§ Mr. Deputy Speaker (Sir Robert Grant-Ferris)Order. We come now to subject No. 4: doctors' and dentists' remuneration. I think that I should point out that the subjects for debate are contained in the Supplementary Estimates between pages 35 and 47 inclusive. This is another of those rather irritating debates in which the subject matter is drawn very tightly. It will be in order to discuss only the reasons for the increases in the Estimates. There are a number of Estimates, each of which has been increased, and it will be in order for hon. Members to speak only as to the reasons. Such matters as 420 the general scope of the National Health Service would be out of order.
§ 12.48 a.m.
§ Mr. William Hamilton (Fife, West)I fully understand and accept that Ruling.
I should like, first, to make an apology on behalf of my hon. Friend the Member for South Ayrshire (Mr. Sillars) whose name appears on the list of hon. Members wishing to speak in the debate. He is keen to speak, but I fear that he is indisposed. He therefore wishes me to convey his apologies to the House.
The House will recall that we had a debate on the—
§ Mr. Ian MacArthur (Perth and East Perthshire)As the hon. Gentleman is making apologies, may I ask whether he proposes to refer to me during his speech tonight? I ask this because he did so on Friday last in an Adjournment debate. I make no complaint about that, nor do I complain about him quoting from an article which I wrote; but he put this in a context which was personal, offensive and inaccurate. It is the agreeable custom in this House, Mr. Deputy Speaker, that remarks which are personal, let alone offensive or—
§ Mr. HamiltonOn a point of order, Mr. Deputy Speaker. This is an abuse of the House. We are discussing Supplementary Estimates and doctors' pay. The hon. Gentleman's intervention has nothing to do with doctors' pay. If the hon. Gentleman wants to raise this issue at some subsequent date, I shall be glad to deal with it, and with him, but do not let the hon. Gentleman indulge in this kind of tactic at this time in the morning.
§ Mr. Deputy SpeakerI understand the point. I think that the hon. Member for Perth and East Perthshire (Mr. MacArthur) is straying a little wide of what he is strictly entitled to do. I thought that he was going to make a short intervention. I do not think that we should enter into an extraneous argument on something which is not being raised by the hon. Member for Fife, West (Mr. William Hamilton).
§ Mr. MacArthurOn a point of order, Mr. Deputy Speaker. It is an agreeable custom of the House that if an hon. Member proposed to refer to another hon. Member in a personal way, let alone in an offensive and inaccurate way, he 421 gives notice to the hon. Member concerned before he does so. I suggest, with respect, that this courtesy should be protected in some way.
§ Mr. Deputy SpeakerI appreciate what the hon. Member is saying, but it is not strictly a point of order. This is a matter between two hon. Members, relating to the ordinary courtesies of the House. I think that we ought to allow the hon. Member for Fife, West to continue with his speech.
§ Mr. HamiltonIt was neither offensive nor inaccurate, and I shall deal with the hon. Gentleman in due course.
The House will recall that we debated the social services on 13th July, when my right hon. Friend the Member for Blackburn (Mrs. Castle) referred in some detail to the doctors' pay dispute. In replying to the debate the Secretary of State for Social Services talked, at columns 1175 and 1176, of doctors leaving the service and the country, about a shortage of resources and staff, about the lengthening of waiting lists, and about needing time to consider priorities and balance. The right hon. Gentleman dealt with the question of doctors' pay in one short paragraph, where he talked about the dispute which he was unhappy to inherit, and he went on to say:
I am glad to say that we have re-established the concept of the independent review body subject to the right of the Government to reject or modify any particular recommendation."—[OFFICIAL REPORT, 13th July, 1970; Vol. 803, c. 1176.]I want to compare that sentiment with the noises made by right hon. Gentlemen opposite pre and during the General Election. They were very different in tone and in content from what the Minister said on 13th July. The noble Lord the Member for Hertford (Lord Balniel), now the Minister of State for Defence, said on 27th May:After eight weeks delay, the doctors and the country as a whole are entitled to a categoric statement …The hon. Member for Farnham (Mr. Maurice Macmillan), who is now the Chief Secretary to the Treasury, said:The whole object of setting up the review body was, in the words of the Commission, to guarantee that the standard of living should not be depressed by arbitrary Government action. The ordinary procedure which the Tory Government followed on every occasion was to publish quickly and to follow the award in full.422 I go on to quote what was said by the hon. Member for Glasgow, Cathcart (Mr. Edward M. Taylor), who is now the Minister at the Scottish Office responsible for health matters. It is a great pity that the hon. Gentleman is not here, because there is a Supplementary Estimate dealing with Scottish doctors.
