§ 4.50 p.m.
§ Mr. William Hamilton (Fife, West)
Before I say what I have to say about the specific Supplementary Estimates on which I wish to comment, I should like to tell my hon. Friend the Member for Islington, South-West (Mr. George Cunningham), who initiated the first debate, how much I agree with what he said about the general principle of debates on the Estimates. I do not know what the public will think when they see or hear that half a dozen of us are deciding to give the Government an extra £590 million to play around with over and above what they have already asked the House for—£184 million extra on defence and £406 million on various civil Departments.
For example, about £20 million extra is being sought for the Royal Marines. I wonder how many mental hospitals we could build for that money. That is a matter that could well be raised in the debate next Monday on public expenditure. I leave the general point at that, because we are today discussing not priorities but precisely what is in the Supplementary Estimates. We are limited to that, and I see that you, Mr. Deputy Speaker, approve wholly of that principle.
But one of the fundamental principles of our constitution is that before we give the cash we have a bit of a bellyache about it, the redress of grievance before the granting of supply. If that were the test, it would seem that the House is completely satisfied, that it has very few grievances, that there are fewer than a dozen hon. Members who have grievances at all. I do not think that 1388 that reflects the view of people outside. They have enough grievances, and I shall come to those directly related to the Supplementary Estimates to which I want to call attention—Class VII, Vote 1, Subhead A, and Class VII, Vote 2, Subhead A, "National Health Service Hospitals", and so on. There is an additional sum of £41 million in the latter and an additional £10,700,000 on the social security side.
I was for many years on the Estimates Committee before it was changed to the Public Expenditure Committee. Many years ago we had in the Estimates detail which has since been removed. The volume of information on the Estimates has been reduced by at least half, on the basis that the House was not interested in that kind of detail, and that anyway the House as a whole was not equipped to investigate in detail the information there provided. I admit at once that I was a member of the Estimates Committee when we agreed that the sheer volume of the information provided should be drastically reduced. I am not sure that we took the right decision. I think that one of the reasons why the public are increasingly cynical about the House and government generally is that neither we nor they receive adequate information, and we do not have the resources to dig it out.
All Governments—I make no party political point—have a vested interest in keeping back-bench Members like myself and the general public in the dark as much as they can. It is only by stern endeavour and stern discipline on our part that we obtain such information as we can from Governments.
Here I should like to give some specific examples. I hope that I am not offending against the etiquette of the House when I say that only yesterday I was approached by the Under-Secretary of State for Health and Social Security, the hon. Member for Barkston Ash (Mr. Alison), who asked me what I would talk about. It is very proper and right that he should know, and I said that I would talk about the expenditure under Subhead A, Class VII, Vote 1, on salaries of Ministers, the Supplementary Benefits Commission and staff. He said "That is my responsibility." But I added "I am also going to talk about the National Health Service hospitals' provision at the 1389 bottom of page 71 in the Supplementary Estimates, dealing with regional hospital boards and boards of governors and something called Increased rates of pay and National Insurance.'" Therefore, both Ministers are responsible, but I guess that the hon. Member for Barkston Ash, who is present now, will reply on behalf of both. I make no complaint about that, but I hope that he is well briefed and will not say that he will write to me. I do not like correspondence courses. Let us have the direct answers to the questions.
I have first a fairly simple question. At the foot of page 68 there is an item on Ministers' salaries. The present provision is £31,500 and the revised provision is £33,500. So far as I know there has been no increase in Ministers' salaries since the presentation of these Supplementary Estimates on 18th December last. What is that £2,000 about? Where has it gone? Who has it gone to?
Secondly, I have a similar question on the Supplementary Benefits Commission. The original salaries figure was £11,250 and the revised provision is £14,700. It is not a big sum—a matter of £3,450—but I should like to know where it has gone. It is a trifle, peanuts, compared with the overall Government expenditure, but it is not peanuts to the taxpayer footing the bill. It is not peanuts to a pensioner. The sum of £3,000 is a fortune to old people, and they are entitled to know what that is provided for.
But the bigger item under the heading of "Salaries, &c." is the third. It concerns staff salaries, where the present provision is £115,757,250, and the revised provision is £126,451,800. That is a difference of roughly £10 million. The explanation provided is that the increases are:Mainly pay awards, increased provision for additional staff, overtime and higher rates of National Insurance contributions.It goes on:The provision made at this stage represents approximately 90 per cent. of the increase likely to be required.No detail is given. On page 69 there is a reference to general administrative expenses, payments for agency services, and the rest, but nothing is spelled out. We do not have even the sort of detail 1390 which we find in the Defence Supplementary Estimates. On page 8, for example, the Defence Supplementary Estimates give all the detail of pay of the Gurkha troops, the pay of the Ulster Defence Regiment and cadet forces, the pay and allowances of army officers, warrant officers, NCO's, men, women and so on, but the Estimate from the Department of Health and Social Security gives no breakdown of its figure.
Nor is there any indication of how many additional staff have been provided. The Minister will recall that a few weeks ago local officials in social security offices had a go-slow or a strike. They said that they were grossly overworked because of the comprehensive means-tested welfare State which we now have, because of the increased numbers who were applying for supplementary benefit, and so on. These people, for the first time that I can recall, were threatening strike action and marching in the streets in protest.
Civil servants are not recognised for their militancy. On the contrary, they have been highly responsible people, and they do not willingly take to the streets. But I remember seeing on the televsion screen the other day the picture of a fellow in a bowler hat, with his umbrella, carrying a placard. Ten years ago, one would never have dreamed that that could happen. Only a Conservative Government could bring about that kind of bowler-hatted revolution. This is what they have been driven to as a result of the Government's policies.
