HC Deb 01 February 1979 vol 961 cc1672-85
Mr. Patrick Jenkin

(by private notice) asked the Secretary of State for Social Services whether he will make a further statement about industrial action in the National Health Service.

The Secretary of State for Social Services (Mr. David Ennals)

The impact of industrial action in the National Health Service remains serious. The effects vary across the country, with very serious disruption in some places which is causing me great concern—for example. Westminster hospital, Great Ormond Street hospital, and the store strike at Bolton.

Most of the country has emergency-only ambulance cover, and between one-third to one half of the hospital service is dealing with only emergency cases. The most serious disruption is in the Northern, North-Western, London, Mersey and Trent regions, but in most parts of the country services have been reduced.

The trade unions involved in this dispute made it clear from the beginning that their members should maintain emergency and essential services. The fact remains that such action is now taking place, and it is therefore essential to take all possible steps to protect the safety and well-being of patients.

In some cases local action has clearly gone beyond the level approved by the unions. This has rightly caused great concern to the Government, the House and the whole country. The leaders of the trade unions have shared that concern, and, while I deplore their policy of calling any form of industrial action in the NHS. I acknowledge the genuine efforts they have made to keep matters under control They have co-operated fully in the "hotline" arrangement between my Department and the union headquarters—an arrangement that has been helpful in solving a number of local difficulties. They have also produced more detailed guidance to their members on the need to preserve essential and emergency services.

Last night I met general secretaries and national officers of the four unions involved to impress upon them the seriousness of the position and the need to ensure that essential services are maintained. I welcomed the further advice that they have given to their members and I sought clarification on a number of points—for example, the impact of industrial action on highly dependent long-stay patients and the need to have adequate warning of local industrial action. They have agreed to consider the points that I put to them. In the meantime, they believe that the more detailed guidance will be of real help in keeping the action within tolerable limits.

It is essential that Health Service staff taking industrial action should, at the very minimum, stay within the bounds set in the more detailed advice agreed by the unions on Tuesday night. Even this may pose risks to patients. But anyone ignoring that guidance would be acting in a reckless and irresponsible manner.

This must be avoided, and effective communication between NHS management and unions can help to avert it. That is why I am today taking steps to ensure that health authorities are fully aware of the need to bring in full-time officials of the trade unions concerned immediately when industrial action goes beyond tolerable levels.

The position is serious, but it would be a great deal more serious if many nurses, doctors, administrators and other staff—as well as ordinary members of the public—had not rallied in this difficult situation. The House and the country will want me to express our thanks to them.

Mr. Jenkin

Does the right hon. Gentleman recognise that that was a statement of unbelievable flabbiness? Does he recognise that what is going on in the country presents a horrifying picture of mounting chaos in the National Health Service?

I turn first to the point which was put to the Prime Minister by my right hon. Friend the Leader of the Opposition. Will the Secretary of State now give the Government's full and unqualified support to NHS staff and volunteers who are struggling to keep the NHS going in the present difficult conditions?

The right hon. Gentleman referred to the guidance, which in the press was referred to as the code of practice. Is he aware that nobody to whom I spoke this morning had seen the code? Is he further aware that nobody knows what is in it? Does he appreciate that the "tape" carries the information that the unions in central London have decided to refuse to recognise any such code? Will he undertake to publish immediately the details of the code, so that at least nobody will be able to deny knowledge of it?

When the right hon. Gentleman met the general secretary of NUPE, Mr. Fisher, did he ask him to withdraw the union's official call for the maximum possible disruption of services—and, if not, why not? Will he recognise that the time for dithering is over? [Interruption.] Those of us who last night saw the Secretary of State posturing before the television cameras believe that it is time he took action.

Mr. Ennals

The right hon. Gentleman referred to "mounting chaos". In some parts of the country action is being taken by irresponsible minorities, and I know that hon. Members on both sides of the House will wish to condemn those who act irresponsibly. The vast majority of those who work in the Health Service are genuinely seeking to maintain the service in the interest of their patients.

I was asked about staff and volunteers—a matter dealt with by my right hon. Friend the Prime Minister. It is extraordinary that the right hon. Gentleman and his colleagues, who believe that decisions about management should be taken by local management, now want us to issue some edict from the centre. We are in a local situation. The services can best be maintained not only by existing staff but by willing volunteers. Of course that is welcome, but it is essential that those decisions should be taken by local management.

