To pay the nurses, would it cost more than the £83 million which the Government gave out in relief to the Surtax payers?
§ Mr. Maclay
The Surtax payers have not got that one yet anyway. Apart from that, it is a quite absurd argument, as the hon. Gentleman knows, to try to relate these things.
§ Mr. Maclay
The reason for that action of the Government was not to help a particular group of people for the sake of helping them. It was generally recognised what the purpose was, and I can remember at least one speech by an hon. Member opposite fully approving what was done.
§ Mr. Maclay
The reason was that we wanted to increase the country's productivity and encourage the people who can do as much as anyone to that end, the Surtax payers.
§ Mr. Maclay
I ask hon. Members to think carefully about these matters and not put too much emphasis on shortages and vacancies, serious though they are. It is possible to formulate demands which are quite unrealistic because they bear no relation to the actual staff or even the potential staff—the number of people with the necessary skills. We must watch this carefully in talking about the number of vacancies.
While we must concern ourselves with the problem of maintaining an adequate flow of recruits and providing reasonable conditions for those who are already engaged in the Service, it is just as important to give attention to the problem of making the best use of the staff we have. I shall return to this later 1223 because I believe it to be immensely important. On this aspect of the matter, I can fairly claim that more is now being done in the Health Service than ever before. First, following the Platt Report, a review is now taking place throughout the country of the use of consultant medical staff. Special committees are not only looking into the demand for additional consultant posts but at the ways in which hospital boards can make more effective use of consultant time by reorganisation which will reduce travelling and other non-productive time.
In nursing, the Royal College of Nursing has been extremely progressive in encouraging the application of new techniques such as work study to eliminate unnecessary work and to do essential work in a more economical way. In my own Department, we have been doing some very interesting and original work in studying proposed layouts of new hospital wards and departments from the point of view entirely of the nurses.
§ Mr Maclay
With the aid of these studies, we have been able to modify plans so that the new units will be considerably easier to run from the nursing point of view than otherwise would be the case. Work study and organisation and methods studies are now being very widely applied north and south of the Border both by the hospital authorities and by the health Departments themselves to improve the methods of work in a wide variety of occupations all through the hospital service. These are only some examples of the ways in which the National Health Service is being helped, and is helping itself in a positive way, in a period such as the present. This is a very productive approach—probably more productive, in the long run, than continually looking round for large numbers of additional people whom it might not be possible to find in years to come, with all the competition that exists.
I do not think that any case has been made for saying that the Government's incomes policy should not be applied to the National Health Service as elsewhere. The criticism must come back 1224 to the point at which the critics are driven to question the policy as a whole.
§ Mr. Maclay
That "Hear, hear" simply means that we can go on paying ourselves more than we are earning. Is that what the hon. Member means? All experience suggests that the people who would suffer most from that policy are the salary earners and wage earners in occupations like the National Health Service, who are not concerned directly with production. I am certain that the policy which the Government are pursuing is right not only in the interests of the country as a whole but—and I repeat this for about the fifth time—in the interests of the National Health Service.
§ 2.1 a.m.
§ Mr. Charles Loughlin (Gloucestershire, West)
The Secretary of State for Scotland said that he thought it was time he intervened in the debate. Having listened to him, I wonder why. He has not thrown in one new idea to the discussions we have had on this question.
I was interested in his suggestion that the Government are pursuing a policy solely in the interests of the nursing staffs. I wonder how the Minister squares up this question of inflation with the case quoted by his hon. Friend the Member for Harborough (Mr. Farr), who talked about a mental hospital in his constituency. I remind the Secretary of State of what the hon. Member said. He quoted the rates of wages received by the adult male nurses in that hospital. He said that the adult male nurse received £8 14s. a week. Does the right hon. Gentleman imagine that he is acting in the best interests of such a male nurse by refusing him an increase of more than 2½ per cent? Is this the weird type of argument that the Minister has sunk to in pursuing a policy that is now completely discredited?
If this House means anything at all, the Minister ought to accept defeat after this debate. Hon. Member after hon. Member from his side of the House has made a case against the Minister. I disagree with my hon. Friend the Member for Greenwich (Mr. Marsh). My view is that the hon. Member for Tynemouth (Dame Irene Ward), the hon. Member 1225 for Hertford (Lord Balniel), the hon. Member for Harborough, the hon. Member for Belfast, East (Mr. McMaster)—and I could go on—each made a sincere contribution to the debate. Each one argued that special consideration should be given to the people about whom we are talking tonight. I have been in the Chamber all the time.
If any power resides in the House, surely in a situation in which back-bench Members on both sides have established a case as it has been established today, it is incumbent upon the Minister to reconsider ibis decision and to do justice not merely to those in the Health Service but to the House. I expected that the first thing which the Minister would say was that, in view of the contributions to the debate from both sides of the House, the Government were prepared to reconsider the whole issue of wages increases for people employed in the National Health Service.
Everybody knows that we are in a difficulty and that throughout England, Wales and Scotland hospitals are short of nurses. Despite all his attempts to colour the picture, at one point even the Secretary of State admitted that there was a considerable shortage of nurses. Every hon. Member has received letters from people employed in the Health Service, and from responsible bodies organising them, urging us to assist them in their difficulties. I accept that it would not be possible to get people to do these jobs in hospitals if they thought solely in terms of wage packets. I cannot imagine a girl of eighteen or nineteen doing some of the jobs which nurses have to do if she thought only in terms of wages. I have visited hospitals in my constituency—I was in one on Sunday—in Which some hospitals have chronic sick and old people. May I pay tribute to those who man these hospitals? No one would undertake the duty involved in looking after the chronic sick and the old if she were doing it merely on the basis of the wage packet. They look on this work as a contribution which they are making to the happiness of people.
I address my remarks deliberately to the Minister: the fact that we know that these people have a vocation, and that they will not exploit their position, is no excuse for under-paying them. They could exploit their position. If the law 1226 of supply and demand were the criterion, I could tell hospital employees how to get a substantial pay increase. All they would have to do would be to leave the hospital service. In three weeks' time the Minister would be issuing the necessary advertisements to bring them back with substantially increased salaries. But we know that they will not do that or indulge in strike action. They will not walk out of the hospitals because they have been offered only a 2½ per cent. increase instead of a 5 per cent. I know it. It would be cowardly of the Minister and of Members of this House, knowing people in the health services will not indulge in industrial action, to see them underpaid in the way they are.
Is the Minister satisfied in his own mind that one of the reasons why he is not prepared to go further than he has announced is not because he knows these people will not indudge in any strike action? Can he honestly say the figure between £8 10s. and £10 a week is commensurate with the duties carried out by an adult male nurse, or sufficient to enable him to give the service he has to give to the patients and at the same time do his duty towards his family?
There is an argument about this treatment of people in the Health Service being part of a national plan. Are we, in a national plan, wholly concerned with salaries and incomes? What has the Minister done in his capacity as a member of the Cabinet to attempt to ensure that there is a standstill on the incomes of those people who are exploiting the land shortage? What has he done to ensure the Courtaulds shareholders would not get the enhanced values offered to them by Courtaulds to resist the I.C.I, take-over? He will not accept that tax comes into this. The Under-Secretary of State for Scotland said they had not got it yet. When it was first announced I said I did not know a Surtax payer who, if he wanted to take advantage of the projected reliefs, could not get all the overdrafts and other credits he wanted. Many of them may well have had them.
But even assuming that the policy of the Government in this matter is the correct one, even assuming it is perfectly correct to pursue a policy of wage restraint in the context of a national 1227 plan—I would not accept it, but let us assume it—is it fair, is it decent, is it honest to say to the people in the National Health Service that the miserable pittances which they are expected to live on can be increased by only 2½ per cent.? How much will the increase in wages be in terms of the net increase to a man now in receipt of £8 10s. a week? Relate that increase of 6d. in the pound to what it will buy in goods of one kind and another. It does not seem to me that the Minister shows any sense of reality. What will eight sixpences and the odd threepence buy a man with family responsibilities? Give him 4s. 3d. on a wage of £8 10s., and how can we possibly talk to him about inflation? How can a Minister or any Member of the House say that man's interests have been studied? We know that within the Service there is a vast shortage of nurses, auxiliaries, porters, grades supplementary to medicine, and that they are totally underpaid. The Minister knows that a case has been made out, not just by my hon. Friends but by hon. Members opposite, and he really should say that he will reconsider this decision, and agree that these people should have a far bigger increase than they have been offered.
§ 2.15 a.m.
§ Sir Douglas Glover (Ormskirk)
I had not intended to intervene until I heard the speech of the hon. Member for Gloucestershire, West (Mr. Loughlin). I do not suppose that there is any hon. Member who does not have a great deal of sympathy with and understanding of the problems of the nurses. To put it in a sentence, I believe that the result of the Orpington by-election stemmed from a revolt of the unorganised against the organised.
Hon. Members, and particularly those opposite, have to face up to the fact that in this modern age we live in a full-employment society, and I would fight to the death, politically, to ensure that we continued to live in such a society. Nevertheless, because we do live in that type of society, it means that our bargaining basis is wholly different from that which we had before the war. I am afraid that we are edging towards some form of agreement—I hope voluntarily—on a national income policy.
1228 In that picture, the nurses, the physiotherapists, and others who consider that they are under-paid today—
§ Mr. Hale
But that is not a hard case. It was an appointment made by the hon. Gentleman's own Government—in which he exercises power—to a nationalised industry at a wage 2½ times as much as has ever been paid before to anyone in a comparable situation, about three weeks before the hon. Gentleman's colleagues found that an economic disaster was approaching which necessitated that nurses and people like them could not have any salary increases. Will the hon. Gentleman develop that point? It is a fair one.
§ Sir D. Glover
Certainly. If the country is to overcome its difficulties, the ability existing in the country needs Dr. Beeching's rewards. It is not a very good moment to argue about Dr. Beeching's ability the day after there has been a claim for a fare increase, but Dr. Beeching has a very high reputation—
§ Sir D. Glover
—as a very good administrator and a first-class business man. Perhaps British Railways are very forunate to have a man of Dr. Beeching's ability in charge of their affairs. However, I do not want to chase a red herring. The hon. Member for Oldham, West, who is a very old friend of mine, knows perfectly well that he is trying to sidetrack me from my argument.
We can argue Dr. Beeching's salary this way and that, but we all know that the great oncost in every activity is the wages and salaries of those engaged in it. That applies to almost every single item that goes into the cost-of-living index. However hard we may try to overcome these problems, the fact remains that if, at this moment, there are some people who are getting more, it means that others will get less, and the fundamental issue is whether, by and large, that adjustment will take place in the salary and wage level of the nation as a whole. We can balk the issue as much as we like. But even with the pay pause over the last nine 1229 months people have observed that those who are more militant and better organised have been able to opt out of it to a greater extent than those who are responsible and less well organised. I have a great deal of sympathy with the nurses and those responsible elements of the community who will not go on strike because they realise their responsibilities. But I regret to say that in our present society they suffer because of that responsibility.
I believe that we must give a great deal more time and thought to how in a full employment society we can evolve a system by which the national cake is divided on a more equitable basis. I notice that the right hon. Member for Belper (Mr. G. Brown) is looking at me in an old-fashioned way. He has a great reputation in the trade union movement—
§ Sir D. Glover
It is not. The only way to achieve this is with the cooperation of the trade union movement. I do not blame the trade unions. Their officers have been elected to do the job of protecting the interests of the workers. But the fact remains the more strongly organised and militant people are, the more likely they are to come out of the incubator with a better result than the more responsible people.
§ Mr. Brown
Will the hon. Gentleman answer this point, which is germane to the whole debate? While the Government are interfering with negotiating machinery and preventing it from operating, and disallowing arbitration awards and holding down the lower-paid workers While the more well-to-do are able to increase their incomes, how is co-operation possible?
§ Sir D. Glover
Certainly I will answer. Because it is those to whom the night hon. Gentleman has referred who, under the circumstances, should have been more co-operative.
§ Sir D. Glover
One has only to note the awards to the coal miners and the railway workers—if the right hon. Member for Belper wishes to make a speech he may be able to do so later. At the moment I am making my speech.
We know that awards have been made to the better organised members of the community. In a free society it is only those over whom the Government have direct control who observe what is definitely in the national interest, that is, to try to keep stability. The arguments which have been voiced are borderline. They wring the hearts of everyone. I should like to make a powerful speech on behalf of the nurses. But I know that by so doing I should be helping to open the door to further demands for wage increases all over the country and we should not be able to preserve stability.
§ Mr. Brown indicated dissent.
§ Sir D. Glover
The right hon. Member for Belper shakes his head, but only because it is politically expedient to do so. Until we get more co-operation from the better organised and more powerful unions, we shall go on having powerful speeches from hon. Members who wish to make a case for the less well organised elements in the community. I believe that the Government have a great task to perform and they need the cooperation of hon. Members on both sides of the House. The issue before us could exist only in a full employment society. No one would suggest that unemployment should be used as a weapon with which to deal with it. This is a new problem which the nation has to overcome in a full employment society. In a society of full employment it is inevitable that a person can automatically sell his labour at a higher price than the productivity of his endeavours will afford. This is something which as a nation we must overcome. The right hon. Gentleman goes on shaking his head, but if he had the responsibility for doing it he would be making very similar speeches to the one I am making now.
One of the reasons why the House of Commons is losing a good deal of its influence in the nation is because we spend so much time shadow boxing when we know perfectly well that there 1231 are fundamental issues which we have to overcome. Therefore, the public do not take nearly enough notice as they should of our debates.
Here is an issue which the best brains of the nation, with co-operation and not with antagonism, should be trying to solve. My right hon. and learned Friend the Chancellor of the Exchequer with his new planning organisation, which, I am glad to say, has the support of the trade union movement, has, I believe, made one of the most constructive moves towards solving the problem by discussion round the table. If the problem is solved then the sort of debate which we are having tonight will cease to be valid in the picture of the national economy.
§ 2.27 a.m.
§ Mr. Leslie Hale (Oldham, West)
Some years ago I found myself on a wet Sunday afternoon at Crewe railway station. I hope that in the absence of the horn, and learned Member for Crewe (Mr. Scholefield Allen) I can carry the whole House with me when I say that this is not perhaps the most appropriate locus for surveying the undoubted beauties of our lovely land. I wandered up and down the platform, taking a glimpse of a little gleam of light between the fourth and fifth signal boxes on the starboard side, walking up and down like Napoleon on the "Bellero-phon." Of course, we all know that Napoleon's troubles came from Waterloo, but mine were still overdue from Euston.
While walking up and down I had the good fortune to pick up a memorable document, one of those illustrious organs of Sabbath information dissemination, which rejoiced in those days in the name of the Sunday Graphic. In it I came across an article written by that paper's foreign correspondent, a lady of distinction who was known as an expert in Mediterranean affairs and particularly those of the Principality of Monaco. The name was that of Lady Docker.
The article contained a sentence which I have never forgotten. The correspondent said, "I long for a gin to relieve the monotony of champagne." We have had so much rhetorical effervescence in the course of the afternoon that I feel I must welcome the gin of the hon. 1232 Member for Ormskirk (Sir D. Glover) even if I disagree with all that he said. He left me in the same state of mind as the heathen Chinese who said,Do I sleep, do I dreamOr are visions about?Is civilisation a failureOr is the Caucasion played out?What the hon. Gentleman said I will try to deal with first, because it is a matter of courtesy that I should endeavour to follow him. He said that we had a new phenomenon, full employment. It is a rare suggestion that this state of affairs has occurred by chance in the course of a Tory Government's economic operations which had presented that Government with something that now required special consideration. But full employment occurred a little before the Tories came to office and about which Tories complained to the extent of the very famous speech in which it was said that it was no use having a carrot for the donkey unless there was a donkey for the carrot and that full employment had really deprived the nation of a corrective and that we cannot really get people to work unless they are driven by some remote fear of starvation. Indeed the right hon. Gentleman the present Minister of Housing has, I think, left his dukedom in my county to take over the housing of the nation. That right hon. Gentleman in an election speech which won him some notoriety in the Tory Party claimed quite fairly that the Socialists had not invented refrigerators, washing machines and even antibiotics, that some notice should now be taken by the Tory Government about the march of science, which, apparently, is now regarded as principally due to C. P. Snow.
The hon. Member for Lancaster—
§ Mr. Hale
—or thereabouts—I hope to be there on Saturday—says "Let us forget all this. What we want is a wages system. We want something organised." I dislike introducing an individual name, but Dr. Beeching was mentioned by the very forceful hon. Lady the Member for Tynemouth (Dame Irene Ward), and it is a point as to where one might put Dr. Beeching in a wages policy, because if one has a wages policy in which people at £8 a week have to be allocated with people at £500 a week there 1233 is a sort of variety of interest, of approach, of remuneration and of status which it might be thought by some people would make a wage policy virtually impossible.
In the meantime, the hon. Member did not deal with the remarkable speech by the Home Secretary some years ago when he talked about doubling the standard of living in 25 years. As I understand Tory Party policy now, one has to halve it first or it does not work. There have been some very appropriate quotations recently. One cannot have it both ways. Apparently, one gets an increase only if one increases production, and one gets that increase only out of an increased production which has been redistributed over the Dr. Beechings, the Charles Clores and the rest of them and on all the main heads of Toryism from the Bahamas to Jersey.
I merely wanted courteously to reply to the hon. Member because he preceded me. I intimated to the right hon. Gentleman—very late, I agree; not more than about 10 hours ago, to be mathematically accurate—that as my right hon. Friends contemplated a further discussion on university grants and gas workers' wages, I thought it would be proper, decent and appropriate, as I wanted to raise other matters with the Minister of Health, that I should postpone my speech until after university grants and gas. But I gather that university grants and gas are not to be the subject of any formal discussion or opening, and, therefore, I do not think I shall inconvenience anyone if I say the few words that I had intended to say about nurses' pay, which I think is important, and then take the opportunity, if my hon. Friends will forgive me, of raising one or two other points with the Minister of Health which I had wished to raise, in particular the action of the Manchester Regional Hospital Board and its attitude to democracy and appointments and its political predisposition to aberrations.
I came into the nurses' question in March last year. Some speakers have said that this just popped up round the corner when we were not looking and that it was terribly unfortunate that it should do so at the moment when the Chancellor was steering the economic ship through stormy seas and about to 1234 reach some port, although no one knew which one. Surely there is a Roman quotation to the effect that if one does not know to what port one is going, all winds are unfavourable. That seems to me to be a relevant point.
I came in with a simple and humble Question on this matter on 20th March. 1961, and the reason was that I had just come out of hospital. I agree with all that my hon. Friend the Member for Greenwich (Mr. Marsh) said, but I particularly want to emphasise my agreement with his statement that nurses are not terribly fond of being told that they are Florence Nightingales. This is a job of blood and tears and sweat and urine. The day may come when the various procedural cases determined recently will enable me to express it even more forcefully than that.
I was tremendously moved by my own experience in two hospitals, one in the north of England and one in London, by the devotion. It is no use talking about ministering angels. We all feel that as patients, but it is a tough, devoted, exacting job which requires immense gifts of patience, immense gifts of tact, immense gifts of generosity and, apart from that, a very large gift indeed for jolly hard work. It is a matter of blood and tears and sweat and urine. One hon. Member who popped in for two minutes and made an observation said that, after all, there may be people who prefer nursing to being a girl employed in a bank. One of my hon. Friends gave figures showing what happened to girls employed in banks nowadays. It seems that they do rather well, have somewhat limited hours and have good holidays. I became a solicitor because I wanted to be a solicitor. I have not found out why. But I was the youngest son and my father was good enough to allow me to follow my bent.
