HC Deb 03 July 1978 vol 953 cc37-109

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Snape]

3.46 p.m.

Mr. Patrick Jenkin (Wanstead and Woodford)

I am very sorry that the Secretary of State for Social Services has had to go back into hospital again. We hope that he will this time make a full recovery and be back among us soon. When I saw the headline in The Guardian this morning reading "Ennals patient", I wondered whether "patient" was an adjective describing the Secretary of State. But we express our sorrow that he is not with us.

Two weeks ago, the Confederation of Health Service Employees had before its annual conference a resolution headed "Protection of patients". The resolution urged the Trades Union Congress to recognise that in the field of industrial disputes there was, as it put it, a fundamental and intrinsic moral constraint whereby hospital patients should not be caught up in, and suffer from the effects of, industrial action. The resolution called on the TUC to "recognise its responsibility" to formulate an explicit code of practice for the guidance of member unions in relation to the moral facts of trade union activity which might adversely affect the wellbeing of hospital patients". There was also an addendum which called for an end "for ever" to what it described as the anachronisms of strikes and lock-outs", and it asked that arbitration and conciliation be used as mature forms of political development". The mover of the resolution was Mr. Cathal Breslin, of the Winwick branch. He was reported in the Nursing Mirror as saying that if the conference rejected his resolution it meant that whatever the consequences to patients, the principle of total strike action is not repugnant to the conference He went on: We have an obligation to prevent hospital patients from suffering hardships as a result of industrial action". He was supported in his motion by Mr. David Edwards of London St. Thomas's branch. He said: This motion makes sound common sense. We have got to find ways and means of hitting hard at the people we are fighting—the system, the administrators—not the sick and dying patients caught in the middle. The resolution and the addendum were fiercely opposed, and, as was reported in the Press, they were overwhelmingly rejected by the COHSE conference. In a hurriedly called Press conference after the debate, an embarrassed Mr. Albert Spanswick, the general secretary of COHSE, explained that the rejection was on technical grounds, but it is worth examining what those technical grounds were. I quote from The Guardian of 23rd June: He said it would have been in direct conflict with the union's Rule 14, which governs the withdrawal of labour and gives the national executive the absolute right to call industrial action as and when it deems necessary. One is forced to the conclusion that to the majority of COHSE delegates union rules loom larger than patient care. I have cited this recent episode because it illustrates dramatically what this debate is about—the threat to patients from disputes in the National Health Service.

We have decided to devote one of out precious half Supply Days to the subject for three reasons. The first is that there is mounting concern, right across the political spectrum, at the spreading rash of strikes, go-slows and work-to-rules in the hospital service.

When two such different political columnists as George Gale of the Daily Express and Hugo Young of The Sunday Times—who are poles apart politically—combine to condemn trade union attitudes and union morality the House should take notice. In his article in The Sunday Times on 25th June, Hugo Young wrote, referring to the hospital service: Here we see electricians and other workers—even, sometimes, nurses—ready to with draw all or part of their labour, whatever the damage this does to an already declining service and whatever the misery it inflicts on sick people. By any objective test, this is an act of impressive moral iniquity. It is the coarse exercise of power for selfish ends, injuring not some profiteering ogre of an employer but solely and exclusively defenceless patients. Our second reason for choosing this subject for debate is to give the Government an opportunity to explain what they are doing about the situation. Earlier this year stories began to appear in the medical Press saying that the Secretary of State was proposing, as part of the 30th anniversary celebrations, according to Pulse an ambitious declaration from all who work in the health service to pull together". In an outspoken speech the Secretary of State said that he was "cheesed off" with those who disrupt services for selfish ends. He said that he wanted to crown his celebrations with a ringing declaration by all NHS staff that they would turn over a new leaf and put patients first.

We now know that the Secretary of State will be disappointed in this. Under the headline A cloud over NHS anniversary in The Guardian on Saturday, we were told not only that his declaration; if it comes at all, will say little or nothing about disputes in the NHS, but that the whole document is so complacent that the doctors have refused to sign it. We need to know from the Government what is going on in the attempt to outlaw strikes.

Our third reason for choosing this subject is more general. These disputes are self-inflicted wounds on an NHS which is already struggling because of constraints on public spending. Naturally, any discussion will involve criticism of trade union attitudes and actions and there is a temptation to remain silent.

I draw comfort from Hugo Young. In the same article that I quoted earlier he said: Yet throughout these latest assaults on the hospital service, how many politicians have straightforwardly attacked the hospital workers or even challenged the ethics of their behaviour? The Tories, crippled by fears of being misunderstood, have been muted. From Labour there has been abject silence…What this great problem needs is ventilation, by people who are not mesmerised by either fear or complacent indifference. Since 1974, unions have not only got more power. They have succeeded in suppressing honest outrage about how they sometimes use it. I have no doubt that Mr. Young is a member of the National Union of Journalists and a sympathiser of the Labour Party. We should take note of what he says.

We on this side do not run away from this issue. I have discussed the issues on many occasions, generally and specifically, with union leaders in the NHS, nationally and locally. I know that in most of the NHS hospitals industrial disruption is rare. In many hospitals it never happens. I say that without equivocation. I also know that many of the disputes are not necessarily of the unions' own making. I know that sometimes the unions have right on their side and that the NHS management is sometimes obtuse and insensitive and sometimes downright obstructive. But I also know that in the majority of cases of disruption there is no need whatever for action that harms patients.

For those three reasons—public anxiety, to give the Government the opportunity to spell out their case and our duty to voice the criticisms—this debate is right and timely. I hope that we can discuss the issues rationally and coolly, despite the deep indignation that is felt by many people at what has been going on.

In the debate on 20th April I referred to the growth of industrial disruption. I was challenged by Labour Members to produce chapter and verse. I did not wish to waste the time of the House and I do not really wish to take up time today. But perhaps it is necessary to remind the House about what has been going on.

We should remember the appalling scenes outside the mental hospitals in the Mid-Surrey district last year when pickets from the Transport and General Workers' Union stopped food, fuel and drugs reaching some of the most deprived and disadvantaged people in our society—elderly, frail and psychogeriatric patients.

Only recently there was the clocking-on dispute at the West London hospital, Hammersmith. Mercifully, that dispute was settled last week, but it led to a sharp cut-back in admissions and therefore lengthened the waiting list. There has been the threatened national strike by electricians and plumbers which—as I said at the time and the Secretary of State agreed—would have led to the wholesale evacuation of major hospitals which would have been left without light, heat and power and would have threatened life because of the switching off of intensive care units, special baby care equipment and dialysis equipment. The country heaved a sigh of relief when that dispute de-escalated into nothing more than a work-to rule. But that was bad enough.

The Guardian reported:— Virtually every health region in the country has been affected by the industrial action ‖ Yesterday concern was growing at Great Ormond Street Hospital for Children— of which ironically, the chairman of the governors is the Prime Minister's own wife— where all open heart surgery has stopped. What of the misery of a small child prepared for a major operation who is told at the last moment that it cannot take place because of industrial action?

Mrs. Jill Knight (Birmingham, Edgbaston)

And what of the parents?

Mr. Jenkin

The parents would suffer, too.

We should remember the telephonists strike which was condemned by both sides of the House because the telephonists were pulling out the plugs and purporting to be able to know which cases were urgent and which were not. There has also been the open warfare at Dulwich hospital because of personality conflicts, culminating in the suspension of all operations because the authorities rightly believed that in that atmosphere it was not safe to go ahead with operations.

There was also the lightning walk-out of porters at the Westminster hospital because one of their number was taken ill and died after admission to the casualty ward. Those disputes achieved national headlines. But there are dozens of others which have escaped wide national coverage.

There have been disputes leading to the threatened withdrawal of services. In April 1976 there was a dispute about overtime payments at St. Stephen's hospital, West Brompton and at St. Mary Abbotts. That dispute led to a suspension of admissions and a lengthening of waiting lists. In July 1976 at the Charing Cross hospital there was a dispute over bonus payments.

If anyone believes that those who lead these disputes are anxious to avoid threats to patients it is instructive to see what the porters' spokesman said on that occasion. He claimed that the hospital had been forced to refuse admissions because of their action while an administrator claimed that the situation was not so serious. That dispute was aimed directly at patients. The patients were not just the unfortunate victims of circumstance. There was a 24-hour strike at the Basingstoke hospital in July 1976. The hospital was reduced to what was described in the Press as a shambles of bitterness and discontent by the activities of left wing shop stewards". In October 1976 there was a demarcation dispute at a North London hospital because, in the absence of porters, the nurses lifted the patients on to the operating table. The result was a lightning strike for the rest of the day and a suspension of operations.

In April 1977 there was a strike over duties at the Queen Elizabeth Hospital for Children in Hackney and at the Great Ormond Street hospital. The administrator at the Queen Elizabeth hospital said: The place is in absolute chaos, and if we have a real emergency there could be trouble. In May last year, there was a dispute over manning at the Seacroft hospital, Leeds, which led directly to the cancellation of operations for 50 children.

I could cite many, many more examples, but perhaps I need only draw attention to what was said in a Written Answer given to my hon. Friend the Member for Woking (Mr. Onslow), who may catch the eye of the Chair later. My hon. Friend asked the Secretary of State if he will list the hospitals in England and Wales at which the admission of patients is currently being limited by actual or threatened industrial action on the part of nursing and ancillary staff."—[Official Report, 27th June 1978; Vol. 952, c. 538.] I shall not read the whole Answer, but the Minister knows that he had to list no fewer than 36 hospitals at which admissions were being limited by the action of staff.

Mr. Cranley Onslow (Woking)

Should I be lucky enough to catch the eye of the Chair, I shall be able to tell the House that that is a far from complete answer. I have information in my possession coming from the Minister himself which shows that there are a great many more hospitals where this is happening.

Mr. Jenkin

That underlines my point, and I am grateful to my hon. Friend.

What all this means in terms of human misery prolonged absolutely defies description. Health Service staff, I know, are individually deeply worried about what is going on, and many will have agreed in their hearts with a recent leading article in the Nursing Mirror, written in the wake of the mid-Surrey blockade to which I have already referred. I shall quote a passage from it: ‖ Industrial action which rebounds on patients and affects the sick, the injured, the elderly and the mentally ill ‖ is surely unacceptble to anyone whose chosen career is caring for the sick, in whatever capacity. The leading article then makes a point which I shall take up: …there can be no nurse who would willingly use patients as hostages in order to achieve her own ends. Yet this is what it amounts to when industrial action makes patients suffer. I am sure that that is right. There is not an electrician in the country who would march into an intensive care unit and pull out the plug on the life support system and let the patient die. Of course there is not. There is not a plumber in the country who would force art incontinent patient to lie for hours in his own urine for lack of washing facilities in the ward. There is not a cook in the country who would set out to starve children in order to enforce some private personal grievance.

But one then has to ask the question. The right hon. Gentleman is himself a member of NUPE and, presumably, has the ear of the unions. Why is it that, when men and women threaten to do these things collectively, somehow they can justify what they do? What it is about trade union collective bargaining which seems to blunt individual consciences?

There was another revealing moment at the COHSE conference a week before last. I think that the whole House knows that it is the policy of NALGO, of NUPE and of COHSE to freeze out from negotiating bodies unions which are not affiliated to the TUC. They are anxious to exclude the Royal College of Nursing, the Royal College of Midwives, the Institute of Health Service Administrators, the British Association of Occupational Therapists and many others from local committees, and eventually from Whitley itself.

The Nursing Mirror carried a report last week of one of the debates at the COHSE conference on a resolution calling on members to exclude "the enemy" from management consultations. That resolution was carried with resounding support. Perhaps I should explain that the enemy" there referred to were, believe it or not, the nurses, the midwives and the therapists who belong to associations not affiliated to the TUC.

One then looks at the reasons given, and this really says it all. I quote from the report in the Nursing Mirror: One delegate complained that the Royal College of Nursing had tried to break up industrial action he had recently been involved in. He claimed that non-TUC-affiliated unions did not care about the fight to improve pay and conditions. The unspoken word there is that they cared about patients. That says it all. It is a very revealing statement. It is not patients who matter to these people; it is pay and conditions of staff.

Mr. Geoffrey Finsberg (Hampstead)

Does my right hon. Friend agree that it is equally bad that the Socialist chairman of the Camden and Islington health authority should give her support to failure of consultation and walk out of a meeting which the local accredited representatives of the Royal College of Nursing wanted to attend?

Mr. Jenkin

I agree with my hon. Friend. If people want to negotiate these things, let them negotiate, but let them not try to coerce unions and administrators by the use of force. This business of walking out and so on is quite absurd especially when, in the Camden and Islington area health authority, the majority of nurses are in the Roy al College of Nursing and only a minority are in the TUC-affiliated unions.

If that is the sickness—it is a sickness, and there is no burking the issue—what is the cure? The first answer must be better management. Of that there can be no doubt. The report of the Dulwich inquiry, which I have read in full, revealed many weaknesses, and they must be put right. But, equally, there must be a recognition of the ultimate responsibility of doctors and nurses—clinical staff—for their patients.

In its comments on the Dulwich dispute, The Times said: But hospitals cannot be run safely and efficiently unless clear-cut responsibility in clinical matters lies with those who are qualified to take clinical decisions. One of the things that we look for from the Minister today is an absolutely unqualified affirmation of that proposition. Nothing has done more damage than that unqualified people should presume to decide which are emergencies and who are the patients who need immediate treatment.

Secondly, with better management must go better leadership. One of the problems of the Health Service is that, as management gets more difficult, so the requirements of leadership become more important, and often one hears from people at all levels in hospitals of the lack of effective leadership on the ground.

Thirdly, we need greater personal respect for all those involved. It is an old saying that if you treat people like dirt they will behave like dirt. I have no doubt that in some cases one can see the cause of disputes in that. Sometimes, only the simplest things are necessary. I read in the evidence of the King's Fund to the Royal Commission that there was a dispute in one hospital about manning of rotas for an accident and emergency unit, and the simple strategem of writing up the names of each team, whether consultants, nurses, secretaries, administrators or porters—from Mr. A down to Mr. W —immediately removed the problem. Each saw himself or herself as a member of the team and there was no question of people fighting for positions. There must, as I say, be personal respect, and sometimes no more than a simple thing of that kind is necessary.

Certainly, we need better consultation procedures. Many disputes are caused because the consultation procedures are unbelievably slow and bureaucratic and people's patience runs out.

I see talk in the medical Press of a patients' safety committee as a sort of ultimate longstop so that there could be groups in each hospital able to say, when a dispute came along, which patients must not be allowed to suffer and be able to identify them. Perhaps that could be looked at.

