HC Deb 24 April 1969 vol 782 cc797-810

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

10.20 p.m.

Mr. E. S. Bishop (Newark)

Although I am pleased to have the opportunity tonight to raise the situation which arises from the pay-as-you-eat scheme which is now operative in our hospitals and affects student nurses, I am sorry that such a discussion should have been considered necessary. In the past few days the Royal College of Nursing, the National Council of Nurses in the United Kingdom, and the Student Nurses Association, which is the profession's own student body, have received protests from all parts of the country after the pay-as-you-eat system became operative on 1st April.

I can summarise the situation by saying that the nurses pay-as-you-eat issue is concerned not only with currant buns, but also with current problems. It is more concerned with pie than with pie in the sky. I should say at the outset that, although there has been a general welcome for the principles of the scheme, experience so far has shown that the £106 repaid for the board and lodging charge for resident students, and the living out allowance of £66 a year for non-residents, results in many thousands of students and pupil nurses finding the allowance inadequate. In effect they have suffered a pay cut.

The nurses want adequate allowances and are entitled to them, but their income is insufficient for them to absorb the extra charges without real hardship. Few people realise that after deduction of Income Tax, National Insurance, superannuation and lodging allowance, if resident, the first-year student nurse has only £5 15s. a week, out of which she has to buy food in the hospital, pay for her shoes and stockings, which she can use on duty only, as well as having to pay for her other needs. The second-year student is only 7s. a week better off. The third-year student receives only £6 10s. a week. She has to pay £30 a year in Income Tax. No wonder the Nursing Times says Their adolescent devotion to an ideal of service is being grossly exploited by the nation. What do we expect from our nurses? We have to ask that question before we know what they may expect of us. There has been no change in the basic requirements since Florence Nightingale published her incomparable work on nurses called "Notes on Nursing" some 110 years ago.

She deplored the view that it requires nothing but disappointment in love or an incapacity for doing other things to turn a woman into a good nurse. She claimed then, and it is true today, that a nurse should be sober, honest, truthful, trained in the habits of punctuality, quietness, trustworthiness, personal neatness, able to manage the concerns of a large ward or establishment, trained in treating wounds and injuries, performing minor operations day and night, managing helpless patients, moving them, changing them, taking temperatures and much else. She says that these and many other principles must be constantly applied.

Today, as the House knows, the student nurse not only has to do all these things; she has to prove that she has the very rare blend of moral, spiritual, physical, intellectual and idealistic resources to match the requirements, basic since the time of Florence Nightingale, and that she also has the ability to grasp and apply the enormous advances in medicine, science and technology in a space age environment. These are the things we ask of student nurses and the nursing profession, and most would agree that we are never let down in our demands.

These are quite considerable demands to make of any human being and it is greatly to the credit of what many would agree is the first-rate set of teenagers we have today that there has been no shortage of people coming forward to train as nurses, and that the real problem so far has not been recruitment but the retention of student and pupil nurses. In the Report of the National Board for Prices and Incomes, No. 60, issued last year concerning the pay of nurses and midwives, we read that wastage is still about 34 per cent. per year. It goes on to say that there is also reason for thinking that it may be more difficult to maintain the present level of recruitment in future.

Between 1968 and 1975 the size of the relevant age group, that of girls reaching the age of 18, will show a continuous decline. To the present problem of retaining nurses there may be added the problem of attracting recruits. Paragraph 45 of the Report makes recommendations that form the basis of the Ministry N.M.C. Circular 148 which has asked employing authorities to bring the new arrangements into force. The Circular revises the present system of living-in charges and since 1st April student nurses have been asked to pay for their board and lodging separately instead of having a lump sum deducted from their pay.

The new scheme has been welcomed in principle, because the objective, and it is a good one, is to enable the student nurse to have the freedom to spend the money as she wishes. We can talk about freedom to do something only if people have enough resources to exercise that freedom. This is all very well, but the increase in pay designed to cover the costs is not sufficient to pay for charges imposed for the food in our hospitals. All over the country matrons are militant, their students are nursing grievances and in some hospitals babies are not the only ones up in arms.