The right hon. Gentleman asked about those who failed to follow the guidance and he also asked whether I would publish it. Anybody who read the newspapers this morning will have seen a summary of the guidance. I shall immediately place it in the House of Commons Library. I have been assured by the unions today that yesterday the guidance was circulated throughout the country. I must tell shop stewards, who say that because they have not seen the guidance they will refuse to co-operate, that they are going against the express wishes of their union leaders. I condemn those stewards for doing so. They are committing acts of great irresponsibility.

Mr. Flannery

Will my right hon. Friend try to learn the lesson that by competing and vying with the Tories in condemning a section of workers in this intractable and difficult problem he will only inflame the situation? Will he accept from me that, as the Prime Minister has already said, these people are entitled to a bigger wage? Therefore, will he not make them a much bigger offer in order to get them back to work? If we could wave a magic wand and get them all back now, the same problem would remain and they would be out again very shortly.

Mr. Ennals

I certainly never vie with Members of the Opposition in making criticisms of those who work in the National Health Service. I believe that the vast majority of those, including those taking industrial action, are responsible. Those whom I have condemned are those who are not providing emergency services. I believe that my task here is to ensure that the truth is known. Some of the allegations made by Opposition Members are not correct. On the question of pay, discussions have been proceeding this week in the hope that a settlement can be found. Of course, these are matters of concern. They must be dealt with properly through the Whitley Council machinery, and this is what is being done.

Mr. Scott

Is the Secretary of State aware that the country will be shocked at his complacency? This strike is not being contained; it is spreading at an alarming rate. Is he aware that the country will regard with revulsion the use of sick children as a lever in order to pursue industrial action? Those who are taking this irresponsible action, in particular those who respond to queries about essential supplies by saying "What code of practice?" are digging the grave of a decent society.

Mr. Ennals

There has been no indication at all that I have been complacent. I have sought throughout, first, to prevent industrial action, and now to ensure that it is effectively contained. Nationally, the unions have co-operated in trying to ensure that industrial action is kept within tolerable limits. Whenever there have been immediate and urgent problems, I have sought to bring pressure to bear and to try to ease situations quickly. The hon. Gentleman knows the position that I and all my colleagues have taken about irresponsible action which can damage the lives of children or any patients who depend on the National Health Service.

Mr. Penhaligon

How many times has the Secretary of State made that statement to the House in the past three weeks? What advantage has he obtained from the previous meetings he has held with the unions? What advantage does he expect to obtain from this one? If the advantage is zero, what does he intend to do?

Mr. Ennals

Since yesterday we have a code of practice that has been worked out by the unions to try to ensure that minimum damage is done as a result of the industrial action that has been embarked upon. That was an important step forward. Our task is to seek to bring this industrial dispute to an end. In the meantime, as long as there is industrial action it is the task of Government and of the unions, who instituted the action, to keep it within tolerable limits. That is what they are trying to do.

Mr. Molloy

Is my right hon. Friend aware that while there are some hard extremists in the trade union movement, many of them quote references from speeches of Conservative Members in support of their claim? Also, is he aware that the leader of the ambulance men in West London wants nothing to do with the Labour Party because he says that the majority of his members are supporters of the Tory Party? It is about time the Leader of the Opposition got in touch with some of her Tory trade unionists, who are right in the middle of breaking the rules in COHSE, and asked them to behave in a proper and civilised manner—

Mr. Speaker

Order. The hon. Member's question was to the Secretary of State.

Mr. Ennals

My hon. Friend is absolutely right. If the Leader of the Opposition and her right hon. and hon. Friends would use what influence they have in order to advise restraint and moderation and to try to ensure there is order, it would be better than some of the exaggeration and condemnation that we have heard from the Floor of the House.

Mr. Crouch

Will the Secretary of State use such influence as he has now to carry out what he has just said—that he and the Government will not tolerate this action by militant minorities in the Health Service? Will he demonstrate not only that Parliament will be supreme in this matter but that the Government will be supreme and will ensure that the sick are not put at risk?

Mr. Ennals

That is precisely what the Government seek to do. We have a situation in which union leaders have come together with responsibility and worked out a code of practice and guidance for their own members. It is only fair to see how this works. In the meantime, we should use all our influence to ensure that both lines of guidance that help to provide emergency services and services for the elderly are properly carried out.

Mr. Crawford

Will the Secretary of State tell the Secretary of State for Scotland that there is a serious situation at Ninewells hospital, in Dundee, where a five-day all-out strike has been begun by ancillary workers? This will have serious repercussions throughout Tayside. Is this not the final example of man's inhumanity to man?

