§ Motion made, and Question proposed, That this House do now adjourn.— [Mr. loan L. Evans.]
§ 10.33 p.m.
§ Mr. William Hamilton (Fife, West)The House will recall that on 29th June, 1967, the National Board for Prices and Incomes was asked by the Government to examine the pay structure and the levels of remuneration and related conditions of service of nurses and midwives covered by the Nurses and Midwives Whitley Council, with particular reference to the current claims then having been submitted by the staff side.
As the House knows, the Board's Report was published as Report No. 60 in March this year. That Report covers a very wide field ranging from the recruitment of nurses, their training, wastage rates, shortages, management problems, local authority nursing services, and the pay claim, to mention only a few.
I want to address my remarks in large measure to the pay recommendations, the Government's response to those recommendations, and the reaction of the profession. It is, of course, impossible to isolate the pay of nurses from all the other problems connected with nursing which I have mentioned, and I shall therefore content myself with asking a few questions on these other matters before passing on to the question of remuneration.
The first one is a relatively minor point which is mentioned in the Report— but it is a not unimportant one—concerning the entry age of a girl into the profession. The Board recommended that the entry age should be lowered in Scotland from 17½ to 17, with a consequential review of pre-nursing courses, and I should be glad if the Minister would comment on that as well as on the other propositions contained in paragraph 160 of the Report on various aspects of the training problem.
I pass speedily to the question of wastage rates, particularly among student nurses. The Minister may not remember that on 15th December, 1965, I asked a 1458 Question of the Secretary of State on this very point. His reply showed that more than one in five student nurses withdrew before completion of training, but the significant fact was that only a small proportion of that number, about one-eighth—I think the figure was 12.2 per cent.—gave marriage as the reason for giving up training. In other words, marriage was the cause of a relatively few students leaving. Has any attempt been made since then to ascertain the reasons why the other girls gave up their training, and, if the Government have made investigations, what steps have been taken to remove or diminish those causes?
For instance, to what extent do these student nurses leave because of resentment against petty restrictions, because of unreasonable measures of discipline, because they are treated as children one minute and as adults the next, and perhaps put in charge of a ward? In December, 1965, and January, 1966, I received many letters from these girls, and it was clear that that kind of complaint was far too common for our comfort.
Tempting as it may be to go into those problems, I want to concentrate the rest of my remarks on the pay recommendations. Let me say at the outset that I agree entirely with the view of the staff side that nurses pay is seriously out of line with pay for similar work, that a nurse gets insufficient reward for any added responsibility that she may take on, and thirdly that she has too little incentive to seek or to take promotion. It was in that context that the staff side made special claims for certain grades, for example, ward sisters, staff nurses, tutorial staff, and matrons, and I should like to examine how the proposed increases measure up to what seem to me to be a reasonable demand by the staff side.
Paragraph 138 of the Report contains the overall recommendations. I need not enumerate them as the Minister is well acquainted with them. In the period between October, 1967, and March, 1970, there are varying increases from 9 per cent. to 14 per cent., with an overall backdated increase of 4 per cent. to 1st October, 1967, to be paid immediately, and the balance to be paid on 1st January 1969.
1459 Let us examine what that means to two of the grades which I mentioned, the staff nurse and the ward sister. To the staff nurse, the first instalment of 4 per cent. means 12s. 1d. gross increase per week. After deduction for board and lodgings, her net weekly increase will be 8s. 7d. Those figures were given in answer to a Question on 12th June, and are based on the means of the salary scales. The comparable increases for a ward sister are 16s. 2d. gross and 11s. l1d. net. A student nurse in her third year of training will receive a net weekly increase of 4s. 3d., or a little over a penny an hour.
Before I become churlish, I would commend the increases recommended for those in psychiatric nursing and the introduction of an allowance for those nursing geriatrics and the chronic sick. No one will begrudge a penny of that and the Government are to be congratulated on, I hope, accepting that recommendation forthwith. I am also delighted that overtime will be paid for Saturday afternoon, Sunday and night work. I recall very well, during a previous Administration, that the then Secretary of State, the right hon. Member for Argyll (Mr. Noble), when I put this question to him, said, in effect, "The nurses would much prefer the status symbol of being in a profession to being paid squalid overtime rates". This will now be rectified, and not before time. I should be glad to know the total cost of the initial 4 per cent. increase and the total annual cost of the full award.
I turn now to one or two of the grievances expressed to me; I have a family interest in this which I should perhaps declare. The first is on board and lodgings. I realise that the Government will lean heavily on the side of the Board's recommendations, and it may be argued that these board and lodgings increases are justifiable. But, justifiable or not, the nurses feel a very strong sense of grievance that, whenever they manage to get an increase in their salaries, a large part of it is automatically and simultaneously taken away by an increase in board and lodgings charges.