Certainly, reform of the staff side of the Whitley machinery should be examined. The McCarthy report is now some months old. We have had an interim report, but we should like the Minister of State to tell us now what is happening about implementation of the McCarthy recommendations.

But even with all that—and it is a big enough recipe—I still say that if we are to avoid these damaging disputes—

Mr. William Molloy (Ealing, North)


Mr. Jenkin

The hon. Gentleman has been bubbling away, and I shall give way to him now.

Mr. Molloy

I am much obliged. I can support much of what the right hon Gentleman has said, but may we have an understanding with him that, if we implement all that he is calling for, he will not then turn tail and say that it all involves extra public expenditure and when his boss comes along, he will have to follow her and not agree?

Mr. Jenkin

There is nothing here which calls for a penny extra of public expenditure. We are talking about better procedures, swifter management and so on. On the contrary—if we can remove some of the burden of bureaucracy, many of these improvements could be achieved with reduced public expenditure.

But, with all that I am urging. we still need a pretty fundamental change of attitudes on the part of some people who are working in the National Health Service. I have quoted before, and I shall quote again because I think it important, the statement of Alan Fisher, the general secretary of NUPE, when he gave an interview to the Health and Social Services Journal a year or two ago. He was asked: How far do you take account of patients? He replied: We all have interest in the welfare of the patients, but they are not our predominant interest. Our job is to safeguard the terms and conditions of our members". We in this House are entitled to say that those who take employment in the National Health Service should be prepared to say that they regard the interests of patients as paramount.

Mr. Stephen Ross (Isle of Wight)

The right hon. Member has made that statement, but will he extend that to the consultants? I take everything that he has said up to now, but he has not actually mentioned the fact that the consultants were in this position about a year or so ago.

Mr. Jenkin

It was, in fact, nearly three years ago. I have condemned that on many occasions. But I am bound to tell the hon. Gentleman that if he goes around the country—as I know he does—and talks to people, he will find that it is not strikes by consultants that people are worried about now; it is what I have been talking about. I spoke to an audience of junior doctors in the Grand Committee Room and told them to their faces that they had no right whatever to withdraw their labour to the detriment of patients. If it is necessary, I reaffirm that today.

I am looking for a recognition by all those in the Health Service that the patients must come first. I welcome the efforts which the Secretary of State has made to get a joint declaration. As a matter of historical accuracy, I think that it was the secretary of the British Medical Association, Dr. Elston Grey-Turner, who made the first move on this and approached the TUC. But one has to say —and I say it regretfully in the absence of the Secretary of State—that the Secretary of State jolly nearly fouled it up right at the beginning by linking this idea of commitment to patients with his thirtieth anniversary celebrations. I am bound to say that at the time I regarded that—and I regard it today—as a very foolish gimmick, and it all but torpedoed an important initiative.

I understand, however, that the initiative has survived and that the Under-Secretary is chairing a committee. Perhaps the Minister of State can tell us something about that.

I would say very firmly to the TUC that it must be ready to meet other unions and associations half-way. But I am not hopeful that these words will be heeded. Last Thursday the TUC held its own thirtieth anniversary celebration. In the words of The Times they did nothing to help the controversial statement of intent on industrial harmony in the service". What was said—again I quote from The Times of 30th June 1978—was this: There was applause for Mr. Reginald Bird, of the Association of Scientific, Technical and Managerial Staffs, when he said he found it deplorable that Mr. Ennals had invited the British Medical Association, the Royal College of Nursing and representatives of other medical and nursing royal colleges to informal discussions about labour relations on exactly the same basis as discussions with the TUC. One is bound to ask Mr. Bird "Why on earth is that deplorable?" One asks him and those who think like him whether they have no sense of common purpose at all in joining with the doctors, nurses, midwives and others in what is, after all, one of the noblest of human aims—the care and healing of the sick.

The unions, I am sure, are among those who would subscribe to the view spelled out in the recent release from the Labour Party from Transport House, which says that the NHS is the cornerstone of the caring society which looks after all its citizens. It goes on to say: The NHS is still the envy of most of the world. The NHS will swiftly forfeit any claim that it may ever have had of being the envy of the world, unless we all, politicians and plumbers, cooks and consultants, recognise that in moving that COHSE resolution two weeks ago, Mr. Cathal Breslin was right and that there is, indeed a fundamental and instrinsic moral constraint whereby patients should not suffer from the effects of industrial action. What we need today is a Geneva Convention by all who work in the NHS—that, come what may, patients will always be their first concern. In a service caring for the sick, the injured, the old, the crippled and the dying, is that really too much to ask?

4.15 p.m.

Mr. Laurie Pavitt (Brent, South)

The right hon. Member for Wanstead and Woodford (Mr. Jenkin) has made a sensational case, and at times he piled sensation upon sensation. The House knew that it was in for a union-bashing afternoon when the subject for debate was put forward by the Opposition. We knew we would get a lot of selective stories—quite true stories of course, but, as the right hon. Gentleman knows as well as every other hon. Member, a sensational story makes news, but a good story does not.

What the right hon. Gentleman has done is to select a wide number of things which perhaps might be deplored by many people, to give a highly unbalanced and distorted account of what happens concerning workers within the NHS. The right hon. Gentleman has been less than fair to COHSE's annual conference. In spite of the fact that he quoted the Press conference afterwards as a kind of apologia, he knows, as well as everybody else who has studied the effects of that conference, that there was nothing in the principles of the proposal that was objected to by the leadership on the platform. A remission was asked for, and had it been remitted it would have emerged in the kind of form which could well have satisfied the right hon. Gentleman. But as a conference procedure, that never happened.

Mr. Patrick Jenldn

But the resolution was not remitted. It was thrown out, as The Guardian said, by an overwhelming majority.

Mr. Pavitt

The reason why it was thrown out was that the mover refused to remit it, and that is the normal procedure at every conference, as the right hon. Gentleman knows. He has been less than fair to Alan Fisher of my own union. I have no interest to declare, because, although I am a member of NUPE, I am not a sponsored Member. However, I am very proud to be a member of that union, in spite of the fact that from time to time, like all other organisations, things happen within it and in individual areas of which I, as a member, would not necessarily approve.

But I would say to the House that no other union has done more to raise the morale of the workers inside the National Health Service than the National Union of Public Employees. Therefore, when one hears attacks mounted upon specific instances such as those made by the right hon. Gentleman this afternoon, it is less than fair.

The right hon. Gentleman has taken on the whole role of the public prosecutor, and he has mounted a prosecution case. If he were to take some kind of balance, some kind of perspective, and if he were sitting in a different position, other than that of being in the Opposition, and if he should ever find himself in the position of being a Minister in the DHSS, he would find a whole number of good reasons why that kind of case does no good to the public at large, does no good to the Health Service, and no good to the feeling in his final words, with which I agree so much, that he is trying to engender a feeling of being part of and being prepared to work for the MIS and being prepared to accept the kind of provisions the NHS delivers.

The language the right hon. Gentleman used was emotive. All the things which he quoted—for example "assaults on the hospital service"— build up an atmosphere of emotion which, in my view, does no credit to this House and does no credit to those people seeking to deal with the real difficulties which we accept exist within the Health Service and which we are seeking to put right.

The hon. Member for Isle of Wight (Mr. Ross) immediately raised the point that, of course, we are talking about the lowest paid and the lower-paid workers. We are not talking now about the clinical staff and we are not talking about the hospital doctors. The NHS is the only organisation in this country which is under constant and fervent attack because it is imperfect. We look at its imperfections and we can tell what is wrong with it. The fact that there are about 2½ million successful operations is never recorded, but if there is one which goes wrong, immediately one gets headlines in the Press.

What has happened in this debate today is that disputes have been taken out of all perspective, because the NHS is the largest employer of labour in this country. The total figure of manpower and womanpower is nearly 1 million people. That means, in ordinary terms, that we are talking of disputes affecting 300 million working days. How many days have we lost through industrial disputes affecting the patients? In 1974 the figure was 17,811. In 1975, it was 13,225, and in 1976 it was 14,931—out of 300 million working days. There is no industry, either nationalised or private, which can show that kind of record of work service.

It is because, as the right hon. Gentleman knows, of the fact that the vast majority of people working in the service are devoted and give of their time and their energy that we ought to be praising them, rather than sorting out the few bad eggs in the basket and not praising the good ones.

When considering the effect on patients of any disputes, NALGO's record is typical. NALGO has 90,000 members in the NHS and in the last two years has had only nine official stoppages. Three were overtime bans, five resulted in non-co-operation and one related to non-participation. That is for a staff of 90,000 in all grades. There is less industrial unrest, non-co-operation and overtime banning and fewer strikes in the NHS than in any industry, nationalised or otherwise.

We must recognise the reality, that nearly 1 million people give devoted service year in and year out on less pay than they would get outside the hospital gates. The ancillary worker whom the right hon. Member for Wanstead and Woodford attacked earned in April 1977 an average of £59 a week. Doing the same job in a nationalised industry he would get £76 and in private industry he would get £74.

What adds to the feeling of wage injustice is the fact that the last two decades of freezes, pauses and pay policies have meant not only that the hospital worker gets lower pay at the time but, because of his pension arrangements, at the end of his time his pension is also that much short. Naturally, that arouses the kind of frustration which in outside industry can be remedied by industrial disputes and in other ways. In the NHS, as the right hon. Gentleman knows, in the majority of cases the feeling is that other action should be taken.

Mr. Patrick Jenkin

That may have been true some while ago, but nearly two years ago, on 29th September 1976, in Blackpool, the Secretary of State said: We have seen the largest increase in Health Service expenditure ever experienced during the days of this Labour Government. Of course I have to say that those who benefited most—and rightly so—were staff. It is not as if they have been neglected.

Mr. Molloy

It is still not enough.

Mr. Pavitt

The right hon. Gentleman is correct. Before that, especially in the period 1970–74, they had appallingly low wages. In 1975, when my right hon. Friend the Member for Blackburn (Mrs. Castle) was Secretary of State, another £800 million was put into the NHS, which allowed us to right many of the anomalies from which the workers previously suffered.

The greatest threat to patients in recent disputes has been the action not of ancillary workers but of doctors. The greatest threat was the junior hospital doctors' efforts; they added 100,000 to the waiting list, which we are still trying to clear. But the right hon. Gentleman never likes to talk about what the doctors do.

There is no way in which a layman can judge the threat to a patient when a consultant decides to work to rule, because only the consultant knows what rule he is working to. Whether one is waiting for a hip operation or something else, if a doctor is politically minded and, as has happened recently, wishes to make political capital out of a bash at the NHS, he can use the problem of a long waiting list, since it is mainly the consultant who controls the waiting list.

Mr. Onslow

The hon. Member will know of my interest in the subject of hip operations, on which he has just touched. Will he categorically state whether he is blaming the doctors for the fact that the waiting time for hip operation is steadily lengthening?

Mr. Pavitt

I blame it on two counts—the first is that they are refusing to have a common waiting list between private and general practice, which the Department has been trying to negotiate with them for 12 months; the second is a specific case. We know that probably nothing attracts attention so much as a specific case. In one area—I will not name it, but the whole House will know of it—public meetings have been held concentrating on hip operations. Had there been more determination and better co-operation between senior registrars and the consultants, the waiting list would have been much better in that area.

There have been advances in some aspects of pay—particularly for the nurses when my right hon. Friend the Member for Blackburn was Secretary of State in 1974. One area where no threat to patients occurs is through industrial action by nurses. Yet when my right hon. Friend is considering the pay structures within the NHS he should remember that, in spite of the 10 per cent. increase for nurses which has just been received, a staff nurse of 28 or 30, who has trained for three years and spent five years on the wards, now gets £3,255—less than many girls working in offices with hardly any training.

COHSE is such a good organisation because its members are devoted to the mentally sick and mentally handicapped and do the kind of job of which many of us would be scared. A staff nurse in that organisation on the top grade in a mental hospital gets £3,424. A male staff nurse has to cope with dangerous situations, with locked wards and with instances in which, unless he is well experienced, a mild outbreak by one patient can in a moment inflame a whole ward.

It would be much better if the Opposition devoted some of their Supply Days to talking about that kind of thing, about the kind of services that our people in the hospitals give—instead of concentrating on industrial action taken, perhaps, to keep open a casualty department which the calculating machines have decided is no longer an economical proposition because it is too small. When workers take that sort of action, many of us feel that there is something to be said for sit-ins, even if that means some kind of industrial action. It is on behalf of would-be patients.

The present situation is the fault of successive Governments. Each Government—I blame this Government as much as their predecessors—disobey the cardinal rule of medicine and treat the immediate symptom without trying to diagnose the basic problem.

I accept what the right hon. Member for Wanstead and Woodford said about McCarthy. What is needed and has been needed for some time is a basic restructuring of the whole organisation, so that frustration does not build up and explode in a way which may harm patients.

It put the blame fairly and firmly for the present bad procedures on the right hon. Member for Leeds, North-East (Sir K. Joseph). He cannot escape respon- sibility for the appalling reorganisation which he forced through against the wishes of this side of the House and which has only exacerbated work relations throughout the hospital service. In this week's British Medical Journal there are two excellent articles, by Sir Francis Avery Jones and Professor Rudolf Klein, which show beyond peradventure that the reorganisation was a mistake because it put too big a distance between administrators and NHS doctors and ancillary workers and broke up the partnership between those working in the hospitals and those running the service.

The Opposition complain about bureaucratic growth, about the fact that there are now too many tiers and about the amount we spend on administration, yet they never admit that their Government forced through the reorganisation over an unwilling Opposition who opposed it at all stages.

I repeat what the right hon. Gentleman said about McCarthy. In its 1976 report, the committee said: Many small disputes in the National Health Service have been exaggerated because there is no regional disputes procedure: therefore everything is taken to Departmental level and takes a very long time. I endorse that.

But it is even worse than that. It is not just that there is no procedure at regional level. There is none at area level either. Many of the instances given by the right hon. Gentleman are isolated cases which stick at district level and for which we have no machinery to get unstuck. As a result, negotiations cannot succeed and the result is the kind of thing that we all deplore, when a small group of people feel that they have no option but to proceed in a way which might harm the patients they normally serve so well.

The unions have now agreed with my right hon. Friend on new procedures and a document has been prepared. I plead with my Front Bench not to let the consultative processes take too long. I think that at the present time the chairmen of regional health authorities are looking at what has been proposed, and that those on the other side of the Whitley Council are also looking at it. The document must be made operative before the House rises. If things go on for longer than that it will be far too late. There is a need for urgency, and the sooner the matter is concluded the better.

