HC Deb 23 May 1974 vol 874 cc679-740

7.7 p.m.

Sir Geoffrey Howe (Surrey, East)

There is no need to remind the House of the huge concern being expressed and demonstrated by the nursing profession. not only about their pay but about some other aspects of their terms and conditions of service, nor of the fact that they are certainly not alone. The medical and dental professions are awaiting the report of the review body and many other groups of National Health Service employees—administrative, clerical and ancillary staff, the professional and technical staff Group A and B, including those covered by the report of the Macmillan Committee set up by my right hon. Friend the Member for Leeds North-East (Sir K. Joseph)—all have different areas of concern and I know that a number have written to the Secretary of State about them.

Most of these have already accepted awards under stage 3, but there are matters still outstanding and the object of this short debate is to impress upon the Secretary of State—though I am sure it is not necessary in her case—the urgency of some aspects of this problem, to make plain outside this House that that sense of urgency is shared on all sides of the House, and to press the Secretary of State to inform us as fully as possible about the Government's intentions. It may or may not be possible for her to say how much money, if any, is to be forthcoming, but I would press her very hard to say when and how this current pay dispute involving the nurses is to be resolved. The House will be particularly anxious to know the Government's re-ponse to the repeated requests of the nursing profession for an independent inquiry into matters referred to in their long memorandum, which 1 will not trouble the House by reading now.

I want to make two important, critical but I hope constructive suggestions to the Government. First, I would urge the Secretary of State to abandon the commitment of the Government to the abolition of the Pay Board, and to be prepared to make use of the relativities procedure established by the last Government. We shall never succeed in getting the right approach to this kind of problem until some effective and acceptable machinery of that kind is established with the support of both sides of the House. If the Secretary of State is unwilling to do that, will she establish in one form or another a review of the kind suggested, at least in respect of pay in the nursing profession?

I hope that the debate will enable the right hon. Lady to make an announcement about that today. If she does so, no doubt she will make clear when the review will be complete and whether any action is proposed while the review takes place. I should impress upon her that she should be prepared to contemplate abandoning her commitment to the abolition of health service charges. With funds for the health service so desperately short. it is positively harmful to the service and those who work in it to discard any such sensible source of extra money at this time.

On a more general point, may I remind the right hon. Lady that in our exchange on the subject last week and, I think, in a speech at the weekend, she attempted to make a partisan point by laying the blame for the present discontent amongst staffs in the health service on some special failing of the Conservative Government, and she attempted to take some special credit for the rise awarded when Richard Crossman was Secretary of State in the spring of 1970. Quite frankly, that charge is unjustified. What is more important is that it is undesirable, when there are so many matters of real contention between both sides of the House, for a subject of this kind to be discussed in that way. It is precisely that kind of presentation of blame that tends to repel the ordinary citizen from the processes of democracy.

We should all recognise the persistence of these problems and acknowledge that neither side of the House can claim a monopoly either of credit or of blame for the way in which they are dealt with. Take the position of doctors and dentists. The Secretary of State will need no reminding that at the time of the second general review by the review body in 1966 the award was caught by the then incomes policy and the Labour Government decided to phase the increases. They postponed half the increment for a year. Subsequently, at the time of the fourth general review in 1970, a Labour Government again accepted only half the increases recommended for the career grades and referred the balance to the Pay Board. In August 1970 after the change of Government a settlement was arrived at on the basis of a 20 per cent, increase on the previous year.

There is a balance of criticism on either side in the story. The Secretary of State referred last week to the nurses. I must remind her that in 1960 when my right hon. and learned Friend the Member for Hertfordshire, East (Sir D. Walker-Smith) was the Minister of Health there was probably the first attempt at a substantial upgrading of pay in the nursing profession since the establishment of the service. Pay for staff nurses went up just under 12 per cent. and for sisters by just over 19 per cent.

The period for which the Secretary of State has sought to take credit, namely the time of the 20 per cent. increase in 1970, followed two or three years in which there had been no increase—[AN HON. MEMBER: "What about 1961?"] That intervention from a sedentary position is precisely the kind of thing that does little credit to the House. It is no good hon. Members saying, "What about this or that?" We all have to face the difficulties and acknowledge that we have all grappled with them in different ways.

Richard Crossman's increase was substantial but it came after a period of little movement in nurses' pay and at the end of a massive campaign by the nursing profession, as they put it, "to raise the roof". Some action was inevitable and was forced upon the Government. No Government have so far been able to evolve and operate a pay review machinery for the health service which has been acceptable in the long term to the health service staffs. The hon. Member for Fife, Central (Mr. Hamilton), who has taken a persistent and understandable interest in the subject, in a moment of charming candour in a debate on 27th January 1970, as reported at column 1322, said that the service had been consistently and persistently under-rated and underpaid by successive Governments, acquiesced in by an apathetic public. That is one of the difficulties, as we agreed when we discussed South Ockenden last week. I hope that we may proceed from that premise. The hon. Member was supported by my hon. Friends the Members for Newbury (Mr. McNair-Wilson) and Birmingham, Edgbaston (Mrs. Knight) and my right hon. Friend the Member for Farnham (Mr. Macmillan). The difficulties have been made all the greater by the persistence of and increase in inflation.

Looking back, it seems almost ironic that in 1962 in a debate on 14th May my right hon. and learned Friend the Member for Hertfordshire, East should have spoken about the fact that the health service and the attempts to upgrade nursing pay had been dogged since birth by the problems of inflation, because in those almost halcyon days the annual rate of inflation was in the 2 per cent. to 2½ per cent. range. If it caused problems then, consider how much greater must be the problems and how much more important must be the effect of inflation today.

It is significant that at that stage there was an awareness that the community had tended to take advantage of the sense of vocation of the nursing profession, and since then in various ways we have been trying to avoid that happening. The problem has still not been resolved. It is immensely difficult to measure the right scale of disadvantage. The difficulty of that measurement has increased because the numbers of hospital nursing staff in the service has shown a pattern of steady growth from 276,858 in 1966 to 313,847 in 1970 and 350,330 in 1972, with the trend still rising. In spite of that trend, the shortages persist. They, too, are difficult to measure because standards are rising all the time, and those standards depend on the amount of resources the community is prepared to make available.

Certainly there are some identifiable wards and units that are still unmanned. We can identify parts of the service which are short of resources. The Royal College of Nursing in its memorandum made a telling remark about that which has all the more force in the light of the awful South Ockenden report. It said: It is difficult to convey, for those who have no experience of the problems, the stress imposed on ward staff. For example, two nurses may be responsible for rousing, dressing and toileting fifty or so severely handicapped patients. There are, therefore, important and difficult questions to be resolved if we are to measure the adequacy and comparability of the pay that should be awarded. They are made more difficult by the factors referred to in the memorandum. They are not made easier—and here I make no criticism—by the changes which will follow the Government's acceptance of the Briggs Report. I have already welcomed that report not least because my wife was lucky enough to serve as a member of the committee. I take this opportunity, because I have had no other, of paying a tribute on behalf of the Opposition to the skill and industry of the chairman and the quality and compatibility of his colleagues.

We attach particular importance to the proposals in the report for encouraging married women to return to nursing and about the age of entry—subject, of course, to the safeguards referred to—and about making the profession one which will welcome part-timers with proper flexibility. Here arises the vexed question of agency nurses. There is insufficient time to say anything much about that now, save perhaps to point out that the existence of nursing agencies, which do not employ more than about 2.9 per cent, of nurses in the health service, at least serves to provide some indicator of how far the standard of pay provided by the monopoly employer may or may not be falling behind an acceptable rate.

There are comparable problems in all the healing professions. My hon. Friend the Member for Aylesbury (Mr. Raison) may say something about them, particularly with reference to the doctors and dentists. I have had letters from virtually all those covered by the Macmillan group through to the ancillaries. I hope that they will forgive me if I do not in this short debate refer to their particular problems in detail, but they are all relevant to this debate, and also underline the case for the existence of an agency or agencies that can keep as far as possible all those related problems under review, with relativity and comparability in mind.

I do not know whether this is a question, "Are we for or against an incomes policy?" The right hon. Lady had much experience with that matter in her last tenure of office. I was closely involved with it when we were in office. We both understand the difficulties. Whether it is philosophically an incomes policy, it is part of the inescapable problem facing any Government. of determining a policy for the pay of the public sector.

I urge the right hon. Lady to echo some words from the 1962 debate: The Government believe that, while the overriding requirements of the national incomes policy must be maintained, the work of this review could and should begin without delay on the lines I have indicated. They trust that it will go forward to results which will be beneficial to the future of the nursing profession and the patients that it serves." — [OFFICIAL REPORT, 14th May 1962; Vol. 659. c. 952.] Ironically, that emphatic tribute to the necessity for an incomes policy sprang from our former right hon. colleague Enoch Powell. But the words would lie quite well in the right hon. Lady's mouth.

It was to that end that the Pay Board was designed, and to that end that the report on relativities was directed. The report referred, by way of example, to the possibility of the problems of the nurses and the teachers being involved in the relativities procedure. I remind the right hon. Lady that at least two of the professions with which we are concerned have made reference to this recently. The Secretary of the Society of Chiropodists, in a lecture given to the Leeds Convention, referred to a statement by the Secretary of State for Employment on 6th April and said that he considered it premature to write off entirely the Pay Board's report, and there may yet be something for chiropodists in their statement". Similarly, the nurses, in their memorandum, acknowledged the relevance of the board from their point of view in paragraph 126, where they said: The Staff Side therefore went to great lengths to present a strong case to the Pay Board within its 'relativities reference'. The fact that the Relativities Report of the Board made special reference to nurses was warmly welcomed by the profession, and it was the intention of the Nurses and Midwives Whitley Council to have early recourse to whatever machinery was set up to deal with such references. I repeat that the board is essential if we are to avoid a situation in which those who are able and willing to resort to industrial action can achieve so much more than those in the healing profession who are perhaps unable, but certainly have been traditionally unwilling, to do just that.

I am sure that most nurses are still reluctant to resort to such action. I regret the statement by COHSE to the effect that action of quite a menacing kind should be begun very shortly. I earnestly urge it to refrain from taking any such steps.

It is on that basis that we urge upon the Government that they will be making a grave mistake if they abolish the Pay Board, that they erred in not adopting the relativities procedure last March, and that they will make a further error if they do not today announce a review of the kind for which the nurses have pressed. Unless they are prepared to proceed on that kind of footing, it is difficult to see how we can lay any secure foundations for a sensible pay policy in the National Health Service.

It is common ground, and beyond argument, that resources are short. For that reason, the present Government have not acted to restore any of the cuts about which they complained last December. The right hon. Lady explained last week how she is now seeking to give priority to local authority hostels, in the light of the South Ockendon report. But she listed in her speech to the Socialist Medical Association many other contending claims. We can all nominate our candidates. The pressures are clear to us all.

The right hon. Lady referred in that speech to the constraints under which she had to operate. She argued that priority should perhaps now be given to people rather than buildings. That is a perfectly tenable judgment. The figure put by COHSE on the size of the nurses' claim is £100 million. I cannot comment on the extent to which that is within the right target area. But it happens to coincide exactly with the cost of abolishing all health service charges. It is a measure of the choices we have to make.

I know the right hon. Lady's commitment to a free service, and in another debate I am prepared to discuss that, on many grounds. But today, simply in the present context, I point to two facts. First, the Attlee Government made provision for amending the original Aneurin Bevan concept to allow for charges. Secondly, the 1964–70 Labour Government similarly were driven to reintroduce charges.

I urge the right hon. Lady to be prepared to profit by experience, to accept that it cannot be sensible to feel obliged to postpone vital buildings to which she attaches priority, that it cannot be sensible to postpone the restoration of cuts that she and others criticised, and that it cannot be sensible, above all in the context of seeking a policy to give priority to people, to reduce the resources available for pay.

I very much hope that the right hon. Lady has listened in the same spirit as that in which I have sought to argue the case for the points I have urged upon her so strongly.

7.28 p.m.

The Secretary of State for Social Services (Mrs. Barbara Castle)

You have asked Front Bench speakers in particular to limit their remarks, Mr. Speaker. Therefore, 1 cannot pursue many of the detailed points the right hon. and learned Member for Surrey, East (Sir G. Howe) raised. I have no doubt that my hon. Friend the Under-Secretary will touch on them in his winding up speech.