Nurses do not want to be described in terms of beautiful Florence Nightingales. They are hard-working women showing great devotion, and there is not a man here who has dared to say that they are not terribly under-paid. No one has said so today. Many courageous and forthright speeches have been made. The result of not having Standing Orders is to enable there to be a great deal more forceful discussion. I personally 1235 am rather averse to compulsory ésprit de corps. Forceful, courageous speeches have been made, but what happened when I popped the question? And when I say "popped the question" I hope that I shall not be misunderstood in relation to the Parliamentary Secretary to the Ministry of Health.
§ Mr. Hale
I was about to tell the House precisely what happened. It is a remarkably story. Many hon. Members will recall it. It is often said that people who saw the divine Sarah once never forgot the experience, and Rachel in Paris created an impression by her histrionic art which was never erased from the memory of those who saw her.
And so we come to the OFFICIAL REPORT on 20th March, 1961, that:MR. HALE asked the Minister of Health what is the present minimum salary of a fully qualified nurse in hospital service after five, 15, and 25 years' service respectively; and what is the estimated value of her additional emoluments.The hon. Lady the Parliamentary Secretary, said:£630, £656 and £656 in a general hospital…and she gave the figures for a psychiatric hospital as well. I then asked:Does not this mean that members of the nursing profession are the worst paid of Her Majesty's subjects… ".It was at this moment that all these talents came into play. I remember the scene. I do not think that anyone has forgotten it. The hon. Lady said:Did I hear the hon. Member aright? Did he say the 'worst paid'?"—[OFFICIAL REPORT, 20th March, 1961; Vol. 637, c. 18–19.]This was the Government's attitude in March of last year. It was monstrous. These people were astonishingly well paid. I remember it. I can hear it now—the voice of a coloratura soprano in a pizzicato passage, a Galli-Curci with the histrionic talents of Anita Ekberg before she was allowed to speak on the films, but not the vital statistics, and with something of the emotion of the Arab saying farewell to his steed. Other hon. Members shared my view that nurses were not the best-paid section of the community. It is difficult for the 1236 hon. Lady to repeat with the same verve, brio, passion and impasto the observations which took me so much by surprise and temporarily silenced me in March last year.
My hon. Friend the Member for Blackburn (Mrs. Castle) said she had received 44 letters. She beats me by four. I have had 40, all very nice letters. I doubt whether I expressed myself with passionate appreciation of all the communications, but I rather suggested that they were my views too. The extra correspondence was a minor burden, but they were moving and nice letters, because they were from nice people. It was rather surprising that one should have a demonstration like that. I was surprised at the care, thought and trouble to which those people had gone to write to me. They were people who normally—I do not say that this is a virtue—keep out of political matters and rarely take any active part. There is no doubt about the depth of feeling in this matter.
My hon. Friend the Member for Greenwich made so able and comprehensive a speech that on the question of figures there is not much left to say. I have had letters from nutricians and from radiotherapists. I have had deputations from the radiographical assistants, and so on, in the Health Service, from a whole variety of them. The real fact is that they are all underpaid. Anything less than consultants and the like are all underpaid.
I am sorry to turn to a point which I put with reluctance. I was one who had a considerable admiration for the talents, courage and ability of the Minister of Health. Indeed, I went about saying so. I still have. I wonder, however, whether he is essentially a democrat. The answers which I have had both to correspondence and to Questions put to the Minister of Health over some months have given me grave personal disquiet. The only justification for most of them is that the Minister really wanted to be rude. If he wants to be rude, he has a perfect right to be rude, and I would defend every hon. Member's right to be rude. If, however, the right hon. Gentleman felt that he was discharging his Ministerial duty to a Member of Parliament who always treated him with courtesy by giving me some of the answers which he has given, I regret it.
1237 I have had to raise one or two matters both in Question and in correspondence. As it hapens, I became involved in inquiries about one or two diseases. One was onchocerciasis, which I had met in West Africa and on which I later took an Adjournment debate. In that case, the right hon. Gentleman transferred the Questions to the Minister for Science, whose Department said "No" at rather greater lengths and with rather more politeness than the Ministry of Health normally says "No" to me. It was made perfectly clear that so far as onchocersiasis was concerned, nothing was to be done, either in nature research or otherwise.
I had a constituency inquiry about muscular dystrophy. In mentioning this terrible complaint, I hope that I may make it clear that nothing I am saying should give to anyone any hope of some new or improved remedial treatment in this dreadful disease. I should not like any words of mine to contradict the impression that people have been given by their doctors about the gravity of the disease and about what may be the ultimate and inevitable course that it takes, although sometimes it may take its course slowly, thank God, and there may be spontaneous remissions. But I am not suggesting that.
I commenced some inquiries on behalf of a constituent of mine who was suffering from this disease. Because my constituent had been told, perhaps completely inaccurately, that some progress had been made in the U.S.S.R. which had not been made in this country, I wrote to the Ministry of Health to ask about it. There is no question but that the pooling of medical information which takes place certainly in the Western Hemisphere is extremely important. When my wife was gravely ill from blood pressure, I was told by someone whose medical opinion was very distinguished that Czechoslovakia had made more progress in the treatment of high blood pressure than any other country. That may be true. I do not know. I did not have occasion to try it because my wife's condition yielded to the normal and ordinary treatment which was available in London, and I am glad that that was so.
My constituent was a man who had been frankly told that he was living 1238 under a suspended death sentence from the trouble of muscular dystrophy. I asked the research department of the House of Commons Library, who gave me the great help which it always gives, to get the medical records of the various conferences and so on on this subject. I wrote to my hon. Friend the Member for Stoke-on-Trent, Central (Dr. Stross), who is always generous with his very great knowledge and experience, and I wrote to the Russian Ambassador and asked if he would do something, and I wrote to a consultant physician who is my own personal friend and I wrote to the medical officer of health for Oldham and to the Minister of Health.
I had some very helpful replies, but not from the Minister of Health. I wrote to ask him to let me know the areas of international consultation and what was the pooling of medical information. The reply I got said:Dear Mr. Hale,Enoch Powell has asked me to reply to your letter of 11th January asking for information about the Russian system for the treatment of muscular dystrophy. Neither the Department nor the Medical Research Council have any knowledge of such a system or can trace any reference to it in medical literature. Perhaps your constituent's doctors can provide more information including the sources of information.If I had had those details, I would not have asked for them.
However, my constituent succeeded in contacting the Russian medical people. Instead of getting a brief letter such as I got from the Minister of Health, we got a long letter giving details of the Russian treatment. It is one of the habits of foreigners, to which all English people legitimately object, that they will speak their own language, and we had some difficulty in getting a reliable and accurate translation. The letter was signed by Mr. Maksudov of the Organisational Teaching Section of the Institute of Neurology of the Medical Academy of the U.S.S.R. Full details of the treatment were sent to a humble man in Oldham. The treatment was examined by experts, but it was found not to add anything of great value to our own existing information, but there was an immense amount of detail of the various drugs which the Russians were using and the application of röntgen rays and so on. However, my own expert advisers told me that this 1239 was known in this country. But this episode is an example of the absence of democratic relations in this country and of something rather surprisingly democratic in a country which we are sometimes apt to dismiss rather lightly as wholly a dictatorship.
Having said that, I want to come to a question which is important and which involves considerations of Parliamentary importance. The Manchester Regional Hospital Board is responsible for the hospitals in Oldham and other areas. The Oldham Hospital Management Committee is responsible for half-a-dozen hospitals, mostly in Oldham—the Strinesdale Sanatorium, Oldham Infirmary, Boundary Park Hospital at Oldham, a small and rather unusual old foundation hospital in Royton and a hospital at Chadderton. Quite suddenly, a week or two ago, the news came through of the appointment of the hospital management committee which appeared to show a political discrimination of the gravest possible kind, a really deliberately provocative political discrimination. I shall come to the details in a moment. I was asked, not by a Labour organisation only, or anything like it, to raise this question in the House and to take it up with the Minister.
I went to the Table Office and was received with the courtesy that I always find there. They said at once, and confirmed it on inquiry, that the Minister said that he had no responsibility for the appointment of the hospital management committee, that he could answer no questions about it and it would be out of order to table Questions to him related to the hospital management committee. To get it in order, I could table Questions about the Manchester Hospital Board which appoints the committee, but I could not raise the question of the hospital management committee because there was no Ministerial responsibility.
This raises very much the question of the privileges of this House. I hope, therefore, that the House will forgive me if I take this opportunity, the only one ever likely to be available to me, to examine the question of whether the Minister was right in that statement. I want to use quite considered words in this. I never desire to overstate a case.
1240 I wanted to find if it was a view that the Minister after carefully examining the facts and the law could honestly have put forward, or whether perhaps it was something said casually over the 'phone because previous Ministers had said it, or perhaps an ill-considered attempt to divert some debate or criticism. I do not know, but I ask the House to consider this because I think it important that it should.
The National Health Act was passed, as many hon. Members will remember, in 1946. Section 1 of the Act provides that:it shall be the duty of the Minister … to promote the establishment in England and Wales of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness, and for that purpose to provide or secure the effective provision of services in accordance with the following provisions of this Act.'The whole responsibility is upon him. In Section 1 he is the person responsible. He is the person who can intervene, as we may find at a later stage, in almost every action, but it is his responsibility. Indeed, his hon. Friends have been assuring us—it may be true—that his new scheme for hospitals is a very substantial development of the Health Service. If he can build hospitals in Oldham on his own decision, it would be a little remarkable, if it were true, that he could not be responsible for the Oldham Hospital Management Committee.
Section 3 of the Act provides that:As from the appointed day,of the coming into force of the Act,it shall be the duty of the Minister to provide in England and Wales to such extent as he considers necessary to meet all reasonable requirements, accommodation and services of the following descriptions…and then we find
Has the Minister delegated these powers to the management committee to the extent that he cannot interfere, or has he the Parliamentary responsibility which he has been trying to evade? This is important. I have watched the rights of individual Members of the House whittled away in a great many ways. The time has come when we might consider the matter.
- "(a) hospital accommodation;
- (b) medical, nursing and other services required at or for the purposes of hospitals".
1241 The Minister has other powers. Under Sections 4 and 5 he has power, on certain conditions, to make accommodation available for payment, whether the hospital committee likes it or not. His is the power under Section 4. Under Section 5, accommodation can be made available for private patients:If the Minister, having regard to his duty to provide hospital and specialist services, is satisfied that it is reasonable so to do, he may set aside in any hospital providing such services special accommodation for patients who undertake, or in respect of whom an undertaking is given, to pay…".If he can do that, where does the hospital management committee come in as a delegated body with full and unlimited powers? But this is not all. By Section 11, the Minister can constitute and reconstitute the areas for which the committee is responsible. Surely that makes him responsible to the House. Section 11 (3) provides:Every Regional Hospital Board shall, within such period as the Minister may by direction specify, submit to the Minister a scheme for the appointment by them of committees, to be called Hospital Management Committees, for the purpose of exercising functions with respect to the management and control of individual hospitals or groups of hospitals, other than teaching hospitals…Subsection (4) provides thatThe Minister may approve, with or without modifications, which may include additions or exceptions, any scheme submitted to him by a Regional Hospital Board "—and so on. It is true that that is the original appointment when the Act was passed, and different conditions apply when vacancies are being filled. I shall return to that later; it is a separate point.
I come now to the Statutory Instrument made in fulfilment of the Act, which is a little more explicit. It is the National Service Statutory Instrument No. 60 of 1948.
Part III, Regulation 5, reads:The hospital management committee of any hospital or group of hospitals shall, subject to and in accordance with any directions which may be given by the regional hospital board concerned or by the Minister, control and manage the same and the services provided in connection therewith on behalf of the board, and for that purpose the committee shall, subject to and in accordance with any directions as aforesaid, exercise on behalf of the Board the following functions of the Board relating to the hospital or group of hospitals:—and so on, with several other provisions. I need not weary the House with it all. Paragraph (5) reads:
- (1) The functions of the board under regulations made under section 3 (2) of the Act and under these regulations with respect to the
1242 making and recovery of charges for the supply, replacement or repair of appliances "—The functions of the Board under Section 12 (1) of the Act with respect to the appointment and dismissal of officers employed for the purposes only of the hospital or group of hospitals other thanconsultants, senior registrars, and so on. Here again, that relates back to section 12 (1) under which the Minister has power to give directions. It is clear that the Minister can do what he likes with the hospital management committee.
I put down such Questions as I was permitted to table on the point. This is what happened. I put down a Question, asking the Minister of Health:whether, in view of the grave dissatisfaction in the County Borough of Oldham at the recent nominations to the hospital management committee made by the Manchester Regional Hospitals Board, he will receive a deputation representative of the county borough before making his current appointments to the regional board".The Minister replied:No; appointments to hospital management committees are the responsibility of regional hospital boards and I cannot intervene."—[OFFICIAL REPORT, 5th March, 1962; Vol. 655, c. 4.]The following week I put down further Questions. I asked the Minister of Health:what steps he takes before making appointments of members of regional hospital boards to ensure that the appointments made by them to hospital management committees are free from political discrimination".The Minister replied:None, other than to appoint fit persons."—[OFFICIAL REPORT, 12th March, 1962; Vol. 665, c. 108.]He does not care. He is not interested. He does not mind that the whole of our local health service is being undermined by the bitterness of this discrimination.
The Manchester Regional Hospital Board has a pretty evil reputation. I do not doubt that it is full of distinguished and able men, including some brilliant scientists and doctors. I came into contact with the board in the case of the Oldham gynaecologist, which lasted seven years. The Minister said that these people were acting entirely beyond his authority, and he refused to intervene. We had to defer action while the gynaecologist went to the courts, obtaining several thousand pounds in 1243 damages and judicial condemnation of the actions of the Board and of the Minister. An immense sum was wasted in the way of costs. That was seven years of a man's life. I want to pay tribute to the right hon. and learned Member for Hertfordshire, East (Sir D. Walker-Smith). When he was Minister of Health, I had a talk with him and he did take some action which produced a measure of reconciliation which secured the re-employment of this distinguished gynaecologist. It did credit to both sides. The Manchester Regional Hospital Board took a decision which was difficult for it and on which, in the circumstances, it is entitled to be congratulated upon taking.
But this was not the first time. I was asked to raise this matter some years ago. First, I must say a few words about Oldham. It has a reputation for political tolerance and political understanding. We do not fight our elections with any bitterness, as is the case in many other towns, and although we have had a Labour-controlled council for twenty years we have never tried to victimise the Tory minority; Tory members still sit as chairmen of committees of the corporation. There is genuine tolerance and understanding.
I am authorised to say that this is a piece of blatant discrimination in which not only Labour or Socialist feelings are involved. The Oldham Chronicle is a very respected Liberal journal—one of the best examples of a local newspaper. It has been Liberal for many years. It tries to give a fair representation for all parties, and I submit that it always has done. But that newspaper is concerned to know what is the explanation, and no one gives any explanation. No one replies to letters. I am not one who is given to extravagant descriptions, but in this matter of appointments the Boards acts like troglodytic politicians with the irresponsibility of bashibazouks.
There is another part of my division besides Oldham. There is the Chadderton Urban District Council, and it is provided in the schedules that urban district councils shall be consulted. It is provided that the Oldham Hospital Management Committee shall itself be consulted before any vacancies are filled.
1244 I am assured that no such consultation took place. I put down a Question to the Minister about that, but he does not care. He is not going to take the trouble to ask about it. I warn him: he went to the courts before and it cost the Ministry of Health and the community a lot of money. If the Minister maintains this attitude I shall go to the courts again and say that every act of this hospital management committee is ultra vires until the provisions of the Act are complied with; that the present appointments are void, and that this Board so constituted cannot sign contracts and cannot exercise its duties because it has not complied with the provisions of the Act.
I made some inquiries about what happened to Chadderton. At the moment that urban district council has a Conservative majority, although we confidently expect to knock it off in four or five weeks' time. There is always a kind of love-hate relationship between Chadderton and Oldham, which arises from a fear that the larger town is likely to take in the smaller. There is no question of collaboration here. Chadderton has been taking up the question of its representatives on the hospital management committee for about eight years. Generally the council gets no reply at all.
I do not want to delay the House in this matter, I want only to make my case fully, but the position at the moment is that there is a member of the Chadderton U.D.C. on the Oldham Hospital Management Committee. He is a Tory member of the council. But I am assured that nobody knows who appointed him. This is no criticism of him. But the Chadderton Council says that it did not appoint him and did not recommend him but in fact recommended someone else—generously, a Labour member of the council. Chadderton starting writing in January, 1953. On 17th April, 1953, the Manchester Regional Hospital Board was informed that the council had not been given an opportunity to submit a nomination for a vacancy. I do not think that the Minister cares, but I care, and it is right and just that I should bring these matters to the attention of the House.
The Manchester Regional Hospital Board replied that the council should 1245 supply the county council and the Oldham and District Management Committee with nominations of suitable persons. The council has been doing it for years. The last time a definite nomination was made arose when the Manchester Regional Board was informed of the death of Councillor Turner and when the council asked for a representative from Chadderton to be appointed to fill the vacancy. After six years, they have the usual answer that councils have no power to delegate. But they should be consulted, and consultation normally means the submission of the appropriate names.
On 7th December, 1960, the Urban District Councils Association took up the matter of Chadderton with the Manchester Regional Board and advised the Chadderton U.D.C. that the hospital board would consider nominations for 1961–62. Councillor Ogden was nominated for appointment. No reply has ever been received to this letter. We have a long history of nominations being put forward and most of them never being considered, with the various formal explanations, "This is out of time", or "You cannot delegate", and so on. There is an obtuse and pigheaded refusal to recognise that urban district councils and other local authorities have a representative function to perform and that they are concerned with the welfare of the community in the area.
On the Manchester Regional Hospital Board we had a member who is known to many Lancashire Members, Alderman Marron, who has had a lifetime of service in the health movement and has been Chairman of the Oldham Health Committee. Oldham has a very special reputation in health matters. It has a brilliant medical officer of health who is known throughout the country. My hon. Friend the Member, for St. Pancras, North (Mr. K. Robinson) knows intimately the work which he has done. Oldham initiated experiments in mental health, with no budget at all, simply by the initiative and courage of a distinguished medical officer of health, and it has made a distinct contribution to the whole question of the treatment of mental illness.
We started off. I say "we." I had nothing to do with it. I get blamed for most of the things that go wrong, and 1246 sometimes, unhappily, claim credit for something which is right. But we had a mental hospital in Oldham in an old Dickensian building. When I first saw it there was no knife or fork in the place. There were locked up rooms, and there was the old, unexhibited notice over the door, "Abandon hope all ye who enter here": there was no one who came out of it. When the National Health Service came along we reformed it. There were people there who had spent over half their lives there and no one knew what they were there for. In some cases it was, perhaps, because someone did not like them; in some cases, perhaps, because they were illegitimate children. We said, "We are going to do something about this place." So in Oldham we started, and we started with nothing, and we had mentally sick people working with circular saws, so that it was almost with a sense of relief that there was the first accident because it happened to an instructor. Then we had a residential hostel for mental people, and we had chaps in Oldham who had been locked up for twenty-five years now having £1,000 of savings in the bank because they were rehabilitated there.
But Oldham Corporation does not like this present attitude of the board, and the corporation has sent me a resolution of protest and has sent a resolution of protest to the Minister of Health. In Crompton Urban District Council considerable disquiet was expressed and I have had sent to me a copy of a resolution by Crompton Urban District Council, for which I have no responsibility, for it is miles outside my area, saying it has been treated like this, too. Alderman Marron, the Chairman of the Oldham Borough Health Committee, whose only fault was that he was a Labour member, was sacked. There were protests and I was asked about it. I said, "Well, I cannot prove there was political discrimination and if I raised it there will just be the reply that there was not." The chairman of the management committee was a very great Oldham man, Archibald Campbell-Robertson, whom I and many others loved and admired, who died in January. So there was another Labour vacancy, and after that they sacked the best known Labour personality.