Mr. Ennals

The Secretary of State for Scotland is aware of that situation and is doing what he can.

Mr. Orbach

Is my right hon. Friend aware that although he said that Westminster hospital was one of those that had closed, as did The Daily Telegraph this morning, I have just returned from Westminster hospital in the last quarter of an hour? I had a full examination which began at two o'clock. [HON. MEMBERS: "By volunteers."] Not by volunteers. I was seen by consultants and nurses and was looked after in the pharmaceutical department. I was very happy with what happened to me at Westminster hospital. I hope that the Secretary of State will realise the provocation that is being caused by Opposition Members, who should be helping us to deal with this matter.

Mr. Ennals

I am glad that my hon. Friend had good treatment at Westminster hospital, as I did in the middle of last year. It is true that those who are able to go to that hospital can get treatment, but it is also true that, on the whole, admissions are now being turned down. Generally, even emergency cases are not able to be accepted, but, as my hon. Friend says, it is not closed. This is one example of the way in which exaggeration can do great harm to the National Health Service and to those who work in it.

Mr. Blaker

Does the Secretary of State recall saying earlier this week that it is difficult to draw the line between urgent and emergency cases, on the one hand, and those in which delay would be harmless? Does he really think that there are many cases in which delay will be harmless? Does he recognise that this point is particularly important in areas such as mine, where there is a high proportion of old people?

Mr. Ennals

I have no doubt at all that where a hospital is down to emergency treatment only and people who would otherwise have gone in for treatment, either as in-patients or as outpatients, are for any reason unable to get to the out-patients department, inevitably a delay is likely to be damaging. One cannot get away from that. However, we ought to look at what the unions have said, namely, that Services in relation to cardiac, dialysis, cancer, intensive care and accident and emergency patients and children must be fully maintained at all times. They have said that No services should be reduced to a level where satisfactory cover cannot be maintained in respect of emergency and high-dependency patients; in particular, delivery and distribution of drugs, oxygen and fuel must not be impeded.

Mr. Pavitt

Whilst I do not minimise the present difficulties within the NHS, may I ask my right hon. Friend to accept that there are more than 1 million employees involved in the various sectors of the Service, 500,000 beds in our hospitals and thousands of children at [...] being successfully treated in [...] of the difficulties? Is it not deplorable that political capital should be made out of the very positive difficulty that arises and that, particularly in the West Midlands, doctors with a political bias can use their waiting lists as a weapon against the trade unions?

Mr. Ennals

I deplore the way in which some situations, be they in the Midlands, London or elsewhere, have been used for party-political purposes. This is deplorable and it is very damaging to the Service. My hon. Friend is absolutely right. Although in many parts of the country emergency services have been held up, patients are being dealt with with great care and great sincerity by those who work for the NHS. Therefore, we must express appreciation to all those in the Service who are doing their best, now under very difficult circumstances, to retain services.

Mr. Eyre

In view of the dire situation in Birmingham, will the Minister undertake to publish within half an hour the precise details of the code of conduct? Will he call upon trade union leaders to undertake that members of their unions who do not observe their code of practice will immediately lose their union membership?

Mr. Ennals

The last matter is not for me. However, the code of conduct has already been published, and I shall ensure that it is made immediately available to the public, to the press and to everyone within half an hour.

Mr. Roper

My right hon. Friend has referred to the stores strike at Bolton, in my constituency, which is causing very great concern. Can he tell me of anything that has been done to deal with this disturbing situation?

Mr. Ennals

There have been discussions during the course of today to deal with the situation, which is very disturbing. Equally, local management involved in these discussions with the unions knows that if it wants to raise this at a national level and involve the national officers of the trade unions, we are immediately ready for that to be done.

Mr. Maurice Macmillan

Will the Secretary of State take a slightly more robust attitude about voluntary workers, as compared with that of the Prime Minister? Will he admit to the House that decisions in these matters cannot be fobbed off on to management committees because they are policy decisions which should be made centrally if the NHS is to remain national? If the right hon. Gentleman is too timid to persuade management committees that are terrified of their unions to allow voluntary workers to work in hospitals on hospital work, will he at least try to persuade such committees to allow voluntary workers to continue to do the work that has always been done by them, such as running Red Cross libraries and hospital shops, and not be turned back by the picket lines for doing work that they have always done, even when the NHS was fully operational?