§ Mr. Buchanan-Smithrose—
§ Mr. HamiltonNo. The Minister responsible for health matters is not here, and I object to the fact that he is not present.
§ Mr. Buchanan-SmithWill the hon. Gentleman give way?
§ Mr. HamiltonNo. The hon. Gentleman's hon. Friend abused the privilege of my giving way to him, and I have learned a lesson. The hon. Member for Cathcart said on that occasion:
When the Secretary of State says that no doctor will lose a penny as the result of the delay, does he mean that the doctors will be exempt from any wage or salary freeze that might be imposed by the Government in the event of their coming back?"—[OFFICIAL REPORT, 27th May, 1970; Vol. 801, c. 1783–87.]The inference was that if he and his party had been in office they would not have subjected the recommendation to any kind of freeze or qualification but would have granted the whole 30 per cent. to the doctors across the board. I ask the Under-Secretary whether the Government intend to accept in full the recommendations of the Kindersley Review Body.On 28th May the hon. Member for Farnham asked my right hon. Friend then Secretary of State for Social Services
why will he not announce the decision now to accept the recommendations?I am sorry in the circumstances to refer to the then Shadow Chancellor of the Exchequer because I had a genuine respect for the right hon. Gentleman, who will be sadly missed by all of us, but I must refer to remarks made by the right hon. Gentleman subsequently in an election speech. But in the subsequent discussions on 28th May, my hon. Friend the Member for Ebbw Vale (Mr. Michael Foot) pointed out that the right hon. Member for Enfield, West had quite recently saidthat the way to deal with the wages problem was for the Government particularly to reject all wage demands in the public sector—a policy that would be most unfair to the doctors 423 as it was when it was applied to the nurses by the previous Conservative Administration."—[OFFICIAL REPORT, 28th May, 1970; Vol. 801, c. 2038–40.]We all remember the incomes policy applied by the Conservative Government in the early 1960s which hit hard not the doctors but the nurses—2½ per cent.—the probation officers and other similar people. The Prime Minister, then Leader of the Opposition, in his General Election campaign gave an undertaking that the Tory Party would honour the recommendations of the Review Body in full.The then Shadow Chancellor said, when speaking in Urmston, Manchester, on 9th June,
The doctors have been disgracefully treated.…The Kindersley Committee have been insulted by the Government and are quite right to resign. We always implemented their recommendations promptly and in full. We would have done so this time. It is in Government often inconvenient to have to keep one's word, but it is more important that undertakings to public servants should be, and should be seen to be, honoured.It was clear before and during the campaign that both the B.M.A. and the Tory Party were determined to make this issue a political football. The Labour Government made an offer which was justifiable, but in the circumstances generous, of 30 per cent. immediately to junior hospital doctors and dentists and trainee G.Ps. and 15 per cent. to consultants, G.Ps. and general dental practitioners. There was in addition the inclusion of an allowance for increased practice expenses which brought the gross rise for G.Ps. up to 20 per cent. The total cost was to be £57 million in one year, which is the Supplementary Estimate that we are talking about today, the £85 million being the cost of the total award.What did that mean? It meant that for the junior doctors and dentists over a period of two years the top pay of a house officer would rise from £1,450 to £1,884, for a senior house officer from £1,790 to £2,328, for a registrar from £2,220 to £2,886, and for a senior registrar from £2,760 to £3,588—all of those back-dated to 1st April last. In addition, junior house doctors could claim a new extra duty allowance, which I need not go into in detail.
The then Labour Government also decided that senior hospital doctors and 424 dentists, general practitioners and general dental practitioners should get an immediate 15 per cent. increase; and that that too, would be backdated to 1st April last. The other 15 per cent. was to be referred to the Prices and Incomes Board. That also would be backdated, whatever the Prices and Incomes Board recommended, to 1st April. The Prices and Incomes Board had agreed to submit its report by 15th July—about a week ago.
It is interesting to put some of the facts on record. The public are not aware of the nature of this increase. The present pay of a consultant with an A award up to the point of the increase was £9,275 a year. The pay increase that he was to receive under the Labour Government was £1,393—making a total of £10,668. That was excluding all private practice fees.