The pay-as-you-eat scheme has given us food for thought everywhere. Let us look at the situation in the country. Taking my own county, Nottinghamshire, there are hospitals there needing nurses for beds which cannot be used because of a lack of staff. We recognise that in many places there has been a deterioration in some of the conditions. Miss Eve Bendall, the principal of the School of Nursing at the Hospital for Sick Children in Great Ormond Street, whose responsible leadership in publicising the shortcomings of the new scheme and the injustices of it, is appreciated, claims that a nurse eating in the hospital seven days a week will have to pay £3 for meals for which the allowance is only £1 18s. Many Members have had representations on this, and have been insistent on making representations to the Government and the Ministry on these points. These include my hon. Friend the Member for Fife, West (Mr. William Hamilton), my hon. Friend the Member for Huddersfield, West (Mr. Lomas), my hon. Friend the Member for Halifax (Dr. Summerskill) and my hon. Friend the Member for Chesterfield (Mr. Varley). There are many others who would support my plea and who would have joined in the debate, but for the time.

My hon. Friend the Member for Chesterfield has been making representations to the Minister and the matron of the Chesterfield Royal Hospital, Miss Elizabeth Horton, whose protest was supported by my hon. Friend, claims that Britain's nurses have been sold down the river. Those are rather strong words, but to some extent they are justified. In Sheffield, some student nurses are claiming that they have to live on bread and jam for many meals. At Sutton in Surrey, officials of the St. Helier Hospital Group, where, incidentally, one of my daughters is a student nurse, have protested to the Minister that nurses could be £1 a week out of pocket and have asked for the loss to be made up.

Sister Patricia Veal, of the United Nurses Association, claims that nurses are threatening to strike. Many hon. Members will wish me to say that we deplore her irresponsible and deplorable claim that the shortage of cash is making some nurses act immorally. That is an unwarranted reflection on an honourable profession and should lead to many dissociating themselves from her views and her activities in this campaign.

Mrs. Pat Williams, secretary of the Student Nurses' Association of the Royal College of Nursing, who has led the campaign on behalf of student nurses throughout the country, claiming that nurses are being exploited and that the real problem is for the country to decide their status. This is the crux of the matter, for student nurses are really apprentices and in any industry would be paid an adequate rate for the job. There is no justification for low pay and poor conditions, even if student nurses are classified as students.

Today we have seen the headlines in the Press reflecting the views of Dame Muriel Powell, matron of St. George's Hospital, who has been adamant in leading the resistance of matrons throughout the country. She claims that student nurses working on the morning shift usually have breakfast around 6.30 and by 9.30 are often hungry as well as thirsty and yet have to pay for tea and coffee. I understand that in a debate in another place a few days ago, Baroness Serota, Minister of State, Department of Health and Social Security, admitted that the estimated cost of meals to nurses did not cover the item of refreshment. Will a student nurse have to act inappropriately by not paying for refreshment, or will she have to pay for refreshments which, during a week of duty, will add considerably to the hardship experienced? We need clarification of this now.

Was annual leave excluded from the calculations when allowances for rebate for board and lodgings charges for annual leave have been allowed by previous agreements? Student nurses in particular depended on this help towards their holidays which they could not otherwise afford. Dame Muriel Powell says, and I agree with her, that it should not be considered irrelevant to take into account the contributions made by student nurses to superannuation, insurance and Income Tax, for they remove a large slice from the gross training allowance to all students.

I ask the Minister to investigate urgently the variation in the price of meals charged in hospitals throughout the country, for the implementation of Circular N.M.C. 148 must result in lower standards of catering, with the alternative of student nurses going without adequate meals, or suffering severe financial hardship.

Further, will he take immediate action to ensure that student nurses get at least £1 a week rise, as urged by the Royal College of Nurses? If this rise is not paid at once, we should consider backdating it to 1st April. I hope that the rumours in some of the newspapers of the possibility of their getting 10s. a week more are not true, because we ought to ensure at least £1 a week to cover the extra cost of food. I urge a review of the position of student nurses who are the main labour force of our hospitals. Without their help, and let us not forget the help of overseas students, our hospital services would collapse.

