HOSPITALS (NOTTINGHAM) (Hansard, 26 January 1972)

§ Mr. William Whitlock (Nottingham, North)

The problems of the hospital services in Nottingham, as indeed elsewhere, are many and varied. Tonight I want to deal with a narrow but very important aspect of them, that of building maintenance.

However dedicated the nursing and medical staff of a hospital may be, all their wonderful work may be made harder by the inadequacy of the buildings in which they work, and it may be threatened by the deterioration of those buildings. The Department of Health and Social Security has plans for existing hospital buildings. The great "in" word in the Department these days seems to be "scenario", which conjures up beautiful pictures about our hospital service as it develops under those plans.

Although it is essential to have plans for the future, in dreaming its wonderful dreams about the future the Department fails to see clearly some of the existing problems which stare it in the face. A battle is going on to preserve the fabric of older hospitals and I have the feeling that the Department is only dimly aware of the intensity and importance of this battle.

To fight battles, generals are necessary, I suppose, but not too many of them, for they do not have to bear the heat and burden of the day where the action takes place. One often hears the somewhat cynical comment that when the Government do not wish to recognise a problem or attempt to solve it immediately, they appoint a Royal Commission. Recently I heard someone say rather bitterly that the Department has a variant on that approach; it appoints a committee and when it can no longer 1578 postpone doing something about the committee's report and recommendations, it appoints more generals at headquarters.

The Committee of Inquiry on Hospital Building Maintenance and the Work of Building Supervisors stated about 18 months ago, after two years' work, in what is known as the Woodbine Parish Report, that greater attention to hospital building maintenance is necessary. All the signs now are that the outcome of that Report will be no more than the appointment of more generals at regional hospital board level instead of at the level where the augmentation of staff is really necessary—namely, at the hospitals. Over the years the staff at regional level has been greatly increased and it can be shown that those increases have not led to commensurate improvements in the lot of patients.

All hospital groups have their building maintenance problems but tonight I shall deal specifically with the problems of the Trent Vale Hospital Group. The Group's Management Committee covers nine hospitals which, apart from a total cubic capacity of buildings in excess of 16 million cubic feet of occupied space, contain within their grounds approximately eight miles of roads and paths. The maintenance of those buildings, roads and grounds presents formidable problems which must he tackled by a supervisory building staff which is far too few in numbers and whose salary scales are much too low.

Two of the hospitals have developed since the 1930s but the other seven date from 1870 onwards. Internally what one might call the social modernisation of the older hospitals has produced in the last 20 years complete transformations. In place of dark and dreary corridors and of wards calculated to depress the blithest of spirits, there is now bright, attractive accommodation which has its therapeutic effect on patients.

The story of external maintenance is somewhat different, for, although much work has been done externally, a grossly under-staffed building supervisory team is fighting hard against the encroachments of decay, eking out finances totally inadequate for the struggle.

I have seen at these hospitals how great the maintenance demands are. They involve correcting faulty or non-existent 1579 damp courses and the brickwork decay which results from these defective damp courses; replacing obsolete and corroding eves guttering which has permitted rain to penetrate and extensively to rot the roof timbers; doing a thousand and one jobs which include repairing broken windows, sash cords, doors and locks, floors, plaster surfaces, blocked drains, sanitary ware and so on. To supervise all these things within a group of nine hospitals, to carry out surveys, to draw up plans and programmes, to make decisions on priorities within the financial limits set, to prepare documents for competitive tendering, to prepare accounts, and to do all the things which the group building supervisor has to do, means that this official is faced with an exceedingly demanding job.

In addition to organising and controlling these tasks he acts as a member of the group management teams and attends meetings on future planning projects, site meetings on capital schemes and so on. When I learned of the salary he is paid I was amazed that we were served by a man as competent as this who obviously could command so much more in pay in the building industry elsewhere. I was even more amazed when I was told of the permitted level of supervisory staff supporting him. But even that low establishment is not reached, because the salaries offered are so inadequate that staff cannot be found. Some of those employed against the establishment are temporary and some have qualification below the standard required.

Recruitment to this department, as indeed to so many other departments of the hospital service, is seriously affected by the low salaries offered. It will not improve until realistic salaries bring in people who are badly needed if the continued life of our vitally necessary hospital buildings is to be assured. Massive infusions of labour and materials must also be forthcoming if further deterioration in the structure of the older buildings is to be avoided. If the money is made available now for Nottingham's hospitals and for hospitals throughout the country with the same building maintenance programme, and if the hospital building programme is expedited, that will make a large dent in the unemployment figures.

