NATIONAL HEALTH SERVICE

HC Deb 15 March 1979 vol 964 cc707-830

3.55 p.m.

Mr. William Hamilton (Fife, Central)

I am glad that we have this opportunity so early in the proceedings to have a debate on the state of the National Health Service. I wish to make particular reference to the question of nurses' pay.

It is interesting to note that the hon. and gallant Member for Winchester (Rear-Admiral Morgan-Giles), who raised the matter a few minutes ago and complained that we were not to have an opportunity of debating it, has now left. However he may well return. I hope that he takes the opportunity of saying exactly what he and his party will do on this matter.

I take the view that, whatever may be the outcome of current negotiations the basic problem of nurses' pay will remain. We get the services of our nurses on the cheap. I have a deep personal conviction that the nursing profession, above all others—excluding neither the police, the firemen nor the Armed Forces—has been over generations at once the most dedicated and the most exploited profession in our society. Indeed, precisely because of nurses' dedication, Governments of all political persuasions have taken the nurses for granted.

In these troubled industrial times when militancy, bloody-mindedness and sheer bargaining muscle seem to count for more than anything else, the nursing profession, unwilling to be bloody-minded or to strike, shrinks from using whatever industrial muscle it has and relies heavily, indeed almost entirely, on persuading public opinion, the House and the Government of the justice of its cause.

I turn directly to the case. Hon. Members may have seen on television a week or two ago a programme in which appeared the headmaster of a large comprehensive school, a miner, a dustman and a nurse. Figures of weekly wages were put up on the screen. Those involved were cross-examined by an independent tribunal in much the same way as the comparability Commission is to run affairs, we hope, in the near future. According to the programme, the headmaster received £185 a week, the miner £110 a week, the dustman about £70 a week and the nurse £58 a week. Those were gross figures.

The participants were afforded an opportunity, as they were cross-examined, of presenting their cases for increases in emoluments. After those cross-examinations the panel awarded relatively small increases to the headmaster, the miner and the dustman, and a substantial increase, from £58 to £81, to the nurse.

There is a moral to be drawn from that programme. The teachers, the miners and the dustmen may, and do, strike. They are men who belong to powerful trade unions. The nurse in the programme is a young woman. In spite of our equal pay legislation and the law on sexual equality, we still as a nation instinctively assume that female labour should be cheap—or cheaper than male labour.

Some time ago the police force created a great deal of noise. It badgered, indeed almost bullied, Ministers and Parliament. The policemen were helped by their paid hacks in the House, and inevitably by the Tory Opposition. The result was that substantial wage increases were awarded. They were probably merited. In fact, they resulted from an independent inquiry.

The independent inquiry into the nursing profession in 1974 resulted in the Halsbury report. As a result, the nurses were virtually taken off the breadline, I am glad to say, by the Labour Government—inevitably so. What has happened since then? A survey of male nurses took place in 1977. Most male nurses were working in nineteenth-century, dilapidated mental hospitals. I sometimes wonder how we persuaded men to work in those hospitals. That survey of male nurses showed that one in five was getting less than £50 a week. Only one in every 10 of the teachers, post office clerks and prison officers covered in that same survey was on that kind of figure. Indeed, even within the mainly female professions, nurses still suffered in comparison with the rest.

The average nurse in 1977 was earning £52 a week, compared with social workers on £60 a week and primary school teachers on £78 a week. Why should that be so? Why should these relativities be so arranged? Why should this House of Commons, why should public opinion, why should the Government, allow that state of affairs to be tolerated? Who dares assert that a three-year-trained nurse is worth £26 a week less than a primary school teacher, or £8 a week less than a social worker? There is absolutely no reason or justice in that.

We have all, I suppose, been in hospital at one time or another. A good nurse can literally mean the difference between life and death. The Halsbury report noted how the role of the nurse has become progressively more responsible, using procedures and treatments which not many years ago were reserved for doctors. This quotation from Halsbury should be framed and put on the desk of the Secretary of State for Social Services: We regard it as essential that the vocational nature of the job should not lead to undervaluation in financial terms. Yet that is precisely what has happened over generations, and not only over the last few years.

I cannot resist putting on record some more odious but telling comparisons, showing not only what is wrong in relation to the nursing profession but also what is wrong with our society as a whole. I start with the police. A ward sister at the moment starts on £3,324 a year, rising to £4,299. A provincial policeman, not a London policeman, starts at £3,600 a year—about £300 a year more than a ward sister gets. He goes up to £5,700, which is nearly £1,500 a year—£30 a week—more than a ward sister gets.

The London policeman is better off still. From 1 September this year the London policeman will start at £4,569—about £1,200 more than a fully trained ward sister gets. He goes up to £6,669—just about what a Member of Parliament gets—and in addition he has his house and the other usual perks, plus an amount for any increase that there might have been in inflation from September 1978 to September 1979.

A senior nursing officer, the highest grade in the nursing profession, gets a maximum of £5,277—£8 a week less than the village"copper ". It is obscene. A police sergeant in the provinces will get £6,250 a year from 1 September 1979. No nursing personnel anywhere in the National Health Service can go beyond £5,500.

It was reported in the press last week that the right hon. Member for Taunton (Mr. du Cann), who is the chairman of the Tory 1922 Committee, the leader of the Tory Back Benchers, made £1,400,000 by shuffling bits of paper around in the City casino. No nurse, however well-trained, however senior, could earn any-think like that over a career of 50 years. Could our society be more unfair than that?

Mr. Julian Ridsdale (Harwich)

Surely it is not by creating envy between one person and another that we can solve our problems. Surely the hon. Gentleman should apply his mind to how the country can increase its gross national product, and to how the proper incentive can be given to enable more wealth to be produced so that the nurses may be paid more.

Mr. Hamilton

The hon. Gentleman can make his speech in his own way, and I will make my speech in my own way. I have every right to emphasise the inequalities, the injustices and the unfairnesses in our society today in regard to the distribution of wealth.

My party was created in order to challenge the distribution of wealth in our society, and that is what we are doing this afternoon. The debate goes much wider than the emoluments of nurses. It goes much wider than the future of the National Health Service. The National Health Service benefits more than anybody the people who, before it existed, suffered enormously because there was no such service. They are suffering now because we have not the resources to give us the kind of service that we want. As long as this goes on, no individual in this country can claim the right to £1,400,000 of our resources for doing damn all. That is the point I wish to make, and it is very relevant to the debate.

Now that I have been provoked, I will go further. There are other people, worthless individuals, right at the top of the tree in our institutions who have been paid massive increases by my Government each year for doing not very much. Not one of those people is worth anything comparable to a nursing sister or a staff nurse in our hospitals. I hope that this message will get home to the Government, because the Government will be coming forward with proposals to give these annuitants massive increases in the next few months.

Mr. David Waddington (Clitheroe)

Will the hon. Gentleman give way?

Mr. Hamilton

No. I have quite a lot to say, and I shall offend a lot of people before I have finished. I am sorry. I shall get through this speech if it kills me.

I want to outline the present state of play. It is not generally recognised that the present claim of the nurses is part of the April 1978 pay negotiations. It is not well known, either, that the Secretary of State has been in possession of the relevant document since the late summer of 1978.

That April 1978 agreement was in three parts. First, there was to be a 10 per cent. increase for all staff. Secondly, there was to be a phased reduction of hours, from 40 to 37½, by 1981. Thirdly, there was to be the investigation of a payment in compensation for nurses having decided to forgo a productivity bonus scheme on professional and ethical grounds. Those words are not too often used in pay negotiations these days.

In a letter dated 8 May 1978 the Secretary of State told the Whitley Council that he would be very ready to consider such a claim for a compensatory payment. The current offer fails to recognise that the negotiations have been going on for nearly a year. It is no wonder that the nurses are so angry and impatient. The increases recommended by Lord Halsbury in 1974 placed the nurses three-quarters of the way up the pay scale for non-manual women workers. Between May 1974 and April 1978 the average pay for all nurses rose from £39.70 to £66.70 per week—an increase of 65 per cent. In the same period, the increase in wages of those above the nurses on that pay scale was almost 90 per cent.

The average earnings of registered and enrolled nurses in April 1974 was £54 per week. At that time, women primary teachers were earning £86 per week. In 1975, nurses earned £6 per week more than secretaries and shorthand typists—very noble and worthwhile workers. Today the nurses earn £4 a week less than shorthand typists. I have yet to see a shorthand typist who does a more worthwhile job than any nurse but that might be a matter of opinion.

The Manifesto Group of the Parliamentary Labour Party held a meeting last night to discuss these matters. I had intended to quote at length from the document that we agreed, but I shall not do so. In that document, we stated categorically that we do not accept that the present offer—9 per cent. plus £1—is adequate. We do not accept that the offer is enough for a section of the community which has forgone the right to strike. That should have been reflected in the offer. I charge the Government with a complete lack of imagination and generosity in dealing with this worthwhile section of our community. That is what is stated in our document. It is a very good document—I should know because I drew it up.

The nurses should not rely on the Prime Minister's answer to a Conservative Member last week. He said that the offer was generous. However, their present wage is already inadequate and the additional sums of £6 to £8 per week are inadequate, too. The sooner we solve the problem on a permanent basis, the better.

I warned my hon. Friend the Under-Secretary of State for Scotland that I would refer to Scottish matters. The situation in Scotland is not as bad as it has been south of the border, but there are ominous signs that it is becoming worse. NUPE has much to answer for. It has lost a great deal of public support by its activities. [HON. MEMBERS:"Hear, hear ".] Before Opposition Members start crowing they should understand that the union represents low-paid workers—some of whom have been on starvation wages. No sympathy for those workers has come from Conservative Members. I believe that the Tory Party would have loved one or two nice juicy deaths in the Health Service if they could have been laid at the door of NUPE. It would have served their political purposes very well if one or two patients had died in the course of the industrial strikes.

However, NUPE does its case no good at all. Damage can be done to innocent people by this sort of irresponsible—but understandable—action and we should devise machinery to prevent a recurrence. The Manifesto Group statement says as much. We are glad that the Government are attempting an exercise in comparability and we hope that the nurses and the staff side will accept the machinery and that we can move forward from a proper base. But there is no excuse for using the machinery as a reason for trying to palm off the nurses with £1 plus 9 per cent. They deserve much more.

From time to time, hon. Members are faced with conflicting loyalties—to the country, the national interest, their constituencies, their parties and their own individual consciences. Taking all those matters into account, I should like to believe that all hon. Members try to do what they think is right. I have never been surer of anything than that I am right to fight for the nurses. I am sure the public is with the nurses and it behoves the Government to be more generous and imaginative than they have been in the past.

Several Hon. Members

rose—

Mr. Speaker

Before I call the Secretary of State, I should inform the House of the course that I propose to follow in the debate. I intend to call successively those who won places in the ballot and whose names have been put to this debate. That means that three Labour Members will be called first. That will be balanced when the debate is opened to those who were not successful in the ballot, when I shall call three Opposition Members. Thenceforward, the normal course will be followed.

4.17 p.m.

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

I shall intervene briefly and shall not deal with the broader issues of the debate. My right hon. Friend the Minister of State will do that later.

I wish to speak about one issue only—the dispute with ancillary workers and ambulance men. That is not because I am not concerned with many other matters that hon. Members will raise and I am as concerned about the nurses as is my hon. Friend the Member for Fife, Central (Mr. Hamilton).

Three unions have voted to accept the offer made to NHS ancillary staff. I warmly welcome that. However, following on from what my hon. Friend the Member for Fife, Central said, I regret that NUPE has advised its members not only to continue industrial action in the Health Service but to intensify that action. A fair offer has been made and I repeat that there is no prospect of that offer being improved. Nothing will be gained by prolonging the dispute, but a great deal can be lost, by those taking the industrial action, their work mates, and, of course, the patients.

It is high time that the protracted and unnecessary dispute was settled. Yesterday I wrote to the chairmen of the Whitley Councils concerned, asking them to hold immediate meetings of their councils so that decisions may be reached. We are in the eighth week of industrial action in the Health Service. During that time, NHS authorities have acted with remarkable restraint in the face of provocation. It has been open to them to respond to those taking the disruptive action with stronger management measures. But they have generally refrained from doing so because they did not want to prejudice the chances of a settlement, first while the negotiations were in progress and then while the Government's offer was being considered by the union members.

However, during the past 48 hours severe industrial action has broken out in a number of areas, and no one can expect nurses, administrators and doctors to continue to struggle to keep services going while those who turn up for work but take disruptive action get paid fully for doing so. Last week I asked authorities to exercise caution during the period immediately following the declaration of the union votes so that nothing could affect the chances of the unions reaching agreement among themselves. But the situation has now changed somewhat and I have concluded that those NHS authorities which are facing serious industrial action should now, at their discretion, and in the light of local circumstances, respond to it with appropriate management measures.

A particularly serious feature of the action that has broken out this week is that it often consists of all-out strikes. sometimes started without notice and aimed at essential services. This is in disregard of the union's own code of conduct.

If essential services can be maintained only with the help of volunteers, the answer is clear. So far, health authorities have been cautious about accepting offers of help from the public. I have explained to the House several times why I believe that they have been right to do so. They did not want to take action that might precipitate a decline in their relations with employees who were observing the code of conduct, and they were aware that the leaders of the volunteer movement were anxious to avoid conflict with the trade unions that could jeopardise the long-term usefulness of volunteers.

There can, however, be no question of union members disregarding their own code and seeking to prevent essential services from being provided while, at the same time, exercising an effective veto on the use of volunteers. While we are faced with action or threats of action which will prevent essential services from being provided in certain areas, it would be quite wrong to deny members of the public the right to give their services. I have told health authorities which are facing severe industrial action that they may now invite members of the public to work as volunteers in the NHS when that is the only way of keeping essential services going.

I deeply regret that the irresponsible threats and behaviour of a small proportion—and it is only a small proportion—of union members in the NHS makes it necessary for me to make this statement. I sincerely hope that the views of the responsible majority will prevail and that it will not be necessary to call upon the public for its help. If that happens, people should be guided by local publicity in the press and other media which will inform them how to respond. It is, as I have said many times, the task of managements to decide on these issues. If volunteers simply turn up at a hospital, they could make the job of hard-pressed managers that much more difficult.

I should also make clear that in large parts of the country serious industrial action is not occurring. In many areas, particularly in the southern part of Britain, work in the NHS seems to be returning to normal. We must all hope that the irresponsible behaviour of a militant minority in other areas will soon come to an end and that the dispute can be brought to a conclusion.

Mr. Robert Hughes (Aberdeen, North)

My right hon. Friend has mentioned his response in England. Have parallel statements been issued by the Secretaries of State for Scotland and Wales about the NHS in those countries?

Mr. Ennals

Neither of those Secretaries of State has made a parallel statement, but my hon. Friend will have noted the important votes that took place in Edinburgh two or three days ago concerning industrial action there.

Mr. Robin Corbert (Hemel Hempstead)

Will my right hon. Friend make clear whether he has discussed the bones of his statement with the voluntary agen cies which are vitally concerned about the use and relationship of volunteers in the NHS in the long term?

Mr. Ennals

Throughout the past few weeks I have kept in close touch with the volunteer centre and its officers and the voluntary organisations involved in the operation. They have respected the position that I have taken throughout the dispute.

Mr. Timothy Raison (Aylesbury)

It is true that action has, generally, been dying down recently, but can the right hon. Gentleman confirm that there have been signs, not only in Scotland, of an escalation today? Is it fair to say that his statement suggests to local authorities that if they take the view that if those who do only part of their job, rather than the whole job, continue to take that form of industrial action, it will be proper for authorities to send them home and not to pay them?

Mr. Ennals

On the first part of the question, I said in my statement that in a number of places—I shall not run through a list, though I could—there has been an intensification of action in the past 48 hours. I added that in many parts of the country there has been a de-escalation, which I find encouraging. The action that managements take is their responsibility and it would be wrong for me to tell them how to deal with a local management problem. They have to take decisions in the light of what they know of local circumstances and the urgency of being able to sustain services.

4.26 p.m.

Mr. Patrick Jenkin (Wanstead and Woodford)

Like the Secretary of State, I had not intended to intervene in the debate. Like his intervention, mine will be brief, but his important statement calls for an immediate response from the Opposition. I preface it by welcoming the right hon. Gentleman back to the House. He is obviously not fully restored to health yet, and we hope that he soon will be. We are sorry about his recurrent illness.

The Secretary of State made an important statement about the response of management to the escalation of industrial action. My immediate reaction is to say what a pity it is that statement was not made earlier! The right hon. Gentleman cannot seek to pretend that the code of conduct drawn up by the unions at the beginning of the dispute has been observed until only recently. He must know, as we know, that time and again actions took place throughout the country in blatant breach of the code of conduct—even if that code was itself regarded as adequate to ensure emergency care in the NHS.

The intention of the code was to have regard to emergencies, but there have been many serious cases of patients suffering not just temporary but permanent harm from industrial action. The right hon. Gentleman will know of the fights that doctors and nurses have had to have in order to get urgently needed treatment for their patients carried out while industrial action has been taking place.

In our debate on 5 February, I took the right hon. Gentleman to task because in his circular at the beginning of the dispute he appeared to take out of the hands of management the sort of measured response that management have to take in the circumstances that they face. The right hon. Gentleman held to himself the question whether pay should be withheld from those taking industrial action or whether workers should be sent home rather than be allowed to sit about drawing full pay.

That circular did enormous damage, because it undermined the right, indeed the duty, of management to respond appropriately to indusrial action according to local circumstances.

The right hon. Gentleman referred to volunteers. None of my hon. Friends has ever argued that it can be for anyone other than management to decide whether volunteers should be called in. Hundreds of thousands of people were prepared to offer their help to keep going services to patients.

Of course it must be for management, for the authorities, to decide how and in what circumstances to call on the help of volunteers. I regret that there has been what I can only describe as a lamentable feebleness on the part of the Secretary of State in encouraging managements—where the code has been broken and emergency services manifestly nave not been kept going—to call on volunteers.

Mercifully, the Secretary of State has now recognised that that is not an appropriate response to the kind of action that we have been facing over recent months. He now recognises that both on the point of employees of the Health Service who are taking destructive action and on the question of calling in volunteers, we must have a firmer hand and firmer management. My hon. Friend the Member for Reading, South (Dr. Vaughan) will deal with other important issues, particularly the points about nurses' pay raised by the hon. Member for Fife, Central (Mr. Hamilton). All I can say at this stage is that at last the Secretary of State has recognised that he has to take this firmer action if we are to eradicate anarchy from the National Health Service and restore some kind of standard of care for patients.

It has been sad in the extreme to see what has been happening in our hospitals up and down the country over recent months. I have to say with regret that I believe the Secretary of State himself bears a very heavy burden of responsibility for the failure to deal with this more firmly and effectively months ago. We welcome his statement now but oh, it is far too late!

Mr. Ennals

I had almost sat down, until I heard the intervention, but I feel that I ought to comment on two or three of the points that have been made by the right hon. Member for Wanstead and Woodford. He always takes me to task, and he always gets it wrong. He has today as on most of the exchanges, sought to be provocative and virtually has urged me to be provocative. I have refused to respond. If I may deal with the three points he has made—[Interruption.]

Mr. Deputy Speaker (Mr. Oscar Murton)

I am sure that the House would agree that the right hon. Gentleman sought leave to speak again. Is that agreed? That is agreed.

Mr. Ennals

I am grateful to you, Mr. Deputy Speaker, because, with the permission of the House, I will deal with three points. First, I believe that the right hon. Gentleman was quite wrong on the code of conduct that was worked out very rapidly by the four unions at the beginning of the dispute. It has been very widely observed. On a number of occasions in the House I have paid tribute to the way in which the unions have sought to respect the code of conduct and the way in which, when things have gone wrong, they have endeavoured, through the"hot line ", to ensure that the code of conduct was observed. I do not accept what the right hon. Gentleman said. This was one of the reasons for my statement today. Some of the action that is new being taken goes beyond the code of conduct. That was why I thought it was right to respond.

Secondly, the right hon. Gentleman asked why did I not make such a statement earlier. We are now dealing with a situation in which offers were made about five weeks ago, when an agreement had been worked out between Ministers on the one hand and the four general secretaries and negotiators of the four unions on the other. That is now almost five weeks ago. The voting has taken place and it seems to me that this is now a new situation, because it is time that this dispute was ended and the Health Service returned to normal.

When the right hon. Gentleman criticises me for having sought to frustrate the freedom of management, he has it wrong. He knows perfectly well that only in the first two or three days immediately following 22 January—" Demo Day "—I said"Let us see that we have some co- ordinated response ". Within a very few days of that I then said"It is the right of management to decide"and I am certain that that was right. I am sure that those in management would not have wished me to tell them then how they should respond, nor would they wish me to do so at this moment.

Finally, regarding volunteers, the right hon. Gentleman and his right hon. Friend the Leader of the Opposition were virtually calling on the Prime Minister and the Secretary of State to make some national appeal for volunteers, utterly ignoring the basis of agreement that had been hammered out between voluntary organisations and the trade unions, through the volunteer centre, and the code of conduct which had been worked out, while absolutely ignoring the position taken by his right hon. Friend who was the Secretary of State in 1973. I have absolutely respected the views of the voluntary organisations and the code of conduct.

4.35 p.m.

Mr. Laurie Pavitt (Brent, South)

The burden of my contribution to this debate, like that of my hon. Friend the Member for Fife, Central (Mr. Hamilton), will be concerned with the nurses. I only hope that I shall be able to put the case half as ably and efficiently as he has done.

First, I must take up two points made by my right hon. Friend the Secretary of State on ancillary workers. I have no interest to declare as a NUPE member. I am not a sponsored Member but I am proud to be a member of that union, and I echo the point made by my hon. Friend the Member for Fife, Central that too often that which is bad is magnified out of all proportion, and that which is good is not even looked at. I have a great regard for Mr. Alan Fisher. I hope that NUPE will accept the advice that Alan Fisher gave four or five weeks ago and that has been given from the Front Bench this afternoon, namely, speedily to come into line with the other three unions and end the dispute.

I say to my right hon. Friend that the advice given to him by the right hon. Member for Wanstead and Woodford (Mr. Jenkin) was probably the nearest advice to disaster he could have had, because the whole point of action is that it shall be productive and not counterproductive. Had a quick, instant reaction to events occurred, an extremely difficult situation could well have been even more difficult and even more exacerbated.

My second point follows that made by my hon. Friend the Member for Hemel Hempstead (Mr. Corbett). Every hon. Member has received a circular from the main trade unions putting up a code of conduct on the way in which volunteers should be used. I hope that my right hon. Friend will now ensure that that circular is part of the advice that is given when problems of this kind are to be settled at local level, where there is a militant or unacceptable break away from what has been a regional or national responsibility, and that in those cases the people concerned will be fully advised of the code of practice agreed by the responsible trade unions.

Mr. Patrick Jenkin

The hon. Gentleman has referred to the code of voluntary practice. He will be aware that the voluntary bodies have recognised, in the light of recent and indeed earlier events, that the code which was negotiated nearly three years ago is now in need of significant revision. I hope that that will have his support. It will certainly have the support of the Opposition because the code has manifestly shown itself to be inappropriate in the circumstances of the last few months.

Mr. Pavitt

Or inappropriate to other circumstances. I am afraid my time does not permit me to talk about the whole of the reaction over the past years on the voluntary services in the hospital sector of the National Health Service. The right hon. Gentleman is quite correct in indicating that great advances that have been made are of value and the use of volunteers is to be praised in every section where they can be used. But this has to be done with some judicious understanding of the realities of the situation in the hospitals.

I wish to concentrate mainly on the problem of nurses' pay and will start with the old adage that"fine words butter no persnips ". I do not know where we got that motto from. In terms of the slogan of the Royal College of Nursing for its pay claim—" Pay, not peanuts "—I suppose it is equally true to say that the present nurses' pay does not buy very much in terms of peanuts. I challenge my right hon. Friend with the fact that the DHSS, not only under this Government but under all Governments, has believed the same thing—that provided it says the right words, gives the right praise and speaks about the dedication of the people who are concerned in delivering health care, it can forget about the cash. If one makes a comparison with the nurses, precisely the same has happened with medical manpower.

For years Ministers have been saying how marvellous the general practitioner is; he is the bastion of defence against illness in the community, the leader of the local social services care team. But it is not the general practitioner who gets the distinction and merit award; it is the highly specialised consultant. It is about time that we praised the nurses and ancillary workers who are also devoted people. But those words are the height of hypocrisy whilst nurses and ancillary workers are amongst the lowest paid. It is time we put reality behind the praise of the nearly 1 million people working in the National Health Service who do so much for us all. I would class a good general practitioner as equivalent to any consultant in the hospital service and just as worthy of a distinction award. He is worth his weight in gold, and it is time these values were recognised.