Let no one misunderstand the situation. When one talks about civil servants, the picture immediately conjured up in the general public's mind is much like what we saw on the television screen—a chap in a bowler hat, with a rolled umbrella, wearing black pin-stripe trousers, and earning a high salary. In fact, however, hundreds of thousands of these people are taking home less than £20 a week——
§ Mr. William Hamilton
—and some of them with less than £15 a week take-home pay. These people have been driven to frenzied fury by the outrageous treatment meted out to them over the past several months by the present Government. Never in my wildest dreams should 1391 I have expected them to show the kind of militancy that they have shown recently. They are not led by Hugh Scanlon, by Jack Jones or by any of the so-called Left-wing ogres whom the Government try to present to the public as responsible for the mess they are now in.
The Minister knows who is responsible. The Government have blatantly ratted on their undertakings to their own servants. The Priestley recommendations of 1956 on Civil Service pay procedure were implemented, and the principle was that the pay of civil servants should be based on wages paid to workers in comparable employment outside. That was the principle of so-called fair comparison. It had many defects. Civil servants were always behind in the rat race, they were a sure loser, especially in a period of rapid inflation such as we have had in the last two years from a Government who promised to resolve the problem without recourse to a statutory prices and incomes policy. The Government would not do that, they said. Prices could be cut at a stroke, unemployment could be cut at a stroke, and we should all be sitting in the garden lovely so long as the Tories were elected to office.
The Priestley recommendation that awards to the Civil Service——
§ Mr. Deputy Speaker (Miss Harvie Anderson)
Order. The Civil Service as such is not in the Vote under discussion, and I hope that the hon. Gentleman will quickly return to the Vote under discussion.
§ Mr. Hamilton
With respect, Mr. Deputy Speaker, civil servants do come in the Vote under discussion. I take it that the staff in the Department of Health and Social Security are civil servants.
§ Mr. Deputy Speaker
Order I have been prepared to allow a certain latitude, but I think that I have allowed rather too much.
§ Mr. Hamilton
With respect, Mr. Deputy Speaker, the staff of the Department of Health and Social Security, the very people who are covered by the Priestley recommendations, are civil servants, and under this subhead the main provision is the additional £10 million for staff. Staff are civil servants. I am 1392 talking about civil servants, and Priestley referred precisely to civil servants. I think that I am, therefore, entitled to say what I am saying about the Priestley recommendations and how they have been breached by the Government.
§ Mr. John Grant (Islington, East)
The Supplementary Estimate would be considerbly affected, would it not, if the Government honoured their commitment to Priestley, so I suggest that my hon. Friend is right.
§ Mr. Hamilton
I am coming to that point. The Supplementary Estimates were published before the Government announced their prices and incomes policy, so the £10 million might well be altered subsequently as a result of phase 2 and the later phase 3 of that policy. Therefore, I can hardly think of anything more relevant than a discussion of the position of the civil servants in the local offices of the Department of Health and Social Security in the context of the Supplementary Estimate.
Priestley recommended that awards should be retrospective. Is there any provision in the Supplementary Estimate, or will there be future provision, for retrospective payments to these people, who have been denied their rights up to now, as from 1st January?
In 1962 the then Government, while preaching the desirability of arbitration to industrial unions, breached the Civil Service arbitration procedure which had existed since, I think, 1926, but subsequently accepted arbitration. The Labour Government of the 1960s limited the retrospective element of awards, and in 1968 that same Government accepted that agreed increases were due to civil servants but would be paid only in stages. It was agreed that a review of wages in the clerical and executive grades should be implemented from 1st January of this year, and the previous increase which had been awarded on 1st January last year was only 7 per cent.
The Civil Service unions have pointed out to me, and, no doubt, to other hon. Members—we have all had representations on this matter—that in that period the wage index had risen by 22½ per cent., three times the rate of the increase for these lower-paid civil servants, and the price index had risen by 16 per cent. or 1393 18 per cent. Therefore, in terms of their standard of living and comparability with other workers, the civil servants had lost all round. Their standard of living had been reduced, and they had been reduced in terms of comparison with other workers.
It is painfully obvious to them that the Government are using the lower-paid workers in their employment as political whipping boys. These are the people who are made the example of the Government's determination to inflict their policy on the country as a whole.
It is not clear from the Supplementary Estimate whether the persons covered are workers in the social security offices at local level, or what they are. It just says "staff". I do not know what it covers. Perhaps the Minister will tell us. What part is due to salary increases and what part is due to the increased numbers that have had to be provided because of the protest by the workers on grounds of overwork? Whether they protest because of bad wages or because of overwork, they have a dual grievance in the sense that they have fallen behind other workers in their standard of living.
As the Minister knows, I took up these matters following reports from local officers of his Department in Fife. I took up the matter first with the Chancellor, and the letter was transferred to the Civil Service Department. I received a reply on 23rd January which took refuge in the fact that the Government had made it clear to the National Staff Side in 1971 that their endorsement of the Priestley principles and the existing agreements was:subject to any requirements of an overriding national policy of general application.It went on to say that the 1973 pay reviews:will have to conform to the Government's counter-inflationary measures.It concluded with the usual nonsense about non-discrimination against Government employees. But this is a case of blatant discrimination against these people, and the figures refer to the injustices perpetrated before the present prices and incomes policy was formulated, when the Government were still saying they would have nothing to do 1394 with a statutory prices and incomes policy. The Prime Minister called the policy fair, and some of the newspapers said it was fair, too. Nobody in their right senses, nobody capable of exercising objectivity, could possibly say that the lower-paid civil servants and the ancillary staffs in the hospitals had been treated other than grossly unfairly.
I quote now correspondence I have had on this matter from someone in Bath, and I am glad to see the hon. Member for Bath (Sir E. Brown) present. I gave him notice that I intended to refer to the matter, and I thought that it was only fair to warn him about what I was going to say. I have had a letter from constituents of his complaining about the meetings that the Civil Service Union had in Bath, and I have newspaper cuttings, including one from the Western Daily Press. They refer to the hon. Member being shown one of these civil servants' pay slips showing that the man was taking home £14.50 a week. According to the newspaper the hon. Member said "If that is the case, get your cards. You will be better off on supplementary benefit." The hon. Member subsequently denied that he said that. I do not know whether it is true or not. The Western Daily Press subsequently quoted him as sayingI never made such a statement suggesting he should give up work. That is pure fabrication.To that the Civil Service Union secretary, Mr. Christensen, replied:I didn't make anything up.He went on:Those were his exact words, and although he may deny it there were five other members of my union who were there at the time.