If the Kindersley recommendations had been accepted in total immediately the total pay of a consultant would have risen from £9,275 to £12,061. A consultant with a B award, whose then pay was £7,625, was to get an immediate increase of £1,147, making it up to £8,772—again excluding private practice. When the general public, when the dockers, when the miners, when all the lower paid workers in my constituency and those of my hon. and right hon. Friends, see those figures they appreciate just how generous the Labour Government was being.
The Labour Government's recommendations on dentists were in similar terms. Their net income was to be increased from £3,590 to £4,129. The Kindersley recommendations in full were for £4,515 in the first year going up to £4,818 in the second.
Nobody on either side of the House would deny the justice of the claim of the junior hospital doctors. Their inadequate pay, their terrifyingly long hours and dangerous overwork have long been indefensible on any grounds—medical, social or economic. The strain on those young doctors was due in large measure to the inadequate number of trained doctors, which could be directly traced back to the Tory Government's decision—taken in 1957, following the advice tendered to them by the infamous Willink Report—to cut the intake of medical schools by about 10 per cent. 425 The Tories accepted this, and we are now seeing the result of that short-sighted policy.
The hardship of those junior hospital doctors led them into considerable dispute with the B.M.A. for its failure to press their cause. The B.M.A. was too busy looking after the top bracket men to bother about the junior hospital doctors, and this was one of the reasons why, in my view, the B.M.A. decided to play party politics with this matter.
They refused for a time under the Labour Government, in the run-up to the election, to sign medical certificates. Is any deduction to be made, or has any been made, from doctors' emoluments for not fulfilling their contracts? It is reasonable to say that if a man does not honour a contract, he should be expected to accept some reduction in his emoluments. Hon. Gentlemen opposite are all in favour of honouring legally binding contracts. I take it that a doctor in the N.H.S. has a legally binding contract with the Service, in which event he should, if he does not fulfil that contract, be penalised.
They refused to sign medical certificates throughout the election campaign, and the Review Body resigned en bloc. However, in the event, with the advent of a Conservative Government, the B.M.A.'s attitude changed almost overnight. That revealed to us what many of my hon. Friends had always believed; that, with some honourable exceptions, the medical profession is true blue Tory. They ended their ban on the signing of sickness certificates and their strike threat.
It was an interesting exercise. The nurses in the N.H.S. have never threatened to strike. But the doctors have never hesitated to use the strike weapon, come what may, if they have not got their way. They have had none of the nurses' inhibitions in this respect, particularly when Labour have been in power.
What undertakings have now been given by the Tory Government to bring about this somersault by the doctors? Is it because the Tories have said that they will withdraw the reference to the P.I.B.? Is it because the Tory Government recognise the principle of "an" independent Review Body and not "the" 426 independent Review Body that existed? This point was put well in an article in the Lancet on 4th July. It said:
The medical profession and the new Government have sensibly found a quick way back from the brink to which the British Medical Association was bundling the National Health Service. After his talks with doctors' and dentists' representatives last Friday, Sir Keith Joseph, Mr. Heath's Secretary of State for Social Services, went so far as to write the letter …which the Lancet reproduced in full. The article continued:But just how far is that? The Government in return for the renewal of doctors' co-operation in N.H.S. administration and in the signing of certificates, has withdrawn from the Prices and Incomes Board the second 15 per cent. of the Review Body's recommendations referred to it by the Labour Government and has undertaken to re-establish an independent review body to advise the Government on doctors' and dentists' pay. Not, it has been noted, 'the' Review Body ('our' Review Body, as the doctors often called it), but 'a' review body. Sir Keith reiterates the Royal Commission's proviso that 'obviously compelling reasons' would be needed to justify rejection or modification of the body's advice".What progress has been made by the doctors to warrant that difference in approach by the Tory Government compared with the former Labour Government? The article continues:From these slight comforts the B.M.A. has taken heart and sense enough to stop its harassment of the N.H.S. to subdue its talk of resignation, and to accept the Government's offer to enter into very early discussions on the matters of pay now taken back from the Prices and Incomes Board. The right decision has thus been reached by an unnecessary painful path. … All the same, the B.M.A. had no justification for rushing in suspicion and rage to the barricades on June 4,"—the only reason it did so was that there happened to be a General Election in prospect—the day the referral was announced, for the Association has now put aside (for good, it is to be hoped) the weapons of non-co-operation and resignation, and yet the situation an June 27 was little different from that on June 4, when the war-cry went up".The only difference was that there was a different Government. The Government have made it clear that if they find obviously compelling reasons they will justify rejection or modification of that Review Body's advice without reference to any independent body—Prices and Incomes Board or whatever. The Government will have the final decision, and they will presumably explain their reasons to the House as well as to the doctors.427 It is as well to remember the terms of reference of the previous Review Body. They were to
advise the Prime Minister on the remuneration of doctors and dentists taking any part in the National Health Service.Will the new body be advisory or will the Government and the B.M.A. together accept whatever it proposes? If they do, that is a negation of government. The Government must reserve the right to the final say. They must determine what is in the national interest, and if it is not in the national interest to accept the complete recommendations of the Review Body they have the responsibility to say so.We want the Government to explain how they will get out of their jam. Will they pay the full 30 per cent. immediately? I suspect that the Minister will say that discussions are still going on. That will be typical. We have had this for the past month. The Government must be longing for Friday to get us away for three months so that they can get on with their dirty work.
