HC Deb 12 December 1975 vol 902 cc828-39

11.22 a.m.

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

I will, with permission, make a statement on the junior hospital doctors' dispute.

I am glad to tell the House that, after protracted discussions with the Hospital Junior Staffs' Committee lasting until the early hours of this morning, an agreement has been reached with the juniors' representatives which they are commending to their members for urgent consideration. The agreement embodies acceptance of the offer which, as I told the House on Tuesday, I made to the BMA at the beginning of this week for an independent audit of the amount of money being paid on extra duty allowances during the current year, which is the money available for distribution under the new contract. It has been agreed that the audit shall cover the latest figures available, that is from 10th March to 5th October 1975, and that the results of the audit shall be sent to the Review Body to consider as further evidence on the pricing of the contract within the pay policy. Both sides have agreed to accept the results of the audit whatever they may be. The agreement makes clear that neither side at this stage knows whether any additional money will be available or what recommendations the Review Body may make.

The agreement also deals with a number of dissatisfactions the juniors have expressed about their current conditions of work and some aspects of the new contract. The Government have agreed to give joint evidence with them to the Review Body on the interpretation of the standard working week represented by basic salary. The agreement welcomes my offer of a joint examination of excessive hours worked by juniors, and HJSC representatives will be holding early discussions on this with their consultant colleagues in the joint negotiating committee. It has also been agreed that there shall be a joint approach to the Review Body to invite it to consider whether, within the limits of the Government's pay policy, and in the light of evidence of the independent audit, the, Class A and Class B payments it recommends for the new contract could commence after 40 hours and not 44 hours as previously recommended.

The agreement provides that when a doctor is requested to provide cover as on a locum basis outside his own job description in circumstances other than occasional emergencies and unforeseen circumstances, he will be engaged at the standard unit of medical time rate. It has also been agreed to set up new appeals machinery, on which the juniors will be represented, to monitor the working of the new contract.

My right hon. Friend the Secretary of State for Employment took part in the discussions. The juniors reiterated their desire to reach an agreement within the pay policy and my right hon. Friend and I are satisfied that this has been achieved. This agreement will be reported to the Review Body so that it may taken into account the relevant aspects of the new contract in its review of the pricing within the pay policy.

I am placing copies of the agreement in the Library of the House.

I naturally asked the juniors what would be the timing for industrial action. The juniors' representatives are now taking urgent steps to consult their members, commending the agreement to them and at my request have advanced the date of the meeting of their executive committee from Thursday to Tuesday next. My Department will be helping them to distribute copies of the agreement to junior doctors over the weekend. I am also grateful for the offer made by Dr. Zacharias, chairman of the negotiating sub-committee of the Hospital Junior Staffs' Committee, that, if I will let him know where the industrial action has been causing severe disruption to NHS services and leading to dangerous gaps in those services, he will do his best to secure an easing of the situation immediately pending the meeting of his executive committee next Tuesday. I shall be sending him this information as quickly as possible.

I am sure the whole House will share my pleasure that this agreement has been reached and my hope that it will lead to an enduring settlement.

Mr. Norman Fowler

Is the right hon. Lady aware that we very much welcome this development? Is she further aware that it is our hope that a new chapter may now open in relations between the junior doctors and Government, which can only be to the benefit of the National Health Service and patients? May I express the hope that the right hon. Lady will acknowledge—as the Prime Minister has already acknowledged—that the Opposition's attitude throughout the dispute has been consistently against industrial action? I endorse the call of Dr. Wardle, the junior doctors' leader, for this agreement to be accepted and normal work to resume as soon as possible.

I turn to the details of the agreement. May I ask the right hon. Lady about the independent audit? She will remember that 10 days ago we urged that there should be an independent examination of whether her figure of £ 12 million available for redistribution was out of date. The right hon. Lady will also remember that her reply was that her figures went up to only March 1975. Do I understand that the audit will now go up to October 1975? Does she also agree that the independent audit is likely to show that more than £ 12 million is available? Will the right hon. Lady emphasise that, if this is the case, it in no way breaches the counter-inflation policy?

Does the Secretary of State agree that it would be a profound mistake to believe that the current unrest in the medical profession is simply about pay and overtime? Does she recognise that there is deep concern about the future of the profession and that doctors throughout the country will be anxiously watching for the result of the Government's negotiations on the consultants' dispute, which is still outstanding? Can the right hon. Lady say what stage those negotiations have reached? Can she give us an assurance that a statement will be made in the House before Christmas?