1247 There are two active politicians in Oldham, Sir Frank Lord, the leader of the Conservative Party, and Alderman Tweedale, the working leader of the Labour Party. Good relations have always been preserved. I know Sir Frank Lord and I like him and respect him, and I have no criticism of him at all. Very likely, if he tried to sell me a horse tomorrow I would buy it on his guarantee, but if he tried to sell me a political horse I would call in a political vet., for I think that would be important.
Sometimes I have had to complain in the last few months about discrimination in appointments of magistrates. I think there I was kindly and generously answered. I have complained about appointments of Commissioners of Income Tax.
There has been a Labour majority since 1946, and there could be a temptation to reprisals and if we took reprisals the Tories would soon have left not a single chairmanship on Oldham Council and the Tories would not be left with many seats. I say frankly I would regret it.
§ Mr. Denis Howell
I had no knowledge my hon. Friend was going to raise this point but it so happens that it is a point which concerns many of us in different parts of the country, and we are indeed indebted to my hon. Friend for raising it. It was quite recently that I wrote to the Minister of Health and drew his attention to the fact that in appointments on Birmingham Regional Hospital Board and other boards throughout the country the boards were become politically lopsided. That was the expression which, calling on my memory, I used in my letter. The Minister replied that he found no general impression anywhere in the country that this was the case. We are, therefore, all grateful to my hon. Friend for making clear that what we thought might be the exceptional case of Birmingham is not an exception.
Further, since my hon. Friend is on this point, I should like to mention that in a consequent conversation over dinner one evening with the president of the Trades Union Congress, Miss Godwin, I happened to mention the Minister's reply because, in part, it concerns some 1248 members of my union, of which she is the general secretary. She gave vent to some almost unladylike expressions, offered me information, and said that I could quote her. She said that the Trade Union Congress had itself been extremely concerned about this trend throughout the country and had, in fact, been asking repeatedly to see the Minister of Health on that very question. Without blaming the Minister, I must say that the T.U.C. had recently been put off from seeing the Minister on one or two occasions by pressure of events.
As I say, I am grateful to the hon. Member for saying that, quite apart from Birmingham, there is this feeling of complete lopsidedness, with Labour men retiring from the committees, or leaving them for other reasons, and being replaced by other people of an entirely different political persuasion. That view has the support of no less an authority than the president of the Trades Union Congress.
§ Mr. Hale
I am much obliged to my hon. Friend, because when I asked the Minister whom he ever did consult on this matter he said that he wrote to the T.U.C. With very great respect, that places a very great burden on the T.U.C, but I am grateful for my hon. Friend's support.
The Oldham Operative Cotton Spinners Provincial Association, which has a great deal of importance in the town, says:The dismissal of Councillor Arnold Tweedale from the Hospital Management Committee is causing great concern, not only to the trade union movement in the town, but to the general public as a whole.That body speaks with very great knowledge of conditions in Oldham.
The Journeymen Butchers' Association, which is associated with U.S.D.A.W.… strongly deprecates the decision of the Manchester Regional Hospital Board not to re-appoint Councillor A. Tweedale to the Local Hospital Management Committee, and requests the Board to reinstate him.The Oldham Provincial Card and Blowing Room and Ring Frame Operatives' Association writes:At a meeting of our Executive Council held on Wednesday, 28th February, 1962, it was noted with very grave concern that the trade union nominee, Councillor Arnold Tweedale, had been deposed by the Committee of the Manchester Regional Hospital Board. This now 1249 leaves the local Hospital Management Committee completely without a trade union representative.'It is rather hard to know, but I think that I am right in saying that on the Oldham Hospital Management Committee, out of about twenty members there remain only three who support the Labour Parity in one form or another. That is my information—in a town with an overwhelming Labour majority.
The Oldham Association of Loom Overlookers makes a… strong protest at the complete failure of the Regional Hospital Board at Manchester to re-elect Arnold Tweedale as a member of its Committee.Believe me, that is a very remarkable demonstration of interest.
The Transport and General Workers' Union writes from Salford:I am writing on behalf of the whole of the trade unionists in Oldham to protest at the system of appointment to the local Hospital Management Committee. We find ourselves in Oldham without one representative from the whole of the trade unions …There was a time when, over cotton, an unhappy Minister said that he had discussed matters with the cotton employers but that it had never occurred to him to consult the trade unions—but he did so, under pressure. It is surprising that these lessons are not learned. Is it of no concern to the Minister that the representatives of organised labour should be completely ignored over the hospitals, some of which they have supported with their pennies, and whose constant manifestation of work and interest justifies their representation? Is it of no concern? Does not the Minister care? He says that he does not care in the words he used in answer to a Question from me. The Electrical Trades Union writes to me—this is the Oldham No. 1 branch—to say that the branch is concerned about the removal from the committee of Alderman Tweedale who has had considerable experience and they are concerned that political pressure has been brought to bear for his removal. So far as we know no one has denied that. And this, despite protests from the Oldham Borough Corporation and the Crompton Council and the Chadderton Council. They have raised the matter, not in the same form, but in the form of a question about their own representation.
1250 What has happened to the public relations department of the regional hospital board? Why has not it written to say that there is a misunderstanding, and that this was not political discrimination at all and was never meant that way? I do not think that the department would do that. The members of the department are too honourable to say that. They know that it would be false. Alderman Tweedale got the sack because he criticised the board from time to time, and he was suspected of giving me information which enabled me to voice some criticisms in this House. If I could prove that, it would be a breach of privilege.
§ Mr. Hale
I made clear that this is an hypothesis. All I say is that every possible hypothesis is equally discreditable and equally irresponsible and lacking in respect for any of our democratic institutions.
The Union of Shop, Distributive and Allied Workers wrote to protest against the non-selection of Alderman Tweedale to the Manchester Regional Hospital Management Committee and stated:From all accounts Mr. Tweedale has served the committee as well as anyone could ever expect and having known him since his early days as a clerk at the Oldham Trades and Labour Council, I know that he will have worked very hard…And so he has. Everybody who knows him says that—Tory, Liberal, Labour, Independent, and particularly the nurses.
I have here a wholly unsolicited letter from Cowes and District Trades Council—I am not dealing with the drink-a-pinta-milk programme, but referring to a place. The Council says,We hope that you can enlarge on thisand states that there is exactly the same trouble round there.
If the Minister does not do anything. If the Minister says, "I don't care; I have no power so I cannot give directions to a hospital board." If he says "I have not the right and if I had, I have not the desire, I don't care and I do not wish to trouble my mind about whether the organised workers of Oldham are represented"—once the Minister says that sort of thing, this will spread insidiously, like a disease.
1251 The Amalgamated Engineering Union from Oldham, the ninth branch, have written to me and also, I understand, to the Minister. The right hon. Gentleman said to the branch that he does not care to say that he will do something about it. I have another letter here from the head office of the union in Peter Street, Oldham,The District Committee notes with great pleasure that you are taking this matter up through the appropriate channels. For your information we are forwarding you a copy of a letter that we have sent to the Regional Hospital Board and also to the Minister of Health.What did the board reply to that? I do not know. No one has informed me. None of the correspondents to whom I have written has any sort of explanation which has been vouchsafed by the board. The Union wrote:You will be aware that Councillor A. Tweedale was not re-elected to the local Hospital Management Committee at the recent elections. His services to the town are well known and indeed to the whole North West area. It cannot be said that he has not been re-elected because of age as he is still a comparatively young man. Councillor Tweedale has served on the Committee since its formation and prior to that was a member of the Council Committees governing the hospitals in Oldham. The failure to re-elect him has shown without question intrigue and chicanery to remove a workers' representative who has fought considerably for the just rights of the ordinary man, woman and child never once questioning their beliefs, and the District Committee of the Amalgamated Engineering Union, representing 8,000 in the Oldham area, strongly protest at the complete failure of the regional board to re-elect a sincere representative of the people and the trade union movement as a whole in Oldham.I have a letter from the Oldham Labour Women's Central Committee which makes a similar protest. I do not want to weary the House by repeating the whole of this. Indeed, I do not want to spend too much time on the matter, but I have known Arnold Tweedale from the first day that I went to Oldham twenty-five years ago this year. It has been a very close and very intimate association. He is one of the best men I know. He is one of the finest Labour agents I know. I think it would be better if he were used in by-elections. He was responsible for the one election victory which they secured in England at the last election. I am happy to say that the last time I spoke in a by-election, in 1958, we had 1252 a very remarkable victory in Rochdale. There it is. Arnold Tweedale is not a political animal. He is a social animal. He is a man motivated by kindness and generosity. He is stirred by suffering. He is liked and respected by all parties in Oldham.
I do not recall in all the years of losing and winning seats a personal controversy in which he was involved. He has an admirable record of attendance. I do not want to introduce any questions about the other people appointed except to say that I am told that people who have attended about three meetings out of twenty-five have been reappointed and that Arnold Tweedale, who has an excellent record of attendance and work, has been sacked.
There was no letter of explanation, and these are the facts. The Minister must be concerned about this. This is one of the great men of Oldham and a man who is too big to bear much resentment. But he feels that he is making an appropriate democratic protest and asserting a democratic right in trying to protect the funds of Oldham, the taxation inquiry of Oldham and the Health Service and hospital management of Oldham from political discrimination which would do infinite harm to the town and would raise old controversies and enmities which I would deplore.
Having spoken of this matter, perhaps I could now turn with even more brevity to one or two questions of general health. I did not hear the right hon. Gentleman's speech. That is a discourtesy, and I apologise to him for it. The reason why I did not hear it was because I was pledged to go to a West London Hospital to see an Oldham man who is there because I sent him there. I yield to none in my admiration for the medical men of Oldham. They treated me with exceptional courtesy quite recently.
When hon. Members speak in this debate, as they did, about doctors emigrating and so on, about the shortage of doctors, I would point out that there has always been a shortage of doctors in Oldham. We have never had enough medical men in the over-populated areas of the North. It is inevitable that the people in the North do not get the medical attention received by people in 1253 the South. Until the right hon. Gentleman produces his scheme it is inevitable that in Oldham hospitals we shall not get the service.
I raise a point which has given umbrage to the Manchester Hospital Regional Board. Through refurnishing and redecorating two additional wards have been made available in the Oldham hospital. The people concerned said, "There has been a bit of a misunderstanding. We have managed the same thing by a bit of reorganisation." Everyone knows that the waiting list for urgent operations is serious there. In a town like Oldham one does not put down one's name for a minor operation. Our medical officers there are working under very unhappy conditions. We have a new and talented geriatrician, a man of great ideas.
But we have to take the hard decision in Oldham when we cannot accommodate in Boundary Park Hospital a person who is going to occupy a bed for more than a week or two. One has to maintain the turnover of nearly 26 patients a year, if one can do it; that represents the maximum use of the bed. This is what the right hon. Gentleman was saying.
The friend I visited tonight might not have been able to get admission to a hospital in Oldham. Certainly he has been ill for years and has not been sent to hospital; but he got admission in London. Here he is able to go to one of the specialist hospitals treating diseases with diligence, care, generosity and kindliness under the National Health Service. His condition was so serious that I understand that an additional bed has been brought into the ward to make room for him and give him the treatment that he needs. It might well have been a matter of life or death.
We have not the accommodation to do that in Oldham. Every doctor there is overworked. So we go on year after year. We have come now almost full circle. I remember when the news came that we were going to introduce the National Health Service. It was one of the great moments in our Parliamentary lives—and it still is. Whatever faults have developed, it was still a major milestone along our political road.
1254 One of the arguments constantly, and truly, used was that lives were being sacrificed, that men were dying because they could not have treatment. It still goes on in Oldham, though not so much. Things have improved, of course. There are better medical services. But we have not the resources to deal with the cases.
An hon. Member has quoted the Minister as saying that we may have to allocate trained resources so that they are not wasted. Put like that, it is an unexceptionable statement. In Oldham we have to take a harder decision, as in the case of the doctor's dilemma. One can save only so many lives. There comes a point where one has to say, "This one is not so useful. This one has to be sacrificed. This man, loved by his wife, family and friends, is not eligible for treatment. We have only so much." Someone has to take the hard decision. That is the position about the Health Service today.
We have one of the great men of Oldham protesting about the situation in the hospital, and I desire to record my own dissatisfaction with the position, in words which I hope will be answered sometime, and to warn the right hon. Gentleman that if it is allowed to continue and if no reply is given there may be Labour Members who will feel that they are forced into some form of retaliatory action. I have said that this is action that I personally would deplore, but the stage has been reached when a good deal of animosity, feeling and indignation is already being engendered.
I hope the right hon. Gentleman will reconsider his position, because I shall certainly refer to the matter again. I hope he will feel that the time has come when he can do his duty to the House and give an answer, and call for an inquiry and find out what has happened, and if he finds that something wrong has been done, use his powers and put it right. That is what he is there for.
§ 3.34 a.m.
§ Mr. Powell
I have exhausted my right to speak on this question, but if the House will give me permission, I should like to deal briefly with the two points which the hon. Member for Oldham, West (Mr. Hale) has just made and of Which he was good enough to give me 1255 prior notice. I hope that on both he will acquit me and my Department of any discourtesy, or any intention of discourtesy, towards him.
As to the hon. Gentleman's first question, which related to an alleged cure—I re-emphasise his warning words—for muscular dystrophy, I listened attentively to the letter of my Parliamentary Secretary which he read to the House. Though it was brief, I must say that it not only seemed to me that it was courteous, but that I am sure that both my Department and the Medical Research Council had made every endeavour to identify the remedy to which his inquiry related. It is not perhaps surprising, since this was of Russian origin, if information was eventually obtained—though I did not gather that when it came it was very definite or helpful—from Russian sources, but I assure the hon. Member that I am certain that every effort was made to identify it and that failing to do so, the only course which was open to my Parliamentary Secretary was to say that the only practicable action was to go back to the original source of the information.
Coming to the major matter with which the hon. Member concerns himself, the question of a specific appointment in the immediate past to the Oldham Hospital Management Committee, the hon. Member referred the House to the general statement of my powers in Section 1 of the National Health Service Act, but that general statement contains the words, and this is the qualification of my duties,… in accordance with the following provisions of this Act …The provisions of the Act with regard to the constitution of a hospital management committee, as set out in Part II of the Third Schedule, are that hospital management committees are appointed by the regional hospital boards, and there is nowhere in the Act, or in the regulations under it, anything which gives me the power to direct regional hospital boards as to their appointments or to revoke or in any way interfere with the individual appointments which they make to these boards. It is therefore not because I do not care about these matters but because I have no standing in the 1256 matter that I was obliged to advise the hon. Member that I could not take cognizance of the specific and individual appointment with which he was concerned.
The hon. Member asked me a question about the consultation which the regional board had undertaken in accordance with the statutory provisions, to which I referred. He asked me—this was on 9th March—whether I was aware that before making recent appointments the regional hospital board had failed to consult the Committee. This is a point to which I might properly direct my mind, although I know, as I know the hon. Member appreciates, that in the last resort it is a matter of law which could be settled in the way in which the interpretation of any statute can be settled. But to the best of my understanding I am satisfied, having called for information from the board, that the communications which passed between them and the hospital management committee did constitute consultation within the meaning of the Schedule. I was not aware, and the hon. Member did not specifically refer me to it, of the question of consultation with the Chadderton Urban District Council. I will confirm whether there was similarly valid consultation in that case and I will write to the hon. Member on that point.
With regard to that and the question of any individual appointments, I, as Minister of Health, have no standing in the matter. This does not mean that the general complexion of hospital management committees is not a matter of concern to the Minister of Health as a matter of national policy. It would indeed be my duty, and it is something to which I have the duty to direct my mind, if there was evidence of widespread policy with which I disagreed on the part of regional hospital boards generally, to offer them my advice on the matter. In that sense I am grateful to the hon. Member. I watch the general complexion of hospital management committees, but it still remains that I must decline, and I am sure that this is the inevitable answer, to take up any position with regard to individual appointments to this Committee or indeed to any individual hospital management committee.
1257 The hon. Member for Birmingham, Small Heath (Mr. Denis Howell) referred to appointments to regional hospital boards. For those, which are made by me, I am indeed answerable, and answerable, as for all my other acts, to this House. The hon. Member referred to the concern of the Trades Union Congress in this matter. I received the deputation to which he referred and we had a very useful discussion on the matter which, I think, was helpful to both parties. That, however, is essentially different from the matter raised by the hon. Member for Oldham, West, who, I hope, will acquit me certainly of any lack of care in the matter and certainly of any discourtesy in a matter in which, as I have defined it, I have no standing.
§ 3.40 a.m.
§ Dr. Horace King (Southampton, Itchen)
My hon. Friend the Member for Oldham, West (Mr. Hale) would not expect me to follow the questions which he has raised with such clarity in the second half of his speech. I wish to return to the main subject of today's debate—the subject of nurses. I admire the skilful way in which the Conservative Party invariably tries to kill fierce criticism by underplaying the issues raised. At its best, this strategy is a feature of our old ruling class which achieved great things in the past, both for that class and for Britain.
We had an example of it tonight, some hours ago, when the Secretary of State for Scotland reproved us about being emotional in this debate. I have listened to the Secretary of State for Scotland in many Scottish debates, in which Sassenachs are still allowed to sit and listen. I have never found the Secretary of State for Scotland himself being guilty of being cold, calm and phlegmatic. There is something wrong with anyone who is not emotional about the wonderful work of the nursing profession. We make no apology for the underlying emotion which has been present throughout this debate on these benches. Indeed, there is another emotion at work of which, I am certain, the Government are becoming increasingly aware, not only among the nursing profession but in all groups affected by its wage policy, and that is the emotion of anger and of just indignation.
1258 This long debate is a magnificent Parliamentary demonstration on behalf of the nursing profession. Its length is itself a tribute to the nursing profession. I hope that the nursing profession will note the fact that there have been speeches from both sides of the House throughout this many hours long debate and will appreciate that that is a measure of the high esteem in which Parliament holds our nurses. The length of the debate, however, is also a token of the growing opposition to the Government's wage pause policy, an opposition which is spreading and intensifying among professional groups of workers as well as among the industrial trade union movement.
I congratulate the hon. Lady the Member for Tynemouth (Dame Irene Ward) for her fine speech, which was full of the kind of emotion that we welcomed and the Secretary of State for Scotland regretted. I have always noticed that if the hon. Lady is convinced that a group of British citizens is suffering injustice she is prepared to fight for them, and not only is prepared to take part in the debate, as a member of the Liberal Party did with distinction and vigour in a maiden speech tonight, but is prepared to sit through a debate, as the Liberal Party is not prepared to do.
I only wish that I could say the same about the speeches of other hon. Members on the Government side. In the many hours during which I and many of my hon. Friends who have not yet spoken have been trying to intervene, I was hoping to deal with the speech of the hon. Member for Hertford (Lord Balniel). But he disappeared from this debate so many hours ago that most hon. Members have forgotten that he ever took part in it.
He defended the Government. His was the speech of all speeches in the debate which most nearly approached the eloquent defence of himself by the Minister of Health. But although he defended the Government, he denounced the differentials in the present wage-salary structure. When I intervened, he promised to answer me later in his speech and he said that I was preventing him from coming to that point. But when he came to deal with what he and 1259 many of us believe to be manifest injustices in the present differentials, all he could say was that he hoped that at some time in the future something would be done about them. He was the classic Tory—a Tory in favour of every reform; but no reform today, every reform tomorrow.