§ Sir Edward Brown (Bath)
I am grateful to the hon. Member for Fife, West (Mr. William Hamilton) for giving way, but I should first like your clearance, Mr. Deputy Speaker. The matter which has now been discussed has gone outside the terms of reference of the debate. We are now talking about defence employees, none of whom is involved in hospitals. The statement I shall make, therefore, will be in relation to the Ministry of Defence.
§ Sir E. Brown
May I finish the explanation? It is true that I received a deputation from the Civil Service Union consisting of Mr. Christensen and four of his colleagues, not five. The pay slips were submitted to me, and one was as low as £14.50. The man who received that amount of pay made the point that he had an incapacitated wife at home. It was suggested to me that where a man had a totally invalided wife there were cases on social security which were receiving more money. I said that if this was the only income in the family, clearly the man would be better off on social security. I said no more and no less than that. The newspapers said that I had applied that comment to all the members of the Civil Service Union.
The Minister will be aware that I immediately wrote to his Department about the three cases in question, and I received an answer from him outlining the Government's policy as wanting to do something for this sector of employees. I have taken up the matter concerning my own constituents because I feel profound sympathy for them in the situation in which they find themselves, and I have made strong representations about both the executive grades and the lower-paid grades.
§ Mr. Hamilton
I am grateful for that speech. The hon. Member may talk about sympathy as much as he likes but he voted for the Government's pay freeze. In effect, he said that those men who are taking home £15 a week and less to keep a family have to make do with an extra £1 plus 4 per cent. He voted for that, and it is no good his getting up and squealing and saying that he has written to the Minister, offering his sympathy and telling these men to hang on with an extra £1 when the Prime Minister and his Cabinet colleagues are being paid an extra £350 a year each.
But I am now straying away from the Supplementary Estimate. There are civil servants under this Supplementary Estimate who are taking home less than £15 a week. It is indefensible for the Government to say that the policy is fair. It is a policy of deception and cruelty, and the Prime Minister has reached the stage where no one believes him. He deceived the country in the General Electiton campaign when he pretended 1396 that we would be one nation and that he would look after the poor. We are now talking about the poor.
I have one point to make about the ancillary staff who are mentioned on page 71. There it says:Increased rates of pay and National Insurance.I should like to know exactly what increases in pay there have been to nurses, for instance. I get very worked up about the nursing profession whenever I talk about it in the House, for very personal reasons. There is not a profession which deserves more of this nation and there is not a profession which gets less from it. Because the Government know that the nurses will not strike, because they know that the nurses are defenceless, they take it out on them year after year. Fine words do not make any noise in the frying pan. No doubt we shall hear many of diem this afternoon from the Minister when he talks about the devotion and loyalty of these people. But that does not put cash in their pay packet, and that is what counts.
What applies to the nurses applies to the ancillary staff, the people who clean floors and wash pans and so on. The right hon. Member for Wolverhampton, South-West (Mr. Powell) talks about coloured immigrants, but it was he who brought them in when he was Minister of Health, and if it were not for those people our health services would break down. In any hospital in the country and particularly in London, one sees how the hospitals depend not on the surgeons—of course they depend upon them, too, but the surgeons are all right financially—but on the coloured people in the kitchens who do the dirty grubby work, and on the nurses, too. These people are to be frozen—literally frozen—under the present magnificent munificent Government and their great policy of phase I and phase 2 and the tougher phase 3 which we are promised some time later this year.
That is what we are talking about, and these Supplementary Estimates are but a peg on which to hang the arguments. I wish that more hon. Members were present to kick up a bigger row than is possible with the limited numbers at our disposal. I want the Minister to spell out for me—he is doing his homework now—exactly what the nurses are to get in 1397 the next six months, what a staff nurse is to get, what a third-year student is to get, and what is to be deducted from that for subsistence when she is living in. I want the figures.
I want to be told how the standard of living of nurses is going up as a result of Tory beneficence, and I want to be told how these coloured lasses and lads are to be paid against the rent increases under the Government's rent legislation. The staff nurse is the key figure, and I should like to be told what a staff nurse in an ordinary hospital is to get in cash terms in the next six months and how much is to be deducted from that if she lives in. It is a simple question and the officials should have the answer and the Minister had better get it. I want it now, not in writing later.
I have made the case as kindly as I can and moderately—I am naturally a moderate man. I have put the story as simply, as plainly, and as bluntly as I could; I hope to have a similar response from the Minister.
§ 5.23 p.m.
§ Mr. Laurie Pavitt (Willesden, West)
The whole House will be grateful to my hon. Friend the Member for Fife, West (Mr. William Hamilton) for raising his voice on a subject in which many of us are interested. In every debate about the hospital services and nursing that I have known since I entered the House in 1959 my hon. Friend has been in the forefront of the battle. I remember our joint efforts on an all-night sitting in 1961 during one of the freezes when the nurses were the first to be caught.
I want to refer to Class VII, Vote 1, subhead A and follow what my hon. Friend said when he spoke about bowler-hatted demonstrations which only the present Government seem able to manufacture.
My local department of health and social security has one of the hardest tasks of all because of the nature of the social problems in my constituency—housing, employment changes and redevelopment and, incidentally I have twice as many immigrants as the right hon. Member for Wolverhampton, South-West (Mr. Powell). Some of these DHSS employees came to lobby me in large numbers last week. I do not want to 1398 repeat the arguments which my hon. Friend has just stated, with which I agree. I am certain that when I send them HANSARD, they will be more than grateful for his work on their behalf this afternoon. I look forward to the Minister's reply.
