§ 10.21 p.m.
§ Mr. William Hamilton (Fife, Central)
Although the subject matter of this debate is ostensibly the pay of nurses in Scotland, it goes very much wider, since the pay of nurses south of the Border is identical with that in Scotland. I got my hon. Friend the Under-Secretary of State for Scotland to stay late for the debate because I happen to be a Scottish Member, and that is why the debate is so titled, but my comments will range a little wider than Scotland.
It may well be said by my hon. Friend and others that the announcement by my right hon. Friend the Secretary of State for Social Services on 23rd May of the setting up of the Halsbury Committee to inquire into the pay and conditions of nurses, and that any award made under that committee would be retrospective to that date, has overtaken this debate. In some degree I suppose that that is true. The statement was generally welcomed by the House so far as it went, and it was certainly far better than anything which the last or any previous Conservative Government ever did for the nurses and the ancillary staff in the National Health Service since it began.
Nevertheless, I had my reservations at the time, and I still have them. I thought that the statement was not good enough. Several of us had referred to an interim payment, and my right hon. Friend said,To agree to that would, in a way, demean the whole status and authority of the inquiry."—[OFFICIAL REPORT, 23rd May, 1974; Vol 874, c. 695.]I find that difficult to understand. My right hon. Friend also talked about threshold assistance and said that that would enable the nurses, especially the lower-paid nurses, to keep up with the increase in the cost of living. There is no guarantee that that will do so in all cases, nor do we know how long threshold agreements will continue. It is by no means certain that when phase 3 170 ends the Government will continue threshold agreements. On the contrary, I think that they recognise that they are highly inflationary and would like to get rid of them.
On several occasions we have been told that we are still operating phase 3 of the prices and incomes policy, and my right hon. Friend said that she would have to cut the hospital building programme if substantial pay increases were given, and that, in her talks with the unions and the negotiating machinery, there had never been any suggestion that there should be cash on the table now.
My hon. Friend knows as well as anyone that exceptions can be made to phase 3, and have been made in the case of the miners and the Glasgow firemen. I am not criticising those awards. I think that they were right. But by any test the nurses are just as exceptional and just as worthy as either of those groups. There are no statistics, as far as I can gather, dealing with the nursing shortage. I think we stopped collecting those some years ago. One estimate given to me by the union which sponsors me in this House, the Confederation of Health Service Employees, is that the shortage in the United Kingdom is about 74,000.
I would like my hon. Friend to tell me whether he has any similar figures for Scotland alone. Generally speaking, however the statistics might turn out, it is generally true that there are now more patients being treated in fewer beds. In other words, the turnover is greater. Nurses are working harder and using more sophisticated equipment and methods. It is fair to say that the staff shortages are more acute in mental hospitals where most of the COHSE members are working.
The union estimates that there is an overall nursing shortage in the psychiatric area of about 22 per cent. Again I would like my hon. Friend to give me some figures on this. I am sorry not to have given him notice of these questions. No doubt he will write to me if he does not have the information available now. There are difficulties and signs of increasing militancy.
I could quote case after case that has come to my notice in the course of my perambulations around the country, in 171 Larbert, Dundee and Aberdeen and in various parts of England. I will quote one or two examples. I have the permission of these people to quote their cases.
A Mr. T. Tripney, a third-year student nurse who is married and whose wife is expecting her first child in November, has a gross wage of £20.08. His average take-home pay is £16.10. He has a mortgage commitment of £7.50 per week. Another case concerns a charge nurse, Mr. S. Sayers, with 18 years nursing experience. He is supporting a wife and two children. His gross pay is £34 and his take-home pay is £25.92—to keep a wife and two kids!
I have a letter from the Paisley and District branch of COHSE written by the secretary saying,you are no doubt aware of the many anomalies in the nursing structure of wages. It is not uncommon for qualified nurses holding senior posts and running wards of 60 patients (and sometimes more) to have a take-home pay of lust over £20 a week. In some cases young married nurses (male) are earning less than they could legally claim from social security.These people can qualify for family income supplement and yet we are expecting them to look after upwards of 60 mental patients in a psychiatric hospital.
I have another letter, this one from COHSE in Lesmahagow, in Lanarkshire. It refers to Hartwood Hospital, which is one of the largest psychiatric hospitals, where wards of up to 120 acute psychotic patients are often left in the care of four staff. This is the kind of situation which exists not only in Scotland but throughout Britain.