I promised—and I speak tonight proud to keep that promise—representatives of the nursing profession in Portsmouth and Southampton to speak on their behalf if I could. I know that I speak for the Southampton district branch of the British Medical Association when I say that we believe not only that nurses are underpaid, but that medical auxiliaries are underpaid. I told a deputation from the B.M.A. who came to see me some weeks ago that I was glad to find that this profession should be holding out a hand to help to lift up some of the subsidiary professions which serve the medical profession in our hospitals so magnificently. Whether my arguments will be accepted by some people in Southampton is debatable, but I am certain that I speak for the vast majority of the people in my constituency when I say that their complete sympathies are with the nursing profession in their rejection of and hostility towards the Minister's award of 2½ per cent.
I had hoped to link the case of the nurses with the similar treatment which the Chancellor of the Exchequer is now inflicting on university teachers, but we learned early in the evening that that part of the debate is now postponed. Indeed, its very postponement is a mark of the keen interest of the House in the nursing profession.
It is important that one who is especially concerned with education should be speaking in this debate in support of those of my hon. Friends who have devoted themselves year in and year out to health matters. The teachers are solidly behind the nurses in their claim for an adequate professional salary. The Times Educational Supplement last week was right to link teachers and nurses as folk with the same attitude to life and giving similar profound service to the community.
The case of the nurses is the case of the other 600,000 white-collar workers who have come together in a Confer- 1260 ence of Professional and Public Service Organisations and who are now resisting the Government. I hope that the nurses will join this new group if they have not already done so. I was very pleased to see in yesterday's evening newspapers that Sir Ronald Gould, acting secretary of this great linking of the white-collar public service workers, on their behalf has expressed solidarity with the nursing profession.
I need not elaborate on the fine work done by the men and women in the nursing profession. I did so some two years ago when in an Adjournment debate I was pleading for one branch of the nursing profession—the great midwifery group. There is no one here this morning who does not owe his health, and some their lives and most the life of someone very dear to them, to the devotion of nurses. Just across the water from this House that magnificent work is going on twenty-four hours a day every day of the year.
There is no conflict between the two sides of the House in the tribute we pay in words and no doubt I believe in the tribute we pay in real appreciation of the work of this great profession. The hallmark of any profession is that it gives service irrespective of the financial reward it earns. All the money in the world would not make a good nurse of someone who was not really fit to be a nurse. There was great nursing, there was wonderful nursing, in the days when nurses were shockingly underpaid and shockingly over-worked under deplorable conditons. One of the notable achievements of the first Labour Government after the war was almost a revolution in the conditions under which the nursing profession was working.
Although there are difficulties today they are nothing to the difficulties under which these women worked in the days before the war. However, having admitted that all the money in the world will not make a good nurse—that nurses are born not bought—I think the hon. Member for Orpington (Mr. Lubbock) was right in his excellent maiden speech when he urged that we ought not to take advantage of the selfless devotion of nurses. I was interested to hear hon. Friends referring tonight to Florence Nightingale. I wrote for an anniversary celebration in my constituency some 1261 years ago an article on nurses which was to appear in the local Press. I gave it to my wife, who is one of the most devoted voluntary workers for the National Health Service in the country. She showed it to her nursing friends. They insisted that I should strike out all references to Florence Nightingale. They said, "We are tired of being called Florence Nightingales."
Such references are based not on emotion, but on sentiment. If the Secretary of State for Scotland had objected to sentimentality perhaps it would have been better than to complain about our emotionalism. Incidentally, if anyone remembers how Governments treated Florence Nightingale they would sympathise with any nurse who objected to being romanticised on the one hand and getting the pattern of treatment which Florence Nightingale had when she created this tremendously wonderful profession.
The Government have had a habit recently of arguing that because we manage to recruit nurses, with some difficulty, and because we manage to recruit teachers, with some difficulty, the salaries cannot be so bad after all. The Minister argued that way today, but speech after speech in this debate has shown that the position in our hospitals belies even that complacent assumption.
The case for an adequate professional salary is a case in its own right. I believe that nurses are worth more than they are getting. That belief is not founded on the number of recruits we manage to get into nursing. It is founded on an estimate of the character and quality of the nursing profession and its value to British society. The Government's attitude is the old attitude of employers throughout the ages, "Pay as little as you can get by with. If you can manage to man the Government services with people there is no point in paying them any more for any reason whatever."
The Minister told us many hours ago—I appreciate his patience in sitting here throughout the debate, just as I appreciate the patience of my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) who, like him, has listened to almost every word spoken in the debate—that he would tell the nurses when 1262 he met them what the Government have told every group of workers on which they have inflicted the wage pause: he will read them the gospel of the White Paper on incomes. I was interested to hear the hon. Lady the Member for Tynemouth and the hon. Member for Belfast, East (Mr. McMaster) beginning to criticise the very White Paper itself. The heart of that gospel is that wage increases must depend upon increased production.
The Minister has told us that the nurses will benefit from having only 2½ per cent., and they would be much worse off if they had 5 per cent. Indeed, he was so sure about it that one almost feels that he may convince them so effectively that they will say that even the 2½ per cent. will do them harm and they had better not have anything at all.
Listening to this Minister, I always have the feeling that he believes in the policies of the Government more intensely than any of his colleagues do. I always felt that he enjoyed charging for prescriptions. I noticed no regret in his speech today that he could not offer the nursing profession, to which his Department owes so much, any more than he has done. It is the basic policy of the Government, the policy which the right hon. Gentleman so earnestly supports, which I believe to be wrong, and morally wrong. I hope to show why before I finish.
Can a nurse increase her production or productivity? How can she earn an increase within the terms of the White Paper? Shall she, or he, double the doses which are given to the patients? How can a nurse, man or woman, do more than his or her best? It is worth mentioning in this debate that the work of our male nurses equals in skill and devotion the work of our female nurses. We once had payment by results in education at the end of the last century—the principles of this White Paper applied to education, it almost ruined British education, as anyone who looks into the history of it will know.
If the Minister argues that we must link wage or salary increases not with the individual's production but with the increase in national production, such a policy makes sense only if the whole of the present wages and salary structure is 1263 correct, morally defensible and scientifically drawn up. The present Government policy of 2½ per cent. for nurses, 2 per cent. for civil servants and 3 per cent. for university teachers, and the various percentage allowances which they are grudingly conceding in the departments which they control, is freezing the present differentials at their present levels.
Is there anyone who can say that the complex structure of differences existing between wage and wage and salary and salary at present are right? It is a matter of fact that some escaped the hatchet men of the Treasury just in time. Others have had to bear the full impact of the White Paper policy. Others have broken through. Some of the trade unions and some of the nationalised industries have broken through the rigid policy which the Government sought to impose. Many professional groups have lagged behind not only industrial workers but other professional groups in past years. It is folly to argue that there is any justice in merely maintaining the present structure of differentials.
Moreover, the body which the Government have set up—the National Economic Development Council—does not contain one representative of the nursing profession, or of all the 600,000 or 700,000 white-collar workers. Yet all these professional people are vitally concerned with every decision made by that Council. The new grouping of public service professions that I have referred to has asked the Chancellor to give it representation on the body which is to make decisions of vital interest to all the professions concerned. There can be no fair national wage policy unless all who are concerned in or have to bear the implications of such a policy are fully consulted and take a full part in shaping it.
One of the issues that we face in this debate, and have faced in many of our earlier debates over the past year—indeed, as I see it, over the past two or three years—is that the power of the Treasury is growing. The Ministers who administer our great social services—education, health and pensions—are second-class citizens in the Government. I have often paid individual tribute, in the House and in Committee, to the fine 1264 work that these social service Ministers are doing. The Minister of Health is proving tireless in everything he undertakes, and in the way that he goes round the country.
I am sorry to find my hon. Friend the Member for Oldham, West charging him with discourtesy. That has never been my experience; indeed, he must be about the only Minister who, when he visits a constituency, not only does what every other Minister does—informs the hon. Member representing that constituency of his visit—but invites the hon. Member, whatever his political party, to take part in the visit. I acquit the Minister of any charge of discourtesy. I admire the work he is doing at present in getting first-hand knowledge in the field of all the various and complex apparatus of the great service that he administers, and I pay tribute to him for the imagination and zeal he has put into the great hospital building programme which is to take practical shape in the years immediately ahead.
But I find the Minister bedevilled not only by the Treasury but by his own past at the Treasury. I have said in earlier attacks on him that he is the Trojan horse, put into a social services Ministry by the Treasury. He was one of those who resigned from the Treasury some years ago because the Government were refusing to carry out the kind of policy that he is carrying out under the Chancellor and the Chief Secretary at present. I look upon him as I look upon one other Minister in Her Majesty's Government—as a Dr. Jekyll and Mr. Hyde—and I fear that the nurses, like those people who were worried about their prescription charges a year or so ago, are dealing with the Minister in his Mr. Hyde capacity. This is the Mr. Hyde who doubled the prescription charges so that the chronic sick of Britain could help to pay for the hospital programme that we are all going to be proud of some day.
I said earlier that the Government are morally wrong. This Minister—any Minister of the Government—could convince the nurses and all the other workers that the wage pause policy makes rough sense, if not perfect sense, if the sacrifices which he and his colleagues seek to impose on all the workers were also imposed on all those 1265 who merely own or speculate. For example, it is partly because the Minister will have to pay "racket prices" for every bit of land on which he builds the hospitals which he plans in his great hospital programme that he cannot afford to give the nursing profession an adequate professional salary—and his Government are responsible for the land racket. It was Government legislation which made possible the present fabulous increase in the price of land.
The hon. Member for Hertford, who departed from the Chamber so long ago, talked about the danger of a wage-spiral. The wage-spiral as a cause of inflation through increased wages during the last few years has been infinitesimal, minimal, compared with the fantastic price spiral in land during the last three years and that price-increase itself is inflationary. When we grudge them anything more than 2½ per cent., the nurses of England must know, as the masses of England must know, that in the last four years land prices in England have gone up not by 2½ per cent. or 5 per cent. but by 400–500 per cent. I believe that the offer of an increase to nurses is derisory, just as the university teachers have said that the offer to them is dishonourable on the part of the Minister. The proposed increase of 2½ per cent. will just about cover the increased health charges, the increased insurance charges, the increased rate burden, and now the increased railway fares—all products of the Government's policy which are adding to the expenses of nurses as of other citizens.
As I watch the Government steadily antagonising every group of workers in the country, the workers by hand and by brain, the professional workers, the industrial workers, the highly skilled workers and the labourers, I realise that their only faithful support in the buildup of British society comes from the landowners, the moneylenders, the property owners and the speculators of this country, who have done so well under a Conservative Government and who are handled so tenderly by the Chancellor of the Exchequer and the Chief Secretary to the Treasury.
What is the matter with the Government is that their values are wrong. 1266 Today's debate is only an illustration of that fact. Society's greatest rewards go to the most useless citizens. The whole structure of the wage and salary negotiating machinery is being taken over by the Treasury. I believe that that is bad for Britain. I believe that what we have built over forty years was worth not only keeping alive but cherishing. It was building a spirit of good will between master and man, between management and man, in many sections of British life, including the Government's own Civil Service It is a pity to jettison all that. Nobody who loves democracy likes to see the growth of bitterness, and there is no doubt of the growth of bitterness in the learned professions and in the Civil Service, as well as in the trade union movement at the present day. I believe that what the Government are doing is bad for Britain. I believe that it is bad for democracy. We told them all this when they began this policy. I believe that in the long run the Government cannot succeed in getting away with it.
But I end as I began by saying that I am as much moved as anyone tonight by the fact that hon. Members on both sides of the House have used the traditional day, when the back-bench Member has a chance, when all in the House are equal, unlike other days when some are more equal than others, to voice the frustration and the pleas made by one of the most valuable elements in this great British community to which we belong. I only hope that the nurses will know that on both sides of the House there is a tremendous amount of good will—which I hope on the Government side of the House will ultimately turn into practical shape and compel the Government to meet what I regard as the just claims of the nurses.
§ 4.10 a.m.
§ Mr. Reader Harris (Heston and Isleworth)
I naturally support those parts of the speech of the hon. Member for Southampton, Itchen (Dr. King) in which he paid tribute to the nurses and expressed the hope that they would get more money. He will not expect me to support those parts of his speech in which he attacked the Government—
—for not paying it. Exactly. I think the first and most obvious thing the Government should do for nurses and other workers in the National Health Service is to ensure that the pounds which they already earn go on holding their value and purchasing as much as they do now. Surely, a stable pound is the prerequisite to any progress. Whether I agree with everything the Government do in this direction I am not going to argue now. At any rate, I give them credit for trying to maintain the value of the pound, and in this they obviously have had a very considerable measure of success. Of course, this does not solve all the tremendous problems surrounding the question of wages for nurses, physiotherapists, radiographers, whom we are discussing today.
I have listened to a good number of speeches today. Unfortunately I was not able to listen to all of them, but I have listened for the last five hours, and I think the best ones have been those which approached the subject on an all-party basis. I think it is unfortunate that any section of employees, especially nurses, should find themselves being used as political ammunition with which to attack Ministers.
§ Mr. Harris
I do not know whether we need go back to the last General Election. One of the things I cannot help noticing is that those employees have done best who have managed to gain all-party support in this House for their cases. We can name the police, we can name the firemen, we can name many others; but as soon as a group of employees begins to be used as political ammunition their case does not do so well. I think the speeches today which have achieved the most are those approaching the subject on an all-party basis and which endeavoured to gain support from both sides of the House.
The hon. Member for Greenock (Dr. Dickson Mabon) hoped we on this side would put down a Motion favouring higher pay for nurses, and said that if we did he would support it. I think there is already such a Motion. There are Motions put down by hon. Members 1268 on both sides of the House. I think it is a pity we do not have all-party Motions rather than Motions put down by one party or the other, because we all want to see the same result.
§ Mr. Edward Milne (Blyth)
Would the hon. Member be prepared to put down a Motion attacking the pay pause, if he is really interested in the wage increases for nurses and the other people he has referred to?
§ Mr. Harris
That goes back to the point I made, that I do not see why, to express the hope of certain increases of wages, it is necessary to attack the pay pause, and that one of the best ways of helping is by maintaining the value of the £ and maintaining stability. I do not suppose everybody will agree about that, but I think that to do that is to take a step in the right direction.
What worries me is that when we plead the case of the nurses we are up against problems of the pay of many other sections of employees who also have very strong cases indeed—for instance, the railway men and the prison officers. What on earth are we going to do about prison officers? Their case is a desperate one and they are getting fewer. Then there are the probation officers and London Transport workers. I do not know how they run London Transport, they are getting to be so few. Then there are civil servants and local government employees. They all want more money.
The alarming thing is this. Before the war workers in the public sector held jobs which were envied; they held positions looked up to by the general run of workers; they had a status which compared very favourably if not more than favourably with that of other workers in industry and elsewhere. Today, owing to the complete change in the economic and industrial situation, the workers in the public sector have all lagged behind, and the great problem—and this Government certainly have not solved it, and I do not blame them for it, because I do not know the complete solution—is: how do we get for these workers in the public sector their fair share of the national cake of prosperity? They are entitled to their slice but, all the time, the nurses and the physiotherapists and the others seem doomed 1269 to lag one, two or three years behind the workers in industry. They are in jobs where it is impossible to get more productivity. As the hon. Member for Itchen asked: how does a nurse increase her productivity? It is impossible.
Why should these people always lag behind? Do we need a national wages policy? If we have one, what happens to our free bargaining? Which are we to have? When we pleaded the case of the firemen a few months ago—a case that most of hon. Members supported—we put forward that very argument. How do we decide what is the position of firemen in the present society? We know what it was before the war, because a public committee pronounced on it. Because the firemen have an active trade union they got a 19 per cent. increase in the middle of a pay pause, but there is something wrong when only those sections of workers get increases that have active bodies working for them who are prepared to do things that are a little desperate and outside the normal pale.
It is at least six years since one of the members of my local Conservative Association in Heston and Isleworth told me that he was a radiographer and complained about his pay. I was shocked when he told me that he got only about ten guineas a week. He had been trained and held a responsible position. People's lives depended on him. I did not feel very good about it, because the only advice I could give him was to ask, "What's your representative body doing about it? Is it not creating a terrific noise; lobbying M.P.s; marching across Westminster Bridge with banners; threatening to get out? Whether they do or not does not really matter as long as they make the threat." I believe that he discussed the matter with his representative body, but nothing happened.
At about such the same time I had nurses asking me, "Why don't we get more pay?" I told them, "You must be more active. Your representative body must take stronger action. It must threaten if it is to get anywhere." But more senior members of that profession said "That's not what we want to do. Furthermore, we think that if we pay too much money to nurses we shall attract (the wrong type of girl to the pro- 1270 fession. "As a trade unionist, I did not go much on that, but I could not do anything about it. The physiotherapists said the same thing. I said "Let's look at the members of the council of your representative body." It was full of extremely respectable people. To have asked them to take violent action was impossible, and they never did take it.
Now they all want something done. I do not blame them, but we have to solve this problem on a longer-term basis, and arrive at some formula whereby the people in the public sector get their share of prosperity. Workers in industry are in a position to demand their share of the profits in every business. They get it by their trade unions negotiating appropriate rates of pay. I know of few engineering firms that are paying trade union rates; they are nearly all paying above those rates. Certainly we do it in our factory. It is inevitable. That is what is negotiated for them on a national basis. And within each factory they can go to the management and say that they want a quarterly, half-yearly or annual bonus, and in many cases they get it. So they can keep up to date with the movement of prices. There are other workers who pay is tied to the cost of living index. Ought we to have a similar system for the workers in the public sector? I am posing the question. Is it possible? How else can we prevent these people from always lagging two or three years behind the workers in industry? This not necessarily a party matter. Any Government would have to face it and I do not think that it can be solved purely on a party basis. I am by no means sure that the National Economic Development Council could solve it. It is a Government matter and the nettle must be grasped quickly. I would support any reasonable formula which would keep these people in line with current prices.
§ 4.21 a.m.
§ Mr. Harold Davies (Leek)
The hon. Member for Heston and Isleworth (Mr. R. Harris) made a constructive speech, and I did not intend my interruption in the manner in which the hon. Member took it. When such issues as this arise we on this side of the House are appealed to not to make a political issue of the matter. We are told that these things are above the political battle. If there is a crisis on the railways we are 1271 asked not to make it a political issue. When there is a crisis in the mines or in respect of education the request is the same. When hon. Members opposite meet in the 1922 Committee I hope that they fight as vigorously as they speak on the Floor of the House on these matters, because that is where the power lies—
§ Mr. Davies
I am glad to hear that. I hope that they will fight much harder. It would frighten the life out of the occupants of the Government Front Bench if some hon. Members opposite, about a hundred of them, actually came into the Division Lobbies with us on these matters.
At this time in the morning I do not wish to go over arguments which have been made in other speeches. But there is more in this matter than just pounds, shillings and pence. I wish that some economists would begin with Ruskin rather than Smith and perhaps combine Ruskin with Marx. They might remember the phrase used by Ruskin:There is no wealth but life.The claims of the nursing profession and the whole of the National Health Service begin with that formula. We cannot measure the contribution of these people in pounds, shillings and pence, right from the porter at the hospital gate to the most highly skilled surgeon.
I submit that if tomorrow night—and God forbid that it should happen—we knew that within twenty-four hours or twenty-four days we should be threatened by war, millions of pounds would be found immediately for defence purposes and for civil defence. Perhaps one of the best contributions which civil defence could make would be to see that we had enough qualified students, nurses and others in and around the hospital service for all types of emergencies.