Expenditure per head of populace on the medical and hospital services in the 1580 Sheffield Region has repeatedly been below the national average figure, and it has, of course, long been obvious that before the National Health Service was brought into being there was in the South of England better provisions for hospital and medical services than in other parts of the country. It has naturally been necessary for each successive government to continue to maintain the services already in being, but elimination of the imbalance between regions has nevertheless taken far too long. It is time the Sheffield region, and particularly the Nottingham area, had its fair share of the national cake available for the hospital service. It is time, too, that a new region was created with Nottingham as its centre, or, failing that admirable change, at least that the regional board was moved to headquarters in Nottingham.

While there may be differences in treatment as between one part of the country and another in the allocation of money for hospital building and maintenance programmes, the Minister will no doubt say that all salaries are at national rates and are determined by the appropriate Whitley Council. But I hope that he will not shelter behind that argument. What the management side of each Whitley Council can offer the staff side in salaries largely depends on the limits to which the hon. Gentleman's Department permits it to go, and behind his Department is the cold, clutching hand of the Treasury, which sees to it that the Whitley Council can offer such inadequate salaries to hospital supervisory building staff while permitting Whitehall Departments—even, perhaps, the hon. Gentleman's own Department—to employ from private agencies teenage copy typists who can earn 87½p an hour. That is £35 for a 40-hour week, and the payment to the agencies includes a fee over and above the salary paid to the typists.

Will the Minister please do something urgently to change this ridiculous situation before greater troubles hit our hospitals? Will he badger the Treasury until adequate sums of money are available to ensure that proper maintenance arrangements for our hospitals are made? Will he hound the Treasury night and day until in the Nottingham area we have a right, fair and proper share of 1581 the money that is made available for our hospital service?

§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)

The hon. Member for Nottingham, North (Mr. Whitlock) has expressed concern about the shortage of building maintenance staff at supervisory and working levels at the Trent Vale Hospital Management Committee. The H.M.C. has not drawn attention to any special difficulty in recruiting staff in these categories of which I am aware. My information is that it has in post a building supervisor—an officer responsible for the planning and supervision of the building maintenance work of the group of hospitals for which the H.M.C. is responsible—supported by two assistant building supervisors. In addition, there are three general foremen, one foreman painter, one chargehand painter, one chargehand carpenter. and one chargehand bricklayer, as well as 14 painters, 12 carpenters, five bricklayers and eight building labourers—quite a substantial tally of staff to cover admittedly a group with a substantial number of hospitals and a substantial area of fabric to maintain. Although I said that I am not aware of any special difficulties, I know that the H.M.C. would like to employ an additional assistant building supervisor.

My right hon. Friend the Secretary of State and his predecessors have been concerned about the general standards of hospital building maintenance. The former Secretary of State, along with the then Secretaries of State for Scotland and Wales, set up in 1968 a committee of inquiry on hospital building maintenance and the work of building supervisors under the chairmanship of Mr. David Woodbine Parish. So the hon. Gentleman's own right hon. Friend was not immune from the disease to which he drew attention of setting up committees.

As the hon. Member has reminded the House, the committee reported in 1970. In sending copies of its report to hospital authorities my Department made it clear that the Secretary of State was in agreement with the committee's view that sound estate management required greater attention to building maintenance and the way it was organised and 1582 managed in hospitals. A number of specific recommendations required detailed consideration and consultation, in the first instance at least, with representatives of the hospital authorities and the professional and staff interests concerned. These considerations and consultations were carried out last year and in August, 1971, my right hon. Friend was able to issue full guidance on the subject to hospital authorities. So the committee and its work had not been abortive.

This guidance was to the effect that in general my right hon. Friend accepted the recommendations in the Woodbine Parish Report as indicating ways in which management at all levels might be improved. In particular the responsibility of the Department to provide policy guidance on building maintenance and a monitoring framework was recognised and hospital authorities were advised that the aim would be to make available to those concerned with building maintenance at hospital boards and hospital management committees the same degree of professional and technical leadership, guidance and support as is already available on engineering maintenance. Hospital boards were reminded of their responsibility for preparing a co-ordinated regional plan for maintenance and for ensuring that hospital management committees instituted an effective organisation for building maintenance, applying the principles of planning, programming and financial control already recommended by my Department. This would entail budgeting for maintenance to meet approved and control programmes which accord with the regional plan and have the support of the boards' professional staff.