I agree with my hon. Friend the Member for Fife, Central, but the Government should not consider the nurses as just a special case. There are many special cases. The nurses are an exceptional case. They are distinct from all other workers with worthy cases which many of us seek to promote. If I am able to carry the House with me in regarding nurses as exceptional and worthy of greater consideration than other special cases, I hope I shall also carry with me the trade union movement. In previous times the TUC has made a declaration that it will not piggyback on a recognised special case in pressing a claim for some other sector. I hope that one result of the recent concordat will be that trade unions will not use this exceptional case as a lever to assist some other sector if we are able at long last to give justice to the nurses and that they will announce this policy.

I claim the exceptional nature of nurses' duties on several grounds. The first ground is that no other work demands so much humanity and dedication. I should like to give a few examples of this. A young student in the second year of her training goes into an intensive care unit. It nearly breaks her heart to see an elderly man thrown on to the floor and brought back to life three or four times in the pursuit of medical knowledge that may eventually save the life of a younger man. What an experience for her to endure at the age of 19 or 20. Then there is the nurse in a hospital for acute chronic illness who has established a good relationship with a patient and has to watch her patient die. All the time she has had to give encouragement and express optimism. She knows that she is fighting a losing battle, and she has to encourage her patient day after day until finally she loses the battle.

It is only the skill of the mental nurse in a locked ward that prevents a riot. A children's nurse has all her maternal instincts aroused. She has to watch the pain of the child and, in the acute stages of illness, she has a relationship with the child hour by hour which makes a demand on her which no other service makes.

The theatre nurse during an operation when life is hanging on a thread stands by all the time giving constant support. The district nurse has to do all that is necessary for elderly and geriatric patients, and that involves great devotion and many arduous jobs within the home setting.

The second count is danger. A generation ago we whispered the word"consumption ". At that time nurses had to take the risk of contracting tuberculosis. The position is precisely the same today with infective hepatitis. I quote the case of a nursing officer at Guy's hospital. In 1969 she was an agency nurse on the renal unit. She caught hepatitis and was away from work for nine months and had to go on social security. She nearly died. Hepatitis was not classified as an industrial disease and only £25 compensation could be claimed under the industrial accident scheme. All nurses on the unit with the exception of three caught the disease. I know the hon. Member for Reading, South (Dr. Vaughan) will be interested in this, as it is his hospital. The House will recall the tragedy at the Edinburgh unit when, again, nurses died.

The standards of care is not all that is at risk on hospital wards. On 29 September at hand-over time a patient went berserk, nearly strangling another patient. It took both shifts to overcome him and remove him to a side ward. Had that happened an hour earlier there would have been on duty only one female enrolled nurse and two students.

The third count is responsibility. I have had the privilege of going round the wards with the consultant and his houseman, and I have watched the ward sister taking responsibility for a good deal of the advice given. I quote the case of a second-year student nurse on an accident and emergency ward, who says: On the night of 29 September I was on duty with a staff nurse on a 30-bedded male accident ward. We had two patients just returned from theatre, one with a transfusion, three others were on head injury observations. One young man, an arm amputee with a fractured leg, fell out of bed and in his confused state was trying to get out of bed all night. Then we had a patient from a mental hospital with a head injury who kept trying to climb over the cot sides of his bed. The staff nurse and I spent the night trying to control this patient. How many people in other jobs would have to cope with problems of that severity?

I quote a similar case of responsibility supplied by a staff nurse: The sister returned, after sick leave, to find she was on a full ward with five totally dependent patients, two terminal, with one auxilliary who usually worked other hours and one voluntary worker. She was also on call for other wards. The ward is a long corridor with single and double rooms off one side only and is not easily managed with a full complement. Patients frequently need two- to four-hourly CDA medication which must be checked by a state registered nurse. Count four is the case made by my hon. Friend the Member for Fife, Central. We are trying to catch up with generations of neglect. All Governments are to blame. They have entirely failed to bring this problem into proper perspective in relation to the requirements of the community.

Dr. M. S. Miller (East Kilbride)

I entirely agree with the categorisation made by my hon. Friend the Member for Brent, South (Mr. Pavitt) of the reasons why he believes that nurses are not a special case but almost a unique case. Does he consider that successive Governments have not gone far enough to remove nursing from the nineteenth century, Florence Nightingale, semi-voluntary aura? Does he agree that Governments have not gone far enough in instituting a nursing career structure in keeping with the professional status a nurse enjoys in these modern times?

Mr. Pavitt

I agree with my hon. Friend. I hope that the structure which will eventually arise from the studies of the Briggs committee on which we both served will help in this regard. To go on patching up time and time again will not help the nurses and we shall leave a headache for whichever party is in power by the end of the year. This time we need a permanent solution. I knew that my hon. Friend the Member for Fife, Central would have many of the facts and figures and that it would not be necessary for me to repeat them. I ask my right hon. Friend the Secretary of State to take note of two or three additional aspects.

First, the nurses are unable to include productivity as an element in their final claim. Such an element is already recognised within the NHS for two groups, namely, ancillary workers and craftsmen, and also ambulance men. In the public services, for local authority workers and craftsmen and some grades of the Civil Service, a productivity claim is possible. The element of productivity in these cases is not a gimmick for finding a way round the percentage formula. In the groups that I have quoted there were productivity agreements long before they became part of the Government's pay strategy. Because of that, the nurses have even more right to extra consideration in any award that is made. They have been missing out for years on an element of pay already secured by many other people.

My second point concerns fringe benefits such as expenses. Nurses have to meet expenses out of an inadequate pay packet. Some nurses who have to run cars because their duties necessitate it receive nothing for doing so because if called in on an emergency they can telephone for a taxi which is paid for by the NHS. If a nurse is called out on a transplant case, for example, and tries to secure a taxi she may find when she gets to hospital that she is not needed after all for it is too late. So she uses her own car. That is a costly journey for her. I cannot understand why my right hon. Friend the Chancellor of the Exchequer does not accept that a nurse's car should rank for a tax allowance as are the cars of those who say that their car is necessary for their work. This problem is even more acute for district nurses.

Community nurses who run their own cars are subsidising the NHS. This is demonstrated by a case discussed at a meeting which I attended. A man was doing 1,000 miles per month in his own car in order to do his job. Thus, he was subsidising the NHS to the tune of £70 per month. In no way can this be regarded as fair and I ask my right hon. Friend to address himself to these two important, though fringe, problems.

It can be seen from the early-day motions which have bombarded the Order Paper that the whole House and the nation are grateful that the nurses, in deciding between patients and pay, have put the patients first. They deserve further praise, not only for putting patients before their pay claim but for their efforts on behalf of the whole profession in many areas of the Service, including recruitment and morale, to ensure that present problems are remedied.

The case made by the Royal College of Nursing in its review of the state of British nursing in 1978 has been quoted from time to time. As standards continue to fall, individual cases can be heartbreaking for those experienced nurses who are working all out to remedy deficiencies in the Service.

An example is a hospital in the Southwestern area, where I am told: Many wards are staffed at night by auxiliaries with one sister to supervise the entire hospital. In this unit the sister acts up for the nursing officer and often, during the afternoon and evening, there have been two nurses for four scattered wards. Many times this has resulted in an elderly patient who has fallen out of bed not being seen or helped for a long period. Due to the shortage of staff patients are not up and ready for physiotherapy, this results in deterioration. Two days ago I had a sad case from my own constituency. A constituent aged 83 went to a local hospital and received the customary, fantastic standard of devotion and care, and returned home. After a month he was admitted to another hospital and during his terminal weeks the account of his experiences reads like something which might have been made into a novel by Charles Dickens. That is not the fault of the nursing profession. It is the result of the inadequate staffing of the Service and of our not giving enough support to the nurses. We are always trying to make do and mend with student nurses, auxiliaries, agency nurses and everybody because we have failed to recruit enough nurses to meet demands.

There is a case to be made for raising the morale of nurses who look after the elderly because there is no greater growth in the NHS than in the geriatric sector. With more nurses, training courses could be given for specialised care of the elderly. Though this is not the occasion for discussing figures, I ask my right hon. Friend to consider a comparison with the doctors' review body and the way in which doctors' pay has worked out in comparison with that of the nurses. I also ask him to ensure that whatever award is made the Government will provide the money. The finest award made to the nurses was the Halsbury award when 30 per cent. was given. But the nurses have now fallen back because the Government, having made that award, allowed themselves to rest on their laurels for the next three years.

Five factors have changed nursing care in the last few years: the Halsbury award, the units of medical time, the regrading of ward orderlies, the institution of extra-statutory days, and the establishment of the family planning service. None of those elements was funded by the Government. That meant that for those improvements—which the Government had decided on—to be brought about, nurses had to be sacked, recruitment cut down and money found from some other major source.

It will be nonsense for the Government to approve the nurses' pay award and not provide the extra money so that it can be paid. Funding this claim requires a Treasury decision. Perhaps we shall have an opportunity during the debate on the Budget to discuss the balance between private and public spending. It is not possible to meet the public expenditure needed for nurses' pay and at the same time to cut taxation with the result- ing loss of revenue. The Chancellor decides for all of us what we shall spend publicly. We decide what we shall spend privately from our own income. I do not seek to interfere with the right of an individual to do what he likes with his own income.

I quote an example of the balance between private and public expenditure in 1978 in the area for which I am seeking help. In the private sector last year £3,925 million was spent on tobacco, £7,570 million on alcoholic drink, and £785 million on betting and gaming. That is a total of £12,280 million. I have no quarrel with that private spending because people may do what they wish with their money. But when I look at public expenditure I see that the whole of the NHS cost £6,730 million, and the whole of our education service £7,853 million—a total of £14,583 million. The Government decide in the Budget whether to spend the same amount on education and health as we spend privately on those three luxuries.

If one asked any mother with a sick child whether she would choose to spend that sum on nursing for her child or in some other way, she would say that she would prefer to pay the nurses more. We do not take that decision. It is a matter for the Chancellor of the Exchequer.

When studying comparability, we must use a peer group. We should choose people who went to school together and achieved the same O-levels and A-levels. There is a difference of £800 a year in the salaries of a senior nursing officer and a librarian who went to the same school and had the same education.

Time is of the essence. A speedy remedy should be found for the charge nurse in King's Lynn who has to live on social security because his own wage cannot keep him and his family. I demand a rephasing from 1 April this year rather than wait to start on 1 August. We must find a permanent solution. A system of six-monthly increments must be built into the comparability standards machinery. I hope that never again shall we have to stand here feeling ashamed of the way a civilised society has behaved and of our own exploitation of the nurses.

5.1 p.m.

Mr. A. W. Stallard (St. Pancras, North)

I intervene with trepidation since I have been absent from the Back Benches for a considerable period of time. Both my hon. Friends the Members for Brent, South (Mr. Pavitt) and Fife, Central (Mr. Hamilton) are well known experts about the Health Service and nurses' pay. For those reasons, I feel a little inadequate. But I know that my passionate belief in the concept of the National Health Service, which is shared by millions, will be sufficient to see me through the ordeal.

I confess that I am horrified at the state of the National Health Service and the way in which it appears to be being eroded. It cannot be denied that the National Health Service is seriously ill. An eminent professor wrote in a recent article: At the age of 30 most people know what they want to do in life and are safely on the ladder of a career, and yet at 31 the National Health Service is in such a state that it might just have started. That is not pleasant to hear from an eminent professor who works every day in the NHS.

A recent editorial in the British Medical Journal stated: Most of the problems of the National Health Service are commonly attributed to lack of money.

Dr. M. S. Miller

Does my hon. Friend agree that it would be terrible if a doctor said to a patient of 30 or 31 years of age,"My God, you look terribly ill "? Surely the doctor should give the patient some encouragement. The analogy is that people should not knock the National Health Service and look only for the bad. They should give the Service encouragement to get better.

Mr. Stallard

I agree. I hope that I shall give some encouragement in my remarks. It is not my intention to knock the Health Service. I believe in it passionately and I intend to ensure that it continues and improves. It is sad that the National Health Service is knocked but it is knocked mainly by people who do not want it. I am in a privileged position. I can criticise it constructively in the knowledge that I wish it to continue.

The shortage of money is not all that is wrong with the Health Service, although much that is wrong can be attributed to a lack of resources. The current industrial unrest in the Health Service is about much more than money, although the money aspects receive much publicity. The unrest is partly because the thousands of workers in the Service are frustrated because they can see the Service being eroded. The turmoil in the Health Service can be traced back to many ills. I shall outline some of the factors which contribute to the turmoil.

There is a loss of morale. This loss of morale comes through when I speak to people who work in the Health Service. The frustration is, perhaps, due to the number of reorganisations that have taken place, both from within and without the Service. The Service does not seem to have been settled for many years. People feel the uncertainty. The constant reorganisation has resulted in a loss of direction and purpose.

We have made leaps forward in recent years in terms of medical therapeutics, but medical management has become worse. Extortionate prices are charged for drugs. That could never have been envisaged by the pioneers of the service, such as Nye Bevan or Beveridge. The present over-administration is due to the constant reorganisations in the National Health Service as well as in the local authorities. The increased number of administrators has made the Service faceless and depersonalised. That must be taken into account.

There is much frustration among the doctors, nurses, ancillary workers, craftsmen and others who work in the hospitals. The frustration has resulted in a frightening growth of militancy among all those workers. We do not appear to have an answer to that militancy. Fine speeches, statements and chat across the Chamber on party political lines do not help. That is not the solution. We must probe more deeply and radically than we can in today's short debate.

Organisation is a key factor in the ills that beset the Health Service. Clearly we have not got it right yet, at any level, and certainly not at local level. Ordinary people can be forgiven if they have the impression that hospitals and the Health Service exist more and more for administrators and less and less for patients and staff. We should correct that. I hope that the Minister will say something about it.

I have mentioned the lack of money and resources, which is serious. I firmly believe that, though we need more money, we also need some rethinking on the re-allocation of existing funds. Someone suggested that hospitals could be funded on a quinquennial basis rather than on an annual basis, which would, perhaps, enable the hospitals to budget, spend or save on a five-year programme. That would certainly be an advantage over the present 12-month period that is taken to discuss the matter, by which time, of course, we are into next year's argument. That might be a way of improving the allocation of resources.

Another suggestion which I have made—which never seems to get further—is for national funding, or cross-regional funding, of some of the services. Consideration of that is long overdue. It should not be rejected, as it has been over many years by all those administrators and civil servants who appear to be running the Health Service from that white elephant at Elephant and Castle. Incidentally, if we are talking about resources and their allocation, perhaps we could look at that monstrosity, Alexander Fleming House, if we want an example of bad management and bad spending.

I was distressed recently when the spokesman for the Government Department concerned refused national funding for a service in which I have a special interest—namely the detoxification centre that was to be set up in South-East London. Suddenly, with no warning, the proposal to fund that service from national resources was withdrawn. In my view it is perfectly reasonable to suggest that alcoholism is not a local complaint and that patients are not from any one locality. Patients come from all areas to such a detoxification centre. Therefore, there must be some national funding or, at least, cross-regional funding for such special services.

I could mention other services, such as the kidney unit in Hammersmith, which recently had to rely on private donations to keep going. That is a disgraceful state of affairs. I could mention the heart transplant units in other areas. I intend—as does my hon. Friend the Member for Holborn and St. Pancras, South (Mrs. Jeger)—to mention the special service for women at the Elizabeth Garrett Anderson hospital. Many of the patients of that hospital clearly come from an area much wider than the immediate locality. There is, therefore, an argument for cross-regional funding for that kind of service. It ought not to be difficult, because it already happens with the social services, and is now being discussed in the Education Bill Committee.

There seems to be no reason why we cannot look at these services on a national basis where they exist, and give support from national funds. If that can be broken down into regions, one area health authority or region should be able to pay on a per capita basis for the services provided. That does not seem to be as far-fetched as I am always told whenever I raise the matter in other circles. I hope that that alternative funding arrangement can still be discussed and not swept under the miles and miles of carpet down at the Elephant and Castle. Who knows what else is underneath those carpets?

I should like to outline some of the immediate problems linked to the question of money and pay facing the National Health Service. One of the matters I should like to draw attention to is hospital closures, paying particular reference to the closure of the Elizabeth Garrett Anderson hospital. I was only too pleased to co-operate with my colleagues from Camden on both sides of the Chamber—including my hon. Friend the Member for Holborn and St. Pancras, South and the hon. Member for Hampstead (Mr. Finsberg)—who have argued, battled and fought to retain this hospital over the years since it was threatened with closure.

Other right hon. and hon. Members will no doubt speak about hospital closures in their own constituencies, because there is hardly an area which has not been touched by this disease. However, I shall talk about the one that affects my constituents. This battle has raged between the faceless wonders at SE1 who direct the Secretary of State and the rest of us—and I can say"the rest of us"with confidence. I am sure that everyone will know that the main political parties inside and outside the House with whom I have had any contact support this hospital and the concept of what it stands for.

The trade unions involved at local, regional and national level support this hospital and what it stands for. The entire staff, and the staff of the other establishments to which the Secretary of State hoped he could move the staff of this hospital, support the Elizabeth Garrett Anderson hospital. Thousands of individuals from all over the country and from abroad support this hospital. We have had letters from America and Japan about it. My hon. Friend the Member for Holborn and St. Pancras, South has had literally thousands of letters of support for the maintenance of this hospital as a woman-to-woman service.

Patients—not just present patients but previous patients and those who would like to be patients in the future should the need arise—write regularly and express the hope that the hospital will be allowed to remain. The hospital is so famous and well known that women's organisations all over the country are supporting a campaign for its retention. Both of the local community health councils are on record as supporting its retention. If the Secretary of State and the Department could agree to some alternative funding arrangement along the lines that I have suggested, the area health authority would also wish to see the retention of this hospital in its present location. The only reason the area health authority is regrettably unable to give 100 per cent. support is to do with funding.

I can say, therefore, that it is the Secretary of State and his Department against all of us. They seem determined to close this hospital. I do not apologise for taking time on this, because I feel that I have been thwarted for a long time on the issue. For the benefit of those who may not have fully understood what it is all about, I shall say something about the hospital's history.

The EGA hospital, as it is known, grew from a small dispensary in Marylebone set up by Dr. Elizabeth Garrett—as she then was—in the 1860s, to offer medical care to needy women. It moved to its present, specially chosen, site in the Euston Road in the 1870s. The site was specially chosen for the obvious reason that it is near all the main line stations and everybody from anywhere could easily get to it. One can walk to the hospital from any of the mainline stations, tube stations or buses. It is a level walk so there are no problems for women with prams, taking children to the hospital. It was, and is, an ideal site for such a hospital. The generosity of British and American women ensured that the freehold of the site was bought. A further freehold site in Barnet was donated for pre-convalescent patients and another freehold property in Belsize Park was bought for use as a maternity home.

A great deal of satisfaction was derived from working in the kind of unit that became established at the Elizabeth Garrett Anderson hospital. This happy state of affairs even continued for 20 years after the inception of the NHS in 1948, when the hospital voluntarily joined the NHS. I say"voluntarily ", because like the Masonic hospital or the Manor House trade union hospital, the EGA could have remained independent. But it did not. It voluntarily handed over all its property, and such money as it had, in good faith, in return for what seemed to be an assurance that it would be allowed to carry on its work.

I do not think that was an unreasonable assumption to make at that time. However, we came to the advent of the"big is good, small is bad"syndrome. Unfortunately, the Department is still in that state of mind. Most people—thankfully—are beginning to join those of us who never joined that school of thought. Many of us did not believe in the concept of tall blocks of flats, huge blocks of offices or everything on a massive scale. That was why we opposed the reorganisation of local government, along with the disappearance of places such as St. Pancras, and the reorganisation of the NHS.

There were many people—but not enough—who never joined that kind of outfit. Unfortunately those who joined were in the places of most authority. Many seemed to be in the DHSS, because it has always believed that to be bigger and bigger is better. It therefore went for these huge hospital complexes, in spite of the doubt among ordinary folk about the facilities provided at such complexes.

It was the advent of that concept in the 1960s—I was there, and I remember it—that dominated the Department's thinking. It was, therefore, decided at that early stage that the Elizabeth Garrett Anderson hospital was too small and would never fit into the concept of huge, rambling hospitals which covered acres of ground. The Department took the view that there was no place in such a concept for this well-loved, delightfully run hospital, and it therefore decided that it would have to go.

It was realised that there would be a riot if it was closed. We come to what can best be described as a conspiracy. It was not something new, because even now it is happening all over the place. I refer to the idea that, if one wants to close down something, one literally runs it down, denudes it of all its services and reaches the point where one can ask"What good is this place? It is useless. Therefore, we shall have to close it."

That is a tactic which, unfortunately, has been used by all Governments and local authorities to establish what they could not establish in a straightforward manner. Unfortunately, that has happened at the Elizabeth Garrett Anderson hospital. Maintenance and repair work was cut down, and the hospital began to look shabby and run down. New consulting staff were offered locum appointments rather than permanent appointments. In 1972, the convalescent home was taken away, ostensibly for the health needs of Barnet. It remained unused for six years.

Later, the nurse training school lost recognition by the Royal College of Nursing, not because the training was below standard but because it was not required for the area's training needs. Some people objected, and some of us issued a minority report at the time. However, the local area health authority did not object because, we were led to believe, it looked upon this as part of the rundown process. Perhaps the local AHA initiated it to prove that, later on, the hospital could be closed. As a consequence of losing that facility, the same AHA was able to announce a short time later that the replacement of trainee staff by trained staff would make the hospital too expensive and that as a result it would have to be closed.

That is a short version of the kind of deliberate rundown that took place at the Elizabeth Garrett Anderson hospital. Once the AHA got to that point—having engineered the whole thing—the Department was able to say"It is useless. It does not function. It is too expensive, it cannot be made to work. Therefore, it will have to close ".

That was when the gauntlet was thrown down. As I have said, it was readily taken up by thousands of people who saw through that scheme right from the beginning and were determined, and still are, that that hospital shall remain a viable hospital in Euston Road.

An action committee was set up. That in itself was unique in medical history, because literally everyone in the hospital served on it—everyone from the consultants down to the ancillary staff. That does not often happen. There was unanimity throughout the hospital, as well as among the general public. After 15 months of expert agitation, the then Secretary of State decided in February 1976: that the present hospital building on its convenient site should be sold ". Although she still maintained that it should be sold, she added: its functions should be relocated in a district general hospital in the same area ". In other words, the Department was determined to retrieve some part of its original decision. After all, civil servants at that level must never be seen to be changing their minds or admitting that they are wrong. Therefore, the Department decided to retrieve as much of the original decision in the hope that everyone would get fed up and that it would get the whole lot. It still had in mind that it would close the hospital. But the Secretary of State said that, provided it could be relocated in the same area, it could remain an identifiable unit.

Yet, before any discussions could take place—this is another interesting part of the saga that is not peculiar to this hospital—and almost immediately after the Secretary of State's statement, the main lift shaft serving the operating suite was inspected by the AHA and an exceedingly dangerous state of affairs was discovered. Of course, all operations at the hospital had to stop. Naturally, if there were dangers in the lift, no one would argue that operations should continue. Until then there had been 10 operating sessions a week.

It is strange that at that point, almost immediately before the ink was dry on the Secretary of State's statement, this inspection was made. A few months earlier a pathologist, who was inspecting the water supply, noticed something wrong with the lift and reported it immediately. Nothing happened. There was no inspection, presumably because it was thought"Do not let us bother with that. If it packs in, well and good. It means that something else has gone." It is strange that immediately the Secretary of State made her statement this inspection took place and the lift was taken out of service.

Surgical work had to go on. It cannot be stopped overnight. Pending the expected, and virtually promised, repairs to the lift—at that time it was estimated that the repairs would take six months-hospitality was kindly offered for surgical cases in the nearby homeopathic hospital. But that could continue only until June 1976 after which all obstetric and surgical work was to be carried out at the Whittington hospital by courtesy of its staff, leaving out-patients and medical inpatients in the main hospital. The other freehold property that has been owned by the Elizabeth Garrett Anderson hospital in Belsize Park was then closed because more services had been taken away and the attitude was that the premises in Belsize Park were not needed. Until a few months ago, when I last checked, it was inhabited by squatters. That is the sad sorry tale of how to run down a hospital and smash a perfectly good service in the process.

The total number of beds available to the EGA throughout this temporary arrangement was 75 compared with 157 beds that existed in 1972. Everything, including operating, was severely curtailed. The hospital staff were forced into the vexatious situation in which they now operate on three different sites, one in Euston Road and two four miles away on the other side of Highgate Road, with all the problems involved in trying to keep track of patients' records, X-rays and visiting, let alone the difficulties for patients and their visitors and relatives. The four miles between the separated hospitals carry probably the heaviest traffic in Britain. It is a crazy scheme. It was a further blow when the expected repair of the lift was finally cancelled. It is still out of action and has not been repaired. A certain amount of scaffolding had to be erected which made the place look shabby and rundown and contributed towards the idea that the hospital would have to be closed.

