HC Deb 09 June 1980 vol 986 cc201-23
Mr. William Hamilton

I beg to move amendment No. 7, in page 15, leave out from beginning of line 43 to end of line 3 on page 18.

Clause 6 is probably the most important clause in the Bill, in that it deals with cash limits and puts very tight shackles on the health boards and other health authorities. It indicates that the Secretary of State will pay to the health boards. sums not exceeding the amount allotted or further allotted by him for that year". That is in place of a clause in the previous Bill under which the Secretary of State was required to defray the expenditure incurred by the health board. The clause puts a legal duty on the health board so to perform its functions as to secure that the expenditure attributable to the performance of their functions in that year does not exceed"— and it goes on with words which I shall not quote. The sums which have not to be exceeded are the amounts allotted by the Secretary of State and any other sums available to the health board.

The health boards have indicated to me that they are not clear what happens if any health authority incurs expenditure in excess of its allotment. If the overriding requirement is that that allocation must not be exceeded, is there any alternative but that health boards should aim for an under-expenditure—in other words, to play safe? That is inevitable.

As the Minister must know, it is virtually impossible to hit the target exactly. In recent years that problem was resolved by carry-forward arrangements of a limited nature. Thus, if a health board was underspent by up to 1 per cent. it could claim that money in the following financial year. But if a health board was overspent by up to 1 per cent. it had to pay it back. In other words, there was some limited flexibility which prevented the end of a financial year being an arbitrary date, with the risk of boards rushing to spend money, or, alternatively, holding bills until 31 March. That argument has been put to me and to my hon. Friends by the health boards. I am not sure whether it would be legally possible for the Secretary of State to determine an allocation within an upper and lower limit with a small margin. It is certainly impossible for a health authority to spend precisely the sum allocated to it to the last penny.

With regard to rigid cash limits, health authorities are exepected to go through a lengthy period of consultation before making substantial changes in health provision, for example, by closing or changing the function of a hospital. Health authorities do not know from year to year how much money they will receive, and if there is no flexibility of carry-over the problem will become insuperable. Those are the nuts and bolts of the complaint of the health authorities, and the basic aim of the amendment is to get rid of cash limits for Scotland. I am not concerned about whether the amendment achieves that aim, so long as we can debate the matter. That is the most important point. The Minister will then be able to speak about the purpose of cash limits.

But I know what the Minister's arguments will be—I could almost write his brief for him—and I shall try to show how ill-advised they are and how deeply concerned the health authorities are that the Government should seek to put this sort of straitjacket on them, with no element of flexibility.

The debate provides us with a peg on which to put forward arguments on the quality and scope of the health services that are likely to be provided in the next few years under what I call the malevolent control of a Government who are dedicated to the principle of increasingly transferring resources from the taxpayer to the private purse of the individual customer of health services generally.

The Under-Secretary of State for Health and Social Security said, in winding up the Second Reading debate on 19 December, that the Bill in general is consistent with our philosophy of individual responsibility … we shall encourage each individual to make provision for himself privately."—[Official Report, 19 December 1979; Vol. 976, c. 765.] We must never lose sight, of that basic fact. This Bill seeks to transfer responsibility for the provision of the Heatlh Service to the private purse of the individual and away from that of the taxpayer in general.

To the extent that the Government can curb and rein back expenditure on the Health Service—this clause seeks to do that—and so cause a decline in the quality of services provided, by that means they hope to "encourage"—I use the word of the Under-Secretary of State—individuals to buy their own health services. They will be able to do that only in proportion to their personal wealth. The wealthy in our community will be able to buy themselves and their families a first-class service, with no waiting for operations, major or minor. They will be able to command scarce professional, medical and nursing resources. The poor, however, will have to wait in pain and perhaps wait just for death because they simply do not have the wherewithal to buy the privileges that the wealthy are buying and will continue to buy.

Generally the poor are less healthy than the rich. They live in poorer environments, and nowhere is that more obvious than in Scotland. Nobody knows that better than the Under-Secretary. They are generally employed, if they are employed at all, in jobs which present a greater hazard to health. Their incomes are lower and they therefore have generally to endure inferior and inadequate diets, with the consequential effects on health. They are unable to take holidays as frequently as other sections of the community. All these factors penalise the poor and make them more reliant on a publicly provided Health Service than are people who can contract out and buy the private high quality service that is now springing up all over the country.

