§ The Secretary of State for Social Services (Mrs. Barbara Castle)
With your permission, Mr. Speaker, I wish to make a statement on the situation as regards the medical profession in the National Health Service.
This is an argument about pay, and, for hospital doctors, about contracts.
The general medical practitioners met me on 8th January. They expressed their serious concern that the pay of general practitioners was shown by the recent Review Body report to have fallen behind that of comparable income groups. I agreed with them that it was essential to avoid delay in securing from the Review Body recommendations, to take effect from 1st April 1975, covering the whole profession, and the dental profession. The Government evidence will be submitted this week. I gave them assurances about the Government's attitude to the report when it is received. I have put in the Library of the House a copy of the joint statement issued after the meeting. I am sure that the decision of the general practitioners not to take industrial action but to wait for the report from the Review Body was wise and in the best interests of the National Health Service.
The assurances which I gave to the general practitioners apply to the medical and dental professions as a whole. Also on 8th January I met the junior doctors' representatives. I agreed with them that the essential thing was to complete our evidence for the Review Body for the pricing of their existing contract as at 1st April 1975. I am also glad to be able to tell the House that I reached agreement with them that a new personal contract would be issued to each junior doctor during this summer, to take effect from 1st October 1975.
Both sides intend to submit evidence on the pricing of the new junior doctors' contract before 1st April with a view to enabling the Review Body to take account of the new contract in its April 1975 report. Again, I have put in the Library of the House the joint statement issued after the meeting.
Finally, I come to the consultants. The initiative for a new contract came from 34 them and it has never been the aim of the Government to impose any new contract on them. Nor have I sought to use the negotiations to impose a full-time salaried service. The option of all consultants to remain on the present contract has always been open. None the less, progress had been made in a working party chaired by my hon. Friend the hon. Member for Plymouth, Devonport (Dr. Owen). When, shortly before Christmas, we were faced with threats of industrial action unless we immediately announced the Government's firm decisions on the contract proposals. I met the profession and presented proposals to them. I have placed copies in the Library of the House of the profession's letters and the Government's response.
I believe these proposals to be a reasonable offer which meets the consultants' wish to have a closed contract which is work-load sensitive and which is of value to the National Health Service. I invited the negotiators to study it carefully and to meet me for further discussions, and I regret that this offer was refused. I made it clear that certain principles were not negotiable but that there were areas where principles and detail were difficult to distinguish and that I should be happy to discuss these. The leaders made it clear to me that they were not prepare to drop their demand that the existing differential between the consultant who works only for the NHS and the consultant who engages in private practice should be abolished. This was not prepared to do. Nor are the Government prepared to accept a system of payment based on items of service.
There are, however, many details of the Government's proposals which remain to be discussed and clarified, not least the details of the new standard contract and the proposed working hours. The proposals for career structure supplements also proved to be controversial. These proposals are designed to bring more remuneration to hard-worked consultants, often in under-doctored areas and in less popular specialties. They are important for the balanced development of the NHS, and it should be possible to negotiate criteria and methods of payments for these supplements which are right for the health service and fair to consultants.
35 The Government recognise that it is difficult for the profession as a whole finally to accept or reject any new contract until they see it actually priced by the Review Body. The consultants, together with the junior doctors and the GPs, are in any case due for a review of their pay in April of this year and the Government would not wish to delay this. I understand that the Review Body is proceeding to do this on the basis of the consultants' existing contract, but, if the profession so desired, the Government would be willing exceptionally to ask the Review Body also to price a new contract before there had been a final commitment by the profession to accept it. It is normal to negotiate modifications to contracts in the existing Joint Negotiating Committee. I should be happy for such negotiations to take place at once in this forum, with the professions' representation modified as they may wish.
In the meantime I regret to inform the House that the industrial action by consultants, though uneven, is damaging the interests of patients in some parts of the country, and I am sure the whole House will deplore such action, which contributes nothing to the solution of this dispute.
