HC Deb 16 November 1966 vol 736 cc592-602

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

11.7 p.m.

Dr. David Owen (Plymouth, Sutton)

I say at once that I am in a slightly peculiar position, because I work in an academic department doing research and have a very real interest in the subject of this debate. It is my contention that the Government are facing an extremely serious situation which is brought about by a loss of confidence of the clinical medical teachers in the policies that have been introduced following the decision not to allow their pay increase. I say to the Minister that unless the Government show some indications in the next few months to the medical profession that they will meet it on this issue, he will face a very severe emigration from this country. The Minister and the Secretary of State have been extremely sympathetic to us over this matter, and I believe that they have pressed their colleagues very hard on our behalf. Our job now is to ensure that this anomaly is cleared up.

Let me make my own position clear. I am a strong believer in the Government's prices and incomes policy. I believe that during the period of wage restraint we have a special responsibility to ensure that the lower-paid workers are given preference, and I would be the last to want to be seen to be arguing on behalf of a professional body of relatively higher paid workers to the detriment of the lower paid. But I believe this situation to be unique. The Ministry has decided no firm commitment was made to university clinical teachers. I can only say that that was a very dubious judgment, and I hope that it is quickly reversed. The situation is not just one of pay, and though I will concentrate on that angle for a moment or two, I want to spread my remarks much more widely.

In April, 1963, the clinical staff had their last pay rise. They have had none since then. In 1964, and again in 1966, the non-medical teachers, university staff, had pay rises. In fact in the National Incomes Commission Report, Number 3, the principle was laid down very clearly that the clinical staff would be treated as a separate salary issue from those of the university teachers. It was laid down in the final summing up: We envisage that revision of their"— that is, university clinical staff— salary scales and ranges will reflect changes in National Health Service scales from time to time", and it is this that we are arguing tonight.

In February negotiations were started, but these were postponed for the very reasonable reason that the Review Body on doctors' and dentists' remuneration had not reported. It reported on 12th May. It was hoped that there would be a successful outcome of the negotiations, but by 20th July those negotiations had not been culminated, so they became the victims of the freeze. I do not altogether complain of this, because the freeze, by its very nature, has had to be arbitrary. It has been unfair in some cases. I now urge the Government to look at those cases where it can be seen clearly to have been unfair, and to revise their judgment and give a speedy increase during the period of salary restraint.

Is my hon. Friend happy about the negotiating machinery? Has he any real practical proposals to offer in its stead? Why was there this long delay between the Review Body reporting and reaching agreement with the university clinical staff? It was because of the delay that they were caught by the freeze.

We know that the medical profession is to have its pay increase back-dated to October, and to be paid as from January, 1967. It is the belief of the B.M.A. that university clinical teachers also should receive this. I am not here to make their case, and that may or may not be the Government's belief when they make up their mind, but I stress that there is real concern, and that this concern arose more than anything else from the fact that the Chairman of the University Grants Committee wrote to the university clinical teachers and said: During the period of salary restraint any future increases will need to be justified under the then current incomes policy criteria. Rightly or wrongly, that has been taken by members of the clinical staff to mean that they will get an increase only of the norm, 3 per cent., or even less, and I should like the Minister to make it clear that he recognises that this is an exceptional case. I believe that an increase can be fully justified under the incomes policy criteria.

I submit that it is absurd that a clinical lecturer earns £315 less than a preclinical lecturer, which is the position at the moment. It is absurd that a clinical lecturer earns £70 less than even a first-year medical registrar. It is absurd for the Government to try to redress the imbalance which has occurred over the last few years by increasing the number of medical students passing through medical schools, and at the same time attacking the very people who will have to put in more work, and who are themselves responsible for any expansion of medical education.

I urge the Minister to realise that it is these people who believe in the Health Service, and who work full time, the very thing which many of us want to see many more practise. It is these people who have given up private practices and by doing so have accepted a lower scale of remuneration throughout their lives. They are dedicated to clinical research.

Science is international, and competition is international, and although they are, and always have been, offered better salaries elsewhere, particularly in the United States, there is something else which they are offered, and this is crucial. They are offered better conditions of work, and better equipment. This is what, above all, makes these people emigrate and this is something which the Minister should consider. Many of us are unhappy about the divided responsibility between the Ministry of Health and the Department of Education and Science, though we realise that, to a certain extent, this is inevitable. Many of us on these benches have great sympathy with university teachers, who naturally resent the differential which exists between clinical and non-clinical teachers.