But there are certain matters of substance concerning nurses which I must discuss. I thought that the right hon. and learned Gentleman wisely made his speech in remarkably low key. I say "wisely" because if ever I try to draw comparisons between the performance of his Government and the performance of our Government he immediately brands me as partisan. I point out to him that when we talk about the situation in which nurses find themselves, we are talking about the fundamental difference of party policy on the crucial issue of the relevance of a statutory prices and incomes policy.

It is no good the right hon. and learned Gentleman lecturing me about being partisan when he proceeds to attack the Government for proposing to abolish the Pay Board, because that is the context in which we face the crisis in the National Health Service. It is in that context that nurses are on the march. It is in that context that they feel more bitter than at any time in the memory of any of us. It is in that context that we have the unprecedented situation that nurses and others in the health service are talking of going on strike, something that we always said we believed was vocationally impossible. I warn the House that it is a measure of the dangers, inadequacies and pitfalls of a rigid statutory pay policy.

The right hon. and learned Gentleman did not have the humility to say tonight, "Looking back, we realise that in those three and a half years we were wrong. We tried to impose a rigid formula, and it failed." If he had said that, I should have been prepared to speak on a bipartisan basis.

The right hon. and learned Gentleman is right; I have tried to operate a statutory pay policy. I learnt from that experience. The previous Labour Government decided, because of the dangers of such a policy, that it was an essential criterion to de-escalate into a voluntary policy. We felt that it was necessary to educate and persuade the people on the basis that it was necessary to establish a system of relationships between rewards and consent. But has the right hon. and learned Gentleman applauded us for that? On the contrary, it was the major theme of the Conservative Party in the last General Election. According to what I read in the newspapers it will be his party's major theme in the next election. It seems that the Conservative Party has not reached the position in which it can think of anything else.

I begin by saying advisedly that when I came into office I found a situation affecting the nursing profession that was directly related to the fact that nurses, under a statutory prices and incomes policy, had fallen lamentably behind. It is no good the right hon. and learned Gentleman saying that it is wrong to wind up the Pay Board and that the nurses should go to a relativities board. His Government never sent them there. It is a historical fact that the only independent reviews that the nurses have had have been under Labour Governments—yes, even under the Labour Government, of which I was a member, which operated a prices and incomes policy.

It was in 1967–68 that the nurses had their first independent review under the Prices and Incomes Board. In April 1970, as the right hon. and learned Gentleman has said, they received a special review under Dick Crossman which gave them the highest increase ever in the history of the profession. That is validly a starting point. We all argue that a statutory incomes policy is designed to help the low paid, but it does not work in that way. Indeed, it worked out less that way under the more rigid policy of the right hon. and learned Gentleman's Government.

I shall give the House some facts to demonstrate how in the past four years the nurses have fallen behind in terms of relativities. Between 1966 and 1970 the nurses' rates, under a Labour Government, rose by 31 per cent. In the same period, the retail price increase increased by 19.5 per cent. and average wages for all industries and services rose by 24.8 per cent. Between April 1970 and April 1974, nurses' rates rose by 46 per cent. In the same period the retail price index increased by 44 per cent. and average rates for the rest of industry rose by 64 per cent.

Do we need any other indicator of the mood that I have inherited? The fact is that the nurses have fallen behind dramatically. I appeal to the House to learn the lessons that we all have to learn. We must appreciate how clumsy and inadequate an instrument we have in the tidy but pedantic prices and incomes policy.

Mr. Donald Stewart (Western Isles) rose—

Mrs. Castle

No, I shall not give way. I must not delay the House by taking up arguments, much as I should like to do so. I shall not follow the right hon. and learned Gentleman into the argument about prescription charges, because in the circumstances it would be wrong to do so. I am trying to obey Mr. Speaker's direction in the interests of hon. Members.

Mr. Nicholas Winterton (Macclesfield)rose—

Mrs. Castle

No, I shall not give way. There is another way in which the nurses were betrayed by the previous Government. The right hon. and learned Gentleman is right to say that his wife played a distinguished part in the Briggs Committee. That being so, she must have told him what a vital key it was for the revision of the status of the whole profession in revolutionising the education system and getting rid of the crudest source of discontent, namely, the fact that student nurses were not treated as students, but exploited as cheap labour. We have not worked out the system of education for which the nurses have been pleading for so many years.

It is right to place on record once again that it was Dick Crossman who set up the Briggs Committee and appointed as a member the right hon. and learned Gentleman's wife. The report came into the hands of our predecessors in 1972. I shall not detain the House by quoting from it. I understand that every hon. Member has been supplied with a copy of the Royal College of Nursing's report entitled, "The State of Nursing 1974". I hope that every Member has read it. It is one of the most poignant and impressive documents that I have ever read. Within it there is the heart cry, "What has happened to Briggs? We are sick and tired and frustrated by Governments sweeping the report under the carpet."

My heavens, we were in office barely a month before we were at the Dispatch Box announcing that we accepted the recommendations of Briggs. We used the transition between the statutory pay policy and the voluntary policy to use the power of consent which was given to us under the present pay code to make a relaxation in highly exceptional cases. We used that period to lay on the table immediately up to £18 million for the nursing profession. We shall start now by paying nursing teachers and clinical teachers sufficient to attract them in the necessary numbers to allow the profession to maintain the standards of care that we all want. The £18 million will also be used to introduce improvements in pay that will pave the way for the legislation that we intend to introduce in the next Session of Parliament to make the implementation of Briggs a reality.

It was a mood of despair that I inherited. As the House knows, I was bombarded by telegrams within a matter of days from the Royal College of Nursing from its meeting in Blackpool. I was asked to implement Briggs immediately. I was asked to meet the college's representatives and to discuss pay. The other unions joined in. I met them as soon as it was practical to do so, bearing in mind the pressure of other matters to which I had to attend.

I met the staff side last March. Its terms were an immediate and independent review of pay. It was 10 days ago that I met a deputation from the Royal College of Nursing. That representation echoed the request for an independent review. By then I was able to say that the relevant paragraph on Briggs in their report was out of date because we had already acted upon it.

That was the crisis that we were returned to face. That was the mess and the demoralisation that was caused by a rigid, clumsy and pedantic pay policy. Of course, we were also left with the need to ensure that the transition from a statutory to a voluntary pay policy was carried out in an orderly fashion. The nurses were the first to agree with me that they are the last to want a free for all. Therefore, we had to ask the nurses to give us a little time to think about the matter and to move towards the creation of machinery that would be in keeping with a voluntary policy and yet would not burst the dam and make it necessary to give way to a flood of pay claims.

We were able to tell the nurses that we took their claim extremely seriously. I think that they were a little worried lest the concession that we made on Briggs should be taken as a substitute for a comprehensive review even though I assured them that was not the case. I hope and believe that when the present excitement has died down, as I hope will happen rapidly, the staff side of Whitley, in view of what I have to say tonight, will be willing to pick up again the offer of £18 million and move rapidly towards the Briggs Report with a willingness to negotiate its detailed application.

We have said to the staff side in the past few weeks, "We have already acted on a vital part of your document, but any pay demands wider than that have repercussions. You must give us time to create the framework within which we can deal with them in a way that will not undo all the improvement that we want the nurses to have." 1 must say that most of the nurses have responded very responsibly to our request for a little more time. The Royal College said to us, "We realise that you have not been in office very long, but we have been waiting for years and years". It asked for an answer in three weeks. That was 10 days ago. I said, "I will meet the staff side again within your period of three weeks. You have already waited long enough and we are considering this problem very urgently."

Then again, last Monday, the nurses' representatives asked to see my right hon. Friend the Prime Minister. I was with him when he met them at No. 10 Downing Street. They pressed us again very strongly and very reasonably. They said, "We have your promise to come back with the answer in that period, but if you could advance it, that would help us to contain the frustration, which is now breaking its banks, with imminent danger to the National Health Service as a whole." That is why the Government have been considering this problem very urgently.

I am therefore glad to be able to tell the House that, as a result, the Government have decided to set up an independent inquiry into the pay and conditions of work of nurses and midwives immediately. [HON. MEMBERS: "Good".] I should say so. It is a good job that we have not got a relativities board still. Nothing would have been done by that body.

Mr. William Molloy (Ealing, North)

Look how angry the Opposition are!

Mrs. Castle

Of course they are angry. We have done what the nurses asked us to do. They asked our predecessors in vain to do it. The Opposition cannot get away from these historical facts.

I want to tell the House the details of the proposition, which we have thought about extremely carefully. Lord Halsbury, who as Chairman of the Doctors' and Dentists' Review Body has wide knowledge of the National Health Service, and has kindly consented to be chairman of the inquiry, and I am most grateful to him. I repeat that the inquiry will be independent, and the Government are not seeking to fetter its finding in any way. I am discussing with the staff side the precise terms of reference and composition of the committee of inquiry. I should have thought it obvious that it should contain some women in its membership.

Mr. William Hamilton (Fife, Central)

And junior nurses?

Mrs. Castle

It is not only that the Government have acted as quickly as possible. We want the inquiry to act as quickly as possible, compatible with the study in depth which the nurses themselves want. I have already discussed this with Lord Halsbury. He tells me that he can get down to work immediately after the Whitsun holiday, and he is satisfied that the inquiry will not have to be unduly prolonged.

So we are on our way to a solution of the nurses' difficulties, and I give them the added assurance that the increases in pay which flow from the inquiry will be backdated to my announcement today. I am sure that the House will agree that we have done once again all that we can to meet the profession's legitimate grievances. Those grievances are urgent and we have dealt with them urgently.

Mr. Timothy Raison (Aylesbury)

Could the right hon. Lady help us by saying whether the inquiry will simply cover the question of more pay, or will it also cover conditions of service, structure and so on? Is she undertaking that whatever the inquiry recommends will necessarily be accepted by the Government?

Mrs. Castle

I think that I have already said that the inquiry will cover the pay and conditions of service. It will consider the structure of pay, the level of pay, the conditions of work, with relevance to the current claim. That is broadly what the terms of reference will be. I have said that we shall not fetter it in any way. We are not working to any particular pay code. The Government's attitude will be the same as it is to the findings of, for example, the Doctors' and Dentists' Review Body itself. As the House knows, the Government normally accept its findings, although the formula is, "unless there are extremely exceptional circumstances".

Mr. Dan Jones (Burnley)

Will the inquiry involve physiotherapists, who do a remarkable job in the hospitals?

Mrs Castle

The House will save time by letting me complete my speech. I am coming to that matter which is of extreme importance. My hon. Friend the Under-Secretary of State can pick up any queries with which I may not have dealt.

Some people may say, "The trouble is that this will not deal with the nurses' immediate acute financial difficulties." Even though it will report as quickly as possible, and even though the findings will be backdated, there are immediate financial conditions of very great severity for many nurses, particularly student nurses. But some of these difficulties arise from the fact that the increase in pay which the Whitley Council negotiated for nurses and midwives from 1st April under stage 3 is not yet in payment. I think that this is the cause of a great deal of the discontent, particularly as the cost of meals went up before the pay increase with which it was associated actually came into force. It was not until I met the nurses and they explained it to me that I realised that there had been this difficulty in payment.

It is due to two things. It is due, first, to the immense complexity of the stage 3 award, with its unsocial hours element and all sorts of new factors. This has jammed up the computers. It is as simple an explanation as that. The second cause is the introduction of the reorganisation of the National Health service on 1st April, which has meant an upheaval in the service and great difficulty for its officers. It has meant that the treasurers' departments in the health authorities have been under immense strain.

When I learned of these facts, I asked my hon. Friend the Under-Secretary of State to make immediate and urgent inquiry into the causes of the delay. As a result, I am glad to say, he has told me that in most of the regions the new rates will be paid this month, and where the arrears for April cannot be paid immediately an advance will be given to those concerned. There are special difficulties for the nurses in the Trent region and for those in the South-East covered by the Hospital Computer Centre for London. But I have asked the authorities in these cases to make advances this month on account of the

additional pay due for April and May. I am sure that the House will be glad to know that additional money will therefore be coming into all nurses' pockets very soon indeed.