§ Sir G. Howe
I join the right hon. Lady in regretting the consequences of industrial action that is now being taken within the National Health Service. More important, I welcome the statement that she has made today. Does she recognise that she has made an unhappy contribution to the development of the dispute by her intransigence at many stages of the negotiations? Does she recognise the extent to which the House welcomes the difference between the statement that she made on 20th December, to the effect that the new contract had to be taken as a whole, and the statement that she has made today that indicates that much wider areas of the contract are now open for negotiation? That is a matter that will be widely welcomed.
Does the right hon. Lady recognise the extent to which it is welcomed that she is now prepared to consider further negotiations on the basis upon which the service supplement should be paid and about the differential between full-time and part-time practice? Will she give the House the assurance that she will 36 now deplore, in terms as strong as those which she has just used, industrial action being taken by other unions within the service which has already secured the closure of private beds in the Westminster and Moorfield Hospitals? A great deal of importance must be attached to that. Have we the assurance that the right hon. Lady will ensure that the negotiations are undertaken not with the primary purpose of advancing the dogma of her party but for the primary purpose of advancing the interests of patients?
§ Mrs. Castle
I noted with interest that the right hon. and learned Member for Surrey, East (Sir G. Howe) was extremely careful not himself to deplore the industrial action of the consultants. He carefully chose his words merely to deplore the consequences. I suggest that he sets the House an example by having an equality of condemnation for industrial action in any form. He knows that he has tried selectively to condemn industrial action or pressure by certain unions in this dispute.
I also recognise that since the dispute started the right hon. and learned Gentleman has tried to make a settlement more difficult by apportioning blame unilaterally, by totally failing to try to understand the contract and never by one word urging the consultants to discuss the details as I begged them to do on 20th December.
There is no change between the tone of my statement and what I said to the consultants on 20th December. It is true that the contract must be taken as a whole. If there is to be a closed contract certain consequences must flow from that. The consultants are asking that they should have a clearly defined basic commitment and that every extra session above that should be paid for separately. Clearly, in those circumstances there must be a definition of the basic commitment, otherwise we would not know the terms of the extra work for which we would be paying.
As I have said in my statement, there is an area of detail—I put this to the consultants on 20th December—that should be studied and clarified. I begged the consultants on 20th December not to commit themselves either way on the proposals that we put before them—we did so necessarily at short notice because we were under an ultimatum from them— 37 but to take them away, study them and meet me again after Christmas. I am very sorry that they were not willing to do that. I have made it clear—I do not know whether the right hon. and learned Gentleman has appreciated this—that certain points of principle are not negotiable. I repeat that included in those points is the maintenance of the existing differential of reward between those who work in private practice and those who are totally and exclusively committed to the NHS.
§ Mr. Cronin
Obviously the consultants are behaving in a somewhat bloody-minded manner. However, does my right hon. Friend agree that some of them are rather underpaid? Is she aware, for example, that at present a consultant surgeon in the NHS receives about £10 for spending the whole of the morning or afternoon performing major operations? Will she bear in mind that they need some financial assistance? Furthermore, will she consider using the good offices of the Presidents of the Royal Colleges to try to settle the dispute?
§ Mrs. Castle
I accept the point that my hon. Friend the Member for Loughborough (Mr. Cronin) has made. That is why the consultants are in any case due to have their remuneration reviewed in April. I have no doubt they will make a strong case to the Review Body. It is recognised that they have fallen behind to a certain extent. Therefore, that is not really the issue. The issue is not whether they should, like everyone else, have their pay reviewed at the appropriate time but whether it should be reviewed on the old contract or on the basis of a new one, which is in itself designed to give remuneration for certain work which the consultants carry out for which they are not now paid.
§ Mr. Hal Miller
Will the right hon. Lady for once manage to restrain the warmth of her emotion and gift for polemics'? Cannot we try to deal with the issue of the consultants and private practice in a logical manner? Will she make a start by recognising that the profession still has a lot to do to put its house in order—for example, consultants who are appointed early to a post and then keep it for 30 years?