I ask my hon. Friend to consider whether the amount of time spent in the wards means that students do not get enough time for study. There are allegations that they are often inadequately supervised with their heavy responsibilities by day and by night. If they were treated as students they would get concessions equivalent to the rise they need, and it may be better for nursing. If, however, they are workers—or apprentices—they should get the rate for the job. We cannot as a nation have it both ways.

In some ways I consider that the pay-as-you-eat crisis has spotlighted the injustices and the problems of the nursing profession, and that the whole structure needs review at all levels as recommended by the Salmon, Platt, and other reports. Pay and conditions' problems will result in restricted recruiting, which in turn will result in shortages at higher levels, even at tutor level, for some schools of nursing are kept going by using unregistered tutors.

We know that our nurses are dedicated to their task, but I often wonder why dedicated people are thought to eat and drink far less than those not so dedicated. Nurses work with religious zeal, and unless we act quickly they will recall the parable of the feeding of the five thousand. To quote St. John's Gospel, they will be thinking of the phrase: Gather up the fragments that remain, that nothing be lost. I believe that the words of Dame Muriel Powell today on behalf of the Association of Hospital Matrons in asking for a review of the rôle of the Whitley Council with regard to pay and conditions echoed the views of people in many parts of the country.

At all levels the staffs of hospitals have been most responsible and moderate, and I warn the Government, on behalf not only of student nurses but of the profession, of the danger of more militant leaders taking over their affairs unless reasonable and long overdue claims are met.

Mr. Kenneth Lomas (Huddersfield, West)

May I, on behalf of the National Union of Public Employees, which recruits many nurses, tell the House that the union has said that if any hospital authority overcharges nurses it will take the most militant action against that authority? Does my hon. Friend agree that, rather than join breakaway unions, the best interests of the nurses would be served by their joining the appropriate trade union so that they can be adequately represented on the Whitley Council through all the trade union machinery?

Mr. Bishop

I am sure the House agrees that that is the best and only way for the nurses to rectify their grievances.

I conclude by saying that the mainspring of mercy which keeps our nurses and our hospitals ticking over with dedication and with duty will recoil with force against those who exploit them, whether by intent or by indifference. For our sakes, and for their sakes, we must not let that happen.

10.37 p.m.

The Minister of State, Department of Health and Social Security (Mr. David Ennals)

I thank my hon. Friend the Member for Newark (Mr. Bishop) for having raised an issue which has caused a good deal of concern in the country and among many of his hon. Friends. I thank him, too, for raising it in a humane way, and for speaking on behalf of the nurses. I think that he deserves their thanks.

I assure my hon. Friend not only of the general sympathy of my Department for the magnificent work that is done by nurses in our hospitals, but of my own special interest. At an early stage in my life I spent three years in hospital, and I formed such an admiration for our nurses during that time that whenever I look at any issues in which their interests are involved I am inevitably biased in their favour. I endorse my hon. Friend's tributes to the work done by our nurses, and I am glad that he referred to nurses from overseas, because they make a considerable contribution to our hospital services.

My hon. Friend mentioned pay and allowances of student nurses. He will, I am sure, be aware that the second stage of the new increases came into effect only in January this year. The present dispute arises, not from the Government's refusal to agree to improve pay and conditions for nurses, but from a concession made as part of the most recent agreement. The National Board for Prices and Incomes, following a joint recommendation of the two sides of the Nurses and Midwives Whitley Council, carried out a comprehensive review and published its report in March, 1968.

The Government accepted that the pay proposals contained in the report were consistent with incomes policy and commended them to the Whitley Council for negotiation. So far as student nurses were concerned, the effect of the recommendations on pay was that first-year student nurses received a 9 per cent. increase in their training allowances, while second- and third-year students received a 14 per cent. increase. The increases were to be paid in two stages, 4 per cent. back-dated to 1st October, 1967, and the remainder to be paid from 1st January, 1969.

At the time of a nil norm and a 3½, per cent. ceiling, both the Board and the Government recognised that exceptional treatment for nurses was called for within the terms of incomes policy.