If they are to give the doctors a 30 per cent. increase right across the board immediately, what kind of reaction do they expect from the trade unions and the lower-paid workers, from the dockers who are now out?
§ Mr. HamiltonIs the hon. Gentleman tired, or has he got a stomach ache?
§ Mr. HamiltonAre the Government accepting immediately the award of 30 per cent. across the board for all doctors? If not, why not? But if they are, if they are to accept this now or in the next few weeks, I hope that they will not be surprised if the reaction of other organised workers is the one that they themselves encouraged when they were in opposition, that everyone should get as much as he can, because they always opposed any concept of a prices and incomes policy. If this award were granted to the doctors, I do not know what the reaction would be of the dockers and the agricultural workers. I know what the reaction of miners in my constituency would be.
This would add fuel to the wages explosion which the Prime Minister, then 428 Leader of the Opposition, talked about during the General Election to try to terrify the hell out of everybody. That explosion would be like a little sparkler by comparison. If the award were given, what would then become of the Government's declared determination to tackle inflation by first holding down very firmly wages and salaries in the public sector? Their commitment during the election was that one of the most important ways to tackle inflation was for the Government to take control over the sector for which they had responsibility. The National Health Service could not be a more public sector. If this award is made, what will the nurses and the medical ancillaries say? Already the nurses are coming back, I hope soon, for a substantial increase on what they have already had under the previous Labour Government. I shall be one of the first to be behind them on that. The Government will release some powerful forces if they accept this recommendation.
If it is granted, another question arises. How will that square with the pledge to cut public expenditure? All kinds of contradictions arise from acceptance or rejection of this recommendation. If, however, the Government intend to welsh on their election pledges on this matter, will the B.M.A. then threaten strike action against the Tory Government? It will be interesting to see. Also, how many of them will emigrate? The Secretary of State for the Social Services talked about the doctors emigrating if they did not get this 30 per cent. Presumably they will go in hordes to Canada and the United States and elsewhere, and there will be none left. Or will they be prepared to accept from their own Tory Government scales of remuneration no more generous than those offered by the Labour Government?
Whatever the outcome of the current negotiations between the Minister and the B.M.A., the statement should be made initially to this House. I suspect, however, that many statements will be made in the recess which the Government are not prepared to make to this House, and this is one of them. This is one of the reasons why some of us will be speaking in the debate on the Adjournment Motion on Thursday—because we suspect that many of the decisions based on the recommendations 429 of the Kindersley Committee will be made during the recess.
I hope that the hon. Gentleman can assure us that that will not happen, but that the statement will be made to the House. I do not expect him to make it tonight: I am sure that he will not. They do not agree with instant Government. Sometimes they do—we have had one or two instances of instant Government—but this will not be one of those cases. I suspect that they will get into cahoots with the B.M.A., and either welsh on what they said before the election, or else give them the 30 per cent. and take the consequences.
§ 1.20 a.m.
§ Mrs. Renée Short (Wolverhampton, North-East)It is a pleasure to follow my hon. Friend the Member for Fife, West (Mr. William Hamilton) and to pursue the question of remuneration offered to doctors as laid down in the Estimates.
This was a totally unnecessary pay dispute. Since the Tory Government came to power they have wooed the doctors with soft words. Like my hon. Friend, I am anxious to know what attitude the Government will take over the balance of the award. If the statement is made that the whole amount is to be allowed, I underline and reiterate warnings that have been given that this will have a serious effect on the whole of industry and claims now in the pipeline. It would be grossly inequitable and unfair, particularly, as my hon. Friend said, because the levels in certain echelons of the medical profession are very high indeed.