I quote the case of the first-year student. 18-year old Eugene Bienek, whose weekly gross pay is £15.30 and whose weekly take-home pay is £13.42.
Finally, I mention one case in Aberdeen. The letter is from a parent, Dr. James Leckie, who talks about his daughter:I would ask you to use your best endeavours to get the pernicious Salmon system modified …".One of the greatest disasters in recent years was the Salmon recommendations and their implementation. This gentleman asks me to use my best endeavours 172 to get the pernicious Salmon system modified… because it prevents the ward sister—who is, as I know from many years' hospital work, the pivot of the service—from obtaining her just financial reward without having to forsake the patients' bedsides for frustrating and soul-destroying administrative work. Ask any experienced hospital doctor and I am sure you will get the same answer—quite possibly unprintable! ".
§ Mr. Ian MacArthur (Perth and East Perthshire)
I am following the hon. Gentleman's argument with great interest. Just before the last part of his speech, he said that a student nurse was getting £15 gross a week, or thereabouts. Perhaps I should declare a personal interest in this matter. I find it very hard to believe that any student nurse is earning as little as that, although I accept what the hon. Gentleman says about the hardship confronting a great many student nurses today.
§ Mr. Hamilton
I attended a hospital meeting. Before that meeting, I asked them to write out, in their own handwriting, the details from their pay slips. I quoted from the paper what that boy, or girl—Eugene: I do not know—wrote to me. He or she said £15.30 gross, £13.42 weekly take-home pay.
I was referring to ward sisters and the consequences of the Salmon Report. I received a Written Answer from the Secretary of State on 15th May which stressed these very points. A newly appointed staff nurse gets a basic salary of £1,338. That is between £25 and £26 gross a week. A 21-year old typist in the National Health Service can get £1,149 and up to £1,596 after five years. In other words, a typist with five years' experience can get nearly £250 more than the staff nurse—£5 a week more—who is one of the key figures in any hospital ward. What is more, that £1,596 for the typist of five years' standing is only £36 a year less than the salary of a newly-appointed ward sister who is, as my doctor correspondent said,the pivot of the serviceAnyone who has been in a hospital knows that the atmosphere in a ward is created, essentially, by the ward sister.
My right hon. Friend's Written Answer gave me all those figures. It also gave figures for ambulance drivers and others. Of course, when I talk about nurses, I do 173 not forget the ancillary workers in the service, but there is too little time at my disposal to deal with them now. I have in mind health visitors, for example. I was at school with a girl who later became one. She is now in her mid-50s and doing a marvellous job in Newcastle. She cannot get beyond £2,000 a year, which is just about average industrial earnings, and a senior midwifery sister can get to the dizzy heights of £43 a week gross.
I watched a television programme some while ago. Nurses were top of the pops in popularity terms but bottom of the wage scale. This is quite intolerable. They have now reached breaking point. The nurses are taking to marching in the streets, making their protests. I have taken part in a few of these demonstrations. They are dignified and peaceful and even good humoured, but very determined. The nurses have had enough and can take no more. Some have resorted to militant action—walking out, refusing to treat private patients, and refusing to do overtime. The Minister has fetching charm, but it does not make any noise in the frying pan, and the nurses are saying that.
I support the nurses in their action. The nurses in Britain will not endanger the lives of patients, and Governments know that, but they are getting to the stage where they are no longer prepared to tolerate the conditions and wages to which I have referred.
I turn now to the timetable. My right hon. Friend the Secretary of State for Social Services said that the report will be ready by late summer. Indeed, I think she went so far as to say late August. We are not quite sure about that. She also said that, whatever the proposals, subject to the economic situation—we can understand that—they will be retrospective to 23rd May. But it is a fair guess that the House will be in recess then. The Government will not need legislation to implement the proposals. I suppose they can take executive action and bring forward a Supplementary Estimate later to pay for it. However, that is a highly unsatisfactory way of dealing with the matter.
§ Mr. Barry Henderson (Dunbartonshire, East) rose—
§ Mr. Hamilton
I cannot give way to the hon. Gentleman. I have already taken 174 too long. We could have an election in September before the full award is implemented, in which case the nurses would have to wait several months before getting a penny. Meanwhile, there is little hope of any let-up in the inflationary process in which we are caught.