Sir G. Howe

I do not wish to interrupt the right hon. Lady at an inconvenient moment, but I must press her on the point raised by my hon. Friend the Member for Aylesbury (Mr. Raison). The right hon. Lady said that the status of the report of the review which she is establishing under Lord Halsbury would be the same as that of the report of the Doctors' and Dentists' Review Body. In the light of the fact that following the second general review of that body which reported in 1966 half the recommended increment was postponed for 12 months and that the fourth general review, which reported in 1970, was also modified so that again only half the recommended increase was accepted by the last Labour Government, what are we to assume about the recommendations of the new inquiry? I appreciate the difficulty of any Government regarding giving a total commitment on this, but can the right hon. Lady tell the House how far the Government are committing themselves to accept in advance whatever the recommendations of the review body will be?

Mrs. Castle

I regret the right hon. and learned Gentleman's intervention, because he knows and accepts the traditional formula which must be followed by any Government. He must realise that by our speed in setting up the inquiry and the promise to back-date increases to this day, and by our saying that the Government do not intend to fetter the review body in any way, we have proved that we believe that only urgent action will save the National Health Service from the perils which face it at present.

It does not help us in what has been a tricky situation—which I repeat, advisedly, I inherited—to try to sow suspicion among the nurses and perhaps to encourage industrial action that would otherwise not take place. I could have expected the right hon. and learned Gentleman to have said that the Opposition would support the Government and pursue the Government to give full implementation of the award. That would have been a very different approach.

I repeat that the nurses can have faith in this Government, no matter what they have experienced under any other Government. Arrears of pay, or something of the kind, will be coming into the pockets of all nurses by the end of this month. I remind the House that nurses are bound to benefit shortly from the threshold provisions in their settlement. The latest retail price index figure will, I understand, be due out tomorow, or within a couple of days, and the House knows that as soon as the figure rises to 7 per cent. above the October 1973 figure, nurses will automatically get an extra 40p a week and another 40p for every further 1 per cent. increase in the index. For lower paid nurses this will be considerably more than would enable them to keep up with increases in the cost of living. It will enable them to improve their position.

Therefore, I believe that some of the worst stresses which the nurses have been suffering will be eased very quickly. I have put it to them, and I think they take the point, that they have asked for an independent review with full status and authority. It is not compatible with that to say: "Let us have a little bit on account meanwhile". To agree to that would, in a way demean the whole status and authority of the inquiry, and I hope that the nurses will appreciate that point.

I turn to the point raised by my hon. Friend the Member for Burnley (Mr. Jones). I know that he and other hon. Members are interested in the difficulties of other workers in the National Health Service, particularly those in professions supplementary to medicine, such as physiotherapists, radiographers, dieticians, chiropodists, occupational therapists, and so on. Their pay has always been closely linked with that of the nurses and they, too, will therefore benefit from the findings of the review. It is our intention that the results of the inquiry relating to the nurses should also be applied to those of the professions supplementary to medicine whose pay has been traditionally linked with that of the nurses, and I propose to discuss with those concerned how this can best be achieved.

It has been suggested in some quarters—and the right hon. and learned Gentleman was hinting at it—that what is needed is a comprehensive independent review of pay covering all the staff in the NHS. This has its attractions. I know that some people have toyed with the idea, but the situation is a bit more complicated than it may seem.

Some groups in the service, such as administrative staff and scientific officers, have close pay links with staff in corresponding occupations in the Civil Service and elsewhere and by that means they keep reasonably abreast of analogues in other public services. Doctors and dentists are covered by their review body, and those concerned would not wish their existing machinery to be disturbed.

Of course I am aware that there are other groups of low paid staff in the service besides nurses and the professions supplementary to medicine with which we are now dealing in this special way. The service is as dependent on its ancillary staff as it is on anyone: the laundry workers, hospital porters, ward orderlies, and so on. They, too, have their links with local government, but they, too, have had their intense grievances over the past few years.

I say to them that I am sure that we all accept that priority should be given at this time to the nurses, midwives and the supplementary professions which have suffered particularly badly from the policies pursued over the past three years. They have shown restraint and a sense of responsibility for a long time, and it is only right that they should now have a review such as they have had from time to time in the past.

Meanwhile, it is the Government's aim to move away entirely from the outworn approach on pay which has produced a situation of such disaffection among people who have always put service to others before themselves. The Prices Bill, which will, among other things, give the Government power to abolish the Pay Board and the associated pay controls, is now passing through the House, and if it receives Royal Assent by the end of June, as seems probable from the progress being made, the Government will expect to abolish the statutory pay controls very soon afterwards in July

Thereafter, we shall move to the voluntary methods on which my right hon. Friend the Secretary of State for Employment is consulting the TUC, the CBI and others concerned. In that new situation I look forward to being able to consult any other groups in the NHS with problems requiring attention about how they might best be handled within the arrangements envisaged by the Government for securing the orderly growth of incomes on a basis that is fair to all.

I must, however, once again emphasise that it is in the interests of all of us to make a sensible transition from the statutory to the voluntary arrangements, as my right hon. Friend the Secretary of State for Employment has explained more than once to the House. It is with this in view that we have asked those who have reached settlements to keep to them for their full term. Highly responsible groups such as the nurses can achieve redress only if the rest of us fully accept the justice of their case for this special independent examination.

This, therefore, is the new deal that we are offering to the staff in the National Health Service, a new deal compatible with orderly progress towards a voluntary pay policy, a voluntary acceptance of relativities by consent. I say to the nurses "You are on your way; you have your independent review; you have immediate action on Briggs; you have my promise to discuss with you in detail some of the anxieties and proposals outlined in the Royal College of Nursing's submission about the health policies and practices which affect the standard of care". I say to the nurses, through the House, "Call off your action because, in your own words, you are no longer being played along".

Mr. Deputy Speaker (Mr. George Thomas)

Order. May I remind the House that there is only just over an hour left for those hon. Members who wish to speak and are fortunate enough to catch my eye. I underline Mr. Speaker's earlier appeal for short speeches.

8.0 p.m.

Sir Derek Walker-Smith (Hertfordshire, East)

I shall certainly have that injunction in mind, Mr. Deputy Speaker. The Secretary of State referred at the beginning of her speech to partisanship. While I do not deprecate a certain degree of partisanship in this House—after all, it is part of the lifeblood of this place—I had never considered this particular subject, in my long association with it, to be suitable for partisanship. Any temptation which I might feel to indulge in it, and I feel no such temptation, would be the more easily resisted because of the right hon. Lady's announcement of the inquiry and the review body.

I welcome that announcement. I have advocated such a body. The right hon. Lady points out that it is on the model of the Review Body on Doctors and Dentists' Pay which was initiated in my own term of office as Minister of Health. I hope that the right hon. Lady will be able to achieve speedy action with the review body although, for reasons I shall give in a moment, I fear that the tasks before the body are formidable. I hope too that the findings of the review body will be speedily implemented.

I make no challenge at all about the good faith of the right hon. Lady in this matter—far from it. What I am more concerned about is whether the financial situation of the country at the time of the report will allow of a full and speedy implementation That is the point about which one cannot feel the same degree of confidence as one can in the good faith of the right hon. Lady. She referred to the possibility of the threat of industrial action. When such a dedicated and devoted body of people as the nurses talk in terms of industrial action, we know that they must feel very keenly the inequity of their position and must have strong confidence in the merits of their case. I believe that such action is foreign to the nature of their high calling and that its initiation would bring inevitable hardship upon patients.

Two things follow from this. First, there being that real and natural reluctance on the part of nurses and health service workers generally to take such action, we—the Government, the authorities, the community as a whole and Parliament—must in equity be careful not to trade on their reluctance and to make them the victims of their good feelings. Secondly, we must acknowledge that industrial action on their part, if it ware taken and if it were applied with the skilled and systematic ruthlessness of some industries, would be an immensely powerful weapon. It is a weapon to which the community might well find it necessary or expedient to yield.

I hope that we never get ourselves into the position of not granting to reason and equity what we might hereafter have to yield to harsher and less commendable following considerations of unwelcome and unwanted confrontation. I hope that my record in this matter will show that my sympathy and good will are not merely an academic matter and that I have some awareness of the problems.

My right hon. and learned Friend the Member for Surrey, East (Sir G. Howe) in his admirable speech was good enough to refer to the increase in nurses' pay which I was able to persuade the House of Commons to accept—there was no great difficulty in that—and also able to persuade those in the Government and in the Treasury to accept. That is not such an easy matter. That increase was the largest for about 10 years in percentage-terms. We sought then to introduce appropriate training allowances and differentials to make nursing as attractive a career as possible financially as well as socially. Yet the problem is still with us, in almost the identical terms with which we were then struggling.

Within a few years demands were in train not because nurses were greedy— they have not changed their nature—but because of inflation, the bugbear of all pay situations, but in nursing especially so because the nurses started a long way behind scratch. They were the victims of the nineteenth-century concept of nursing which divided nurses into the Florence Nightingales who did not need more pay because they were following a vocation and the "Sairey Gamps" who did not deserve any more pay. So it was that at the start of the National Health Service the standards of pay were unrealistically low.

In the years that followed, the nurses have never been able to get on to an appropriate basis of comparability. To achieve that we need a substantial revaluation exercise. In the idiom of this matter, certainly when I was concerned with it, there are two sorts of pay claim —the cost-of-living claim and the revaluation claim. The former seeks only to keep pace with inflation. The latter seeks to put undervalued or underpaid workers on a proper basis having regard to the comparables in other walks of life. The difficulty in an inflationary period is that people need so many cost-of-living claims that the revaluation claims get jostled aside and lost in the crowd. They do not receive proper attention.

It is no doubt for that reason that the present claim looks so large in percentage terms. It is, in effect, combining cost-of-living and revaluation elements. In substance they are both justified. I am sad that we are still faced with this problem after so many years. Like my right hon. and learned Friend, I do not apportion blame on a party basis. It is a problem not only of nurses. Theirs is a conspicuous part, but not an exclusive part of the problem. It affects many others in the National Health Service— the supplementary professions of which we have heard, the physiotherapists and many others.

It is not only workers in the Health Service who are affected. There is a central problem of securing for those large sections of our people who do socially valuable work, but work which is not directly productive in the sense that it can be measured by economic indices, a fair share of the nation's economic growth. My right hon. and learned Friend was good enough to refer to the debate of 14th May 1962. On that occasion I outlined to the House four principles affecting these matters. I said: First, we have to see these matters in the full economic context. Good will is not enough. We have to see that we have the wherewithal to pay. Second, if the whole, or virtually the whole, of the nation's economic growth is to be claimed by, or reserved for, those who are engaged in direct production in industry, then there will be inequity for many of our fellow citizens, the so-called white-collar workers. Third, the strength of a pay claim must not be judged solely by its organised strength in collective bargaining irrespective of merit or the value of the work to the community. Fourth and last, but very important, no calling must be prejudiced because of a conscientious reluctance to invoke the weapon of strike or any other form of direct action."—[OFFICIAL REPORT, 14th May 1962; Vol. 659, c. 966.] Those principles hold good today. The only pity is that we should have made so little progress in their implementation. Twelve years later almost to the day, speaking from within a few yards of where I stood then, instead of being able to state those principles as milestones in the progress already achieved, I still have to indicate them as goals we have to seek.

I hope I have said enough to show that I appreciate the difficulties of the problem. It is a supremely important problem not only for the workers in the National Health Service and for others doing this type of work but for the patients and, through them, the community as a whole. I wish the professions, the committee of inquiry, the review body and, indeed, the right hon. Lady well in their efforts. I urge her to those positive actions so eloquently commended by my right hon. and learned Friend the Member for Surrey, East in furtherance of the solution of this vital and human problem.

8.11 p.m.

Mr. Kenneth Lomas (Huddersfield, West)

In the interests of brevity, I do not intend to take up the remarks made by the right hon. and learned Member for Hertfordshire, East (Sir D. Walker-Smith). I must first declare an interest in that I am sponsored by the National Union of Public Employees, which has over 450,000 members, 200,000 of whom are employed in the National Health Service. Many of them are employed as nurses or in the nursing section. As a union we want to ensure that the lower-paid worker in the health service gets a square deal. Although I welcome the statement which has been made tonight by my right hon. Friend the Secretary of State, it does not go far enough.