Mr. Ennals

I do not think that much is served by a competition in robustness. It is very easy to devise words of condemnation as though we were competing with each other, so I shall not seek to vie. I think that the right hon. Gentleman knows, from statements that I have made time after time to this House, where I stand in regard to industrial relations in the NHS.

On the question of management, I had the opportunity this weekend of discussing with chairmen of all the regional health authorities the best way in which they could respond to this very difficult situation. What they said—I believe that it was right—is that management must respond in the ways that are best to meet local situations. They were not wanting national edicts about what should be done, because almost every situation is different, and it is they themselves who want to have the opportunity of taking those decisions. They do not want to be told precisely what to do from London.

Mr. David Young

In view of the stores strike at Bolton, to which the Minister previously referred, and because many of these hospitals were in a near-derelict condition before the dispute began—indeed, before the present Government took office—will he keep hon. Members concerned informed of the situation as it develops?

Mr. Ennals

I promise that before the end of the day I shall inform both of my hon. Friends who have asked questions about the stores strike of the exact situation. I shall keep my hon. Friend in touch.

Several Hon. Members


Mr. Speaker

Order. I propose to call three more Members on each side of the House.

Mr. Graham Page

Is the Secretary of State aware that when a number of my constituents offered their voluntary help to the hospital authorities—both district and regional authorities—they were refused? They were turned away, because the authorities said that they had no instructions and no directions. They also applied to the emergency committee, the Government's regional committee, and received the same discouragement. Is there a deliberate refusal of voluntary help because of a fright of the unions?

Mr. Ennals

The work of our hospitals the year round benefits greatly from volunteers, who do an enormous amount that adds to the humanity and warmth of the care of patients. Volunteers are still working in the Health Service. In some situations where there has been a breakdown of emergency services, they have responded to calls to help. I think that whenever a call goes out to volunteers, they will respond. Of course there is no opposition from the Government side to the normal work that volunteers can do in a hospital. What is not right is that they should seek to do professional tasks which are carried out by others in the hospital.

Mr. Buchan

Does my right hon. Friend agree that if society is asserting that certain groups of workers should not come out on strike, society must face that problem and create the wages and conditions under which they are not compelled to come out on strike? Do not two things follow from that? First, the whole country would welcome and accept an immediate substantial payment towards the low-paid public service workers as a means of returning to sanity in the incomes policy position in this country. Secondly, will my right hon. Friend consider the kind of agreement that was made last year with a similar group, the firemen's union, on a link basis, to give us a long-term solution? Will my right hon. Friend try acting on those two propositions?

Mr. Ennals

Certainly this period of industrial dispute and the inevitable damage that it does to the NHS must cause us to reflect on the way in which those who work in the Service can use the strike weapon, or the weapon of industrial action, for the purpose of wage bargain ing. These questions must be reflected upon, perhaps with a little more coolness than we can expect in exchanges across the Floor of the House.

As regards the low-paid, my hon. Friend knows of the initiative taken by the Prime Minister, which is the point from which discussions have proceeded between those working in the NHS, particularly the NHS ancillaries, to see whether we can find a basis of a settlement, recognising the points made by the Prime Minister.

Mr. Raison

Does not the Secretary of State understand that he and he alone is responsible for what happens in the NHS? Does he really contend that throughout the NHS over the last year there has not been a very strong sense of a complete vacuum of leadership, and does not he realise that everything that he has said today reinforces the impression of a vacuum?

Mr. Ennals

It would be extraordinary if we thought of the National Health Service as a sort of one-man band, in which the Secretary of State issued edicts from the Elephant and Castle as to how everything should be run throughout the regional health authorities and the area health authorities. That would be a nonsensical way of handling the Health Service. We have suffered enough from the reorganisation imposed upon the Service by right hon. and hon. Gentlemen opposite, and in the light of that experience we have to reflect pretty clearly on what lessons we can learn from the great damage done to the Service through the management structure imposed on it by the party opposite when in power.

Mr. Grocott

Does my right hon. Friend agree that one surprising benefit derived from the present difficulties is that there is now apparently unanimous agreement in the House that there is only one satisfactory way in which to deal with sick people, and that is by dealing first with those who are most sick, and so on, until we get to the end of the queue? If that is the case, will my right hon. Friend now take the Opposition at face value, if this indicates their conversion to this principle, and introduce legislation, which would have widespread support in the House, to abolish private practice and private medicine?

Mr. Ennals

I must say that I find it very difficult to take the Opposition at their face value. Therefore, it is difficult to proceed on the lines suggested by my hon. Friend.