My right hon. Friend accepts the need for monitoring building maintenance but he does not wish to dictate to hospital authorities the manner in which it should be carried out. He takes the view that building maintenance is a function of general management some will handle it one way, some another. He intends to set objectives and review performance rather than tie management to particular organisational solutions. What is essential is that for each hospital group there should be an officer accountable for building maintenance, technically qualified or with technical competence at his 1583 command and with a duty to ensure that professional advice, guidance and information is obtained from the regional architect.

Hospital boards were also reminded of their responsibility for monitoring the maintenance programmes of H.M.C.s and—through their regional architect and regional engineer and their staffs—for providing technical officers with advice, guidance and information.

The guidance to which I have referred went on to make it clear that hospital management committees were responsible for ensuring that a proper level of maintenance is carried out, avoiding extravagance and false economy and according to a comprehensive, ordered programme that covered all the hospitals in the group and was compatible with the regional plan. Obviously, the organisation adopted by H.M.C.s for this purpose might take various forms: single or separate building and engineering services, arrangements for using the maintenance services of another H.M.C. or their sharing and pooling arrangements. Technical responsibility for building maintenance would normally rest with a building supervisor, supported professionally by the regional architect.

Although the Woodbine Parish Report recommended the introduction of an improved career structure involving a new grade of deputy building supervisor and the recruitment of trainee technicians as well as a higher level of qualification for building supervisors, the guidance from my Department to which I have referred could not cover these items as, along with salaries and conditions of service, such matters are for the Whitley Council that has building supervisors within its purview. I shall say something about this as I move on.

I am aware that the Whitley Council has had a number of meetings at which the implications of the Woodbine Parish Report have been discussed. The council has also had under consideration a claim by the staff side for improved salaries for building supervisors as well as the allocation of responsibility for technical and managerial matters, levels of qualifications, protection for staff who are displaced and so on. Although full agreement between the two sides of the council on all these aspects, including re 1584 vised salaries, has not yet been reached, I understand that a further meeting of the Whitley Council has been arranged for Friday, 28th January. I hope that at that meeting the outstanding differences will be resolved so that steps can be taken to begin implementing the sort of staffing structure advocated by the Woodbine Parish Committee. This will obviously have a bearing on the effectiveness of several of the other intended measures to improve hospital building maintenance.

The hon. Member has criticised the salary levels of building supervisors. Their present scales have been in operation since 1st July 1970 and no one would dispute that they are in need of improvement. As I have said, part of the task upon which the Whitley Council is currently engaged is to agree upon new salary scales but the scales now need to be set in the context of the new grading structure recommended by the Woodbine Parish Committee and to take into account that in future a higher standard of qualification will be expected of new entrants to the hospital service than in the past. Our hope is that the new grading and salary structure to be agreed upon in the Whitley Council—and, I hope, agreed soon—will set the pattern for the development of more attractive careers for building supervisors in hospital building maintenance attracting into the service a higher proportion than exists at present of the fully qualified supervisor able to provide the expertise that will lead to a marked improvement in the general level of maintenance. We look, therefore, for the increase in staff to be not in the region, as the hon. Gentleman said but in connection with the plant and needs on the ground at hospital level.

I would here draw attention to recent changes in the grading structure and pay of hospital maintenance workers up to foreman level. During the past year agreement has been reached with the trade unions to grade all hospital works maintenance staff up to foreman level within a five-banded common grading structure based on job evaluation. Grading is determined by a requirement to exercise differing ranges of skill and responsibility allied to qualifications gained by training and/or experience. New rates of pay applicable to this grading structure were negotiated and applied in 1585 two stages dating from October 1970 and March 1971, and negotiations for a revision of these rates are currently taking place.

There is another means of improving maintenance, by making fuller use of the craftsmen already employed, mainly by the introduction of incentive bonus schemes. My Department is anxious to see more incentive bonus schemes introduced for maintenance work as soon as circumstances permit. Progress with their installation is at present severely restricted by the availability of work study officers. Such staff as are available must for the time being be concentrated on schemes for more lowly-paid ancillary workers but, as more staff are trained, we should like to see incentive bonus schemes developed much more widely than at present. While there is no scheme as yet in operation at the Trent Vale H.M.C., if this H.M.C. considers there is scope for such a scheme I have no doubt that the possibilities can in due course be looked into.

I hope that the hon. Gentleman will appreciate from what I have said that we are very much alive to the need for 1586 general improvement in the attention given by all hospital authorities to building maintenance. My Department will gladly consider further, with the H.M.C. and the Sheffield Regional Hospital Board, as the hon. Gentleman has brought them into the picture, any specific local problems on which the group consider that special advice is required.

We will, therefore, look carefully at what the hon. Gentleman has said in the light of what he has said, which will appear in the OFFICIAL REPORT, and see what further we can do.