The National Incomes Commission Report on this subject concluded that nothing could be done, but I should like the Minister to look again at a dual system of payment whereby those doctors who make a real contribution to the National Health Service could benefit, for let us not forget that these university clinical teachers look after beds and patients and work throughout the year and, on top of this, are responsible for teaching medical students.

I should like my hon. Friend to consider whether it is not possible to make a direct contribution to these clinical staff who are themselves making a great contribution to the National Health Service. This is a serious situation. A senior lecturer with honorary consultant status, bearing all the responsibilities of a consultant in the National Health Service, starts at £2,480 a year. People may say that that is a lot of money, but a consultant in the National Health Service starts at £3,200, and the natural inclination for the former is to leave academic medicine for the National Health Service, if not to emigrate. This is the situation we face.

Certain departments, particularly obstetrics, surgery and pathology, are already having difficulty getting people into the academic units. One cannot increase the number of medical students and the standard of medical tuition—which need to be done—if we are to have a poor standard of staff and not enough staff. Time is not on the Minister's side. I am very sceptical about any form of questionnaire.

The B.M.A. is conducting one at the moment and I have received a letter from it which says that several hundred clinical lecturers are seriously considering leaving this country. But I and some of my friends in some of the London teaching hospitals have taken a small survey. Of 81 London medical teachers questioned, 67 per cent. are seriously considering emigration. Again, the important fact to emerge is that pay is not the main factor, but inadequate equipment and facilities and no prospect of senior posts—

Dr. M. P. Winstanley (Cheadle)

Would the hon. Gentleman add to those figures some from a questionnaire just published from Manchester, which shows that, of 101 medical and dental staff questioned, of the 71 who have replied, 54 are actively considering leaving, five are in the course of negotiations for new jobs and three have just given in their notice?

Dr. Owen

That reinforces the point.

One other thing which came out of the survey was that 18 per cent. are already negotiating positions abroad and a further 10 per cent. expect to do so if conditions do not improve. The loss of one doctor to the National Health Service is critical in its present state. The loss of a university lecturer is all the more serious because of its connotations for research and medical education.

This Government came into power because many people believed that we would reverse the "brain drain" and that our commitment to science and technology and the advance of higher education was real and absolute. We must show that we are prepared to carry this through. The record of politicians on the question of medical emigration is very bad. In 1962, when Dr. John Scale presented his figures, they were scoffed at and the then Minister of Health denied their accuracy. I must admit that my own party spokesmen were not very forthcoming.

It took until 1964, when Abel Smith showed that those figures were correct. We have the history of the Willink Committee and we are still suffering from the decision then not to increase medical manpower in 1957. We cannot afford to go on making mistakes.

Much of the trouble in the National Health Service is due to lack of judgment over manpower. We know that the Minister is sympathetic and that he has to present his case to the Department for Economic Affairs. But he has a real responsibility. Shortage of manpower was one of the points mentioned as a justification for increases in salary in the Statement of Intent on the Prices and Incomes Policy. With falling manpower, I believe that he has a very strong case. The negotiations should have been completed by 20th July.

I very much hope that he will be successful, for if he is not, the outlook for medical research in this country is dim indeed. Tied with this is the whole question of financing medical research in this country—and this is a serious question for those of us who work in the field. Today, I went to the National Physical Laboratory and worked with their computers and the equipment which they have. I go back to the hospital where I find that we simply have not enough syringes in the medical unit and that we have to take them off the ward because our allocation is not large enough.

These are real problems, and I submit that urgent action upon them is now needed.

11.22 p.m.

Mr. Bernard Braine (Essex, South-East)

I wish to associate the Opposition with the plea made by the hon. Member for Plymouth, Sutton (Dr. David Owen) on behalf of university clinical teachers—and I will be brief.

I am sure that the Minister is aware that his colleague, the Minister of Health, has already accepted that there is an urgent need to increase the number of medical students and to open new medical schools. To maintain, let alone expand, the number of trained doctors, the medical schools need to attract the best possible staff, and to do this they must offer a satisfactory career structure to clinical teachers. Obviously that means conditions comparable with those obtaining in the National Health Service.