There are one or two first-aid measures that could be taken immediately to bring the dispute to an end. First, there is no reason why the full adult rate should not be paid to students and pupil nurses, nursing assistants and nursing auxiliaries at the age of 18. Secondly, I see no reason why all nursing staff should not receive payment for weekend, shift, night and overtime duties on the same basis as that which is currently applied by the Ancillary Staffs Council.

I welcome the news that an independent inquiry is to be set up to examine the pay of nurses. The inquiry should go a little further than that. It should have been an inquiry to look into the whole structure of pay of the National Health Service. We must remember that behind every nurse there are scores of ancillary workers who do the dirty, mean jobs and who get very low rates of pay. I hope that there will be an inquiry into the structure of the service and that the views of the people I have mentioned will be noted, so that some help can be given to them in the form of increased wages.

Instead of setting up a review body for a short time to make recommendations which are acted on, after which the review body is forgotten for five years, I should like to see a permanent review body that will consider the problems all the time.

I have mentioned ancillary workers because I believe that without them the NHS would come to a standstill. We need them desperately. That is why I urge that the pay and conditions of everyone employed in the NHS should be considered.

It is no wonder that the nurses are becoming more and more militant—as they are in my area. My union is against an all-out strike and, after what we have heard tonight from the Secretary of State, I am sure there will not be one. I hope that unions which have been pressing for more militant action will take note of that.

There should be a greater degree of co-operation between trade unions in the NHS. The 12 organisations whose members serve on the Nurses and Midwives Council should work together in a joint campaign and not simply go it alone. The time is not approaching but is long past for having one trade union for all who are employed in the NHS. From that would come a unity of strength and purpose.

As the right hon. and learned Member for Hertfordshire, East said, direct action would have been unthinkable years ago, but times have changed, and the Florence Nightingale attitude must change as well. I believe that nursing is still a vocation, but it is more than that: it is a profession as well. Those who work in the NHS, especially on the nursing side, deserve a proper rate for the job.

Just before the General Election I spent nearly 14 days in hospital. I cannot pay too high a tribute to the devoted and dedicated care I received from all sections. That goes for ward sisters, nursing staff, ancillary workers and staff in all parts of the hospital. The girls who are in charge of wards all night have a tremendous job on their hands, and they should be properly rewarded for it.

Some time ago my right hon. Friend the Prime Minister said that one week was a long time in politics—and so it is. I hope that the committee of inquiry will not drag its heels and that we shall get a report quickly. The committee is not to start until after Whitsun, but I assume that it will report before the House adjourns for the Summer Recess. When they came to power on 28th February the Labour Government managed to settle the miners' strike within days. It cannot be beyond the wit of a Labour Government to resolve this problem so that we do not have to wait too long. [HON. MEMBERS: "Hear, hear."]

Mr. William Hamilton

Listen to the Tories. Absolute humbug.

Mr. Lomas

We recognise it for what it is worth. That is why I totally ignore it. Let us not go back to what the Conservatives did on the introduction of the National Health Service in the late 1940s.

The health service today is not what it used to be. It is deteriorating fast. It does not attract the staff that are needed. Only a truly realistic recognition of the work being done by those who are employed in the NHS will put things right. Let us not run away with the idea that we are spending a lot of money on the NHS. Both Governments are to blame for that. We spend a smaller proportion of the gross national product on the health service than is spent in Canada, United States, Sweden, the Netherlands and France. We spend less than 5 per cent. of the GNP, and we must recognise that that is not good enough. I am sure that no member of the public would begrudge paying extra taxes to ensure that nurses and other staff employed in the NHS received a square deal. I should like to develop the argument in favour of radiographers, physiotherapists and other grades, but many other hon. Members wish to catch your eye, Mr. Speaker.

Almost 50 per cent. of the total cost of the NHS goes on wages and salaries. Inevitably, if we want wards properly and adequately staffed we must be prepared to pay for it. Many wards have had to close down because of the short- age of nurses. I was surprised that the Secretary of State referred in such glowing terms to the £18 million that has been offered by the Government. First it is chicken feed, and secondly the extra £18 million was for nurse tutors, ward sisters and staff nurses only. Although I believe that this is a necessary step if the Briggs recommendations are to be implemented, it will do nothing to give immediate assistance to the lower-paid grades of the nursing staff.

I welcome the fact that an inquiry is being set up and I hope that the Government will ensure that it reports at the earliest opportunity. If it reports quickly and its recommendations are acted upon, the Government will earn the respect, admiration and good will not only of NHS employees but of the nation as a whole.

8.20 p.m.

Mr. Donald Stewart (Western Isles)

I hope that the hon. Member for Huddersfield, West (Mr. Lomas) will forgive me if, in the interests of brevity, I do not take up his comments. I am sorry that the right hon. Lady the Secretary of State for Social Services has left the Chamber. I thought that she dealt with the House in an unctuous manner. She preached arguments of which we are all aware. What we want is action on behalf of the nurses, since action is what is lacking in the present situation. The right hon. Lady thinks that if she can prove that the Tories were the culprits, that solves the problem. That may satisfy many people as an argument, but it will not satisfy the nurses.

When hon. Members mention prices and incomes policy, they omit to mention that this argument ignores the fact that the present situation has existed for decades under Labour and Tory Governments. The trouble with the nurses' case is that their pay scales initially were not set at a high enough level. Because it has been thought over the years that the nurses, because of their vocation, would never go on strike, they have been put at the end of the queue, and over this long period of time the value of money has eroded considerably in terms of the cost of living.

I welcome the review announced by the right hon. Lady, but the figure of £18 million is derisory. There is no doubt that if the Government had the will to do so, they could deal with the problem immediately. They have the power to make exceptions even under phase 3, or whatever phase we are now operating.

I hope that the review body will report within a short time. Unfortunately, the demands of the National Health Service are increasing rather than decreasing; the techniques are becoming more involved and the geriatric problem is increasing all the time. The National Health Service is in a serious condition which might come to a head within a very short time.

I welcomed the right hon. Lady's speech so far as it went. Her proposals were somewhat pathetic, but they constitute a start. I hope that the review body will be obliged to report within a short time and I hope that whatever party is in power—if the Labour Government manage to achieve this solution, I shall be the first to congratulate them—it will see to it that, at long last, justice is done to this worthy profession.

8.23 p.m.

Mr. John Cronin (Loughborough)

In conformity with yesterday's proceedings, I wish to declare an interest in this subject. I am chairman of the Parliamentary Committee of the Confederation of Health Service Employees, which makes some contribution to my constituency Labour Party. It is a somewhat indirect interest to declare, but perhaps it is as well that I should mention it.

I very much welcome the proposal by my right hon. Friend the Secretary of State for Social Services to set up an inquiry into the conditions of service and pay of nurses and midwives. This move will be greatly welcomed by my confederation and indeed throughout the nursing profession.

I hope that my hon. Friend the Under-Secretary of State for Health and Social Security in replying to the debate, will give the date when he thinks that Lord Halsbury will report. My recollection is that in the days of the coal strike before last, Lord Wilberforce reported in about 10 days. I wonder whether Lord Halsbury will report with the same degree of celerity. The situation is grave, and it is by no means certain that the Secretary of State's announcement will prevent all industrial action, because there is a marked feeling of bitterness among nurses. The Secretary of State was unfortunate in that she inherited this appalling problem from the Conservative Government. She has also inherited all the bitterness engendered by the neglect of the Tory administration.

The right hon. and learned Member for Surrey, East (Sir G. Howe) made a bipartisan speech. He wept crocodile tears over the plight of nurses, but we must remember what little was done for the nurses under the Tory Government. We accept that the Conservatives had to face the situation of a freeze on incomes, but there can be no excuse for the way in which that Government sat on the Briggs Report—a report produced in October 1972. It was only when my right hon. Friend the Secretary of State came into office that she immediately implemented the main recommendations of that report. The bitterness felt by the nurses has been almost entirely brought about by the fact that their wage claim has been caught up in a succession of freezes as a direct result of Conservative policy. The nurses' claim was laid on the table in January 1972. All they have received is a small increase of 7 per cent.

Hon. Members on both sides of the House agree that nurses as a class of individuals display remarkable qualities. I think that most of us at some time or the other have benefited from the services of nurses, but probably not all of us realise what exceptional qualities are demanded by their profession. I have been a consultant surgeon for the last 30 years and I have been in operating theatres and wards of many kinds, and I know at first hand that nurses deserve the greatest sympathy and understanding for the work they undertake. I think not only of the ordinary services in healing the sick, but of those appalling jobs such as caring for incontinent people, attending to the dead, caring for frightened patients, people who are in pain or breathless and all the rest of their tasks. All these harrowing jobs require a high standard of character.

Mr. Donald Stewart

That does not butter their bread.

Mr. Cronin

The hon. Member for the Western Isles says that that does not butter their bread. This is partly the fault of the nursing profession. Most nurses are inexperienced, unworldly young women. There are about 350,000 of them, and more than 200,000 are totally unorganised. They belong to no union and they have no representation of any kind. It is partly the fault of the profession that our nurses have no one to put their case more strongly. If they had a Joe Gormley, they would not be in their present position. I hope that they will rectify this in the very near future— certainly in terms of organisation.

The Secretary of State said that there was to be an increase which would be payable probably this month. The House should bear in mind however that even the 7 per cent. increase which is to be paid—which incidentally was due on 1st April—will leave first-year student nurses with salaries of £816 a year and third-year student nurses with £936 a year. In other words, they will be getting less than an office junior—a completely unskilled worker. Under the new rates which they are to receive this month, staff nurses will get between £1,300 and £1,500 a year, and ward sisters will get between £1,600 and £2,000 a year. It is a very unsatisfactory thought that a ward sister, who in a London teaching hospital had to have A levels even to be a student nurse, should get less than the average secretary who has completed a course in typing and shorthand which has taken about six months.

I have no doubt that these matters will be considered by the Halsbury Committee. But I feel that if the Government can do something now additional to the 7 per cent. that will probably ease the situation a great deal. I appreciate that it is difficult to do it now, but I hope that my hon. Friend the Under-Secretary will give my suggestion some consideration because the present award of 7 per cent. will not be enough to assuage completely the bitter feelings of our nurses, despite my right hon. Friend's announcement about the inquiry.

I hope that the Halsbury Committee will look into the possibility of higher rewards for our nurses. This was a matter considered by the Salmon Committee in 1968, but the recommendations of that committee were such that nurses got substantially higher rewards only if they left nursing and moved into administration.

I hope that consideration will be given to increasing the pay of our nurses in accordance with their qualifications. At present nurses are not accepted into London teaching hospitals without at least two A levels, whereas at lesser hospitals they can get in with relatively minor educational qualifications. Nevertheless they are paid the same, and this is inequitable.

In my view, the Halsbury Committee should also look into the practice of employing agency nurses. This is chiefly a problem in London where 90 per cent. of agency nurses work. But we have the absurd situation where a nurse working for the National Health Service finds herself in a ward with another nurse doing the same work who is employed by an agency and who is getting up to double her wages. This is a matter which is obviously grossly inequitable.

I trust that the Halsbury Committee will look into hospital discipline. This is unduly harsh on nurses. Although matrons and others in administrative positions in the nursing profession are more enlightened than they used to be, there is still a tendency to make life more disagreeable for nurses than is necessary. There is still too much of a spirit of maternalism in hospitals. Nurses are not allowed sufficient freedom, and they do not like the restricted lives that they have to lead in nursing homes.

I hope that the Halsbury Committee will bear in mind that nurses are obliged to work very much harder than ever before. The turnover in beds is very much greater than before, with the result that there is a much higher proportion of very ill patients.

I wonder whether my hon. Friend the Under-Secretary is in a position to say when his Department is likely to obtain some figures about recruitment and some official figures to indicate how serious is the shortage of nurses. An estimate has been made by the Confederation of Health Service Employees, taken on a sample of 100 hospitals, that the number of nurses is roughly 17 per cent. below strength, but that is not an official figure, and I hope that we shall have an official figure very soon.

I welcome the statement by the Secretary of State. I feel sure that, with the present Government and my right hon. Friend's recommendations, our nurses may look forward to a better future than they have ever seen in prospect before in their glorious profession.

8.35 p.m.