Further moves have taken place at Whittington. But the staff and action committee demanded that before any interim or long-term closure or change of use occurred, the area authority and the Department should embark on a proper consultative process. They were sick and tired of the shilly-shallying, the pushing around and the shoving around, and suggested that matters should be brought into the open through the proper consultative process with a properly drawn up consultative document. The consultative process should have started when the closure was first envisaged. Instead, it was started when the matter was almost a fait accompli, making the issue much more difficult for people who were not directly involved to understand. Those people might ask"What is the EGA?"They might go and see this shabby, rundown building, with its scaffolding, and say"My goodness, that will fall down if nothing is done soon."

I am trying to put the matter in its proper perspective. As recently as yesterday, we had still not been able to get permission to repair the lift, although on that day my colleagues and myself were able to present to the Secretary of State a firm proposal for repairs using private money. We are not asking the Government for money. Money would be donated voluntarily by people who understood that there might be no return in getting the lift back in temporary use. The work would take four to six weeks and the repairs could last for up to five years. Even yesterday the Government were not able to give a decision for the work to go ahead. When the matter was last raised we were told that it was difficult to use private money in National Health Service hospitals because it was an assault on National Health Service property.

We were able to point to precedents. A hospital was recently saved in Newcastle because local doctors, the public and organisations rallied round and contributed £20,000 to build a lift, not repair one. An agreement was reached, with no inhibitions, to use the money. Why cannot the same attitude be taken about a hospital in the heart of the metropolis? I have mentioned the kidney unit at Hammersmith. A recent reply by the Secretary of State points out that this hospital has used private donations and subscriptions to keep the unit going.

The discussions that have taken place, certainly at regional level, were a travesty. There was only one debate at regional level. If there was time, I could outline what happened. It was the lowest level debate that ever took place on any issue, let alone the closing of a hospital. At that meeting, however, the decision was taken to close the hospital. The Secretary of State afterwards gave 21 July 1978 as the closing date. That was to be final. No doubt everyone in Alexander Fleming House rubbed their hands with glee and said"My goodness, it has been a long haul. It has taken 10, 12 or 14 years to close that place, but at last we have managed it. The hospital is finished. There is a party in my room tonight. Bring your own wine and cheese." They reckoned without the House of Commons.

Because of the efforts of my hon. Friends, including my hon. Friend the Member for Holborn and St. Pancras, South, hon. Members opposite, and noble Friends in another place, a number of debates have taken place to draw attention to the amount of support for this hospital and the special place that it occupies in the Health Service.

Following those debates and the pressure that was aroused—even after the final date had been set and the party held—the same Secretary of State, a month later, was able to say that the closure date had been removed, that the hospital would not close on that date and that another working party would be set up. I understand that the working party is to report soon but that the alternative at which it looked is worse than the present building, even with the scaffolding. The Secretary of State will obviously, I hope, have to think again about the terms of reference and look for further alternatives for this working party to examine.

Mrs. Lena Jeger (Holborn and St. Pancras, South)

The hospital can be left where it is.

Mr. Stallard

I am pleased to corroborate what my hon. Friend has said. The only solution for the Elizabeth Garrett Anderson hospital is to leave it where it is in Euston Road, to refurbish it and bring it up to date, and to establish a closer link with University College hospital across the road.

If one wants an example of Alice-in-Wonderland economics, one should com- pare the closing of the EGA hospital, which at one time had 157 beds, while positive plans are being discussed at the same time to build a brand new unit for the University College hospital for 150 beds. I do not understand that. It is no good saying that University College hospital is a teaching hospital and that different standards apply. Beds are beds. It does not matter whether 150 beds are on this side of the road or directly opposite. One does not even have to catch a bus. The hospitals are so close that one could fall out of one bed and into another.

It is proposed to close the EGA because it is uneconomic. It already contains beds. With some refurbishing and a minimum amount of spending, it could be brought up to standard. The plan however, is to build a brand new unit across the road. There is bound to be an official explanation that fools everyone except ordinary people. Perhaps we will hear it later.

I have spent some considerable time discussing the Elizabeth Garrett Anderson hospital. I entered this ballot on the Consolidated Fund debate today deliberately to do just that. No one involved in this matter needs to apologise if we take a few minutes. I have made some suggestions on hospital closures, although I have only dealt with one. I hope that my hon. Friends will deal with others because there are some which are just as serious which I should have liked to mention.

I should be overstaying my welcome if I were to make the speech that I had prepared on nurses' pay. Suffice it to say that the fact that I do not make that speech does not detract from my interest in and feeling about nurses' pay, which is the crux of the whole issue. Over the years we have expected loyalty of our nurses, and we have exploited their loyalty to the NHS. We have expected far too much of them. What we have done is nothing short of a scandal.

My hon. Friend the Member for Brent, South spoke in his usual elegant style. He is an expert on the nursing profession and its difficulties. He outlined some of the crazy comparisons that may be made. It is all very well to say that no solution will be found by comparing one with another. That is true. I do not think we shall find a solution merely by adopting that approach. However, to reject such comparisons means that we reject comparability studies. The essence of a comparability study is to compare one with another and to examine relativities.

I am constantly being asked"Is it right that a person whose only skill is putting on gramophone records, or making noises on a loud electronic gimmick, should be able to amass a great fortune in a short time, whereas trained nurses, who are devoted and spend years in training, receive such poor pay?"I know of a nursing officer who has responsibility for a group of wards. In some instances nursing officers run small hospitals. She has received all the necessary training. She spent two years as a staff nurse and served three or four years in an assistant capacity. She takes home £51.20 a week. How can we justify that?

That sort of pay goes right down the line. A ward sister takes home £45 a week. A district nurse—these are not my figures but those of the Royal College of Nursing—takes home £45.20. A staff nurse receives £37, an enrolled nurse £34 and a student nurse £31. No wonder we cannot get nurses. No wonder the service is being starved. Surely our whole approach is wrong. We should be offering encouragement and incentives. We should not be encouraging people to learn how to operate gramophones and other such gadgets. Those who do so put many of us into hospital, where we find that there are no nurses to treat us.

Nurses' pay and our approach to it has been wrong for years. Certainly it has been wrong for the past 20 or 30 years. The Halsbury award was the biggest and most welcome step forward in nurses' pay. It delighted my hon. Friends and me. We were able to boast that it was naturally a Labour Government that introduced the study that resulted in the award. However, we have let that progress slip. We have returned to pre-Halsbury days. That is what my hon. Friends and I are angry about. We want to continue the progress that was made with the introduction of the Halsbury award.

It is not good enough to say that it was accepted that the nurses were a special case in 1978 and to relate that special agreement and special case to the 1979 situation. Let us back-date to 1978 on the basis of the Halsbury award and make some sense of nurses' pay, That would be a reasonable solution to the problem faced by our nurses.

I am happy to stand alongside those who will not rest until the nursing profession is given its rightful due. That does not mean an annual ramsammy, with demonstrations and marches. That is the degrading and undignified approach into which we have pushed our nurses in the process of wage bargaining. We should not treat nurses and others who are dedicated and devoted in that way. Let us ensure that we get nurses' pay on the right lines once and for all and never again let it slip.

5.45 p.m.

Mr. Geoffrey Finsberg (Hampstead)

The references in some speeches to the shortness of the debate were somewhat unclear. To the best of my knowledge, we have at least until 10 o'clock tomorrow morning for the Consolidated Fund Bill debate. I do not propose to restrict myself, and I suggest that other hon. Members should not take any self-denying ordinance.

I welcome the belated but strong words of the Secretary of State. I echo the comment that we are glad that the Secretary of State was able to be with us. We hope that it will not be long before he is relieved of what is obvious pain. I add one comment. I hope that the unions will ensure that their members act in accordance with and not in breach of their rules and codes of practice. It is all very well to have codes of practice. We all welcome them. However, if unions are not prepared to ensure that their members follow them through, the unions must take the consequences. They must realise that there is a procedure in most union rules providing for branching when members disregard the instructions of their union.

As always, the hon. Member for Brent, South (Mr. Pavitt) deserved to be listened to because of the moderate language that he uses on these subjects that move all of us. That moderate language is much more likely to be listened to and to be found more convincing than the speech of the hon. Member for Fife, Central (Mr. Hamilton).

I take up the remarks of the hon. Member for St. Pancras, North (Mr. Stallard). I shall confirm many of his comments on the Elizabeth Garrett Anderson hospital. The hon. Gentleman presented a most carefully reasoned case. I hope that the Minister of State, who has been subjected to a meeting on at least one occasion with the three Members of Parliament who represent the Camden area, will not think that a happy reply at the end of the debate will be the end of the saga. It will not be the end unless he is able to give us a satisfactory answer.

I am certain that the hon. Member for Fife, Central had the courtesy to tell my right hon. Friend the Member for Taun-ton (Mr. du Cann) that he would use gutter language in talking about him. The nurses I have spoken to over the past weeks have given me the impression that they do not want their case to be advanced by the hon. Gentleman with the language that he used today. That is the only comment I want to make about his speech.

Mr. William Hamilton

rose—

Mr. Finsberg

I shall give way to the hon. Gentleman very shortly. Unlike the hon. Gentleman, who did not give way when another hon. Member wished to interrupt him, I shall give way. I hope that those who want to ascertain the facts surrounding the nurses' case will pay more attention to the speech of the hon. Member for Brent, South.

Mr. William Hamilton

The nurses have applauded what I have been doing on their behalf over the years. I notified the right hon. Member for Taunton (Mr. du Cann) that I would refer to him. Probably the right hon. Gentleman is in the City making more cash.

Mr. Finsberg

That is typical of the snide remarks that the hon. Gentleman makes. I shall waste no further time—I trust that the House will not—on any remark that he had to make, except to acknowledge that it is correct that he has always fought hard for nurses. However, he spoils the case by the language that he uses from time to time.

Mr. Pavitt

rose—

Mr. Finsberg:

No. With great respect, I shall not give way to the hon. Gentleman. I was complimentary about him and there is no tradition of giving way when one has been complimentary.

I do not believe that there is an hon. Member who fails to sympathise with and understand the case that is put in the House for the nurses. It seems unbelievable that any Government can fail to honour last year's settlement and make an offer this year in such unfeeling terms. Surely no one can doubt that the nurses have a special case. If it is described in the words of the hon. Member for Brent, South as an"exceptional case"or as a special case, I am sure that every hon. Member recognises that it is a just case. We should honour the silent vigil of the Royal College of Nursing. It may even move the heart of the Department of Health and Social Security. Not much else seems to have moved it so far.

The Royal College of Nursing has said firmly that it is not—

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

I am grateful for the support of the hon. Member for Hampstead (Mr. Finsberg) on nurses' pay. But where would his party find the money, given that his right hon. and learned Friend the Shadow Chancellor is always urging us to cut public expenditure?

Mr. Finsberg

The right hon. Gentleman will doubtless put his case, and my right hon. Friend will put ours. The money might be obtained by cutting down the waste in the National Enterprise Board and elsewhere, which would save money that could be better used, and also about £25 million which is being filched from the National Health Service by cutting out private beds.

The Royal College of Nursing has been demonstrating the dedication of the profession, but that must not be taken advantage of by this Government in their so far unacceptable pay offers. I hope that nurses represented by other unions will follow the example of the Royal College of Nursing, and that the Government will decide to deal with the nurses as a special case. They should prove that there is no need to strike and cause distress to patients in order to achieve proper recognition and reward.

Like the hon. Member for St. Pancras, North, I feel that there is another issue that should be raised and that is the closure of hospitals. I refer specifically to hospital closures in the London borough of Camden. All three Camden Members are present and hope, Mr. Deputy Speaker, to catch your eye. They are united as never before on the issue—a most unlikely event that will probably never be repeated.

The hon. Member for Holborn and St. Pancras, South (Mrs. Jeger) has been a leading campaigner to keep the Elizabeth Garrett Anderson hospital open, and I am sorry that she is not standing for re-election. There is another hospital close to her heart, and I shall not steal her words in relation to this hospital, although I am afraid that many of her words on the EGA will be used by her right hon. Friend and myself. There are rumours that the office at the Elephant and Castle would like to close the Royal Homoeopathic hospital. Attacks have been made not merely on the hospital but on the practice of homoeopathic medicine. In the end Parliament will decide, and Ministers must recognise that on that issue there are voices in Parliament that cut across party boundaries.

Ove 140 right hon. and hon. Members have signed the early-day motion on the EGA tabled by the hon. Member for Holborn and St. Pancras, South and seconded by me. It is fairly strong stuff for such a substantial number of people to sign without a massive lobbying campaign, and had we wanted we could have had such a campaign. We had hoped that the pledge given by the right hon. Lady the Member for Blackburn (Mrs. Castle) that the hospital could be repositioned in a district hospital in the same area would be fulfilled. Without that, anyone with honour would assume that the process would be stopped and money would be spent on the EGA on its present highly acceptable site.

The history has been rehearsed by the hon. Member for St. Pancras, North. Women had to fight hard to join the medical profession. When they did, they became available for women who wanted treatment from other women. The EGA was an early result of that campaign, and there is as much need as ever for these special hospitals. The Minister has totally ignored the fact that we have a growing immigrant population. I have a substantial number of immigrants in my constituency, as have many London Members. Many women constituents who come to me are strict Muslims and do not want to be treated by men. If they go to a hospital they may be able to see a female gynaecologist, but if they have a related cardiac or psychiatric problem, how certain can they be at any of our superb district general hospitals of those three specialties being performed by a woman? That does not exist, but at the EGA it existed in full measure before the death of a thousand cuts started.

The area and regional authorities and the Department of Health and Social Security find it inconvenient for the EGA to exist. To echo the words of the hon. Member for St. Pancras, North, a conspiracy exists to allow it to decay and finally to close. The community health councils have played an honourable part and tried to prevent the closure, but full nursing training was withdrawn because it was said that there was not wide enough experience available. But wards had already been closed because of a faulty lift and unsafe wiring, so there was not the breadth of experience needed, which must be evident to everyone but the Elephant and Castle. From then until now there has been little help from the DHSS. The closure was partly postponed while the Department set up a working party, and certain parliamentary tactics had to be used to force the Secretary of State on one occasion to come to the House to make the position clear.

As late as yesterday volunteers offered to pay for the restoration of the lift service, and when we saw the Secretary of State he did not undertake that his right hon. Friend would give a favourable answer tonight that these volunteers would be allowed to spend money on a National Health Service hospital. He said that he would consider the matter and speak to his right hon. Friend. If there are volunteers charitable enough to spend £6,000 or £8,000 restoring a lift, knowing that the hospital is threatened with closure and that the work can be done in four to six weeks by qualified engineers, it should not need a great deal of thought for even this Administration's officials to advise the right hon. Gentleman that he can safely go ahead without adding to public expenditure or jeopardising other Health Service expenditure. I hope, with a certain degree of confidence, that we shall get the right answer from the Minister tonight. There is a precedent for private money being spent on a National Health Service hospital in the North-East of England.

There is a clear need for special beds for women. The Kensington, Chelsea and Westminster area health authority is proposing to close 24 beds in the hospital for women in Soho. Members of Parliament in the locality received a circular on 28 November, and I was asked for my views.

It said: I enclose a copy of a consultation document approved by my Authority and being given wide circulation under the terms of HSC(IS)207 on the closure or change of use of health facilities. It went on to say: The document deals with the circumstances which make it necessary to seek to close 24 gynaecology and radio-therapy beds in the Hospital for Women, Soho. I sent my comments on this matter to the area administrator. I said on 5 January: I refer to your consultative document on the Hospital for Women in Soho. Provided that resources are transferred so as to ensure the retention of the Elizabeth Garrett Anderson hospital on its present site I see no objection to your proposals. Since that date there has been a deathly silence from the Kensington, Chelsea and Westminster area health authority on that subject. The latest nasty saga repeats so much of the history of the Elizabeth Garrett Anderson hospital.

I turn now to the third hospital, St. Columba's, which is a long-established terminal hospital in my constituency. In a letter to our excellent local paper, the vicar of the Hampstead parish church, with whom I do not always agree but who always writes a splendid letter, said: As a Chaplain to the Marie Curie Edenhall Nursing Home in Hampstead I am acutely aware of the value of the magnificent continuing care afforded by Hospices and Hospitals like St. Columba's. There are all too few of them. As the Archbishop of Canterbury said recently when he stressed the urgent need for more of such Hospices, such institutions help to reverse the unfortunate trend in recent years to institutionalize medical care and dying. There is great need to enable those at home to offer the care that they can give and wish to give. These are institutions specially designed for terminal cases, where technical skills are married to deep but non-sentimental compassion and where arrangements are such that there is time for a loving relationship to be built up between patient and doctor and between patient and nurse. That is a factor that does not fit into the statistics of the Kensington, Chelsea and Westminster area health authority. I should add that this hospital has private funds of £150,000 which are in the care of the Kensington, Chelsea and Westminster AHA.

When the reorganisation took place—and I am not entering into that argument—St. Columba's hospital, which was originally located at Swiss Cottage, moved, because of the new civic centre, to the Spaniards in Hampstead. It was given to Kensington, Chelsea and Westminster instead of to the local area of Camden and Islington, where logically it would fit. In this case the logic of the Department does not seem to have worked.

Fairly soon after the NHS reorganisation, Camden and Islington AHA asked Kensington, Chelsea and Westminster to agree to the transfer of this hospital from one authority to the other. Kensington, Chelsea and Westminster agreed. However, big brother in the form of the North-West regional health authority stepped in and said"No ". To this day it has given no reason for that decision. I can only suppose that someone did not want to lose part of his empire. The transfer would have solved many of the problems and local people would have known what was happening.

I come to the next stage of this saga. I was suddenly telephoned by a member of the staff to be told that the area health administrator had instructed the hospital to stop admissions. I then did something that is totally alien to my nature. I am a square, and I believe very strictly in following both the letter and intention of the law. However, I told the staff to take no notice of the instruction until it was confirmed in writing—a thing which the bureaucrats love to do anyway.

I was told this at the beginning of March. The staff were first informed of this possibility on 15 February by the AHA. To this day the Kensington, Chelsea and Westminster area health authority has not had the common decency, good manners, courtesy or common sense to advise any of the local Members of Parliament in writing of its intentions. This is treating Members of the House with utter contempt. When the hon. Member for St. Pancras, North and I saw the chairman of Kensington, Chelsea and Westminster AHA, Dr John Dunwoody, we told him exactly what we thought of him. At least at that stage he had the grace to apologise, but still we have had nothing in writing on which we could base the arguments on which we now must work.

I have had some documents given to me and I shall use them in whatever way I can to try to give facts to the House. It was mentioned in one document which eventually came that the closure was temporary. Why should a closure be temporary? Because temporary closures need no statutory consultation. They are a nice, clean, convenient way of running things down and no one can do anything. This is another way of allowing decay to set in. The hospital would be run down in the same way as the Elizabeth Garrett Anderson hospital. It would be under-used so that the Department would say that bed occupancy was very low and very expensive and that there was not sufficient nurse training. It would then seek permanent closure.

In case I am accused of an exaggeration I quote from a letter from the Kensington, Chelsea and Westminster AHA (Teaching). It came from the district administrator, Mr. Hunt, and was addressed to all staff. I shall read just one paragraph: In practical terms this means that no more admissions will be made to St. Columba's for the time being. As the patient numbers decline, the point will be reached when the need for staff has diminished significantly, and ultimately, when there are no patients left, there will only be a requirement for staff to look after the building. Could anyone with an ounce of feeling write that sort of letter? Could any chairman of an AHA allow that sort of letter to go out over the signature of a dedicated member of the staff? Why did the chairman not have the courage to put his name to that sort of document?

I stress that St. Columba's is not in a bad state of repair. It is just that Kensington, Chelsea and Westminster AHA is short of money for a variety of reasons, none of which is St. Columba's fault. I shall give five reasons that are contained in the documents I have had. These are excessive staff recruitment costs, rising drug costs, the engineers' industial action, the drop in private patient income and the result of the work of the resources allocation working party, which wants parts of London to suffer more misery so that other people can have less misery.

One should not deal with resource allocation by cutting down on areas carrying out specialised work and with a mass of day-time population to cater for. Instead, the working party should tell these areas that they will not get any increase, but, on the other hand that they will not receive any less money and in time they can begin to reallocate. What has been done will happen in many other places where the working party has been allowed to get away with it. Which is easier, to try to close a hospital within the physical location of Kensington, Westminster and Chelsea—which would stir up the same hornet's nest as did the threatened closure at the Elizabeth Garrett Anderson hospital, with all the statutory implications involved—or to attempt to slide the closure through the back door?

I quote from a latter sent by the Health Service unions at St. Columba's and in the North-West district: The North-West District of Kensington and Chelsea and Westminster Area Health Authority, to which St. Columba's is attached, is £400,000 overspent. The following quotation from a document recently approved by the authority shows the incredibly callous thinking behind this move. The hon. Member for St. Pancras, North will confirm that the chairman of the area health authority, Dr. Dunwoody, did not like the word"callous"being used. I am sorry that I cannot think of any other word that fits the situation. The document continues: ' St. Columba's hospital provides a service for the dying. Only 20 per cent. of the patients come from within Kensington and Westminster and Chelsea. It was considered, therefore, high on the list for closure'. That extract from the authority's document indicates the reasoning behind the temporary closure decision. The authority could have tried for a permanent closure by means of statutory processes. Instead, it chose to do a fiddle and tried for temporary closure.

Not all members of the AHA are prepared to give their addresses. When I asked for a list of names and addresses I was told that the AHA members did not like disclosing this information but that if I wrote to the area administrator my letter would be forwarded. I appreciate that offer. However, when people take on the public responsibility of closing a hospital, members of the public are entitled to know where those people live so that they may write and put their point of view to them.

Even if a permanent closure is decided upon, the local community health council, covering Camden and Islington, has no statutory basis. The CHC to be consulted would be the body covering Kensington, Westminster and Chelsea, not the council that understands the local conditions in Camden and the area where St. Columba's is located.

I asked whether there was still a possibility that Kensington and Chelsea would agree to transfer the hospital to Camden-Islington, which would be happy to accept it. I was told that the chairman of the Kensington, Chelsea and Westminster authority could not guarantee what his authority would do, and that he had said that once the decision was taken he did not see why the authority would wish to change it but that no money would be available, of course. When pressed, he said that it cost approximately £200,000 to run St. Columba's for a year, that in next year's budget, starting in April, the area would wish to keep the £200,000, but that St. Columba's must go to Camden-Islington without any money. I call that a dog-in-the-manger attitude. It does not want to run St. Columba's and says that no one else shall. I find that unacceptable. It would not be right to expect this year's costs to be transferred, as the money has been spent. However, I see no reason why the money should not be transferred in the new year. The chairman of the AHA said that a meeting of his authority was to be held yesterday. I asked him to invite his authority to reconsider its decision.

Today I received a helpful letter from the Minister of State in reply to my letter to the Secretary of State of three weeks ago. The Minister said he understood that the matter was being reconsidered by the AHA. I hope that he will say whether the authority took a different decision at its meeting yesterday. I look forward to hearing what he says about the matter. If the authority has not taken such a decision, I ask the Minister to use his influence, not statutory power, to ask Kensington, Chelsea and Westminster to halt the temporary closure, to make certain that all the beds are occupied, and to assist in the transfer from Kensington, Chelsea and Westminster—which clearly does not want these people—to Camden-Islington. That would be welcomed by patients, their families and the staff. There is a long history of loving care in this terminal hospital. Those patients who do not go to St. Columba's for their terminal period will go into modern, expensive district hospitals such as the Royal Free hospital.

The Secretary of State received a letter dated 28 February from Dr. Skeggs, the director of the department of radiotherapy and oncology. On paragraph reads: I know I do not need to tell you that there is a serious shortage of terminal care accommodation throughout the country. In Hampstead, where we have both St. Columba's hospital and the Marie Curie home, Edenhall, the demand for accommodation is so great that we have at times to wait for six to eight weeks to transfer a patient. It is well understood that economies in the Health Service are being required, in spite of your reassurance that you have managed to make more money available for the improvement of the National Health Service. At the Royal Free hospital we are fortunate in having some of the finest facilities in the country for acute medical care and I understand that the cost of each bed works out at around £450 a week. Let alone the fact that from the humanitarian standpoint it is wrong for terminal cases to be nursed in the necessarily energetically active environment of a hospital designed for the care of acute cases, it obviously does not make financial sense to close terminal homes when the beds cost probably as little as one-third of the cost of beds in an acute hospital. I look forward to hearing the Minister's answer.