This point has not been made today, but we have had figures. In answer to a Question on 12th March, the Minister said that the nursing staff today is at its highest point ever. I do not understand this, because in the Birmingham Region, in the west Midlands, in north Staffordshire, in Stoke-on-Trent and in Leek we receive masses of letters on this point. Why is it that in one of my local 1272 newspapers Mr. K. W. Taylor, hon. branch secretary, The Royal College of Nursing (Stoke-on-Trent and District Branch) had the following letter published? He wrote:Sir, Your readers (our employers!) may wonder why nurses have rejected their pay offer of 6d. in the pound, and why we express our concern and dismay. We are asking for a really big salary increase for two reasons: 1. We believe that a nurse is worthy of better rewards than she is getting. 2. We are concerned over the continuing shortage of nurses, due to low recruitment and high wastage rates. A good salary scale may not completely cure this problem, but will help considerably. We deny ourselves the right to withdraw our services in any degree. The public we serve is denying us also, through its Minister of Health, the right to claim good pay for good work. It is this fact that causes us concern and dismay.In every region throughout the country, despite the fact that the number of nurses is at a higher level than ever before, we know that there are local complaints. How are those statistics built up? Another point which I believe has not been made or answered in the House is how much it would cost to pay the nursing profession properly and to meet the ancillary and auxiliary services. It is well known that many of our hospitals are kept going by the auxiliary services.
In a rambling constituency like mine I have many places to visit. Last Friday a grandmother came to me about her young granddaughter who is now doing a magnificent job in the North Stafford Infirmary as a student nurse. She receives £11 a month out of which she pays for her books and fares for the long distances that she travels to the hospital. In the same area I met male nurses working in St. Edwards Hospital, one of the finest hospitals in the country, doing a fine job rehabilitating people so that once again they can go back into the busy world in which we live. They receive £8 14s. a week. When the Rent Act came into force, the rents of their cottages, unlike the rents of people in other sections of the public service, shot up enormously.
We do not want an investigation. We do not want another committee. Nurses cannot eat committees. Why could not a questionnaire be sent out and a White Paper introduced quickly? Cannot the Minister find a way of standing up to the Treasury so that something can be 1273 done to meet the need immediately? It could be a simple questionnaire. It does not need erudite people to find answers to these questions.
Magnificent work is being done in the hospitals. This is true of geriatric wards, particularly. Sometimes they are kept going by auxiliary nurses alone—on low pay from which they have to meet superannuation and insurance payments, uniform charges and so on.
No one has said that nurses, physiotherapists and others are not underpaid. They are underpaid. When I interrupted the Secretary of State for Scotland I was accused of being political in referring to the Government's £83 million concession to Surtax-payers not long ago. I believed it to be fair and legitimate criticism of the Government, for that was an irresponsible act while we have this valuable profession suffering from wastage and lack of recruits. In a way one could say that the Government are neglecting part of the defence of the country by neglecting to provide pay and conditions which would attract the people we want.
Many of us are very grateful for the hospital services that we have received. The little girl of 19 that I mentioned has been left on night duty entirely on her own because of the shortage of nurses. Many of us appreciate what qualified nurses, students and all the others connected with the hospitals have done. The answer to the problem is not sentiment. It is no use calling these people angels. As I said to the Minister the other day, angels apparently do not eat or sleep or have to pay rent or examination fees or buy books. We may think of nurses as angelic, but that is mere sentiment.
I pay tribute to the Minister for having sat here through nearly every moment of the debate. Whatever I may say, there is no personal attack on him. The fact that he has sat here has shown his deep concern in the problem. I beg him now to show courage, as he has done in the past, and stand up to the Cabinet and the Treasury over this problem. It is idiocy to suggest that an increase of pay for this low stratum will create an inflationary spiral. Much more of an inflationary spiral has been created by the racketeering in land values. Those are the things which are creating 1274 the inflationary situation, not the salaries of one of the most underpaid and least protected sections of the community.
§ 4.35 a.m.
§ Mr. A. Fenner Brockway (Eton and Slough)
I am not now one of those who enjoy speaking at twenty-five minutes to five in the morning, but I am so concerned about the issue which we are discussing that I have sat throughout this debate and the earlier debate with a view to making some contribution. I have also promised my constituents that I would voice their particular needs in this debate.
Perhaps my concern about the problem may be illustrated by the fact that it is now 30 years since I introduced the first Bill in the House to provide a minimum living wage for nurses and an eight-hour day. That was way back in 1930. My hon. Friend the Member for Southampton, Itchen (Dr. King) was perfectly correct when he said that the Labour Government, immediately after the last war, almost revolutionised the position of nurses. But in 1930 British society exploited in the most self-righteous and hideous way the devotion of nurses to their profession. It was one of the most sweated industries or services in the whole of our land.
I can remember so well, as I introduced my Bill from the benches opposite, the criticism which came of any idea that a minimum wage should be established for nurses, on the ground that they did not enter the service for a wage but that they were dedicated to it from the point of view of love of service. We all recognise that love of service.
I say quite frankly that I speak on this subject with emotion. I have had three months in a hospital, very seriously ill. Anyone who has been through that kind of experience has a sense of gratitude to nurses which is perhaps unique among any of the professions. But to use that devotion to service on their part to deny them the necessities of life and the enjoyments of life, to deny them from the community a response to their service so that their lives may be happier, seems to me to be about the lowest meanness that any society can perform. It is no contradiction to say that one 1275 recognises the dedication of nurses to their profession but one also recognises the duty of society to do justice to them in return for that service.
I speak perhaps with particular feeling on this point because three of my daughters have been in the nursing profession. They were in the nursing profession before the post-war standards of life were raised. I was able to see then the absolutely impossible conditions under which nurses worked. The first year is a drudgery and a hard experience which only a girl who is very devoted and courageous will undergo. Anyone who has had intimate association with the lives of nurses knows the hardships which they have to overcome.
I want to add to that some representations from my constituency to which the House should have its attention drawn. We have, as the Minister knows, an old hospital in Slough, the Upton Hospital, which is soon to be replaced by a new hospital at Wexham. I received last week a petition signed by twelve sisters and forty nurses at the hospital asking for support for a salary commensurate with the responsibilities of their profession. I was interested to receive only yesterday a letter from twenty-six patients at the hospital supporting the demands of the nurses. It is from Ward 3 at Upton Hospital and it states:We the undersigned are in full agreement with the nurses receiving their well-deserved rises in pay. The invaluable and devoted attention which they have shown to us all is deserving of further recognition.The fact that a number of the twenty-six who have signed the letter have girls' names suggests that it is probably a women's ward which has responded to the nurses in that way.
The other issue which I desire to raise from my constituency is the question of the physiotherapists. The Windsor Group Hospital Management Committee is responsible for the hospitals in the Slough area. At present, they are short of nine physiotherapists, three at Upton Hospital, three at King Edward VII Hospital, Windsor, and one each at Cliveden, Pinewood and Maidenhead. To maintain a service at all, the hospital management committee is now advertising in Germany and in some of the Scandinavian countries for the necessary physiotherapists.
1276 The salary starts at £525 a year and rises to £650. That is to say, the maximum that physiotherapists can obtain is £12 10s. a week. The Minister cannot possibly defend that. He cannot possibly expect that when he pays wages of that character the shortage of physiotherapists will be met.
I have in my hand a letter from the superintendent physiotherapist at Upton Hospital. He has been there for ten years and he says that in that ten years he has been able to maintain a reasonable physiotherapy service for a total of only three years. He says that the rest of the time has been spent on a succession of restrictions, emergency programmes and contractions of a much needed service.
The service at Upton is now 50 per cent. under strength. The consequence is that there are long waiting lists for treatment and a reduced service. Last month a complete breakdown was avoided only by the recruitment of two Norwegian physiotherapists for a short term of from four to five months' duty. Against that must be set the loss of the locally recruited physiotherapist who, at the end of last month left for Canada where there are better conditions than there are here.
The superintendent adds:In spite of repeated and energetic advertising by the Hospital Management Committee over the years, involving no mean expenditure of public money, the response has been poor and only short term.What has been the cost of advertising for vacancies, not only in this country but abroad? It is likely that the figure has reached a point which might have made some contribution to the increased salaries for which the nursing and the auxiliary medical professions are asking.
The superintendent continues:Over the past two years we have had to rely on the recruitment of foreign staff in order to maintain any minimal service.I said earlier that Upton Hospital was old and was to be replaced by a modern hospital at Wexham. I put it to the Minister that if he builds a modern hospital with a modern physiotherapy department, it will be of very little use to the growing population of the Slough area, or other areas affected in a similar way, if there are not any physiotherapists to staff it. That appears to be the present danger.
1277 This is not a problem confined to Slough. It affects all hospitals in the Health Service with the exception of the very small minority of large teaching hospitals. The result is long waiting lists, drastic curtailments in rehabilitation of the disabled, especially the severely disabled, the chronic and the elderly. The cost in human suffering and unhappiness resulting from the loss of personal independence and earning capacity, to say nothing of the effect on the national economy, is immeasurable. Rehabilitation cannot always be given when accidents occur. When there are injuries men cannot report for work, production suffers. It must amount over the whole country to a very considerable figure in the reduction of our national production. The large scale building programme of new hospitals to which the Minister referred will not solve the problem, but will only add to it. I suggest that these facts which I have quoted from Slough, and which could be repeated from almost every town, add great strength to the plea which has been made during the debate all through this night.
The physiotherapists are very modest. They ask only for a committee of inquiry. The Minister has refused a committee of inquiry. Why has the Minister refused it when recently he agreed to a similar committee for the administrative and clerical staff in the hospital service? If the administrative and clerisal staff could have a committee of inquiry, why could not the physiotherapists, whose service is so essential to the hospitals?
I quote the last paragraph of the letter from the superintendent at Upton Hospital:We are not unreasonable people. All we ask is to be able to perform our service to the community with the high standard of efficiency our training provides. To do this we need adequate staff and a reasonable salary to encourage men to remain in the Health Service. A maximium of £12 10s. a week can hardly do this.The Minister cannot fail to respond to that appeal. The Minister cannot possibly be ready to preside over a health Service when he knows that essential trained workers, as well as nurses in that Service, are being underpaid to an extent that it is less than the requirements of healthy living. One hopes 1278 that the Minister, who has sat through this debate—for that we pay our tribute to him—will have been impressed by the pleas made from both sides of the House and will remedy this failure, which is not only a disgrace to the Health Service but a disgrace to the nation. If we are prepared to accept service from men and women without in return giving them an opportunity to live a happy and full human life we are falling down on our social duty.
§ 4.54 a.m.
§ Mr. Laurence Pavitt (Willesden, West)
The difficulty of following my hon. Friend the Member for Eton and Slough (Mr. Brockway) is that he always leaves me quietly humble in face of the sincerity with which he puts a case. What he has done for me in his opening remarks this morning is to remind me of the depth of feeling which exists upon this matter because most of us in this debate are not just echoing the nurses' indignation at their treatment, but, because of our contact at various crises in our lives, we are identifying ourselves with the work they do.
When my hon. Friend the Member for Eton and Slough spoke of his hospital experience, it immediately took me back to the time, just after my son was born, when my wife hovered between life and death for ten days. During those ten days I was permitted to be by her side day and night. During those ten days I was almost a nurse. My son is 15. My wife is remarkably hale and healthy. That debt I try to repay at five o'clock in the morning by saying something on behalf of those nurses who did that job so many years ago.
During our long debate there has been on both sides of the House a deep sympathy and understanding of the problems involved. I share with my hon. Friend the Member for Southampton, Itchen (Dr. King) a disappointment at the contribution made about ten hours ago by the noble Lord the Member for Hertford (Lord Balniel), because in all our Health Service debates he is, perhaps, one of the best informed Members on that side of the House and I was extremely sorry that he was unable to go beyond what appeared to be a quite formal Government brief.
We have been concerned primarily with the effect of the Government's 1279 present policy. Inevitably, therefore, we must attack the Government because we believe their policy to be wrong. When the hon. Member for Heston and Isle-worth (Mr. R. Harris) appealed to us to take the matter above party considerations, I was reminded that on almost every day there appears on the Order Paper a Motion the first of the six names against which is that of the hon. Member for Putney (Sir H. Linstead), the last one being my own. We shall struggle on and press the Government in every possible way to obtain some justice in the way their policy is applied to Health Service employees and auxiliaries.
What hurts is not that the Government are anxious to stabilise the £. That is desirable, of course. It is not that they wish to have an economic policy which will make the country prosperous. It is that the pursuit of their policy has meant that those who have to carry the greatest part of the burden are those who, perhaps, can least afford so to do.
In another debate recently, the Minister of Labour made quite clear that the economic position was so bad that we could not rely upon exhortation in the matter of wages and salaries. In the same speech, he went on to express the hope—an exhortation—that incomes, profits and dividends would be restrained. Thus it is that to one class of the community—in this case people giving a public service who are more or less in the grip of the Government and cannot escape—the Government are prepared to apply enforcement in their desire to keep the £ firm, whereas for those in commerce and industry, especially in the higher echelons, there is only exhortation.
I asked the Minister yesterday how long his interference with the machinery would go on. Although I agree with my hon. Friend the Member for Itchen that the Minister always deals courteously with the Questions which we put to him, I have some sympathy with my hon. Friend the Member for Oldham, West (Mr. Hale). As one who is, perhaps, one of the Minister's most persistent questioners, I find that I am continually fobbed off with intelligent negatives. Yesterday, when I asked the Minister to what extent 1280he proposes to continue to give guidance to the management side of the Nurses and Mid-wives Whitley Council after the cessation of the pay pause on 1st Aprilhis reply wasAs and when necessary".—[OFFICIAL REPORT, 26th March, 1962; Vol. 656, c. 84.]That reply, of course, left me precisely where I was before I started.
Question time is one of the rare opportunities which we have to put ideas to the Minister. We usually have only one Health Service debate each year, and I assume that this is it. We have to save up a years study and then make our contributions at 5 o'clock in the morning. The only other opportunity open to us to influence the right hon. Gentleman on matters like the treatment of nurses and doctors, on the position of general practitioners and local health authorities, and so forth, is at Question Time. He always receives our Questions with tact and courtesy, as my hon. Friend the Member for Southampton, Itchen says. But he never accepts them as attempts to be constructive towards a service which we have at heart because we feel that it is part of the great contribution that the Labour Party has made to the country.
Our indictment of the Minister tonight is that he is doing irreparable damage to the machinery, the morale and the relationships which exist, and to the people within the National Health Service. I have some criticism of his planning in buildings—bricks and mortar and equipment. I hope that we shall have an opportunity of debating that matter at some other time. But my charge against the Minister is that he has a blind spot for people. He fails to incorporate them into his plans. This was typical of the hospital programme. We have great problems involving nurses, medical staffs and auxiliaries, but there has been no preliminary research to find out where those people fit in, despite the fact that the Ministry sustains a hospital unit which is able to advise on the best way in which the buildings can be constructed.
On the question of nurses, I wish to confine myself mainly to one sector, because this question of all types of nursing covers a very wide area. Although it is true that we have the rest of the morning to debate the matter, 1281 there is not much of it left. The hon. Member for Harborough (Mr. Farr) has already ploughed a little of the field that I want to follow, namely, that of male mental nurses. I am choosing for my example a hospital which is not in my constituency, because I happen to be on the hospital management committee in my area, and rather than tread on my own territory I have gone to a large hospital in Essex which the Minister has visited and knows well. It has 600 male beds and 700 female beds. I have tried to follow up some generalities that have already emerged in this debate by trying to discover an actual application of a generality frequently mentioned—about the loss to the hospital service of persons attracted by industry.
I want to quote the case of Mr. Timothy Ryan, who spent three years being trained at our expense between 1957 and 1960 and who passed his examinations on the first occasion he sat for them. He had a natural flair for mental nursing—which is not one of the easiest tasks—and his ward reports were excellent. He has recently resigned to go to a local factory—Fords. He has chosen a job that he does not like in preference to a job for which he has a flair, and had satisfaction in doing, purely as a matter of arithmetic. His take-home pay at the hospital was £12 1s. 5d. a week, on day and night duties, with shift work, whereas at Fords he receives £16 a week and, if on night work, £19, plus overtime. He is married, and has a family, and finds no alternative if he is to care for his family, so he has chosen to take a mechanical job for which he has no great bent or interest. Because he is a family man his loyalty must be to his family.
Hon. Members opposite have expressed a great deal of sympathy for nurses, but it is a case of sympathy "but". There is always the tribute, and then the word "but", and with it comes the difficulty. When the Minister was under strong pressure from us last week at Question Time in relation to nurses' pay he lapsed into lyricism—I do not know whether it was something to do with spring—and said that he thought that many of them were angels. My hon. Friend the Member for Blackburn (Mrs. Castle) quoted poetry again tonight.
1282 When the Minister called the nurses angels he was echoing the lines from the poem:When pain and anguish wrack the browA ministering angel thou ".If the Minister had been in his poetical mood of his early years, he might well have added the coupletAt other times. Nurse don't be brashI'll give you credit, but no more cash",This has been going on throughout the debate. Hon. Members have been giving credit and paying tribute, but when it comes to converting that into practical terms, many reasons are given why it should not be done.
I wish to give some figures of male mental nurses in this Essex hospital. In 1960 we had 12 student nurses in and 13 out, and eight of those who went out did so because of pay. In 1961 there were 14 in and 10 out, and seven of those who left did so because of pay. In 1962 to date, only three months, there have been four in and six out, and five of those who have left have done so because of lack of finance. Three trained staff have left already this year, and two more are about to leave.
The disastrous effect which pay has on recruitment is shown by an analysis of the numbers applying for posts and the numbers accepting posts. From 31st March, 1959, to 30th September, 1959, 73 people applied for posts as mental nurses in this hospital; none was accepted, and 54 did not pursue the application when they learned the rates of pay. In the next six months, 30th September, 1959, to 31st March, 1960, 48 applied, 30 did not pursue the application on learning the pay and eight started work. From 31st March, 1960, to 30th September, 1960, 28 applied, 12 did not pursue the application further when they learned the rate of pay and four started work. From 30th September, 1960, to 31st March, 1961, 65 applied, six started work and 23 did not pursue the application once they had learned the pay.
We can readily understand this when the rates of pay are known. A qualified male nurse in this hospital, first-year resident, doing shift work and working a seven-hour day on a Sunday, has a take-home pay of £6 12s. after deductions. In the same hospital a ward orderly on exactly the same conditions 1283 after deductions of board and lodging takes home £10 l1s. Rather than be a trained nurse with three years' training, and pass the necessary examinations, from the point of view of cash it is far better to be a ward orderly.
Figures have been bandied about on the general nursing situation. A figure of a shortage of 25,453 has been taken from the Ministry of Labour Gazette for February. The House Library has been busy handing out that information. But the significant figure is not the 25,000 vacancies which are being advertised, with the breakdown among the various groups, but the fact that in the last 12 months there has been an increase of 6,000. There was an almost 30 per cent. increase in the number of vacancies advertised over last year. This is the significant figure, because it shows that the position is deteriorating.
The General Nursing Council's Report for 1960–61 shows that the wastage rate of mental nurses for that year was 78 per cent.; three out of every four who were trained became part of the wastage. This is a grave situation in mental nursing, and if the Minister does not put it right he will invite disaster. Does he believe that no tragedies have occurred as a result of the fact that the nursing officer in charge has had to leave on duty people who are not qualified for that responsibility and that people not particularly well qualified have been forced to accept responsibilities beyond those for which they have been trained? I hope that the Minister will seek the advice of his nursing inspectors and others in the mental hospitals who know how many student nurses have been left in charge of wards during day and night, in spite of the fact that, as his nursing officers at the Ministry well know, this is contrary to the Regulations of the General Nursing Council.
We have been concerned with economics, with pay. I submit to the Minister that the wastage which the country is paying for, for people who are trained at the expense of the National Health Service, but are not used, amounts to more than he would need to give an adequate rate of recompense to the people in the profession. The loss on training would be about equivalent to 1284 the cost of decent pay and conditions to maintain the staff.
