NATIONAL HEALTH SERVICE (CONSULTANTS' CONTRACT) (Hansard, 10 March 1975)

§ The Secretary of State for Social Services (Mrs. Barbara Castle)
At the time of my last statement to the House, on 17th February, I was awaiting the profession's reaction to my letter of 11th February. Its response was to ask the Prime Minister to intervene. Copies of the correspondence between the Prime Minister and Dr. Stevenson have been placed in the Library of the House.
In his replies my right hon. Friend the Prime Minister explained that he did not intervene in pay matters because these were for the independent Review Body on Doctors' and Dentists' Remuneration, that when I put to the consultants proposals for a new contract I was doing so with the full authority of the Cabinet, and that he was willing to see the consultants' representatives on any wider 30 National Health Service issues as soon as sanctions had been removed. He pointed out also that by limiting their hours of work unilaterally consultants were not honouring the accepted obligations and that in consequence the interests of patients were being damaged. I regret to say that this situation is arising in many parts of the country.
As my right hon. Friend the Prime Minister has told the consultants, the Government are satisfied that sufficient common ground exists for a settlement to be reached when negotiations with the Health Departments are resumed. I hope that, having studied the Prime Minister's replies and the assurances they contain, the consultants will decide to drop sanctions and get round the negotiating table.

§ Dr. Vaughan
I thank the right hon. Lady for her statement, but many of us will be extremely disappointed at how little she has had to say today and at the unsatisfactory nature of the Prime Minister's replies to the consultants. The right hon. Lady will know that I am a consultant. Will she agree that nothing in her statement and her recent actions will have helped to resolve the present dispute? Does she recognise also that waiting lists are now lengthening to a most dangerous extent, and there is now the likelihood of serious damage to the care of patients in the National Health Service?
Will the right hon. Lady agree that a major difficulty is that many leading hospital consultants have no confidence in her whatever? Will she, please, not play party politics over this matter, and may I suggest to her—I say this knowing that it will not be easy for the right hon. Lady —that the most useful thing she could do now would be to put her personal feelings to one side and to reopen negotiations at once, or, failing that, will she hand over the discussions to an independent arbitrator?

§ Mrs. Castle
I suppose that it would be asking too much to expect a consultant to be objective about a consultants' dispute. The hon. Gentleman will, therefore, not be surprised that I reject all his propositions except the one to the effect that this dispute is damaging the interests of patients. May I ask him, in reply, to discharge his duty and call on consultants 31 to withdraw sanctions first, in the certain knowledge that, as the Prime Minister has stated, I have in this matter been acting not personally but with the full authority and knowledge of the Cabinet, and second, recognising that there are no grounds left that would prevent a settlement if the consultants were at least willing to show the shadows of a compromise?

Dr. M. S. Miller
Will my right hon. Friend acknowledge that, in addition to the opinion of a large number of people in the country, there is a growing body of opinion among consultants who are irritated, annoyed and impatient with the small group of consultants who put monetary advantage above the necessity to do the best for their patients?

§ Mrs. Castle
I think that my hon. Friend is right. We had an example of that on the television only yesterday when Professor McColl, professor of Surgery at Guy's, appeared on the programme "Weekend World" and was asked by the interviewer whether the whole profession was behind its negotiators in demanding that we drop the current differential in favour of the whole-time consultant. He was asked what he thought the reaction would be if I were to accede to that pressure, which is now almost exclusively the issue before us, and he replied: … there would be a riot if you take away the extra payment …". It is clear, therefore, that the profession is divided on this issue, and that in standing by the principle of maintaining the present differential I am acting in the interests of the National Health Service as a whole.

§ Mr. Paul Dean
Will the right hon. Lady recognise the unhappy fact that the consultants have lost confidence because of her dictatorial and unfeeling attitude? Does she realise that this dispute is not fundamentally about pay but about the freedom of the consultant—[An Hon. Member : "To make more money."] —to do his duty and fulfil his responsibility to his patients without political interference?

§ Mr. Harper
Anyone who believes that will believe anything.

§ Mr. Dean
In view of that unhappy fact, will the right hon. Lady consider the 32 plea which has already been put, and will she ask the Prime Minister—as often happens in similar circumstances—to set up an independent arbitrator acceptable to the consultants so that their grievances and views may be properly aired?