St. Columba's is occupied by patients from a variety of health authorities. I take up the point made by the hon. Member for St. Pancras, North that there should be contributions from other area authorities for patients from their areas going to terminal hospitals. A similar arrangement applies in the education and social services. That arrangement would go a long way towards solving much of the problem. As over 90 per cent. of such patients come from within the London area, the regional authorities could make contributions without the necessity for the areas to make their own allocations. That would be a simple and common sense arrangement.

I do not want to say this, but I must. If the Minister is not prepared to agree either to joint funding or to say that this should be done by an allocation according to the area from which the patient comes, I hope that he will at least ask the Kensington, Westminster and Chelsea area health authority to have enough courage to consider a permanent closure. I say that not because I want it closed but because full statutory consultation would then take place and the full weight of public opinion brought to bear on this problem. Until that happens, neither Members of Parliament in the area nor anybody else will have the full details—not because we have not asked for them but because they have not been given to us. Statutory consultation would enable information to be made available to everyone concerned.

I do not think that hon. Members can be accused of being partisan on this matter. I hope that the Minister will take on board my suggestion to close the loophole of the temporary closure, which means that no consultation is required. He could do it by simple administrative action, by issuing a circular. If nothing else comes out of the debate, I hope that it will have highlighted the anomaly. I hope that the Minister will step in and close that loophole.

I gather that the original decision for the temporary closure was decided, on officers' advice, by the AHA by a majority of one. A majority of one is always sufficient in Parliament. This decision did not even need the 40 per cent. that was not reached in Scotland in the referendum. None the less, I cannot believe that many Members of this House would have taken that type of decision on such a sensitive issue on a majority of one. I am sure that we would have said"Let us see what is the local opinion and look at it again next month." But, no, the decision was taken, and so far, up till yesterday, the authority has been prepared to pursue it.

I should like, in conclusion, to summarise the main points of my speech. First, I have made my views perfectly clear on the question of nurses' pay. I support the initiative and the methods by which the Royal College of Nursing is proceeding.

With regard to hospital closures, I have said that the Royal Homoeopathic hospital ought not to close, and that it ought not, either, to be done by a series of snips, perhaps not by the Minister but by somebody else. Many hon. Members have been receiving letters from constituents who are worried not only about the future of the hospital but about the practice of homoeopathic medicine. These letters are not written without some justification.

I hope that the Minister will allow the temporary lift repairs to be carried out at the Elizabeth Garrett Anderson hospital. I hope, too, that he will then be man enough to say that 140 Members of the House deserve to have their views taken into account and that he will set up an independent inquiry into the future of the hospital on that site. I cast no asperations on Dr. Ford, a most capable official of the Ministry, who is chairing the working party, but in her own interest it ought to be seen that the decision that is put to the Minister in due course has come from an independent source and not from someone who is, faute de mieux, in the position of being one of the Minister's own officials. I would not want to be in her position, for, sooner or later, whatever decision her working party takes, some member of the public will say that this was never a genuine inquiry, however hard the members of that inquiry have been trying. I repeat my call for an independent inquiry into the future of the hospital.

I also ask the Minister to stop, by means of his influence, the temporary closure of St. Columba's hospital.

A real responsibility rests on the Minister tonight. In the light of the answers that he gives to us we shall be able to judge whether he really has a Department which cares for patients and those connected with the hospital service.

6.24 p.m.

Mr. Timothy Raison (Aylesbury)

My hon. Friend the Member for Hampstead (Mr. Finsberg) has presented a most formidable case. I pay tribute to him and also to the hon. Member for St. Pancras, North (Mr. Stallard) for the way in which they have set out these very important hospital questions.

I do not propose to make a constituency speech this evening, although I am tempted to do so. My only reason for not doing so is that, as the Minister of State knows, very recently I had the Adjournment debate on the subject of Stoke Mandeville hospital. If I may say so, I thought that the Minister's reply in that debate was very depressing and ungracious, full of bureaucratese rather than humane politics. He did not mention that Stoke Mandeville hospital does some quite exceptional things. Even in saying"No"to me, the Minister might have paid some tribute to the work done at that remarkable place.

While listening to my hon. Friend and the hon. Member for St. Pancras, North I could not help thinking that in London there is a serious problem of over-provision, whereas in my constituency, with a growing population, we have the even more difficult problem of under-provision. I want to press on the Minister the need for a much more sensitive understanding of the problems of those areas in which the population is growing quite rapidly. We have, in the county of Buckingham, the new city of Milton Keynes, which is still going ahead fairly fast. This imposes enormous pressures on the existing hospital capacity.

By any standards this has been a timely debate. At times it has seemed a little like a timeless test match. I have a feeling that it is the sort of debate in which Geoff Boycott would rather like to take part if he were a politician, with the prospect of debating until 10 a.m. tomorrow. I have come in rather more as a Randall or a Gower, to launch a few shrewd blows and then disappear from the scene fairly rapidly, rather than as one who seeks to build up a very long and powerful innings, such as we have just had from my hon. Friend.

It is a timely debate because there is tremendous anxiety at the moment about what is happening in the National Health Service. Although there are still very many good things happening in the Service, there are many things about which, inevitably, we are bound to be deeply concerned. Like other hon. Members, I welcomed what the Secretary of State had to say this afternoon. It seemed to me to be somewhat more resolute than some of the things that we have heard from him earlier on. What we really want to hear in the debate is something from the Minister of State about nurses' pay, with which the debate started.

Having heard the rehearsal of the case for the nurses put forward by several hon. Members, I do not think that there is any need for me to go through those facts again. I want only to stand up and be counted and to say that I also take the view that the nurses should be regarded as having a very special case. Whenever I hear in detail what the nurses are being paid, I, like most other people, am rather shocked.

The Government must respond to public opinion and ensure that the nurses receive the kind of treatment that the country is demanding for them. If the Minister were to ask me where the money could come from, I could tell him, although I hope to deal with these matters in the public expenditure debate on Monday. A great deal of money is being expended in preserving and creating non-viable jobs, rather than on meeting genuine needs.

It is farcical that in my own county money should be spent on providing bogus jobs, in an area where there is no unemployment, when at the same time the ceilings of Stoke Mandeville hospital are falling down. In other words, resources must be allocated to the right place. The Health Service, in general, is in need of additional resources, but there are other areas in the public sector where savings could be made.

The Royal College of Nursing has specifically renounced the use of strike action. I, like some other hon. Members, have for some time been advocating the case for what is commonly called a no-strike agreement. I continue to advocate that case. Where we are talking of people in really essential services, such as nursing, the police and the Armed Forces, it should be made possible for them to renounce the right to strike. I am not saying that such an agreement should be imposed on the nurses, but we need to create a framework in which those in professions such as nursing, and some of the other essential services, should be able to renounce the right to strike or to take industrial action, and in return they should get cast-iron guarantees that their pay will go up with inflation. Whether it should be done by linking their pay to average earnings or to the rate of inflation is a matter for argument. Probably it should be by some sort of link with average earnings. This would be enormously beneficial. In particular, it would be beneficial to the people to whom it is meant to be beneficial. If the nurses had felt that their pay would rise in line with earnings they would not have gone through all the hassle and trouble that they have faced. They would have been in a secure position.

The unions do not like that idea because, after all, union leaders believe in their ultimate weapon—the right to strike. A union leader is always reluctant to relinquish that right. On the other hand, if the matter were put to the rank and file of the profession I believe that they would take a different attitude. They would see that it would be greatly to their advantage if a system could be evolved by which the right to take industrial action was renounced and, against that, firm guarantees about pay were provided. Of course, it would have to be implicit that if—because of reasons of incomes policy—the guarantees were overturned—I do not believe that they should be—the right to strike would be revived. We should give serious consideration to that matter.

We should also examine the pay of others in the National Health Service. I accept that some NUPE members are very badly paid. It has also become apparent during the last few weeks that a terrible muddle exists at the lower end of the pay scale. I have talked to members of NUPE in my own constituency, and many matters have been discussed. Something that cropped up time and again was that because of low tax thresholds and the mish-mash of benefits there is no longer a rational relationship between pay and reward.

I derived from a recent parliamentary question that if someone was earning £45 per week in November 1977—a low wage—a year later, in November 1978, after a 5 per cent. increase, his take-home money, after tax and benefits had been taken into account, would have been just over £44 per week. However, if he had received a 15 per cent. rise, perhaps as a result of industrial action, his net pay would have been £43 per week. It is farcical that someone can receive less from a 15 per cent. pay rise than from a 5 per cent. one.

I realise that the reality of selective benefits is that they linger on for some months and that it is some time before the figure that I arrived at is reached. Nevertheless, there is not a sensible relationship between pay and reward, and something must be done about that. The one thing that we can try to do is to raise the tax threshold as rapidly as possible, although the economic position does not make that easy. That is a measure which is in the power of Government and will have to be taken if we are to emerge from these disputes.

There is a good case for taxing some of the other benefits. That is an administrative problem. However, rather than introduce the administrative apparatus necessary to do that, the threshold should be raised and the unfairness and cause of resentment will disappear.

We should be worried about low pay in the public services, and I have always felt sympathy with those who have expressed their concern, although I have no sympathy with some of the actions that we have seen. On the other hand, we should look realistically to see whether the best use is being made of manpower in the National Health Service. I recently spoke to a doctor at a well-known hospital where there are about 250 beds. He told me that at his hospital there were 80 porters. In another hospital down the road—with about the same number of beds—there are 40 porters. As an outsider, it is not for me to pronounce which hospital has the right complement of porters, and I shall not make that judgment. However, I have a shrewd suspicion which is nearer to employing the right number.

The National Health Service has not planned its manpower use well but it has suffered from not having tight management. We all know why that is. When there is no profit and loss account or financial incentive in the background to look carefully at the numbers of persons employed and how they are employed, there is a tendency for numbers to rise. It is often said that administrators like the idea of having many people working under them rather than few. That may well be true. However, the problem has been highlighted by recent events and it must be tackled.

There has been a lack of leadership from the top in the National Health Service. There are many solutions to the management problem, and one of those will have to be the introduction of cash limits. I believe that the National Health Service needs more money. Therefore, I am prepared to see the cash limits of the National Health Service raised. If the nurses are to be treated as a special case the extra money will have to be found. But I believe that the cash limit system is right in principle, though I do not think that those sitting at the centre can determine how every penny of money will be spent.

A system of devolving the spending power of the National Health Service and its management within proper limits should be brought into operation. Comparability has been sanctified by the setting up of the comparability Commission but it is not right that the Commission should have excluded from its remit an examination of efficiency and productivity. It does not make sense to look at proper pay levels and make comparisons with other industries and other occupations unless efficiency and productivity are taken into account.

The poor leadership at the top of the National Health Service is partly a matter of personalities, but it is also because of the structure of the Health Service. One matter that has emerged time and again in recent weeks is the great ambivalence about who is responsible and accountable and who is running the show. Like my right hon. Friend the Member for Wan-stead and Woodford (Mr. Jenkin), I am glad to see the Secretary of State back in the House. However, I believe that he, too, is being ambivalent about the matter. Much of the time he says that he cannot make certain decisions and that they are for local negotiation and handling. When I spoke about people who take selective action, the Secretary of State said that he could not deal with that matter and that it would be dealt with by local management. Statutorily he is responsible, and he cannot duck these matters. Nevertheless, even if I am correct about that, he has today given a clear lead on the use of volunteers—rather belatedly as my hon. Friends and I would say. He gave strong guidance to the area health authorities throughout the country on that matter. Therefore, on two comparable issues, the Secretary of State acknowledges one as lying within his province and yet he treats the other as being exclusively a matter for local management.

Dr. M. S. Miller

The hon. Gentleman referred to cash limits and, at the same time, evinced a sympathetic attitude towards the funding of the Health Service when he said that he thought it should have more money. Is he aware that a recent survey of several countries, including the United States, France, Germany and Sweden shows that Britain has spent very much less per head of population on health than have those countries? Does not that indicate that we are not spending nearly enough on health, and that we are getting a good Health Service on the cheap?

Mr. Raison

I agree, and I have already argued that matter. Another factor is that our economy is not as effective and productive as the economies of those countries. When our economy is creating more wealth, we can increase the amount that we spend per head on the provision of health services. We are not doing that, and that is the root of our problem in this and other social services.

At the time of the supervisors' dispute in the autumn, which did so much damage in terms of lengthening waiting lists and so on, I received a letter from a senior NHS personnel officer who said: This dispute exemplifies in the classic manner the management vacuum in which senior managers in the field are typically expected to operate…An even more craven absence of management resolve was recently exemplified in relation to a dispute concerning a claim by Professional or Technical ' B ' staff Whitley Council unions for a reduction in the hours of normal working from 38 to 37. The unions nationally unilaterally recommended their members to work a 37 hour week. Management nationally and locally took the view initially that a pro-rata reduction in pay should be made whenever it was absolutely clear that hours had been reduced without authority. Imagine our feelings as managers when within the last week formal advice has been received to the effect that deductions from pay so effected should be re-imbursed and yet no indication has been received that an agreement on this issue has been reached. Not unnaturally some of the staff who had worked a normal 38 hour week are now inclined to press for extra payment ". I know that the story of the 37 and 38-hour week is a complicated saga which went on for some time, but it showed the almost despairing feeling of managers in the NHS that they did not know where they stood or what steps they could take. It was a clear weakness to make such a concession to workers who had unilaterally reduced their working hours. That, together with the way that the supervisors were handled, did much to add to the excessive demoralisation in the NHS.

Mr. Ennals

The hon. Gentleman knows that the letter that he read is an old one, and I am sure he recognises that managements now know exactly where they stand. There was a period when we suspended the rigid application of the rule that if a person worked for less than the period for which he had contracted he should be paid less. We did that in the hope that it would enable an agreement to be reached in the Whitley Council. Unfortunately it was not possible to reach an agreement acceptable to the Government and that suspension was lifted and we went back to the strong position that we now take. I hope that the hon. Gentleman does not wish to mislead the House by implying that managements do not know exactly where they stand.

Mr. Raison

I have no wish to mislead the House, and I have not done so. The letter was written towards the end of last year, but the problems outlined in it have led to great confusion and a lack of confidence among managers, who do not know where they stand. That is not a tolerable situation.

The problem of waiting lists has become extremely serious. I know that it is a long-standing difficulty, but it has been getting worse and recent industrial action—perhaps last year rather more than this year—has inevitably added substantially to the length of waiting lists. We all regret that, because every time that the list lengthens, someone else suffers.

I wish to repeat to the Secretary of State a suggestion that I have made before. The problem should be approached in terms of implementing a crash programme of catching up. It is intolerable that waiting lists have become so long, and I hope that the Secretary of State and his Department will look at every possibility of bringing in additional resources in order to catch up.

That may mean going to the Ministry of Defence and asking for better use to be made of Service hospitals. I know that they already help the NHS, but a number still have spare capacity. I also realise that there may be financial problems over who is to pay, and so on, but they should not be allowed to override the necessity of reducing waiting lists. I hope that the Secretary of State will go to the Service hospitals—and private hospitals—and seek help to overcome the terrible problem of waiting lists. I should be surprised if he did not get a favourable response from both quarters.

I do not intend to abuse the Secretary of State, but the job of running the DHSS is too much for one man. The NHS is going through severe troubles which will not disappear overnight. Dealing with those problems will be more than fully demanding for one man, and if he is also given responsibility for our vast and ever-burgeoning social security system, we are imposing an impossible burden on him.

Perhaps my suggestion should be directed more to the Prime Minister than to the Secretary of State, but I believe that we must split up the DHSS. The Minister for Social Security is in the Cabinet, and I am not saying that he does not work hard, but that is not enough. Sometimes we must look at the organisation of the Government in terms of the burden placed on Ministers and the importance of what has to be done. The time has come for us to have separate Secretaries of State for health matters and for the social security side. There are also tremendous problems on the social security side. The relationship between social security and tax needs much more consideration.

My suggestion would not necessitate a major reshuffle within the DHSS. I understand that the health and social security sides are not closely integrated except at certain points, for example in dealing with the disabled. It may be thought that it would be a mistake to split up the administrations, but we have effective precedents for splitting up the work of the Secretary of State while keeping common services. That has happened in the Department of the Environment with the appointment of the Secretary of State for Transport. There are a number of common services between the two Departments, and that splitting up was achieved without too many problems. The same thing happened to the old Department of Trade and Industry. We now have the Departments of Prices and Consumer Protection, Trade and Industry, which have a number of common services.

It is to the credit of the civil servants involved that they have been rather clever and sensible in ensuring that life at official level can go on without great disruption even if sensible political decisions are made about having separate Secretaries of State. The hon. Member for St. Pancras, North told us, with a good deal of wisdom, that big was not that beautiful. The DHSS is an example of that. I am not saying that my proposal is necessary because of any personal failure of the Secretary of State. It is simply that the job is much too big and important to be done by one man.

6.48 p.m.

Mr. Julian Ridsdale (Harwich)

I am grateful to the hon. Member for Fife, Central (Mr. Hamilton) for initiating the debate and. particularly, for giving us the opportunity to discuss nurses' pay. Those of us who have visited hospitals and seen the devoted service of nurses know that they should be treated as a very special case. I am particularly disturbed that since the last pay award nurses' pay has been allowed to fall grievously behind.

I am glad to see the Secretary of State in the Chamber. I do not wish to be unkind to him, but he must take some of the responsibility for what is happening in the NHS. The Service is facing a crisis because of lack of funds. It would have been better if the Secretary of State, when he realised the problems that were arising, had resigned dramatically in order to make the country realise that the Government appreciated what was happening and that the Service was at crisis point.

What disturbs me is that I hear the same argument every time I ask that more money should be spent. I am asked"Where is the money to come from?" I would say, as my hon. Friends have said in regard to the £800 million, of which news was leaked recently, being paid out to industries which will not make a profit, how much better it would be if that money were diverted into services which were needed, and which would be worthwhile, so that catching-up takes place.

I am disturbed over the question that has been raised about the difference between our Health Service and health services abroad. I can well remember my visit to Germany and Japan in 1964 when I compared the health services in those countries with ours. At that time we were proud of our Health Service. Because the Germans and the Japanese have concentrated on making wealth, they are now able to have health services that are twice as good as ours. We are accused of saying how bad the situation is here, but we look at the broad general problem today; and it is that here we are not making wealth, the economy is not making wealth, because of the failure of Socialist Governments to give people incentives in the right sector. When we see what has happened in Germany and Japan and the state of the health services in those countries compared with ours, we realise, taking the broad general picture, why we find ourselves in this position and why our Health Service today is at crisis point.

I am very glad that my hon. Friend raised the question not only of the nurses but also of the ancillary workers because many of us will know that there are workers in our constituencies who are trying to live on low wages, £45 a week, and then finding themselves being taxed, and they know very well that the tax thresholds have to be raised. This is a much broader question than just the detail of the lower paid workers. It is a question of ensuring that the country's resources are deployed so that we are able to make the kind of wealth that Germany and Japan have been able to make, so that we can have the kind of health service that we need. In saying the Health Service is at crisis point, one naturally turns to one's own constituency and sees the situation which has arisen in those parts of the country with which we deal personally.

Naturally, during the debate many London Members have asked for more money to be spent on London services, but over the last 15 years my constituency has grown by almost 100 per cent., mainly by people coming from North and East London and other places, without the reallocation of funds. On the nursing side alone the increase in pay for Essex as a whole would be £7 million, but that would not be enough to get the recruitment we really need in our hospitals. Going round one's own hospitals one sees the shortage in the nursing profession and realises the kind of sums that should be given so that we can recruit nurses. This would mean even more than the £7 million which the Minister has been told we need in Essex as a whole.

Dr. M. S. Miller

There are more nurses now than ever before in the history of the Health Service.

Mr. Ridsdale

I know the hon. Gentleman is full of statistics. I wish he would come to my part of the country, North-East Essex, to understand the shortages in the hospitals.

Dr. Gerard Vaughan (Reading, South)

If I may help my hon. Friend, there are more nurses than ever before, but there is also a grave shortage of nurses, because more and more is being asked of the nurses.

Mr. Ridsdale

I am grateful to my hon. Friend, but the problem in North-East Essex hospitals is that there are not enough nurses. The Minister knows very well that Essex is under-funded by £20 million on a budget of £100 million. He knows the kind of cuts that have to be made in such a situation. He also knows that in the Colchester district the number of people awaiting admission to hospital has risen from 2,855 to 4,431; and 264 people have been waiting for more than one year for surgery classified as non-urgent, despite being in pain and great disability. It is complete and utter nonsense for the hon. Member for East Kilbride (Dr. Miller) to interrupt me and say there is not a shortage of nurses. It shows that he has not been in touch with the kind of problems that I have in my constituency.

Dr. M. S. Miller

The hon. Gentleman should not get so excited about it. All I was trying to point out was that there are more nurses than ever before, and it does not necessarily follow that, because there are greater calls made upon nurses, making more money available to the nurses would necessarily recruit more. There is great difficulty concerning skills of all kinds in the country. It is not just a question of money.

Mr. Ridsdale

Unfortunately, because of today's philosophy, we have equal shares of less and less and we are now finding that we are having equal shares of misery under Socialism. It is that kind of attitude and the philosophy behind the hon. Gentleman's comment that has brought us to this position. The hon. Gentleman may say I am getting rather excited and disturbed, but when one understands the situation in my con- stituency in North-East Essex—and, as the Minister, who is an East Anglian Member, knows, not only in North-East Essex but in East Anglia as a whole—one knows how near to breaking point the Health Service is in East Anglia and Essex, too.

Mr. Ennals

I am sure the hon. Gentleman will recognise that, as a result of the policy that I, as Secretary of State, have been pursuing of the reallocation of resources, those parts of the country, of which East Anglia is one, which have been traditionally deprived of resources over the years are now getting a substantially faster rate of growth than the national average simply because we are trying to ensure that funds go to places where the need is greatest.

Mr. Ridsdale

The Minister may say that. Nevertheless, the waiting lists are increasing. There is a two-year waiting list for eye cataract operations. The Minister knows very well of the kind of mentally handicapped people who have come to my part of the country, having been taken out of mental hospitals and put into guest houses without adequate supervision. Indeed, he knows of the serious fire that occurred in my constituency because of inadequate supervision. This is why I feel strongly. This is why I may be excited. But I am most disturbed to see the breakdown of the Service. I do not know how the Minister can see these things happening without protesting to the Chancellor of the Exchequer about what is happening. I am surprised that he has not resigned before now.

We must have a catching-up operation as quickly as possible on the question of the nurses and ancillary workers. But, on the broad general picture, I do not believe that the problem can be solved, as I have told my nurses and others, until we have a change of Government and a change of philosophy. The situation reminds me very much of 1951 when the Government and Ministers were saying"We cannot end rationing and we cannot end controls"and then, at the end of it all, we had 13 years of good Conservative rule that made wealth for the country. We have had 12 miserable years of Socialist rule that have brought us to this situation and equal shares of misery. I only hope that before long we shall see the resignation of this Government and a new Government that will be able to make wealth for the country so that the nurses and the skilled can get their just rewards.

7 p.m.

Mrs. Lena Jeger (Holborn and St. Pancras, South)

After more than 20 years in the House I am no stranger to having my best speeches made beforehand by other hon. Members. Today I do not complain about that because I much appreciate the help I have received both in the debate and outside the House from my hon. Friend the Member for St. Pancras, North (Mr. Stallard) and the hon. Member for Hampstead (Mr. Fins-berg), who have co-operated in a way which the hon. Member for Hampstead rightly described as unusual. I do not mean that we are not on friendly terms, but we have worked especially hard together and I much appreciate their help.

I have been concerned for a long time about the problems of nurses. I confess that I never got further than being a wartime VAD, but I shall never forget the strain of those years, working at a casualty clearing station after D-day, and going out on a mobile surgical unit in the blitz. This is no sudden concern of mine, because those experiences have stayed with me.

Today, nurses are under even more strain because they are expected to add to their general bedside care and compassion totally new standards of scientific understanding and sophisticated treatment which make their job much harder than it was in the days when people expected not much more than kindness and attention. Of course it makes their job more interesting, but it demands higher standards of general education and higher levels of concentration and endurance. Many processes in modern hospitals are highly skilled and difficult. These new demands all add to the case for the nurses, men and women in the profession, getting much better pay.

If I were still nursing I would feel a bit ambivalent about this debate. I would hear hon. Members showering marvellous compliments on the nurses for all the wonderful things they do, but unless at the end of the day there was a firm com- mitment I would go away from the House very fed up. It is not a question of another Halsbury type one-off award. We have to get this subject right, as we have to get the rate of pay of all workers in the public service right. Otherwise we just have the swings and roundabouts of demands, strikes and awards, which is not good enough.

I want to make one or two unkind remarks to my right hon. Friend the Secretary of State. The disastrous inheritance of the Tory so-called reorganisation—which I prefer to call disorganisation—of the Health Service left the Labour Government with a terrible legacy. Many of the matters which have been raised today and which are much in our minds will be considered by the Royal Commission on the National Health Service. It would be helpful if my right hon. Friend were able to say when we might expect the Royal Commission's report. We cannot suggest any fundamental reforms until we get it.

