§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Ernest G. Perry.]
§ 11.13 p.m.
§ Mr. William Hamilton (Fife, West)The subject of this short debate has been the cause of great comment throughout the country in the Press, on television and on radio; in other words, through every means of mass communication. No pay claim has received or has deserved as much unanimous support as that of the nursing profession, and I believe that it has the support of the vast majority of hon. Members.
The Minister will be aware that Early Day Motion No. 45 has attracted 120 signatures from among my hon. Friends—and that without any great effort on the part of its sponsors. Nurses should write to their hon. Members and urge them to support that Motion, for in the absence of a militant trade union leader—or, as far as I know, any leader at all—their battle must be fought and won, or perhaps lost, on the Floor of this House.
The Motion expresses appreciation of what the Government have done, which is right and fair, but it then urges the Government to further action in giving
all nurses a substantial and immediate increase in remuneration, at least commensurate with increases given recently to other groups of lower paid workers.1445 I might have added "and other not so low paid workers."There is an Amendment to the Motion, signed by eight Conservative Members, seeking to delete all reference to what the Government have done and simply urging a big salary increase for nurses. That comes very strangely from a party which is pledged to reduce public expenditure. It is even more strange, when we look at the signatures, to find among them some who, in 1962, in the debate on nurses' pay, voted against the nurses getting more than a 2½ per cent. increase. Those Tory Members should read that debate on nurses' pay in the OFFICIAL REPORT, 14th May, 1962; Vol. 659, c. 933.
The Minister of Health was the right hon. Member for Wolverhampton, South-West (Mr. Powell), who has recently gone on record as saying that an incomes policy was a nonsense and could not be worked. But in column 949 in that debate he used these words:
I do say that these are not circumstances in which it would be right or possible for the Government to recognise a clear and urgent case for a major exception from their own incomes policy in their own field of influence."—[OFFICIAL REPORT, 14th May, 1962; Vol. 659, c. 949.]That was after ten years of allegedly Tory affluence. The norm then was 2½ per cent.A former Minister of Health, the right hon. and learned Member for Hertfordshire, East (Sir D. Walker-Smith), spoke about
the problem of how to devise, in the context of our economy, fair and just rewards for those people who are doing work which is socially valuable though not directly productive"—these are magnificent words——work, in other words, which is not easily susceptible to precise evaluation by indices of productivity, but is no less precious simply because it is less precisely ponderable."—[OFFICIAL REPORT, 14th May, 1962; Vol. 659, c. 960.]The right hon. and learned Gentleman is notorious for never using one syllable where six will do, but we took his point at that time. Nevertheless, we were very surprised when he dutifully went into the Lobby, having uttered those sentiments, against giving the nurses more than 2½ per cent. But it is not surprising, because it was he, as Minister of Health 1446 in 1957, who vetoed an increase in pay for the lower paid staff in the hospital service which had been agreed by both sides of the negotiating machinery. So the record of the Conservative Government in this sphere is not one of which they can be proud.I turn to the present Government. I think that they have done fairly well, given the economic difficulties with which we have been grappling. But a lot remains to be done.
In 1965 increases averaging a little less than 11 per cent. were granted. In 1967, following the report of the National Board for Prices and Incomes, further increases were given varying from nine to 14 per cent. for some grades. But that was to be payable in two stages, and nothing more was to be paid until 31st March, 1970. So it was strictly within the confines of the then prices and incomes policy.
More recently, a £48 a year taxable allowance was given for meals, which at once created an anomaly—and it was admitted as such by Treasury Ministers—compared with the 3s. tax-free luncheon vouchers which often go to less important workers. When the first instalment of that 9 per cent. was paid, up went residence charges for the nurses, and so many of them found that at the end of the day they were little, if any, better off. In January of this year the nurses received the other 5 per cent. of that 9 per cent., but in April hospital meal charges were again increased. It was at that point that the £48 taxable allowance was given.
The profession is now making two separate claims, one for those hospitals which have accepted the Salmon structure, and the other for those outside it. Perhaps I might give some examples, though they must necessarily be curtailed because the Minister knows them very well. For a chief nursing officer—that is, the top manager—the largest claim is for £4,500 a year against the present £2,950 maximum, but a chief nursing officer can receive as little of £2,180 For that he may be in control of as many as 20 hospitals spending millions of pounds a year and have under his authority thousands of nursing staff and ancillary staff of one kind and another, and tens of thousands of patients.