§ Mrs. Castle
I certainly realise that by the time I took office the profession had totally lost confidence in my predecessors —the hon. Gentleman and his right hon.Friend who refused even to set up a working party to examine the consultants' demand for a closed contract. The first thing I did was to set up such a working party, in response to what I felt was the legitimate grievance of consultants that hours had lengthened to a degree which could not be remunerated within the context of the present open-ended commitment. There is no dispute between the consultants and me about that.
As to the request for an independent arbitrator, I must ask, first and foremost, what such a person would be asked to arbitrate about. It could not be about pay, because that is a matter for the independent review body and is currently before it. It would, therefore, be necessary to define exactly what the arbitrator would have to arbitrate about, and that the consultants have never made clear because in their own minds they are divided and confused.

Mr. R. C. Mitchell
Is my right hon. Friend aware that in the Southampton area a small minority of consultants are acting in a thoroughly despicable and disgraceful manner? Does she know, for example, that one of my constituents who had an appointment with a consultant on 28th February had it cancelled at the last minute and an alternative date given in January 1976? Is that not a thoroughly disgraceful state of affairs?

§ Mrs. Castle
Such action is totally tragic from the point of view of our National Health Service, the interests of which the consultants say they have at heart. I believe that action of that kind is deplored by a large number of members of the profession itself. There is an increasing consciousness that the breach of their accepted obligations is doing violence to the medical ethic by which the profession claims to stand.

§ Mr. Norman Fowler
Surely the Secretary of State is not claiming that Professor McColl speaks for all the consultants. 33 Is her understanding of this dispute so small that she does not understand the real feelings which exists among consultants throughout the country on this issue? At this stage will she reconsider her view and either set up an independent inquiry or take some new initiative?

§ Mrs. Castle
Of course, no individual spokesman speaks for all the consultants. I believe this to be one of the real difficulties. There is a conflict of interest here between the whole-timer and the maximum part-timer, between the man who can and does earn large sums from private practice and those other consultants in the Cinderella areas, the neglected specialities, who depend totally upon the whole-time emolument. What I am doing now is—[HON. MEMBERS : "Nothing."] I am defending the whole time emolument. I am defending, and will defend a proper reward to those who are devoting themselves full-time to the health service in areas where there are not fat private practice pickings to be made.
The best way the Conservatives can bring this dispute to a conclusion is to condemn the intolerable behaviour being indulged in by so many consultants.

§ Mr. Molloy
Is my right hon. Friend aware that the banality of the current situation is reminiscent of some of those troglodyte attitudes adopted by ignorant and greedy people when the National Health Service was first established? Will she give the House an assurance—not that my right hon. and hon. Friends and I require it—that she will stick to her guns in defending this great service because other members of the health service, like the members of the COHSE, are looking to her to do so? She will have their support for her campaign, and that support will be given not merely in the health service but by all the sick and ailing.

§ Mrs. Castle
The answer to my hon. Friend's question is "Yes ", and in defending the health service I shall be standing by a compromise which has obtained for many years, a compromise which the consultants are now trying to breach unilaterally. On the one hand the consultants want to retain the option agreement which permits them to choose, 34 after having accepted an appointment, whether they will serve whole-time or only maximum part-time, and on the other hand they are trying to drop the other part of the compromise which has also given a differential in favour of the man who opted to go whole-time.
The only way out of this trouble is by a compromise. I have compromised. I suggest that before the Conservatives ask me any further questions they should read all the correspondence that both I and my right hon. Friend the Prime Minister have had with the consultants. In it they will see that I recognise the importance to the consultants of the option agreement. I am therefore not proposing to interfere with it. In return I ask them not to interfere with the present agreement on the differential. That is reasonable.

§ Mr. Maxwell-Hyslop
Is the right hon. and noble Lady aware that more than 10 per cent. of consultant posts are vacant, and is she aware that the trend in filling registrar appointments is becoming very dangerous? While she plays politics and refuses to do her job as Secretary of State, the National Health Service will bleed to death in both the consultant and the registrar grades.

§ Mrs. Castle
I am very grateful that the hon. Member for Tiverton (Mr. Maxwell-Hyslop) recognises my nobility of spirit. Of course I am aware of the recruitment problems. That is a matter currently being looked at by the review body, the independent body on pay. That is a matter for it, not for me. As I have told the House on previous occasions, my Department has given evidence to the review body supporting the increase in pay and pointing out the latest recruitment and manpower figures and the implications these have for the coming award.
I have always made clear that consultants have the right to be adequately remunerated. I am willing to negotiate with them a limited contract which would give them extra pay for the long hours many of them do. There is no difference between us on that score. I therefore see absolutely no reason why the dispute should continue a moment longer or why sanctions should be retained.