Against this background how can anyone reconcile the unfair discrimination which obtains at the moment between university clinical teachers and their colleagues in the National Health Service? I hope that the Minister is fully aware of the dismay, even anger, that this is causing among clinical teachers. He must be aware that it would pay many of them, as the hon. Member said, to teach pre-clinical subjects or to leave the medical schools altogether. Such a situation cannot be reconciled with the Government's long-term policy for the National Health Service, it cannot be good for the country, it cannot be good for the patients and it cannot be good for medicine.

I trust, therefore, that we shall have an encouraging reply from the Minister. If he is not in a position to give it tonight, I hope that he will convey to the Secretary of State the very strong feelings which exist on this subject in all three parties and in all quarters of the House.

11.24 p.m.

Mr. Victor Yates (Birmingham, Ladywood)

I should like to congratulate my hon. Friend the Member for Plymouth, Sutton (Dr. David Owen) on raising this vital matter, and I am grateful for the opportunity of speaking for two or three minutes in order to support him in the plea which he made.

It is quite unjustifiable and unfair that a section should be discriminated against. The clinical teachers are not wholly university people, nor are they wholly hospital people, and to leave them out and to do nothing about their salary scales from 1963 seems to me to be unjustifiable and unfair. I have interested myself in the matter because I was in communication with the Minister of Health about junior doctors. When he came to Birmingham he told me that in four years there would be eight virtually new hospitals. I asked him, "How are we to staff them?"

I want to put to the Minister the main point of my consideration of this subject. I fought as hard as possible, in the House and outside, to get a new dental hospital in Birmingham. That hospital has been built, but unfortunately there is at present a waiting list for people requiring dentures, who must wait 12 months, a waiting list for children requiring orthodontic treatment, and they must also wait 12 months, and a waiting list for people requiring fillings, and they must wait about three months.

At the Queen Elizabeth Hospital in Birmingham, one-third of the clinical beds are being supervised by clinical teachers. The dental hospital is three lecturers short. How can we staff these hospitals unless we provide financial justice for those who work in them? In the dental hospital in Birmingham I have seen dental surgeons and clinical teachers working side by side. There are 13 full-time surgeons and 27 teachers. The clinical teachers are assisting the surgeons in giving this treatment, yet one section of the staff has been given increases while the other has been totally left out and given nothing.

I hope that the Minister of State will be specific in this matter. I do not have time to make many of the points I should like to have made and my hon. Friend appreciates how strongly I feel about this. In Birmingham we have a beautiful new hospital which we cannot adequately staff. Every possible step should be taken to prevent university lecturers and doctors from leaving hospitals. Had the advice of the University Grants Committee been taken at the time, these increases would have been paid.

I know that my hon. Friend is sympathetic to this case and that he appreciates the position. I plead with him to give an answer that will give confidence to the staff and assure us that these services will be able to flourish; in which case my hon. Friend the Member for Sutton will have performed an even more valuable task tonight.

11.28 p.m.

The Minister of State, Department of Education and Science (Mr. Goronwy Roberts)

I am grateful to my hon. Friend the Member for Plymouth, Sutton (Dr. David Owen) for having raised this matter and for the responsible, if forceful, manner in which he dealt with a topic which I know is causing great anxiety not only to those directly affected but to everybody concerned with the teaching of medicine. I listened with appreciation and sympathy to the sincere and cogent contributions made by my hon. Friend the Member for Birmingham, Ladywood (Mr. Victor Yates), the hon. Member for Cheadle (Dr. Winstanley) and the hon. Member for Essex, South-East (Mr. Braine).

I warmly endorse what has been said about the importance of the rôle played by clinical teachers and I pay tribute to the responsible way in which they have presented their case. The Secretary of State and I received deputations on their behalf. While they were obviously deeply moved by the conditions facing many clinical teachers, they presented their case, the difficulties involved and their argument in a way which commanded attention and which, I feel, will command sympathy and action.