Mrs. Elaine Kellett-Bowman (Lancaster)

I have received more letters and representations on the subject of nurses' pay than on any other single matter in the last two Parliaments. Every single one from those outside the profession supports the nurses' claim wholeheartedly. I quote only one from a recent patient: A recent stay in hospital has brought home most forcibly to me the outrageous exploitation of the nursing profession. How right that lady is! But the interesting feature of those from people in the profession is that through every letter runs the same theme: "It is not simply our own future which is driving us to despair, but our anxiety that unless the terms and conditions of service of all ages and grades is improved, the whole service will collapse". That is true.

The £18 million that the Government have offered to improve the pay of nurses directly involved in the education and training of nurses, described by one hon. Gentleman opposite as "chicken feed" —again, how true—only aggravated the fury in the profession since it was regarded, in the words of one of my nurses as "an attempt to divide the profession". The Royal College of Nursing confirmed this view in its lucid document of 9th May.

The House will know that in the last century it was considered advisable to establish large hospitals away from the largest centres of population. So it is that in our relatively small city we have no fewer than six hospitals with a bed complement of 3,029 and 1,000 staff.

Lancaster covers the whole range of hospital services. The Royal Lancaster Infirmary is an acute general hospital with 237 beds and 129 staff, including the midwifery unit. The Beaumont Hospital is an acute specialty hospital with 121 beds and 66 staff. The Garnett Clinic, an acute specialty hospital, has 106 beds and 59 staff. The geriatric unit sited at the Lancaster Moor Hospital has 158 beds and 93 staff. The Lancaster Moor Hospital, which is a long- stay psychiatric hospital, including Ridge Lea, has 1,405 beds and 391 staff. The Royal Albert, which is for the mentally sub-normal, has 1,002 beds and 290 staff.

A superficial look at these staffing ratios might give the impression that the ratio of patients to nurses is reasonable. But closer examination shows that nothing could be further from the truth. With the exception of the Royal Lan-1 caster Infirmary, all the hospitals are 5 under establishment, and the proximity 1 to total establishment figures has been achieved only by over-recruitment of untrained staff, and the service is kept 5 going only by these and by selective overtime working and the fact that many nurses have time only to snatch a bite and rush back to their posts instead of 'taking the proper meal breaks that their s arduous work entitles them to take. I have seen that happen scores of times.

Some of the figures for in-post staff are little short of horrifying. At the Garnett Clinic, the acute specialty hospital, there are only 13 sisters/charge nurses out of an establishment of 19 and only six staff nurses instead of 10. The figures for the geriatric unit are even worse. Instead of 20 sisters/charge nurses, there are only 10—half the proper number—and only four staff nurses where there should be 13.

At the Lancaster Moor Hospital there are only 50 sisters /charge nurses where; there should be 71. At the Royal Albert there are 30 staff nurses where there should be 77. What bodes ill for the future is that there are only 43 students where there should be 97.

Even these figures do not tell the whole story. These hospitals are very old. The lay out of the buildings, as one hon. Gentleman on the Government Front Bench was heard to mutter, necessitates a higher establishment than the regional board ratio allows.

Moreover, the enormous advances in medical-surgical techniques and the new ideas with which surgeons are constantly and properly coming forward in themselves increase the nursing workload and put a strain on the nursing establishment. It is essential that nursing establishments should be realistic to avoid some of the problems which are otherwise inevitable. For instance, in psychiatric hospitals wards are understaffed to such an extent that, particularly at night, inexperienced staff and student nurses are left with disturbed and epileptic patients, thus increasing the strain and danger to all concerned.

During the election campaign when my husband and I were discussing with people in my constituency the dangers of different occupations, such as mining, it was interesting how many nurses, or their wives or husbands, pointed out the acute danger to staff in these conditions and the number of times that they or their relatives had suffered injuries in the performance of their duties. They pointed out that, although the patient is protected by the Mental Health Act 1958, the staff are not. From the comments that I have heard these people make about miners, I cannot think that they would welcome Joe Gormley among their ranks.

Even when wards are understaffed overtime is not allowed, or time has to be taken off in lieu, causing even greater shortages and depriving nurses of the cash advantage, which they would very much value, of overtime at an enhanced rate, as applies in almost all other walks of life. The pay for the unsocial hours which nurses have to work is totally unrealistic. It is only one-fifth, and even this is based on the old salary scale.

In many parts of our psychiatric hospitals nurses are required to wear their own clothes instead of uniform, to give a homely atmosphere, and I am sure that this is right. This applies particularly to what used to be a locked ward, a horror ward which has been converted into delightful hostel-type accommodation, but the nurses' clothing allowance is a wholly unrealistic 30p a week.

The increment scales in some grades are odd, to say the least, and I hope that the Halsbury Committee will go into this most carefully. Ward sisters and charge nurses grade 6 have nine increments compared with three or four in other grades. This means that staff with clinical expertise, however devoted they are to nursing, are leaving the nursing side to go into administration to get better pay in the interests of their families.

That inevitably adversely affects patient care, as younger sisters and ward charge nurses, however good and keen they may be, have not had the experience to have acquired both ward management and clinical expertise to teach students and pupil nurses, again reflecting badly for the future.

There is also a strong feeling that nurses, right up to highest grade, are given insufficient say in the planning of new buildings and the alteration of old ones. We constantly hear similar complaints in education. There is a particularly good example of this in one hospital. We were given two "Crossman hospitals", but clearly no nurse had ever seen the design before they were put up, because the bathroom door was so placed that it was impossible for a nurse to get an old or incapacitated patient into the bath. One hospital has been altered, but one has not, and they provide an object lesson of the futility of not consulting those at the grass roots.

But, despite all this, our hospitals manage not only to do a superb job, but to continue to pioneer and innovate. Under a scheme of community psychiatric liaison, which has been in operation for only six months, no fewer than 400 patients have been able to return to their homes, and the hospital staff do the outpatient work, following the patient home, visiting as often as they can, but again this makes demands on the time of the staff.

I had hoped that questions of nurses' welfare, pay and conditions would have been referred to the relativities board so that justice could be done to them under this procedure with better pay, conditions and holidays. However, the Halsbury review will be very welcome, and I trust that the right hon. Lady will be able to persuade her right hon. Friends to refrain from profligate spending on indiscriminate subsidies right across the board, to rich and poor alike, so that there will be money in the kitty to pay the bill when the review comes along.

8.43 p.m.

Mrs. Renée Short (Wolverhampton, North-East)

I welcome very much my right hon. Friend's statement and I, too, hope that it will be possible for us to have the report from this committee in a matter of weeks rather than months so that it can be implemented.

I assure the hon. Lady the Member for Lancaster (Mrs. Kellett-Bowman) that if she wants to find additional money to help nurses and others working in the National Health Service we could look at some of the expenditure within the service. I believe that there is a great deal of wasteful expenditure, and I hope that the Select Committee on Expenditure will be able to consider that matter in the months ahead.

As my right hon. Friend said, the speech of the right hon. and learned Member for Surrey, East (Sir G. Howe) was in a low key, and that is not surprising. I bet that the right hon. Member for Leeds, North-East (Sir K. Joseph) is glad that he is not speaking in this debate. There were a few debates on this subject when the right hon. Gentleman was responsible for the National Health Service, and I should like to refer to one that took place in December 1973—which is not all that long ago—when we discussed a subject that has affected the National Health Service and all the staff working within it, namely, the reorganisation of the National Health Service, for which the right hon. Gentleman was responsible.

In December 1973, we, then silting on the Opposition side of the House, tried to persuade him to defer the introduction of the new system which followed the notorious McKinsey Report. We saw that there would be chaos after the implementation of his proposals and the introduction of the managerial system, which was alien to the whole concept of the National Health Service, but he was not prepared to listen.

We were concerned not only with the scheme which would be introduced but with the kind of appointments which were being made to the different authorities. We were concerned because there were not enough women in the administration of the NHS. We were concerned because there were not enough trade unionists or manual workers involved. We were concerned that, last December, not one medical officer had been appointed in any of the 90 areas and that, in each of 17 areas, no administrative officer or finance officer had been appointed. Posts of district community physicians had not been advertised. We foresaw considerable difficulties.

The right hon. Member said that if reorganisation were deferred, it "would be no kindness". How wrong he was. He went on to say: It would only prolong the uncertainties from which health service staff have been suffering for too long. … Our job now is to see that"— the authorities are staffed to promote the interests of staff on transfer, and, above all, to maintain the continuity of service to the patient."—[OFFICIAL REPORT, 11th December 1973; Vol. 866, c. 220, 221.] Splendid oratory, but we see now exactly what has happened. We have never known such confusion, frustration and militancy. Therefore, I hope that the hon. Member for Aylesbury (Mr. Raison), who is to wind up the debate for the Opposition, will show a little penitence. That is what is needed from the Conservative Party.

Right hon. and hon. Members have had representations not only from the nurses but also from NALGO, yet no one has mentioned NALGO and its position in the NHS. There are 80,000 NALGO members who are very concerned about the lack of consultation in the service arid the way in which senior appointments have been made, advertised and generally handled. They are concerned about the massive uncertainty that large numbers of them face since the new system was introduced on 1st April. NALGO, together with NUPE and COHSE, have made sure that the whole country knows their difficulties. They are totally disillusioned because they were clobbered by the Pay Board when it vetoed the agreement reached by the Whitley Council about the additional duties payment which was due on reorganisation.

Enormous numbers of NHS employees have now been "latched on", that is, they are doing extra duties for which they receive no extra pay. It is no wonder that they feel upset and militant. Thousands of staff are still completely in the dark about the posts that will be available to them, and it looks as though this situation will go on for several years unless my right hon. Friend takes the problem on board.

In addition to the "latching-on" situation, the consultation situation has been farcical. The para-medical services have a very poor range of salaries. There are some physiotherapists, for instance, who after three and a quarter years training— considerable academic qualifications are required to start training—take home £18 a week. Yet they are responsible for dealing with mentally and physically handicapped patients and for helping patients get back on their feet after operations.

Let us consider senior radiographers. I have received a letter from a senior radiographer in one of the hospitals in my constituency. She has been qualified for 10 years, and she holds a senior post. Her salary is £1,780 a year. Her take-home pay is £33 a week. All these rates of pay are less than the national average industrial wage. I have with me a copy of the journal of the Society of Radiographers. It is full of advertisements for vacant posts in hospitals, teaching hospitals and others, up and down the country. There are very many jobs on offer. I also find in this journal that an agency is advertising for senior radiographers at £40 a week, whereas the senior radiographer at the hospital in my constituency has a take-home pay of £33. Is not this a nonsense?

I find, too, an advertisement by a pharmaceutical firm, headed, "Are you ready for a new career?" By gosh, I think that most radiographers are. This firm is offering to hospital representatives a salary of up to £2,850 a year, plus a car, if they will call on hospitals and promote the sale of drugs made by the firm. For people to call on general practitioners to promote the sale of drugs, the firm is offering £2,500 a year plus a car.

With these blandishments offered to underpaid people working the National Health Service, it is not surprising that most hospitals are facing a staffing crisis. It is not surprising that a large number of hospitals, including teaching hospitals, are facing the problem of under staffing. Doctors have called attention to the fact that standards of medical care are falling because of understaffing. Beds in many new hospitals are unused or have never been brought into use because of shortage of staff. This difficulty will continue to grow unless my right hon. Friend takes drastic action.

No one has mentioned in the debate the junior hospital doctors. They are very concerned about their pay and working conditions. Some of them, too, are supplementing their pay by working for agencies or for commercial deputising services in the time when they ought to be studying or resting. Again, the situation is deteriorating.

No one has mentioned dentists in the debate. The dental services, too, are facing a crisis situation because we are not paying dentists enough to carry out the range of conservative treatment which ought to be undertaken. Again, large numbers of dentists who were working in the National Health Service have left to work in the private sector. As many hon. Members know, in many towns we have reached a situation in which it is not possible to obtain National Health Service dentistry.

I hope, therefore, that we shall return to the House in a matter of weeks and find a report before us which will show that there will be a revolution throughout the National Health Service, but a constructive revolution, which will make it possible to win back those who have left the service. I am certain that the whole House would welcome such a report and would see that my right hon. Friend was given every help to implement it.

8.54 p.m.