Furthermore, will the right hon. Lady recognise the valuable experience that is 38 brought into NHS hospitals by private practice—particularly that of foreigners and the many consultants who use NHS hospitals as colleges? These people build up world-wide reputations as clinicians and provide experience for health service staff at all levels that would otherwise be lost to this country.
§ Mrs. Castle
The dispute over the new contract to which I have just been referring is nothing in itself to do with the pay beds issue. The hon. Gentleman must know that it is the Labour Party's policy, stated in two election manifestos, to phase pay beds out of our National Health Service hospitals. We stand by that, and so I cannot agree with the point put by the hon. Gentleman.
Dr. M. S. Miller
My right hon. Friend and the Government are to be commended and not pilloried for the contract which has been placed before the consultants, in that many of us on this side of the House applaud those surgeons and other consultants who are full time in the NHS. Should not the consultants in England and Wales take a leaf out of the book of the consultants in Scotland, 80 per cent. of whom operate whole time in the NHS?
Leaving aside the question of the contract itself, would my right hon. Friend care to give the House an approximate figure of the total amount of extra money which would be going to the consultants, in the light of the fact that the new contract would pay them for overtime for which they have not been paid before and are not being paid at the moment?
General practitioners have been mentioned. I am sure that the Government will accept the deliberations of the Review Body. Will my right hon. Friend indicate how many recommendations of the Review Body have been accepted by the Government—for example, what percentage increases have been paid to the general practitioners in the last three years?
§ Mrs. Castle
I am glad that my hon. Friend the Member for East Kilbride (Dr. Miller) welcomes the new contract. Although not supported in every detail, it has received substantial and considerable welcome in some remarkable quarters. In the columns of The Times, The Guardian and the Economist, to name 39 only a few, there has been a recognition that the basic principles of the contract are designed to help hard-worked and underpaid consultants and to get a more balanced development in the National Health Service.
Like my hon. Friend, I pay tribute to those who work full time in the NHS. Over the country as a whole, 45 per cent. of the consultants are whole time in the NHS. I say advisedly to the House that I am not prepared to penalise the whole-timer by removing from him the differential he at present enjoys because he is totally and exclusively committed to the NHS.
My hon. Friend also referred to the question of putting a figure on the contract. He will appreciate that it is not for the Government to put a figure on any contract or claim. That is a matter for the Review Body, an independent body, on which that responsibility has been placed.
I accept that one of our difficulties is that always when one produces a contract it looks bare and cold in its details. What the consultants need to know is what the contract will mean to them in terms of remuneration. That is why I have said that the Government are willing, exceptionally, to ask the Review Body to price the new contract, even if it has not been wholly accepted by the profession and in advance of acceptance. The Review Body does not usually like to do this, but in the circumstances, in order to help the consultants, the Government are prepared to ask it to do so.
§ Mr. Pardoe
Is the right hon. Lady aware that the Liberal Party supports her aim to phase out private beds in the National Health Service hospitals and to separate private treatment from NHS treatment?
During the recess the right hon. Lady said that the consultants were using industrial action to blackmail the Government. What did she mean? Was it not always so? Is not all industrial action taken to blackmail the Government? Will she now, as I do, condemn the attempts of staff within the NHS to blackmail the Government and Parliament into phasing out pay beds quicker than perhaps the right hon. Lady thinks possible?
§ Mrs. Castle
I have said all along to the unions in this matter that they should leave it to Government and Parliament to settle. Unlike the right hon. and learned Member for Surrey, East (Sir G. Howe), I have said it unequivocally. When I said that the doctors were trying to blackmail the Government, I had in mind the fact that we were pressurised into producing our proposals very quickly, not only by threats of industrial action but by action itself on the part of the consultants.