It is not in dispute that the clinical teachers expected a salary increase, effective from 1st April, to follow the Kindersley recommendations on the salaries of hospital doctors. Nor is it in dispute that they confidently expected that it would be possible to reach such a settlement. Unfortunately, at the time of the Prime Minister's statement about the prices and incomes standstill on 20th July, there had been no formal commitment and no payment had been made. It was not possible, therefore, for my right hon. Friend to give the clinical teachers the promise given to the National Health Service doctors of an automatic increase after a period of deferment. This was not a decision which we came to with any degree of pleasure. The economic situation demanded certain measures and the rules for applying the standstill policy to particular cases were necessarily undiscriminating and somewhat inflexible. It is unfortunate that the clinical teachers and, indeed, other very deserving sections of the community fell on the wrong side of the dateline.

My right hon. Friend the Secretary of State has recently received representations from the B.M.A. and others and has had the views of the University Grants Committee on the clinical teachers' case. The unfortunate effects which withholding the salary award may produce have been very forcibly and fully represented to him and to me. We are looking at these representations very carefully. We are closely in touch with my right hon. Friend the Minister of Health. But we must look at the claim in the light of the evolving policy of the Government towards salary and price increases after the period of complete standstill. I know that my hon. Friends and hon. Gentlemen opposite will not expect me tonight to attempt to foreshadow the announcement of the Government's Policy which will shortly be presented to the House in a Command Paper, but I think I can assure the House that the position of the clinical teachers will be looked at most carefully in the light of the evolving policy and that what has been said tonight will be given full weight.

My hon. Friend the Member for Plymouth, Sutton raised the question of the relationship between the salaries of clinical teachers and those of hospital doctors. I should like to make it perfectly clear that the present situation is a direct consequence of the incomes standstill and does not spring from any new decision about that relationship. In recent months my right hon. Friend and I have received very strong representations in support of the view that university clinical teachers should receive the same salaries as their colleagues of equivalent standing in the National Health Service. This is an engaging argument, but it is argued equally strongly by others in the university world that any salary differentiation between academic staff on the grounds of the subject taught is divisive and undesirable. Nevertheless, I acknowledge the need for a thorough examination of the relationships between the salaries of university clinical teachers and those of hospital doctors on the one hand and their colleagues in the other faculties on the other hand.

Dr. Winstanley

There is already discrimination between academic staff in that clinical staff work a 48-week year whereas non-clinical staff work a 30-week year. In other words, the clinical staff do 18 weeks' additional work for no additional remuneration.

Mr. Roberts

I cannot engage in a prolonged and detailed argument on the point. There is an answer to this which I think the hon. Gentleman knows. The conditions are somewhat different.

My point was that we will certainly be conducting a thorough examination into the question of relationships. There are two sets of relationship. I wish I had time to deal with them tonight, but I have not. I have to say something which will perhaps interest the hon. Members who have been good enough to stay in the House to raise this question.

My hon. Friend and other hon. Members raised the important question of negotiating machinery. The House will be aware, for example, from the Secretary of State's Answer to my hon. Friend the Member for Yarmouth (Dr. Gray) on 21st July, that we are at present discussing with all the interested parties what should be the machinery in future for keeping the salaries of university academic staff, including clinical teachers, under review. We have proposed to the bodies concerned that these salaries should be made the subject of a standing reference under Section 3 of the Prices and Incomes Act. This would be, formally, a reference to the National Board for Prices and Incomes, to which would be added for this purpose some additional members chosen for their particular suitability for considering this field; but in practice the matter would be remitted by the Board to a smaller group of which these additional members, mainly from the universities, would form part.

The other bodies concerned have these proposals under consideration, and the Secretary of State is at present collecting their views. It is the opinion of the Government that the longer-term question of the relationship of university clinical teachers' salaries to those of other university teachers on the one hand and of hospital doctors on the other should be reserved for consideration among other aspects of the whole salary question both in universities as a whole and in sectors of the university staff in particular by the new machinery when it has been established.

I therefore say in response to this short but brisk and pointed debate, first, that we are fully aware of the concern among clinical teachers, and indeed in the universities and the world of health generally, and, secondly, that the representations made tonight will be very fully taken into account in considering how to apply the new criteria which will govern the period of gradually relaxing stringency after 1st January.

What has been said tonight will be joined to what has already been said very forcibly and factually by the representatives of both the medical clinical teachers and the dental clinical teachers. This short and important debate has therefore indeed served a real purpose.

Question put and agreed to.

Adjourned accordingly at twenty-four minutes to Twelve o'clock.