Equally shortsighted is the case with the radiographers. A radiographer's hospital pay is £11. His pay with a private contractor is £17. The firm of private contractors charges the hospital £25. So a man we have trained gets £17 and the firm makes an additional £8 out of his services. I cannot see that this is economically a sound policy.
I should like to raise a matter affecting just a small sector of the N.H.S. I refer to 2,000 medical teachers and research workers. This question is really a by-product of the Pilkington Report. There have been increases in pay since the Royal Commission, but people of these grades are doctors who also do clinical work and teaching; they are teaching doctors and their rate of pay is not to be compared with consultants' and they did not benefit to the same extent as their colleagues under the Pilkington award. Medical teachers, they also hold honorary contracts usually, and do much the same work as their colleagues in the hospital service. It is wrong that there should be these discrepancies between two sections of doctors having the same qualifications and sometimes doing very similar work. If we want to overcome the shortage of doctors, and have an increase in the number of medical students being trained, then the claim of the research workers and medical teachers is one to which special attention should be paid. Strangely enough, this is an official B.M.A. point of view. Before I came to this House I used to be associated with a rival organisation which organised general practitioners, and I am rather surprised to find myself presenting what is virtually a B.M.A. brief, but I do think that that is a case which the Minister ought to look into.
Attention has been paid in the debate to the fact that nurses and others who are serving the sick are defenceless in that they cannot exert force, or use power they cannot strike. I would remind the House of an exactly parallel situation in 1956. In 1956 the doctors put forward a pay claim which was rejected. The British Medical Association then entered negotiations and tried to get the Government to accede to its wishes. The Government proved 1285 adamant and gave a very dusty answer. At no time since the inception of the Health Service were relations between the profession and the Ministry so strained. The B.M.A. took legal advice and found that under the terms of the Association it could not organise a strike. So it formed the British Medical Guild, a ghost body with no members but which had power to organise a strike, and which still exists today. In 1956 plans were made for a withdrawal of doctors from the general medical service in given areas, so that, for example, all doctors in Manchester would come out, but all the rest of the doctors would work, and the doctors working would pay a percentage of their remuneration to pay the strikers. This was a quite well-organised and well-laid plan for doctors to go on strike. The result was that the Prime Minister immediately announced a Royal Commission. It was the doctors' threat of the use of the strike weapon that led to the Government giving consideration to their case. What was the result of the Royal Commission? The doctors had asked for 29 per cent., and the Commission gave them 29 per cent.—and gave it retrospectively. I do not know whether the nurses are able to withdraw from one hospital in the same way—I do not think that they are—or whether they could have a similar type of organisation, but it should not be necessary for such people to have to bring that kind of pressure on the Government when their case is so obviously right and just.
That situation was exactly parallel to the present one. I well remember Sir Thomas Padmore, perhaps one of the most able of the higher staff at the Treasury, reporting to the Royal Commission that the only reason why the doctors had not received their pay or had their case considered by the Government was that at that time there was a pay pause; it was a time when the Government could not consider anything like that because of the general economic situation. That seems to be very much the present position with the nurses and the other auxiliaries in the Service.
The debate has raised the whole question of the way in which wages and salaries in the National Health Service 1286 are to be settled. The Whitley Council scheme has proved an utter failure, because in the Service there is not just a management side and a workers' side, for the management side has the overlord of the Treasury behind it, and this arbitrary power has made the situation quite unworkable. Is it not time for the Minister to stop treating the management side as office boys to the Treasury, to convey his wishes?
Has the Minister not enough faith in the people he appoints to regional hospital boards to be able to leave them to exercise their capacities of leadership and judgment without having this very tight rein on them all the time? Before any of them can move, they have to ask, "Please, sir, may we?" I do not want to go into the dilatory performance—in August, the management side not ready to reply; September, again; October, again. Each time the management side had not formulated its views. In fact, it could not make any genuine offer, could not negotiate, because of the over-riding strictures placed on it by the Minister and by the Treasury.
The only chance I can see of there being any real, constructive forward development in the relationships between the management side and the workers' side, between the Minister and the management side, is for the Minister to show a little more faith in the people appointed and a little less of the schoolmarm attitude. The people in the Service are devoted to it. Let the Minister give them a little credit for knowing what is right and wrong, and if, occasionally, he finds that he has to pay a little more than he would have wished, let him remember Danckwerts, which although being more than was intended, was soon absorbed. Let us have more of leadership, and less of the doctrinaire approach.
§ 5.20 a.m.
§ Mr. Anthony Fell (Yarmouth)
It seems to me that Conservative policy on wages must be based on the fact that a person must be rewarded for skill, efficiency, hard work and general ability. On the edge of my constituency, two miles from where I live in Norfolk, there is a great mental hospital called Plumstead. The Minister will know about it. It is one of the most advanced 1287 mental hospitals in the country. In charge is a dedicated doctor, perhaps one of the most respected in the country; and supporting him is his head male nurse. Because of the work of the head male nurse, Doctor Morris has been able to concentrate on improving the hospital and on thinking up new ideas and working out new routines. There are no regular hours for this man. This head male nurse is highly trained and skilled; I suppose—I am not well versed in these matters—that he is the equivalent of a top matron in a hospital. I have not heard a complaint from the doctor that he is not getting sufficient pay, but I have frequently heard complaints from the head nurse and from the doctor about his rate of pay.
On what should we base this man's salary? It is all very well to talk about the pay pause as though it were something that is good. It is good only in so far as it has become a necessary evil to make up for our inability to run our economy properly. Is the pay pause to be a permanent feature of our economy? Shall we have a pay pause of some sort until April and then another sort of pay pause following that? What will be the situation? How are we to get over the difficulty of not having sufficient production? I should have thought that we should reorganise, and it may be that the Chancellor of the Exchequer is hoping to do that through his committee.
It will be terrible for the trade unions, but we must reorganise our whole system of wage payment. Unless we can get to the point where a person doing a really good job of work can be paid according to merit, I do not believe that we shall ever get a healthy economy.
To give an example, I understand that in the docks, if there are ten men on the list and there happens to be some overtime to be done, they will be called in strict rotation even though one of the men is known to be a slacker. Obviously, this makes a nonsense of any sort of wages policy based on individual worth and not on the lazy methods of the trade unions which is so liked by the unions and the managements and which has been built up over the years. Of course there are slight differentials, but, naturally, they are based on a flat rate for everyone whether they be good, 1288 bad or indifferent. We must somehow get over this difficulty for otherwise we shall never get the high rate of productivity which is essential if the Minister of Health is to be able to pay the nurses, both female and male, the physiotherapists and others what he would like to pay them.
There is one other point I wish to make. I am not going to indulge in any sentimental talk about the nursing profession because my wife was a nurse for many years and she would not like me to be sentimental about nurses or about the profession, but I want to ask this one question. It is all very well, but if we are to pay people the rate for the job, how are we going to assess what we should pay the nurses? It is all very well also to say that nurses had a 20 per cent. rise, or whatever it was, two years ago and another 5 per cent. rise a year ago. That does not prove anything. It all depends on what they were getting before.
I believe that when my wife was a nurse she was taking away about 12s 6d. a week, and loving being a nurse but not loving very much the 12s. 6d. a week. How are we going to set a standard? Is a car worker earning £20 a week engaged on a mass production job really worth all that much more than, say, a ward sister or a staff nurse who is, perhaps, assisting in the theatre and working in high temperatures for many hours a day and working with the greatest conceivable skill? How is one to assess worth?
I doubt very much whether the car worker earning £18 or £20 a week is worth any more at all than the nurse in terms of work. Therefore, we are faced with the great difficulty of how we are going to settle the matter. I am sure that the Minister of Health, unlike some who have spoken, wants to do a lot in the way of raising salaries in the medical profession, but he cannot do it because he is caught up in our failure to do what the nation must do if it is to be able to indulge not in the luxury but the necessity of paying its most faithful servants adequately.
At some time we have got to decide what these people should be paid and not what we can get away with as the minimum rise which they can be given at any one time. But we can only do that by the success—and it rests completely 1289 on the success of our general economy—of our industry. We can only have success in industry if we get away from the present deadening effect of a bad system of paying wages. That is going to be a difficult task and one that will tax the ingenuity, (the guts and the strength of any Government. But even more will it tax the strength and courage of the trade union leaders and of management in the country. If we do not achieve success, we shall continue to have this sort of debate in which Ministers are put in an impossible position. At the moment the Minister cannot break the pay pause; he has to support Government policy. The Minister's hands are tied until we have more money available, and that depends on our industrial productivity.
I should like to see us reach the stage where we could pay the nurses considerably more than they are now geting. This is urgent. It is also very important that we should get our sights right for such professions. The differential between the nursing profession and certain other professions is far too great, and the differentials within the profession between young trainee nurses, staff nurses, ward sisters and matrons are not nearly large enough.
I hope that the Minister will consider these things very carefully and persuade his colleagues to get cracking on a wages policy which will enable us to be a prosperous nation.
§ 5.32 a.m.
§ Mr. Michael Cliffe (Shoreditch and Finsbury)
The debate has followed the pattern of that some three or four weeks ago when we discussed the Government White Paper on the reorganisation of London local government. On that occasion almost every hon. Member opposite who took part wholly or partly disagreed with the Government's policy, but when it came to the vote they found their way, with the exception of three, into the Government Lobby.
The same thing is happening in this debate. Very few hon. Members opposite have found themselves wholly in agreement with the Minister. In fact, most of them have been critical of the Government's present policy for nurses and their profession. But this time they are saved the embarrassment of having to vote.
1290 If we did not know the situation that exists in the hospitals in respect of staffing, we should have assumed when the Minister spoke about 10 hours ago that everything in our hospitals was flourishing—that they had all the doctors that they required, and also all the medical staffs, including ancillary services.
The Minister made no reference to the acute shortage of nurses and the desperate shortage of midwives. Strangely enough, I have received a document which comments on advertisements for staff which have appeared in various medical journals. It states that at a Leicester hospital the nursing staff are to be given an 88-hour fortnight and in order to do this 183 beds are to be closed down, and this at a time when there are 6,786 names on the list of people waiting entry for treatment. The same could be said of Farnborough. A heading in one newspaper reads:Shortage of nurses hits three Sussex hospitals.In December, South Shields appealed for nurses and two wards were closed. In the same month the West Middlesex Hospital advertised the vital need for nurses. As for mental hospital staffing, the Aycliffe Hospital is 50 per cent. below establishment. One of the nurses concerned writes:… it happens quite often that one man finds himself in charge of 120 patients.Similar remarks are made about hospitals in Birmingham, Tolworth, Bolton, Minehead, and Skegness. That is a fair sample of the country as a whole and it has already been established in Ministry of Labour returns that there are about 26,000 vacancies in the hospital service.
What is true of the staffing situation throughout the provinces is equally true of the position in London. This offer of 2½ per cent. by the Minister is insulting. It has to be said that it was the Minister who made the offer, because the employers' side of the Whitley Council were not able to consider the merits of the case and make an award accordingly. The instructions came from the Minister telling them how much they could give.
It would have been far more decent if the Minister had given instructions to the employing side to adjourn any further discussion of pay increases until 1291 after 2nd April. To offer nurses a 2½ per cent. increase is to insult them. We can well understand the indignation of the nursing staff, and not only in the London hospitals. Hon. Members on both sides of the House have received letters protesting and expressing indignation at the offer made.
I have received sixty letters, but I want to read only one. I have letters from three matrons. Rarely do they write to their Members of Parliament asking them to help in any way. I know very well the matron whose letter I am about to quote and that her purpose is to obtain support from Members of Parliament to ensure that their case is properly heard and that justice is done to their request for increases. She writes:I am writing to ask for your support in our claim for higher salaries … I am matron of a geriatric hospital which is a training school for State-enrolled nurses. I am, therefore particularly interested in the salary paid to the pupil nurse and the State-enrolled nurse. The pupil nurse's salary commences at £299 per annum. From this money, there are deductions for National Health Insurance contributions, superannuation and £128 per annum is deducted for board and lodging. The second year the salary is increased to £315, with deductions as for the first year.On becoming a State-enrolled nurse, the salary commences at £452 and over a period of six years, in increases of £21 per annum, a maximum salary of £578 is paid. No matter how many years' service is given, the maximum remains unchanged. Deductions are made as above, but with an increase of £37 … for board and lodging.This matron says something about what the ward orderly can earn, and she goes on to speak about staff nurses:State-registered nurses are also underpaid and, consequently, many of them leave this country on completing their training for Canada or the United States of America, where they receive a much higher salary.She relates the salaries which have been referred repeatedly throughout this debate, and she concludes:We are rather tired of hearing that there are more nurses employed in the Health Service than ever before, but many of the student nurses in training are from overseas and intend returning home when they have completed their general and, possibly, their midwifery training. This means that we are, and will be in the future, short of trained nursing staff. I do ask for your support in this matter, for without suitable remuneration we can neither recruit nor retain nurses in the service.1292We know that nothing we do must jeopardise the service which we give to our patients. We are opposed to any form of restrictive practice by working to rule or going slow or strike.P.S.—I have just seen two advertisements in in the Nursing Times for two staff nurses required in Canada",for which the salary to be paid is £1,213, rising to £1,378 over a three-year period. Another advertisement is for a State-registered nurse for the Toronto General Hospital, at £104 a month. These are the kind of conditions which attract a good many of our trained, qualified staff to Canada and the United States of America.
While it may be true that more people are now training to be nurses and that there has been an increase in the numbers qualifying in midwifery, that is not the case in my constituency.
About 99 per cent. of the patients in St. Matthew's Hospital in my constituency are senile. Most of those who come into the hospital do not leave it until they die. While this may be a laughing matter for hon. Members opposite, I visit this hospital every week and I think that the nurses there are kindliness itself. They must have hearts of gold and a deep-rooted affection for these old people, because they do for them all sorts of things which, frankly, I could not do. Some of these old people are so frail that one feels that if they are touched they will break. The nurses handle them kindly and try to make what is left of their lives as comfortable as possible.
I know that hospital and its nurses well. Whatever else has happened in the nine months of the pay pause, the Minister ought to consider increasing what is now his insulting offer to the nursing profession, for I am sure that no industrial union would use it as a precedent for forcing its wage claims. I would like that increase to be given even before the setting up of a Royal Commission to examine the whole of the salary scale within the hospital service. If anyone is entitled to considerable sympathy, even if the Government insist on their pay pause after 2nd April, it is the nurses. Such a gesture would remove the atmosphere which has grown up in a service in which at one time, regardless of local elections, there were no politics. Hospitals workers were very canny about their politics if they had 1293 any. Now that they have taken this stand, I hope that something will be done for them.
§ 5.50 a.m.
§ Mr. William Whitlock (Nottingham, North)
The last three spokesmen from the Government side of the House have spoken longingly about a national wages policy. They have a peculiar way of going about creating the kind of atmosphere in which a national wages policy is possible.
The British people are a fair-minded people. If the Government say to them, "We are in difficulty", explain that difficulty and admit that it is due to their own mistakes and if in those circumstances there is equality of sacrifice, the people will accept the position and respond. Precisely because there is no equality of sacrifice so much feeling is engendered among people in the professions we are talking about. My hon. Friend the Member for Southampton, Itchen (Dr. King) said that there was no conflict in the tribute paid to the nursing profession by both sides of the House. The Secretary of State said that there were champions of the nurses on both sides of the House. Some of the champions opposite were very uncomfortable in that they hopped absurdly from one leg to the other. They admitted that the wages of nurses are far too low and that all is not well with the Health Service, but on the other leg they agreed with the Minister that after all nurses should not have more than a 2½ per cent. increase in salary and that after all things are not so bad in the nursing and other professions.
There were certain honourable exceptions to this. One was the hon. Member for Belfast, East (Mr. McMaster), who seemed to adopt a firm two-legged stand and completely supported the nurses' claim for an increase. Then he went away. Apparently he was waylaid somewhere around the Palace of Westminster by the Whips and driven back to the Chamber to admit in an interjection that the speech he had made was, after all, on one leg and, had he the opportunity, he would make a speech on the other leg and back up completely the attitude of the Minister of Health. All this is humbug which will be apparent to members of the 1294 nursing profession when they read the details of this debate.
Some hon. Members have objected to the mention of Florence Nightingale. I apologise for mentioning her name again. I am prompted to do so because a nurse in my constituency has written to point out that Florence Nightingale was a woman of means and had no reason to concern herself with the remuneration of those who dedicated their lives to the service of others. From the time of "The Lady of the Lamp" it has been argued that the people in this profession have not been at all interested in or concerned with material rewards. The letter I have received says, somewhat bitterly, that perhaps there is a need to say that members of the nursing profession are not likely to be less dedicated if they are in receipt of a salary which is more than a paltry pittance, which is what so many of the profession are receiving. If now they ask for more in a stronger voice than they have ever used before, they are still nevertheless Florence Nightingales and, in these days, Frederick Nightingales. They are still the wonderful and devoted people they have always been. Every Member of the House knows that, should he have the misfortune to have to go into hospital, he will receive great kindness, infinite care and every possible attention.
The injustice which has been meted out to the nursing profession is building up a bitterness in the minds of nurses which I have never known before. I have a letter here which ends,Yours faithfully, the underpaid and undersigned staff …".The letter is signed by what appears to me practically all the nursing staff of one hospital in my constituency, and the signatures are headed by that of the matron. Her signature is indicative of the feeling which exists among members of the profession now. This is revolutionary. As some of my hon. Friends have pointed out, it is exceptional for matrons to behave in this way. They have always been greatly concerned for the welfare of the staff under them but very seldom have they thought it wise to associate themselves with any kind of organised move for improving salaries. That this matron has put her name at the head of the signatures to the petition I have received shows that she sees 1295 all too clearly that, unless something is done about the pay of the people in her profession, great harm will be done to both her profession and the Health Service.
We have traded for far too long on the sense of vocation of nurses. We must start looking in an entirely new way at the essential human fabric of the Health Service. If we do not do that, undoubtedly, in the not too distant future, the patients in our hospitals will begin to suffer.
I come now to the subject of physiotherapists. I have recently asked several Questions about the shortage of physiotherapists in Nottingham. I have been answered by the hon. Lady the Parliamentary Secretary. On 26th February, she admitted that in the Nottingham hospitals there was a deficiency of 16 physiotherapists, but, some time after this debate began, I received a letter from the hon. Lady in which she says:In my reply to your Question on 26th February I said that the present staff, in whole-time equivalents, was 26 and that the Regional Hospital Board aimed at recruiting 16 more. In terms of posts formerly filled and now vacant the vacancies of staff, in whole-time equivalents, amount to one deputy superintendent physiotherapist, four senior physiotherapists and one and a half physiotherapists in the basic grade—that is a total of six and a half.I wonder whether the hon. Lady is being a little less than frank in that letter. Is the deficiency of 6½ of which she speaks assessed only in terms of posts formerly filled and now vacant, or are the vacancies assessed against the recognised establishment of the hospital? To put it in another way, is the deficiency assessed on the basis of figures which include not only posts formerly filled and now vacant but also on newly created posts yet to be filled?
If it is the latter, there must have been some very recent and unexpected increase. The hon. Lady's figures do not accord with my information, which is quite recent. If it is the former, then it seems to me that the hon. Lady is endeavouring to put up a smoke-screen solely for the purpose of this debate in order to conceal the true position in relation to physiotherapists in Nottingham. On 5th March she admitted that some posts in Nottingham had been vacant for up to three years. On 12th March, 1296 when I asked what steps had been taken to overcome the shortages, she replied that the regional hospital board intended to open a school for physiotherapists in Nottingham. Again, I have to say that it seems to me that the hon. Lady was less than frank, because on the day after she answered my Question the Nottingham Evening Post got in touch with the Deputy-Secretary of the Sheffield Regional Hospital Board, and that gentleman admitted that the plan of which she talked—of having a school for physiotherapists in Nottingham—was still in its early stages, and that he could not give a definite starting date for the school.