Therefore, the Government must reconsider the case for giving an interim award of, say, 20 per cent. to all ancillary staff up to and including ward sister. If such a gesture is not made the unrest will continue and the militancy will grow. I do not believe that any lives will be lost, certainly not through any deliberate act of neglect by any nurse in the land, but there will be undoubted suffering and hardship and a decline in the quality and the quantity of nursing and nurses that we have come to expect.
I urge my hon. Friend, with as much good temper as I can, to go back to his right hon. Friend and to tell her that there is a strong feeling in the country, and certainly in the nursing profession, that the nurses want something and want it now. They cannot afford to wait until the end of August.
§ 11.38 p.m.
§ The Under-Secretary of State for Scotland (Mr. Robert Hughes)
I am glad that my hon. Friend the Member for Fife, Central (Mr. Hamilton) has raised the topic of nurses' pay in Scotland. I note that earlier he said that his comments were as much directed at my right hon. Friend the Secretary of State for Social Services as myself. That is understandable. There is no doubt that the nurses' pay will be settled nationally and applied equally north and south of the Border.
My hon. Friend asked some detailed questions about shortages in the United Kingdom, and in Scotland in particular. There are no nationally approved criteria for staffing standards in hospitals. Therefore, it is difficult to arrive at precise shortage figures. My information is that there is no national shortage of staff in Scotland, but that there are local difficulties.
Each area health board works out its staffing complement on the basis of the facilities needed and often on the finance that is available. There being no nationally approved complement of so many nurses per bed or per ward, it is not possible to give detailed figures tonight.
§ Mr. Hughes
I should not give way because of the short time that is left to me to reply to the debate, and there are many points to cover, but I will give way to the hon. Gentleman.
§ Mr. Henderson
I think I understood the hon. Gentleman to say that there was no national shortage of nursing staff in Scotland. There are two hospitals in my constituency, and a responsible person told me that in one the number of staff was 20 per cent. below the figure required for the minimum standard of patient care, while in the other there are 750 people on the payroll to do the work of 500 people, which is the measure of part-time working. Where are the places which have more staff than are needed which compensate for the shortage?
§ Mr. Hughes
Perhaps the hon. Gentleman will write to me about that, and I shall reply to him. This debate is about pay and conditions of nurses in Scotland, and it is a little unfair for other hon. Members to introduce detailed points such as that on this occasion.
Because I say there is no national shortage, it does not mean that we are complacent or that we think the position is perfect. My hon. Friend mentioned the letter from a doctor about the Salmon system of staffing in the hospitals. I do not have time tonight to go into this in detail, but I can say that the Salmon report was widely welcomed and applied. It is no secret that many doctors do not like the report, but they seem to forget that hospitals and wards will not run without administration, and it is right that nurses should do that administration.
It is important for the House to realise that we appreciate the work that is done by the nursing profession in the National Health Service. Those are not empty words by the Government, and that is demonstrated by the recent announcement. We are kept aware of the strong and bitter feelings in the nursing profession over the long delay in dealing with the claim for an independent revaluation of their salaries. On 17th May I had the opportunity to meet representatives of the Scottish Board of the Royal College of Nursing. I heard at 176 first hand their views on the pay situation which ranked high among the many matters discussed. I promised that I would report their views to the Secretary of State for Scotland and to the Prime Minister, and that I have done.
We understand the feelings of the nurses about their pay. They have never had a formal review system linking their pay with that of other workers. Nurses have become accustomed to special reviews every two or three years to enable them to catch up on pay. The last review was in 1970, and the last two serious attempts to improve the lot of nurses—the first was the reference to the National Board for Prices and Incomes in 1967 and the second was the record increase of 20 per cent. in 1970—were both undertaken by a Labour Government.
The Staff Side of the Nurses and Midwives Whitley Council submitted a major claim in January 1972, but consideration of it was prevented by the Conservative Government's pay policy. Thus, nurses have had to accept what was available under that policy, but they had expected to be able to use the relativities machinery. When the Government took office the nurses naturally enough wanted to know what they would do about their claim and how soon action would be taken upon it.