1447 I was looking through the advertisements in the Observer last Sunday, and I found that Sandhurst Royal Military Academy was advertising for a head of the Department of War Studies. The salary for that gentleman is in the range £3,029 to £3,596, and it could be higher, depending on his qualifications and experience, plus a non-contributory pension scheme. I have no doubt that some people regard that as a very important job demanding high qualifications, but who would stand up in this House, or in the country, and say that that job was more important than, or indeed as important as, the job of running 20 hospitals? No manager anywhere in the British economy is paid so little for shouldering so much responsibility as chief nursing officers are paid, even if they get the maximum which they are demanding.
For a matron in a training hospital with 1,000 beds or more, the proposed scale is £2,400 to £2,900. At the bottom of the scale—that is to say, a matron in a training hospital with fewer than 200 beds—the scale would be £1,770 to £2,050. The maximum asked for for matrons in large non-training hospitals would be £2,350, and in the smallest non-teaching hospitals the maximum would be £1,950. If one goes down the scale a little to ward sisters, the demand is for anything from £1,400 to £1,600. The key people in hospitals are the ward sister and the staff nurse. The maximum for a staff nurse is now £925, rising from £785. In four years she gets to the maximum, which is less than £20 a week. The suggested increase is only up to £1,250, or less than the average earnings in industry. To that £1,250 would be added another £75 after three years on the maximum, but even then it would work out at only about £25 10s. a week gross. Nobody could claim that that was an unfair or extravagant demand.
For nurses aged over 25 the claim is for £700 going up by stages to £800, and for the under-25s from £525 up to £575 and then to £625. But it is admitted that the £48 meal allowance would be discontinued for that group. The new demand for staff in psychiatric hospitals is for £3,000 a year.
I have received letters from, particularly, male nurses with family respon- 1448 sibilities. I must impress upon my hon. Friend—he knows well what the problem is—that this is probably the most difficult, demanding and testing hospital service work, and that for these men to live on a pittance keeping a family is completely indefensible.
If the claims are to be criticised, it is not because they are too extravagant or too greedy but because they are far too modest. I do not know what the total cost of full acceptance of the claims would be, but whatever it is, it should be met. The very future of the National Health Service might depend on it.
Coming back to the general problem, what we are seeing now is an increasing awareness by lower-paid workers, not only in the nursing profession but elsewhere, of their economic power. Militant and often unofficial action is seen to be paying off. For example, the unofficial strike of dustmen got an instantaneous response and all the demands were met—a 16 per cent. increase overnight, and good luck to them! Other lower-paid workers in local government got comparable increases. Miners got an increase of 10 per cent., stimulated by unofficial action. Building workers are to get a 24 per cent. increase. B.O.A.C. pilots seek an increase of up to 45 per cent., and nobody would class them as lower-paid workers. London dockers are now refusing over £30 a week; they want a lot more than that. Mr. Clive Jenkins secures an increase of over 20 per cent. for supervising engineers and technicians at B.E.A. and B.O.A.C.
The "white cap proletariat" of the hospitals are now on the march as well, but there is an important difference between them and the people that I have mentioned. They will not strike. It is unthinkable that nurses should strike. They are bady organised. Their negotiating machinery is not good. Their salaries have to be paid out of taxation, and everybody is "agin" increased taxation. But it is precisely because of those considerations that this House and this Government have a very heavy responsibility to ensure that these women and men are well looked after and generously treated.
After all, the general practitioners threatened to strike. There was no question of them not striking because it would damage the Health Service. They 1449 threatened to strike. I should like to ask my hon. Friend what the increase in salary was for the average general practitioner over the last 10 years compared with a ward sister or a staff nurse in a medium-sized hospital.
One other thing is that the acuteness of the problem is high-lighted by the closure of wards and the employment of agency nurses. Wards have been closed in Scotland, but the employment of agency nurses is not such a problem there as in London and the South-East. There was a report in one of the London evening newspapers last week about the acuteness of the problem. It mentioned certain management committees and groups of hospitals, such as the East Kent Hospital Management Committee and the Brighton and Lewes group of hospitals. A new 20-bed maternity unit at Stoke Mandeville Hospital at Aylesbury has not yet opened although it was completed three months ago. It advertised for six midwives, but not one answered. University College Hospital mentions that it is using 30 to 40 agency nurses. I believe that an answer was given in another place about the cost of agency nurses. It is not a terribly big problem but it is evidence of the fact that there are not enough nurses coming forward and that some of the hospitals are under-staffed partly because of the inadequacy of remuneration.
The Government's future plans for their incomes policy are to be published shortly. In fact, I think they were published by the Daily Express last Saturday unofficially. It is clear that the Government intend to have an annual wage increase norm of anything from 2½ per cent, to 4½ per cent. But it has been made clear that lower-paid workers in the public service and those whose productivity and efficiency cannot be measured accurately will get above that norm. Presumably that includes nurses.
