§ Sir G. Howe (by Private Notice)
asked the Secretary of State for Social Services if she will make a statement on the current industrial action in the National Health Service.
§ The Secretary of State for Social Services (Mrs. Barbara Castle)
Industrial action is being undertaken at some hospitals by works staff, a small group of medical physics technicians and nurses.
Action by the works staff is connected with the negotiation of salaries for new senior management posts in the reorganised National Health Service. The Staff Side is considering a revised offer made in the Whitley Council yesterday. In view of this I hope that the staff concerned will carry out their full duties.
The technicians' action concerns an arbitration award of 1972 which could not be implemented under the previous Government's statutory pay policy. The management side has made offers for implementation after the ending of statutory controls but agreement has not yet 390 been reached. I am keeping in touch with health authorities as regards the maintenance of essential treatment for patients.
I announced on 23rd May that Lord Halsbury had agreed to take the chair of an independent inquiry into the salaries of nurses and midwives. This was welcomed by the Staff Side of the Nurses and Midwives Whitley Council, but one union, the Confederation of Health Service Employees, maintained its view that nurses should receive an interim payment before the inquiry had reported. It advised me on 21st June that it had imposed certain restrictions on the work of its members and that these would be extended by 1st July.
Having appointed an independent inquiry, I was, and am, unable to agree to make interim payments. But I spoke to Lord Halsbury, and to remove any doubts about the timing of his report I issued a statement on 28th June. In this I indicated that Lord Halsbury had told me that he would be in a position to give me a firm date for his report at the end of July. He was of the view that his report would be completed by the late summer, and I have no reason to believe that it will be delayed beyond then. But I made it known that, should it appear in a month's time that the report was likely to be seriously delayed, I would then consider asking Lord Halsbury to make an interim recommendation.
On 29th June COHSE announced that it had called off its industrial action except for a refusal to undertake non-nursing duties, to work with agency nurses or to work with private patients. The position is not yet clear, and action is sporadic and localised.
Some nursing and other staff, including some who are members of COHSE and others who are members of the National Union of Public Employees, are threatening to refuse to work with agency nurses or to provide services for private patients. At Charing Cross Hospital certain staff threatened to withdraw their services, including domestic, catering and linen services, unless the private wing was closed by the end of June. [HON. MEMBERS: "Shame!"] To safeguard the patients the area health authority proposed that patients receiving treatment in the private wing should be transferred 391 to general ward beds. In view of subsequent representations from the consultants responsible for the treatment of private patients on clinical grounds the authority is having further discussions with the unions and is meeting consultant staff this afternoon.
In all these discussions the concern of the area health authority has been, and will be, to safeguard the interests of patients as a whole. As the House is aware, it is the policy of the Government, as set out in our manifesto, and reiterated since, to phase out private practice from the hospital service. [HON. MEMBERS: "Hear, hear."] While, therefore, I can understand the feelings of the staff, I cannot condone the action they are taking. We believe that this issue must be dealt with by the Government of the day and in an orderly way.
Immediately upon taking office we established a joint working party with the medical profession to deal with this and other aspects of the consultants' work in an effort to reach agreement, and I hope to be in a position to present our proposals early next year. I ask all those who work in the National Health Service not to damage these negotiations or the interests of patients by action of this kind.
§ Sir G. Howe
Is the right hon. Lady aware that the whole House will endorse her hope that normal working will be resumed as promptly as possible? Can she confirm that the decision of the area health authority to close the private ward at Charing Cross Hospital was taken after consultation with her? Can she tell the House whether either she or the hospital has the right to authorise the transfer of private patients to different accommodation in that way, interfering directly with relationships between doctors and patients?
Will the right hon. Lady tell the House why it has taken her 11 days to answer a letter on this subject from the Secretary of the British Medical Association? Is she aware that action being taken as a result of the decisions she has described, relating to agency nurses, for example, at the Maudsley Hospital, is already gravely affecting the availability of beds and the standard of nursing there for seriously ill patients? Is she further aware that the great mass of people in the country are deeply angry that patients 392 should be treated as pawns in what is essentially a political matter? Will she demonstrate that this action is deeply deplored by the whole of the House.
§ Mrs. Castle
The position is that the area health authority informed us of the situation, that discussions did take place, and that the action taken was that recommended by the authority as seeming to it to be the only way in which it could preserve the interests of all the patients concerned. We agreed that it should be entitled to follow its judgment in handling this difficult, tricky situation. May I point out to the right hon. and learned Gentleman that there is another meeting taking place this afternoon between the consultants and the authority, following further discussions with the union. It is a delicate situation, and I suggest that we do not say anything in the House this afternoon to make it impossible for a decision to be reached which will safeguard the interests of all the patients in the hospital.