There is one policy of which my right hon. Friend is very proud, and to which he has just referred. That is this ugly expression RAWP—the resource allocation working party. I take his point, and appreciate his difficulties, but I find in practice that arid statistics are being used far too rigidly. For instance, in my constituency the last time that I counted—I am never quite sure of the up-to-date figure—there were 13 hospitals. I am proud that we have some of the most famous hospitals in the world in Holborn and St. Pancras—Great Ormond Street, the National hospital in Queen's Square, the Throat, Nose and Ear hospital in Gray's Inn Road—but in no way can these great hospitals be regarded as part of the local hospital service.

If I go into one of them it is quite unusual to find a constituent there. In Great Ormond Street hospital there are children from all over the country, indeed from all over the world. I am proud and glad that people travel across continents to come to these hospitals, but when statisticians at the Elephant and Castle do their sums and tell us that we locals are over-bedded, that strikes me as ridiculous. University College hospital for instance, because it has to provide what is ungraciously called teaching material—which is how the doctors refer to the patients—over a wide range of specialties, cannot just be treated as the local cottage hospital. People are referred to it from a very wide area.

Another idiotic aspect of the arithmetic is that it is always tied to the population. No one at the Elephant and Castle is bright enough to think out whether that means day-time population or night-time population. In central London there is an enormous influx of population in the day time, with the incidence of sudden illness, accidents, road accidents, and so on. There is also an increasing tendency, which I think we should encourage, for people who have to go to out-patients' clinics for fairly minor ailments to go to the clinic which is near their place of work, thereby losing less time from work and often avoiding difficult journeys.

When I visited the Elizabeth Garrett Anderson hospital on Monday at lunch-time the out-patients' department was full. Many of the out-patients were office workers who had come in for a check-up, taking no time off from work. It is unrealistic to base the number of beds on the number of people who live in an area.

My right hon. Friend might tell me that he has given us a little bonus in respect of the teaching hospitals, but it does not read like it. I have received an extraordinary document called the area strategic plan which states categorically that the Royal London Homoeopathic hospital is surplus to requirements and should be closed.

To whose requirements is it surplus? It is not surplus to the requirements of those who seek homoeopathic treatment or of homoeopathic doctors who wish to practise homoeopathy. It certainly cannot be described as surplus in relation to other homoeopathic beds in the region, because there are none. That is an outrageous statement. Is Parliament to have no voce in this?

Not long ago an early-day motion asking for the continuation of the homoeopathic hospital was signed by about 230 hon. Members from both sides of the House. My right hon. Friend may say, as his predecessors said until I was tired of hearing it, that homoeopathy within the National Health Service will be allowed to continue as long as there are patients who want it and doctors who are prepared to practise it. But how does that square with a proposal from the officers to close the only homoeopathic hospital in this part of England?

Mr. Ennals

I give my hon. Friend the assurance that no such decision has been taken. She will understand that in preparing their plans areas look years ahead. They may reach a certain conclusion which becomes open for general consideration in the area, the region and elsewhere. I assure her that no decision has been taken about the future of the Royal Homoeopathic hospital.

Mrs. Jeger:

I am most grateful for that assurance, because further on the letter says the closure of the Royal Homoeopathic hospital and the Elizabeth Garrett Anderson hospital should be vigorously pursued. I do not know how vigorously the Minister is pursuing these closures.

Mr. Ennals

As I understand the procedure, if the area authority reaches a decision about the future of a hospital it has to consult before it reaches that decision. It must put its proposal to the region and also consult the community health council. Such consultation takes a considerable time, and if the community health council does not agree with any such recommendation the matter has to be determined by the Secretary of State. None of those procedures has even been started.

Mrs. Jeger

I am grateful, but what the Minister has said is a contradiction of the words"vigorously pursued."

Dr. M. S. Miller

This is an issue about which I also have had letters. I did a homoeopathic course during my years in medicine and found it extremely interesting. But if the situation is that homoeopathy is not being pursued as a career by doctors—I hasten to add that the only homoeopaths that I would care to allow to continue are those who also have medical degrees—it may be because there is not any great demand for it. I am saying it is possible that there may not be a demand in the future. But if there is the possibility of closure my right hon. Friend should pursue with vigour the maintenance of the hospital by ensuring that those people who still want homoeopathic treatment let Parliament—not the officials at the Elephant and Castle—know so that we can do something about it.

Mrs. Jeger

I assure my hon. Friend that there will be a further petition on this subject. It is calculated that over the last two years the hospital has had inquiries from over 35,000 people who wish to be patients there. I am not making a speech in favour of homoeopathy. I just about know what it is. My husband was not a homoeopathic doctor but this hospital is in our constituency and we had very good relations with it. My husband always took the view that if anybody wanted homoeopathic treatment he should have that freedom of choice.

Time after time, from the earliest debates on the National Health Service, Ministers of both parties have affirmed the right of the patient to choose homoeopathic treatment. When I speak of homoeopaths, I am talking about those who are also qualified medical practitioners. It would be a breach of undertakings given in this House if anything were done to endanger the continuance of that free choice.

However, there is more than one way to kill a cat. The Government are using another one here, because postgraduate grants are not paid to qualified doctors who want to do a course in homoeopathy. We are told that the reason for this is that the postgraduate medical deans and the Council for Postgraduate Medical Education have total say in giving our money to whichever doctors they choose. This is extraordinary.

I received an answer to a question on 26 April 1978 when I asked whether postgraduate doctors could even claim expenses while they were on these courses. I was told: Postgraduate medical education is primarily for the professional educational bodies concerned, especially the Council for Postgraduate Medical Education. The Council's view is that training in homoeopathy is not of sufficient relevance to modern medical practice to warrant financial support for courses for general practitioners and the post-graduate deans have accepted their advice."—[Official Report, 26 April 1978; Vol. 948, c. 601–2] What about the patients? What say do we have? Who are these people who are breaking undertakings given to this House by previous Ministers of Health that homoeopathy would be available in the National Health Service as long as patients wanted it and doctors were prepared to practise it? This use of public money must be made accountable to this House. We cannot have the Minister washing his hands of it and saying that because the medical mandarins do not like marigolds, nobody in the country may have a homoeopathic doctor.

This is causing a great deal of hardship, because many people I know who want this form of treatment have to go to private practitioners for it. The lack of facilities for doctors to take extra training means that very few homoeopathic doctors are practising in the National Health Service.

At least one very important lady in this land has a homoeopathic doctor. The patronage that Her Majesty the Queen gives to the hospital is a great encouragement. It is not playing fair for local officials to say that they will vigorously pursue the closure of the hospital. The Secretary of State denies that but then the Minister says that there is no money to train homoeopathic doctors.

Dr. M. S. Miller

I would be willing to have a wager with my hon. Friend that no homoeopathic doctor was responsible for any case of thalidomide deformity.

Mrs. Jeger

I am grateful for the intervention of my professional Friend because I was about to say that while we talk about the National Health Service needing more money, what is eating up the resources is the drugs bill—the pharmaceutical products—to say nothing of the profits, which are made out of them as well as the harm, and potential harm, and the uselessness of many of them.

There is an awakening interest all over the world in more natural forms of medicine. We are becoming more sensible about these matters, and it would therefore be inexcusable if either through this financial back door, this execution by malnutrition, or by a decision to close the hospital we put this trend into reverse.

Consideration is being given to a scheme to make a special hospital authority for the three adjoining hospitals, Great Ormond Street, the National and the Royal Homoeopathic. I receive many letters—I have such a large file that I was not able to carry it—saying that this is still being considered. I hope that a decision can be taken fairly soon because it is very unsettling for a hospital to feel so uncertain of its future. It is not fair to the staff and it makes it very difficult for the authorities to plan ahead to work out improvements or to decide on policy.

The Minister would be surprised if I did not say a word in passing about the Elizabeth Garrett Anderson hospital. I do not know who wants to close this hospital. We had 142 signatures from all parts of the House on our early-day motion. The annual conference of the Labour Party said that the hospital was not to be closed. The Labour women's annual conference said that it was not to be closed. That should be a formidable enough argument for my hon. Friend. Petitions have been signed by thousands and not just women because a number of men are glad that their wives are receiving the attention that they want, where they want it.

This brings me back to my earlier point about the allocation of resources. Here we are getting to the heart of the subject. We are not simply saying that the National Health Service should have more money. We are trying to work out how best to make use of the available money. One of the problems about a special hospital such as the Elizabeth Garrett Anderson is that it is difficult for the local area health authority, and for the region, to take the whole cost of such an establishment on board.

Putting the argument at its lowest, we are asking the members of these committees to say that they will go short on something that is badly needed, such as a health centre in Somers Town, because we must look after these women from all over the country. I maintain that people should not be put in that position. About 73 per cent. of the patients at the Elizabeth Garrett Anderson hospital come from outside the region. Many people in the regional authority feel ambivalent about the homoeopathic hospital because people who come from other parts of the country attend it.

We are experiencing a useless statistical reallocation of resources. I cannot understand why a scheme cannot be worked out for the payment of a capitation fee or a national funding so that health committtees do not have to be so parochial about looking after people from somewhere else.

That is often done in the social services. Capitation fees are paid if a child in care is thought to be better in the country than in the town, for example. I am sure that in that monument at the Elephant and Castle one person could think up how to spread the funding. That is what I should call reallocation of resources. We must put the money where the patient is and not where he is supposed to live. Money should be spent where the patient is being treated, where he has been knocked down on the road or where a specialist hospital exists to treat him.

The Minister will be surprised that I thank him for setting up the working party on the EGA. I accept that there are many difficult arguments. My hon. Friends have done so well that I shall not go over the ground again. In the talks that we have had the Secretary of State has stressed that he is following the decision of his predecessor, my right hon. Friend the Member for Blackburn (Mrs. Castle). That is arguable. My right hon. Friend the Member for Blackburn said that EGA should be moved as an identifiable unit within the region. I feel that that proposition has now been dropped.

The Secretary of State says that he is interested in his predecessors. My filing is so good that I still possess a letter from one of the best Health Ministers that we ever had—Kenneth Robinson. The letter is dated 10 April 1967. It is headed"Elizabeth Garrett Anderson Hospital"and states: There are no proposals to discontinue the services provided by this hospital. One precedent is as good as another. I do not see why the present Secretary of State should choose one precedent rather than another.

I agree with what the hon. Member for Aylesbury (Mr. Raison) said about reorganisation. It was the kingdom-building of the late dearly beloved Dick Cross-man that started things going wrong with the National Health Service. He had ideas of bigness and followed the concept of enormity and power. That broke up the old Departments. The system has never worked since. I say that in a non-political sense. I have lived with the National Health Service at home as well as at work and I have been conscious of how wrong that concept went.

The idea of bringing the Departments of Health and Social Security together was good in theory. That is why it appealed to the donnish minds of those involved. But it would have made more sense to bring them together at the local level. Our constituents still have to attend separate offices. For them, the two are totally separate. After the little local difficulty that we are expecting in October I hope that some thought will be given to this matter.

In the Adjournment debate on 16 May 1975 I suggested that we should examine ways of funding the EGA and other specialist hospitals instead of taking the money out of local resources to pay for services which cannot be regarded as local.

My hon. Friend the Member for St. Pancras, North referred to the apparent contradiction in the plans to declare the EGA and the homoeopathic hospital"surplus to requirements ", at the same time as establishing between 100 and 150 new beds at the University College hospital. I appreciate that teaching hospitals have special requirements, but it does not make much sense to the people whose houses must be pulled down to make way for an extension, when they can see the possibility of the EGA being simultaneously taken from them. Too little thought is given to the impact that plans have upon people, for whom the National Health Service exists.

Mr. Moyle

I can reassure my hon. Friend. The region has decided that 100 beds will not be established at University College hospital,

Mrs. Jeger

I am grateful to the Minister. His intervention proves the usefulness of the debate, because it would have taken 100 years for the Department to have written me a letter to that effect.

We should not knock the National Health Service so much. We have all had experiences with our families, friends and relations of the marvellous work being done in the NHS. If ever I have to be ill—which I am sure is not likely— I would rather be ill in this country than anywhere else in the world.

7.27 p.m.

Mr. Robert Boscawen (Wells)

The hon. Member for Holborn and St. Pancras, South (Mrs. Jeger) spoke with her usual self-effacing humility about her services in the Voluntary Aid Detachment during the war. I do not regard that as a mean or humble occupation. She has my deepest respect for that service.

The hon. Lady and others have made a powerful case for retaining the Elizabeth Garrett Anderson hospital. I have signed her motion about this matter and I have received many letters in support of her case. I am pleased that the case for retaining the hospital has been put in such a clear and powerful way tonight. I hope that the Minister will pay attention to it.

Hon. Members have done well to be chosen first in the ballot for the debate on such a burning issue as this. Whenever my hon. Friends have tried to raise such a burning issue on the Consolidated Fund it has been debated in the early hours of the morning.

The charge that the nursing profession has laid against society is serious. Society must pay heed to it. Miss Catherine Hall summed it in a speech in February. She said: The pay of nurses has never reflected their vital contribution to the Health Service. In 1979 they can justly be described as the most exploited group of professional workers, not only in the Health Service but within the country. That is a moderate way of putting a serious charge against all of us in the House and against the public generally. We are not treating this vital profession in the way that it should be treated. On all counts a case has been made for a substantial increase in nurses' pay. A number of hon. Members have mentioned comparability with other professions, and on that ground nurses' pay simply does not reflect reality.

In the Nursing Standard I see that a comparison has been made with primary teachers. On that comparison their pay does not reflect reality. I am sure that the figures have been checked, and some hon. Members have said that on average the difference is about £32 per week less for an SRN in 1978 compared with the pay of a primary school teacher. The nurses have a lot in common with primary school teachers and it is a good comparison. The nurses, like primary school teachers, must have dedication, skill and the ability to accept considerable responsibility. Nurses and primary school teachers work in difficult conditions. Therefore, on that comparison, the nurses' pay does not reflect reality.

As to the shortage of nurses coming into training, I agree with the hon. Member for East Kilbride (Dr. Miller) that when attracting individuals into skill training pay is not everything. But it makes no sense, when the number coming into training is falling at such a rate, not to regard pay as one of the major factors. Again, I quote from the Nursing Standard: In the period April 1977 to March 1978 the number of learners entering nurse training fell by 21.45 per cent. In certain specialties of nurse training the effect on waiting lists has been very serious. I have often cited the appalling orthopaedic waiting lists in the Wiltshire area health authority, which covers part of my constituency, for people hoping to have operations. On that count, too, nurses' pay is in need of substantial jacking up.

Next, I come to what I shall call the"X"factors, if one can use the analogy of Service pay. I shall be repeating what a number of hon. Members have already said. The risks to health in the Service are high. Training is long and hours and conditions are difficult, particularly in such specialties as psychiatric nursing. Therefore, on the ground of the"X"factors, too, nursing service pay is in need of considerable jacking up.

We then have the most important and current"X"factor, which is the voluntary no-strike agreement which the nurses have recently declared so firmly, and to which the vast majority of them have always held. That also must be taken into account.

I congratulate those members of the nursing service who have taken no action and who have withstood the industrial action of their unions in the recent disputes. There are a number of hospital workers in my area who have adopted a low profile in the industrial action during recent weeks. All that concerns them is the patients. We regard their attitude as extremely valuable.

So on all those counts the head of steam building up on this issue is powerful and important, and society must take account of it.

Finally, there is the question of morale. If the NHS is employing 1 million people, and their morale is so affected by the level of reward which they receive for their work, that must have a major effect on the standard of service given to the nation. That is a very powerful and critical issue.

Morale in the Service has not been good for a number of years for many reasons. I shall not rehearse all of them, but there has been far too much politics in the Health Service in recent years and that contributed to the earlier strikes and disputes. The problem of the separation of private treatment and NHS treatment affected morale. But I am not speaking of that. I am speaking about the low morale which exists generally because of a lack of resources being given to the NHS in terms of pay and conditions.

I am critical of the Department in that this situation has been a long time coming. Nurses have not suddenly become short of adequate rewards. From the way that things are going, I suspect that it will last a long time yet. There has not been sufficient urgency in past months—if not years—to try to find a better basis for establishing a system of paying nurses more in accord with what they give to society.

I do not believe that the Department has given as good a lead on this issue as we have a right to expect.

Mr. Moyle

Just before the hon. Member for Wells (Mr. Boscawen) leaves his point about pay, may I say that I think that there has been a welcome onset of responsibility among Opposition Members during the debate. The hon. Gentleman's Front Bench colleagues are always calling for a reduction of public expenditure, and he is calling for an increase in nurses' pay. No doubt he will have thought of where the money is coming from. His hon. Friends the Members for Hampstead (Mr. Finsberg), Harwich (Mr. Ridsdale) and Aylesbury (Mr. Raison) have all said that they will take money away from industry, with the consequent impact on employment, in order to pay for it. I should like to know whether the hon. Gentleman joins them in advocating that.

Mr. Boscawen

If the right hon. Gentleman had waited half a second more, he would have realised that the rest of what I wanted to say deals with that matter. I was about to say where the money was to come from.

In the past 30 years society has wanted this ideal of a free Health Service—a service that is free at the point of use—yet it has given little considered thought to the best way of funding it. I remind the Minister of State that at the beginning it was said, rather airily, that in a few years it would pay for itself by cutting down the cost of ill health and the cost arising from people being away from work. It was thought that by improving the health of the nation the Health Service would automatically pay for itself. In practice, that has not happened. The Health Service may have improved the nation's health, but in real financial terms it has not paid for itself. In fact, very much the opposite is the case.

The funding of the Health Service has been ad hoc all the way through. It has been funded out of hand-to-mouth grants from central taxation, and latterly it has been funded out of inflation. Until cash limits were imposed on the NHS system, in reality it was being funded out of the public sector borrowing requirement, which, as we all know, is a major cause of the gradual devaluation of our currency.

So far no one has been able to find a solution to the problem of how to direct more wealth into the resources of the Health Service without raising taxes very much higher than they are or without substantially depriving other forms of Government expenditure of funds. I entirely agree that the resources in the Health Service today must be put to their best use. Many hon. Members have made suggestions in this regard, and what they have said is one way that must be looked at.

Nevertheless, we must consider how we can get a more regular basis of putting money into this service without doing so through extra ad hoc grants that are given every so often when pay goes up or when there is a vast demand for more money to be given to psychiatric hospitals and so on. We should think more about whether the insurance principle in the national insurance fund has some merit which may be used partially for funding the NHS.

I know that the Treasury boys will have nothing to say in support of"hypothecated revenue ", as they call it. I know that they do not want certain percentages of income or other taxes actually hypothecated directly to any particular service. I appreciate that argument and that it is never likely to happen because the Treasury is against it. Nevertheless, in our social security provisions, particularly in our retirement provisions, we have hypothecated revenue. In other words, people purchase their ticket for their retirement by weekly contributions out of their income. I believe that there is a case for looking at a partial funding of the NHS through a national insurance fund system.

I do not believe that we have given this nearly enough thought. At the present time 6½ per cent. of every working individual's income up to a top rate goes into purchasing his retirement benefit. I shall not advance any percentage figure that we should ask of individuals in order to establish a national insurance fund that would be hypothecated to the NHS. Since this would be tied to increased earnings, to a certain extent, it could provide the increases in the cost of wages in the NHS. And since wages in the NHS are a substantial part of the cost of that Service, because it is such a labour-intensive industry, it could be used to get over some of the problem of never having enough money at the right time to pay reasonable wages or salaries to those who work in the NHS.

I put that suggestion forward for consideration. There are many other ways of doing this. The Minister will remind me that the Conservatives want to cut taxation. Yes, we do.

Mr. Moyle

That is not the point that I wanted to put to the hon. Gentleman. Perhaps he can tell the House what would happen if the individual runs out of insurance benefits.

Mr. Boscawen

I am suggesting that the individual cannot run out of Health Service benefit, if that is what the right hon. Gentleman means. I am suggesting that the insurance fund should provide the wages that are payable in the NHS. Of course, some individuals will require a great deal more of the Service than others. In that sense, the scheme that I have suggested can never be purely equitable, because different individuals will never get back the same amount, just as they do not from their contributions towards the retirement pension. Nor, of course, if one contributes to a privately-funded health scheme, does the fitter individual benefit to anything like the same extent as the individual with a lot of health problems. Therefore, I do not believe that this will be quite the hurdle that the right hon. Gentleman may think. It would not be equitable in respect of what different individuals get back, but it would at least be equitable in guaranteeing a growing amount of money to finance the wages of the NHS.

Of course, this need not increase the total take from the individual in the form of tax plus contributions, but it will not be seen as tax in the same way as now. If taxation is to be reduced, as I believe it must if we are to produce more wealth and resources generally in the country, that would have to be balanced against cuts in other forms of Government expenditure. Other countries have experimented with different forms of insurance schemes. I have not introduced the element of the private insurance schemes, because although there is a place for them I do not believe that they can ever be of such a substantial size as to replace the vast sums of money that are needed in the NHS.

Some new thinking is required with regard to the funding of the NHS, instead of falling back every time to raising the resources from central Government taxation. Otherwise, with all the other demands on central Government, the pay of NHS employees will for ever be squeezed. As a result, we shall never be able to pay them a wage that is comparable with people outside, which is what they deserve.

I hope that there will be a continuing debate, especially when the Royal Commission on the NHS reports, into more sensible ways of finding this vast sum of money to run the ideal that people want, which is a Health Service free at the point of use.

7.50 p.m.

Dr. M. S. Miller (East Kilbride)

My hon. Friends the Members for Fife, Central (Mr. Hamilton), Brent, South (Mr. Pavitt) and Holborn and St. Pan-eras, South (Mrs. Jeger) have eloquently put the case for the nurses. I join in the tribute to them for the arduous, dedicated, onerous, difficult and extremely skilled job that they do. As I said in an intervention, the Government must lose the Victorian outlook which still applies to some extent in the nursing profession. Nurses are professionals. They are not the gifted amateurs or semi-amateurs that they were in the past. As my hon. Friend the Member for Holborn and St. Pancras, South pointed out, they are now much better educated. We should examine their career structure, not merely from the money aspect but from the point of view that their better education makes them much less likely to accept the old patronising system which applied in the past. Not only doctors but even some senior members of the nursing staff took that attitude towards junior nurses. Those nurses who are old enough to remember the days before the National Health Service will know what I mean. A relic of that system remains even to this day.

As my hon. Friends have indicated, fine words are not enough. It is not sufficient to pay tribute to the nurses and leave it at that. They need more money. The hon. Member for Wells (Mr. Boscawen) indicated that I had said that money was not everything. I was trying to point out that, although there are more nurses than ever before in the National Health Service, more skills are now required of nurses. In every country in the world, there is a lack of skilled people in all grades. The nursing profession is no exception. It does not necessarily follow, although it would be a fillip, that increased salaries would bring an immediate rush to join that profession. The problem is obtaining skilled people. My right hon. Friends, however, have no option but to give the nurses a much fairer deal than they are getting. I hope that my right hon. Friend and his right hon. Friend the Secretary of State will take this to heart and settle the argument with the nursing profession forthwith.

The Health Service needs more money. The technological advances alone which are being developed fast and furiously in medicine are extremely costly procedures. There is an open-ended commitment due to ever-increasing expectations by the public. That is not a bad development. The public expect and are getting more from the medical, nursing and ancillary professions, and from hospitals and doctors. This is tremendously costly.

Some Tory Members have said that they believe there should be cash limits, albeit cash limits which are higher than at the moment. I have given a good deal of thought to the cost of the Health Service. I have concluded that this is one area where there cannot be cash limits. If there are to be limits, they would have to be extremely high. They would have to be flexible. I do not believe that a ceiling can be put on health. A price cannot be put on good health or on the cost of trying to obtain good health.

I do not agree with those who talk about the Socialist concept and principles of the Health Service being responsible for what are considered the ills of the the Health Service and that the whole matter should be left to free enterprise. That reminds me of the astronaut who was asked after he had been to the moon what he was thinking about as he waited to be shot into space. He replied that his only thought was that all the instruments in front of him on which his life depended had been installed as a result of the lowest tender. I would hate to think that the Health Service was run in that way.

Most of the carping against the Health Service comes from those who are lukewarm about accepting the basic principles of the Service. I am not saying that they object to it. But they did not approve of the principles in the first instance and retain even now some objections to the way it is funded. They believe it should be organised on a free enterprise basis and gull some of the public into the same state of mind. Let me say this. The private sector in medicine exists only because it is underpinned by the Health Service. I was speaking recently to a doctor who had been asked to take part in discussions about renovating a building and turning it into a private hospital. When the project had been costed, the conclusion was that the patient would have to be charged £90 a day before he or she even paid for the cost of an aspirin, let alone any intensive medical or surgical care. The basic cost would be over £600 a week. A person going into a private hospital of that kind, undergoing intensive care for four weeks, or having a serious operation, could run up a bill of £5,000 or £6,000 without difficulty. If any hon. Member can tell me that many people in this country, or in most countries, could privately fund that situation, I would be extremely surprised. Private practice exists only because the Health Service is there to prop it up.