The incomes policy has been breached in many places and it has been abandoned in all but name by the Government, and it would be a criminal outrage on the part of the Government if they now sought to salvage something from the wreckage of their policy by appearing to stand firm against the most dedicated and responsible but weakest profession in the land. I cannot believe that the Government will be so crassly 1450 stupid and so unmindful of their social responsibilities. I think the legitimate and modest pay demands of the nurses must be met. Public opinion must be educated to understand and accept that the nurses are sick and tired of sympathy and admiration for their arduous and dedicated work. People must learn to translate their noble sentiments into hard cash. That is the one certain test of their sincerity.
I hope the Minister will not seek refuge behind the skirts of the Whitley Council. I hope he will state clearly and unequivocally that his Department is wholly in favour of a substantial and immediate increase in the emoluments of the most tolerant, long suffering, responsible and respected profession in the land.
§ 11.32 p.m.
§ The Joint Under-Secretary of State for Health and Social Security (Dr. John Dunwoody)I would like to thank my hon. Friend the Member for Fife, West (Mr. William Hamilton) for raising this issue tonight because it gives me the opportunity to express the appreciation shared by this House and by the whole country of the magnificent work and devotion to duty of our nurses in the National Health Service. This for me is no politician's platitude; 14 years working as a doctor in daily contact with the nursing profession gives me a degree of understanding of their problem denied to most hon. Members. I have been impressed by the response of the general public to the recent appeal for their support in the nurses' cause, and I am sure that the country as a whole, as well as the nursing profession and their representatives, will be taking the greatest interest in this debate.
As my hon. Friend has said, the pay and conditions of service of nurses employed in the National Health Services in Great Britain are determined not by the Secretary of State but by a process of negotiation between the two sides of the Nurses and Midwives Whitley Council; the Management Side representing hospital management and local authorities, and the Staff Side comprising professional organisations and unions representing all the grades of staff concerned.
I am not, however, suggesting that the negotiation of salaries on the Whitley Council relieves the Health Ministers of 1451 all responsibility for nurses' pay. Representatives of the three Health Departments serve on the Management Side and play their full part in negotiation, and when any of the National Health Service Whitley Councils has reached an agreement the statutory approval of the Secretary of State is required before it is put into operation. Only once since the Whitley Councils were first set up in 1948 has approval not been forthcoming, but that did not concern nurses, and, I would remind the House, it was when the party opposite was in office.
But while we do not leave all the responsibility to the Whitley Council, we certainly do not take over their function. We believe that nurses' pay is best dealt with by the normal processes of collective bargaining, for which the Whitley Council provides the forum and in which the nursing profession is well organised and represented.
Since this Government took office the system has worked well and there have been substantial improvements in nurses' pay. In 1965 the Whitley Council reached a two-year settlement giving increases in pay averaging just on 11 per cent. This settlement, representing a considerable improvement in nurses' pay, was reached by agreement between the two sides of the council. The circumstances were in marked contrast to the difficulties which had attended nurses' pay claims under the previous Administration. The House will recall that under that Administration nurses were the first victims of the attempt in 1961 to hold pay increases in the public sector to 2½percent. This led to a very difficult and acrimonious period of negotiation which in turn led to arbitrations in successive years.
In 1967, following a joint recommendation from the two sides of the Whitley Council, the whole question of nurses' pay and related conditions of service was referred by the Government to the National Board for Prices and Incomes. The board carried out a comprehensive review, and as a result of its recommendations, and the subsequent negotiations in the Whitley Council, nurses received further increases of 9 per cent. and in some cases 14 per cent. The latter increases were paid in two stages, the first stage being paid from 1st October, 1967, 1452 and the second from 1st January, 1969. With other major improvements to which I shall refer later, the total estimated cost of the board's main proposals on pay and conditions of service was over £37 millions a year. The board recommended that this comprehensive settlement should run until 31st March, 1970, and the Whitley Council is now embarking on a review in readiness for a new settlement to operate from 1st April, 1970.
At the time of the last settlement both the National Board for Prices and Incomes and the Government recognised that exceptional treatment for nurses was called for within the terms of current incomes policy. While it is always possible to criticise pay agreements, a major settlement costing over £37 millions a year was a definite and major step forward.
My hon. Friend has touched on the question whether nurses are among the lower paid. In considering the earnings of nurses in relation to those of other workers the information in the Department of Employment and Productivity Survey of Earnings will, of course, be relevant, and I think that this will provide more meaningful information than any answer that I might try to give now. Moreover, the White Paper on Productivity Prices and Incomes will be published shortly. I can assure my hon. Friend, that the position of nurses will certainly be given the most serious consideration in the light of the guidance it gives on the problems of low pay so far as it may be relevant to the lower nursing grades.