§ Mr. William Hamilton
Does my right hon. Friend recognise that almost every hon. Member on the Government benches will treat with the utmost contempt the remarks made by the right hon. and learned Member for Surrey, East (Sir G. Howe) in view of his Government's record in the treatment of hospital staff? We shall not shed many tears about the refusal of hospital nurses to work with agency nurses, nor about their decision to treat private patients in the same way as they treat NHS patients. Will my right hon. Friend, nevertheless, reconsider her decision not to give an interim payment to the nurses, when it is clear beyond peradventure that they will get a substantial increase from Lord Halsbury? If an interim increase will stop this kind of industrial practice, the sooner she makes that interim payment the better.
§ Mrs. Castle
In reply to the first part of my hon. Friend's question, I repeat that I and all my colleagues in the Government are as strongly opposed as he is to the continuation of private practice in the hospital service, but we also believe that we must phase out private practice in an orderly way which will safeguard the interests of the health service as a whole and of the NHS patients.
In reply to my hon. Friend's question about the award of an interim increase 393 to the nurses, I remind my hon. Friend that COHSE has asked for the industrial action to be called off in the light of my undertaking that by the end of this month Lord Halsbury will be in a position to give us a final date.
§ Dr. Winstanley
As one who believes that many patients receive better treatment and better nursing care in general wards than they do in private accommodation, may I ask the right hon. Lady whether she is aware that in areas where the NHS flourishes—there are many—and in which the doctor-patient relationship is adequate, the hospitals are adequately staffed and the waiting lists are short, private practice is virtually non-existent? Does not the right hon. Lady agree, therefore, that those who wish to see an end to private practice would be best advised to direct their efforts towards improving standards in the NHS?
§ Mrs. Castle
We want to do both. It is obvious that the real way to abolish waiting lists is to increase the staff in the service and improve and extend the facilities. It is equally obvious that the principle of priority being only on medical grounds can be overridden in the NHS and that less urgent medical cases can buy their way to the top of the list. That is an increasing affront to our society. It is an increasing affront to the patients and the staff of the NHS. Those who want an orderly transfer and who like to talk about constitutional situations should realise that the best way of containing this growing sense of outrage is for the whole House to pledge itself to phase private practice out of the NHS.
§ Mr. Orbach
I agree with my right hon. Friend that nothing should be said to upset the delicate negotiations that are going on this afternoon, but has she seen the illuminating statement made by the Secretary of the British Medical Association this morning to the effect that private practice brings many patients to this country from abroad, which has the effect of helping our balance of trade position? Will she convey that information to the Chancellor of the Exchequer so that he may collect some of the taxes which are due to the country from professors and consultants in the NHS?
§ Mrs. Castle
One of the first steps I took was to increase the cost of pay beds in the NHS so as to recoup at any 394 rate some of the advantages that private practice presently gains from operating within the context of the NHS.
§ Mr. Grylls
Does not the Secretary of State agree that it is rather a shame—to put it mildly—that either British people or foreigners who come to London for medical treatment and are prepared to pay the full price for it—[HON. MEMBERS: "And over."]—should be evicted by people like female Red Guards under their beds? Is not London internationally famous for having the best doctors and best nurses in the world, and is that not of great benefit to all British people?
§ Mrs. Castle
No one is suggesting that private practice should be outlawed by an Act of Parliament. [HON. MEMBERS: "Oh."] No, the trouble is that right hon. and hon. Gentlemen are so blinded by party prejudice that they will not even listen to what is said. I said that our policy is to phase private practice out of the hopsitals of the NHS. The issue before us is whether the facilities of the NHS, which are supposed to be available only on the principle of medical priority, should contain facilities that are available on the different principle of ability to pay. We say that those two principles are incompatible in the NHS.
§ Mr. Leslie Huckfield
I congratulate my right hon. Friend on the stand she has taken, but does she realise that there is still no standardised accounting system for private practice in the NHS? Does she accept that, while we recognise the commitment which the party has made, we should in future ask the staff how they feel about the admission of private patients, because they have never before been asked?
§ Mrs. Castle
The step I announced of increasing the cost of pay beds was an interim measure. We are looking more fundamentally at the financial questions raised by my hon. Friend.
§ Mr. Deedes
Is the right hon. Lady aware that the account that she has given contains one inaccuracy? When her Department was first approached for advice on the subject, the advice it gave was that private patients should as a compromise be transferred from private wards to public wards at a reduced price.
§ Mrs. Castle
I have here the letter concerned from the area health authority 395 from which the suggestion for compromise came. The area health authority believed that it would help in containing an increasingly tricky situation which seemed to endanger its capacity to meet the interests of its patients as a whole. All we told the area health authority was that if in its view this was the best way of safeguarding the interests of the patients, the authority should go ahead in the light of its judgment.
§ Mr. Speaker
Order. This is a half Supply Day, and many more Members want to speak than can possibly be called. We also have a statement and an application for a Ten Minute Rule Bill. I suspect that this is not the last we shall hear on this subject, and I think that we should move on.