My right hon. Friend will be pleased to know that I do not intend to say anything about the Elizabeth Garrett Anderson hospital. I do, however, intend to say something about a hospital to which many of my constituents are taken and about which I have had some correspondence in recent months, although it is not actually situated in my constituency. I hope that my right hon. Friend will take note of my comments about Stonehouse hospital and convey them to my hon. Friend the Under-Secretary of State for Scotland, the hon. Member for Stirling, Falkirk and Grangemouth (Mr. Ewing).

I gather from the correspondence that I have had with the hospital board that there have been problems resulting mainly from the fact that it has been difficult to obtain anaesthetists. I am pleased to see that my hon. Friend the Under-Secretary of State has entered the Chamber. I am glad that he is present to hear about the problems of Stonehouse hospital.

It may be that the hospital now has anaesthetists. A considerable amount of pressure was put on the board. However, there is a fear that the hospital will close down in the near future. My right hon. Friend knows that I do not take the view that every cottage hospital is of the best. I take the view that if I were ill and taken to hospital, I should like to be in a hospital where the surgeons, physicians and everyone else was there after having faced strong competition and consequently were of the highest possible calibre, and not well-meaning doctors, practising in some of the smaller hospitals. I do not say that Stonehouse hospital is in that category.

Although big is not beautiful, a hospital has to be of a certain size. It has to have a certain catchment area if one is to be assured that the doctors who practise in it are of a high calibre. I think that the hon. Member for Reading, South (Dr. Vaughan) will agree with that as a general principle. The cottage hospital and the small hospital dealing with run-of-the-mill matters is all very well, but such hospitals do not necessarily comply with what is needed in the latter part of the twentieth century and as we move into the twenty-first century.

Dr. Vaughan

There seems to be a general view in other countries as well as in Britain that if a hospital has more than about 400 beds, or if it tries to serve a population of more than 300,000 to 500,000, communications within the hospital start to break down. I am sure that the hon. Gentleman agrees that there should be hospitals with a larger number of beds. However, we cannot have hospitals with a large number of beds without paying the price in terms of comunications within the hospitals.

Dr. Miller

A similar argument applies to huge comprehensive schools. We no longer build 2,000-pupil comprehensive schools. We are now building schools for half that number. It is the same with hospitals. I could not agree more with the hon. Gentleman. A 500-bed hospital for a population of 300,000 or 400,000 in a catchment area is excellent. There are problems if the hospital and the catchment area are larger. In Glasgow, for example, I do not think that we need more than one hospital for children. The children's hospital serves for a much greater catchment area than the city of Glasgow.

I ask for an assurance from my hon. Friend the Under-Secretary of State that Stonehouse hospital is not at risk and that a close watch will be kept on it from the point of view of ensuring that those in its area have a hospital. At present, they have a good hospital. I know that there are plans for another hospital in a wider area—

The Under-Secretary of State for Scotland (Mr. Harry Ewing)

I apologise to the House for intervening. I had a meeting with the Lanarkshire health board on Monday of this week. After the meeting there was a press conference, during which the assurance was given that there was no question of Stonehouse hospital closing. We announced that the health board had had a number of applications to fill the anaesthetists' posts and that the applications would ensure that the hospital returned to full service.

Dr. Miller

I am glad to have that assurance.

I conclude by again referring to the cost of the Health Service. My hon. Friend the Member for Holborn and St. Pancras, South (Mrs. Jeger) poured scorn on those who felt that raising extra money for the Health Service depended on private injections of finance. The hon. Member for Hampstead (Mr. Finsberg), for whom I have a high regard, suggested the taking of funds from the National Enterprise Board. I imagine that nothing would be less likely to raise the extra money that is required than either of those methods.

I confirm what my hon. Friend said about the drug bill. It is enormous. It is 50 per cent. higher than the total cost of the family practitioner service within the Health Service. We should consider again the possibility of nationalisation. There should be a national enterprise running the production of drugs. That would save an enormous amount of money.

One of the great problems faced by the Health Service was reorganisation. I do not say that the right hon. Member for Leeds, North-East (Sir K. Joseph) meant it to be a disaster, but it turned out to be a difficulty. I know that my right hon. and hon. Friends have been accused of not doing something to alleviate the difficulty when the Labour Government took over in 1974. When we have had the little hiccup that my hon. Friend the Member for Holborn and St. Pancras, South talked about coming in October, it may be that we should consider the structure of the Service and whether it can be streamlined and made much more cost effective.

I repeat that I would be chary of putting a cash limit on what we spend on the Health Service. At present Britain is quite a long way down the scale of expenditure per head of population on health. That statement takes into account what we can afford to spend. We can afford to spend more per head of population than we are spending.

The Health Service should be looked upon for what it is—a service for the benefit of patients. It has not been instituted for anyone else. As well as constructively criticising what we find wrong with it, we should give credit where credit is due. That applies not only to the architects of the Service but to all those who work within it.

8.8 p.m.

Mrs. Margaret Bain (Dunbartonshire, East)

I follow the pattern set by other hon. Members. My speech will fall broadly into two categories. The first will take in the problem of nurses' pay—the current dispute—and the second will include some general matters of concern about the National Health Service in my area of the West of Scotland.

I hope that both Front Benches have noted that the speeches made by hon. Members on both sides of the House have attempted to reflect the anger and frustration over nurses' pay. I hope that both Front Benches have taken on board that it is necessary to take steps to ensure that appropriate machinery is established to prevent a pay dispute arising again as well as solving the immediate problem. That point of view has been advanced by many hon. Members in motions on the Order Paper as well as in speeches today. I hope that we shall hear from both Front Benches any ideas that they have for machinery that will prevent such a difficult situation from arising again.

One of the major problems that we are facing is the long-term confidence of nurses in their negotiating machinery. They are concerned about the future well-being of the nursing profession. I have a letter from a nursing sister at the Glasgow Royal infirmary. She writes that she is witnessing highly qualified nurses either going abroad or leaving the profession in increasing numbers. We must ensure that we provide some method of guaranteeing nurses the form of negotiation that will make it unnecessary for them to bring to bear in Parliament the sort of pressure that they have brought to bear in the past few weeks.

Earlier in the debate the Secretary of State said that nurses had earned the total respect of the community by not taking industrial action. But respect is not in short supply, and nurses want to earn more money. It is a gross insult to those highly trained and dedicated indivi- duals that they have not even received the 5 per cent. that was promised in 1978 under phase 3. That was a small sum of money and would have made such a difference to them.

Comparisons have been drawn with other professions and types of work. The hon. Members for Brent, North (Dr. Boyson) and for Fife, Central (Mr. Hamilton) went into great detail. I should like to take up the comparison with primary teachers. In Scotland teachers are threatening strike action over their pay claim. They, too, want to be restored to the position in 1974. It has been indicated to myself and other hon. Members by the Education Institute of Scotland that according to the DHSS definitions 7,000 teachers are on or below the poverty line. I have asked the Secretary of State for Scotland for clarification, but if such a large number of teachers are on or below the poverty line, how many more nurses must be in that situation? Can the Department tell us how nurses' salaries relate to the poverty line?

I have come from the teaching profession and know something about teachers' salaries, but like others, I have perhaps not paid such great attention to salaries in other forms of employment. I was therefore horrified to hear what was said by a constituent who works at the Glasgow Royal Infirmary as a nursing officer with 25 years' experience. She is responsible for more than 50 members of staff and three wards. Twice a week she controls the whole infirmary, both staff and patients. Her take-home pay is £62 a week, which is a small reward for that responsibility and all those years of dedication, and, as the hon. Member for East Kilbride (Dr. Miller) said, the work of the nursing profession is becoming increasingly complex. I hope that the Government will make a positive statement towards solving the nurses' wages dispute.

I should like to refer specifically to the Baird Street clinic in Glasgow. Over the past two or three months there have been worrying reports in the press that it has lost two of its main consultants. That clinic is a centre for rheumatic diseases in the West of Scotland, where they frequently occur, as they do throughout Scotland. The consultants are leaving because they are disillusioned with the Health Service. Their research work and the level of their experience in the treatment of rheumatic diseases has been lost not only to Scotland but to the United Kingdom. Are there plans to ensure that they will be replaced by equally experienced men, and is there any possibility of extra resources for the Baird Street clinic to enable it to expand its research facilities?

Again on the West of Scotland, I should like to know whether the Tinbury report is to be published soon. It has been awaited for some time. I have met Mr. Tinbury at Gartnavel hospital and his interest in the care of geriatric and psychogeriatric patients is beyond doubt. It would be a most useful report to have available in the House and would facilitate decisions on expenditure for facilities in the West of Scotland.

There is increasing concern that such facilities do not meet the demand. I should like to see more care within the community, and sheltered housing facilities, but the number of day-care and long-term places is far short of the requirement. The care of senile, demented persons can cause great distress to families.

More generally, there is the problem of dentists withdrawing from the National Health Service. Over a year ago I was assured that the dental service would be examined. I received a letter today from a constituent in Dullatur in my area near Cumbernauld saying that his dentist has withdrawn from the National Health Service. Dentists do not want to take on extra patients because of rising costs, and I should like to know what consideration the Department has given to dental services.

There is a problem with the escalation of NUPE action in Scotland. In today's press it is said that 50 hospitals in the Glasgow and Lanarkshire areas will be severely affected. Most of these hospitals have only enough linen to last a few days, and some are already restricting admissions. It will be useful to have a statement from the Scottish Office on contingency action to alleviate the hardship suffered as a result of NUPE action.

There is a general loss of confidence about the efficiency of the Health Service. As the hon. Member for East Kilbride said, the public have high expectations of the Health Service but do not appreciate the costs involved; for example, that a week in hospital costs £600, before taking account of drugs. In the Sunday newspapers in Scotland last week there were headlines about committees of people deciding who lives and dies in hospital. A statement by the Scottish Office or DHSS is needed on that. It is totally undermining confidence in the Health Service.

Unlike the Minister, the Under-Secretary has not been bouncing up and down and asking where I propose to get the money from to make the Health Service work effectively and pay the nurses. My party does not support cuts in public expenditure. We would cut defence expenditure, leave aside massive prestige programmes such as Concorde and demonstrate a new sense of priorities within the limited resources available. The services for the welfare of the community, such as health and education. are vital. We claim to be a caring society. As politicians, we must decide the priorities and gain the respect of the community outside this House by demonstrating that we understand the problems.

8.20 p.m.

Mr. Allen McKay (Penistone)

I do not intend to keep the House for long because others have made my points already. All the facts and figures about the nurses' claim have been put, and there is a great deal of sympathy for that claim.

The National Health Service is the jewel in the crown of Socialism, but at present it appears that the lustre of the jewel has gone. I do not think that people have lost confidence in the Service, but they are worried that it is losing the edge that it had when it was first set up by Nye Bevan.

My constituency is an area of concern as it is somewhat deprived of facilities and money. The regional organiser of the Trent regional health authority wrote to me and said: You will be aware that the Trent region as a whole is a deprived region in health terms, and is indeed currently funded at only 88 per cent. of the national target funding level. Whilst the implementation of the recommendations of the Department's Resource Allocation Working Party gives the Trent region a growth rate of approximately twice that of the national growth rate, it still means that the region will not achieve equalisation to the national target until after 1990. Obviously we must look at this. If we have to wait until the 1990s to achieve equalisation, ours is indeed a deprived area.

The Government should also look closely at the standby arrangements. There is no single system of standby arrangements, and individual practitioners are responsible for visiting their patients at nights and at weekends as may be necessary. However, they may arrange for another doctor to deputise for them. A commercial deputising service is used for this purpose, and it has fallen down on many occasions. I have many letters on my files from people who have had to wait two or three hours for a doctor, and this has caused great anxiety, not only to patients but to those who have been ringing round trying to get help. There are occasions when the doctor comes from outside the district and gets lost. If we must have a deputising service, let it be a nationalised one, run on a proper basis and with an efficient career structure.

Another area of concern is that of the ambulance service drivers, who are seeking parity with the police and the fire service. There is merit in their claim. No doubt the Minister will say that a comparability study is being made and that ambulance drivers spend only 10 per cent. of their time working on emergencies. Perhaps he would care to look at the police and the fire service and see how long they spend on emergency cases. I think that there is comparability.

There is sympathy on both sides of the House for the nurses' pay claim, just as there is outside. One has only to look at the television ratings to see that programmes involving hospitals and nurses get very high ratings. That is not just because these programmes are good entertainment value, but because nurses and hospitals are close to people's hearts. Therefore there is a great deal of public sympathy for the nurses' pay claim.

It could be argued that if the nurses' claim was met there would be pressure from others with claims. But which trade union would dare to oppose the nurses' claim? My union—the National Union of Mineworkers—would be the first to come forward and say that the nurses should be paid and that it would not use their claim as a leapfrogging exercise. The Yorkshire miners' leader, Mr. Arthur Scargill, has gone on record as wholeheartedly supporting the nurses' claim. In the mining industry we know the value of nurses. We call them angels with dirty faces because that is how we see them. But their faces are welcome—not only underground when there are accidents, but in the hospitals as well.

One might ask where the money will come from to meet the pay claim. If we have to ask ourselves that question, we should look carefully at our priorities. In local government a good treasurer has a contingency fund which he draws upon, and if he gets into trouble with that, there is a slippage fund which somehow manages to find money for unexpected things. I urge the Minister to ask the Treasury for the money. I am sure that it could be found and that we could pay the nurses what they deserve.

8.27 p.m.

Mr. Peter Brooke (City of London and Westminster, South)

I am delighted to follow the hon. Member for Penistone (Mr. McKay). I refer, as he did, to the popularity of and enthusiasm for television programmes about nurses.

I must apologise to the House for being absent for half an hour, but in doing so I pay a compliment to the House and this debate. I was due to attend a constituency occasion elsewhere in the Palace at half-past six, but so engrossing was the debate that I remained until I was reminded that I was supposed to be elsewhere.

This is primarily a nursing debate. My mother and sister trained as nurses. Before her marriage my sister ended her service as sister in one of the great London hospitals. I have no interest to declare as those events are retrospective. However, they add to my knowledge and understanding of the profession.

I live in Ashley Gardens, next to one of the Westminster hospital nurses' homes. Other hon. Members who live in Ashley Gardens, Vincent Square or Rochester Row will be familiar with nurses coming and going at hours that are as anti-social as those that we keep.

Last Friday the BBC did a profile of a senior staff nurse. She came from St. Bartholomew's hospital, which is at the other end of my constituency. I do not know how many hon. Members listened to that programme. In 20 minutes the BBC conveyed to an even greater degree than the other television programmes, novels or films the enormous sense of service and dedication that underlines the nursing profession.

In my early days as a Member of Parliament I was invited to spend 24 hours in St. Bartholomew's hospital to see a complete cycle of a day in the life of a hospital. I saw everything that happened in that period. From that experience I derived a vivid sense of the service that the nursing profession provides.

I received the documentation from the unions involved, including the Royal College of Nursing and COHSE. I was slightly surprised to be addressed as"Dear colleague"by the general secretary of COHSE. I do not know whether other hon. Members have had that experience.

This is a debate on nursing, and also on the hospital service in general. I refer to the code of conduct to which tribute was rightly paid. I shall not enter into the reasons why the code of conduct was not prepared in advance of the disturbances in the earlier part of this year. I regret the attitude of Mr. Morris, at the Westminster hospital, towards it. He recently acquired a certain notoriety. Mr. Morris and I have an easy collaboration within my constituency when he wishes me to raise constituency cases. When the code was issued he said that he had not seen it, that he would pay no attention to it until he had done so, and that he imagined it would be some days yet before he received it. When I reflect that in the days of Nelson it was possible to send a message by signal between Portsmouth and the Admiralty or vice versa within five minutes, it is a reflection on modern trade union communications that the time factor could intervene in the way that it did in this case.

I thought that Mr. Morris's remarks were sadder still as a comment upon the degree of compassion inherent in some parts of the Health Service. They seemed to compare unfavourably with the attitudes that the nurses' profession has shown, implicitly and explicitly, not only in unhesitatingly covering in recent months the gaps in care that have arisen as a result of these disturbances, but also for the manner in which they advanced their case. That manner and the nurses' unstinting traditions of service put the Government and the House under a peculiar obligation to make certain that nurses are justly and generously treated.

The hon. Member for East Kilbride (Dr. Miller) accused my hon. Friend the Member for Hampstead (Mr. Finsberg) of climbing on a bandwagon. I think that behaviour such as challenging the motivation of hon. Members is unworthy.

Geography requires me, as a parliamentary neighbour, to refer to the Camden hospitals issue. I was born and grew up in Camden-Hampstead. Before entering the House I lived my married life in Camden-St. Pancras, North. I had the privilege of serving on the Camden borough council with my hon. Friend the Member for Hampstead. I greatly enjoy the collaboration which I have with the hon. Member for Holborn and St. Pancras, South (Mrs. Jeger) on matters relating to Covent Garden, which is divided by the boundary between our two constituencies. I was happy to put my name on early-day motion No. 4 with theirs in respect of the Elizabeth Garrett Anderson hospital. I admire the way in which they fought the campaign on behalf of that hospital.

St. Columba's hospital, for reasons of family and long residence near Hampstead Heath, means a great deal to me. My hon. Friend the Member for Hampstead can count on me as an ally in the battle for that hospital. I regret, however, that he did not warn me that he intended to attack the Kensington, Chelsea and Westminster area health authority. I am the only Member from the area covered by that area health authority who has been seeking to speak in this debate. There may have been things which could or should have been said in the debate by a local Member on behalf of the area health authority if one had known in advance that certain things were to be said.

I should like to say a word in sympathy with the hon. Member for Holborn and St. Pancras, South concerning the Royal London Homoeopathic hospital. I share her concern that if a part of the Health Service is being run down at its heart, the body and limbs will subsequently wither, and wither away.

I have had the greatest misgivings about the way in which the Government are treating the academic staff—and particularly the junior academic staff—at our dental hospitals. If that section of our Health Service in the great teaching hospitals, or in the Royal Dental hospital in Leicester Square, in my constituency, becomes sour, that attitude will in due course infect the pupils, and that contagion will spread again in due course to the dental profession as a whole. On an evening when we are primarily concerned with the nurses, it is an embarrassment to me that that junior academic staff at the dental schools received only a 2 per cent. salary increase last year. But the principal thrust of the debate is related to the nurses and every Member who has spoken has referred to them, and referred to them glowingly.

I referred at the beginning of my speech to my mother and sister as having been nurses, and to the great teaching hospitals in my constituency. I close by quoting from a letter—perhaps it is a happy note on which to end this long but worthwhile debate—which I have received from one of my constituents. It is more telling perhaps than the printed documentation which we received by way of representation on this subject, however admirably the Royal College of Nursing set out the data. My constituent writes: I am a theatre sister of eight years' standing; because of this I am at the top of my salary scale. Combined with the fact that I have fairly low outgoings in the form of rent, travel expenses (I usually bicycle to work) and no financial family commitments, I am able to retain a reasonable standard of living. However, not unnaturally, most of my colleagues have one or more of these financial burdens to bear. Not surprisingly, it is very difficult to fill the staff nurse vacancies which occur, and because of this my area of work is suffering from a gross staff shortage. At the present rate staff are leaving it is a matter of weeks before theatres will be shut or operating sessions drastically cut, with all the ensuing consequences to the patient. There is also a very real danger of falling standards if staffing continues at such a low level, and of a high level of stress and frustration amongst staff. Surely nurses as a professional body deserve some remunerative recognition and our just claims to this…government not dismissed. If we do not get a reasonable salary increase I fear the NHS will quickly become less functional, as despite the job satisfaction, more and more nurses will leave the profession to do unskilled jobs for a higher wage simply because they cannot make ends meet. Then, as a profession we will sink to the level of the Sarah Gamp's of the nineteenth century. Nothing in that letter seems to me to be avaricious or aggressive. The whole letter radiates that same concern which underlies all the traditions of the nursing service. I hope that the Government will respond to it.

8.39 p.m.

Mrs. Audrey Wise (Coventry, South-West)

It will be a pity if hon. Members seek to play off one section of those working in hospitals against another section, or to claim more compassion or higher moral standards for one section as against another. I have a great admiration for all who work in our hospitals. I think that they have all been facing a dilemma which is not of their making and which they should not face.

The central issue is not whether those working in the Health Service decide to take collective action but whether they even have to consider it. The hon. Member for City of London and Westminster, South (Mr. Brooke) read a letter which referred to the danger that faces the Health Service when nurses leave jobs or if the profession is not taken up. The same danger applies to the ancillary workers.

As long as the problem exists, it cannot be met by nurses or others deciding not to take collective action. If necessary it will be solved if enough nurses take individual action, but that is like a slow bleeding of the Health Service. I should not like the Health Service to suffer either a slow bleeding by individual withdrawal of labour or an immediate crisis by collective withdrawal of labour. Both are undesirable. It is not the workers who are at fault in either case. The fault lies in the situation that they face. They should not have to choose whether or not to take the decision. There should be no necessity for them to consider it.

I received a letter, dated 7 March, from the Coventry community health council. The waiting list for orthopaedic operations in Coventry numbers 1,500. Many cases have been waiting for well over 12 months and some for over two years. That is intolerable and it imposes a fearful burden upon the prospective patients and the nursing staff.

The Coventry and Warwickshire hospital is under-staffed and one ward has been closed because of the staff shortage. The opportunity is being taken to up grade the ward, but that is not the reason for its closure. The reason is short age of staff through shortage of money. Headlines accompany a closure through industrial action but that is not the case when wards are closed because of the shortage of nurses or money. Those cases are more or less ignored by the press, but I believe that they are equally serious.

In Coventry and throughout the country only trauma cases are being treated in orthopaedic wards. No normal orthopaedic operations—cold orthopaedic operations—are taking place in Coventry. Last week I visited the orthopaedic wards in the Coventry and Warwickshire hospital. They were almost entirely filled with elderly patients, mainly elderly ladies in their eighties who were suffering from broken bones. They occupy those beds for a long time, partly because they are slower to heal and partly because there is nowhere to discharge them to when that would otherwise be possible. The wards are filled almost entirely with very elderly accident cases.

The few beds that are not occupied by patients in their eighties are occupied by other accident cases, particularly motor accident cases. That is why orthopaedic surgeons are keen that the House should pass the seat belts Bill when it comes before us shortly. It has been put to me strongly—and I agree—that prevention would be a great service to hospitals and surgeons. While the beds are occupied in the way that I have described, no normal orthopaedic operations are taking place.

One aspect of this matter is particularly relevant to the question of nurses' pay. It is an irony that nurses dealing with geriatric patients get a plusage, but the yardstick for deciding whether a nurse is entitled to that plusage is whether the patients are under the care of a geriatrician. In the orthopaedic wards that I visited, which were filled with elderly ladies aged between 75 and 92, no plus-age was paid to the nurses because the patients were under the supervision of orthopaedic surgeons rather than geriatricians.

If it is difficult to nurse geriatric patients, and nurses need a plusage for doing that work. They should certainly not be deprived of it when the geriatric patients have broken bones. I suggest that it is even harder to nurse an elderly lady with broken bones than it is to nurse a lady of the same age who has no broken bones. I urge the Minister of State to consider changing the yardstick for determining whether a plusage is paid, so that it relates to the average age of patients in a ward rather than to the consultant who is supervising the patients.

We have solved many more complicated problems. It would be administratively simple to check the normal ward occupancy and decide that nurses working in an orthopaedic ward with elderly patients, who are geriatric as well as orthopaedic, should receive the plusage. I urge the Minister to bring that suggestion to the attention of anyone dealing with nurses' pay. It is an anomaly which needs to be corrected. I should add that the Coventry community health council and the orthopaedic surgeons concerned share my views.

We have to grapple with the fact that it is inescapable that there must be proper remuneration in the NHS. It is scandalous and intolerable that nurses are among those receiving less than average earnings. It is equally intolerable that ancillary workers who carry out essential and often unpleasant work should be in a similar position.

The Government should remember that one of their first actions in 1974 was to redress some of the grievances of the nursing profession. Substantial increases about which we could boast were paid at that time, and I urge that the same spirit should imbue the DHSS now. I am sure that if that means a battle with the Treasury my right hon. Friend will receive the support of these Benches. I hope that he will receive support also from the Benches opposite. I say that even though I am conscious that the loudest cry from those Benches is to cut public expenditure, and cutting public expenditure as a general slogan is not compatible with another slogan of paying people in the public services the wages and salaries to which they are rightfully entitled.