Mrs. Castle

I shall try—after only three hours' sleep—to remember all of those questions. Perhaps if I leave one out the hon. Gentleman will remind me of it.

I am grateful to the hon. Member for his support this morning of the settlement and the hopes of peace. I recognise that the Opposition have been consistent in their opposition to industrial action. The whole House has made it clear that it does not support industrial action by the juniors. This pressure of public opinion has helped in creating a determination to overcome the differences dividing us.

When I last reported to the House, I was dealing with the latest information we then had. When we met the juniors yesterday, I was able to give them the figures up to the end of June. The juniors were able to study those figures, which show some rising trend. How significant that will prove to be for the period we have agreed—to 5th October—it is impossible to predict. The juniors accept that. We are taking all steps we can to speed up the arrival of the later figures. They are coming in dribs and drabs. In a few days we shall have to the end of August and a few days after that we shall have up to 5th October.

We are not yet aware how long the independent auditors, Price Waterhouse—whom we jointly selected—will need to examine the figures. The firm has told us that it is still considering its programme of work. It hopes to let us have the results before Christmas, but it cannot guarantee that. We should be put forward to January and the figures would then have to go to the Review Body. This is why that part of the agreement which says that both sides bind themselves to accept the findings of the auditors is important: it enables an earlier settlement to be made.

I have always made it clear that the money available for distribution under the new contract is that paid in the current year under extra duty allowances. If, by taking later months, we find that the money is increased, it would not be out-with the pay policy to distribute that extra money if the Review Body were satisfied that that increased amount was due to factors which it felt able to take into account additionally. This is a complicated matter and I would rather not go into it any further at this point.

The important thing is that the juniors' representatives agreed to accept the results of the audit. We have agreed that when the results of the audit are known, we shall meet again to examine what representations we might wish to make to the review body and whether it would be possible at that stage to give joint evidence, because the Review Body has made it clear that it will require the comments of both sides in helping it to interpret the figures. That is a matter for a further meeting.

The hon. Gentleman is right about the dispute having arisen not purely from the question of the £ 12 million. It goes deep into the discontents of the juniors. The hon. Gentleman and the House will see that the agreement is comprehensive. We spent 10 hours last night and four hours on Tuesday probing these detailed grievances and adjusting them wherever possible within the pay policy. I hope and believe that a new atmosphere has come out of this matter and that the juniors will in future feel that a new deal is opening up to them. Talks are still continuing on the consultants' dispute.

Mr. Freud

Does the Secretary of State accept that we are aware that she has been negotiating all night and that all hon. Members are grateful that she has come into the Chamber to make the statement herself?

We appreciate the new Class A and B payments after 40 hours and the new local rates. However, will the right hon. Lady confirm that there will now be meaningful negotiations to reduce the very long working hours of the junior doctors? Will she also confirm that it continues to be her aim to ensure that no doctors will be any worse off as a result of this settlement? Finally, what guarantees have we that this proposed settlement will be accepted by those doctors who took militant action in October?

Mrs. Castle

I am grateful to the hon. Gentleman for his courteous remarks. I know the anxiety felt by the whole House about the growing effects of the junior hospital doctors' dispute and therefore thought it right to report to the House as quickly as possible.

As I said in my statement, the long hours of work constitute a matter of importance. The junior doctors welcomed my earlier offer of a joint examination of the excessive hours worked by some of them. But they also appreciate that the reduction in their hours that we are all seeking can be achieved only by the full co-operation of the consultants. That is why the juniors suggested that the right way was for them to hold early discussions with their consultant colleagues on the joint negotiating committee. I can only hope that those discussions will be fruitful. We shall be only too anxious to follow them up.

I assure the hon. Gentleman that no junior hospital doctor will be worse off as a result of this agreement. Indeed, on the contrary.

Mr. William Hamilton

Does my right hon. Friend agree that the whole House and, indeed, the country now hope that the junior doctors will exercise a degree of statesmanship and get back to work as quickly as possible? Has any firm indication been given to her by the junior doctors to that effect?

On the crucial question of hours, which has been mentioned by the hon. Member for the Isle of Ely (Mr. Freud), may I ask how soon she expects some kind of announcement to be made?

Finally, as one who has not always seen eye to eye with her on these matters, may I say that we on this side of the House, at any rate, are profoundly angered by the degree of personal attack on her by the media in general and not least in the House only yesterday? We deeply deplore these attacks and hope that they will not occur again, the more so since she was trying in her own way to pursue Government policy.