We did two things: first, we decided to take action on the Briggs Report which had been available for 18 months. The Government decided to publish the report and to recommend its general acceptance. We decided, as a gesture of good faith—not to show that this was the only thing that needed to be dealt with—to make money available to begin to introduce the improvements required in nurses' training because these things are important.
We also decided that there should be an independent review of nurses' pay and conditions. As my hon. Friend will recollect, this review was announced by my right hon. Friend the Secretary of State for Social Services, together with its terms of reference, on 7th June. Those terms of reference bear repeating. They areto examine the pay structure and levels of remuneration of related conditions of service of nurses and midwives covered by the Nurses and Midwives Whitley Council with particular reference to the current claim.177 The Chairman is Lord Halsbury and there will be six other members of the Committee, including three women. The Government have already said that they would not, and did not wish, to fetter the committee in any way whatsoever in regard to its findings and that any increases in pay arising from such findings would be backdated to the announcement of the independent review, that is, 23rd May.
I am told that Lord Halsbury has started work and our hope is that the inquiry can be completed by late summer or early autumn. The procedure which the Committee will adopt is up to Lord Halsbury and his other members, but I have no doubt that they will wish to proceed with all possible speed. Both sides of the Whitley Council have already been asked to submit written evidence by the end of this month.
I must be careful tonight to ensure that anything I say will not inhibit the consideration of the Review Committee and I hope I will not transgress when I say that I was extremely impressed by the submission made to me by the Scottish Board of the Royal College of Nursing on 17th May. A number of factors affecting the working conditions both in the clinical sphere and in more domestic affairs were raised. At one end of the scale it was demonstrated to me very vividly how the changing patterns of treatment and care and the adoption of various policies and practices had increased the pressure on the nurse both in terms of her work-load and in the complexity of her rôle in relation to the patient.
My hon. Friend mentioned the turnover in patients, which has increased, and the way this has led to increasing strain on nurses—
§ Mr. MacArthur rose—
§ Mr. Hughes
I am afraid I cannot give way, not even briefly. Time is running out very quickly. This is primarily my hon. Friend's Adjournment debate and he is entitled to answers to his questions.
We are all aware of how the different patterns of health care have increased the strains on nurses, and of how difficulties have grown over the years, especially in long-stay hospitals, such as 178 geriatric hospitals and hospitals for the treatment of the mentally ill——
§ Mr. MacArthur rose——
§ Mr. Hughes
I am afraid I cannot give way.
My hon. Friend raised the important question of the timetable. He is concerned that if the Review Body reports during the recess it may take some time for the awards which are made to get into the nurses' pay packets. I can give him the assurance he seeks on this and say that if and when pay increases are due to be implemented, regardless of whether this might be in the recess—if the Halsbury Committee works with thoroughness and speed and the report becomes available during the recess—the increases will be implemented by the area health boards because they will have the funds to make the necessary payments there and then. The question of a Supplementary Estimate having to be brought forward later would in no way affect the payment of the increases. There is no question of payment of a settlement being held up because the House might be in recess. In this respect it is important that nurses should be aware of the backdating arrangement.
My hon. Friend said he was aware that no nurse would deliberately take action which would lead to the death of a patient. I accept that entirely. During my meeting with the Scottish Board of the Royal College of Nursing I was impressed—I do not say this lightly after a two and a half hours discussion—that they were concerned that the results of militant action might lead to damage to patient care. They were also concerned about shortages of nurses and that there should be many more nurses, and that it might affect patient care if morale in the profession were not raised by Government action on pay and conditions.
I am aware of the effects of industrial action on nursing services in Scotland. I receive regular reports. I would be less than frank if I did not say that I was worried about the standard of care available to patients in several areas in Scotland. At the same time, I am impressed by the strenuous efforts made by the nursing profession, by ordinary nursing personnel and senior nursing personnel, to cover gaps here and there 179 and to provide the best service and care available in the circumstances. This is tiring work.
The findings of the inquiry will be unfettered. They will be implemented and backdated to 23rd May. I would ask the nurses to trust the Government to carry through the review thoroughly and to implement it. I would ask them to call off their action. At the end of the day what we are doing in the review will be to their advantage. They have nothing 180 to lose, because the award will be backdated. I would prefer this to be handled in a sensible manner. Both sides of the Whitley Council have already been asked—
§ The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at nine minutes to Eleven o'clock.