The newspaper credited the gentleman with the following remarks:It will certainly not be within a year. We hope to be able to make a start within five years. The final decision to proceed with the school will depend on the assurance that teachers are available. We have wanted to have a school in Nottingham for years, but the shortage of teachers has been the main reason why it has never been possible to do so.It takes three years to train a chartered physiotherapist. Even if the school starts in 1963, therefore, it will be 1966 before we have qualified physiotherapists coming from it, and if it does not start until 1967 we shall have to wait until 1970 for them. The new school will do nothing at all to meet the problem of keeping people in once they have qualified, nor to relieve the shortages that exist not only in Nottingham but also in Derby, Leicester, Mansfield, Sheffield, Doncaster and Lincoln—and I have particulars of shortages in the hospitals of all those towns.
One of the vacancies in Nottingham is for an Assistant Superintendent, who left last August and whose position has still to be filled. He left because his salary was not high enough to enable him to obtain a mortgage on a house. A physiotherapist has to have five passes in G.C.E. and has to undergo three years' training. The salary he has at the end of that time is £525, rising by six yearly increments to £650 in the basic grade. As the hon. Member for Harborough (Mr. Farr) pointed out, a traffic warden is better off. He needs none of these educational qualifications and does not have to undergo long training, but he will receive between £600 and £670. People leave the service, and those who remain are increasingly frustrated by the 1297 ever-mounting work which is thrust upon them, and by the consciousness that the waiting lists of people wanting treatment are constantly growing.
In one hospital in Nottingham a large proportion of all cases are brought in by ambulance from far distant points, and such is the pressure upon physiotherapists that each one can spend very little time with those patients. I gather that the average time spent on people brought in for treatment from areas many miles away is no more than 5–8 minutes. We need more physiotherapists and we need more teachers, and the problem is that the teachers, too, are emigrating.
In December I had correspondence with the Parliamentary Secretary which admits that only about 50 per cent. of all births to mothers resident in Nottingham take place in hospital. That means that there has been little if any improvement since 1957. No other town of similar size has as low a percentage. The national figure is 65 per cent., and the 1959 Report of the Maternity Services Committee recommended the provision of beds for 75 per cent. of all confinements. We have a very long way to go in Nottingham. Although I have no up-to-date information about the percentages, I have no reason to suppose that they have vastly improved since those which I have quoted were given to me.
On 29th December the Parliamentary Secretary wrote to me as follows:In Nottingham and elsewhere the problem is not primarily a shortage of women qualified or qualifying as midwives but rather a shortage of those willing to practise their profession. If all who qualified worked in the profession for a year or so most needs would be met. Clearly the problem is one of finding ways and means of making the practice of midwifery more attractive and of making better use of those who are practising. With this in mind the Minister earlier this year issued to hospitals a memorandum of guidance on action they should take in this matter.Improved physical conditions for both patients and staff are highly desirable, but in the directive which the Minister sent out he said nothing about the greatest factor in attracting more mid-wives to remain in the profession—the need for improved remuneration. Unless something is done soon to stop this wastage of people who have come from the schools and have been trained, and to attract recruits, the whole Service will 1298 break down and the blame for the breakdown will rest squarely on the shoulders of hon. Members opposite.
§ 6.8 a.m.
§ Mr. G. M. Thomson (Dundee, East)
At this time in the morning the House is beginning to look like one of the older and more out-of-date waiting rooms in one of our more obsolete hospitals, where the understaffing and lack of nurses leads to people lying around on benches for very long periods waiting for something to happen. At this stage I do not wish to prolong the agony of hon. Members opposite for very much longer.
But hon. Members on both sides of the House are conscious that in the debate we have been discussing particularly the case of the nurses of the country. As these nurses as a matter of course work through the night in order to look after members of the community when their services are needed, the least that any of us can do when we feel strongly the need to have their pleas expressed in the House is to be prepared to carry on until all the various letters which all hon. Members have received have been given some expression.
Before going on to the plea for nurses and the other workers in the medical service, I should like to take up with the Minister a point with which he began his speech. That was the question of the number of doctors who are emigrating from this country and the kind of losses which the community is suffering. My hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) demanded that the Government should make a thorough inquiry into what were the actual facts. I hope that the Minister is right in the optimistic view he takes and the feeling he expresses that the figures of losses of doctors by emigration are in fact exaggerated, but the truth, of course, is that the Government do not really have the slightest idea of what the situation is, and the reason for their not having the slightest idea is that they have dealt with this problem of emigration from this country of doctors and other skilled people with the same sort of muddle and incompetence as they have been dealing with so many aspects of the Health Service.
It was only very recently that the House debated the renewal of the provisions in the Commonwealth Settlement 1299 Act. That Act raised the question of the utter inadequacy of the statistics of emigration from this country. Indeed, we are the only country in the world, I think, which is without this kind of information as to what is happening about its population going from its borders and about people coming into the country. The Government have been repeatedly pressed by their own advisory committees on the need for these statistics. The reason why the Government have not got those statistics is a characteristic one. We have had a good deal of talk tonight about Florence Nightingale, and some of the speeches we have had from hon. Members opposite have rather indicated that some hon. Members opposite still feel that the nursing profession ought to be able to be run with the kind of spirit which existed in the time of Florence Nightingale who, as my hon. Friend pointed out, was a lady of independent means.
By lack of information about doctors emigrating from this country the Government show that they are still in the pre-airline age. The astonishing fact is that the existing power which the Government have to obtain these figures relates to long sea voyages from this country, and the Government have never given themselves power to get figures of those who emigrate from this country by means of aeroplanes. Of course, the great majority of professional people, like doctors, who choose to emigrate, do so by airlines, and for this reason nobody knows for certain exactly what kind of people are leaving the country and in exactly what numbers. I think that the Government are overdue in taking the necessary powers to get these essential figures.
The very least we ought to know in our present circumstances, if we are to plan the life of this community in many different aspects, is what is happening to our population, who goes from it, and what kind of people are entering the country. I hope that the Government will respond to the plea made by my hon. Friend and that there will be a thorough investigation into this and that we shall get the facts. I hope that the facts turn out to prove the case the Minister believes; but we simply do not have the facts, and we ought to have them.
1300 I wish to pass from that to the position of the physiotherapists in the Health Service. Like my hon. Friend the Member for Nottingham, North (Mr. Whitlock) I have been pressing a Minister about this. I have been pressing the Secretary of State for Scotland about the poverty of the physiotherapy service in Scotland. I am bound to speak of it particularly in relation to my own constituency, but I have no reason to think that the situation which exists in Dundee is any different from that in other parts of Scotland or, judging by the speeches I have listened to during this long debate, in other parts of the United Kingdom.
The fact is that in the City of Dundee the present establishment of physiotherapists is rather less than half of what it ought to be, and this is leading to some really deplorable results in terms of medical treatment in the city. For instance, to take one simple example, in the Fairmuir School in Dundee, a school for backward and handicapped children, it is impossible at the moment to provide them with any proper physiotherapy services, and those children, whose need is particularly acute for this kind of help, are simply not getting it adequately because the physiotherapists are not there.
Again, at the geriatric unit of the Victoria Hospital there are no physiotherapists to provide their essential services to old folk. Dundee takes a legitimate pride in its geriatric services, but we are gravely handicapped because, owing to the very poor reward offered, we cannot fill the posts. There is a very long waiting list at the Dundee orthopaedic and rheumatism clinic and, in order to keep it down, those concerned have had to stop using physiotherapists altogether in connection with the limb-fitting centre.
I have given a series of examples of people in acute need of these services, but not getting them. There can be no doubt that all that is caused by the pitifully inadequate salaries offered. Reference has been made repeatedly to the offer of a starting salary of £525 a year to physiotherapists—a quite ludicrous figure—but even the superintendent physiotherapist in Dundee only has a salary of between £710 and £870 per annum.
1301 On the other hand, the Dundee football club recently advertised for a physiotherapist to look after its players at a salary very considerably greater than that being received by the superintendent physiotherapist at the main teaching hospital in the Eastern Region of Scotland. I must confess that that football club has recently been showing some need for a good physiotherapist, but it is now recovering, and looks as though it may yet be able to win the League championship.
All the same, it really is utterly cockeyed that a physiotherapist looking after twenty or thirty professional footballers should command a salary so much in excess of that received by the man in charge of that part of the Health Service in a city with a population of 200,000. That illustrates the utter immorality of the kind of situation created by the scale of values adopted by the Government in their approach to the problem.
From the physiotherapists I move to the nurses. In the Eastern Region of Scotland the Government seem to be trying to solve the nurse shortage by the simple method of so planning the future of the Health Service that the number of hospital beds will be very substantially cut. The Government's record in the planning of hospital beds is deplorable. My hon Friend the Member for Greenock (Dr. Dickson Mabon), who has much more experience of these matters than I have, complained that the Government were repeatedly making magnificent plans on paper, but that one seldom saw any physical results on the ground. That is spectacularly true in the Eastern Region.
Dundee is the site of the first new teaching hospital to be built in Scotland for many years. That hospital was announced with a considerable fanfare of trumpets in February, 1955—as part of the preliminary propaganda for the impending General Election. We had another General Election in 1959 and, again, this great new teaching hospital was a piece of window dressing for it. To be fair to the Government, it is true that some advance had by then been made; by that time we had a rather splendid model of the hospital. That model continues to be steadily improved and, judging by the way the 1302 Government are going, we shall soon, beyond doubt, have the most perfect model of a hospital in the world.
It is only recently that I obtained from the Secretary of State for Scotland the disastrous information that the starting date far this hospital has been postponed until 1964 and there are doubts in Dundee whether it will be started then. It may not start until 1965 and it will take six years to complete, so that we shall not have the hospital until 1970 or 1971. The only consolation is that perhaps in due course a Labour Government may be able to take some electoral credit for the completion of this hospital.
I am puzzled by the Government's figures about hospital beds. In the Eastern Region of Scotland they are proposing that by 1975 the number of hospitals beds in the area shall be cut to about 770. In the Western Region the number is to be dropped by about 1,000. This is estimated on the basis that the number of beds needed for acute cases in the area will be substantially less by 1975 than now.
I have tried to follow the medical reasoning given in the Government White Paper on this matter, but it seems extremely doubtful, and I know that many people whose opinions are more valuable than mine feel that that will not be the situation at all. It looks as though the only contribution from the Government to ease the situation caused by the shortage of nurses is to plan the hospital expansion in such a way that the number of hospital beds at the end of the period will be substantially less than now.
Everyone feels that the offer of 2½ per cent. increase for nurses was not only completely inadequate but an insult to a group of people who are held in particularly high esteem in the community. The only argument in favour of that figure is that it is all the Government can give them at the moment in the light of the general economic situation and the need to maintain the pay pause. That is a shocking statement to come from the Government.
The hon. Member for Yarmouth (Mr. Fell) who in many ways made a most interesting speech, after saying that in a decent society nurses ought to be paid 1303 more generously, added that in the present circumstances it was impossible for the Minister to break the pay pause by doing the right thing.
§ Mr. Thomson
Surely the position is that the economic crisis which has been used as a justification for treating the nurses so unjustly is a crisis of the Government's own making. The hon. Member for Yarmouth gave us some old-fashioned Conservative philosophy, some pre-Macmillan, pre-"You're all right Jack" philosophy, and came near to expressing a point of view which is very acceptable to hon. Members on this side of the House. He said that it was an unworthy society in which nurses were paid such a niggardly reward, while other people, whose services to the community were less worthy, were being paid more generously.
Unfortunately, the hon. Member compared nurses with workers in a motor car factory. It would have been more accurate and illuminating to have compared a nurse with a property speculator or someone making a tax-free fortune on capital gains. That would have indicated the times in which we are living. Of course, it is a fact that for years now we have had a Government who have given that kind of people their head, who have worked on the basis that if people have a flair for making money, if they have a streak of unscrupulousness or an ability to do well for themselves, they ought to have freedom to go ahead and to make as much money as possible, and that as many as possible who can do this should be allowed to do it.
What has happened is that these people in our society have done well. Alongside the people with money-making ability are the people who have been able to organise themselves either in industrial trade unions or in such bodies as the B.M.A. so that they have been able to protect themselves. But the people whom we are discussing, the nurses and others, have been left out because of the economic climate which the Government have deliberately created.
In the medical services of the country today we have the nurses and others 1304 who do a job which demands a sense of vocation and of dedication, people who do this vital job for the community of helping to cure our ills. But these are the very people who are being asked to bear the brunt, the main burden and sacrifice, of helping to cure the ills of a society which have been created by the Government's policies.
This is what is so utterly wrong and so completely indefensible about the Government's position in the matter. Nurses have been poorly paid, insultingly paid, precisely because the Government have run the economy in the way they have in recent years. When hon. Members on this side of the House make the plea for the nurses and others, they are not only speaking up for their constituents but are making, quite legitimately, the kind of criticism of the Government that lies at the heart of the difference between the policies of the Conservative Party and those of the Labour Party. Had a Labour Government been in office this situation would not have arisen. No Labour Government would have allowed those in the public service section of the community to be made the victims simply because they allowed those who had the economic power to forge ahead without regard for the health of the community as a whole. This is our indictment of the Government and this is why we have kept the House up so late. I believe that it has been justified.
§ 6.28 a.m.
§ Mr. Michael Foot (Ebbw Vale)
Like my hon. Friend the Member for Dundee, East (Mr. G. M. Thomson), I think it is quite right that the House should have continued this debate even though we have gone on for a very long time and even though some of the things that have been said are naturally repetitive. It is right that the Minister should be told the feeling that exists in many parts of the country.
Before dealing with the more general matters which have been debated, I want to return for a minute or two to the case which was raised by my hon. Friend the Member for Oldham, West (Mr. Hale), the case of Mr. Arnold Tweedale, to which the Minister replied promptly at the time. I wish to say at the outset that I am quite certain that the Minister would not fail to deal with that case, 1305 or the other case which my hon. Friend raised, through any lack of care or courtesy. I am sure that he would not. I am also sure that anyone who does not recognise the personal high qualities of the Minister of Health is a fool. But my complaint, and the complaint of many who have spoken in the debate, is that the Minister is a doctrinaire high Tory and believes in a quite different kind of Health Service from Chat which we hoped was founded in this country in 1948.
The right hon. Gentleman has never disguised his opinion about the Health Service and he therefore approaches the matter in a quite different way from all of us. But I do not think that the right hon. Gentleman would approach the question of the appointment of particular people in an area in a prejudiced manner. However, as I understood it, the reply of the Minister to my hon. Friend was that he did not have any power to deal with such a case as this.
I am interested in the case partly because I happen to know Mr. Tweedale very well. I can certainly confirm all the high tributes paid to him by my hon. Friend. On occasions when I have been to Oldham I have been able to see something of the immense part that he plays in public life there. Everybody holds him in the very highest esteem. I had not previously heard that he had been removed from the hospital committee, and I was absolutely shocked to hear the statement. This seems to me to bear all the outwards signs of a first-class political scandal.
How is such a matter to be probed? It is easy to make such charges, but it is very difficult to prove them, and it is very difficult for a Minister to disprove them. How is such an accusation to be dealt with? The Minister apparently says that he has no power whatsoever to intervene in such a case. If that is the correct interpretation of the Act, it seems odd, because it means that a Member of Parliament is entitled to raise in the House something that may happen in a hospital, such as whether someone has given the wrong treatment, but he is not entitled to raise any question about those who are in charge of administering the service there.
The Minister may be able to say that this was all laid down in the 1948 Act. I should need to be convinced that that 1306 is absolutely the case. If his retort to my hon. Friend the Member for Oldham, West is that he is absolutely excluded from intervening in such a matter, then he ought to alter the law and secure such powers. It is intolerable that we should have a situation where there is apparently, according to the Minister's explanation, no remedy and no appeal to him. I can well understand that Ministers of Health want to keep away as much as possible from the detailed appointments to hospital committees—that is natural—and to delegate some of their power, but they could surely delegate most of their authority while still retaining a final appeal to the Minister. I hope that the Minister will consider the matter very carefully.
References have been made to one or two other cases. Allegations of this kind are bandied around very frequently—that political bias may have been used in appointments or that other improper pressures may have been used. Those are very easy charges to make. However, I do not think they would be pressed very often. Indeed, the very fact that such cases are rarely referred to in in the House of Commons stresses the importance of the case raised by my hon. Friend the Member for Oldham, West.
From the mass of letters that my hon. Friend read there is no doubt about the stir which has been caused in Oldham by the case. So I hope that the Minister will reconsider the matter afresh very carefully to ascertain whether he can intervene. If he is prevented by law from so doing, I hope he will consider amending the Act in order to restore to him in respect of this part of the Health Service the might that he possesses over the whole of the rest of the Service. When Aneurin Bevan founded the Health Service one of his paramount aims was that the Minister should be responsible for every aspect of its operation. The Minister may say that in this one respect he did not carry that through for reasons which he may have thought satisfactory at the time and that he specifically did the opposite. Even if that is the case the Minister should reconsider it, because it is utterly anomalous that apparently there should be no remedy for such a state of affairs. An appeal can be made only to the regional hospital committee, and they are the 1307 people responsible for the misdeed, if it is a misdeed. We cannot have a situation in which there is no possibility of appeal in such a case.
To turn to some other aspects, I have listened to most of the debate, except for the Minister's speech, and I have already apologised for missing that. I heard the Secretary of State for Scotland who said he was repeating the Minister's speech. I am sure that he did not do it so eloquently as the right hon. Gentleman but I had from him the general hang of what the Minister said at the beginning. I have never before heard a debate of so many hours in which there was such a deep conflict of testimony about what is happening. I do not say that the Minister said that all things were well in the Service. He is too clever for that, but he gave figures to show that they were going better now than they were five or ten years ago. I do not say that the right hon. Gentleman was complacent, but he was trespassing very near complacency in describing the state of affairs in hospitals and the position of nurses, and particularly their payment.
The Minister's testimony is that there is nothing much wrong with the present situation, pay pause or no pay pause. But the testimony heard from both sides of the House absolutely conflicts with that. I do not believe that there has ever been an occasion in the House when so many letters have been read out from matrons and nurses giving their testimony which absolutely conflicts with that of the Minister—and the same evidence has been offered from both sides of the House.
Here we are in March, 1962, and the Government's claim is that things are pretty well all right in the Health Service, in particular, and they are all right as regards the recruitment of nurses and doctors and other people in the Service. That is the Minister's claim and what he stands by. We shall have to see whether that is the case and whether it prevails over the years ahead. The right hon. Gentleman has claimed that today, in defiance of all the statements and evidence that have been produced from all over the country by pretty well all who have spoken in the debate.
1308 The Minister, on his evidence, says that things are pretty well all right. Nearly everybody else says that there is something deeply and radically wrong. I should have thought that the figures given by my hon. Friend the Member for Greenwich (Mr. Marsh) and others showed by themselves that there is something wrong. I do not know what the average wage in the country is now. It leaps upwards according to the statistics of the Ministry of Labour. I suppose that it is about £15 a week or even higher. The vast majority of people in the Health Service are not merely receiving a wage below the national average but one which is miles below it. That cannot be right on any test of the merits.
One of the most tedious things that ever happen in the House—and I do not accuse the Minister of doing it, although I think that the Secretary of State for Scotland did it—and heaven knows that is a serious charge to make, is when Ministers compare what is happening in 1962 with what happened in 1951 or 1950. It is an unfair comparison, and every Minister who makes it knows that it is unfair. If we are to make a fair, accurate and meaningful comparison we must go into the terms of trade in the past ten years.