Mrs. Castle

I am extremely grateful to my hon. Friend for those remarks. I agree that the amount of personalisation in this matter has probably been unprecedented. Churning up history, I find that I probably scored higher marks in that regard than Aneurin Bevan.

This has been a long and protracted business because it has been essential not to breach the pay policy. The one hopeful point, as I kept telling the House, was that the juniors said that they did not wish to breach the pay policy. Therefore, it was a question of convincing them of what could and could not be done within the restraints of the pay policy.

I share my hon. Friend's anxiety about reducing the excessive hours of work. However, I must await the outcome of the talks between the juniors and the consultants on their joint negotiating committee. Some matters need to be sorted out between them on that question.

Regarding industrial action, the juniors' representatives put it to me that it was essential for them to consult their rank and file to get acceptance of the agreement. I accept that they could not impose it on them. That is one of their democratic obligations. However, I am grateful to them for speeding up the meeting of their executive council.

Above all, I am grateful to Dr. Zacharias for his offer that, if I would inform him of areas where serious gaps were now developing in the National Health Service, gaps which have caused such concern to the House in the past few weeks, he would try to advance the meeting to discuss ways of trying to close those gaps. If hon. Members have any information of that kind which they wish me to put to Dr. Zacharias, I should be glad to do so.

Mr. Adley

It the right hon. Lady aware that my act of conciliation this morning has been to withhold the presentation of a petition of a number of medical people in the area which I represent calling for her dismissal as Secretary of State? Notwithstanding what the hon. Member for Fife, Central (Mr. Hamilton) said, many people, including the medical profession, feel that her attitude in the past six months has caused a great deal of unrest. I do not wish to disturb the calm of the House this morning, but the right hon. Lady should be aware of this situation. Let me ask—

Mr. Deputy Speaker (Mr. George Thomas)

Order. This is an opportunity for seeking information and many hon. Members wish to put questions.

Mr. Adley

Finally, will the right hon. Lady re-read the Labour Party manifesto on conciliation as opposed to confrontation?

Mrs. Castle

It is the difficult job of conciliation on which I have been engaged for many weeks, and on which I am still engaged in another direction.

Mr. Skinner

Is my right hon. Friend aware that we on this side of the House, at any rate, note the significance of the absence of the hon. Member for Uxbridge (Mr. Shersby) who, having had other things to say, might well have graced us with his presence on this occasion?

Does my right hon. Friend accept that some of us, who voted against the Government's statutory non-statutory incomes policy so-called, are somewhat bemused as to how much money has been expended in excess of the amount which would have been expended under the previous policy? We do not accept words or phrases such as "later months" and "complications". Does my right hon. Friend acknowledge that, although the Tory and Liberal Parties and many others in the House might want to sustain this non-statutory or statutory incomes policy, she has a duty to tell the country, not after Lord Goodman has dealt with the matter, but quite soon, precisely how much money has been paid in excess of the amount which would have been paid in order that observant groups of workers who have been collectively fenced in by the policy may know what their future action should be?

Mrs. Castle

Lord Goodman has had nothing to do with these negotiations. The matter has been thrashed out between us and the juniors' representatives, with the help of my right hon. Friend the Secretary of State for Employment on a couple of occasions.

I think that what my hon. Friend has just said shows how important it was, even at the risk of some delay in reaching an agreement, to be sure that we were able to justify it within the pay policy, because, as my hon. Friend said, many other workers are watching to find out what juniors get that they themselves have not received.

I can tell my hon. Friend that it is extremely simple. As the juniors last April received increases of between £13 and £30, under the £6 pay limit no extra money could be made available for the introduction of the new contracts. As I have explained again this morning, the agreement had to be launched on the basis of the amount of money being paid in extra duty allowances in the current year, and the figures are changing from month to month.

As to the exact extra amount that will have to be paid that otherwise would not have to be paid, as my original reply makes clear, this is something that must await the outcome of the independent audit and of the Review Body's consideration of that audit.

Mr. McCrindle

I welcome the calmer atmosphere in which we are discussing this matter in contrast with what happened yesterday, which some of us felt did not do the House of Commons a great deal of good. May I, nevertheless, express to the right hon. Lady the genuine and continuing concern of some of us about the gaps that appear to be developing in the emergency services? Is the right hon. Lady reasonably satisfied that the offer by Dr. Zacharias is likely over the coming weekend, which one fervently hopes will be the last weekend during which doctors will be carrying out their industrial action, to prevent any major gaps in the emergency service?

Mrs. Castle

I am sure of one thing, and that is that Dr. Zacharias made that offer in good faith and that he will try, in so far as he can, to influence the situation to close any serious gaps.