On the subject of Vote 2, subhead A; I start more or less where my hon. Friend finished. I have worked out that we in this Chamber are each worth about £4 million on the basis of the £41 million involved here, for there are only about 10 hon. Members present. What changes are being made as a result of extra pay allocations for regional hospitals boards? I challenge the Minister to discuss the subject of danger money for nurses, for instance. It is ridiculous that a nurse still gets danger money for nursing a venereal disease patient, although she is in no danger unless she is a participating member of the permissive society, and then the danger does not come from nursing; but if she nurses renal dialysis on a day-in day-out basis, she is exposed to the possibility of serum heptatitis and may die and yet gets no danger money.
The Minister will recall the tragedy in Scotland. The numbers have never been given to the public, and I do not blame the Scottish Ministry for that, but a number of doctors and nurses died as a result of doing their duty in a renal dialysis unit. If the Minister is to consider this section of the Estimates, he should consider some of these changes within the basis pay structure for nurses, which, quite apart from the Briggs Report and the Salmon Report, need immediate attention.
It is a disgrace to the country that we pay nurses and ancillary staff in hospital service so little at a time when as a nation we are spending twice as much on alcohol, cigarettes and gambling as on the whole of the National Health Service. We are still paying poor money to these essential people. Anyone going along Victoria Street from this House can see agency advertisements for temporary shorthand typists offering a five-day week at five hours a day with a pay twice that of a State registered nurse who does night duty, day duty, on-call duty and so on. There is something wrong with our society when we cannot put our values right in that regard.
1399 I ask the Minister not to say that these are matters for the Whitley Councils. If it is good enough for the doctors to have direct representation, why is it not good enough for the nurses? Why not a comparable review body for nurses? I pay credit to the Secretary of State for being prepared to act on his own initiative in the scandals in the long-stay hospitals for the mentally handicapped and geriatric patients. On his initiative, more money was provided. We are here considering the pay of people who give devoted service to the community, and this, too, is an area in which he should take the initiative.
The Estimates include the figure of more than £2 million spent by regional boards and management committees on advertising for nurses. Considerably more is being spent on agency nurses because we do not pay enough to our own nurses in the hospital services. The agency nurses are paid considerably more and have better conditions than nurses who choose to remain in the National Health Service. Surely it is possible to devise a system in which it is not necessary for millions of pounds a year to be spent by hospital after hospital seeking nurses. The money spent on such advertising would be better devoted to improving the pay and conditions of nurses.
How miserably mean is the extra overtime pay now agreed for complete Sunday working! It is worked out at fractions of a pound. A nurse might have done 50 or 60 hours in a week and yet, because of some special responsibility, be called in to work on a Sunday. After allowing for fares and so on, if she is lucky she may have 50p for the extra hours and the loss of her weekend. These matters affect not just basic pay but the additions which ought to go with the pay. I hope that the Under-Secretary will address his mind to them.
Another sector which has been neglected year after year is covered by those employed in the professions associated with medicine. I do not intend to deal with all of them, but I wish to draw attention to the position of radiographers and the nonsense which occurs because we do not pay them enough. We spend more than £500,000 on training grants. A radiographer has a period of training lasting two years. At the end of that period in my area his 1400 basic pay is £23.76 a week. But there is a shortage, so what happens is that after his two years' training he can go to an agency. In my constituency we pay £35 a week to agencies for radiographers whom we have trained in our hospitals to come back and work in the same hospital where they trained. If ever there was an economic nonsense from a Government who believe in management efficiency it is this. Surely something could be done about it.
I know that negotiations are proceeding. The Society of Radiographers has been engaged in negotiations for three years. Next week, through their Whitley machinery, the radiographers will be trying to agree a new grading structure. In the economic crisis into which the Government have forced us, does that mean that any increase to them will be frozen in stage 2 and that, despite their negotiations lasting for three years without any sign of daylight, when, if they are lucky next week, they reach an agreement with the management side, they are to be told that the three years must be extended to the end of phase 2, the end of phase 3 or the end of some other phase?
I referred just now to the problem of danger money for nurses. In the pay given by regional hospital boards to doctors in certain specialties there is also the problem of danger money. The Central Committee for the Hospital Medical Services of the BMA has been having discussions for two years about what amounts to employer's liability to doctors engaged in the National Health Service who by reason of their duties find themselves seriously ill or involved in an accident. A doctor may attend an accident on the MI and find as a result that he is himself involved in an accident. At the moment there is no danger money for danger to doctors. As so often happens, the situation has now reached an impasse, and, as usually happens in Government circles, negotiations are taking place between two departments, with the result that those affected are in danger of falling between two stools. Is it the Department of Employment or the Department of Health and Social Security which should solve the difficulty? I hope that the Under-Secretary will deal with that point.
1401 The last matter that I wish to raise was touched upon by my hon. Friend the Member for Fife, West, and it concerns the lowest of the low-paid workers. I refer to those in our community who serve as ancillary staff in hospitals. It has been pointed out already that only 10 hon. Members are involved in approving this Estimate of £41,000,000. However, at least 10 members of the Opposition were interested enough in the subject to march from St. Thomas's Hospital to the Department of Health and Social Security to show our support for the claim being made by the ancillary staff.
What is the position? For a male member of the ancillary staff in the hospital service the present basic rate is £17.48 rising to £21.48. The Government must have realised the measure of the injustice to these workers. They have moved quickly with regard to the freeze and said that their negotiations might continue. The result? They have been offered a meagre £1.84. But one has only to look at what is happening in other sectors which are just coming out of the freeze—gas workers, electricity workers and miners—to see that once again the lowest paid of the lot are made the lowest offer.
The Government talk about their policy being to help the lowest paid get a square deal. How do they justify that when they make such an offer to ancillary staff in National Health Service hospitals? How do they justify the fact that the earnings gap between ancillary staff in hospitals and other manual workers in outside industry is now £8 a week and yet the best offer being made at present is only £1.84?