Moreover, in addition to the increases in the training allowances, the Board recommended other substantial improvements in the pay and conditions of service of student nurses. These included the introduction of special rates of training allowance for students in general training over 25 years of age, the increase in the mental "lead" from £50 to £100 per annum for students undertaking psychiatric nurse training, and the extension to students for the first time of special duty payments for duty at night and at weekends. Previous to that, they had a real case that they were being exploited.

The Board also considered the question of residence and payments for board and lodging. It accepted that there was a case for compulsory living in for first-year student nurses, but said that the aim should be to give them, after their first year, a choice between living in and living out. It said that if there was to be a real choice, there must be a revision of the existing system of living-in charges, the objective being to give the student nurse freedom to spend her money as she wished.

This reflected the views of the Staff Side of the Whitley Council, expressed over a number of years, that a system of payment for meals as taken should replace the system of fixed annual charges. Nurses had complained in the past for a considerable time because the deduction of an annual charge meant that, apart from rebates for certain authorised absences, they were having to pay for their meals whether or not they actually took them. When they went out to eat, or took days off, they felt they were being diddled because they had already paid for their meals. I think that they had a very good case.

As a first step to meeting the wishes of nursing staff generally, a system of pay-as-you-eat was introduced for nonresident nursing staff early in 1967 and was gradually implemented in most hospitals. It was introduced without difficulty and seemed to be generally welcomed. As it has a bearing on what I have to say later, I should explain that it was made quite clear at the time that the system was based on the provision of reasonable basic meals at the standard charges agreed by the Ancillary Staffs Council. These charges, which, of course, include an element of subsidy, amount at present to 6s. 7d. for four meals a day. In addition to the basic meals, alternative meals or snacks are provided in some hospitals at suitable charges which are determined locally.

In making its recommendations on resident student nurses, the National Board for Prices and Incomes said that a system of payment for meals as taken should be introduced for them and that in future the only charge which should continue to be deducted at source should be a combined charge for lodging and personal laundry. This charge would be relatively small, as a realistic price for meals actually taken during a normal year would amount to about £100. The Board, in fact, set the charges for lodging and personal laundry for student nurses at £50 per annum, with a reduction to £25 per annum for first-year student nurses, in recognition of the fact that they are generally compelled to live in. I might say that these recommendations were known as long ago as March, 1968, and the Whitley Council gave advance warning in a circular dated 12th December, 1968, that they proposed to make the charge, where practicable, on 1st April, 1969. In neither case, to my knowledge, was any objection raised.

The Nurses and Midwives Whitley Council, the Staff Side of which, of course, comprises organisations representative of all grades of nurses and midwives, accepted the Board's recommendations. It also accepted the level of charges for lodging and personal laundry recommended by the Board and agreed that the previous board and lodging charge should be reduced by £106 to allow student nurses to pay for their meals as taken. It is important to realise that £106 is a net amount, because there has been some misrepresentation of the agreement by staff who claim that the £106 which the resident student nurse will have available to pay for her meals will be reduced by income tax and superannuation contributions. This is not so.

Non-resident student and pupil nurses formerly were allowed free meals on duty. The Board recommended that this privilege should be abolished. At the same time it recommended that a living-out allowance of £50 should be introduced so that second- and third-year students could have a real choice between living in and living out. The Whitley Council agreed that the figure should be £66 so as to leave a net figure of just over £50 and thus ensure that no student was worse off than under the old system of free meals on duty. The new arrangement was one of many changes made to give greater freedom to the student nurse. It is all part of the long overdue process of treating as adults these girls who have to shoulder such heavy responsibilities. I am sure it was a wise decision.

But the main problems seem to have arisen among the resident student nurses. The first is the claim that £106 is not enough. The answer is quite simple. This is the cost if hospitals supply meals at the standard charges which have been nationally negotiated. No one is saying that £106 would be enough if nurses had to pay for all their meals outside.

I mentioned earlier that when the arrangements for pay-as-you-eat for nonresident staff other than students and pupils were introduced in 1967 it was made clear that the system was based on the provision of reasonable basic meals at the standard charges agreed by the Ancillary Staffs Council. The new Whitley agreement simply extends this system to resident nurses.