It is time that society—and that includes the Government. Parliament and ourselves—faced the fact that in this debate we are discussing ordinary rights of workers. Rights available to workers in every other industry are far higher than those available to those who work in the hospital service.

In that recognition we have to accept responsibility. We have to agree not to find scapegoats for what goes on but try to put the darned thing right. We have had 30 years in which to do it but successive Governments have failed. Teachers cannot strike without affecting children. Hospital doctors and others cannot exercise muscle in a dispute without hurting innocent people—in this case, as the right hon. Gentleman said, patients who are often crying out for the alleviation of pain and distress.

I submit to the House that we must take responsibility for creating a framework within which justice can be done without the normal action of industrial disputes. We must realise that unless there are alternative methods there is the likelihood of industrial disputes occurring. If there are inordinate delays in seeking to resolve real grievances frustrations build up and the situation becomes explosive. When that happens it becomes extremely difficult for us to be able to have the kind of service of which we are all proud.

4.32 p.m.

Mr. Cranley Onslow (Woking)

What on odd speech that was. Here and there it contained some quite sensible bits, but here and there some crazy ones. The hon. Member for Brent, South (Mr. Pavitt) accused my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) of union bashing—the sort of instant reaction of any Socialist who knows that he is on to a thrashing at the polls. And what a silly attitude to take, to put all the blame on the doctors, as if they genuinely wish to see patients suffer, and as if they alone were guilty in any way of causing suffering to patients. What a partial little speech. What a pity because the hon. Gentleman knows something about the subject and he ought to do better.

I go with the hon. Gentleman in one respect: I accept that blame can be put on successive Governments of all parties, but I think that the hon. Gentleman could have placed a good deal more blame on his own Government without stretching credibility too far.

Mr. Pavitt

Can the hon. Gentleman explain why in the Good. Hope hospital at Sutton Coldfield only three hip operations were done in 12 months?

Mr. Onslow

There are always particular cases that can be distorted to provide evidence for exaggerated points. When I have finshed speaking the hon. Gentleman will probably accuse me of using similar evidence for the same purpose, but I do not see any point in trading insults with him, because I want to talk about one or two things which concern me and which I believe are relevant to this debate. If the hon. Member for Ealing, North (Mr. Molloy) would like to suck his teeth somewhere else, it will cause me no offence because this is a serious matter and I hope that it can he taken seriously.

Mr. Molloy

Get on with it.

Mr. Onslow

I shall get on with it, because Brookwood hospital in my constituency has attracted some national attention because of disputes which have arisen there and attained a good deal of prominence lately.

I admit—and everybody who studies this problem must concede—that there is a long history of friction at that hospital. It goes back at least four years, and I have no intention of wearying the House by rehearsing the whole of it, but there are things about the present situation which I believe could properly be drawn to the attention of the House.

The House probably knows the events concerning the so-called takeover by a workers' council and I hope has welcomed, as I do, the fact that the matter has now been resolved to the point that there is to be a full inquiry into what has gone on and what has been wrong. I do not wish to pre-empt that inquiry or to do anything to make its task more difficult. I think, however, that it is right to express some reservations about the way in which things may go unless those concerned are very careful.

I do not know how things will go, because so far we have got no further than that the committee of inquiry is meeting today to settle its own terms of reference, but if we accept—and I hope that all concerned will accept—that relations are so bad that workers feel obliged to resort to a particular action, and that management on its side feels entitled to react, the prime public interest in the matter—and it is this with which we should be concerned—is to find out what has gone wrong and try to put it right.

In any dispute there may be many reasons why people have fallen out with one another. It may simply be a personality clash in conditions of stress. That is something that we need not regard as being in any way political or unusual. The reason may turn out to be nothing worse than that. On the other hand, there may be administrative failures. There may be failures of communication on both sides, and I am sure that the hon. Gentleman will accept that those can be a cause of dispute. If those are the reasons, I hope that this inquiry will bring them out.

If reorganisation is part of the reason why these things have happened I shall be delighted if that, too, is brought out, because there is a good deal of force in the argument that reorganisation has lengthened the chain of decision to a point where people who used to be able to take decisions are now criticised not for their faults but simply because the system prevents them from taking decisions. That is something that we should not be afraid to admit and discuss, and I am not afraid to admit or discuss it.

Equally, if there is—and there may be—a campaign on the part of one union or another—and COHSE is one union in dispute here—against the members of another professional body, the Royal College of Nursing, and if that is part and parcel of the dispute, that, too, had better be brought out. I am sure the Minister knows that at least one former employee at this hospital, a Royal College of Nursing member, has just successfully brought proceedings before an industrial tribunal for unfair dismissal. If there is such friction between COHSE and the RCN, and it seems, from reports in the Press yesterday, that that may be a general and not a particular develop- ment, that is something else which has to be brought out in the public interest, and brought out impartially.

It may be—and I suppose that this again may be a reflection of inadequate management on somebody's part—that there is a simple conflict of objectives in a mental hospital such as Brookwood. There is some evidence to show that that may be so in the comments of the area health authority on the local community health council's report for 1976–77. This drew attention to the difficulty in getting full use of the rehabilitation unit in this hospital.

The area health authority commented: Nursing unions are reluctant to divert resources from the sick towards rehabilitation. Regretfully the current staffing situation is such that it is possible only to deal with the rehabilitation of patients from Brookwood Hospital, and it would be unrealistic to attempt to deal also with patients from other units. If there is a conflict there—and there seems to be one—it is probable that the responsibility for that lies higher than health authority level, and if that is so, that fact needs to be identified.

If the root cause of all the unrest in the Health Service is basically a total inadequacy of Government funding, that again is something that should be brought out into the open here and now.

My point in going through that list of possible causes of the dispute is to question whether an internal domestic inquiry within the orbit of the area health authority will be adequate to protect and define the public interest. I do not believe that this is the only hospital where this sort of thing has happened, and it is important that when there is a dispute of this kind—just as we had a different cause for inquiry at South Ockendon and elsewhere—we should get at the root of the matter. There should be no hesitation in and no inhibitions about establishing the reasons why things go wrong.

I hope that the hon. Gentleman will agree with me on that, and that he will not be reluctant to see that the truth is brought out and that no accusations of union bashing, doctor bashing or any such thing are made. I hope that he will have the responsibility to agree with me there, because these matters are too serious to be brushed off with electioneering gibes of the kind he gave us.

In his admirable speech, my right hon. Friend the Member for Wanstead and Woodford referred to my recent Written Question about the number of hospitals at which the admission of patients is currently being limited by actual or threatened industrial action on the part of (a) nursing and (b) ancillary staff."—[Official Report, 27th June 1978; Vol. 952, c. 537.] I intervened in my right hon. Friend's speech to suggest that the Minister's answer had been less than complete and accurate. I can give one instance, again very close at hand, which I hope will show that I am not making a light or unfounded criticism.

I refer to Botleys Park hospital, which was not in the list in the Minister's reply and which was the subject of a letter to me from the right hon. Gentleman on 25th April. He said: As you know, the admission of patients to Botleys Park Hospital for long-term care has been suspended because of industrial action taken by nursing staff, in support of their demands for improved nurse:patient ratios at the hospital. There has been no change at the hospital since then. I confirmed that by telephone this morning.

I completely fail to understand why that hospital was not included in the list. If the criteria were so drawn as to exclude it, I am fairly sure that a number of other hospitals were similarly omitted. I wish to know more about that, because when we are discussing the effect of industrial action on patients in the National Health Service I should like to put in a word for the people who do not even get into hospital. That hospital is a case in point.

Dr. Gerard Vaughan (Reading, South)

Would it be of assistance to my hon. Friend if I later gave him what is quite a long list of hospitals where admissions are at present being refused? The Westminster hospital has been doing it for about one week a month. That hospital does not appear in my hon. Friend's list. Borocourt hospital near Henley is doing it. One of the Bristol hospitals is doing it. I can give my hon. Friend a long list of hospitals which do not appear on his own list.

Mr. Onslow

I am grateful to my hon. Friend, but he gives me no comfort. However, he underlines the point, and I want to underline it further by telling the Minister and the House what is the situation at Botleys Park hospital. It is a hospital for mentally handicapped people, who are perhaps the least able to raise their voice in the House.

On that hospital's waiting list at present there are 23 urgent cases and 60 less urgent. Of the 23 urgent cases, there are six male adults, 12 female adults and five children. The House might like to hear a little about one of those children. She is classified by her consultant as being in a situation of serious risk to herself and to her mother. She is a severely disturbed girl of 13½, needing special attention. A special request was made to the trade union action committee to admit her, but as she will create extra work for the already hard-pressed nursing staff the committee was unable to accede to this request.

Let that be noted by the House as a situation faced not only by patients but by those who should be patients. I have given the example of a girl of 13½. There are four others like her at that one hospital. There are 18 adults in a similar position and 60 less urgent cases. Who draws the line between urgency and non-urgency?

That is the position we confront on the thirtieth anniversary of the NHS. When I press the Minister on the subject, as I have done for some time, in the end he returns to this defence, as he did in a letter: I would, of course, have preferred to see a higher level of forecast expenditure‖ but‖ recognition must be given to the overriding importance of other national priorities within the Government's economic strategy. All right, But as a defence that does not seem to me to be particularly watertight, even if the hon. Member for Ealing, North and his hon. Friends say "That means that you are arguing in favour of increased Government expenditure." We are not necessarily doing anything of the kind. What we are doing is to attack the Government for failing to understand that part of the answer may be better deployment of the resources that the NHS already has.

The hon. Members for Ealing, North and Brent, South, who take such a keen interest in these matters, no doubt rejoice and boast to their constituents that another £50 million has been made available for the NHS. Not a penny of that is filtering down to Botleys Park hospital.

Let us be factual about the matter. While it would be possible to identify matters such as the gift of ships to Poland or the giving of aid to Mozambique—which could be cut out of public expenditure at no great loss, the money being spent on the NHS instead—it is also possible, without arguing for any additional expenditure, to say that there are resources which could and should be better spent.

That is what the debate is about. I am astonished that it is not a censure debate. It is a poor way to celebrate 30 years of the NHS to have to say that waiting lists for the mentally handicapped, urgent cases, are growing longer; that there is, as all hon. Members know, increasing industrial friction within the NHS and that the position is evidently unlikely to improve in the short term.

In such a situation it behoves hon. Members on both sides of the House to ask themselves where the priorities lie. Of course, nobody would contemplate holding patients hostage. But there is another way of looking at the matter. The hon. Member for Brent, South spoke about the rights of workers in the NHS. If one wishes to complete that argument, it is necessary to think about their duties as well, because rights and duties balance one another.

In the end, the community must decide what sort of health service it wants. The community has to pay for it. The hospitals work for all of us, for the healthy as well as the sick. The question which worries me, and which the debate brings out, is this: are we not in some danger of losing the right, as a democracy, to decide what sort of hospitals we want? Is this not being taken away from us? After 30 years of the NHS, I do not find that a very encouraging reflection to be driven to.

4.47 p.m.

Mr. William Molloy (Ealing, North)

I think that the hon. Member for Woking (Mr. Onslow) will forgive me if I do not go all the way with him in his submissions. I cannot understand why he got so angry with my hon. Friend the Member for Brent, South (Mr. Pavitt), who accused the right hon. Member for Wan- stead and Woodford (Mr. Jenkin) of being the supreme trade union basher. I could only think that it was because the hon. Gentleman had a much better trade union bashing argument to submit.

If the alleged matters have been going on in the National Health Service, they must cause us all concern. As the right hon. Gentleman said, if anyone went into an operating theatre, pulled out a plug and deliberately ended someone's life, if action as deplorable as the instances alleged were being taken every day by all those who work in the NHS, by now the NHS would have broken down. Any such action is to be deplored. To say that it is the rule rather than very rare is irresponsible.

But what is even more vulgar and deplorable is to use such arguments for political advantage. That is what we have mainly heard this afternoon, and I find it distressing. Anyone listening to the debate so far would have thought that practically everyone—every doctor, nurse, auxiliary worker and administrator—within the NHS was a nefarious person with ill designs on the entire British nation.

I know that there is nothing that the Conservatives would not stoop to now that they know there is a General Election coming. Would any stranger, witnessing their crocodile tears, believe that the Conservatives, who speak of the noble concept, the wonderful, compassionate idea that is the NHS, fought tooth and nail to prevent its being born? I hope that the silence from the Conservative Benches indicates some remnant of embarrassment—

Mr. Patrick Jenkin

The hon. Gentleman is talking nonsense.

Mr. Molloy

The right hon. Gentleman is a great authority on the subject.

We have to try to be sensible. It would be silly for us to say that everything done by the trade unions in the Health Service is perfect and wonderful. Equally, it would be grossly inaccurate for Tory Members to put forward certain selected cases and seek to represent them as normal practice. I hope that the Minister will tell the House, in view of what was said by the right hon. Member for Wan-stead and Woodford, how many people died, or suffered and died as a result of that suffering, following industrial action. That is the test.

I agree with what I believe the hon. Member for Woking was trying to say on this point. He was perhaps too shy to say it. There cannot be a dispute unless there are two sides to the argument. It may be that a dispute is caused by a trade union which is not just or temperate. On the other hand, such a dispute could arise as a result of coarse or insensitive management. I believe that that is the more likely proposition.

Mr. Onslow

I am always obliged to any hon. Member who attempts to improve on my speeches. That cannot be too difficult. What I was trying to say was that it does not make much sense to argue about where to put the deckchairs when the "Titanic" is sinking.

Mr. Molloy

Have we just heard some Freudian slip? Are the Opposition hoping that the "Titanic" of the Health Service will sink? We shall not let it sink. We created it and we shall save it.

My hon. Friend the Member for Brent, South has made the point that there are levels within the National Health Service at which it is difficult for trade unions to negotiate. Many of the issues with which they are concerned, sometimes to the point of exasperation, have nothing to do with wage increases or conditions of service. They are related to the attempt to improve conditions for the patients they try to serve. It would be wrong for the House to give the impression that the millions who work for and are associated with the NHS are not trying to give of their best in this most noble of services. It is wrong for the Tory Opposition to give that impression.

As serious as irresponsible trade union action or stupid management action—which, it appears from our experience, takes place too often—is the ganging-up of consultants within the pay bed system which stops someone from having a vital operation because they do not have the money. This is vulgar. We all assume that those who use the pay beds and receive preferential treatment pay once they have received that treatment. But that is not true. Many hospitals have been stung as a result of someone jumping the queue and promising to pay for a bed but subsequently vanishing without paying a halfpenny.