The Under-Secretary will recall that the late lamented and too speedily wound-up National Board for Prices and Incomes said in December 1970 in its report No. 166 that around a quarter of the whole work force in hospitals had earnings in the lowest tenth of earnings for all men in manual work in Great Britain. If there is some social justice in the Government's wages policy, this Estimate for £41 million is totally inadequate. The Government must do something more for the lowest paid.
1402 When one examines the take-home pay position, once again hospital workers find themselves at the bottom of the heap. Taking into consideration their shift work and the number of hours worked, the rates paid for overtime mean that, compared with any other section of the working class community, hospital workers come out much worse than anyone else.
When the Under-Secretary replies to the debate on this part of Vote 7, I hope that we shall have no more bromides from him. Like him, I have been campaigning against barbiturates, because the nation is taking too many of them. But also we do not want any soothing syrup today. These are basic, fundamental and key questions about the kind of nation that we are and the kind of health service that we run. I hope that the hon. Gentleman will not tell us that the Government leave the negotiations with the Whitley Council, that they have every sympathy with the Florence Nightingales' devoted service but that when it comes to a comparison between their earnings and those of their one-time schoolmates the nation cannot afford more.
I have just had the personal experience of coming out of hospital. It was my first hospitalisation for many years. Like every other hon. Member who has had a spell in a public ward in an NHS hospital, I came out feeling eternally grateful. The newspapers never report the successes of the National Health Service. One reads about the service only when something has gone wrong.
I end on what might seem a slightly facetious note. Having spent some time in a public ward, I have come to the conclusion that the Estimate ought to be increased in order to provide nurses with roller skates. I have never seen so much running about and hard work put in for members of the public who are in hospital as done by nurses from seven o'clock in the morning until they go off duty.
I know the problems. I know that in preparing the Estimates the Government are responsible across the board for a totally comprehensive service. But surely the highest priority is not in bricks and mortar or machinery. It is to improve the livelihood and increase the numbers of hospital personnel who give such devoted service to us all.
§ 5.39 p.m.
§ Mr. John Grant (Islington, East)
I want to underline a few of the things that were said by my hon. Friend the Member for Fife, West (Mr. William Hamilton), in his customary robust style, particularly about Class VII of the Supplementary Estimates relating to the Department of Health and Social Security staff and, indeed, the Civil Service as a whole.
The revised provision in this Estimate for the DHSS clearly will not help one bit the crucial situation in the Civil Service and that Department particularly. I have previously spoken in the House on the general subject of the Civil Service pay grievance. My hon. Friend has mentioned it, and I shall not go over that ground again. However, I remind the House and the Under-Secretary that the Chancellor failed completely to respond to the request of my right hon. Friend the Leader of the Opposition in winding up the debate on the White Paper last week, when he was asked to tell the House that the Government would not rat on the principle. Perhaps the Under-Secretary could put right the Chancellor's omission. That is, perhaps, a little unlikely, but he might consider it.
An article appeared in The Times yesterday on the whole question, written by Mr. Eric Wigham, who was formerly the labour correspondent of that newspaper and a member of the Donavan Commission on Industrial Relations. The article said:One of the most important things to ensure is that the Government gives a fair deal to its own employees, who have always had the thick end of the stick under incomes policies. Civil servants and others whose pay by specific agreement follows that of other comparable employees, so that they can never set a pattern, should be allowed a catching up stage in any period of freeze or restraint Careful consideration should also be given to those who follow others in a less formal way, as for instance health service manual workers follow those employed by local authorities.Here is the nub of the argument. They ought to be allowed to catch up, whatever happens subsequently. It is for that reason that we assert that the Prime Minister and the Government are practising discrimination against their employees.
It was not long ago that the DHSS staff took a form of industrial action. They banned overtime. They did it not for money but because they were absurdly 1404 overworked. Countless hours of overtime were being worked, and they were grossly understaffed. The Secretary of State refused to budge. He refused to increase the establishment. None of this whole question of establishment has been spelt out in the Estimates, and it should be. I suspect that the Secretary of State was desperately defending the ridiculous election promise made by the Conservative Party prior to June 1970, that it would reduce the size of the Civil Service. That promise should never have been made, because it was never capable of being kept.
The staff banned overtime so that their lives would be made more tolerable and so that the public would get the service not only which they deserved but to which they were entitled. It was only the pigheadedness of the Minister which caused that industrial action. Eventually we got the agreement, and there is to be an increase in the establishment. It is a pity that that is not spelt out in the Estimates, because it would be helpful to know the exact position.
No doubt the Under-Secretary will know by now that there is a particularly hostile feeling in the Department about the freeze. I have had this reflected to me in representations in my constituency. I shall not be surprised if there is some form of industrial action there in the future. Indeed, from what I hear, I shall be more surprised if there is no industrial action.
In relation to what was said by my hon. Friend the Member for Fife, West, in his exchange with the hon. Member for Bath (Sir E. Brown), I remind the Minister that there is great resentment not only about overtime working but about the fact that many departmental staff, counter clerks in particular, are paying over the counter to claimants for benefit more than they take home in their pay packets, and some of them are themselves eligible for benefit. That is a sad commentary on the Government as an employer.
There are rumblings—I know not whether they have reached the UnderSecretary—in the governmental undergrowth about possible disciplinary measures if civil servants are involved in any form of industrial action. I beseech the Government not to head up that road because their first step in that direction 1405 will escalate any dispute into a most grave confrontation. There is at present tremendous volatility in the Department. The Government should allow the civil servants to catch up on pay before any counter-inflationary policy is applied to them. That would not be discriminating in their favour. It would be fair. That is a word which the Prime Minister uses constantly, but he rarely practises fairness.
§ 5.45 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
Perhaps I could begin by saying how very sorry I was to hear that the hon. Member for Willesden, West (Mr. Pavitt) had been in hospital, but also how delighted I am that the National Health Service looked after him well and that he returns to us in his typical sprightly form.