Consultants with the top merit award are often receiving as basic pay from the National Health Service for what is a part-time job more than Cabinet Ministers. They do an easier job, which carries less responsibility and probably less work. If the Government accede to this, it will have repercussions throughout the whole industrial scene. Probably the Government will be very sorry that they have sparked that off. I hope that they will proceed with caution.
The situation immediately before the General Election was rather ugly. Doctors who very frequently with hand on heart take a rather pious attitude to certain problems affecting the profession, 430 particularly to problems about which Members of Parliament have been rather active in introducing legislation, were prepared to take industrial action. They were prepared to impose sanctions to get what they wanted from the Government. They were prepared to create so much difficulty and chaos within the administration of the Health Service that they were risking their patients being affected. This is something which doctors always say they do not want to see. They say that their medical training precludes them from doing this. Yet they were prepared to go to those lengths. It was an ugly prospect.
The Review Body, doing its best for the medical profession, made strenuous efforts, but when the Government were faced with a 30 per cent. rise right across the board, they were bound to pause for it would be in breach of prices and incomes policy. I think doctors and the profession have damaged their own image vis-à-vis the general public, and certainly vis-à-vis politicians. They have not helped their own case but rather inferred that politicians are always opposed to the profession. They think that we are "paper tigers" not prepared to take necessary action which is the natural consequence of policies we have introduced and pursued.
According to the Estimate, we are giving £57 million, a very considerable amount and a considerable proportion of all the money spent on the National Health Service and salaries. This is given as a 30 per cent. increase for lower paid doctors and represents a 15 per cent. increase for higher grades pending the report by the Prices and Incomes Board. This is not the only increase that has been given under a Labour Government, nor the first. In 1966 and in 1969 there were increases for the medical profession. It is not true that a Labour Government have always refused to implement increases to the profession. There were those two increases during the lifetime of the last Labour Government.
My hon. Friend gave some information about what these awards mean. Supplementing what my hon. Friend said, as a result of the 30 per cent. award the top pay of house officers rises from £1,450 to £1,884 per annum, an increase of £8 7s. 0d. a week. Compared with the weekly allowance granted to a widow 431 this is a considerable increase and is what many people have to live on as total income. The top pay for a registrar increases from £2,220 to £2,886 per annum.
The pay of a typical general practitioner rises by £21 a week. General practitioners are ready to pose before the general public as being grossly overworked and grossly underpaid. An increase of £21 per week is a considerable increase. I do not begrudge general practitioners the increase, because they work very hard and are some of the hardest working members of the profession.
The pay of a top consultant working in the Health Service rises from £9,275 to £10,668 per annum, an increase of £27 a week, which is about equivalent to the national industrial wage on which many families have to live. Many families live on much less. There is the increase in the average dentist's pay. All these considerable increases are backdated to 1st April. 1970.
For junior hospital doctors there is the extra duty allowance. They can claim units for time off. A hospital doctor who works for a certain number of units can receive extra pay—£6 per unit for a house officer to £13 10s. 0d. a unit for assistant grade. A pre-registration house officer on £1,626 per annum who worked three extra units a fortnight would get £480 per annum extra.
I do not think that anybody would grudge these increases to junior hospital doctors. The recent Press and television publicity devoted to the life that junior hospital doctors must live—long hours, long spells of duty without time off—has shown that these increases are well justified. The mind boggles at the long hours these doctors work and the complicated and varied types of work they are called on to undertake when the consultants are sleeping soundly in their beds. No self-respecting trade union in any other profession or trade would have tolerated the conditions that junior hospital doctors have tolerated for so long.
I stress that I am not opposing any part of the additional remuneration that has gone to the junior hospital doctors. It is well deserved.
432 During the election campaign we were attacked by the Conservatives for agreeing to meet only the £57 million. The Conservatives certainly gave the impression that they would have been quite happy if we had allowed the whole £85 million. That does not fit in with the pledge to curb expenditure in publicly owned industries, nor with the pledge to reduce expenditure. It does not even fit in with their pledge to reduce taxation, because to provide the £85 million means that the money has to come from somewhere and, presumably, it comes from the general consumer—in other words, the taxpayer.