These are the types of people who ought to be condemned by the right hon. Member for Wanstead and Woodford, not the others whom he mentioned. If the Opposition want to implement all the wonderful things they have talked about, it is necessary for them to unite with all other parties to bring about Aneurin Bevan's dream of a free and comprehensive Health Service at the point of need. That is something which the Tory Party has never been prepared to accept.

Much of the work carried out by COHSE, especially in the mental health area, has nothing to do with the wages or conditions of its members. It is working to deal with the faults within the NHS. Let us put that on the credit side. Much of the time of unions such as COHSE is taken up in examining what can be done to improve the efficiency of the service and making recommendations to successive Governments, sometimes without much success.

Many of the problems within the service could be avoided if we were prepared to allocate the money which the service demands. The hon. Member for Woking remarked that I sometimes seem to get upset about some aspects of the NHS. Let me tell him about the latest example. It has nothing immediately to do with the Health Service or with nurses, auxiliary workers or the unions. In Ealing we have been waiting for over seven years for the completion of a hospital which ought to have been constructed in two or three years at the most. I had to raise the matter on the Adjournment.

The hospital was partly built and it has been necessary to repair the damage that has been caused to this hospital. This is a far greater disgrace than anything mentioned this afternoon. During the long campaign to have this hospital built, the people in Ealing received the massive support of COHSE—not because it wanted the doctors, the nurses and the auxiliary workers to have employment but because it could see a need in that part of London and realised that somewhere in the upper echelons of the Health Service insufficient pressure was being exerted. This is to the credit of the trade union movement.

While many matters need to be put right in the NHS, it would be frightful if our people believed that they were at grave risk when they entered hospital because of the attitude of the millions who work in the NHS. It would be an enormous crime to produce such an inference, for whatever reasons. I trust that we shall have a much more balanced appreciation of the Service. Let us recognise what is wrong and condemn dangerous behaviour wherever it arises—whether in the higher echelons of management, among the consultants or the trade unions. In some instances it has been possible that an industrial dispute would involve a withdrawal of labour. In such cases no action has been taken by COHSE until there has been a guarantee to the effect that services can continue so that no one's life will be in danger. That is why I ask my right hon. Friend to give some statistics along these lines.

I acknowledge that some of the matters submitted by both sides of the House are damaging to the National Health Service and should be eliminated wherever possible. But I believe that we in this House also have a responsibility to acknowledge that much depends on the allocation of resources. Many of the irritations and other things that are a cause of concern and worry to those working in the NHS and to the public who require the services of the NHS are caused by the fact that we are not giving it the money it demands. We must go further.

The NHS is a noble endeavour. It is almost the apotheosis of the principle of the good Samaritan. We have to say all these things, and if we mean them we must have the courage to vote to the National Health Service the funds that it requires to achieve what we believe that it can achieve for the benefit of the people.

5.1 p.m.

Mr. Stephen Ross (Isle of Wight)

I very much agree with the closing words of the hon. Member for Ealing, North (Mr. Molloy). My right hon. and hon. Friends would like to join the right hon. Member for Wanstead and Woodford (Mr. Jenkin) in conveying our best wishes to the Secretary of State for Social Services for a speedy recovery.

I do not normally speak for the Liberal Party on health matters, so I make it clear at once that I do not have the expertise that many hon. Members have. But, like the hon. Member for Brent, South (Mr. Pavitt), I have nothing but praise for the hospitals with which I have been associated, as a fairly frequent visitor, or as a guest at management meetings, having sat in on several in the Isle of Wight, or as a patient. On behalf of my constituents, I can say that we have nothing but praise for the hospitals in the Isle of Wight. We have a magnificent new maternity wing at St. Mary's. The Minister himself is coming on Thursday to open our new geriatric day centre.

Despite all the pitfalls of the NHS, an enormous amount has been done over the years, and, like the hon. Member for Brent, South, I believe that it is far too often used as an Aunt Sally by the Press. I welcome the subject of the debate. I find myself very much in agreement with the comments of the right hon. Member for Wanstead and Woodford. Those things needed to be said. Like him, I was impressed by the recent article by Hugo Young in The Sunday Times and the challenge that he presented to the political parties.

The whole subject has some poignancy for me. This is because my father died in the early 1970s as a result of extensive power cuts in the London area, not, I hasten to add, because of a dispute in the NHS. Therefore, like, I am sure, other hon. Members, I know what can happen if power or heat is suddenly withdrawn, as might have happened again a fortnight ago. To put life at risk through a withdrawal of labour as a means to force through a settlement of a dispute can surely never be right. I personally cannot accept such actions. The hon. Member for Canterbury (Mr. Crouch) said as much last Friday week, and I very much agreed with him.

That is one of the reasons why I could not support the firemen's strike. Whatever the merits of their case—and there may well have been merits in parts of the country—I could not see how decent men, normally so kindly disposed and to whom we owe a great deal, could withdraw their labour and put people's lives at risk. Such a case is, of course, far worse when it affects the National Health Service. The sooner that we as a nation totally reject such action, the healthier the atmosphere will be in which discussions can take place. People's lives must not be put in jeopardy in this way.

That is not to say that I do not appreciate the frustrations which are affecting all sections of the NHS. That includes doctors and consultants—and senior consultants certainly have frustrations, since it appears that junior hospital doctors are now earning more money than they are, which is another situation created because the Secretary of State was forced into an ill thought-out settlement two or three years ago. Nurses and engineers, too, have grounds for complaint.

I found such action hard to accept when the consultants carried it out three years ago in withdrawing some of their services. I expressed the same view as the right hon. Member for Wanstead and Woodford apparently did to the consultants. That action was a dreadful example from professional people which I never expected to see in this country and which I hope never to see again.

I am a great supporter of the National Health Service. Over the past weekend I seem to have been receiving nothing but calls from constituents telephoning me from private nursing homes or complaining about dentists who are withdrawing from the NHS. I went to a private nursing home in my constituency on Saturday afternoon to meet a constituent who has contributed for over 20 years to BUPA. He has been paying £250 to £260 a year to BUPA for help which now it is needed has not been forthcoming. He is not the only one to complain about this. A lady aged 72 telephoned me to inform me that my own dentist was about to go private. That means that I, too, shall have to leave his list. She told me "I have phoned up three dentists in the constituency but they cannot take me on. I cannot afford to pay dental fees."

This is the other side of the story. I hope that the Conservative Party will realise what can happen if we do not take to heart the last words of the hon. Member for Ealing, North and provide a greater share of the nation's wealth for the NHS. We know that this country does not contribute as much to its health services as many other countries do to theirs. We do not, for instance, give as must of our gross domestic product as does the United States. But, whatever the faults of our NHS, I could not accept living in a country where, for example, 40 per cent. of the bankruptcies in California arise from doctors pursuing their patients for their fees. That would be a dreadful situation to contemplate returning to. If, in order to get more money into the NHS, we have to put extra taxes on cigarettes and drink, I am all for it. Why on earth do we not do it?

But the frustration comes not only through lack of money but through management procedures which have become more complicated and need to be simplified. I welcome the constructive remarks about this emanating from the right hon. Member for Wanstead and Woodford. He has been trying to tackle the situation in reports that we have seen in the newspapers. The Government, too, are beginning to see that there must be some amalgamations between areas and regions. This is all on the right lines. There will have to be changes in the administration of the NHS.

Mr. Pavitt

In considering the question of resources and allocation, of course it is right that we should look not only to the global sum but to the way it is put out. 'Will the hon. Gentleman accept from me that when the Conservatives left office we were spending 4 per cent. of the gross national product on the NHS but now we are spending 6 per cent.—half as much again? But there is a limit to the amount of money one can find.

Mr. Ross

Of course I agree that the problem is that this country must create more wealth as a nation and then we can devote more of that money to the things that we badly need. I disagree with the Conservative line that we can go on cutting public expenditure. I want to see more spent on things like hospitals, health services, roads, education, concessionary fares and so on. We have to be prepared as a nation to face up to the situation. For example, I also want better mental health facilities. I have paid two visits to Broadmoor, and I have been staggered by the dreadful lack of provision of mental health facilities, particularly for teenagers.

There also has to be a more realistic wage structure. It is true that the wages paid in the NHS are often below those which can be obtained outside. It is true in the case of the engineers, and it is certainly a reflection on our moral values that nurses are not paid as much as some secretaries in this House who are probably doing half the work that nurses do. These things are all true. We certainly need more surgeries and more operating theatres. We need to give more priority to these problems.

The NHS was a wonderful concept. It must not be allowed to flounder through lack of funds or commitment on the part of the political parties. As a House, I believe that we should be able to agree on that. If the leadership can be given from this House that we intend to provide the resources needed by the Health Service, and that we intend to deal urgently with the anomalies, then the threats to life and limb will surely disappear.

I am sure that hon. Members have seen the series of articles by Mr. Hugh Hebert which have appeared in The Guardian and which ended on Thursday. In the last paragraph of the last article he wrote: A young enthusiastic doctor, who works in a crumbling Victorian pile far from London, said to me recently: 'What's right about the health service? The first thing that's right is that however poor or inarticulate a patient is, he can get treatment without money entering into it. That's a principle that's almost worth dying for. Cash doesn't enter into the doctor-patient relationship at all. And secondly, I have the right to give the patient the best treatment I can without thinking about the cost.' That remains true, however much or little money the NHS has—and the lesson of 30 years is that it will never have enough. I welcome those statements and they sum up my own sentiments entirely.

5.11 p.m.

Mr. William Hamilton (Fife, Central)

In all our debates on the NHS every speaker advocates either increased expenditure or a reallocation of existing expenditure. Only very rarely do we get down to the basic proposition which underlies the Health Service, which is that, in addition to what was quoted from The Guardian by the hon. Member for Isle of Wight (Mr. Ross), there is also the fact that the Health Service does not exist for the workers in it, whether doctors or manual workers, but for the patients who are unfortunate enough to have to seek its help. Anything which threatens the welfare or the well-being of those patients must be frowned upon, and all steps must be taken by everyone concerned to eliminate the causes of those threats.

Along with my hon. Friend the Member for Ealing, North (Mr. Molloy) I am a sponsored member of the Confederation of Health Service Employees. I bow to no one in saying without fear of qualification that from top to bottom the workers in the NHS, probably more than workers in any other service, are noteworthy for their selfless dedication. The industrial action about which we are all concerned at present must, nevertheless, be seen in its proper context. It really is minimal. When one looks at the history of the NHS over its 30 years, one will see that the amount of industrial action which has been engaged in quite properly has been fractional compared with any other industry or service throughout the length and breadth of the land.

That is not to say that such industrial action is any the less serious when it occurs. However, as has been pointed out by several of my hon. Friends, if we are to be fair minded about this, we must emphasise that such industrial action as there has been has not been confined to manual workers. Some of the most reprehensible behaviour has been engaged in by the medicals—the consultants, the junior doctors and the rest. If we condemn the manual workers we ought not to smooth over the more reprehensible actions of the others, because the more well paid sections become, the more reprehensible for any action which they might take.

Whenever such action occurs it inevitably hits the headlines. All too often Conservative newspapers and Tory politicians are more than eager to exploit these events for their own nefarious political purposes. My hon. Friend the Member for Brent, South (Mr. Pavitt) was quite right to castigate the right hon Member for Wanstead and Woodford (Mr. Jenkin). He made not even a veiled attack but an open, unconcealed attack on the trade unions, separately and collectively. As a sponsored Member, I take very strong exception to those attacks. There is no more responsible or moderate trade union operating within the Health Service than the Confederation of Health Service Employees. It is dedicated to the preservation and improvement of the NHS, and nowhere more so than in the mental health service, the Cinderella of the Service. Yet the right hon. Gentleman chose to castigate in unequivocal terms every single union which is engaged within the NHS.

He said that no plumber, no electrician, no cook, or anyone individually employed in the Health Service would seek to take action to jeopardise the welfare of any patient. But he then went on to say that collectively the consciences of the trade unions to which those people belong are somehow dulled. In other words, he was saying that the National Union of Public Employees, COHSE and the rest are prepared collectively to threaten the lives of patients. That is a squalid, indefensible and inexcusable charge which must be refuted by this House.

The right hon. Gentleman went on to advance causes of the industrial unrest. He couched his proposals in fairly general terms. I suppose that was inevitable. I do not complain too much about that. I agree with him that there must be better management. It is very easy to make a general announcement of principle. But any faults there may be are highly likely to be the direct consequence of the reorganisation of the Health Service implemented by the previous Tory Government, who have a lot to answer for in this area. I hope that the Minister will refer to this and will indicate what progress is being made to remedy these grievances.

The right hon. Member for Wanstead and Woodford made an interesting observation in this context. He said—and I quote the words which he used almost exactly verbatim, because I took them down—"If you treat people like dirt, they will behave like dirt". It was not very elegantly put, but it called to my mind a comment made some years ago by a very prominent, and by Tory standards very liberal, ex Tory Minister, now Lord Eccles, who used the expression: Treat 'em mean and make 'em keen". That was the Tory philosophy which was carried out in practical terms within the Health Service in the early 1960s. The late Mr. Speaker, Lord Selwyn Llovd. who was the then Chancellor of the Exchequer, was the man who sought to implement Tory incomes policy by first knocking the nurses on the head.

The right hon. Member for Down, South (Mr. Powell) was at that time an ardent supporter of that same incomes policy which knocked the nurses. They were to get 3½ per cent. and no more. It must be remembered that at that time they received a tiny fraction of incomes which they are now receiving. Now, less than a week ago, the right hon. Lady the Leader of the Opposition no less, indicated that a future incomes policy of a Conservative Government will be much more stringent against people in the public sector than against people in the private sector. That means precisely the people about whom we are talking today. It means the nurses.

According to the right hon. Lady, the 1 million workers in the Health Service will be the first for the knock. That is the clear implication of what she was saying. That, coupled with the Tory threats to make far more vicious cuts in public expenditure, not excluding the Health Service, as "The Right Approach" makes abundantly clear, will mean that the difficulties facing the National Health Service today, serious though they are, will be devastating if the Conservatives come to power.

Dr. Vaughan

The hon. Member cannot get away with that.

Mr. Hamilton

I was interested to overhear that interjection sotto voce—that I should not be allowed to get away with that—

Dr. Vaughan

The hon. Member knows that what he is saying is totally misleading. Our party is pledged not to reduce resources in the National Health Service at all, and he knows that.

Mr. Hamilton

The hon. Member had better re-read "The Right Approach". I think that I have probably read it more thoroughly and more often than he has. I know his party's policy better than he does. If he looks at the section on the Health Service he will see that it says that all the charges will go up. That means prescription charges, and charges for dental and optical services and so on.