If my hon. Friend has his battle with the Treasury, he will certainly receive wholehearted support from these Benches. If this battle is not fought and won the Health Service will be eroded whether or not nurses or other staff decide to take industrial action. I have every sympathy with those who take the one decision and with those who take the other. I know how I would feel if I were placed in their shoes. I simply would not know how to balance the needs of my own family against the needs of the patients who have to be served. It is an intolerable decision to have to make, and the only people who can save them this additional burden are the Government, supported by this House.

I am glad that this debate has taken place. I endorse everything that has been said by other hon. Members about the Elizabeth Garrett Anderson hospital and the Royal London Homoeopathic hospital. I shall not repeat the arguments because the cases were made absolutely splendidly. I deplore any suggestion that there is any hospital which is surplus to requirements. There might be areas with greater needs than others, but I deny absolutely that there are anywhere medical services that are surplus to requirements. That phrase ought to be censored from all communications in future.

The hon. Member for Harwich (Mr. Ridsdale), who called for a change of Government so that these problems could be solved, was gravely mistaken. I believe that a change of Government to one pledged to cut public expenditure could only add disaster to our present distress, but it is up to the Government and to my right hon. Friend on the Front Bench to prove us right in expressing those words. We shall support him, but he must win this battle with the Treasury and nurses and hospital ancillary staff must get the salaries which they deserve.

8.53 p.m.

Dr. Gerard Vaughan (Reading, South)

I can tell the hon. Member for Coventry, South-West (Mrs. Wise) that she has no right to imply that we wish to cut the resources available to the National Health Service. Quite the opposite. We wish to see a vital and effective National Health Service, able to deliver care at the time of need to everybody in this country. To imply that in some way we would start to cut it and deprive people of services is a total smear and an untruth. Early in the debate the hon. Member for Fife, Central (Mr. Hamilton) referred to the absence from those speaking of my hon. Friend the Member for Winchester (Rear-Admiral Morgan-Giles). Quite clearly, the hon. Gentleman had overlooked the procedure of the House in this debate which means that had my hon. and gallant Friend spoken on this subject, he could not have spoken again later in the debate on his own subject. I hope, therefore, that the hon. Member will withdraw that assertion.

Although, for obvious reasons the numbers in the House are now distinctly depleted, I agree with my hon. Friend the Member for City of London and Westminster, South (Mr. Brooke) that this has been a most worthwhile and useful debate. It is very tempting to follow him into mentioning our various medical contacts. I shall resist that. But, of course, he is right. The nurse is the most essential person in the medical team and in the care of patients.

I was pleased when the hon. Member for Fife, Central opened the debate by referring to the deplorable pay problems in the nursing profession. We value our nurses, for all the reasons set out by the hon. Member for Brent, South (Mr. Pavitt). They are dedicated and hard working, particularly at this time of industrial strife. This we recognise. We recognise, too, their appalling salary scale in comparison with the salary scale of teachers and secretaries and many other careers which are open to women. The Opposition recognise that there is no doubt that the nurses are a special case and should be treated as such.

My hon. Friend the Member for Aylesbury (Mr. Raison) said that nurses came within the same category as the police, the firemen and the members of other services which look after our essential needs, and I agree with him. For this reason, they must be paid adequately so that their confidence is restored in the Service for which they work.

From the Opposition side of the Chamber I say to the nurses"We understand your situation over pay, we deeply sympathise with you and we welcome your undertaking not to strike. It is also our view that, if we expect you not to strike we—society—have a responsibility to see that your living standards and your pay levels are reasonable, and that your confidence is restored by the institution of adequate machinery which will respond quickly, if necessary, to your needs." That point was made by the hon. Member for Dunbartonshire, East (Mrs. Bain).

It is necessary for negotiations to take place now. There is a great deal of catching up to be done. We press the Government to get on with this, as already a large number of nurses wonder why they gave an undertaking not to strike and whether it was sensible and worthwhile. They cannot be blamed for thinking along those lines when the Government appear not to have regarded their case as urgent or essential.

We recognise, too, the problems of many ancillary workers in the Health Service. These problems were referred to convincingly by my hon. Friend the Member for Aylesbury, but the nurses are a different case and should be considered separately from other workers in the Health Service. The leader in the Daily Mail of 7 March reads as follows: To dole out—and then only grudgingly—to the nurses no more than has been offered to the ancillary workers is to insult duty and to reward anarchy…the nurses have an unanswerable case for a more generous award. The ancillary workers have harried and harassed the sick. The nurses, skilled, disciplined and devoted, have coped magnificently amid the chaos. Failure to recognise this in terms of hard cash mocks natural justice and is utterly beyond the comprehension of the overwhelming majority of men and women in this country. I shall not say that I agree with every word in that leader, but the general view that the nurses should be regarded separately and have played a magnificent part in the present industrial chaos I endorse entirely.

Given the strength of their claim, it is extraordinary that the Government found it necessary to take so long to give attention to their predicament. It was as long ago as March last year that Miss Catherine Hall, the moderate, cautious and highly respected secretary of the Royal College of Nursing, pointed out that standards of nursing care were now so low that the safety of patients in many hospitals was in question. She drew attention to the lack of pay, to their claim, and to the fact that junior nurses were being asked to look after whole wards without proper supervision. She spoke of the fact that wards were closed because of the shortage of nurses and that in certain areas nurses were unemployed.

I know from my experience that in Guy's hospital there are, every day, misunderstandings and complications because of shortage of staff. A few years ago that would have been totally unthinkable. Now it is taken as one of the necessary day-to-day features of hospital life.

I raised this issue with the Secretary of State shortly after Miss Hall had made her statement. He brushed it on one side with the totally unfeeling statement that nurses were always asking for better conditions. By the time he got to Harro-gate he realised what a disastrous mistake he had made and that the situation was far more serious than he had recognised. In October, the Royal College of Nursing presented its detailed examination and comparisons of wage scales with other careers. In that document the nurses gave—in writing—their undertaking not to strike. In the last paragraph of that document the nurses said that they would put service before self and refrain from using the strike weapon.

Sadly, the nurses went on and said that morale was damaged when their voluntary renunciation appeared to be exploited rather than appreciated. That renunciation was exploited by the Government. They carry a heavy responsibility for that. The nurses now find themselves lumped with all the other staff. No wonder they are disillusioned and wondering whether they have made a mistake in saying that they would not consider striking.

That is no way to treat the only professional body of people working in this area who have clearly and outspokenly stated that under no circumstances will they take strike action.

Mr. Moyle

I should not like the hon. Gentleman to be under any misapprehension. He is aware, is he not, that negotiations are still going on? He is talking as if a decision has been reached.

Dr. Vaughan

I am not talking as if a decision has been reached. But I cannot avoid the observation that it is now 11 months since the seriousness of the situation was realised. Yet meaningful negotiations started only after Christmas. That seems to us a most extraordinary delay. It is typical of the delays that occur over and over again in the administration of the Health Service under the present Government. I do not understand it. I cannot see the need for it.

Mr. Moyle

I can give the hon. Gentleman a very short explanation. The reorganisation for which he voted slows everything down.

Dr. Vaughan

That is a cheap and untypical remark from the Minister. This Government have had the responsibility for the Health Service for over four years yet they have decided not to put right the present chaos.

I was interested to hear the hon. Member for Holborn and St. Pancras, South (Mrs. Jeger) point out—and it was very refreshing—that many of the problems in the Health Service today stem not, as the Minister would say, from the Conservative Benches but from the grandiose ideas of the late Mr. Crossman.

The Secretary of State made an important statement about the use of volunteers. But why did he wait until now? Why could he not make that statement when we asked him to do so a few weeks ago? Why did he have to wait until the industrial situation had deteriorated even further? In most places where the health authorities called in volunteers, clearly and firmly, and said what they were going to do, the militant action was reduced. But where the health authorities dithered and waited for directions—which they never received—the militancy almost always increased.

We criticise the Government because there is no clear leadership in the Health Service. The Government must take the responsibility for having allowed the industrial situation to drift in this way. They knew, as we heard from the press in November, that a major strike by NUPE was being contemplated. Yet the Government took no action. They knew even more clearly in December because by then the union had sent out instructions to its shop stewards saying that it planned to cause the maximum disruption of services to patients. But the Government took no action.

It could have been no surprise for the Government to hear it said last week: We intend to put the squeeze on the Health Service. We will gradually build up our action so more and more hospitals are reduced to emergency services only. What an appalling, callous and deplorable thing to say. Those are the words of the NUPE spokesman, a senior trade union official.

Whatever the outcome of the dispute, words such as those and the actions that go with them have damaged morale in the Health Service even further. It will be a long time before some sections forget and forgive. Those involved are uncaring. They have no regard for the feelings, sufferings or even the basic safety of patients—children, old people and the seriously ill. It is simply not true that emergency cover of the kind to which reference has been made will safeguard all seriously ill patients. I am afraid that many of the strikers know that—but not all of them care. That is the frightening aspect about the present industrial scene.

Mr. Stallard

We are following the hon. Member's speech closely. But I did not hear him make similar remarks when junior doctors made the same type of protest. We should not play the party game. The action was wrong then. There should have been strong protests from the Opposition Bench as there were from the Labour side of the House.

Dr. Vaughan

The hon. Member will be fair enough to admit that we were critical of the junior doctors. We were clear about our position. We were clearer than Labour Members.

Mr. Pavitt

But the hon. Member did nothing.

Dr. Vaughan

That is not so.

The terrible aspect is that the strikers do not care. Otherwise, how could it be said that: If it means lives lost, that is how it must be.

Mrs. Wise

Does the hon. Member not know that that quotation was taken completely out of context? The person who was alleged to have made that statement was saying that the whole decline in the Health Service would put lives at risk. The hon. Member should be more responsible before he inflames passions even more. Why did he not say some time ago that these workers had a good case for better wages and put his efforts into helping them achieve that and so prevent these activities?

Dr. Vaughan

I am not surprised that the hon. Lady jumped up, because she knows that the words have not been taken out of context. I quoted the words accurately. She knows that there were other words of a similar kind. What about the picket who said"Do not ask us about the patients going for cancer surgery, ask them "? They were harsh, unfeeling and brutal words.

Mrs. Wise

Is the hon. Gentleman not aware that claims about cancer patients were refuted by a particular hospital in Birmingham and that the responsibility was laid at the door of the consultant concerned? Is he not lowering the tone of the debate by playing off one section of health workers against another? The fact is that they all have a good case. They have all had terrible decisions to make in balancing the needs of their families and the needs of the patients. It is our job to take away from them the need to make those decisions, because it cannot be satisfactorily done by them.

Dr. Vaughan

The hon. Lady is irate because she realises that I am stating facts.

Mrs. Wise

Oh no.

Dr. Vaughan

I am looking reality in the face and merely saying what has been happening. In many cases life-threatening situations are now beyond the capacity of doctors and nurses to deal with. In many hospitals decisions are now taken not by the staff but by union representatives—often by a porter. He is a very valuable part of the hospital team but not, I would suggest, the person to make medical decisions or say what is or is not a medical emergency.

Had the hon. Member for Coventry, South-West read The Daily Telegraph on Monday—I do not suppose that she did—she would have seen set out various examples of appalling situations from first-hand knowledge that have occurred in hospitals where emergency cover only was being allowed by unions." Emergency cover only"does not mean that lives will not be at risk.

I was interested in a leader—

Mr. Pavitt

The hon. Gentleman has tried to make the maximum amount of political capital out of the situation and has not tried to solve the problem or help matters. I should like to point out that although in my experience the majority of doctors and consultants do not play politics, over this last period of go-slows and so on, doctors in my own constituency were deliberately exacerbating matters by not using the usual channels of procedure so as to be able to make a political point against the strikers.

Dr. Vaughan

I should have thought that that was absolute rubbish and totally against the Hippocratic principles of the medical profession.

Mr. William Hamilton

Come off it!

Dr. Vaughan

I was brought up on the dictum of that famous physician, Sir William Osier—to comfort always. That is the first priority. To say that members of the medical profession play party politics in the way the hon. Gentleman suggests is absolute nonsense.

I was very interested to see in the leader of the Daily Mail a discussion as to why words such as I have quoted should be said, and how such an appalling situation can occur where the Jamie Morrises of our society are able to mislead their colleagues within the unions. He is the man who will not work at his proper job and yet apparently he cannot be sacked. It strikes me that one of the reasons is that so many members of the unions are afraid that they will be victimised if they do not agree with whatever directive is given to them.

The point that I wanted to make in regard to the leader in the Daily Mail was that that newspaper was asking why this should happen, and was pointing out the arrogance of the so-called public servants. That leader also made what I thought was a relevant point about remoteness in administration. That is one of the reasons why we as a party, subject to the recommendations of the Royal Commission, are so determined to restore small health units, where communication can take place and where the local community will once again be in touch with those units.

The result of all this unrest—again, this is uncomfortable for Labour Members—is shown most clearly and tragically in the waiting list. What do Labour Members say about 28,000 hospital admissions cancelled? The hon. Member for Coventry, South-West is walking out of the Chamber. I am not surprised. What would the hon. Lady say about the fact that the waiting list is now over 800,000? It is an absolute disgrace in personal terms. Even before the recent increases, and ever since the present Government took over in 1974, the queues for treatment have got steadily worse.

Mr. Moyle

There is absolutely no justification for saying that the waiting list is over 800,000—none at all.

Dr. Vaughan

Then the Minister should talk to his own advisers, because our information is that it is just around 800,000. I should like him to say categorically in this House that that figure is wrong. I do not think he will find that it is. I should like him to say that the most serious feature of this is not just the total waiting list but the number of people who are now waiting for urgent investigations.

A few weeks ago—and the percentage will have gone up since then—we knew that in the Oxford area 70 per cent. of patients needing urgent investigations had to wait two, three, four, or five months—and all over two months. I heard the other day that in the Manchester area the waiting time for urgent investigations is now well over two months and is rising rapidly.

The hon. Member for Coventry, South-West looks perplexed, but these are facts from different parts of the country. If she does not agree, I suggest that she goes round the country and talks to people.

Mrs. Wise

I was looking perplexed, because I was searching in my mind to try to remember any occasion when the Conservative Opposition brought before this House any motion urging more expenditure on the NHS. I am afraid that I did not remember a single occasion, because the Conservative Opposition spend their time calling for cuts in public expenditure. Can the hon. Gentleman quote any proposals that have come from the Conservative Opposition—say, on a Supply day—calling in specific terms for more money for the NHS?

Dr. Vaughan

All the hon. Lady has done is to make me regret that I gave way to her. [HON. MEMBERS:" Answer the question ".] The hon. Lady is walking out again. Of course, I shall answer the question in a moment, but let me make my speech in my way. Labour Members have had their chance to make their speeches in their way. The point I am making is this. When, a few weeks ago, I put to the Secretary of State that there were now hundreds of hospitals restricting their services, he said that I was alarmist and exaggerating. What about the figure now that there are over 600 hospitals dealing with emergencies only? Nine hospitals are closed completely, and 5,500 beds are out of action. What a terrible indictment of the Socialist Administration.

Sadly, in recent years, we have witnessed an almost total lack of leadership from the Government. They have sheltered behind the Royal Commission, decisions have been postponed, muddles have been created and frustration has been allowed to build up until it can be exploded by the Jamie Morrises of this world. If Labour Members think that that is an exaggeration, they should stop and think and look at the situation over the nurses. Months have gone by. They should consider the strike of the maintenance supervisors just before Christmas. About 60,000 people, we are told, were added to the waiting list as a result of that strike alone. The problem of their pay had started four years previously. There was no denial in this House when it was put to the Secretary of State that the dispute could have been averted in January 1978—over a year ago—if there had been proper negotiations and attention paid to the matter. Instead, it was allowed to build up and explode into a disastrous strike.

There has not only been delay in industry matters. I can produce a list of inexplicable delays by the present Administration. The Howie report on the safety of laboratories was available in January last year. It stated specifically that certain laboratories were working at a dangerous standard. Nothing was done until the disaster at Birmingham, which led to the Shooter report.

I was horrified at the reply I received when I wrote to the Secretary of State before Christmas about the state of laboratories and asked how much it would cost to put the laboratories back on to a safe footing. I would have thought that was a perfectly reasonable and responsible question. In his reply, the Secretary of State said he had discussed the matter with Sir James Howie who, for various reasons, had refused to give him the information. He was, therefore, unable to tell me the cost. In the Secretary of State's view, it was not his responsibility to see that our laboratories were safe. It was the responsibility of individual health authorities. What a washing of hands of responsibility that is. I shall make the letter available to the hon. Member for Coventry, Southwest if she wishes to check what I say.

There is delay on every side. It is not surprising that, going round the country, one finds not only appallingly low morale in many places, but a widespread feeling that there is a lack of direction, a lack of leadership and a lack of any sense of purpose on the part of the Secretary of State. I appreciate as much as any hon. Member in this House the personal health problems of the Secretary of State. At the same time, he and the Government must recognise that morale is low and that there is a feeling of a total lack of any sense of purpose and direction in the administration of the National Health Service.

Mr. Stallard

I am also concerned about this question of morale. Would the hon. Gentleman not agree that much of that loss of morale occurred as a result of the reorganisation of the Health Service by his right hon. Friends and hon. Friends? That reorganisation threw the whole Service out of gear. That was where the loss of morale started. It has got worse ever since.

Dr. Vaughan

Are we to sit back forever? Are we to make no decisions or restore any sense of direction? Do we merely say that this is all the fault of the previous Government? That is absolute nonsense. It is a total lack of responsibility. My hon. Friend the Member for Harwich (Mr. Ridsdale) was right—

Mrs. Wise

rose—

Dr. Vaughan

I am sorry but I intend to continue my speech. It is late in the day. I am sure hon. Members want to get on to other parts of the Consolidated Fund Bill. My hon. Friend the Member for Harwich was right when he said that one has to go outside this country if one wants to see a first-class health service and first-class health care.

Mr. William Hamilton

In America?

Dr. Vaughan

No, not at all. Why, in France, for instance, are there no waiting lists? That country has the same size of population and a smaller number of hospital beds. In terms of actual personal health care, France does not have the tragedies that occur in Britain of people becoming incurably ill while waiting to get into hospital.

Mr. Pavitt

I have seen the operation of health service in most countries, including France. What the hon. Gentleman ignores is that the standard of care in the industrial sector, especially the nationalised industries such as Renault, is based on an industrial and occupational health system which does not exist in Britain. If only the hon. Gentleman would support an occupational health system we would be able to achieve more.

Dr. Vaughan

That is an interesting intervention. The French have a system whereby, if a person has an accident, an emergency, or one of 25 major illnesses which cover practically all the major illnesses one can think of, there is 100 per cent. and immediate health care. Surely that is a desirable state of affairs. More than that, they have a philosophy that is constructive and go-ahead. The French are determined to maintain a high level of health care for all their residents.

Mr. Pavitt

What happens in practice?

Dr. Vaughan

Before the hon. Gentleman makes that sort of remark he should go to the country concerned.

Mr. Pavitt

I have done. I am talking from experience.

Dr. Vaughan

If that is so, the hon. Gentleman has spoken to the wrong people.

My hon. Friend the Member for Wells (Mr. Boscawen) suggested a number of ways in which improvements could be made. I have already referred to the remarks of the hon. Member for Holborn and St. Pancras, South when she referred to the late Mr. Crossman. She made an interesting comment but I am sure that she did not mean it in the way in which I took it. She said that we should put the money with the patient. That is exactly what is done in many countries. That is done by means of insurance systems. The patient carries the cost with him to wherever he cares to seek treatment. He may go to any doctor or hospital in any part of the country and he knows that his health care will be covered without any restrictions or restraint. I am sure that that is not what the hon. Lady meant.

Mrs. Jeger

The two situations are surely not comparable. In Britain one can go anywhere and receive medical treatment without having to take any money. I was trying to say that we have so localised the financing of what should be a national health service that we have become in a muddle. I am sure that the hon. Gentleman would not want to misrepresent what I said.

Dr. Vaughan

I assure the hon. Lady that I have no need to do so.

We should consider closely alternative methods of financing the National Health Service after the Royal Commission has reported. Opposition Members are as determined as hon. Members on the Labour Benches to have a National Health Service that provides proper, first-class health care to every person who requires it at the time that they require it. There is no difference between the parties on that score. The differences lie in the way in which that sort of care is achieved.

Many hon. Members have referred to the administrative problems of the National Health Service. I shall not go into the difficulties now. However, there is the problem of remote administration. That could not have been better shown than by the examples we were given by many Labour Members, especially those who were concerned with the Elizabeth Garrett Anderson hospital.

If women feel the need to have a special hospital dealing with their illnesses, we think that they are entitled to have such a hospital. We support them on that issue. As Labour Members have said, the tragedy and the disgrace surrounding the Elizabeth Garrett Anderson hospital is that the hospital has been destroyed by bureaucracy. It has been destroyed by uncertainty. The hospital has been steadily run down. Maintenance has not been done. I shall not go into all the matters that have been so graphically described.

It is difficult to get staff for the Elizabeth Garrett Anderson hospital because the hospital's future is unknown. One arrives at a point where the hospital is no longer viable and there is then the argument that it should be closed. That is an absolute disgrace. When we come to power later this year, if at all possible the hospital will be kept open.

Mr. Stallard

Is the hon. Gentleman supporting my argument that the EGA shall remain unconditionally on the site?

Dr. Vaughan

What I said was that the way that the hospital's existence has been thrown into question is an absolute disgrace. We totally support the right of women to have such facilities. Its structure is decaying and the whole thing is falling into disaster, but if it is possible to maintain it we shall certainly want to do so.

The situation at St. Columba's hospital in Spaniards Road is similar. A question mark was thrown over the future of the hospital and within days there were telephone calls inquiring whether the staff could be moved to other hospitals and asking what would happen. I congratulate my hon. Friend the Member for Hampstead (Mr. Finsberg) on his immediate action. That hospital is carrying out the kind of care that is immensely compassionate and cannot be undertaken in large institutions. It requires a small hospital with close contact between staff and patients. People from all over the country and all parts of the world visit the hospital to learn about the treatment and care that is given there. There should be more such hospitals, not fewer. It is incomprehensible that viable, flourishing and highly effective hospitals should be shut down.

I headed a deputation to the Minister about the Lord Mayor Treloar hospital at Alton, which again has a large question mark over it. It is a specialist orthopaedic hospital threatened with closure at a time when in other parts of the country such specialist centres are being established. With one hand we are tearing down a specialist centre and with the other planning to build more. That just does not make sense.

With few exceptions the debate has been useful. It is over four years since the Government took responsibility for the National Health Service. During that time the decline has been steady, progressive and disastrous, not only in the standard of service offered to patients but to the morale of the Service as a whole. The Secretary of State and the Ministers have totally failed to give the leadership and directives necessary to restore the situation.

9.33 p.m.

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

The debate has been wide-ranging and useful. I congratulate my hon. Friend the Member for Fife, Central (Mr. Hamilton) on coming top in the ballot and selecting this subject for debate. It has enabled us to review the situation in the Health Service, consider some pressing problems and make useful suggestions for the way forward.

To begin with, we must consider pub-lice expenditure. There should be a steady growth in the resources available to the National Health Service. We are prepared to meet that commitment and have struggled to do so. The rate of growth has not been as high as we should have liked, but we have maintained it.

On the other hand, there is an uncertain call from the Opposition. On any particular issue right hon. and hon. Members always call for increased public expenditure, and in this case they want an increase to meet the nurses' pay claim. That is typical. But when it comes to an overall statement of policy, their cry is for a substantial cut in public expenditure.

Until now we have had complete irresponsibility in approach displayed by the Opposition. This afternoon there has been a slight break. There has been a rush of blood to the head in the case of two or three hon. Members who have stated clearly that the correct way to meet the problem of increased expenditure for certain aspects of the National Health Service is by taking funds away from the support of industry—and presumably meeting the consequent rise in unemployment—and redeploying them to the National Health Service.

The alternative put forward by the hon. Members for Reading, South (Dr. Vaughan) and for Wells (Mr. Boscawen) is that the funding of the National Health Service should be based on the national insurance principle. As I understand the national insurance principle, people make contributions and receive the service to which their contributions entitle them. What happens when they run out of benefit under the national insurance scheme? Does it mean that they have to go without health care, as happens in a number of European countries, or that there is some form of subvention from some other source—in which case why bother with the national insurance system anyway? That question has not been answered, and I do not believe that it is answerable in any terms of logic. People would have to pay for the services of the Health Service at the time when they had to use them, and that is a principle which we on this side of the House are determined to avoid.

Mr. William Hamilton

Does my right hon. Friend recall the official commitment of the Tory Opposition in"The Right Approach"that they will increase charges all round—ophthalmic, dental and so on? That is how they would get the cash.