It would appear, therefore, that if the whole claim is to be met, taxation has to go up or the service provided within the National Health Service has to be reduced. Perhaps the Under-Secretary of State, when he replies, will be good enough to tell us how the money is to be found if the Government intend to meet the whole claim. The situation needs very careful consideration by the Government and we are anxious to know exactly what stand they are taking.
It could be said that if the money is available and the Government intend to provide the additional £30 million or so for the award, there are other ways in which the money might be spent. The junior hospital doctors might have an additional claim for improved conditions of work and amenities. There is great difficulty in many hospitals concerning the accommodation that is provided for junior hospital doctors.
Sixty per cent. of the medical students who qualified last year from the teaching hospitals in the Birmingham, Oxford and Bristol areas were married, but in the areas covered by those hospitals only 35 per cent. of them had married quarters to offer. Here is an immediate example of where money should be spent, perhaps, rather than giving the award to the consultants, to much better purpose. This would certainly aid recruiting, and the Government must clearly be concerned about recruiting for the National Health Service. Therefore, the building of better married accommodation for young hospital doctors and the provision of better facilities for them in hospital represents an important claim, because—the hon. Gentleman may not 433 know this—some junior hospital doctors do not even have a peg on which to hang their coat or a cupboard in which to put their possessions.
§ The Under-Secretary of State, Department of Health and Social Security (Mr. Michael Alison)indicated assent.
§ Mrs. ShortThey are almost as badly off as some Members of Parliament, although male Members of Parliament at least have a hook on which to hang their swords, so that they have some amenities that junior hospital doctors do not have.
Although we have provided a great deal more money for hospital building, more money is always needed. If the Government were so minded, more could be provided from this additional money for salaries. The speeding up of procedures on out-of-date planning delays which hold back hospital building is a matter to which the Government should have regard.
The utilisation of the services of the medical profession at all levels—not only doctors, middle grades and consultants, but general practitioners, too—the development of the general practitioner service and the community service and the provision of after-care facilities for patients after discharge from district general hospitals and the medical supervision that is needed for those patients, could lead to a very high standard of medical care and would yield dividends, because we could then provide bed norms of two per 1,000 for acute beds. This is something that the Government should be thinking about in the future development of the service.
If we are looking for real advantage in the hospital service as a whole, we should develop group training schemes for nurses and other staff rather than spend this money on providing inflated salaries for the top consultants. We should consider the establishment of a compendium for the equipment which has to go into all the new hospitals which we are building similar to that now instituted for building components. This, again, could be of great value and would in many ways save money in the future. Further, we should study ways and means of introducing more automation into hospitals, another way of saving money on salaries and wages within the service.
434 We should look to post-graduate education as a means of educating general practitioners and adding to the qualifications of junior hospital doctors, helping them to go up the ladder and be able to earn the better salaries given to consultants. The blockage at consultant level is a matter of great concern to junior hospital doctors. The Government ought to give attention to these things so as to improve the lot of the junior hospital doctor.
In its report published earlier this month, the Central Health Services Council suggests that there ought to be provision of a family planning service within the National Health Service available to all patients without charge. This would be a means of saving a good deal of money not only in the service itself but throughout the whole range of Government social expenditure which could bring great dividends if only the Minister would accept that recommendation in the report and implement it.
If the Government are willing to spend the additional money required to meet the Review Body's recommendation, there are better ways of spending it within the National Health Service so as to give better value and a better return not only for the patients but for the doctors working within the service.
I am convinced that we have the best health service in the world. In spite of the criticism, sometimes the carping criticism, which we frequently hear from doctors and people outside the National Health Service who ought to know better, and even from some politicians, we have a marvellous Health Service of which we should be proud. We all ought to support it and defend it. Those who are coming all the time from abroad to look at our hospitals endorse that view and are envious of the kind of hospital service we have.
Doctors working in the National Health Service, and in our hospitals in particular, ought to understand how lucky they are to work in such a service and such hospitals as we have. They ought to understand that they can advance within their profession, they can achieve the sort of ideal conditions which all of them want, and they can have the kind of hospital equipment they want and the fruits of advances in medical science and research only in co-operation with politicians. They cannot have it without us.
435 I hope, therefore, that this whole affair of the award will have had a salutary and calming effect on the leaders of the medical profession and that hon. and right hon. Gentlemen opposite will, in effect, take careful note of what has been said from these benches tonight. I hope that they will make their proposals to the House of Commons, not leaving the matter till the recess when we cannot get at them. If they are willing to spend more money, let them consider some of the eight or nine suggestions which I have made, which would bring enormous benefit to doctors and to patients.