All Governments reply that these services are heavily subsidised, but—perhaps I have not been inquisitive enough—I have never been able to find out how much they are subsidised and what it 1460 would cost the Health Service if the whole cost were borne by the Exchequer, in other words, if the nurses, who are, in most cases, compelled to live in the hospitals, got those services as a necessary part of the job and did not have to find the cost from their salaries.
The second point of grievance was not represented to me, but I read about it in an article in the Scottish Daily Mail, by Mary Cavanagh on 11th June, which quoted some harsh words used by Miss Elizabeth McLaren, secretary of the Royal College of Nursing in Scotland. She pointed to certain anomalies in the recommendations of the Prices and Incomes Board, for instance a three-year trained staff registered nurse earns at her maximum £25 a year less than the two-year trained senior enrolled nurse. In other words, the more highly qualified nurse gets less than the less qualified.
Again, she quotes the case of a night sister in charge of a ward who will earn, with her extra payments, more than the superintendent who is in charge of the whole hospital when the matron is off duty.
I presume it will be for the Nurses and Midwives Whitley Council to iron out such anomalies as that if they exist. But I would ask my hon. Friend whether they will be allowed to do that if in so doing they go beyond the recommendations of the Prices and Incomes Board.
I want to say this in conclusion. I suppose that in the context of the present economic climate it might be supposed that this was as generous an award as could be expected. Certainly it makes a welcome and favourable contrast to the behaviour of the previous Conservative Government, when nurses' pay was one of the first to be frozen. I remember attending big nurses' meetings and rallies up and down the country when that happened. But let not the Government preen themselves too much. It is my firm belief, and one which I have held for a very long time, that as a nation, as a community, we have been guilty for as long as I can remember of gross exploitation of what I think is the most dedicated profession in the world.
Maybe if our nurses emulated the women of Fords and came out on strike, they might extract from the community higher and juster rewards, and maybe because we as a community play on the 1461 certain knowledge that they will not do that, that is the reason why they are where they are.
So I say to the Government in conclusion, "Thanks very much for such generosity as you have been able to distribute on this occasion". But we must insist, as I certainly do, that if we are to maintain, let alone increase, existing standards of nursing care we must be prepared to pay much more for it than we shall be doing even after the implementation of all the proposals in the Report of the Prices and Incomes Board.
§ 10.49 p.m.
§ The Under-Secretary of State for Scotland (Mr. Bruce Millan)I would certainly agree with my hon. Friend that it is an obligation on all of us who have responsibilities in this matter to see that our nursing staffs are adequately paid, and I want to say a good deal about the question of payment, and I hope to answer the points that my hon. Friend has raised, a little later.
If I might put my remarks in the same order as he has put his, perhaps I could say something about the two additional points he raised at the very beginning of his remarks. On the first question about the entry age and the recommendations of the Prices and Incomes Board, I think we should make it clear that the recommendations of the Board have been accepted by the Government so far as pay is concerned, but the same consideration does not necessarily apply to other matters, such as training, entry age and so on, which the Board covered in its Report.
Of course all the matters which the Board recommended on are, in one way or another, under consideration, but it is the question of pay that was accepted by the Government very quickly after the Board had reported. But the question of entry age, in any case, is not a matter for the Government but for the General Nursing Council for Scotland, which is, of course, an independent body and not a Government Department. No doubt it will be considering what the Board said about this recommendation and the implications of it in the context in which the recommendation was made. However, my hon. Friend will accept that I cannot make 1462 a pronouncement on this matter because the question of the age of entry and other aspects of the training arrangements are subjects for the General Nursing Council and not for the Government.
I agree with my hon. Friend that wastage is an extremely serious problem. The figures are, if anything, rather worse than he quoted. The wastage rate is probably in the region of 30 per cent., which means that for every 100 nurses entering training, only 70 eventually successfully complete their courses. This is, therefore, an extremely serious problem.
I do not think that there is a simple answer to this problem. There is certainly no particular prescription for it which could guarantee success. Much of this is concerned with the whole organisation of nurse training, and some of the recommendations of the Report are in line with what is happening in Scotland. Indeed, the recommendation that there should be larger group nurse training schools is said by the Report to be a matter on which Scotland has gone further than England. That process will continue. It is in the general organisation of training that, more than anything else, the final answer to this question of wastage lies.
I would not suggest that the sort of matters to which my hon. Friend drew attention—such as the general attitude of those in authority towards student nurses —are not relevant considerations. They are relevant and if my hon. Friend studies Appendix III of the Report and the circular which my right hon. Friend the Minister of Health sent out in September, 1967, he will see that a number of the points drawn to the attention of those responsible for nurse training are designed to improve the efficiency of the training and the attractiveness of it from the personal and professional point of view.