Mr. Ernie Money (Ipswich)

1 fully appreciate the fact that the Secretary of State did not want to give way when she was making her important statement. For that reason I address the first part of my brief remarks to the Under-Secretary. I ask him whether he would be good enough to deal specifically with the position of the nurses in the Ipswich and King's Lynn areas—my hon. Friend the Member for Norfolk, North-West (Mr. Brocklebank-Fowler) has a similar problem—who are faced with a difficult situation regarding the problem of the re-programming for the East Anglian Regional Hospital Board. This is dealt with in Written Question No. 120 standing in my name on today's Order Paper.

The right hon. Lady made specific mention of something on account for, she said, the Trent area and southeastern area, specifically in the London area, hospital boards. But she has not mentioned those anomalies in regard to East Anglia. I shall be grateful if the hon. Gentleman, if he can get it in time, can give us information about that, so that it can go back and be some encouragement to nurses in Suffolk and Norfolk who at this stage are being told that they are not likely to receive what was awarded to them in April until the end of June.

The other matter I wish to raise follows remarks made by the hon. Member for Loughborough (Mr. Cronin). He touched on something very important in relation to the report. Although we all welcome the appointment of Lord Halsbury's committee, I very much hope that the committee will deal not only with pay and the structure that goes with pay but with other matters also, such as standards of care, education, manpower and particularly conditions of work. I know that when a Royal Commission or any similar body is set up in these circumstances, the debates in this House are carefully considered by its members. I hope that in this respect the Halsbury Committee will consider specifically some other things which, from conversations with members of the nursing profession, I find are causing great distress, particularly the question of unsocial hours of work. Nurses still have the longest working week of any of the caring professions. This inevitably involves working extremely long hours and bites into their social life; it involves them in filling in for other social services which do not provide a 24-hour service. Another matter which is causing great distress is that in order to meet the problems of the basic economic structure many of them have to take on additional jobs by way of "moonlighting".

A second problem is the question of the price—and, I am afraid, occasionally of the quality—of meals in hospital canteens and the lack of uniformity in pricing policy. In many cases the question of study leave gives rise to a great deal of uncertainty because too often funds are not made available for members of the profession by different local authorities.

Finally there is the need for an occupational health service for all health service employees. The Secretary of State mentioned the most impressive document which has been put forward by the Royal College of Nursing and the National Council of Nurses, "The State of Nursing, 1974". This document stressed that the concern of the profession was not simply with the question of material reward, high though that must now rank in the financial circumstances in which the profession stands. It also stressed that the profession was concerned fundamentally both with the general conditions of service for the profession and in particular the extent to which these affected the way in which employees are able to serve their patients.

8.57 p.m.

Mr. Pefer Hardy (Rother Valley)

I shall endeavour to emulate the hon. Member for Ipswich (Mr. Money) in his interesting and brief speech, none the worse for being brief. The points he made were quite legitimate. It is a great pity that the hon. Lady the Member for Lancaster (Mrs. Kellett-Bowman), who preceded him in speaking from the other side, indulged in a speech in which she attacked the present Government for what she described as the outrageous exploitation of nurses, treated the House to a survey of the hospitals in her constituency, no doubt in anticipation of a General Election, and then promptly departed without observing the courtesy of offering my hon. Friend the Member for Wolverhampton, North-East (Mrs. Short) very much attention.

I wish to speak briefly, and relatively constructively, and I must declare an interest as a member of the National Union of Public Employees which has over 200,000 of its members engaged in the National Health Service. The union will give two loud cheers and perhaps a third, a little less loud, for the Secretary of State's speech. Certainly, the first two cheers will be sizeable and loud. Basically, those of us in NUPE concerned about the hospital service would have preferred a very deep exhaustive, in-depth study of the whole question of manning in the National Health Service. We realise, however, that would be a very large job and therefore, while we hope that the other occupations in the health service will not be ignored, we welcome the detailed study of the nurses' problems. We hope, too, that when the committee completes its deliberations the position of the physiotherapists, the radiographers, the medical technicians and others may be given similar consideration because their position is as serious as that of the nurses.

The debate has been interesting, but more detailed figures could have been given even at this stage. Staff nurses at present receive 64p an hour; State-enrolled nurses 57p an hour; and a charge nurse, who is at the top of the scale, after nine years' experience and service in that grade, receives £1 an hour or £2,097 a year. That for a person with considerable responsibility, who has perhaps engaged in a first-line management course, and who will have a great deal of experience, probably with qualifications in advance of the State-registered nurses is scarcely sufficient.

Perhaps the nurses are to some extent at fault because of their lack of organisation. But we cannot blame the politicians or the nurses. We must look at the attitude of British society. A society which is prepared to pay shorthand typists, who are not necessarily highly qualified, perhaps 40 per cent. or 50 per cent. more than it pays an experienced and qualified nurse deserves the sort of health service it will be getting unless my right hon. Friend's activities bear fruit. The report upon the South Ockenden Hospital described a villa which accommodated 76 mentally subnormal patients, 30 of them incontinent, which was staffed by four nurses and one orderly. A society which is prepared to tolerate that sort of thing will eventually get the health service it deserves.

I hope, therefore, that my right hon. Friend will persist in her decision and determination to press the case of the health service nurses, because that is necessary. It may be that many people are happy to accept that if the mentally sick and the geriatric patients are out of sight and out of mind they will not put a strain on the public purse. If that is the case, the situation in Britain will become even more severe and conditions in the health service will be such as to rouse the nurses and their colleagues to even greater anger than they have now begun to feel.

I am pleased that some hon. Members opposite have not engaged in an exercise to try to blame the Government, who have been in office for less than three months, for the situation which exists. To have done so would have been to cheapen politics. I hope the attitude displayed by the hon. Member for Ipswich will be echoed by his hon. Friends. I hope that they will be able and willing to express sincere applause and congratulation for the important step forward announced by my right hon. Friend today and for the significant improvement we hope it will bring for the nurses.

9.4 p.m.

Dr. Michael Winstanley (Hazel Grove)

I must begin by declaring an interest, since I work as a general practitioner in the health service. During the Whitsun Recess I might do a great deal of work in that capacity.

The debate is an important occasion. What we say and do tonight is of great importance. In the debate yesterday many hon. Members suggested that we had no real power and that what we said did not matter. We should not forget, however, that the public believe that we have the power as Members of Parliament to demand that certain things must happen.

Practically every hon. Member has received letters from nurses, physiotherapists and others in the service. We have all been writing back to say that we are entirely in support of their case. Therefore I should like to feel that none of us will leave here without feeling that something will be done.

Perhaps the right hon. Lady's statement will have that effect. I listened to it very carefully, and it seemed to me that some of her commitments were unambiguous. She would have great difficulty in getting out of some of the things she said, if she wanted to do so, though I do not think that she ever will. I believe that what she said will be enough to restore the climate to some kind of tranquillity.

There are two aspects to the problem. First, there is our obligation to what are fundamentally our employees. We employ them in the National Health Service. Many of them—nurses, physiotherapists and so on—are living in desperate difficulties. One hon. Member referred to moonlighting to keep body and soul together. It is true that that happens, particularly in the case of married couples both of whom work in the health service—the nurse married to a male nurse, the physiotherapist married to a nurse. Such couples are often in extreme financial difficulty.

We have a second obligation to the health service. We spent a long time on reorganisation of administration. Administration is important, but the efficiency of the health service depends far more on the number and the quality of the people who do the work than on anything else. We are now experiencing shortages of those who do the work in almost every capacity.

Where there are such shortages the problem snowballs. If a hospital becomes short of one or two nurses, it soon becomes much shorter of nurses. One girl with inadequate training and experience may be left to exercise responsibility over a ward at night. She often goes home weeping with nerves and fatigue on her day off, and sometimes does not return because she is frightened of the job. We lose nurses because there is a shortage of them, and we are losing physiotherapists, radiographers and radiotherapists for the same reason.

We see the same thing even in medicine. If a hospital advertises for nine house surgeons, it will have no applicants, because any doctor who applies knows that he may be the only applicant and that he will then be doing nine people's work. If a hospital advertises for one house surgeon, it will have many applicants. If we do not remedy shortages in staffing, they will snowball, and the health service in the area concerned can come near to collapse.

I am very glad that so many hon. Members have referred to all the different workers. It is regrettable that my own profession has sometimes appeared to be rather more preoccupied with doctors' economic and financial problems than with the problems of some of the other workers in the health service. I am very happy that doctors are now coming out wholeheartedly in support of the ancillary workers within the service. The professions all act together in the service, and I hope that we, too, will regard them as being all together.

Each profession has its special problems. The radiographers have on-call payments that are wholly inadequate. Speech therapists have almost disappeared. We cannot recruit them because of inadequate remuneration.

We have a special obligation today, for three reasons. First, the nature of the work of those employed in the health service makes it impossible for them to use the industrial weapons used by so many workers. Secondly, because they are fundamentally employed by a monopoly employer, they are in a very weak bargaining position. Thirdly, they are in effect civil servants. When a Government wish to control wages, they tend to do so with the only wages under their control, those of the Civil Service. We have seen that over and over again, right back to the time of the Geddes axe.

We have a special responsibility to all those concerned. I hope that the debate will show that we have fulfilled that responsibility.

Mr. Speaker asked particularly for short speeches from Front Bench spokesmen. We on the Liberal Bench are all Front Bench spokesmen, so I shall follow that advice and sit down very soon.

The right hon. Lady said that she hoped the present excitement would die down. I hope that every hon. Member feels that the excitement should die down by our making sure that the people within the National Health Service are convinced that they will at least receive justice.

9.10 p.m.

Mr. William Hamilton (Fife, Central)

. I was asked a few months ago whether I would be a sponsored Member of the Confederation of Health Service Employees. I agreed on the strict understanding that I should speak exactly as 1 felt without any kind of pressure from the confederation. I am speaking on that understanding.

I do not know whether the confederation will be wholeheartedly and unconditionally enthusiastic about the statement made by my right hon. Friend the Secretary of State. I think that its criticism will be a little less vehement than it would have been if she had not made her statement. I hope that it will reconsider the action it was proposing to bring into effect within a few days.

I say at the outset that ever since the National Health Service was inaugurated we have had the service that we have deserved. I do not blame or criticise any Government for the service's faults. The public are at fault for tolerating the conditions in which they are treated by the service when they go into hospital. I have said before that we all salve our consciences when we have been in hospital by saying what wonderful treatment we have received, but we then forget about it. Perhaps we give a box of chocolates to the nurse, say goodbye and that we shall call in to see her, and that is that.

I hope that I might be allowed one or two slightly acid comments. My right hon. Friend's statement was relatively short of statistics. It was a fairly general statement on a review that is to report at some unspecified date. The chairman was named and guarantees were given about the representation of the nurses. 1 hope that will mean that not only the nursing officers but the junior staff will be represented.

One of the great shortcomings of the Whitley Council procedure is that the junior staff are not represented. I hope that the Whitley Council machinery, and particularly the nurses' and midwives' section, will be examined with a view to overhaul. I hope too that we might have some specific figures from my hon. Friend the Under-Secretary of State for Health. My right hon. Friend must have worked out what the backdating will amount to. She must have worked out the figures relating to the advances this month that will date back to 1st April. I should like to know her estimate and where the money is coming from.

My right hon. Friend's initial reaction when the campaign started was that if an improvement were made, cuts within the service would have to be made by her Department. I was appalled when my Government accepted without question the cuts that were announced in the previous Government's White Paper last December. It was then announced that there would be £111 million worth of cuts in the health and personal social services throughout the United Kingdom, including a cut of just over £40 million on hospital and community services. The Government must know the sort of figure they have in mind for immediate payment to the nurses this month. They must know where they will get it from. I ask specifically where they are going to get it from other than cutting still further the present Estimates.

The sub-committee of the Expenditure Committee on which I am serving is to demand a detailed explanation of how the £111 million cut was arrived at and why the present Government accepted it without question. Did they accept the same arguments as the Conservative Government accepted? Did they accept the same priorities? If they did, there is something radically wrong.

My post-bag, like that of other hon. Members has been filled by correspondence on this subject in the last few weeks. In many ways it is a compliment to the present Government that the militancy of the nursing profession is far greater under a Labour Government than under a Tory Government. I suspect that this is a backhanded compliment, because the nurses know that generally speaking a Labour Government are more compassionate than a Tory Government on these matters.