§ 1.40 a.m.
§ The Under-Secretary of State, Department of Health and Social Security (Mr. Michael Alison)May I start by expressing my regret that the hon. Member for South Ayrshire (Mr. Sillars) is indisposed? He is an assiduous questioner on this subject and I should have welcomed his intervention in this short debate.
The hon. Member for Fife, West (Mr. William Hamilton) covered a fairly wide canvas in recapitulating the antecedents of the present consideration of the 12th Kindersley Report and some of the drama that went before it. The hon. Lady the Member for Wolverhampton, North-East (Mrs. Renée Short) ranged even wider with a skill which I envied and greatly enjoyed. I should like to debate with her further the more general items of National Health Service policy, but tonight we ought to confine ourselves to the narrower issue raised by the hon. Member for Fife, West, the issue of the proposed increase. This must be set in the context of the different priorities within the Service, and it is on this claim, this invitation to the Government to spend more, that we have to focus our attention this evening.
May I assure the hon. Lady that I have carefully noted the points she has made and the priorities she has listed? I agree with much of what she has said. We must nevertheless include the doctors as part and parcel of the excellence of the Service to which she rightly referred. We must not tend to set them off as a sort of liability, as the hon. Member for Fife, West did when he talked about them being all true blue Tories. Coming from him, that was a suggestion that they were a liability to the Service, and I was 436 glad when he qualified that by saying that they were not all true blue Tories.
At this late hour, I do not propose to weary the House with a detailed recapitulation of the facts, now fairly well known in the House and the country, surrounding the 12th Kindersley Report. We believe that the present Administration inherited a genuinely unhappy situation from their predecessors. This is not a situation, as the hon. Member for Fife, West implied it was, arising from malevolent political ill will on the part of the doctors. I refute that.
The doctors are a body of professional people whose interests are meant to be guarded by the Pilkington and Kindersley procedures. They have felt that they had their fingers burnt in 1966, when there was a squeeze and freeze following the 7th Report, and they saw the same hazard looming again as we came into the period of the general election following the publication of the 12th Report. We should sympathise with their genuine misgivings that once again they were to become a political shuttlecock.
It was precisely this that the Pilkington and Kindersley review procedures were meant to try to avoid. One of the first actions of my right hon. Friend on taking office as Secretary of State for Social Services was to meet representatives of the doctors and the dentists and have talks with them. As a result of those talks on 26th June, the professions resumed co-operation. I am happy to say, in Health Service administration and in the signing of medical certificates.
I should specifically interpose at this point that no reduction in the emoluments for doctors is envisaged by the present Government, because we want to preserve the atmosphere and spirit of co-operation, which, I am happy to say, has been restored. Nothing is more likely to undermine co-operation and the right spirit of co-operation than vindictive retrospection in the application of penalties.
§ Mr. William HamiltonWould the hon. Gentleman now say that, whichever worker is in breach of contract, if he is a Government employee, or is paid by the Government, then the Government will take no action against him? I thought that the Tories were in favour of the sanctity of contract.
§ Mr. AlisonThe spirit of the matter is that in every case where legalism might rear its ugly head there is nevertheless scope for discretion and human flexibility. This is the principle we would wish to apply, whether to the dockers or the doctors. The Government for their part, following the return to co-operation by the doctors in the N.H.S., withdrew the outgoing Government's reference to the National Board for Prices and Incomes of certain recommendations of the Kindersley Review Body's 12th Report. We expressed our willingness, and this is a key point in the restoration of the right spirit of co-operation, to arrange for the re-establishment of an independent review body to advise the Government on doctors' and dentists' pay. Here I take up a question raised by the hon. Member for Fife, West as to whether the re-establishment is to be of an advisory body. The answer is quite specifically "Yes, an advisory body, no more and no less." It will be independent and impartial, we believe, but advisory.
§ Mr. William HamiltonNo change.
§ Mr. AlisonNo change in this sense. The withdrawal of the reference to the Prices and Incomes Board has not escaped criticism, both tonight and at other times. The position is quite clear and it is the fundamental issue in the dispute which has arisen between the outgoing Government and the doctors. We regard it—as I think the doctors regard it—as inappropriate for the findings of one review body to be referred to, as it were, a second umpire, a second jury or a second review body. It is not fitting that advice received from the proper advisory body should be further scrutinised by other advisors. This is bound to undermine the confidence of those whose advice is sought and tendered in the first place, officially and statutorily.