It also says that there are to be two services—an increased private provision and a public sector. The right hon. Member for Leeds, North-East (Sir K. Joseph) has said that the public sector will include the Cinderella services—the geriatrics, and the mental patients—while the private sector will include all the others. In other words, we shall have two Health Services, and one will be able to go into the private sector only if one has the brass. [HON. MEMBERS: "No."]—I know the manifesto of the Tory Party, and I know that this is so.

Dr. Vaughan


Mr. Hamilton

The hon. Member must curb his impatience.

Dr. Vaughan

Where will these supposed cuts fall?

Mr. Hamilton

I am telling the hon. Member where the cuts will be. If there are to be two services and one of them is a public service, obviously the public service will be the Cinderella. One can imagine all the public resources that a Tory Government, devoted to creating two services, would spend on geriatrics and mental health people. They will say "If you cannot pay the cash you will do without the service."

There would be a division in the medical profession as well. The cream of the medical profession would go to the private sector and the public sector would once again be the Cinderella. Let nobody pretend about the issue of the National Health Service when the General Election comes along.

The right hon. Member for Wanstead and Woodford ended with a rallying cry. He called for a Geneva Convention on the Health Service—come what may the patients will not suffer. By God, under the Tory proposals they would suffer. Those are fine words, but as has been said already, fine words butter no parsnips. We have on the record now in black and white what the Tory Party are committed to do within the Health Service.

I end with a slight castigation of my own Front Bench. I agree entirely with those who have said that the Health Service in the last 30 years has suffered from financial restrictions of one kind and another. The basic principle of the service has been diluted by successive Governments—by the introduction of charges and so on.

The simple reason for that is that as a nation we have not been producing enough wealth to satisfy the growing demands on the Health Service, the services for which, whether it be the salary of a nurse or the cost of a drug, have increased in cost far more rapidly than our overall GNP. This is the basic reason for the troubles that are the subject of today's debate, not managerial procedure, or whatever. It is the frustrations created by the shortage of resources devoted to this magnificent service.

I am very sorry that my right hon. Friend, the Secretary of State is in hospital. Nevertheless I say to him and his colleagues on the Front Bench that they are not as committed to the basic principles of the Health Service as I would like them to be. I would like my right hon. Friend to be bloody minded in the Cabinet Room. I think that he should demand more resources for the National Health Service. I fear that he does not do that with the kind of venom that is needed in his Department. That is the only way to get resources out of the Treasury. The Treasury is a mean-minded Department and one must be mean minded with it in order to get what one is entitled to. I fear that we have not got the venom or the conviction of a Nye Bevan at the moment. I fear that that is what we are suffering from at present, not the kind of shortcomings and trivialities to which we have devoted our time this afternoon.

5.27 p.m.

Mrs. Jill Knight (Birmingham, Edgbaston)

Indeed it is not only possible but likely that Conservatives are far more aware of what is in the Conservative manifesto than is the hon. Member for Fife, Central (Mr. Hamilton). Some of us simply cannot wait to put the Conservative manifesto in front of the electorate because we are confident that we shall gain support when we explain what we intend to do.

Two tactics have been used by the Government Back-Bench speakers this afternoon. One is that they have taken the view that attack is the best method of defence, but they are trying to defend the indefensible. The other is to attempt to draw the fire from the main subject that we are debating. We are talking about the threat to patients from disputes in the National Health Service.

I was very pleased to read a few weeks ago that there were to be moves to formulate a code of practice. Although Members opposite may not be worried about the actions of the Health Service unions, persons within those unions are very worried. The suggestion of the code of practice came from a member of COHSE. He said that a code of practice must be formulated because it could not be tolerated in this country that sick people should be made to suffer from union disputes. I was pleased to see that a resolution was put forward to that effect and I was appalled when it was fiercely opposed and finally rejected. I could not believe that that was its fate. It seemed so reasonable and sensible for COHSE members to see that the public were becoming severely troubled about the way in which sick people were being made to suffer by these disputes.

The hon. Member for Brent, South (Mr. Pavitt) said that we were in for an afternoon of union bashing. All I will say about that is that when unions ask for a bashing it is a cowardly politician indeed who fails to bash them. I have a great deal of support for the original principle of the trade unions in working for a fair day's pay in return for a fair day's work. That is very honourable. But what we are seeing today is the unacceptable face of trade unionism—trade unionism within the Health Service which has become heartless, totally selfish and cruel.

Perhaps it is true that we used to have autocrats in the Health Service. But today we have tyrants. The old-time consultant was often an autocrat and so was the matron. What a pity that we have no more matrons—the patients have suffered from that. A godlike status was accorded to consultants but it was commensurate with their efforts in patient care. These were people who had studied for many years and had spent many more years acquiring experience. They gave freely of their time and expertise to help the sick.

It was mentioned by the hon. Member for Brent, South that workers in the Health Service could get paid more money outside. In the early days, even before the NHS began, many cases were on record of consultants giving their time totally freely without any concern for hours worked, or the number of times they were called upon day or night, or indeed whether they received any money at all for their services. Today's tyrants have no such qualifications or experience and show no readiness to give their time freely.

Worst of all, today's tyrants have no regard for the patient. There are many cases on record in which operations have been put off by disputes within the NHS, leaving people in pain. Elderly and sick people have been moved about like pawns. Because of the dispute in one hospital they have been pulled out of that hospital and put in another in order to have their treatment continued. Many patients have been exposed to the lesser discomfort—but nevertheless a discomfort—of having no proper sheets or towels. Tiny babies have suffered grievously, some have even died.

Many private patients have been victimised in petty and unkind ways. In some cases one has taken the view "How could people be so unkind to sick men and women just because they chose to go into hospital as private patients?" Many people decide to spend their money on health treatment rather than on beer, bingo or anything else, which apparently is quite acceptable to the Government. I do not think it right that sick people who choose to take what is left of their income after the tax man has had his slice and to spend it on private care should be victimised in the way that they so often have been.

Today we have news that COHSE and NUPE have refused to allow the Royal College of Nursing to represent its members at pay talks. That is indefensible. The Royal College represents 105,000 nurses. The College was founded on 27th March 1916–62 years ago. Yet COHSE and NUPE want the College to be stripped of national and local negotiating rights just because it is not affiliated to the TUC. When did COHSE start? When did NUPE begin its operations? Certainly those bodies have nothing like the record of 62 years' service to nursing. It is appalling that those bodies should be so tyrannical in attempting to strip the College of its right to negotiate on behalf of its members.

The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)

If the hon. Lady is seeking after knowledge and wants to know when the National Union of Public Employees began, let me tell her that it began its operations about 1895.

Mrs. Knight

If it commenced in about 1895, it must have been extremely inept. It had obviously then been going for many years when the Royal College of Nursing decided that something must be done and set up as a college. I am astonished to hear the date given by the Minister. Surely he is not suggesting that NUPE could have been competent, because if it had been competent there would have been no need in 1916 for the Royal College to be set up.

The Royal College of Nursing has said "We will fight these undemocratic trade union moves to the bitter end." That demonstrates that there is a great deal of bad blood and friction between the Royal College and COHSE and NUPE. That can only be bad for the patients.

I was recently hospitalised for a short time and I was shocked to see the standard of cleanliness in the wards. That standard has sadly fallen in recent years. I have since visited other hospitals and I have been sorry to notice similar low standards there. I made inquiries about cleaning. I was told that the hospital cleaner came into the ward in a desultory fashion, swept round the ward and left it, leaving many piles of dust quite untouched. When I asked why this was tolerated, I was given a rather strange reply. Surely hospitals of all places should be clean, but I was told that it was quite impossible to argue with the unions because, if there was any argument about the standard of cleanliness operated in the wards by the people who swept them, there would immediately be a strike. I was also told that when the cleaners went off it was the nurses who cleaned the wards themselves when conditions got too bad.

Mr. Molloy


Mrs. Knight

The hon. Gentleman may not like to hear this, but these are the facts. He can check their veracity for himself. All this has been inconvenient for the nurses, and it is certainly not good for patients that standards have been allowed to slip so far.

I should like to know how much trade unionism of this kind is costing the NHS and whether that cost is avoidable. Some time ago my husband was hospitalised. He was desperately ill and I sat by his bedside for many hours. Over his bed was a socket for a lamp. There was no light for the simple reason that there was no bulb in the socket. The sister came in and said "We need that light on. Would you mind reaching out to switch it on?" I said "I'm sorry, sister, but there is no bulb in the socket." She bustled off and came back with a sheaf of forms which she proceeded to fill in. I asked "What are you doing?". She said "I am indenting for a light bulb." I asked "What does that involve?" She said "I fill in three forms and they get sent down to the electricians' department. Those requests w ill then be processed in the electricians' department and eventually a bulb will come up with the electrician carrying it and he will place it in the socket."

I said "How long will all this take?" She said "It should not take more than about three days." I said "Please do not go to all that trouble. When I go out to lunch I shall bring a bulb back with me and place it in the socket myself." The sister blenched. She said "Please do not do that because there will be a strike at once." [HON. MEMBERS: "Never."] That is the absolute truth and I do not regard it as a laughing matter. Perhaps Labour Members are not competent to put an electric bulb in a socket, but I can assure them that the most inexperienced schoolboy or schoolgirl knows how to put a bulb in a socket.

Why is it necessary for a highly paid electrician to be indented to cause him to have to come up to a ward to place a bulb in a light socket? One has only to bear in mind how many sockets there are in a hospital. This was a demand by the trade unions concerned that trade union members should be the only ones allowed to put an electric light bulb in a socket. I am all for electricians handling jobs that only electricians can do, but this is such a simple task. We read in today's newspapers that electricians in hospitals have had a wage rise bringing their basic money to £70 a week. I gather that this would mean an average payment of £80 a week. That appears to illustrate that it would cost almost £1 to replace a light bulb without even paying for the bulb. This is the type of practice that we should have the sense to change, for it must be costing the NHS a great deal of money.

Like my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin), I am anxious that we should have more teamwork in hospitals. We demand that there should be no strikes in the NHS. My right hon. Friend rightly condemned all strike action, including that suggested on behalf of the junior hospital doctors. All strike action in hospitals is bad. All strike action that harms people is bad. If we say that there should be no strikes in the NHS, there is a duty on us all to see that people in the Health Service are paid a fair amount for the work they do and are treated as a team. That is the Opposition view and I shall be amazed if there are still Labour Members who will attempt to defend the indefensible.

5.40 p.m.

Mr. David Crouch (Canterbury)

The House is indebted to my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) for her vivid description of something that is wrong in the provision of health care in hospitals. The story of the light bulb is not a laughing matter. I am not concerned about whose fault it is that forms have to be filled in before a light bulb can be provided, but I am sure that the Minister knows that such problems exist.

There are bureaucratic barriers which must be removed and my hon. Friend the Member fo Edgbaston was right to colour her argument with such a vivid story, which was so close to her at an anxious time in her life and her husband's life. She was talking about patients and that is what the debate is about. It is not about the 1 million people who serve in the NHS. It is about the millions of people served by them—the sick and the dying.

There are great problems in the National Health Service. Every speaker has admitted that fact. There are problems for all those working in the NHS, which is the biggest industrial enterprise in Britain today. Great problems face them all, whether they are administrators at the top of the tree, top consultants or those at the lower end of the delivery of health care. There are also problems for those who want a service from the NHS, but I wish to direct my remarks to the problems of those working in the Service. Let us examine what has sometimes driven them over the limit of what we are prepared to stand for as a society.

Sometimes the strains on NHS employees have been almost too much for them to endure. They have resulted from inadequate pay and excessive burdens at work. Hon. Members have mentioned the consultants and the junior doctors, but no one has referred to the enormous strains imposed on young housemen in the first year after they qualify as doctors. Sometimes they work 160 hours a week—impossible hours in any other enterprise, but allowed in the National Health Service. These strains have been sorted out as a result of the junior housemen going to the limit in pressing their demands. I do not agree that they should have gone to those limits and I entirely agree with what my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) said about their action. But they revealed the impossible burden put on them in their first year of work as doctors.

Many other strains exist for those working in the NHS, apart from the question of overtime and excessive work. There are problems produced by staff shortage. Hospitals work far below their establishments of nurses and other essential services. In some hospitals, working conditions do not match up to the requirements of modern factory Acts. There are some hospitals where even the sanitation provisions are not up to the level found in modern offices and factories. Such are the conditions in the nineteenth century hospitals in which so many people have to care for the sick and do their best to carry out their jobs efficiently.

The problems and strains apply to almost everyone in the NHS, whether they are consultants, registrars, nurses, radiographers, scientific and technical officers, electricians, plumbers, ambulancemen, orderlies, porters, catering staff, cleaners or clerical and administrative staff. In these days of inflation and the under-funding of our Health Service, it is understandable that employees in the NHS feel frustrated and, at times, very angry indeed. Like the rest of us, they have to keep up with inflation and face up to its problems. They are married people with children to educate, feed and clothe. They have the problems of living in these days of inflation.

I have heard many people say that inflation is evil. We have seen the evil that inflation can breed in an area of society where compassion should be the overriding priority and, at base, still is the overriding priority. We see inflation producing an evil that bursts out every now and again and hurts the good name of the British National Health Service. Like everyone else, people in the NHS want to keep up with the Joneses and we should not say that they should not be able to keep up with the Joneses.

I declare an interest because I serve on a regional health authority and I am a director of a pharmaceutical company. The management in the Health Service must recognise the desires and aspirations of everyone working in the NHS. My right hon. Friend the Member for Wan-stead and Woodford was right to speak of the need for better management and procedures and for the removal of the sort of bureaucratic barriers that were illustrated so well by my hon. Friend the Member for Edgbaston.

Mr. Molloy

Those barriers were set up by the right hon. Member for Leeds, North-East (Sir K. Joseph).

Mr. Crouch

Let us not argue about who created the barriers. Parliament created the barriers and produced certain problems. I work in the service and I do not suggest that all the problems in the NHS stem from the type of management that we have in it. However, I claim that many of our problems stem from inadequacy in management, which is a different thing altogether.

Management in the NHS must not rest on its laurels and on the feeling that the spirit of dedication of doctors, nurses and others in the service will ensure that there is less urgency about their problems than about those in other areas of public service or in industry. We must not draw on the reservoir of good will and the deposits of dedication to service of the sick. Nothing less than good management will do if we are to correct the problems of the NHS.

However, just as management must not trade on dedication, no one who works in the Health Service serving the sick must trade the patients in any dispute concerning pay and conditions. The patients must never be allowed to become bargaining counters in these material arguments. As I have already said, material arguments are important. We must recognise that they exist. We must understand them and seek a solution to them. But we must never allow the patients to become bargaining counters and to be traded against other issues in disputes.