My hon. Friend explained the background to the recommendation on pay and I need not go over that ground. He asked what the total cost of the pay recommendations would be, when fully implemented. That figure is quoted in paragraph 143 of the Report—that is, if one adds up the various components in the recommendations—as being £40.9 million on an existing salary bill of £201 million, which represents a total increase of about 20 per cent.
1463 When one considers the details, it is possible, as the nursing organisations have done, to point out individual anomalies. It should be borne in mind, however, that this matter should be set in the context of what amounts to a substantial increase. It is somewhat misleading to look at this award simply in the context of what has been done by way of the 4 per cent. increase, which has been backdated to 1st October, 1967, because that is only a part—in some respects a small part—of the total recommendations of the P.I.B. Report. That increase has been made effective as from 1st October, 1967. At the same time there have been increases in the board and lodging charges. It has always been inherent in the system that when increases in salary are given equivalent increases are made in the board and lodging charges. This was taken into account by the Board in making its recommendations.
The Board has made recommendations which would change the basis upon which these charges are made to student nurses. That is still negotiable. It is not something which operates from 1st October, 1967. At the same time, certain other increases have already been agreed. For example, the increase in the lead for nurses in psychiatric hospitals from £50 to £100 has been made effective from 1st April, 1968. That represents by itself for those concerned a substantial percentage increase. A similar allowance of £100 has been introduced for nursing staff in hospitals or units for geriatric assessment, long-stay geriatric, and/or the young chronic sick. This allowance is specifically designed, as is the mental hospital lead generally, to add to the number and quality of recruits to this field of nursing, particularly in areas where there are special difficulties in recruitment and where there are also very often particular strains and tensions involved in the work concerned. That recommendation has already been made effective as from 1st April. There is also the question of special duty allowances for working at night, on Sundays and on Saturday afternoons. These, again, are under consideration at present.
I want to make a point about what my hon. Friend said as to the anomaly which might arise between night superintendents and night sisters. One important point 1464 about the special duty allowances is that the Board has recommended that they be extended to ward sisters. Although an anomaly can possibly arise between, say, a night ward sister and a night superintendent, there have already been anomalies between staff nurses, who were eligible for these special duty allowances, and ward sisters, who were not. I am not trying to justify an anomaly. I am merely pointing out that, taken as a whole, the extension of these allowances to ward sisters, who are the basic career grade in the service, is a considerable step forward.
It has not been possible yet to get final agreement on this matter. Both sides of the Whitley Council have now referred this back to the N.B.P.I., indicating the reasons why they have not been able to reach an agreement on this. The difficulty is that, although the recommendations taken as a whole represent a step forward, for particular nurses they can, because of the peculiarities of the system, actually represent something which is not quite as favourable as what they have at present. I hope very much that this particular question can be settled between the Whitley Council and the Board, but my hon. Friend will recognise that it is not possible for me in these circumstances to make any pronouncement about it.
A number of other things have already been done. For example, the leave entitlement for certain grades of local authority nursing and midwifery staff has been approved with effect from 1st April, 1968. There is an extension of overtime payments in psychiatric hospitals which will be effective from 1st October, 1968. The existing overtime provisions in psychiatric hospitals, which at present are limited to student and pupil nurses and nursing assistants, are to be extended up to ward sister level. Adding to this the increases in lead for mental hospital staff, it will be seen that for many nurses the increases proposed are quite considerable.
A number of other matters are still being discussed in the Whitley context, for example, a general further salary increase which is recommended for implementation on 1st January, 1969, and which will be done by introducing scales on the basis of the structure recommended by the Salmon Committee. I 1465 am not able to comment on the details, but these negotiations are going ahead.
My hon. Friend drew attention to another apparent anomaly between the recommendations concerning enrolled nurses and those concerning staff nurses. This is still subject to negotiation in the Whitley Council and I am not, therefore, able to make a final statement on that. It would be quite improper.
The background is that the senior enrolled nurses grade represents the top of the career structure, whereas the staff nurse grade is the basic grade for registered nurses. So the two are not comparable. The number of enrolled nurses who become senior enrolled nurses is still comparatively small and there is quite a difference between the time at which the registered nurse, as a staff nurse, reaches the maximum, and the time at which the senior enrolled nurse would reach the maximum to which my hon. Friend drew attention. It is not for 1466 me to argue for or against the Board's recommendation. This is still with the Whitley Council and the apparent anomaly to which my hon. Friend drew attention will be considered.
There are a number of other questions because, as my hon. Friend pointed out, this is a complicated Report with wide-ranging implications and I hope he will accept that I have tried to explain its total effect. I hope that one will not judge it on the particular implication of the 4 per cent. increase from 1st October, 1967, without taking account of the very substantial—
§ The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at three minutes past Eleven o'clock.