The board paid particular attention to the difficulties of staffing psychiatric and geriatric hospitals. It recommended an increase in the mental nursing "lead" from £50 to £100 per annum, the extension of the lead to all grades working in psychiatric hospitals and the introduction for the first time of a similar "lead" for nurses working in geriatric and chronic sick hospitals. As a further measure to relieve staffing difficulties in psychiatric hospitals the board recommended an extension of the system of overtime payment to cover grades up to and including ward sister/charge nurse in those hospitals.
For student nurses, besides the pay increases already mentioned, the board recommended special rates of training 1453 allowance for students in general training who were over 25 years of age and the extension to all students of special duty payment for duty at night and at weekends. Students undertaking psychiatric nurse training also benefited from the increase to £100 per annum of the mental "lead" to which I have already referred.
Although some of the board's recommendations had a mixed reception in the nursing profession and some gave rise to certain anomalies between one grade and another, I think that by and large the board's objectives were right in their intention and were successfully applied by the Whitley Council in the agreement it subsequently negotiated.
My hon. Friend has asked me to compare the increases in nurses' pay with those for doctors. I think perhaps a more valuable comparison can be made with increases in hospital doctors' pay because their two occupations are in almost exactly the same field. Over the period 1963–69 nurses as a whole have had larger increases than consultants, although they were not so great as those for junior hospital medical staff.
The last general pay increase under that agreement was operative from 1st January this year, but time has passed since the board's report and a new review of nurses' pay by the Whitley Council has now been initiated, set in motion by a Staff Side claim. This review is highly important, and the Government most certainly recognise it as such. There are more than 300,000 nurses in over 100 grades in the various parts of the National Health Service. This time the negotiations have to take into account the major changes taking place at the present time in the nursing administrative structure as hospitals replace the traditional hierarchy by the pattern recommended by the Salmon Committee. This will stimulate efficiency in the provision of nursing services, and in the long run it will streamline the pay structure, but for the present it means that there are two separate sets of scales to be negotiated, one for the old structure and one for the new; and they have to maintain a reasonable relationship one with the other.
Perhaps I might say a few words about the posts in the new Salmon grading 1454 structure because this is a subject which the profession—indeed, the whole hospital service as well as my Department—regards as of the highest importance. The National Board for Prices and Incomes had as part of its remit the salaries to be paid to the chief nursing officer posts, which are the senior posts in the new structure. It had a very difficult task because at that time no group of hospitals had completely gone over to the new structure. Indeed, at the time of its report there were only five chief nursing officers in post, and they had all been very recently appointed. Its assessment was, therefore, necessarily tentative. Since then the new structure has become more firmly established, and it is now possible to arrive at a more positive assessment of the considerable responsibilities carried by chief nursing officers. The Whitley Council will have to translate these into salary terms.
At the other end of the spectrum the council will no doubt be paying particular regard to the very special problems of student nurses. As hon. Members will recall, the council made provision for one of these earlier in the year, at the time of the introduction of the pay-as-you-eat system, by introducing a special meals allowance of £48 per annum to meet the dietary needs of these younger nurses. It was made clear at the time that this was an interim measure, and no doubt the council will be considering how this will be taken into account in reaching a new agreement.
Between the grades of student nurse and chief nursing officer there are a large number of complicated grading and salary problems to be considered. The hospital service is aware that, despite the overall benefit obtained from the report of the National Board for Prices and Incomes, there are some anomalies still to be removed; they have caused dissatisfaction among some staff, and I am sure that the Whitley Council will have these problems very much in mind in the course of its negotiations.
My honourable Friend mentioned the employment of agency nurses by National Health Service hospitals as one of the factors which should be borne in mind when considering nurses pay. The employment of these nurses is a longstanding problem. It is in the main a 1455 problem of the Greater London area where, in spite of controls on their employment, numbers have increased in the last year or so, and I am concerned about this. This is a problem not merely because of cost but because it is desirable to have a stable nursing team, and excessive reliance on agency nurses tends to have an unsettling effect on the permanent staff.
While it may be that a substantial pay increase would make more nurses willing to take employment with National Health Service hospitals—indeed, one would certainly expect such to be the case—it will not necessarily solve the problem completely. The attractions of self-employed status are very considerable from the point of view of many nurses.
1456 with its freedom to move from one post to another as they wish and to be selective in the type of work they will undertake.
As far as the Staff Side's present claim is concerned, I have already described the Whitley machinery, and it would not be appropriate for me to comment on the claim in advance of consideration and negotiations—
§ 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 seventeen minutes to Twelve o'clock.