As a matter of great urgency my Department is this morning taking further steps to try to establish where the serious black spots are, and I am keeping in touch with the BMA about them. I repeat that if any hon. Member is concerned about any particular situation and lets my Department know, the information will be passed through the BMA to Dr. Zacharias.

Miss Richardson

I am sure that we all congratulate the Secretary of State on her tireless efforts in this matter. Does she agree that many other groups of workers go back to work right away pending consultation with their members, and does my right hon. Friend further agree that the doctors might do the same thing instead of leaving it till the middle of next week before resuming normal work?

Mrs. Castle

Naturally, nothing would give me greater pleasure than to feel that all industrial action had been dropped as from now, but I must accept the judgment of the juniors' representatives as to what is the best way to get over the industrial action as quickly as possible, and I believe that that is what they are trying to do.

Mr. Lawson

May I congratulate the right hon. Lady on having at long last achieved a reconciliation between practitioners of the physical science of medicine and the metaphysics of the Government's pay policy? Is she aware that, following what was said by the hon. Member for Bolsover (Mr. Skinner), this shows that it is less than wholly clear precisely what is within the pay policy and what is not? Will she, therefore, ask her right hon. Friend the Secretary of State for Employment to make a statement setting out the matter in total clarity so that we all understand it?

Mrs. Castle

I think that that is really not necessary. It is true that it has taken some time to convince the junior doctors' representatives how the pay policy applies to them, but I must repeat that from the beginning they and the BMA itself have reiterated that they did not want to breach the pay policy, because, contrary to the view of some of my hon. Friends, they believe that it is a bulwark against inflation and that it is inflation that has constituted the biggest threat to the National Health Service. The juniors' representatives have identified with the Government in the end.

Having been Secretary of State for Employment in the past, I have had to operate pay policies and I know that it is an infinitely complex and difficult matter. We have spent hours trying to spell out that we have treated the juniors in the same way as everybody else. Secondly, we have said that if we were to try to settle the dispute by rustling up, as if by magic, some extra money that was not due to them, that would give rise to widespread repercussions elsewhere. The governing criterion of this agreement is that the relevant parts of the new contract must be priced by the Review Body within the pay policy.

Mr. Raphael Tuck

Is my right hon. Friend aware that we are all grateful to her for the tremendous effort that she has put into this and that we congratulate her on the resulting settlement that she has been able to reach? May I earnestly ask her to use all the wisdom, diplomacy and tact at her disposal when she comes to consider the burning issue of pay beds, because she may find that she has the vast majority of the medical profession against her, which may result in an exodus from this country, which would be disastrous?

Mrs. Castle

I am grateful to my hon. Friend for what he has said. I can only say that he had better await the outcome of the discussions.

Mr. Spriggs

I should like to ask my right hon. Friend whether, when discussing the final outcome of the talks between her Department and the junior doctors' representatives, the standby hours will cover the effect upon the health not only of junior doctors but of National Health Service patients in accident and in-patient departments? It seems that the junior doctors' case has been well debated, but that very few right hon. and hon. Members have dealt with the problem of the patients. Something should be said about in-patients in our hospitals who depend on the service and treatment that they obtain from junior doctors.

On the question of the consultants' pay bed issue, may I remind my right hon. Friend that this—

Mr. Deputy Speaker

Order. This is not the time for remembrance.

Mr. Spriggs

I assure you, Mr. Deputy Speaker, that I am not asking for memories or remembrance. This issue has been placed before the nation on two occasions.

Mr. Deputy Speaker

The hon. Member has an opportunity to put his question to the Minister, and it would be fairer to his hon. Friend the Member for Darlington (Mr. Fletcher), who is waiting to put his motion before the House, if he were to do so.

Mr. Spriggs

I conclude by asking my right hon. Friend whether she will arrange to place at the disposal of hon. Members the answer to a question that is before the European Economic Community about junior doctors who have been crossing over to Europe and earning as much as £500 a weekend for service in Europe. Will she please make the answer to that question available to the House?

Mrs. Castle

I agree with my hon. Friend that those whom we should have first in our minds are the patients, who are the whole object of the activities of the National Health Service. It has been the risk to patients that has concerned us all increasingly during the past few weeks. That is why I am so thankful that this agreement was reached. It was for that reason that my right hon. Friend the Secretary of State for Employment, my hon. Friend the Minister of State and I were determined to stay at the meeting not only until 3.30 a.m., but until any time that was necessary to get an agreement.

I shall have to look into the point about the EEC.