When the Conservative Party went to the country in February, it said that it wanted to continue firm and fair government. Fair to whom? Certainly not the nurses. The right hon. Member for Sidcup (Mr. Heath) boasted that 6 million workers, including the nurses, had accepted increases under phase 3. He knew very well that the nurses accepted because they could not do otherwise. They accepted under duress. They are one of the weaker sections who would not use the strike weapon.

I want to quote two cases to let the House and the country understand just what slavery we have in this country today. The first example is of a male three-year student nurse, with a wife and family, in Lincoln. He is living-in. His net pay in the month was £85-76—about £21 a week on which to keep a wife and four children. That pay included £440 overtime.

Worse than that is the case of a Mauritian girl who writes: I came to this country in 1970. I was asked to follow a 2 year course for pupil nurse. I passed my examination about two years ago. The wage then plus overtime was fairly reasonable. Now I have started a post-registration course for 3 years. The wage I came out with last week was £10.82. I have her pay slip here to confirm it.

We all know that in London particularly and in other big cities the hospitals would come to a grinding halt if it were not for coloured personnel. A lot of them were brought here by Mr. Enoch Powell when he was Minister of Health. Now he wants to send them all home. If they went, the hospitals would close. This is a form of colonial exploitation which is still going on.

I hope that the Halsbury Committee will have a look at the extent to which we are using these girls from overseas, because the Briggs Committee said that it was highly unsatisfactory that in many cases we should have to take more nurses from Mauritius, Barbados, Jamaica and elsewhere than those countries have in total themselves.

I hope we shall get from my hon. Friend the Under-Secretary some specific answers to my specific questions. I also hope that the full cost of implementing whatever Halsbury recommends will not be criticised too much by the Opposition, even though the recommendations are bound to cost hundreds of millions of pounds. The money will have to come from one source or another. The cost will have to go either on the insurance stamp or on tax, and I hope that it goes on tax. But I trust that when we come to implement the proposals the Opposition will not say that Labour Governments increase taxation.

I believe that even if their wages were trebled the nurses would not be getting enough. If the girl from Mauritius whom I mentioned as getting £10.82 had her wage increased to £32, who would say that she was a greedy girl? I doubt whether anyone in the House would say that.

It is all very well saying that any award will be back-dated. Reference was made earlier to how we settled the miners' dispute. During the General Election campaign I said to miners in my constituency that I regarded the nurses as being as vital a section of the community as the miners. We settled with the miners within a week, and we ought to give an interim settlement to the nurses within a week. I do not mince my words. The statement by my right hon. Friend the Secretary of State was very acceptable, although she was pressurised into action; but she has been very responsible, as we expected her to be. In my view, however, what she announced is not enough, and I hope she will reconsider the possibility of giving a sum—COHSE has quoted a figure of £100 million but I am not quoting one—as a gesture within the next few weeks.

What about militancy amongst nurses? They are not Left-wing Reds under the bed. They are people who are simply fed up to the teeth with being exploited by all types of Governments during the past 25 years. We must remedy the situation very quickly or there will be serious trouble.

9.24 p.m.

Mr. Jim Spicer (Dorset, West)

J am certain that all hon. Members on the Opposition side, indeed the whole House, will welcome the inquiry which has been announced and that we shall give full support when the recommendations are made.

I wish to mention matters concerning fringe benefits. I believe that there is a strong case to be made for the inquiry to be wide ranging and to consider benefits. I should like the inquiry to consider the position of students and the privileges they have as nurses. The full privileges which other students get when attending university could be extended to nurses, and that would give them some slight benefit.

Travel allowances and travel warrants should also be considered for all those in the nursing profession and in the paramedical services. These girls and men have only limited time in which to get away to their homes. Time is precious to them and often they cannot afford the money needed to travel, and so they stay in the hospitals when they could be at home with their parents having a well-deserved break.

Reference has been made to meals. It is my contention, supported by many people in the nursing profession, that we should abolish payment for meals. In every hospital I know of where nurses have to pay for meals it is found that they do not buy them, because they have run out of money. They should have the money. It seems absurd that a shorthand-typist can collect luncheon vouchers while a nurse must pay for her meals. I hope that the terms of the inquiry will permit this problem to be examined.

9.26 p.m.

Mr. David Crouch (Canterbury)

I must declare an interest in that I am a director of a pharmaceutical company. I also have another interest in this matter in as much as I am a member of the South-East Thames Regional Hospital Authority. It is not just an interest, it is a responsibility.

As the publication of the South Ockendon report showed the other day, when things go wrong in the health service it is proper that ultimately the House and the Government should point their finger at those who have failed in their duty. Things are going wrong in the health service. It is the biggest employer of manpower in Britain. It has 850,000 employees of whom 310,000 are nurses. In my own locality there are about 35,000 nurses.

Time is not on our side. I welcome the right hon. Lady's immediate establishment of the Halsbury Committee, which I hope will report to the House quickly. The House, people outside, patients, even auxiliary hospital workers, want to know why hospital cleaners are sometimes paid more than the nurses looking after patients with the sophisticated type of nursing required, for example, in intensive care. I have recently had the opportunity to study this in hospitals. I do not see my job primarily as an administrator of the hospital service. I believe that I should be trying to find out what is going on and what are the problems. I was shocked to hear last week that some nurses are driven to "moonlighting", to taking on extra work outside their normal nursing duties as waitresses and even barmaids to earn money.

The sort of pay given in the Health Service is a disgrace. It is remarkable that in The Times today there are advertisements for secretaries offering salaries ranging from £2,100 a year to £2,500 plus a car, age immaterial. One, which has been placed by three young doctors in an "easy-going practice" seeks a secretary at £1,850 a year. This is more than is paid to a senior ward sister on night duty. It is intolerable. Let us consider the pay under the Whitley scales of a senior nursing officer. For those who do not recognise the new term, that is a matron. Such a person in charge of a hospital of 300 to 400 beds is getting less than some of those secretaries because her pay scale as from 1st April this year starts at £2,460 rising to £2,949.

We all have a responsibility. I have never had a great deal of time either in my heart or my head for the Pay Board. I hope that the right hon. Lady will not feel that the Secretary of State for Employment is standing in her way and that the Pay Board is the structure which must decide for us what people in the service of the sick should be paid. It is not the Pay Board which must make these complicated decisions, not the civil servants, not those bewildered out-of-touch staff officers; it is hon. Members. I hope that when the right hon. Lady gets the report, she will quickly come to the House and say what she is determined to do on behalf of these underpaid people.

Mr. Deputy Speaker

Before I call the Opposition spokesman, I should like to express my gratitude for the very brief speeches and the way in which hon. Members have co-operated.

9.30 p.m.

Mr. Timothy Raison (Aylesbury)

I too must declare an interest, a new kind of interest which I might describe as a once and future interest, in that I have been in the past and may be in the future a director of the Provident Association for Medical Care.

There is no need to emphasise that the sympathy of the House for the nurses and other professions which we have been considering in the debate has come through strongly. That in itself means that the debate has had some value. Perhaps I could also not unreasonably claim that the debate has had a particular value in that it has jollied along the Secretary of State to declare a few days earlier than would otherwise have been the case her intention to set up an inquiry. I can, therefore, at least claim a few days' extra pay for the nurses.

What has come through is the fact that people are aware that we have to face not only the problem of pay but also—as the excellent report of the Royal College of Nursing brought out—the sheer hard work that has to be done and, as my hon. Friend the Member for Lancaster (Mrs. Kellett-Bowman) made so clear, the under-staffing. It is right that these facts should have come through so forcefully in the debate.

The Opposition wholly welcome the inquiry which the Secretary of State has announced. It is absolutely right that this step should be taken, and we are glad that the inquiry will cover conditions of service as well as pay. We note that the implications of the inquiry will extend to other professions, although it will not directly cover them.

Lord Halsbury has a considerable problem. Reasonably, there is a desire, on the one hand, for great speed on his part and, on the other hand, that he should be thorough and cover a wide variety of aspects. We wish him every possible success and look forward to receiving the report soon.

I strongly support the Secretary of State in one other comment she made. I sincerely hope, in the light of today's announcement, that COHSE and other unions will call off any industrial action that they have been contemplating. There is every justification for their doing so. I still adhere to the old-fashioned view that it is sad when the professions turn to industrial action. We fully support the Secretary of State in her plea to COHSE.

Now that the Secretary of State has arrived, I must refute what she said about the Conservative approach to incomes policy. She was extremely unfair about the relativities procedure, which was specifically designed to introduce a measure of flexibility and which would have been an indispensable tool if and when we moved on from a statutory or compulsory policy to a voluntary policy. There was no doubt that the nurses were one of the categories most likely to be referred to the relativities procedure, and the Secretary of State was a little unfair in what she said. She may find the transition to a voluntary policy a little more difficult than she suggested. I remind her of the words of her right hon. Friend the Member for Grimsby (Mr. Crosland) in his recent book, "Socialism Now": It is the purest wishful thinking to suppose that … Government can adopt a dirigiste attitude to the control of prices, but a laissez-faire attitude to the determination of incomes. We rather resent the Secretary of State's attitude towards being questioned about her announcement. There are moments when she seems like a lady bountiful who dislikes anyone intruding into her private estate.

I particularly wish to speak on the important matter raised by the hon. Member for Fife, Central (Mr. Hamilton) who seems, no doubt temporarily, to have deserted the Chamber. As my right hon. and learned Friend the Member for Hertfordshire, East (Sir D. Walker-Smith) reminded us, the question how to find enough to pay for the health service professions and also for the unskilled or less skilled occupations has bedevilled us for many years. It is a profoundly difficult problem. This problem may become more rather than less acute as the years go by.

The so-called caring professions rightly do not in these modern days accept that their reward should largely have to be a matter of job satisfaction or vocational feeling. They rightly feel, particularly in a time of acute inflation, that they should be paid a proper and fair salary or wage. Nevertheless, the problem of overall resources unquestionably grows harder, not easier.

The Under-Secretary of State for Health in a parliamentary reply only a few days ago said that pay now accounts for about 49 per cent, of National Health Service expenditure. The Government have said that it is their policy to tip the balance more in the direction of helping staff rather than in other directions. They have said—and I do not think they are necessarily wrong—that their priority is to see that the staff comes first.

We do not grumble about that view, but we are right to ask the Under-Secretary the question, which was so well put to him by the hon. Member for Fife, Central—namely, what are the likely implications of whatever the Halsbury Report produces on the rest of the National Health Service? This is a question of tremendous importance and the Cabinet and the Secretary of State for Social Services must have carefully considered it in coming to the decision which has been announced today.

Perhaps the Under-Secretary of State in his reply could lift the veil on the situation. If we look at the various other commitments in the National Health Service we observe that there is every prospect that vast sums of money will have to be made available for other needs as well. The Government have a commitment to abolish prescription charges, although I hope that at this time that commitment will be put on one side. It would be an indefensible action at a time of acute financial shortage.

We must also bear in mind the important commitment or undertaking made by the right hon. Lady the Secretary of State in the light of the South Ockendon Report. This was referred to by the hon. Member for Rother Valley (Mr. Hardy) who said that there was the most appalling overcrowding in that hospital. The Secretary of State reacted to that view recently by saying at a Press conference

Somewhere, God knows how, we must find the resources. Other things will have to take second place. She made it quite clear, as she did in the House today, that she regards it as vital that we should find the resources needed to prevent anything remotely resembling what happened at South Ockendon. That is another important charge on the National Health Service.

Then there is the commitment— admittedly a much smaller one—to a totally free family planning service. In the longer term there is the problem—which is perhaps as difficult as any in the National Health Service—involved in the change in the structure of our population. The proportion of population in the older groups has been getting steadily larger and will continue to do so. At the same time at certain moments we have sharp increases at the younger end of the scale. These are matters on which we should have as clear an idea as possible whether we shall cope with them.