We have a duty to remind everyone in the National Health Service that the patient must be above disputes. The patient must be the first concern of those who work in the National Health Service, and the patient must also be our first concern. The public must recognise this fact. Parliament—let alone the Minister and the Government—has a duty to establish clearly, for the whole of our society to see, that the patient comes first, without conditions.

Let Parliament establish something else from this short debate today—that strikes and picket lines will have no place in our hospitals. If we were to reach the stage where they had a place, we should have reached the end of the road. I am not prepared to accept that. We have a responsibility to bring home to everyone, in and out of the NHS—

Mr. Molloy

What does the hon. Gentleman mean by "out of the NHS"?

Mr. Crouch

I am referring to those who work in the NHS and the general body of the public—everyone in this country. We must establish that hospital closures and shut-downs put lives at risk. This was revealed clearly in the hospital dispute the other day in London. It arose out of a very understandable concern on the part of electricians and plumbers at not being able to keep pace with inflation. That dispute was eventually solved by the intervention of the Government, and by the skill of the Minister of State and the skill of the Secretary of State. We know that the Secretary of State is a sick man. We send him our best wishes today and hope that he will soon be out of hospital and back with us.

I give credit to the Government for the way in which they were able to solve that dispute rapidly, but I also give credit somewhere else. The matter was aired in Parliament one Friday morning. The Secretary of State came to the House and made a statement about his belief and the Government's belief that there is no place for strikes and picket lines in the NHS. He said that lives would be at stake. It was a dramatic statement. It was heard throughout the country and it was heard in the union concerned.

I never had any doubt that the union, which had always been reasonable in the past in its approach to these matters, would recognise that it must not trade a patient's life—not even one patient's life —in the bargain that it was seeking to drive. I am glad to say that when Parliament spoke with a strong voice, with strong leadership from the Secretary of State, the union listened, because the public was behind the Government and behind Parliament.

The position was made clear in this House, and one could feel it in the country. It was not just the headlines in the Press. The mood was reflected in a feeling that, having gone to the brink, this was too far. The Secretary of State will no doubt read tomorrow what has been said in this debate. I take my hat off to him for having stood up and answered some very tough questioning, and for giving a lead in the way that he did.

I do not believe that the message is a difficult one to put over. I believe in the dedication of those who serve the sick. I believe that they are all prepared, from the top to the bottom, to accept this limitation on their opportunities for industrial action. I am sure that this was recognised when the Secretary of State gave a lead a fortnight ago. He must give another lead. He must make clear, across the length and breadth of the NHS, to all the varieties of representation which exist, from the consultants down to the porters, that they must all accept and agree that there are now unwritten codes of behaviour in regard to pressing a case or a claim in the National Health Service, because patients and patients' lives are at stake.

Mr. Molloy

I am grateful to the hon. Gentleman for giving way. I agree with nearly everything that he has said. Now that I have agreed with him, I hope that he will agree with me that what irritates many young doctors, nurses and auxiliary workers is that some people are jumping the queue and occupying beds which ought to be occupied by more deserving people. These young doctors, nurses and auxiliary workers, with their dedication to the National Health Service, are greatly irritated when people are admitted to hospital not on the basis of priority but because they can pay the money.

Mr. Crouch

I know the point that the hon. Gentleman has made. It has been made frequently over the last two or three years. His Government have been fighting very hard to eliminate all private patients. I cannot support him on this point. I am sorry.

I want to get on to another aspect which relates to the whole of society. I want the Secretary of State, the Minister of State, and their officials, and also the members and officials of health authorities, to get out more into the field, so that they may see what happens where the battle is taking place. I want them to see what it is like at the place where patients are cared for—in the hospitals, in the health centres, at the general practitioners' surgeries, and so on. I want them to see what happens at all these places in which a million people are working in the NHS to look after the sick, the anxious, the very ill and the disabled. It will help enormously if the Secretary of State will give this lead to all those who work under him, from the permanent secretary downwards. I hope that they will urge people to get out into the the field, so that they may see on the spot what is happening.

Mr. Moyle

I should not like the hon. Gentleman to mislead the House. I am anxious to find out what suggestions he has, but I should like him to know that at the moment I go out into the National Health Service on at least one day a week, sometimes two. Whenever I do so I talk to the staff side as well as to the management. It would be very difficult for me to do my job here if I were to do any more visiting.

Mr. Crouch

The Minister has anticipated what I was about to say. I am asking the Secretary of State and the Minister of State to go on giving this lead, but to ensure that their lead is followed by their officials.

Mr. Molloy

Hear, hear.

Mr. Crouch

I hope that their lead will be followed by their officials in Alexander Fleming House and their officials in the 14 regions and 90 areas in England and Wales—and also in Scotland—to ensure that those who deliver health care, the doctors, the consultants, the nurses, the radiographers, the ancillary workers, the porters, and everyone involved, will see that management and administrators are interested in what they are doing and are in a position to hear about their problems. I want to see the administrators getting much closer to those who work in the NHS and closer to the patients.

I learned more about health care and about the dedication of the doctors, consultants, nurses, cleaners and everybody in the NHS, when my wife was in Guy's hospital for a fortnight in a public ward built in about 1860, than I learned in eight years working in the NHS as a remote administrator. I learned by being able 10 see for myself on the spot, rather than being concerned with paper work, the re-allocation of resources, and so on.

I believe that administrators of all sorts have become remote—or, at least, have often seemed to become remote—from those who are working in the field. A closer understanding between administrators and the men and women working at the point of delivery of health care—if I may use that complicated, almost legal, phrase—would lead to better management.

In my opinion, the NHS as underfunded. It is short of money. It seems to be over-managed. It does not seem to be short of administrators. But the real problem is none of those things. The real problem is one of frustration that it is being taken for granted, frustration that it is being overlooked. We must tackle this problem and correct it. We must never allow the patient to be overlooked and put at risk.

6.0 p.m.

Mr. A. P. Costain (Folkestone and Hythe)

I am sure that the House must contrast the speech made by my hon. Friend the Member for Canterbury (Mr. Crouch), who has practical experience in the hospital service, with the most extraordinary speeches from the Government side of the House. We have heard the Conservative doctrine on the National Health Service a là West Fife. There have been interruptions from the hon. Member for Ealing, North (Mr. Molloy) which sound like political commercials. He talks a lot about private beds.

My hon. Friend the Member for Canterbury referred to the Secretary of State being in hospital. The hon. Member for Ealing, North used that as an excuse to interrupt. We wish the Secretary of State well and hope that he is soon back in the House. Is the hon. Member for Ealing, North trying to persuade the House that the Secretary of State did not receive priority in order to get a bed in hospital? Is he suggesting that the Secretary of State's illness was any more serious than the illnesses of others on the hospital waiting list? The Secretary of State and his predecessor received priority.

Mr. Pavitt

Anyone with a thrombosis is admitted to hospital immediately, whether he is a Minister or anyone else.

Mr. Costain

I doubt that. Some of my constituents with thrombosis are not admitted immediately. I do not suggest that the Secretary of State should not have been given a hospital bed. But I am fed up with Labour Members saying that a Minister should have priority whereas anyone with money should not. That is what is wrong with the argument.

Mr. Molloy

Will the hon. Member give way?

Mr. Costain

The hon. Member is always interrupting.

Mr. Molloy

On a point of order, Mr. Deputy Speaker. The hon. Member for Folkestone and Hythe (Mr. Costain) asked me a question. In my normal, courteous way, I thought that I should try to enlighten him but he refuses to be enlightened.

Mr. Deputy Speaker (Mr. Bryant Godman Irvine)

This is a normal debating point. Unless the hon. Member for Folkestone and Hythe (Mr. Costain) says something derogatory about the hon. Member for Ealing, North (Mr. Molloy), he has no right to intervene.

Mr. Costain

I do not wish to say anything derogatory about the hon. Member for Ealing, North. The hon. Member interrupts every day. He sounds like the same gramophone record. He always asks how the Opposition will save money. My hon. Friend the Member for Canterbury and I sit on the Public Accounts Committee. In the last four years we have considered hospital expenditure. On a recent visit to Liverpool we saw how hospital expenditure has gone through the roof. We saw how £30 million had been overspent. Only when the Public Accounts Committee became involved was £14 million cut off that expenditure. We are talking about saving substantial amounts of money, not chicken feed. The Committee is an all-party Committee. Members of the Labour Party agreed that those savings should be made. The hon. Member for Ealing, North should not make political points about this subject.

The debate is about how we can give a better service to patients. Since I am a Member of the Chairmen's Panel I hope that the House will forgive me if I stick to the issue in hand. We are talking about whether anyone has the right to strike and thereby put peoples lives at risk.

Once upon a time strikes were called in order to make life more difficult for the boss. The boss would lose money through a strike and there was a reason for calling a strike. At one time people went on strike because they believed that it would put the boss's money at risk. Today in the large industries where strikes are most common it is not the boss's money which is at risk. It is not even the shareholders' money. It is the taxpayers' money. There is therefore less reason to strike.

When there is a strike on the railways, who suffers? It is the poor people waiting on Folkestone station in the snow when the driver does not turn out because he is having a row. Today we are talking about those who suffer, who are on the point of dying or ill, because some bloody-minded porter decides that he does not like a pretty girl being treated in a private ward when his wife is waiting for a hospital bed.

Liverpool teaching hospital is not to be opened because a row is in progress. About £5 million has been spent and there is a row about whether, when this hospital opens, others will close and some people will lost their jobs. That hospital costs £45 million to build. The interest on that money and the depreciation on it involves the fantastic sum of £10 million a year. Every day that that hospital does not open, taxpayers' money is being used, not to provide a service, but for an argument about why it should not open. People argue that my wife, my daughter or my grandchild might be involved. But is that an argument for opening or not opening this hospital?

This is the moment to make an appeal to those who are affected. It is not the time to make party political points or to base an argument on who started the Health Service. We know who started the Health Service—the National Government. We know who reorganised the hospitals. Some of us did not agree with what happened then. But this bunch has had nearly four years in which to put right our mistakes.

Many improvements are spoiled by bureaucracy. Many of my friends are nurses. I have been told by an eminent theatre sister that she joined the hospital service in order to save lives. She says that she used to have enormous job satisfaction by saving someone's life. But now that she is at the top of her profession she spends each day filling in forms. This theatre sister at a well-known London hospital is browned off with form filling.

The hon. Member for the Isle of Wight (Mr. Ross) mentioned private dentists. My own dentist—and I hope that he does not hear this debate, because I have to see him shortly—has told me that he no longer takes National Health Service patients because he is so sick of filling in forms and explaining his treatment to non-professional people who think that they know more about his patients' mouths than he does. He says that he is now going back to square one and treating private patients only.

If we want to get the service which both sides of the House know is needed—this is what the debate is about—we must make a special appeal. Strikes are out of place. Everyone should get together and organise things properly so that they are not necessary.

6.10 p.m.

Mr. Robin Hodgson (Walsall, North)

My hon. Friend the Member for Folkestone and Hythe (Mr. Costain) has demonstrated and underlined the capacity of hon. Members on the Government Benches to avoid facing unpleasant facts. We have heard a series of speeches from them, on the one hand, about industrial relations troubles in the National Health Service being only figments of Tory imagination, or, on the other hand, when the facts are shown to be proved, telling us that it is just Tory pre-election propaganda. However the truth is well-known to all Members when they go to their constituencies. People tell us about the problems and difficulties being faced in the hospital service.

Although we have heard speeches today referring to the big official disputes, I wish to concentrate on the distressing increase in niggling disputes, disputes which result not in a withdrawal of labour but in work-to-rule, large-scale absenteeism and other forms of unofficial action.

We have had a number of examples of that type of dispute in the West Midlands, and I shall cite two. Neither is of the kind likely to lead to the death of patients, but a great deal of inconvenience is caused. First, there has been a work-to-rule by telephonists. For a time, they were prepared to connect only critical medical telephone calls. They seemed to pay no heed to the effect which such a decision would have on relatives anxious to find out how patients were after operations or treatment of some kind or other. I had the experience myself of telephoning to one of my local hospitals to discuss the matter. After I got through to the appropriate department, a voice came on the line to say "You are not having an urgent telephone conversation" and the next I knew was holding a buzzing disconnected telephone. This is not satisfactory, and such action does not take enough account of people's fears when their relatives are in hospital.

My second example relates to the local ambulance service. I am speaking here not about the emergency ambulance service but about ambulances which take people, usually elderly people, for outpatient treatment—physiotherapy and so forth. We have had a rash of cases of ambulance men either not bothering to pick up patients or, alternatively, picking them up so late that they are too late for their appointments.

My community health council in Walsall has asked the physiotherapy departments at the local hospital to keep a record of these cases, but it has been told that it would not be in the public interest for them to have such a record. This leads local people to believe that the authorities in the National Health Service are not prepared to face up to the difficulties of industrial relations troubles.

Why have these niggling disputes and problems becomes so prevalent? My hypothesis is that there are two major reasons. First, there is the question of union rivalry between COSHE, NALGO and NUPE, with each union trying to increase its relative membership in the NHS and, to this end, bidding for members and appearing to be aggressive and strident on the workers' behalf.

I understand that the code of conduct now under consideration has so far been seen in terms of the unions vis-à-vis the NHS. I hope that there will be some provision for inter-union codes of conduct in an effort to prevent the demarcation troubles and poaching between unions which has led to a bidding-up attitude among local union organisers.

Secondly, there is the question of pay, career structure and working conditions, especially working conditions, for many non-medical staff in the NHS. Working conditions in many places are undoubtedly poor. The Minister has been to Walsall. Walsall is a typical example of a place with poor working conditions, and I can well understand why many of the workers find them thoroughly unsatisfactory.

Obviously, that state of affairs can be put right only by an increase in resources, but we must understand that the NHS slice of the overall cake cannot be made larger. Taxation is already too high, and incentives are already too low. Although we are all agreed that we must increase the rate of wealth creation, we cannot do so if we increase the burden of general taxation.

Therefore, we must try to improve the use of existing resources, using them more effectively to improve working conditions and thereby cut down the number of niggling disputes. Such an approach demands imagination at all levels within the NHS, but this is a task in which all who work in the Health Service—I pay unreserved tribute to them —could wholeheartedly join.

I return now to what was said by my hon. Friend the Member for Folkestone and Hythe. It was disappointing that we hardly heard a word from the Government side about positive ways of improving resource utilisation or improving working conditions and employer-employee relations within the Health Service. We have heard all the old shibboleths and mythology trotted out for the nth time.