In negotiating an agreement of this nature, a Whitley Council obviously has to have regard to the arrangements which are reasonable for the average nurse. This applies in particular to the average savings which are likely to be made by a nurse through annual leave, off-duty absences of various sorts and generally through not taking every meal in the hospital every day of the week throughout the year. Four meals a day is a reasonable provision and there is no reason why student nurses should go hungry. It is possible, of course, that if a nurse is given the freedom to spend her money as she wishes, she will choose to spend less—or more—on food than she did under the fixed-charge system, but if she is to be given the choice it is a matter for her to decide.

But there does seem to be clear evidence that some hospitals are not providing basic meals at the agreed standard prices. This is the cause of the present feeling, brought to the House tonight and to the country by demonstrations and statements of one sort and another.

It really is essential that hospitals do provide meals at the standard rates. Following the recommendations of the Whitley Council, which met on Tuesday, we are writing tomorrow to hospital authorities insisting that the provision of meals at the agreed rates is an essential feature of the new arrangements and that, if meals are not being provided on this basis, they should be so provided without delay.

We do not know how many hospital authorities have yet implemented the new system of charges for meals but it seems probable that it is not more than half. The Whitley agreement operated from 1st April or as soon after as was practicable.

The Whitley Council deliberately chose the date of operation of 1st April rather than 1st January, when the new salary scales came into operation, largely in order to give plenty of notice of the introduction of the new system. The circular issued in December setting out the new rates of pay gave advance warning of the introduction of the new system. It would appear that communication at hospital level has not in all cases been as good as it might have been and that in some cases this warning was not passed on to the staff concerned. There are clear lessons to be learnt from this. Communication is an essential part of good management.

The other reason for delaying implementation was that it was realised that the first month of operation would be a particularly difficult time since the full board and lodging charge would be deducted from the pay for the last month under the old system and the nurses would have to pay for a month's meals before receiving a pay packet with deductions at the lower rate. It was thought that the difficulties on this score would be greater immediately after Christmas than at other times. In order to alleviate this particular difficulty the Health Departments authorised hospital authorities to make reasonable advances of pay for up to three months.

It is hoped that all hospital authorities which have not yet implemented the new arrangements will do so in full consultation with the staff. The importance of consultation and of salary advanced is mentioned in the letter we are sending out tomorrow. I hope that action on these points will greatly improve the situation.

One other problem that has arisen concerns the arrangements for tea or coffee served on the wards. Those of us who are regular visitors to hospital wards know that the kettle is usually on the boil, and in my view the cup that cheers is often as necessary for the nurse as for the patient. But strange as it may seem, when the Whitley Council negotiated the new agreement no account was taken of the fact that tea and coffee were supplied free to the resident nurses. This matter has been brought before the Whitley Council this week.

The Whitley Council, which met on Tuesday, reaffirmed its belief in the principles of pay-as-you-eat and was right to do so. But it is examining a number of the problems that have arisen and is meeting again on 13th May.

In the meantime, I believe that the action we are taking in seeking the immediate co-operation of the hospital authorities should go a long way to put things right. But let me add that the 'situation will not be improved if some of the absurd and sometimes shocking accusations made by so-called militants are repeated. I agree with the intervention of my hon. Friend the Member for Huddersfield, West (Mr. Lomas)—that the thought that one can best achieve one's purpose by breaking away from the trade union which acts on one's behalf is not the way to success. It would be a pity if the nurses' cause, which is a good one, were to be prejudiced by irresponsible statements and actions.

10.45 p.m.

Mr. Lomas

I am grateful for the opportunity to say a few words on behalf of the nurses who are enrolled in my union, the National Union of Public Employees. I am glad that, from what has been said, it would appear that, from now on, nurses will not have to pay more for meals than the scale laid down by the Whitley Council Agreement. It would seem that the Department has accepted its responsibilities to ensure the agreement is honoured. It recognises that it is responsible for the recruitment of nurses and, above all, that nursing is no longer just a calling or vocation that people went into because it was right but a profession entitled to good pay and conditions.

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 nine minutes to Eleven o'clock.