With the permission of the House and the particular indulgence of the hon. Member for Fife, West (Mr. William Hamilton), I shall start with a short and specific point, as I can dispose of it fairly quickly. The hon. Member for Islington, East (Mr. John Grant) raised the matter of the Priestley commitment, so-called. I cannot help the House further than saying that my right hon. Friend the Prime Minister, in a debate as recently as 24th January, spelt out in terms an assurance, which I shall quote because it is exactly the point the hon. Member raised. He said thatthe Government endorses the principles for determining the pay of the non-industrial Civil Service set out in the Priestley Report and accepted by the Official and Staff sides following its publication. Subject to any requirements of an overriding national policy of general application, the Government intends to continue to reach and implement settlements on the basis of surveys by the Civil Service Pay Research Unit in accordance with these principles and with the existing procedural agreements between the Official and Staff sides.Having quoted that, the Prime Minister went on to say:The proviso is subject to any requirements of an overriding national policy of general application. The policy put forward in the White Paper"—that is, the second White Paper—and which is being put forward in the legislation before the House, is obviously a policy of an overriding nature and of general 1406 application. That cannot be denied. That is the position as far as the Civil Service is concerned."—[OFFICIAL REPORT, 24th January, 1973; Vol. 849, c. 482.]
§ Mr. Alison
There was a proviso in the assurance relating to the overriding needs of the national situation at the time.
Perhaps I could next take in order the points made by the hon. Member for Fife, West and conclude with a reference to those raised by the hon. Member for Willesden, West.
The hon. Member for Fife, West focused our attention, first, on Class VII, Vote 1, subhead A. I refer to pages 68 and 69 in relation to the figures we are discussing, and particularly page 68. The hon. Member quoted the overall figure of £10.7 million, referred to on page 68. Perhaps I can spell out how this is made up. Of the £10.7 million, £7.11 million is for the cost of the 1972 Civil Service pay increase, effective from 1st January 1972. £1.66 million is for the increase in complement of 4,000 posts in the DHSS—I shall spell this out in further detail shortly—authorised by the Civil Service Department during the current year. A further £1 million is for additional costs of overtime: £0.75 million is for higher rates of graduated and national insurance contributions for staff; and £0.18 million is for agency typing services, which is an accounting adjustment between subheads.
I dare say that the hon. Member for Fife, West is particularly interested in the figure of £1.66 million for the increase in staff numbers during the current year, together with the £1 million for additional overtime costs. The £1.6 million relating to staff increases occurred in the following conditions. In the early months of last year the pressure of supplementary benefit workload in local offices rose substantially for a number of reasons, and while my Department was carrying out an urgent review of staffing needs the growing pressure on staff at local offices gave rise to considerable dissatisfaction which, as I think the House knows, culminated in a ban on voluntary overtime.
In consultation with the staff associations and the Civil Service Department an agreement was reached for the provision of an additional 4,000 permanent 1407 posts made up as follows. There were 1 million—I beg the House's pardon; the Supplementary Benefits Commission would have rejoiced to have got 1 million extra office workers; there were 1,500 for supplementary benefit work and 2,500 to reduce the Department's dependence on casually employed staff and overtime. The agreement, of which this forms part, also includes a review of the Department's staffing procedures, improvements in training programmes and in the physical conditions in local offices, and a study aimed at simplifying and improving work methods. All these matters are now in progress.
Recruitment of additional permanent staff is proceeding as quickly as possible, and by the end of 1972 the staff in post in local offices had increased by 1,000. The present level of casual staff, which is currently between 4,000 and 5,000, will necessarily continue till the full complement of posts is filled and the new staff are trained.
The financial provisions in respect of the additional costs of overtime arise, first, from the higher rates of overtime pay arising from the 1972 Civil Service pay award, secondly, from the more rapid consumption of overtime forecast in the early part of the year because of growing work pressures, and, thirdly, from the complications to supplementary benefit work of the application of the fair rent scheme.
I have done my best to spell out the details of the subhead for which the hon. Member asked in order not to have to write to him.
§ Mr. William Hamilton
I am grateful for what the Minister has said, but can he tell us whether, in his view, the standard of living of the civil servants has decreased in the last two years?
§ Mr. William Hamilton
Of those people I referred to who had a 7 per cent. increase in wages as compared with a wages index figure of 22½ per cent. and a prices index increase of 16 per cent. to 18 per cent.
§ Mr. Alison
I cannot comment on that also—because I have only generalised figures for very large global totals of pay. 1408 The figures go right across the board. But taking only the global figures, the average earnings, published, as the hon. Member knows, for the employed population as a whole, have risen substantially in excess of the rise in the retail prices index.
§ Mr. Alison
The hon. Member also referred to the typical staff nurse pay figure, and asked what it was likely to be in the next six months. That point is not strictly in the purview of the Supplementary Estimate because a claim has been submitted for a further increase of salaries of the nurses, and, clearly, this is subject to negotiation. However, looking at the position as of now—I cannot guarantee what it will be like in six months' time—the typical figure, subject to a very wide range of variations, for a staff nurse would be between £1,089 to £1,299 per annum, going up to £1,383 after three years' service. One has to deduct, say, £185 for lodging charge for resident staff. This, again, is a rather generalised figure; it is subject to wide variations. The hon. Member, with his own family connections with nursing, may be able to produce cases better or worse than that. This is a round figure. I cannot guarantee that it will be like this is six months' time, but I hope the hon. Member will accept that as at least a partial answer to him by word of mouth rather than in writing.
§ Mr. Ronald Brown (Shoreditch and Finsbury)
The Minister will realise that these figures are meaningless, because, for instance, the real problem in London is that we cannot get staff nurses to pay them that percentage. We have to go to agencies for agency nurses, and they are being paid in excess of that.
§ Mr. Alison
The question of agency nurses, which the hon. Member for Willesden, West touched on, is a very difficult and tricky one in the National Health Service. It is essentially a London problem. A whole range of peculiarities arises in London, not least from the wide range of employment opportunities available in London and the competition which there is in the Metropolis for female labour. In this debate I cannot elaborate on the rather specialised 1409 subject of agency nurses and what we are doing to minimise their employment, but I can assure hon. Members that this issue is very much in the fore front of our thought and planning in the Department. We do not like to employ more agency nurses than is absolutely necessary. I am glad that this problem is essentially confined to London.