I hope therefore that, instead of resorting to the sad tired old clichés about union bashing, the Minister will make clear that the Government realise that industrial relations in the National Health Service are unsatisfactory and give cause for public concern. Instead of pursuing a vendetta against pay beds, the Government should look at all the various ways of increasing the revenue of the National Health Service, which we all know is desperately needed. Instead of running away from union power, the Government should remind NHS workers of their duty—their Hippocratic duty—to patients, whose safety and comfort are paramount. I hope that the Government will be more decisive on this issue now than they have been in the past.

6.17 p.m.

Mr. Peter Bottomley (Woolwich, West)

I shall make two brief points. First, I refer to a group of NHS workers, school health nurses and tuberculosis visitors, who were heavily penalised by the Halsbury report several years ago. Many had worked for 20 years without certification because they started before certificates came in, and they were put at a penalty of over £1,000 a year. Although it took three years for the Government to find the opportunity to make sure that these hard-working and long-serving NHS employees came back on to the right salary scale, they did not take industrial action and did not even threaten it. That is another side to the issue under debate which ought to be brought out.

Secondly, I refer to the stay at my Eltham and Mottingham hospital. They are under great strain at the moment and under great temptation to start issuing threats of one kind or another. Their hospital has been recommended for closure by the regional health authority. Public opinion is on their side. The area health authority and the community health council want to keep the hospital going. Yet, here again, these workers have not issued a word of threat, blackmail or anything of the kind. Their concern is for their patients, as was the concern of the school health nurses and tuberculosis visitors. In a debate of this kind, it is important that such examples be brought out and emphasised.

Mr. Pavitt

Hear, hear.

6.18 p.m.

Mr. Christopher Price (Lewisham, West)

I am grateful to the Opposition Front Bench spokesman, the hon. Member for Reading, South (Dr. Vaughan) for giving me a minute or so of his time. I have heard most of the debate, and I feel that it should be said that, if what emerges from the debate is no more than a succession of union-bashing arguments, that ought not to be our final conclusion. I take at face value the Opposition's desire not to use the debate simply to get at the Health Service unions, and I think that it should be made clear that the majority of the difficult disputes in the NHS at the moment stem from a genuine effort on the part of members of unions to improve the lot of patients, not their own lot.

The dispute at St. Augustine's hospital in Canterbury arose simply because some young nurses felt that the patients had a raw deal and that the administration was just sitting on top of them. The dispute which has been going on in Greenwich has nothing to do with nurses trying to get more money for themselves. It is a genuine argument about who does what in operating theatres. The dispute at King's College hospital, which we have seen discussed on television, has nothing to do with Health Service workers being greedy and wanting more money for themselves. It arises from a genuine argument between doctors and nurses about how full a hospital can be and still operate properly.

In the light of some of the comments which we have heard from the Opposition, loading all the responsibility for these problems on COHSE, NUPE and NALGO, the record should be put straight. Most of the problems which come up in the NHS arise from a lack of money, from genuine demarcation disputes and, in some cases, from appalling management. If there is militancy, that militancy was led by the consultants and the junior hospital doctors some time ago. I hope that that spirit will be reflected in both winding-up speeches.

6.19 p.m.

Dr. Gerard Vaughan (Reading, South)

The news that the Secretary of State was still unwell was very sad. I add my wishes, again, for his rapid recovery.

It is also very sad that we have needed to put down a subject such as this for debate this evening, because the Opposition are deeply concerned about the very rapidly falling standards of care in the NHS, and it is the care of patients that we are talking about.

Also, I thought that it was very sad that the hon. Member for Brent, South (Mr. Pavitt) immediately started to divide the House and suggested that all was well on the part of the unions and that all was wrong in what we had been saying.

Mr. Pavitt

The hon. Member was not listening.

Dr. Vaughan

I was listening very carefully. I thought it was particularly sad when the hon. Member said that this debate was about the rights of workers. He never, at any moment, said that this debate was about the rights of patients. That, I am afraid, shows the kind of thinking which most Labour Members have shown in the debate.

In fact, it was my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) and my hon. Friend the Member for Canterbury (Mr. Crouch) who first brought up the question of the needs of patients. My hon. Friend the Member for Folkestone and Hythe (Mr. Costain) brought us back to the realities of the situation and the needs of patients. That is what this debate is all about. My right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) put the position very fairly and very clearly when he listed over and over again the kinds of damage now being done by industrial disputes within the Health Service.

The Minister said that he has been visiting hospitals. So have I. Most hon. Members know this. I have been visiting a lot of hospitals recently. I find that there is hardly a hospital today which is not restricted in some way by industrial disputes of one kind or another. They do not all hit the headlines. But over and over again, when I talk to hospital staff, they tell me that they cannot do this or they cannot do that because there has been a threat of industrial action.

My hon. Friend the Member for Woking (Mr. Onslow) has a list of 36 hospitals where admissions are restricted. As he knows from my intervention, I could give him a very long list indeed of other hospitals which do not appear on that list of his, where the admission of patients is now being handicapped by industrial action. I have mentioned one just round the corner from here. We heard last week about problems in the Bristol area, in the West Country. We hear this over and over again. This is what I am finding when I travel around the country.

The administrative staff are frightened to take action against these restrictions because they have so many problems in keeping the hospitals going that they do not want to add extra problems by arguments about tiny union actions of one sort or another.

For the first time in my life, I am now meeting patients who are seriously afraid to go into hospital—not because of the medical treatment that they will receive, but because they are afraid that they will suffer from some sort of industrial action.

That brings me to one of the other things that the hon. Member for Brent, South tried to do. He tried to suggest that what we were saying was unreal and that it was not happening. That is not the case. I would ask the hon. Gentleman to turn his considerable talents and knowledge of the Health Service to looking at what is going on today.

I shall not go through a long list of examples. My right hon. Friend gave a very clear account of industrial action of one sort or another. But with this background in mind, it seems incredible that on 22nd June the general secretary of COHSE, Mr. Albert Spanswick, should tell the union's annual conference that the care of patients was always the union's number one priority. Then he went on to make what, in my view, was an even more unreal statement. He said: No one has ever suffered as a result of industrial action by members of this union. I cannot accept that, having regard to the information I receive from the people whom I meet. I would ask him where he is getting his information from, because he must be out of touch with his own union members.

I was rather disappointed that the Minister, although it is his right, chose not to speak until the end of the debate, because I thought that many hon. Members would have liked to ask him questions and to comment on his statements. I hope that when he winds up this debate he will deal with the whole range of questions which we have put to him.

Mr. Moyle

I received absolutely no representations, to the effect of what the hon. Gentleman has just said, before this debate started. I decided that if I spoke only once one or two extra Back Bench Members could speak. I thought that, if I was to be the only Minister to speak, I would speak last. That is the background of the arrangements for this debate.

Dr. Vaughan

For that reason also I propose to keep my remarks very short, so that the Minister will, I hope, have ample time to answer every point that we have put to him.

What about the patients who have been refused admission recently? Some of them will die; there is no question about that. What about the patients who have been sent back from operating theatres? What about the enormous increase in the waiting time for urgent investigations? What about the child who died the other day waiting to have her heart investigated? She was not waiting for the operation; she was waiting for the investigations which would have led to the operation. Is that right?

I suggest to Labour Members that they should examine their consciences and look very closely at what is happening in the Health Service, because there is an opportunity for both sides of this House to combine with ideas, nonparty ideas, on how to bring the NHS back on to its feet.

I do not think that it helps—and I am sorry to say this in his absence—for the Secretary of State to choose to assume that these problems do not exist. We have said this to the Secretary of State before. In January this year he did enormous damage to his credibility and to the credibility of the Government when on a major television programme he said that there was no such thing as long waits for investigation, and that if there were cases waiting more than five months he would like to hear about them. They are commonplace.

It was shortly after that that we heard that, for example, in my area, 60 per cent. to 70 per cent. of cases are having to wait over a month as a routine for urgent investigations.

I refer to a passage in Hansard, when the Secretary of State said that, by referring to widespread industrial unrest in the National Health Service, I was "trouble-making". Surely it is not trouble-making to say to the Minister ultimately responsible "We have this situation today. We know that it is going on. What are you, the Minister in charge, prepared to do about it?" That is not trouble-making. That, I suggest, is reality.

I have referred to the Minister the comments of Miss Catherine Hall, the general secretary of the Royal College of Nursing. She is a most cautious woman, a most moderate woman by any standards. Yet she had to say the other day that the standards of nursing care in this country had now fallen dangerously low and that we had hit the lowest level ever of morale in the nursing profession. I know that the same applies in the medical profession.

Mr. William Hamilton

Not true.

Dr. Vaughan

That is what she said. That is what the nurses tell us.

Mr. Hamilton

It is not true.

Dr. Vaughan

That is what the doctors say. The hon. Gentleman does not want to believe it is true because it does not fit in with his doctrine.

Mr. Hamilton

It fits in with yours.

Dr. Vaughan

Why not have a nonparty approach to this disastrous situation?

This week we are asked to celebrate what appears to most of us a rather sick farce-30 years of the National Health Service. I think it is ludicrous. After four and a half years of Socialist management, or mismanagement, the situation is the worst that we have ever known. That celebration is nothing more than a publicity exercise which has backfired on the Government. Now they can neither cancel it, because it is inappropriate, nor go ahead with it realistically and sensibly.

As my right hon. Friend said, the centrepiece of this week has gone. It was to have been the announcement of a code of practice—a kind of non-medical Hippocratic oath. It was to have been the beginning of a new era in the NHS. Apparently, only the nurses are prepared to sign. We believe not only that a code of practice is essential in health but that it can be achieved.

Our advice to the Government is that they should continue—I hope that they will do so seriously—with their discussions on this matter. They should take more notice of the words of people actually working with patients. Some of the speakers at the COHSE conference were clearly unaware of what is going on—

Mr. William Hamilton

Practising nurses? How can the hon. Member honestly say that?

Dr. Vaughan

What about the porter at Greenwich who said on television the other day that there was a need for proper decisions to be made in the NHS, that lie was seeking proper orders and instructions about what to do because there was so much confusion?

The Secretary of State should use his influence to stop the unions turning, for example, on the Royal College of Nursing, attempting to deny it negotiating rights on behalf of its members. That kind of inter-staff warfare will do nothing for the NHS and will damage still further the care of patients. The nurses will resent that. We understand their feelings and we support them.

The Secretary of State should listen much more to what we are saying, and should accept our view that the NHS will not function unless decisions can be made locally, quickly and easily once again. He should accept that we want to restore the NHS as much as he does, that we want a service which is in touch again with the needs of patients and with the local community.

I suggest four steps that the right lion. Gentleman should take. First, we should like him to condemn over and over again any kind of strike action within the NHS. We have condemned it by junior doctors and consultants, we condemned it by dentists and we condemn it by porters, telephonists and all the other staffs. In our view, there is no place for militant action in the care of the sick. We believe that today we need a kind of Hippocratic oath not just for doctors but for everyone working in health care.

Secondly, we ask the right hon. Gentleman to continue much more forcefully than he has so far with his attempts to draw up a proper code of behaviour.

Thirdly, we ask the right hon. Gentleman to recognise that professional groups such as nurses have a right to take part in consultations and to speak out firmly and clearly on their behalf to say that he will have no truck with inter-union strife, by which they want to bully the nurses out of the negotiating table, room and the conference hall.

Mr. Pavitt

The Royal College is represented on the Whitley Council and there is no pressure for change there.

Dr. Vaughan

They are trying to get rid of them. The hon. Member should know that if he reads the papers.

Finally, we would ask the Government to make it possible once again for professional staff in hospitals to get on with the job for which they are trained. That means fewer committees, less interference on all sides and a simplification of the administrative structure.

To say that we introduced that structure is no answer, because the Government have had four-and-a-half years to change it. What do they intend to do about the breakdown in the NHS? They are the people responsible for it at the moment. I ask them not only to be aware of and to admit the problems but to tell us what they will do about them. The whole situation is now desperately urgent.

6.36 p.m.

The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)

I should first like to thank all those hon. Members who have wished the Secretary of State well in his treatment in hospital and have added a wish for his speedy return to us. Naturally, I should like to associate myself and my hon. Friends with that sentiment.

We have had an interesting debate, although not all the subjects raised have been directly concerned with industrial relations in the National Health Service, which I take it is the purpose of this debate. However, I shall do my best to answer most of the industrial relations points and the other points so far as they relate to industrial relations.

I want to dispose of one subject immediately—the organisation of the NHS. It is no use the hon. Member for Reading, South (Dr. Vaughan) saying that we are trying to dodge the issue when we talk about the Tory reorganisation. We have tried to repair the damage with which we were left—not just by the right hon. Member for Leeds, North-East (Sir K. Joseph) but by all his colleagues in government. It was right hon. Ladies and Gentlemen opposite who imposed the present organisation on the NHS. It is we who have had to try to struggle with the problems they left us.

The hon. Member for Reading, South spoke about decisions being made locally, quickly and easily. One reason that that is difficult to achieve in the present-day Health Service is that he and his right hon. Friends imposed on the service the existing bureaucratic structure. It is no use Tory Members giving us advice on what should be done with the NHS for the future, because there is no subject on which the Tory Party so lacks credibility in the country as their comments about the future organisation of the NHS. They have forfeited any claims to expertise by allowing the proof of their pudding to be eaten.

Dr. Vaughan

What have you done?

Mr. Moyle

What we have done, among a number of short term palliative measures—including restricting the numbers of managers, holding back management costs and amalgamating districts into single district areas—is to set up the Royal Commission on the National Health Service, so that we shall have a good, sound, properly informed basis for reorganising the NHS. When we do so, we shall not make the mistake that the Tories made of imposing a D-day on the NHS by which all the troops had to march off to their new positions. Change when it comes will come at a pace which can be absorbed by the NHS. That is the lesson that we have learned.

In the meantime, I see that the Tories have not lost their desire to fly by the seat of their pants. That is the trouble with making suggestions about abolishing various parts of the NHS instead of waiting for proper advice. My advice to them is to wait for the Royal Commission, follow it through and take part in the debate then.

But all this is largely irrelevant to the subject of the debate. [HON. MEMBERS: "Hear, hear."] It was not I who raised the matter first, and I was asked specifically by the hon. Member for Reading, South to answer all the points which had been raised. I am now doing so.

The problem that we are discussing is industrial relations in the NHS. I think that we can all agree on one proposition anyway—that any dispute in the NHS is bound to call into question to a greater or lesser extent the interests of patients. Regrettably, disputes do occur in the ranks in the NHS. I had hoped that we could devote most of this afternoon's debate not to a rehearsal of grievances, which is what many of the contributions of the Opposition have amounted to, but to trying to sort out workable solutions to the problems under discussion.