Not even the Government will deny that the great difficulties of the Health Service are not structural but financial. It is a question of more efficient use of the resources that the Government say we can currently afford. I deny that resources are limited to the extent that the Government say. In Committee I carried around faithfully with me at every sitting the White Paper on defence. There is no suggestion there that we cannot afford another nuclear submarine or another dozen Tornado aircraft, which cost £10 million each. There is no suggestion of asking local people to volunteer money to finance the defence service. That is done only for the Health Service. People have to rattle a tin on a flag day to finance their own local hospital ; they do not have to organise a flag day to buy the next nuclear submarine. That is the difference between the Government's attitude on defence and their attitude to the health and education services.

12.30 am

Let me quote some of the difficulties which result from the under-financing of the Service in Scotland. I quoted this case in Committee and the Under-Secretary promised an inquiry. In the Glasgow Herald of 26 March appeared the question : Would you pay £140 for an adenoid operation on your child rather than risk the child suffering ear damage during the six-month to a year's delay on the hospital waiting list?

The article reads : A few weeks ago a young Stirlingshire couple were told that their four-year-old only son needed to have his adenoids removed as soon as possible. Their GP pointed out that there was the possibility of complications if this was not done—it could have resulted in partial deafness—and that he would be willing to do the operation in a Glasgow hospital for £140. He suggested that if the money caused any financial difficulty (which it did) they could pay the fee over a number of months. Within three weeks the child had his adenoids removed and received every comfort and consideration in a Glasgow clinic. The parents were relieved and are quite happily paying the cost which they understandably think was well worth while.

That situation is increasingly developing. To the extent that the Health Service will be increasingly under-financed in forthcoming years so parents will increasingly face that kind of problem—indeed, not only parents, but others with serious or painful conditions in need of urgent surgery.

Earlier the Minister said that there were no cutbacks in financial provision. But he must know that is nonsense. Indeed, on 12 February, the Prime Minister was asked by my hon. Friend the Member for Glasgow, Queen's Park (Mr. McElhone) about finance for the Royal hospital for sick children at York-hill, Glasgow. In the parliamentary exchanges—I was present when they took place—the Prime Minister flatly denied that there was any financial cutback at that hospital at that time.

As a direct result of those exchanges between my hon. Friend and the Prime Minister an eminent authority at that hospital wrote to him—I do not want to give the gentleman's name—saying : I think you are perfectly correct in your approach and that Mrs. Thatcher is, to put it mildly, being obtuse when she denies that there is any financial cut-back. The sum of money allocated is unchanged and in view of inflation, rising VAT, numerous price increases and some wage settlements we are unable to balance the books. By March 1980 we will be about £½ million overspent and this will come off next year's budget. We estimate that we would require approximately an extra £1¼ million to break even at Yorkhill in order to provide the ordinary service for the sick children. We feel strongly that although we are funded like a local hospital this is inadequate as we provide a service for children from Galloway to Stornoway and Rothesay to Ross-shire with many specialised units and services. We have a number of other problems also, namely the funding of our new Renal Unit requires about £½ million capital and £150,000 a year running costs. Our new fast brain scanner is partly promised from charitable sources, but again we need a capital sum of about £¼ million and running costs of £50,000 per annum. Most of this will have to come from Central Government sources as the sums required, especially the running costs, are too much even for the generosity of the Glasgow public.

He continues : We have been flooded by offers of help, both physical and financial, by members of the public in the past few days and we have already decided to establish a Trust Fund which will deal with money raised by the public. Regrettably, this puts the clock back about 50 years, but in view of the present Government's policies this will be essential for our survival as a useful service to the Community.

That hospital was built by private contractors and opened as recently as 1970, since when it has virtually fallen to pieces. It cost £4 million or £5 million to build and it is now costing £7½ million to rebuild. Problem after problem is being created by the Government at that hospital.

I quote a Fife example directly from the Fife health board's staff journal of autumn 1979. It states : Fife Health Board's building programme is to be firmly 'squeezed' in order to stay-within tough cash limits. Existing schemes will proceed, but all further work is being halted until the start of the next financial year in April 1980—a decision which inevitably affects developments such as the modernisation of Ward 5 at the Dunfermline and West Fife Hospital and Wards 25 and 26 at Stratheden.

As the Minister knows, Stratheden is a mental hospital. The journal continues : The 'running cost' of the health service in Fife—also faces even more rigid control, notably the need to find £300,000 in a full year merely to meet the increased cost of VAT. The sum, enough to run a small 30 or 40 bed hospital for a year, has to be met from the Board's own budget.