In my constituency I received a telegram from consultants locally saying, even before they had seen the contract, that they were starting industrial action on 17th December because of the Government's delay in producing their proposals. We were told by the BMA in its letter of 13th December that it would not tolerate any further proscrastination. It agreed to meet us on 20th December only on the understanding—all this can be seen from the correspondence that I have placed in the Library—that… you will make a full statement of the Government's position, on the nature of which, of course, the members of the Staff Side will make their decision as to the future.The Government hurried to do that and I call it blackmail when the BMA, having exercised this kind of pressure to produce fresh proposals quickly, instead of taking back our proposals to discuss them with its membership, told us that the doctors were going to take action because of the Government's intransigence. I call that blackmail.
§ Mr. Atkinson
Is my right hon. Friend aware that, unlike the case of the BMA, the comments coming from consultants meeting throughout the country seem to suggest that they are not obsessed with the pay bed question, and that what they are looking forward to is a decent, well-paid contract at the end of the day? Therefore, does she accept that she has earned the praise of the profession in her attempt to get the right balance between acceptance of the contract, after the pricing has been arranged, and discussion of the relationship of consultants in the pay beds issue? That is an important change.
Finally, will my right hon. Friend accept that if the Review Body's recommendations at the end of the day are extremely generous to the services put in by the consultants, trade unionists will not use that 41 as a precedent, in the same way as they also will not use as a precedent a generous award being made to the miners?
§ Mrs. Castle
I am grateful to my hon. Friend for what he has said. He is right in saying that we have managed to separate the issue of the new contract from the issue of the pay beds. Indeed, the BMA itself has made it clear, and Dr. Brian-Lewis, in his many television appearances, has made it clear, that the pay beds issue is separate from this argument. I think that there is considerable misunderstanding among the consultants throughout the country as to the exact implications of what we are proposing, which makes it all the more sensible that the details should be examined and discussed.
With regard to getting the new contract to the Review Body for pricing, I must say, because I want to be perfectly fair to both the profession and the House, that the Government make it clear in this case, as in the case of the junior hospital doctors, that they reserve the right to put in ex parte evidence, and, again as I have told the doctors, cannot give any cast-iron guarantee about their treatment of the report.
§ Sir G. Howe
If, as the right hon. Lady insists, and as has been stated by the medical profession, the current dispute is separate from the pay beds dispute, is not that all the more reason why the right hon. Lady should accept the invitation proffered by the hon. Member for Cornwall, North (Mr. Pardoe) and deplore the industrial action, directed to the pay beds issue, being taken by other staffs in the hospital service? Will she not respond now more genuinely than she has in her last answer to the fact that she herself, by her style and manner, has gone a long way to arouse and multiply the concern felt by the medical profession in this dispute? Will she not recognise that the truculence with which she denounced the medical profession for having moved into industrial action so quickly missed the point, which is essentially that the cause of the strife and dispute is the initial decision on the pay beds issue, coupled with the decision by the Government in the contract negotiations to force through very substantial changes in the basis upon which consultants can continue to do private work alongside NHS work?
42 Until the right hon. Lady recognises these factors and also her responsibility for restoring confidence amongst these leading people with whom she has to work, she will not come near to resolving the dispute.
§ Mrs. Castle
In the past few weeks I have met three sections of the medical profession, all of whom came to those meetings full of frustration, doubt and anxiety. I refer to the general practitioners, the junior hospital doctors and the consultants. Since my score in terms of the creation of confidence at those meetings was two out of three, I leave the House to draw its own conclusions as to where responsibility for any failure to reach understanding in this particular case lies.
The right hon. and learned Gentleman constantly returns to the point about deploring industrial action. Hansard will clearly show in this afternoon's exchanges the contrast between what I have said and what he has said on this matter. I have said that I deplore industrial action in the hospitals from whatever quarter it comes. The right hon. and learned Gentleman merely deplores the consequences of the action of the consultants. I challenge him to deplore their industrial action now.