Mr. Moyle

Yes, that is the logic of the approach of the hon. Members for Wells and for Reading, South. It means either a further increase in bureaucracy, in order to check that those who cannot meet the charges are helped from an alternative source—and we already have much too much bureaucracy in the NHS—or denying health care to those who need it but cannot afford it. Those are the questions that Opposition Members continually dodge.

The hon. Member for Reading, South said that we had had a responsible debate. That is true, apart from one passage in his speech. After some weeks of industrial action, three of the four unions representing the ancillary workers have agreed to accept the latest offer made to them and throughout much of the Health Service members of those unions and some members of NUPE are going back to work. At that junction and against that background, the hon. Member took the opportunity to rake over the cold ashes of the disputes and disagreements of the last few weeks. He must have known that that would have the effect of resurrecting all these disputes, stirring them up and making the situation worse.

I cannot condone industrial action in the Health Service. Although people may feel that they are forced to take such action, we should have a situation in which they do not feel forced to take it. When they do take action, they can only put the patients at risk. All the instances and examples that the hon. Member quoted arose where individuals, beset by members of the press, local and national, had had their remarks taken out of context and blown up out of all proportion in order to make a headline. When this happened, right hon. and hon. Members, week after week, made the maximum use of these remarks.

On every occasion when matters were raised with the headquarters of the unions concerned, the unions took action, and those disputes were quickly sorted out. I do not pretend to defend the code of practice as desirable. However, the code was applied and the emotion and heat were taken out of the situation.

Mr. Christopher Price (Lewisham, West)

Does the Minister realise that it is not only the hon. Member for Reading, South (Dr. Vaughan) who adopts this thoroughly irresponsible attitude towards the unions? The hon. Gentleman's boss, the right hon. Member for Wanstead and Woodford (Mr. Jenkin), recently called for the sacking of the chairman of the Lambeth, Southwark and Lewisham AHA, accusing him of moving a resolution mentioning COHSE and NUPE, which was a mendacious statement. The chairman had not mentioned COHSE and NUPE. The right hon. Gentleman was obliged to retract the statement in spite of the fact that it was issued as a Conservative Party press release. Does not my right hon. Friend think that that shows that Conservative Front Bench Members are in no business other than simply waging an anti-union battle for votes and are doing absolutely nothing to help the situation and get things back to normal?

Mr. Moyle

My hon. Friend has put the case clearly of Mr. Hardy, chairman of the Lambeth, Southwark and Lewisham AHA. I endorse every word my hon. Friend said. I understand that my hon. Friend notified the right hon. Mem- ber for Wanstead and Woodford (Mr. Jen-kin) that he would raise the case.

Dr. Vaughan

I understood that the Minister intended to refer to the correspondence on this matter from my right hon. Friend.

Mr. Moyle

I did not intend to refer to the case. The right hon. Member for Wanstead and Woodford made an unfounded accusation against Mr. Hardy, chairman of the Lambeth, Southwark and Lewisham AHA, which Mr. Hardy refuted. I accept from the records that Mr. Hardy is absolutely right. I shall leave the matter there. It is a matter for the right hon. Member for Wanstead and Woodford to take further if he wishes.

Mr. Christopher Price

I should like to make the record clear. I understand that the right hon. Member for Wanstead and Woodford retracted the statement that mention was made of COHSE and NUPE in a letter from Mr. Hardy, and admitted that his statement was false.

Mr. Moyle

It appears that that handsome gesture buries the matter. It is best that these matters are not started in the first place.

The hon. Gentleman agrees that there is too much bureaucracy in the Health Service. The Conservative Government created the organisation that set up the bureaucracy. There has been a 20 per cent. increase in the number of administrative and management staff in the Health Service as a result of that reorganisation. Although some of it was taken from the local authority community health services, a great deal of it was self-generated as a result of the reorganisation.

We are waiting for the advice of the Royal Commission to tell us the way forward out of this burgeoning mess with which we were landed. We are determined not to rely on the management consultants employed in the early 1970s by the Tory Government, who later said that they had made a mess of the Service. This time we have chosen people with considerable experience of the Health Service in one capacity or another. We hope that they will give us good advice.

In the meantime, it lies ill in the hon. Gentleman's mouth to criticise this Government for bureaucracy when the Conservative Government were the source of it. If the hon. Gentleman has any doubts, I refer him to the remarks of his right hon. Friend the Member for Wan-stead and Woodford in Committee yesterday in discussions on postgraduate hospitals. His right hon. Friend admitted that he and his colleagues had considerable responsibility for the bureaucracy in the Health Service and he was heartily ashamed of it.

We have said that the Howie report must be introduced over the next three years and the laboratories brought up to the appropriate standard. But it is a question, as my right hon. Friend said, for the area health authorities, because this is the organisation with which we were left by the Conservative Administration—that area health authorities should have the administrative responsibility for running the Health Service.

My hon. Friend the Member for Fife, Central and many others—in fact, practically every hon. Member who spoke in the debate—referred to the nurses. I agree that it is a very dedicated profession and that the nurses are a hard-working group of people within the Health Service. I would be the last person to say that we could do without any of the various groups within the Health Service. They all perform a vital role and function. But if one had to go through the exercise of shedding any groups of people, the last group that I would want to see leave the Health Service—either short-term, by industrial action, or by losing them in any other way—is the nurses. If one has a good, hard-working, dedicated nurse force, one can run some sort of a health service, whereas without the nurses, either in the community or in the hospitals, one would be in a very serious position indeed.

My right hon. Friend and I appreciate the decision, reached the other day by the Royal College of Nursing, that nurses would refrain from the use of industrial action in support of their claims for improvement in their terms and conditions of service and in their wage rates. We very much appreciate that, but it is not, of course, an exclusive decision. Other groups of nurses in other organisations have not taken the same decision. It is a Royal College of Nursing decision. As a result of that initiative, the Royal College of Nursing has mobilised public opinion and sympathy behind its case—and that, in my opinion, is the vital deciding factor in all these pay matters—and it could not have achieved this in any other way.

My hon. Friend the Member for Fife, Central, having done a great deal of research, presented a very powerful and cogent claim, argued in great detail. He quoted comparable rates of pay, such as those of primary school teachers, social workers, police and many other groups. I would not wish to argue with him on the case that he put forward. I suspect, without having the details at my fingertips, that there is a considerable amount in what he says. For that reason, it is particularly important that that case should be argued, because our power to influence wage settlements in the private sector of employment in this country was removed shortly before Christmas by the Opposition in a vote.

Mr. William Hamilton

By the right hon. Member for Taunton (Mr. du Cann).

Mr. Moyle

I would not restrict responsibility to him. I would extend it to the whole of the Conservative Party. The result is that everyone in the public sector feels vulnerable. People feel that their relative position will be made much worse by movements in the private sector. This is the problem that we have to solve.

It is a result of this that we are basing the solution of public pay problems on the institution of a comparability study. All the arguments that my hon. Friend put to the House—generally supported by my hon. Friends and other Members—will be capable of being argued in front of the comparability body.

My hon. Friend the Member for Brent, South (Mr. Pavitt) said that nurses cannot be given productivity payments. That point will also be argued when the comparability study takes place, and can be taken into account in comparing nurses' remuneration with that of other groups, and an appropriate solution sought.

What is absolutely true is that the only other two occasions in the history of the nursing profession when it has received a substantial increase in pay have been under a Labour Government. In 1970 they received an increase of 20 per cent. but under the succeeding Conservative Government they fell back. When we came to power in 1974 the Halsbury Committee was set up to carry out a comparability exercise which led to increases of 30 per cent.

I am prepared to say that the Government have made a mistake. We thought that if the normal pay policy increases were taken into account the nurses would be kept in their rightful position in society. Today we have considerable doubts about that. Therefore, the comparability study is being set up and this time we are taking steps to avoid the mistake made after 1974.

The Government will accept the comparability study on the nurses if they accept it. It is on offer to the nurses not only for this year but for 1980,1981 and 1982 and succeeding pay rounds so that, in future, any likelihood that nurses will fall behind will be automatically corrected by the continuing review. I believe that when the history of the nursing profession and its terms and conditions of service is written, 1979 will be regarded as even more significant than 1970 or 1974.

The comparability study will be instituted in two stages. The first stage will operate from 1 August of this year and the subsequent stage on 1 April 1980. Although the review of the position of nurses in society has begun later than that of the doctors, they will, by 1 April 1980, have caught up and will be moving in step with them. The Government have been urged to adopt a speedy solution, but if a proper and scientific study of the position of nurses in society is to be carried out we are not likely to be able to complete the necessary investigations and evaluations before 1 August of this year.

Mr. Pavitt

In view of the representations made by Labour Members about the backlog of 1978–79 would not my right hon. Friend reconsider the phasing date to see whether a stage should be introduced on 1 April of this year in relation to the 1978 figures?

Mr. Moyle

The nurses have been offered 9 per cent. plus £1 on account of the comparability study. I shall not comment in any more detail on the negotiation except to say that there was another meeting of the Whitley Council last Tuesday. It was a good, hard-working session and further progress has been made. I am sure that there will be future meetings of the council.

We fully appreciate the value of nurses to the Health Service and we wish to ensure that their proper position in society is achieved, relative to those groups with which they have always compared themselves. I deprecate remarks that seem to imply that a decision has already been taken on nurses' pay. Their normal settlement date is not until 1 April of this year. Negotiations are still continuing, but I shall not comment on the details at this stage.

Mr. Pavitt

Will my right hon. Friend give a specific answer to the point made by a number of my hon. Friends? In modern jargon, the nurses' case is not just a special case; it is an exceptional and unique case. Therefore, it should have a different standing in the Government's assessment. We are asking my right hon. Friend to say categorically that it is exceptional and unique.

Mr. Moyle

I have attempted to indicate to the House why I regard the nurses' case as being of considerable, exceptional—or whatever adjective my hon. Friend wishes to apply—importance. I cannot elaborate further. I have indicated that I believe that nurses play a vital role in the NHS.

My hon. Friend the Member for St. Pancras, North (Mr. Stallard) made a brisk, breezy and enjoyable return to the Back Benches after years of silence in the Whips' office and made a powerful speech. He said that he was horrified by the NHS and that it was seriously ill. That over-dramatised the position a little and I should like to give some figures about the flow of resources into the Service.

Dr. Vaughan

May I take the Minister back to what he was saying about nurses' pay? I was not clear whether he was saying that there would be annual or twice-yearly increases or whether there was to be a continuous upgrading, linked to comparability.

Mr. Moyle

It has been the practice of nurses to put in an annual pay claim, and annual adjustments in pay rates are part of pay policy these days. When the nurses have had their rate of pay for April 1979 to April 1980 settled, I would expect that they will want a review of their pay rate from April 1980 to April 1981. No doubt they will put in a claim and, under the Government's scheme, the comparability Commission under Professor Clegg would still be in existence and would review the nurses' claim against the background of movements in the pay of groups with which nurses have traditionally compared themselves. Further adjustments could be made and the nurses would be joined in that exercise by other groups, rather as the Doctors' and Dentists' Review Body reviews the pay of those professions. That is what is on offer to the nurses and why I said that 1979 will turn out to be a more significant year than 1970 or 1974 in terms of the pay and conditions of nurses.

Mr. William Hamilton

Is it clear that the Tories are in favour of the comparability machinery? I understand that they poured a lot of cold water on the idea when it was first announced.

Mr. Moyle

My hon. Friend has a point. That has not been mentioned by the Opposition in this debate. I understand that they have undertaken that the four groups that the Government have said will be referred to the Commission will be allowed to go forward, but they have not committed themselves to what will happen in subsequent years or whether anything will be done for other public service groups.

If any Conservative Member wishes to intervene to elucidate that point, I shall be happy to give way to allow him to clarify the position.

Mr. William Hamilton

They will not answer that question.

Mr. Pavitt

Speak up or for ever hold your peace, Gerry.

Mr. Moyle

I should tell my hon. Friend the Member for St. Pancras, North that when the Government came to power in 1974 we devoted about 5.3 per cent. of the gross national product to the NHS. That figure has risen slowly over the years to 5.6 per cent. We are putting aside each year a greater proportion of our national wealth to the sustenance of the Service.

We are also recruiting more doctors and nurses and more professional and technical staff, such as occupational therapists, physiotherapists and radiographers. The nursing and midwives' force has increased by 10.3 per cent. while the Government have been in power, the medical force has increased by 11 per cent. and the professional and technical group, which was seriously under-recruited when we came to power, has been increased by 24 per cent. In addition, the works and maintenance staff has increased by about 13 per cent. That is a force which we set up in 1974.

Mrs. Wise

I am grateful to my hon. Friend for those figures which are very interesting. Since the hon. Member for Reading, South (Dr. Vaughan), after demanding my presence in the Chamber so imperatively, twice refrained from answering my specific question, I wonder whether my right hon. Friend can recall any occasion when the Opposition have brought forward specific requests for expansion of the National Health Service on any of the many opportunities that they have had to bring subjects before the House.

Mr. Moyle

I must confess that now the point is put to me by my hon. Friend—and I have searched my mind since she made the point in an intervention in the speech of the hon. Member for Reading, South—I cannot recall, certainly in the two and a half years that I have been in this position, any such proposal being made. Of course, the number of patients admitted to hospital has gone up from just over 5 million to 5,340,000, and outpatient attendances have gone up from 45 million to nearly 47 million and day case attendances have gone up very substantially from about 400,000 to 536,000.

So we get a picture of a very large National Health Service, beset by bureaucracy as a result of the reorganisation of 1974 and struggling with a new era of industrial relations problems, perhaps in a national mood of industrial relations militancy, but one which is deploying greater numbers of caring staff for ever greater numbers of patients. In that context we can discuss the problems that my hon. Friend has brought forward.

Mr. Stallard

I am sure that my right hon. Friend would not want to misinterpret what I said, because I said also that it was not only a question of how much money. Like all hon. Members on this side, I recognise and am very grateful for the fact that our Government have at least tried in very difficult circumstances to raise the amount expended. I was suggesting that there may be some different forms of allocation of available resources. It is a question of national funding, and cross-regional funding if necessary, for specialised projects. That was what I was arguing.

Mr. Moyle

Frankly, I am regularly beset by national funding requests. My hon. Friend mentioned the Elizabeth Garrett Anderson hospital, the Hammersmith renal unit and some other projects also in relation to national funding. The hon. Member for Aylesbury (Mr. Raison), in an Adjournement debate, asked for national funding for the spinal injuries unit at Stoke Mandeville. There are 12 postgraduate hospitals in London which want to be nationally funded. The teaching hospitals sometimes make representations that they want to be nationally funded. If these organisations are to be nationally funded, they have to be nationally managed. [HON. MEMBERS:"Why? "] One cannot allocate money to various units of the National Health Service unless one is confident that the money has been properly spent, and that means accepting a managerial responsibility for them. That would mean that my right hon. Friend and myself would rapidly be beginning to manage the greater part of the Health Service from our office. I gather that our office at the Elephant and Castle is not the favourite place of my hon. Friends. That was the deduction I made from their contributions to the debate—that, if anything, they would like the Elephant and Castle office reduced rather than expanded, but the proposals made for national funding lead entirely the opposite way.

For that reason, under the RAWP formula, allowances are made for cross-regional flows for special purposes—for example, if a facility for treating women by women, and not just for women's diseases, on a national scale, is maintained then the RAWP formula allows the resources for that facility to be drawn from the National Health Service and the cross-boundary flow is across regions and from one end of the country to the other.

Mr. Geoffrey Finsberg

In trying to refute the argument put by his hon. Friend the Member for St. Pancras, North (Mr. Stallard) about national funding, the Minister said that it would mean control from the centre. Does he not realise that since the war all Governments have in some cases given 100 per cent. specific grants without imposing any managerial control?

Mr. Moyle

That is not true of the modern Health Service. We do not retain national funds at the centre, apart from funds for specific experiments. That reminds me of the question raised about the detoxification unit at St. Thomas' Hospital. We believe that the proposal is much too expensive, but if the officials of the St. Thomas' health district and the Lambeth borough council and the other bodies concerned, who are holding discussions with officials, can agree on a more economic and streamlined experimental service, we would fund it for three years because it is experimental.

The broad bulk of Health Service funds is given to social service departments and area health authorities on the basis of the resource allocation formula to manage as they see best. That is the way in which we carry out the management of the Health Service, and that is the system for which the hon. Member for Hampstead (Mr. Finsberg) voted in the last Parliament but one.

On the question of the Elizabeth Garrett Anderson hospital, I first wish to say on behalf of my right hon. Friend and myself that we want to keep a facility for women to be treated by women, not just for women's diseases but generally to allow a woman to be treated by a woman. A facility for this is necessary for the next 20 years or so. If the number of young women going into medicine increases at the present rate, that service will be available on a routine basis at any general hospital probably by the end of this century. The hon. Member for Hampstead said that a large number of Muslim women had inhibitions about being treated by male doctors, which was why this service must be provided.

What is at issue between ourselves and my hon. Friends and the hon. Member for Hampstead is not that this facility should exist but where it should exist. We have been endeavouring to implement the undertaking given by my right hon. Friend the Member for Blackburn (Mrs. Castle) that it should be in another district general hospital within the same region. We have the Whittington hospital in mind, but it now seems that the Whittington hospital would be unable to accommodate a unit of this sort for about 12 or 13 years ahead. So we have to decide what to do in the interim and, maybe, permanently.

I gather that my hon. Friends and the hon. Gentleman discussed the matter yesterday with my right hon. Friend and he told them that he thought the best way of reducing the overheads of the Elizabeth Garrett Anderson hospital facility would be to examine whether it could be installed in the Royal Homoeopathic hospital buildings along with the Royal Homoeopathic hospital. There has been no decision to close the Royal Homoeopathic hospital. Indeed, as a postgraduate hospital it is a candidate for inclusion under a London postgraduate health authority. Therefore, the letter quoted by my hon. Friend the Member for Holborn and St. Pancras, South (Mrs. Jeger) would be from an administrator of an area which would have no responsibility for the Royal Homoeopathic hospital.

My hon. Friend the Member for St. Pancras, North made some harsh remarks about size and said that small is beautiful. I must defend the Department. It has moved away from the 1,400—and 1,500—bed hospitals of the 1960s. It believes that a district general hospital should have no more than between 600 and 900 beds.

Mr. Speaker

I am sorry to interrupt the Minister, but he is addressing the House, not his hon. Friends. He has had his back to me for the past 10 minutes.

Mr. Moyle

I apologise for turning my back on you, Mr. Speaker. The Department believes that a district general hospital should have between 600 and 900 beds and that, depending on local circumstances, that is the level that is required to maintain the conditions for modern medicine.

The real argument against the maintenance of the Elizabeth Garrett Anderson hospital is its size. Even with its maximum number of 157 beds, let alone the smaller number in existence now, it is not an economic proposition to maintain all the facilities of high-grade medicine. That is the reason. It is not because of the deterioration of the fabric of the building or the non-existence of the lift.

If money is spent on the lift, we will be committed to that building and the maintenance of the fabric for a long time. We do not wish to pour money into such a facility. The reason for trying to combine the hospital with other facilities is to share the overheads and reduce costs.

Mr. Geoffrey Finsberg

Will the right hon. Gentleman answer the point made by the hon. Member for Holborn and St. Pancras, South (Mrs. Jeger) and myself about the voluntary offer of £8,000, with no commitment on the part of the Government? Is he accepting or rejecting that offer?

Mr. Moyle

My right hon. Friend has not yet had an opportunity to discuss that offer with me. I was unaware of it until this afternoon, but I shall consider it against the background of the remarks that I have just made. If one used that money for the purposes indicated, one would commit oneself to that building, which is too small for the practice of modern medicine at the best level. Nevertheless, when my right hon. Friend tells me the details of the offer I shall consider it.

The hon. Member for Hampstead raised the question of St. Columba's hospital. At its meeting in February, the area health authority decided to close the hospital temporarily because it was overspending and wished to retrench in order to keep within its budget. The hon. Member voiced his deepest suspicions that this might be a prelude to permanent closure because the authority has not carried out the proper consultative procedures.

I can reassure the hon. Gentleman. The area health authority will review its decision at its April meeting. The authority will consider three options. The first is the retention of the hospital. The second is a reaffirmation of the temporary closure. In that case the authority will give undertakings to me that the closure will be temporary. The third option is permanent closure. If the authority decides to close the hospital permanently, it will have to go through the normal consultative procedure and the hon. Gentleman would be able to make his views known to the appropriate management.

I am not prepared to comment in detail further on St. Columba's because, if the authority decides to close it permanently and the hon. Gentleman's opposition succeeds at local level, the matter would come to me for decision. I do not want to prejudice any decision that I might reach by discussing the details of the problem now.

Mr. Geoffrey Finsburg

Is the Minister prepared to look, without commitment, at the point that temporary closure provides what appears to be an unfortunate loophole in the procedure of consultation?

Mr. Moyle

That would obtain only if there was an element of dishonesty. It does not provide a real loophole. But I shall continue to watch to ensure that nobody tries to get away with permanent closure by pretending that it is temporary closure. Under those circumstances, there will be no need to alter the consultative procedures.

Dr. Vaughan

Will the Minister bear in mind that this kind of nursing is highly specialised and requires a special kind of dedicated staff to carry it out effectively? Does he agree that temporary closure must mean the disposal of the trained staff?

Mr. Moyle

I am sure that that will be one of the factors which the area health authority will take into consideration in reaching its decision. If it came to permanent closure, it would certainly be one of the features I should have to consider in reaching a decision, if the matter came to me.

Mr. Stallard

I accept that the area health authority is to discuss the matter again in April, but my understanding is that admissions have been stopped as from now. If admissions are stopped, I imagine that the staff will begin to leave. Can my right hon. Friend assure the House that admissions will continue until this reconsideration of the situation in April and that efforts will be made to retain the staff?

Mr. Moyle

Against the background of uncertainty, there will be no new admissions before the April meeting. But staff will be retained until the health authority reaches its decision.

The hon. Member for Wells said that nurse trainee recruitment was falling. He said that between March 1977 and March 1978 it fell by 21 per cent. I am happy to say that between March and December 1978 nurse trainee recruitment increased by over 30 per cent. That helps.

The Under-Secretary of State for Scotland will be writing to the hon. Member for Dunbartonshire, East (Mrs. Bain) and to my hon. Friend the Member for East Kilbride (Dr. Miller) about the issues that they raised.

My hon. Friend the Member for Penistone (Mr. McKay) spoke of the inadequacies in the deputising services for general practitioners. Two years ago there was considerable criticism of the services. My hon. Friend suggested that the deputising services should be run by the NHS. We considered this. But at the time our predecessors had already begun negotiations with the British Medical Association on a code of practice to govern the deputising services. Eventually we decided to follow that course.

Under the present system, a general practitioner is responsible for services to his patients throughout the 24-hour period. If anything wrong happens under the deputising service, the general practitioner is responsible. At least the existing system enables us to place responsibility exactly where it should lie.

The code of practice has been agreed between my right hon. Friend the Secretary of State and the BMA. If hon. Members hear of incidents which highlight inadequacies in the deputising service, complaints can be made to the family practitioner service, which will discover whether the code of practice has been applied and take action if it has not.

The hon. Member for City of London and Westminster, South (Mr. Brooke) spoke about Jamie Morris and his relations with him. I must warn him that owning up to having relations with Jamie Morris will cause him to be regarded with the greatest possible suspicion by the right hon. Member for Wanstead and Woodford. I commend the hon. Member for the courage he displayed in owning up to an association with that gentleman.

The hon. Member also said that junior academic staff in dental hospitals received only a 2 per cent. increase last year. That was as a result of the Doctors and Dentists Review Body. It did not involve Government action. We always implement the DDRB reports.

My hon. Friend the Member for Coventry, South-West (Mrs. Wise) asked about the waiting lists for orthopaedic surgery in Coventry. She and her constituents are not unique. Lengthy orthopaedic waiting lists arise from a number of causes. She highlighted an important cause—bed blocking. Elderly ladies break their femurs and receive orthopaedic treatment, but no facilities are available in the community when they have finished treatment. They therefore have to stay in hospital and block beds to other patients. Road accidents also add to the orthopaedic waiting lists.

Relatively new techniques have been introduced in the last 15 years and there is still a shortage of consultants in these techniques. It takes many years to train a consultant, and that leads to lengthy waiting lists. Other inadequate facilities such as a shortage of operating theatres also add to the problem.

My hon. Friend the Member for Coventry, South-West said that the problem could be solved partially by a plus rate for geriatric orthopaedic nursing. If the trade unions concerned put in a claim of that sort, I am sure that the management side will consider it and negotiate upon it. What the outcome will be, of course, I cannot foretell. It is a matter for the negotiating machinery.

We have had a wide-ranging debate on a number of interesting topics. I believe I have answered all the points raised. If by inadvertence I have missed someone out, I shall write to him.