Perhaps the Under-Secretary of State will be able to say whether the Secretary of State's announcement made today means that there will have to be a further clamp down on capital spending. The hon. Member for Fife, Central mentioned this topic and asked why the Labour Government had not rejected the cuts which the Conservative Administration made last December. He is right to say that the Labour Government have not taken that course and, if anything, the signs are that pressures in this respect will be intensified. Nobody welcomes the cuts, but they have been accepted by the Government. Therefore, it is as well to ask what the prospects for capital spending will be. In other words, will the extra money that is to be made available to the nurses have further adverse effects on capital spending in the hospital sector and also in the local authority sphere?

There are many very grave needs to be met. I know from my constituency that our own Stoke Mandeville Hospital is desperately in need of the second phase of its rebuilding programme. Right across the country, people will ask what is to happen to these projects which are so important. We should like the Under-Secretary to say at least a word or two about whether the additional money which is coming for the nurses will come out of additional funds or out of the existing total which has been allocated to the National Health Service.

We welcome the announcement about the inquiry. I hope that the Under-Secretary will confirm that it will take in health visitors. One of the most interesting and perhaps the most thought-provoking quotations from the RCN document which the Halsbury Committee presumably will consider is where the document says: The health visitor, who must hold two statutory qualifications and may well hold more and whose training covers a minimum of 4½ years, receives a salary about £400 less than the qualified social worker and at the maximum about £100 less than the unqualified social worker. In other words, there are some very interesting questions to be asked in terms of comparisons between these caring professions and other professions which in their way are also caring—in this instance, social work.

I wish to say a brief word about doctors and dentists. This debate, in view of the right hon. Lady's announcement, not unnaturally has concentrated on nurses. But there are urgent problems to be faced concerning doctors and dentists, especially dentists, as one hon. Member reminded us.

The British Dental Association is extremely concerned about the present position of dentists. It argues that, during the period 1972–73, there was a substantial shortfall from the target earning of £5,050 which the review body had recommended. It says that the shortfall was £350 and that this is made worse by the fact that the fees for the 1973–74 period were based on a 5 per cent, increase on the fees for the previous year. But, as I have said, the fees received in the previous year fell below what the review body recommended. In other words, the dentists have been doubly hit.

In addition, the materials which dentists use have soared in cost because of the increase in the price of gold, and so on, and the increase in the cost of laboratory processing work. Clearly some dental work has now become thoroughly uneconomic. As a result, dentists are refusing to do it within the National Health Service. This is a matter which the House must recognise to be very important.

The doctors also have their problems. Reference has been made to the junior hospital doctors. At the same time, the consultants also feel that they have been left behind. In the medical profession, I am afraid that there is some risk of a general loss of confidence in the review body procedure and even some tendency to talk about going back to those direct negotiations which were so deplored a few years ago.

I do not blame the Secretary of State for any of this. I simply say that these are very important matters. If the Under-Secretary can say anything about them, even to the extent of saying when we can expect the findings of the review body to be published, the House will be grateful and it will add something else to this debate.

As hon. Members have said again and again, there is great concern about the other professions and about the technical staffs—the radiographers, physiotherapists, speech therapists and so on. I know from my own constituency, which is singularly rich in medical services and which has the famous hospital at Stoke Mandeville as well as a number of others, how deep these problems are and how difficult it is to get these groups of people. It is important that we should face these problems.

The specific point about these groups is that there seems to be a great deal of dissatisfaction with the slowness and clumsiness of the Whitley set-up. This point has been made by a number of para-medical professions. Again, it is not unreasonable to ask the Under-Secretary to tell us whether the Government have yet formed any views.

I believe that the debate has been worth while. We welcome the announcement by the Secretary of State. However, I hope that the hon. Gentleman will meet some of the important points that have been made in the debate.

9.45 p.m.

The Under-Secretary of State for Health (Dr. David Owen)

I think it is fair to say, perhaps with qualifications, that there has been a broad acceptance by the House of the statement made by my right hon. Friend the Secretary of State for Social Services and a welcome for the independent inquiry that she was able to announce today.

Many hon. Members have stressed the importance they attach to the fact that the inquiry should take in conditions of service as well as pay. Without exception, all hon. Members who have spoken in the debate have stressed the need for urgency and speed. When Lord Halsbury consented to chair the inquiry he made it clear to my right hon. Friend that he too attached considerable importance to speed.

There is a problem here. The inquiry must be thorough, but it has to cover many different aspects. Indeed, if all the matters that have been mentioned were to come within the terms of reference of the inquiry its length would be extended considerably. Of course there is a need for speed. That is accepted by the chairman, and we attach great importance to having such an experienced chairman with a comprehensive knowledge of the health service and a staff already in existence to help him. We think that this will give the speed that we accept as being necessary.

The hon. Member for Hazel Grove (Dr. Winstanley) referred to our obligation to employees. In the National Health Service the Government are the largest single employer in the country with over 800,000 employees. Many hon. Members, while emphasising the importance of nurses, particularly as their first priority, have rightly drawn attention to other sections of the National Health Service. We cannot look at any one section in isolation. They all work for the National Health Service.

Sadly there are many sections where pay has lagged behind compared with other professions and industries. Equally there has been a common acceptance throughout the debate that the highest priorities are the nurses and the professions supplementary to medicine.

Since taking office my right hon. Friend has consistently stressed that we attach great importance to people. We really believe that, inasmuch as we have to choose between priorities, the priority for the National Health Service is people before buildings. The hon. Member for Aylesbury (Mr. Raison) must be careful not to argue this matter both ways. We all want more resources for the National Health Service, and no one will strive harder for those resources than my right hon. Friend, but there comes a time when we must choose, and we have to recognise what has happened historically.

I would point out to hon. Members on both sides who will press for greater capital allocations, new district general hospitals and health centres that in most cases increased capital allocation brings in its train increased revenue applications. This is a fact of life with which we have to work.

The hon. Member for Dorset, West (Mr. Spicer) made an impassioned speech about free meals. I think he should speak to many more nurses. It was the wish of the profession than they should give up free meals. The nurses do not want charity. They want to be treated as normal people with proper salaries and to make their own choice. I believe that they would consider free meals to be a retrograde step.

The hon. Member for Canterbury (Mr. Crouch) speaks with the experience of being a member of a regional health authority. He understands the difficulties. He raised the problem, as many other hon. Members did, of comparing salaries earned by women between the ages of 20 and 30. There have been frequent references during the debate to how much a secretary can expect to earn compared with the amount paid to a senior ward sister on night duty.

My hon. Friend the Member for Fife, Central (Mr. Hamilton) asked how much the stage 3 settlement was worth. The answer is that it is worth £56 million a year or £4.6 million a month. We do not know how much money nurses will get in back pay because they have not been paid in May. There are different amounts for different grades, but a staff nurse will get an increase of £12.25 a month gross.

My hon. Friend also asked about the total cost of the settlement. I think he is in danger of asking for it both ways. My right hon. Friend gave a pledge that the Government would not seek to fetter the negotiations and the inquiry, and we could not possibly come to the House and say that the inquiry was to take place and that we could put a figure of cost on it before it had even reported.

The hon. Member for Ipswich (Mr. Money) raised a problem about nurses in his constituency. I assure him that they will be treated in the same way as others and that we shall make a payment on account for the month they have been held up by the negotiations.

My hon. Friend the Member for Rother Valley (Mr. Hardy) mentioned among other things the problem of medical technicians. This is an immediate problem affecting 3,000 medical, physics and physiological measurement technicians whose work has been looked at by the Whitley Council in accordance with the January 1972 award of the Industrial Arbitration Board. This has caused some problems. Both sides have discussed the difficulties and neither side intends breaching any of the stage 3 Pay Code provisions. I am advising them that I see no reason why they should not continue their discussions on the recommendations of the Industrial Arbitration Board, and I hope that the difficulty can be resolved.

A number of hon. Members raised the question of the Briggs Report. The hon. Lady the Member for Lancaster (Mrs. Kellett-Bowman), in an extremely intemperate speech, said that the Government's recommendations on the Briggs Report had attempted to divide the profession. I should like to quote what the Royal College of Nursing said in the memorandum that has gone to hon. Members: the profession as a whole, and the membership of the RCN in particular, has been disappointed, disillusioned, and has become progressively frustrated and exasperated at the inexcusable delay of the Government in stating its policy on the findings of the Committee on Nursing. The College conveyed its feelings in a telegram to us. If we had accepted the implications of the Briggs Report without providing any money for its implementation, how cynical that would have been. How often have Governments in the past willed the end and not been prepared to provide the means?

Mrs. Kellett-Bowman rose—

Dr. Owen

No, I am not giving way. The hon. Lady came into the debate and left the Chamber as soon as she had finished speaking.

My hon. Friend the Member for Wolverhampton, North-East (Mrs. Short) raised many issues. She and the hon. Member for Aylesbury raised the question of dentists. Recently my right hon. Friend and I listened with considerable sympathy when representatives of the dental profession came to see us about the economic difficulties facing practitioners who provide dental treatment under the National Health Service arrangements. We share their anxiety to preserve an effective general dental service and will consider many of the useful suggestions which have been made to us.

There is, however, one urgent issue which clearly needs to be dealt with. The established machinery for implementing recommended increases in the average net incomes and practice expenses of general dental practitioners is very slow. We have therefore arranged, both as a gesture of our good faith and in a genuine attempt to alleviate to some extent the immediate pressure under which dental practitioners are providing their services, that fees scheduled by the Dental Estimates Board from 1st April will be increased by 6 per cent. This will represent a payment on account roughly equivalent to an increase of 10 per cent. in practice payments. The first payment in respect of April, May and June will be made next month and subsequent payments will be made monthly until a revised scale of fees is introduced. We attach great importance to the problems of dentists at the moment and we hope that we will be able to meet many of their difficulties.

The hon. Member also asked me about the Doctors and Dentists Review Body's report. The Government have received this report and it will be urgently considered. We should like to publish it as soon as possible, but there are printing difficulties, apart from the problem of servicing it—

Mrs. Kellett-Bowman

On a point of order, Mr. Speaker. Since the Minister has described me as intemperate, will he accept that I was quoting from the report of the Royal College of Nursing, which said—

Mr. Speaker


Mrs. Kellett-Bowman

—that the Royal College was immediately apprehensive that such a limited "—

Mr. Speaker


Mrs. Kellett-Bowman

measure would aggravate the unrest and discontent in the profession."?

Mr. Speaker

Order. That is not a point of order.

Dr. Owen

The House—

Rear-Admiral Morgan-Giles (Winchester)

Further to that point of order. Is it not a convention of the House that when a Minister attacks an hon. Member he normally, as a matter of courtesy, gives way to that hon. Member?

Mr. Speaker

It may be a matter of courtesy or not, but it is not a point of order.

Dr. Owen

The hon. and gallant Member for Winchester (Rear-Admiral Morgan-Giles), who has just come into the Chamber, knows that in a very short debate it would always help if an hon. Member who has made points which might be challenged then stayed so that she could be answered immediately.

Mrs. Kellett-Bowman

I was away for only five minutes.

Dr. Owen

Many other points have been raised in this debate. My hon. Friend the Member for Loughborough (Mr. Cronin) mentioned a number of matters arising out of his own knowledge of the medical profession. He mentioned particularly the student nurses. My hon. Friend has apologised to me for the fact that he cannot stay. Several hon. Members have pressed upon me arguments for the payment of the adult rate at the age of 18, as well as the question of payment for weekends and shifts. These and many other issues will obviously be some of the most pressing aspects to be discussed by the committee when it begins its work. Indeed, many of these things can be started and processed now.

One of the responsibilities that we all have in as large a service as this is to face the necessity to choose. This is the problem that the House consistently faces. The spirit of this debate has been that the nurses deserve more money and that this House wishes to see greater resources paid to people who devote long and dedicated service to the National Health Service. I have no doubt that the quality of the service overall depends on the dedication of those who work in it. We can have any number of buildings or any number of new hospitals, but unless we have the people to staff them and the dedication to go with that staffing, whatever the buildings are, they will fail in their major purpose.

It is to create a new atmosphere in the National Health Service, in which pay can be negotiated as openly and as sensibly as possible, that we on this side are now dedicated. It will be a difficult task, and we ask hon. Members on both sides of the House who are interested in the welfare of the National Health Service to help us in that orderly movement away from a strict, rigid statutory policy towards a voluntary policy by agreement.

Mr. Ernest G. Perry (Battersea, South)

I beg to ask leave to withdraw the motion.

Motion, by leave, withdrawn.

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