The hon. Member for Willesden, West went on to raise a number of other points, particularly in relation to the extremely low pay of ancillary workers. I must say that I was a little—what shall I say—cynical—I am afraid I must use that very strong word—about his diatribe against the lowness of pay amongst ancillary workers in the National Health Service. He must know that this question resulted from the days of his own Government. Indeed, the point was made in the Report, No. 29, of March, 1967, by the National Board for Prices and Incomes. There the whole gloomy story was spelt out, and no other solution than on the lines of more effective use of labour, or the introduction of a properly constructed and controlled scheme of payment relating earnings to performance, was looked into. This is nothing new. The hon. Member's own Government, to do them credit, turned the spotlight of the Prices and Incomes Board upon it, and, the veil being drawn aside, it depicted, not a less gloomy but indeed a far gloomier picture than there is now.
§ Mr. Pavitt
Will the hon. Gentleman cease to ride off on his eulogism? We made mistakes, it is true, but it is no answer to them for this Government to continue them. The wage increase given last year, 1971, was 7½, per cent. My hon. Friend the Member for Fife, West (Mr. William Hamilton) spoke about the figures. The Minister cannot say that that was our fault. It was his.
§ Dr. Shirley Summerskill (Halifax)
The hon. Gentleman will recall that in the second stage of the freeze the low-paid hospital workers will be very slightly better off—only very slightly—than they were before, and yet the Government profess to be going out of their way to help the low paid. Would the hon. Gentleman not agree that the new freeze arrangements hardly alter the take-home pay of hospital workers?
§ Mr. Alison
The hon. Lady has come on to the category of worker upon whom I want to spend most of my time in addressing the House on this subject. I shall try, without dissimulation, to cover the point she has raised, because it was the category of hospital worker which the hon. Member for Fife, West specifically picked out. It is particularly relevant to our debate because it is one group whose pay is at present subject to negotiation and is fully caught up, as it were, in the complexities of stage 1 and stage 2. It is, therefore, worth looking in some detail at ancillary workers. I will not fail to come to the specific points on the slightly wider issue made by the hon. Member for Willesden, West when the time comes.
§ Mr. John Grant
I do not understand why the hon. Gentleman says that this group is exceptional in having entered into negotiations. Many groups of workers have negotiations in the pipeline.
§ Mr. Alison
The value of looking at the position of hospital ancillary staff is that they are the one group for whom a pay claim has been submitted on which negotiations are in train and which has been precisely caught up in the complexities of the freeze and stage 2.
I ask the House to consider hospital ancillary workers in some detail, because they provide an extremely wide range of vital hospital services. They are the ward orderlies, hairdressers, porters, operating theatre attendants, and others perhaps less in the public eye but nevertheless playing an important rôle—kitchen staff, laundry staff, boiler house staff, gardeners and so on. The results of their work may not be apparent to the public but are quickly apparent to patients, in a decline in the quality of food, laundry and heating if those services break down. The hospital ancillary worker has a crucial rôle to play in the complex range of services performed by a hospital in securing the patient's full restoration to health. It is none the less vital for being less spectacular and glamorous than the rôle of the nurse or doctor.
We are discussing an extremely large group of workers. There are 230,000 ancillary workers employed in hospitals in Great Britain, about two-thirds of whom are women. About 90,000 work part-time, nearly all of whom are 1411 women. In full-time equivalent terms the total is about 203,000, of whom two-thirds are women. The annual wage bill for this group is £238 million.
The rates of pay and conditions of service for the group are negotiated by the Ancillary Staffs Council, which is one of the Whitley Councils set up in 1948 for the National Health Service. The Whitley Council which covers ancillary workers throughout Great Britain is composed of two sides, a trade union side with four unions represented—the National Union of Public Employees, the Confederation of Health Service Employees, the General and Municipal Workers' Union and the Transport and General Workers' Union—and a management side composed of representatives of hospital management, namely, members or officers of hospital authorities and members of the health departments. The Whitley Councils are autonomous bodies, not appointed by Ministers but the implementation of their agreements requires ministerial approval under the relevant National Health Service regulations.
The procedure is for the trade union side to present claims for improvement in rates of pay and conditions of service and for these to result in negotiated settlements following discussion in the council. In practice, for many years these settlements have been very much in line with settlements reached for manual workers in local government service. That is understandable, because there are considerable similarities—in the type of work done, the common trade unions and in the similar machinery which has descended from pre-National Health Service days. This link with local government work, although traditional, has never been either automatic or formalised. Each negotiating body—the Ancillary Staffs Council and the National Joint Council for Local Authorities—has retained complete freedom to negotiate separately for its staff.
It might be helpful to mention the current rates of pay of ancillary staff. The basic male grade B rate is £18 a week outside London, although there is an agreement that staff requesting it can increase earnings on a virtually guaranteed basis to £19 a week. For women the basic grade A rate is £15.28, again outside 1412 London. These rates are increased by an extra £2.40 a week for London weighting. Above grade A the rates rise to a maximum of £26.36 per week for men and £24.28 per week for women.
The average weekly earnings are somewhat higher than the basic rates. For men the average weekly earnings are £27.13 a week and for women £20.60 a week. Although 8 per cent. of the men in this category earn under £20 a week, 28 per cent. earn more than £35 a week. The level is not high by national average standards, and this I readily concede—indeed, the NBPI report made this clear as long ago as 1967—but at least the earnings levels are substantially above the basic rates.
§ Dr. Summerskill
What plans are being made to implement the Equal Pay Act? The Minister has said that the male and female rates are rising by an extra £2.40. Surely the rate for the female should rise slightly higher than that if the Act is to be implemented by 1975?