First, we ought to look at the facts and get the whole problem into perspective. The NHS costs £6 billion per annum and employs 1 million staff. About three-quarters of that sum of £6 billion is spent on the staff, and that covers a wide range of professions and trades. Good industrial relations are essential in an organisation of this sort, because it is extremely labour-intensive, as I have said, and the quality of service to the patient depends on harmonious co-operation between a tremendous range of professions, crafts and occupations. It is a large and diverse work force in which there has to be cooperation between the various sections. It is an organisation that is probably more complex and less homogeneous than almost any other organisation of comparable size, certainly in this country, and probably in most others too.

A patient can be affected by industrial action on the part of any of those staff groups—whether doctors or ancillaries—or by a dispute between different staff groups, and sometimes they can he affected by industrial action by workers outside the NHS which disrupts services to patients. The NHS is particularly vulnerable to the latter kind of disruption because by its very nature, it spreads to every geographical corner of the country.

In recent months we have heard a great deal about the industrial relations climate in the NHS, and we have heard a great deal about it from the Opposition Benches this afternoon. A lot of evidence has been produced to support particular theories of industrial relations. Most of the evidence that has been adduced by the Opposition has been anecdotal. The only way in which people can judge the state of industrial relations in the NHS is by looking at the overall statistics. They are the most reliable measure.

Department of Employment figures for 1976 show that the amount of time lost through industrial action in the NHS was less than the equivalent of 10 minutes for each member of staff over the whole year. As far as I am concerned, that is 10 minutes too much, but nevertheless that puts into perspective the tale of doom and woe that we have heard from Opposition Members today. In addition, the NHS has a long tradition of Whitley-ism, that is, negotiation through established machinery and joint resolution of its general problems by a process of negotiation and discussion between employers and unions.

The figures also show that there was a change in the type of industrial relations disruption that we have been experiencing in recent years, and this is important for what I want to say later. In 1972, 1973, 1974 and 1975 a large number of NHS staff were involved in national action, stoppages and disruption over pay and related matters—general terms and conditions of service. In recent years there have tended to be more stoppages involving fewer staff.

That was the interesting point made by my hon. Friend the Member for Lewisham, West (Mr. Price) in his brief intervention when he drew attention to the fact that many of the disputes that have hit the newspaper headlines recently have involved specific local issues—very often issues which have probably been unwisely pursued—directly related to what employees of the NHS have thought was a better way of providing health care than the way they were being asked to follow. This suggests that recent industrial action has resulted from specific local action issues where the scope for remedial action is at local rather than national level, and this is important.

Mr. Hodgson

Will the Minister give way?

Mr. Moyle


That has to govern the nature of the solution of the problems; and I shall return to this matter of the localisation of issues when I talk about our hopes for improvement. After all, the right hon. Member for Wanstead and Woodford (Mr. Jenkin) asked what the Government intended to do about this matter. I share my right hon. Friend's concern about the effect on patients of stoppages by all types of staff in the employment of the NHS. My right hon. Friend has over and over again emphasised his disquiet about the results of such actions, and I do not wish in any way to detract from anything that he has said.

We deprecate industrial action in the National Health Service which might endanger the care and safety of patients. My hon. Friend the Member for Ealing, North (Mr. Molloy) asked for statistics of how many patients might have been killed or died as a result of industrial action. I know of no case where that has happened, although I confess that there have been times when a great deal of worry has been caused.

We recognise the right of any National Health Service employee—and, indeed, of any employee anywhere else—to be able to air his legitimate grievances, and in an organisation of the complexity and size of the NHS the desire to do so is bound to occur from time to time. It is true that grievances and complaints have not always been dealt with as effectively as they might have been in the past. On going round the NHS I have been very disturbed to see in many cases either the breakdown or the total absence of arrangements for joint consultation between management and staff at local level. There are, of course, many exceptions. In some localities the arrangements are working remarkably well, but there has been a tendency for all negotiations to be centralised at national level, and there has been a tendency on the part of some managements at local level, either through inadvertence or through general resistance to modern trends, to carry out the sort of joint consultation that there ought to be.

I have no doubt that when it comes to the resulting industrial unrest many employees in the NHS, as the right hon. Member for Wanstead and Woodford said, are dedicated people who share the general apprehension about the damage being done to patients. In fact, that is true of the overwhelming majority of employees in the NHS. If one takes a historical look at the NHS, one cannot deduce from the rates of pay prevalent in the service that the unions have exploited their undoubted power to look after themselves and not look after patients. I believe that the leadership of the affiliated TUC unions and many other professional bodies and associations in the NHS is ready to say that sort of thing.

Mr. Onslow

If one looks at the history of the NHS, one would not say that it was marked by the fact that prospective patients were denied admission to hospital because of action by the unions. This is a new and disturbing development. Can the Minister tell me specifically why his answer to my Question the other day was so inaccurate?

Mr. Moyle

If we are talking about the answer to the hon. Gentleman's Question, we have to get it into perspective. The hon. Gentleman quoted about three dozen hospitals where admissions are restricted. That is three dozen too many, but it is 36 out of 2,600. That is why I say that most of the evidence which the Opposition has adduced this afternoon has been entirely anecdotal and local, and it is this local issue which is the most important matter that we have to discuss.

Mr. Onslow

On a point of order, Mr. Deputy Speaker. The Minister is in grave danger of misleading the House. I quoted nothing. The statistics came from the Minister. I want to know why the answer that I received was so misleading. I am sure that the Minister does not wish to mislead the House and if he is thought to have done so I hope he will explain why the answer took the form that it did.

Mr. Deputy Speaker (Sir Myer Galpem)

As the hon. Gentleman says, the Minister may mislead the House. He has not misled it so far.

Mr. Moyle

I have said that I think that most of the TUC affiliated unions and many of the professional associations in the Health Service are willing to say that they will work on the principle that patients' interests come first. It is very important that in return—this was the point made by the hon. Member for Canterbury (Mr. Crouch)—the employees in the Health Service must be sure that their willingness to devote themselves to their patients will not be used against them.

The change of atmosphere in the Health Service possibly occurred during the ancillary workers' strike in about 1972–73, when ancillary workers, rightly or wrongly, came to the conclusion that their unwillingness to harm their patients was being used against them by the Government of that time to break an industrial claim which would have breached that Government's pay policy. I think that it was then that the worm entered the bud of the NHS. That is a valuable lesson that we should all take on board.

We must not exploit the willingness of NHS workers to dedicate themselves to the care of their patients. This lesson will guide my right hon. Friend and myself in the time to come.

Mr. Patrick Jenkin

I said in my speech that the right hon. Gentleman was a member of NUPE, and I believe a NUPE-sponsored Member. I quoted the interview with Alan Fisher in which he said that the patients were not the unions' first consideration, that their first consideration was the pay and conditions of staff. Is the right hon. Gentleman now saying that he will try to persuade the leaders of the unions that that is not the right attitude, and that patients must be their first consideration?

Mr. Moyle

We have been engaged in an exercise of that sort for some weeks. It is by no means a new departure. If the right hon. Gentleman will possess himself in patience for just a little while, I shall explain what we shall do in this matter.

When industrial action has taken place, health authorities have so far succeeded in maintaining essential services to patients. I am confident that they will continue to do so in such conditions, but what is needed now is a move towards dealing with these problems before they reach a stage at which patients will be affected.

It is not only the Government and employing health authorities that are concerned to improve matters. I find that the health professions and the trade unions, without exception, are equally anxious to find the solutions.

First, as the House knows, my right hon. Friend has been engaged in discussions with representatives of the main NHS professions and unions, discussions which are aimed at improving the industrial relations climate and in particular at safeguarding patients. I think that within the next day or two those discussions will come to fruition. It will not be as complete fruition as I should have liked—I grant Opposition Members that —but a substantial measure of agreement will be reached with most organisations.

Clearly, I cannot say what is in the document that is to be issued before it is issued. There is no doubt that trade unions are concerned to make sure that the good will of employees in the NHS is not exploited and to ensure that proper resources are provided for the NHS. I know that they are also anxious to ensure that the idea that patients should be given first priority is seen to be important, a matter which should receive particular attention this week, when we are all not only looking at the past 30 years of the NHS but are looking forward to the next 30 years.

Mr. Pavitt

Has my right hon. Friend set a term for the time in which the document to which he has referred will be discussed by the other side of the Whitley Council? Is there a set date?

Mr. Moyle

No set date has yet been decided on, but these matters will be considered by the Whitley Council.

Many of our recent problems have had local causes, requiring local solutions. The general declaration of principles for the future of the NHS will be followed up. In many cases industrial action might have been avoided if there had been adequate local machinery for dealing with points at issue quickly, before they reached a disruptive stage.

I apologise for not having been present when my hon. Friend the Member for Brent, South (Mr. Pavitt) was making that pertinent point. There is nothing more frustrating than for someone to feel that he has a genuine grievance but no way of getting a fair hearing in a reasonable time. Delay of itself can lead to industrial action.

Whereas on matters of pay and terms and conditions of service there is a national Whitley machinery, which by and large for most of the time the NHS has been in existence has provided a solution to those problems, many matters lie outside the Whitley machinery. If a local appeals machinery and local disputes procedure could be implemented, they would lead to a ready solution of such problems. Although I do not want to comment in any detail on the problem, I think that the dispute at the West London Hospital is a typical example of what I have in mind.

When we came to power and took over the NHS in 1974, we took stock of the situation. We came to the conclusion that there were great gaps, particularly in local consultation and in some ways in which the employers' side of the Whitley Council was constructed. Therefore, we asked Lord McCarthy, who is one of the leading industrial relations experts in the country, to look into the whole machinery of negotiation and consultation in the NHS.

We have already reformed the management sides of the Whitley machinery to make sure that they are more responsive. We are quite clear that these reforms have a vital role to play.

We shall carry on a continuing dialogue on such matters with the staff side of the Whitley Council. Discussions are also in train under this general approach on the improvement of joint consultative machinery and on procedures and appeals in relation to disciplinary action and redundancy and retirement procedures.

What about the longer term in the NHS? We have been actively encouraging the development of the personnel function in the NHS. Since reorganisation—and this is a benefit of reorganisation—personnel officers have for the first time been appointed in the Health Service. We are making sure that they gain the appropriate experience and the appropriate training. They are undergoing a series of intensive industrial relations courses mounted to make sure that their contribution is even more effective.

We are taking steps at the same time to improve our arrangements for monitoring the industrial relations climate in the NHS in order that we may identify trends which suggest scope for remedial action at an early stage.

At all levels, locally and centrally, there is still a great deal of work to be done in the NHS. I believe that we are in the process of making slow, steady, significant improvements. I hope that this week's activities will ensure that all those in the NHS will rededicate themselves to the idea that the patients' interests are the paramount concern in the Health Service, and that we shall all act on that basis.

Of course, this is a two-way business between management and unions. It is therefore very distressing that Conservative Members can speak as some of them have spoken today. For example, I took down the words of the hon. Member for Birmingham, Edgbaston (Mrs. Knight) who said "When unions ask for bashing, it is a cowardly politician who does not bash them." That statement was made with great relish and enthusiasm. Whereas the right hon. Member for Wanstead and Woodford and his hon. Friend the Member for Reading, South I think mounted the debate with the idea that we might have a philosophical discussion about the future of industrial relations in the NHS, contributions such as the hon. Lady's are of no help. I notice that she adheres to what she said.

Mrs. Knight

The hon. Gentleman should read what I said.

Mr. Moyle

I took down what the hon. lady said word for word as she uttered those words. I do not think that I have misquoted her. It was the sort of contribution that too many on the trade union side of industrial relations feel is typical of the attitude of Conservative Members. That attitude will contribute more towards worsening industrial relations in the NHS than almost any other contribution I could think of.

Against this background, it is important to go through the points made by the hon. Member for Reading, South. He called for professional groups to be allowed to negotiate practically daily on their terms and conditions of service with the NHS management. Nurses are involved in daily negotiations. They have seats on the Whitley Council.

Dr. Vaughan

Will the right hon. Gentleman ensure that nurses are not turned out of the negotiating room?

Mr. Moyle

Of course I will. There is no problem with this. Nurses are on the Whitley Council as of right. There is no attempt to ask the nurses to leave. I cannot understand how remarks of that sort can be made by the hon. Gentleman, who is supposed to be an Opposition spokesman on this subject.

Mr. Patrick Jenkin

Does not the Minister know that in hospital after hospital across the country there are joint consultative committees where TUC affiliated unions are refusing to sit down with representatives of organisations not so affiliated? Does the Minister support that or is he now prepared to use his influence to tell these TUC affiliated unions that they must sit down with all the organisations and negotiate jointly?

Mr. Moyle

The right hon. Gentleman's intervention serves to show the degree of ignorance, which he shares with the whole of his party, on the subject of industrial relations. I have been talking about joint negotiations and the comments made on them by the hon. Member for Reading, South. With joint negotiation, there is no doubt that nurses are on the Whitley Council as of right and negotiate on behalf of those they represent. The right hon. Member for Wanstead and Woodford is talking about joint consultation, which is an entirely different, local, matter. If the right hon. Gentleman and his hon. Friend cannot distinguish between joint consultation and joint negotiation in industrial relations, they are losing a great deal of ground. They are not grasping the problems.

When it comes to joint consultation, the management of the Health Service will talk to any representative body to discover the views of that body and incorporate them into its policy. The intervention by the right hon. Gentleman and the hon. Member shows their degree of misunderstanding of the industrial relations set-up in the Health Service. I hope that they will soon inform themselves about the correct position.

The hon. Member for Reading, South asked me to condemn strike action. I have supported the Secretary of State in all his statements in that respect. The hon. Gentleman called for a code of behaviour. I hope that this week substantial steps will be taken in that direction. As for allowing professional staff to get on with their job, I have already said that the most substantial obstacle to this is the organisation of the Health Service and I do not propose to rehearse what I have already said on that subject.

I welcome the opportunity which the debate has provided to air this subject because industrial relations is an important topic. I say to my hon. Friend the Member for Fife, Central (Mr. Hamilton) that my right hon. Friend the Secretary of State fights a passionate battle within the Cabinet for extra resources. Even during the darkest days he maintained a rate of real growth in the service. It was exempted from the International Monetary Fund cuts for the purposes of revenue expenditure. In September 1976 capital and revenue were increased. Capital was provided for the construction industry. In this Budget we got an extra £50 million. I am sure that my right hon. Friend will carry on fighting with effectiveness, if not necessarily always with venom.

Mr. James Tinn (Redcar)

I beg to ask leave to withdraw the motion.

Motion, by leave, withdrawn.

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