Mr. William Clark

Is the Minister aware that his statement today will have given no comfort whatever to patients throughout the country—in fact, the very reverse? Will he, when he sees the official trade union leaders, suggest to them that the irresponsible minority, the small commissars throughout the country who are not paying attention to what the official trade union leadership is saying, should have their union cards taken away? Lastly, does the Minister realise that his complacency and sheer incompetence in running the Health Service call for only one thing, his resignation?

Mr. Ennals

That is easy, cheap stuff to throw across the Floor of the House.

I think it is true that the irresponsible minority who have taken action within the Health Service that has gone far beyond the guidelines and advice of their unions have not only endangered patients' welfare but have done great damage to the trade union movement itself. Some of them—I believe that it is a small and irresponsible minority—are challenging both the spirit of caring one for another within British society and the sense of brotherhood that is a basic element of our trade union movement.

Mr. George Rodgers

Does my right hon. Friend agree that the attitude of Opposition Members is in startling contrast to that displayed when the consultants were in dispute with his predecessors in power? Does he also agree that it is enormously difficult for the low-paid workers in the Health Service to get attention focused on their dispute without taking some action that is bound to cause offence and disturbance to some people? Finally, does he agree that in view of the merits and justice of their claim it would be better to settle it earlier rather than later?

Mr. Ennals

Naturally, I should like to see a settlement of this dispute as quickly as possible, and I said in the House the day before yesterday that I do not think—I regret this—that we can expect to see an end of the dispute until there has been a wage settlement, which I hope will be reached as soon as possible.

In answer to the first part of my hon. Friend's question, it is certainly true that there is a striking difference between the attitude taken by the Conservative Party to the action of the doctors, which did very great damage to the Health Service, and the attitude that they are taking now. I believe that we should condemn industrial action that does damage to the Health Service, whether it comes from doctors, nurses or anyone else who works in the Service.

Mr. Patrick Jenkin

Does the right hon. Gentleman recognise that that last statement was totally false? Does he not recollect that both I, on many occasions, and my predecessor the hon. Member for Sutton Coldfield (Mr. Fowler) have repeatedly condemned strikes in the National Health Service wheresoever they occur, and that my hon. Friend's remarks were made with specific reference to the industrial action taken by doctors in 1975? Will the right hon. Gentleman withdraw that last statement, therefore?

Mr. Ennals

I welcome the statement now made by the right hon. Gentleman but if he is going to talk about irresponsible statements, I would refer to a question that was put to my right hon. Friend the Minister of State on Tuesday. I have a very long statement here alleging that I had made some statement in relation to a consultant in Birmingham. That is absolutely irresponsible. I made no statement in relation to the consultant in Birmingham; I simply published a statement that had been issued that day by the area health authority.

Mr. Eldon Griffiths

On a point of order, Mr. Speaker. You will recall saying a few minutes ago that you would take three more questions from either side, and quite rightly you recognised, following those six questions, the spokesman for the Opposition to seek specifically to deal with the matter that the Minister had put before the House. That, of course, was the exercise by you of your discretion, which I think everyone would support. But in those circumstances must it not be right, to protect the balance of the House, that when the spokesman for the Opposition speaks again at the Dispatch Box on a specific matter, he gets a specific answer? He did not get such an answer.

Mr. Speaker

I want to make it clear once again that when I tell the House that I will take two or three questions from either side I always exclude the Opposition Front Bench, because very often I have to call on the spokesman to ask the final question. That custom has now become well established.

Mr. Rost

On a point of order, Mr. Speaker. Hon. Members will have heard the Minister in his opening statement refer specifically to the Trent regional authority as one of the three most seriously affected areas. May I seek your guidance on how an hon. Member representing one of the constituencies in the East Midlands can catch your eye, because I do not think that any of us have been called upon?

Mr. Speaker

The hon. Gentleman knows that it is impossible, whoever sits in this Chair, to call everyone who is affected by the current dispute. It is an impossible position, and all I can do is my best.

Mr. Ian Lloyd

The notice announcing the private notice question that was in the Members' Lobby this afternoon was specific, in that it referred to the term "industrial action". Since the National Health Service is not an industry, and since there is a world of difference between action and obstruction, is there any way in which the House can be defended from this sort of misrepresentation, because clearly what we have been discussing this afternoon is social mutiny?

Mr. Speaker

I think that the hon. Gentleman ought to talk to his hon. Friend who tabled the question.