If the Minister has a good case and things are as satisfactory as he claimed in his presentation of the case, he should be prepared to argue the case on its merits now: that is, to argue that nurses, physiotherapists and the others are getting a fair reward in our society today. Either he thinks that they are not or that they are not. If he thinks that they are, as, apparently, he does, he should say it openly and not shelter behind the pay pause; but on the figures given by my hon. Friend the Member for Greenwich, which have not been contested by the Government, I do not see how anybody could make that claim. I do not believe that anybody could listen to those figures and not recognise, not merely that the position is not right but that it is a disgrace on any test of the merits. All Governments should start on the basis that henceforward this is a disgrace which must be put right as quickly as possible, pay pause or not.
The other argument on which the Minister rests his case—although, if 1309 things are so satisfactory in the Health Service, he does not need to rely on this so much—is the question of the pay pause. He says that we have got to carry out the pay pause and protect from inflation the money which these people now get. That has been answered many times by my hon. Friends. Had the Government said that they were making an exception in the case of nurses, it would have been taken as a sign of grace by the Government and not used against them any more than the general argument is used against them. It would not have made hon. Members on this side accept the pay pause, but they would have understood what the Government were doing.
Other hon. Members, like the hon. Member for Heston and Isleworth (Mr. R. Harris) and the hon. Member for Yarmouth (Mr. Fell), go much more fully into the matter and say that it raises the question of a national wages policy. Of course it does. I am strongly in favour of a national wages policy. The country's affairs cannot properly be planned without one. The Government can solve the problems of inflation, in so far as they solve them, either by unemployment or by stagnation, or by a bit, or plenty, of both. To solve these problems of inflation, much more of the economy must be planned.
If the National Health Service is to be given its proper place in our economy, a lot of the rest of the economy must be planned to do it. However clever and converted even the Minister may have been judging from some of the pamphlets he wrote about the Health Service before he got to the Ministry—and he may have undergone some conversion since he got there—even if he was fully converted he could not carry through a great policy of renovating the Health Service as he should unless his colleagues had much greater power over the national economy. Part of the power which they should have over the national economy if they are running the country justly and fairly, is some control over wages, too, because inflation cannot be defeated otherwise. That is the Socialist case.
One of the reasons why the Minister is not given the power to make the National Health Service what it ought to be is because no Conservative 1310 Government wants the Service to succeed in the sense in which it was originally established. If it succeeded well, that would be a good reason for applying the same principle to many other operations. That is the last thing that the Conservative Government want.
The Minister must be working in a kind of financial straitjacket. All the time he is having to work out how he can switch expenditure in the Service so that he can do something for the hospitals; so that he has to damage one part of the Service to assist another. While he is doing this balancing act, the nurses do not get much of a look in with only 2½ per cent.
A proper Health Service cannot be run that way. When we talk of this affluent society, or whatever term is used to describe our present miserable condition, we find that the Health Service is squeezed. The Government have been doing it more and more for ten years and we now have the situation in which the people who actually run the Service are living in conditions which no hon. Member could defend.
This is a pitiable state of affairs. Hon. Members opposite voted against the Service, but we have always regarded it as the greatest and most imaginative idea in domestic politics since the war. Instead of looking to see how they can cut it, the Government should be considering what ought to be done to have a proper Service. Regardless of the right hon. Gentleman's views before he was converted when he took office, regardless of what he has been told by his Smart Alec Prime Minister, the right hon. Gentleman should be estimating how much is required to be spent on the Service, partly to remove the charges altogether, partly to carry through an appropriate hospital building programme and partly and perhaps primarily to ensure that those working in the Service have decent wages.
We have not been told how much it would cost. We have not even been told how much it would cost to give the nurses a decent wage. How much would it cost to make the Health Service an expanding service? It might be a lot of money and perhaps as much as £150 million, which is how much the Chancellor of the Exchequer was out in his last year's Estimates. That £150 million 1311 could be found if the Government really wanted to find it.
During the debate we have had a lot of sentimental stuff from hon. Members who have spoken of their lives being saved in hospital and so on. They have said that they are most anxious that our hospitals should be put on a proper basis. The difference between the two sides of the House is that most hon. Members on this side of the House want the money to be spent on the Service while the expenditure has to be forced on hon. Members opposite.
If it cost 6d. or 1s. on Income Tax to provide a proper Health Service, it would be worth it. In spite of the Minister's skill at parrying what would have been the allegations against him, I hope that he will go from this debate determined to fight the Treasury and at any rate to get a decent deal for the people for whom we have appealed in the debate and that he will work out what it will cost to make not a third-class Health Service which is not what we want, but the best Health Service in the world, which is what we once had and could have again if only the right hon. Gentleman showed courage and imagination.
§ 6.50 a.m.
§ Mr. Arthur Skeffington (Hayes and Harlington)
I am very glad to have the opportunity of following the hon. Member for Ebbw Vale (Mr. M. Foot) even at this early hour of the morning and adding my protest to the many which have been made from this side of the House about the mean and ungenerous action of the Government on the question of the pay and conditions of nurses and midwives and many others who do such valuable work in the hospitals.
I realise that with this hard-faced Government with its discreditable economic and fiscal policies our protest is not likely to get very far, but at any rate it will show the nurses and others outside that there are some here—and indeed some hon. Members opposite—who believe that the nurses' claim is morally and socially unanswerable and who are thoroughly ashamed of the ungenerous policy of the Government in this matter. I believe also that this demonstration through the night will 1312 help the British public to realise that it is absolute nonsense to pretend that the whole edifice of the British economy will collapse if we treat nurses and mid-wives justly and decently. We all know that after a decade of Tory rule our economy has been deteriorating every year because of the failure of their policies, but if in fact the economy is so vulnerable that if we treat nurses decently the whole question of British solvecy is at stake, then the Government should resign straight away.
This is not the case. This is a rightful claim which should be met, met fully and at once. The Government's case seems all the more hollow and cynical because, while Conservative hon. Members say how much they agree with the wonderful work nurses do but regret it is impossible to pay them properly without imperilling national solvency, at this very period the tax reliefs given in the last Budget and amounting to £83 million are coming into operation for one class of taxpayer—enough to meet this and many other just claims. An earnest of the speeches made by hon. Members opposite about the desirability of treating hospital staffs recently would be seen if Amendments were put down to the Finance Bill to reverse the £83 million concessions made to Surtax-payers. It is quite impossible to pretend that we cannot do the proper, just and decent thing for nurses at the same time as we make this extraordinarily large and generous gesture to Surtax-payers who do not contribute one tithe as much to the nation as do workers in the hospital services.
It is a curious fact but the Health Service workers have had a raw deal, not only from this Minister, but from a previous Minister of Health. It was not so long ago that a previous Minister of Health started this unsavoury course of interfering with negotiating machinery. Hon. Members may remember that it was in November, 1957, that the then Minister of Health vetoed a 3 per cent. wage increase freely negotiated through the Whitley Council. We find in the Health Service this first deplorable departure from what hitherto had been a respected working arrangement between those who employ public servants and the public servants themselves through the whole elaborate procedure 1313 of the Whitley Councils. This interference in 1957 with this freely negotiated award caused a great deal of cynicism and bitterness about the Ministry of Health. Its legacy will last for a long time apart from what has happened since.
The cynicism then engendered stemmed not only from the breach of the negotiating arrangements which had worked so successfully hitherto but from the way in which the Government were prepared to use arguments first one way and then another to suit the case which they wanted to advance at the time. In 1956, hon. Members on this side of the House pressed the Government to do something about the salary scales of various types of hospital workers, including physiotherapists, and we had made strong pleas, backed up by the facts of the case, to the Government. When, in 1956, we made approaches on these lines to the Government, the then Parliamentary Secretary to the Ministry of Health, the right hon. Lady the Member for Chislehurst (Dame Patricia Hornsby-Smith), who has now departed from that Ministry to lusher fields, rebuked my hon. Friends for suggesting that the Minister could intervene. This is the argument which the Government used on that occasion. On 8th February, 1956, the right hon. Lady said that it would be quite improper for the Minister to override a decision of the Whitley Council:The Whitley Councils are established on a recognised principle of negotiation, of joint councils of employers and employees. I have been somewhat surprised to hear… hon. Members suggesting that the Minister should intervene. In view of the authority that he carries, intervention could only mean that one way or the other he would be overriding decisions. It would be a complete contradiction of what we accept as joint negotiating machinery if he were to do so. My right hon. Friend believes that it would be quite improper for him to intervene in these negotiations."—[OFFICIAL REPORT, 8th February, 1956; Vol. 548, c. 1763.]Nevertheless, he successfully did so less than twelve months after that memorable enunciation of the doctrine of nonintervention, and, of course, we have since then got quite used to the Minister during it.
It is deplorable. What the Minister has done will wound the relations between the staff, the hospitals and the Ministry and so damage confidence in 1314 the Ministry that we shall suffer from its effects for years. It has added to the cynicism that the Government are apparently able to use any argument to Obtain the result they want, quite irrespective of the morality behind it. Nothing is more despicable than that.
It is no wonder that civil servants, local government officers and many others are now beginning at long last, I hope, not only to turn away from the Conservative philosophy but to see that it is no longer even associated with respectability or, in cases like this, with an ordinary sense of honour.
On the specific case of nurses and mid-wives and the subject of interference in their salary negotiations, I, like many hon. Members, have received letters from people who generally would never dream of troubling their Members of Parliament. They say—it is almost pathetic—that they would never dream of striking. Of course they would not. They will continue to render their service whatever happens. But they are asking how much longer the community can expect to take advantage of their position. There is a depth of feeling in these letters which I have seldom known before.
Furthermore, I have been much impressed by the fact that the letters have been individually written, but also in different language. I say frankly that, if I received a duplicated document—often rather badly duplicated—at the end of which someone has scribbled a more or less illegible signature, I am not greatly impressed that it represents a mass demonstration of true feeling. These letters, on the other hand, are individually written and couched in such modest terms that they are very moving indeed.
It is remarkable that this group of dedicated people should have felt the need to express themselves in this way. I never thought that I should receive a communication from the Royal College of Nursing saying that the history of the negotiationshas not been a happy one and nurses and midwives have had many disappointments in the agreements which have been reached. Nevertheless it is unquestionable that at no time has there been such disquiet and bitterness as has been aroused by the Management Side's offer of 2½ per cent. in response to a claim which had been before them for over six months.1315 The phrase "disquiet and bitterness" is used by a body which usually shrinks from this kind of expression. That is a graphic illustration of the deplorable relations which exist between the Service and its workers, which the Government policy has produced.
This must not be thought by the Minister to be merely exaggeration or emotion—as the Secretary of State for Scotland described it—on the part of the Opposition. We are affected by this only by what we ourselves know and by the letters that we have received. It is clear, judged by any test, that the salaries, or remuneration, or wages—whatever term one likes to use—of so many who work in the hospitals are deplorably low. It is a strange society that uses the kind of argument that we have heard from the Government today to prevent justice being done.
If we turn to the position of midwives we find that 80 per cent. of confinements still take place without the presence of a doctor, which means that the midwife has the full responsibility for the mother and the baby. Only where there are abnormalities or complications does other assistance have to be sent for. But we know that between 1955 and 1960 there has been a fall in the number of midwives—
§ Mr. Powell indicated dissent.
§ Mr. Skeffington
That is very extraordinary. The Minister shakes his head, but the figures to which I am referring have been sent out by the body representing the midwives. It is true that in 1961 there was an increase, but between 1955 and 1960 there has been a decrease of 500. The representatives of the mid-wives say that the increase in 1961 is due to the fact that some of the mid-wives who left and have since married have now returned to the service.
§ Mr. Powell
In fact, between 1955 and 1960 there was a substantial increase in the number in the hospital service, and an appreciable increase in the number in local authority employment.
§ Mr. Skeffington
Well, this is something in respect of which I am not taking what the Minister says as being the absolute truth, with respect to him. The figures I have been given are that in 1955 1316 there were 17,082 practising midwives in England and Wales and that in 1960 that number had fallen to 16,582.
§ Mr. Harold Davies
This is another example of the constant conflict of testimony that we have been having all the time. Some of us obtain local testimony which is completely different from that which the Minister gives the House.
§ Mr. Skeffington
At any rate, that is the information given to me. We know that shortages exist in this category in certain districts. If the position is better than my information leads me to believe—and the information comes from the professional body which looks after the interests of midwives, the Royal College of Midwives, which would hardly want to mislead Members of Parliament, and whose access to its registered members would seem to make its information fairly reliable—I shall be glad to hear it. But it still means that the case for their proper remuneration is unaffected.
When we think of the responsible work these people do and reflect that after seven years their wage may be only about £840, we realise what a strange society ours is. The most valuable job other than that done by a doctor is worth only that sort of remuneration. No wonder there are comparisons with many factory workers and transport workers. The wage is even less than traffic wardens receive, as one hon. Member pointed out. The position is quite unjustified by any of the circumstances described by the Government.
Apart from the justice and fairness of the claim of the nurses and midwives, if we do not provide better conditions we cannot hope to get the recruits we want. I am not impressed by the figures given by the Government. Obviously we want more time, and far more expert knowledge than I possess, to examine them. But we have heard lots of these general statements before and often, when they have been analysed, they have not meant what they seemed to mean at first sight, or they have been wrong.
The Willink Committee estimated a few years ago that we should have too many doctors, and so we cut the numbers in training hospitals by 10 per cent. We have had to reverse that decision since.
1317 I had a letter from a young midwife in my constituency, writing on behalf of her colleagues, in which she said, "I shall not be affected by whatever the Government do because I am going to the United States where my first job will give me a remuneration of £1,132, plus a number of additions." Hon. Members who have spoken have time and again given such examples or examples of the shortage of midwives and nurses. The editor of the Nursing Mirror said, "The days of the dedicated spinster are passing in the hospital service". We can no longer hope to cash in on that. We must modernise conditions, and one way is to ensure that the conditions and remuneration of nurses and midwives are more nearly adequate for the responsibility Which they undertake and the nature of their work.
We should all like to think that we have a Minister Who is on the side of the nurses and midwives in this fight. I do not mean that he is in any way lacking in appreciation of their services, but, as the hon. Member for Ebbw Vale said, I cannot imagine him going to the Cabinet and fighting for them. My hon. Friend the Member for Greenock (Dr. Dickson Mabon) said that the Minister reminded him of James I of England and James VI of Scotland, but that was not a wise allusion, for James I was described as "A wise fool", and nobody thinks that of the Minister—or, if anyone does, he is himself a fool. I can easily visualise the Minister, because of his old, doctrinaire Conservatism, rather more in the rôle of Torquemada, dressed in black, sending us to the fire for the good of our souls, particularly at this time of the morning after we have kept him up all night. But I pay tribute to the fact that the Minister has stayed here throughout the debate.
He has always believed in the profit motive as a regulator of our affairs. He believes in people paying for the Health Service, whereas we sought the decommeroialism of medicine and so to remove financial inhibitions of one bind and another. When one tries to introduce payment and part-payment, one inevitably creates a complicated system so that bureaucracy often spoils the general benefits of the Service and creates a difference in treatment between one part of society and another. This often induces some people to opt out of the 1318 Service. When that happens the whole basis of a high level comprehensive Health Service fails.
If the Minister will fight for the nurses and others in the hospital service at this stage, knowing that we are soon to have the Budget, he will redeem his political career as it will be seen in history; otherwise there will be a great sigh of relief from the nurses and from everyone else if he resigns.
§ 7.10 a.m.
§ Mr. Edward Milne (Blyth)
By the close of a debate of this length many things have been repeated, but I am quite willing to add my tribute to the Minister of Health for the attention he has paid to pretty nearly all the contributions to this debate. I would have a much higher regard for him if I felt that he would pay close attention to the appeals which have been made. I hope I am wrong in supposing that he will not. As my hon. Friends have said, not only the history and background of the Minister will cabin, crib and confine him from tackling this problem; the whole history and attitude of the Conservative Party to the National Health Service will be the determining factor in deciding whether nurses will be any better off after this debate than they were before it, despite the appeals of certain Members opposite who thought that, if we are to combine together on this issue, we might be able to push the Minister into granting increases which the nursing service requires.
The history of the Minister and of most hon. Members opposite is one of having opposed the Health Service from its inception. I have seen Ministers move in and out during this long debate. I felt a certain amount of disappointment that the Minister of Housing and Local Government did not appear on the scene, because he was the person who, when the National Health Service Act was being placed on the Statute Book by the Labour Government after the war, charged from one end of the country to the other galvanising forces to oppose not only the Service but its whole conception. It was not until the British Medical Association, with Dr. Charles Hill as its secretary, called in the aid of the Colin Hurry research organisation and found out what people really thought of the Health Service that they found out that they were on a political 1319 loser by opposing the Health Service and changed their tactics and attempted to change their attitude. Much of what happened in the history of those days immediately following the war has been looking over the shoulders of hon. and right hon. Members opposite during the long hours of this debate.
Why is it we have had such impassioned speeches? The hon. Member for Yarmouth (Mr. Fell) made a distinctive contribution. He talked about a national wages policy; he talked about industrial workers earning £20 a week; and he asked, to what should we equate the wages of nurses? Of course, we have to equate the wages of nurses to the type of society we live in. If we live in a society which believes that service to one's fellow men ought to be rewarded and not taken advantage of, then we shall get the wages of nurses and others in the Health Service into proper perspective, but if we support a society which says that the person who works with two telephones is far more valuable to the community than the person who works with two hands, or who ministers to the sick and suffering, then we shall have the type of situation we have today.
Many in this debate have said that we cannot take the question of productivity into the argument and the clash of opinions on the wages of nurses and others in the Health Service. Why not? Hon. Members on both sides have spoken of new and magnificent hospitals that have been built in various parts of the country but which cannot be used, or used fully, because the staff is not available to administer to the needs of those who ought to be receiving treatment in them.
If we are to look at this in terms of output, would it not be far better to attract nurses and others into the Service by paying decent wages so that the in-patient and out-patient waiting lists could be drastically reduced, and the waiting time for entry to hospital also reduced? Has the Minister ever tried equating the cost of paying proper wages to those in the Service with the saving gained to industry by taking workers off the sick and injured lists a lot more quickly than at present? If he did that even on an actuarial basis I am sure that he would very rapidly find that we should show a profit.
1320 I do not intend at this late stage to deal with all the letters I have received from my constituents, but I know that my hon. Friend the Member for Hayes and Harlington (Mr. Skeffington) was quite right in saying that the pressure being exercised on hon. Members on both sides has not been a matter of stereotyped letters—by people merely scribbling their signatures on a duplicated letter—but something done as a result of a tremendous depth of feeling. That is why I made my appeal to the Minister at the outset. We have here a dedicated class of people who feel that they have put up for too long with the treatment that has been meted out to them.
One of the baser sides of this debate has been the manner in which many hon. Members opposite have tried to turn this into a clash not, as is the fact, between the nursing profession and the Government, but between the industrial workers and people engaged in Health Service work. They have tried to demonstrate that it was not the action of the Government that was keeping the nurses from their increased wages; that it was not the Government's attitude that kept down the salaries of physiotherapists, but that some industrial workers had been able, by organised pressure, to make certain breaches in the pay pause.
That is flying in the face of reality. The real villains of the piece sit on the Government Front Bench. It is they who have created unrest in a very dedicated section of the community, and only they can remedy the situation. If they are not prepared to do that in the way that has been asked of them, the more quickly they should make way for others who are not only better equipped to do it but whose outlook is geared to the National Health Service as it was visualised in those magnificent years after the war; a Service based on need, and not just on the ability to pay.
§ Question put and agreed to.
§ Bill accordingly read the Third time, and passed.