§ Mr. Alison
The £2.40 is the London weighting figure, the extra allowance paid to men and women working in London. It was conceded irrespective of the stage that had been reached in the implementation of equal pay. It was decided that men and women should receive an equal increase and that is to the advantage of women. There is no differential against them in London weighting. Equal pay is being implemented by the steady one-third increase and I shall have a word to say about that in the context of the current negotiations.
Against that background of the basic rates of pay and earnings I should like to say something about the negotiations now going on for the ancillaries. In the summer of last year the trade unions submitted a claim for a £4 increase in basic rates, for a 35-hour instead of a 40-hour week, for four weeks' paid holiday instead of three weeks, and for two additional Bank holidays. The claim would have cost about £100 million and increased the wage bill by about 40 per cent. The operative date of the claim was to be 13th December 1972–12 months after the preceding agreement. Negotiations had just begun when stage 1 of the Government's counter-inflation measures was announced on 6th November.
1413 Negotiations on the parallel claim for local government manual workers had also opened, the operative date being at the beginning of November, again, the anniversary of the preceding agreement 12 months ago. The local authority negotiations were brought to a rapid conclusion on the eve of 6th November, the cut-off date for stage 1. In consequence the local government manual workers received an increase of £2.40 for men and women, plus two extra days holiday, from the beginning of November last year. Since the settlement with the ancillary workers was not reached by 6th November, the standstill applied to them, whereas it did not apply to local government manual workers. Therefore, the operative date had to be deferred until the end of the 90-day deferment. Furthermore, the amount payable had to be subject to the terms which were to be settled in stage 2 of the Government's counter-inflation policy.
The management side of the Whitley Council considered the first White Paper which introduced the freeze, and at the November meeting of the Whitley Council informed the trade union side that it thought it necessary to defer making an offer until the terms of stage 2 were available. They wanted to conduct meaningful negotiations and an offer made during stage 1, when both the operative date and the amount of any future settlement were still unknown, would not have been meaningful.
Both sides of the Whitley Council made strong representations to my right hon. Friend the Secretary of State for Social Services about the pay of ancillary staff and at the end of November my right hon. Friend, accompanied by Ministers from the Scottish and Welsh Offices, received a deputation.
My right hon. Friend acknowledged the unfortunate—to put it mildly—timing of the standstill so far as it affected ancillary staff, and said that he would consider whether to exempt them from it. There was no escape from the conclusion that exemption for one group of workers would inevitably lead to claims from other groups, and would undermine the efficacy of the standstill and the subsequent stage 2 period. My right hon. Friend had to say with great regret that he could not arrange any exemption for the ancillary staff, nor could he give them 1414 any assurance about their prospects under stage 2, which was then being formulated. However, he promised to represent to the Chancellor of the Exchequer and to his other ministerial colleagues the strong views expressed by the Whitley Council on behalf of the ancillary workers, and I can assure the House that he did not fail to do this.
Stage 2 of the Government's policy has now been published and under it the operative date for a settlement for ancillary staffs becomes 14th March—a deferment of 90 days. A settlement is subject to the limit prescribed in the White Paper of £1 per head plus 4 per cent. of the total earnings of the group during the preceding year, excluding overtime. Negotiations have been resumed on the basis of the White Paper proposals, and I understand that the management side has put forward to the trade union side its assessment of the sum available for a settlement. This amounts to about £20 million which, if shared equally among men and women, would give an increase of £1.84 per week. This would represent an increase in the overall wage bill of about 10 per cent. and would give increases of 10 to 12 per cent. for men and women in the lowest grade rising to about 7 per cent. for those in the top grades.
I understand that the trade union side put forward counter-proposals and that the Whitley Council is to meet again shortly to continue negotiations. It would be improper, and indeed impossible, for me to speculate about what form of agreement may finally emerge from the negotiations. We all wish the greatest possible success to both sides in achieving an agreed settlement on the basis of what was offered. As a result of the deliberate policy of the Government in leaving scope for negotiation, there is considerable opportunity for a cut of the cake which will give considerable satisfaction and improvement to the various grades. The White Paper allows a certain flexibility in terms of the movement towards the elimination of the men-women differentials. These are matters which are being looked at in some detail in the current negotiation. I would prefer not to be too specific about what scope there might be, but it is conceivable that a satisfactory agreement may result. It is perhaps as well that I say as little as possible about that situation.
1415 It is appreciated that the absence of some special provision for ancillary workers in stage 2 greatly dismayed and disappointed ancillary staff, and we understand the significance of the traditional link which has existed between their rates of pay and rates paid to local government manual workers. We are well aware that the Government action against inflation has interrupted that traditional, if not formalised, link. We would like to have restored it in stage 2, but we have had to conclude that there was no way in which ancillary workers could have been treated as a special case without including a great many others.
Stage 2 will operate until the autumn and it will include the setting up of a pay board. The Government intend to consult the pay board on how to deal with anomalies, particularly the broken link with the manual local government workers. We are hopeful that this aspect of the pay of ancillary staff can be dealt with, in consultation with the board, in stage 3.
The hon. Member for Willesden, West asked about restructuring agreements. I can do no better than to ask him to refresh his memory by referring to paragraph 27 of the White Paper, under the heading of "Productivity and Pay Restructuring Schemes".
The hon. Gentleman also asked about possible dangers to nurses working in hazardous situations, particularly in renal dialysis units. Discussions have been held with representatives of staff about improving benefits in the event of death or injury occurring to staff while on duty, and substantial improvements in existing benefits have been agreed in principle. A separate rate claim in respect of improvements for junior hospital doctors is still under consideration. Therefore, there are prospects for improvements.
I hope that I have dealt adequately with the matters of detail which have been raised, and I hope that I shall not have any letters to write to the hon. Member for Fife, West. I trust that I have given the House a fair reply on some complicated and detailed points which have been raised. I have given the House specific information about the important negotiations which are taking 1416 place on the position of ancillary workers, and we can only hope that they will have a happy and fruitful outcome.