Let me remind the House of the terms of reference of the Kindersley Review Body. It is:
to advise the Prime Minister"—and here I stress the point that the hon. Member for Fife West was seeking to make—on the remuneration of doctors and dentists taking any part in the N.H.S.438 In our view, and this is not a matter of issue with the professions, it is for the government of the day, and I accept the obligation which the hon. Gentleman sought to lay upon us, to reach their conclusions on whether they can accept in full the advice given to them, or whether, for compelling reasons they have to reject or modify them. We do not attempt to dodge this. It is well understood by the professions. This body is an advisory body, reaching conclusions independently and impartially, but it does not evacuate the right or obligation of the government of the day, and no other body, to assess and consider the advice tendered to them and maybe to modify or even reject that advice if compelling reasons arising from the national interest make it necessary to do so.
§ Mr. William HamiltonOne of the points that I was making was that this kind of statement was very different from the statements made in the course of the General Election when the Shadow Chancellor and the present Prime Minister said specifically that they would give the award in full, with no qualifications whatever.
§ Mrs. Renée ShortThe Prime Minister said that the whole of the £87 million should be given.
§ Mr. AlisonPerhaps I had better get on to the selective quotations by the hon. Member for Fife, West, from speeches made in the General Election by my right hon. Friend the Prime Minister, and by the late Chancellor of the Exchequer, whose untimely death all hon. Members regret. I should like to thank the hon. Gentleman for his kind words on that matter.
There is no doubt that on one occasion my late right hon. Friend the Member for Enfield, West, said that we had always implemented Kindersley's recommendations in full and would have done so this time. I do not attempt to deny this, but he made it clear very shortly afterwards that all depended on the economic situation.
§ Mrs. Renée ShortAh!
§ Mr. AlisonWhich can only be judged by the Government of the day in possession of all the facts.
§ Mrs. Renée ShortThat is what we were doing.
§ Mr. AlisonThis is what my right hon. Friend the Prime Minister pressed for time and again in asking whether there was a national emergency and in saying that we would have to look at the books.
§ Mr. William HamiltonHe said there was an emergency.
§ Mr. AlisonIt is not true to say he said there was. My reading of the script of the famous Press conference—[Interruption.]
§ Mr. Deputy SpeakerOrder. I have allowed this debate to range very widely indeed and I hope that no hon. Member will take advantage of that fact.
§ Mr. AlisonPerhaps I must restrain myself in chasing hares raised by the hon. Gentleman and the hon. Lady opposite. The truth of the exchanges in the General Election, as I understand them, is that acting on the precedents of the Tory years, when we had no reason to do other than implement all the Kindersley proposals, we thought it the proper and normal course to implement in full. The 64,000 dollar question then and now was whether there was an economic emergency. It would be reasonable for my right hon. Friend the Prime Minister to say that we would implement in full subject to there being no emergency. The question he put was whether or not there was an emergency.
I turn briefly to the present. This will bear on the request by the hon. Gentleman for an ex cathedra statement from my right hon. Friend before Friday or from me tonight about what the future holds. My right hon. Friend the Secretary of State has had a series of meetings, as was foreshadowed in his letter to Dr. Gibson of 27th June, with representatives of the medical and dental professions about the remuneration questions withdrawn from the National Board for Prices and Incomes. I believe that both they and we now understand each other's viewpoint more clearly as a result. These discussions are still going on. It would be improper for me to lay down any time table by the end of which they should be drawn to a conclusion. 440 Consultations and discussions of this sort should not be carried on against any background of haste or undue duress on either side. The hon. Gentleman, with his knowledge of trade union negotiations, realises that negotiations between employers and those who are employed by them should allow maximum flexibility for consideration by both parties in reaching a common mind on the matters withdrawn from the N.B.P.I.
With regard to an annoucement before Friday, I can do not better than quote the words of my right hon. Friend the Prime Minister in the House on 2nd July:
… an announcement will be made at the appropriate time. The Government will pursue their own policies and they will inform the House accordingly when they take decisions—and not at the behest of right hon. Gentlemen opposite."—[OFFICIAL REPORT, 2nd July, 1970, Vol. 803, c. 91]