I can quote examples of the way in which the Service is being increasingly run down. The quality of the Service is increasingly deteriorating. I quote further from the Glasgow Herald of 5 February, which refers to the enormous waiting lists in the various regions in Scotland. The article states : There is no more glaring example of how the NHS is failing the people who pay for it than the waiting list for orthopaedic surgery in the West of Scotland. Many of those in the queue are victims of arthritis. One of the most respected names in the world of fighting that crippling disease is Professor W. Watson Buchanan, who ran Glasgow's Centre for Rheumatic Diseases (better known as the Baird Street Clinic).

The professor is quoted as saying : People use fancy phrases like 'multiple deprivation' and talk round the subject. But that is all twaddle. The reason"— that is basically for arthritis and other orthopaedic diseases—

is poverty. If you live in bad housing in the Glasgow area you feel the symptoms earlier than someone living in a better house in the south-east of England. Poverty is reflected in all manner of illnesses because we have the worst health record in Europe.

One of his reasons is that there is insufficient financial support for arthritis and rheumatism research and treatment. 'We have 55 million people in the UK and H million of them have rheumatoid arthritis and 5 million suffer the symptoms of osteo-arthritis, which is the major crippling disease in the eldest'.

He provides examples of enormous waiting lists for all sorts of disease, but mainly poverty-derived diseases in Scotland. These are overwhelming reasons why Scotland should be treated in this as in other areas as a special case for special treatment.

The pay increases have to be contained within the cash limits which the Government are seeking to impose in the clause. The pay of doctors and nurses has to be contained within those cash limits imposed on the boards. Despite what the Government say about incomes policy, that is the unofficial incomes policy for the Health Service. The more the nurses get in wages, the more other staff get in wages, the greater the corresponding deterioration in the services provided. That is what cash limits mean.

Let me say a few words about nurses' pay in this context. Whenever we get a Tory Government they hammer the nurses because they know that they are extremely reluctant to strike. I am glad that the Minister for Health is here, because I promised that I would say something about these matters when I had the opportunity to do so. It is reported in The Guardian this morning that when the Minister attended the annual conference of the Royal College of Nursing the other day he held out his hands and said "I love you all." By God, he would do that. He is just the guy who would do that, because it costs nothing whatever. Sympathy costs nothing. The cheapest commodity in the market place for the hon. Gentleman is the kind of sympathy that he expressed to the Royal College of Nursing.

During the debate on the NHS on 15 March 1979, before the Minister got power, before he became the Minister, he said that there is no doubt that the nurses are a special case and should be treated as such.

He added that they came within the same category as the police, the firemen and the members of other services which look after our essential needs ".—[Official Report, 15 March 1979; Vol. 964, c. 800.]

Let us look at the comparison. I asked a series of questions on the pay increases that each of those services had received between 1 April 1978 and 1 April 1980. I asked what were the minimum rates for the respective services. On 1 April 1978 the minimum rates for a staff nurse and a constable, an ordinary policeman, were £2,775 a year. On 1 April 1980 the staff nurse was getting £3,715— that is before the 14 per cent. increase to which they are objecting—and the constable was getting £4,086. A difference of £7 a week had developed between the two. Who is to say that a constable is worth more to our society than a staff nurse? It is arguable which is the more responsible, which is the more worthy. I come down in favour of the staff nurse, but clearly the Government come down on the side of the constable.

Let me take a second example. On 1 April 1978 a nursing officer, grade 1, was receiving a minimum of £4,535. An inspector of police was receiving £4,563, a difference of £28—not very much. The nearest approach in terms of cash is the inspector versus nursing officer, grade I. By 1 April 1980 the nursing officer, grade I, was getting £5,351, and the inspector £7,095—a difference of £1,744 now compared with £28 in April 1978.

12.45 am

I come to one of the most disgraceful examples. The area nursing officers—these are the people on the highest salaries—have written to me to the effect that they have had no increase in the period. An area nursing officer was receiving a minimum of £10,721 on 1 April 1978 and £10,721 on 1 April 1980: there had been no increase whatever in that period. Meanwhile, the salary of chief constables had risen from £10,606 on 1 April 1978 to £18,840 in April 1980. The difference at 1 April 1978 was £115 a year. The difference now is £8,119. It is plain that chief constables are infinitely more important to the Government than are area nursing officers.

It is the same story or a similar one with the sister, grade II group. On 1 April 1978 a sister, grade II, was in receipt of a minimum salary of £3,454. A sergeant constable was on £3,918, £464 a year more than a sister, grade II. By 1 April 1980 the sister, grade II, was getting £4,698 and a sergeant constable was getting £6,186. The difference of £464 in 1978 became £1,488 in 1980.

That demonstrates the Government's priorities as between the nursing service and the police service.

I turn to the firemen, again taking minimum salary scales. A fireman joining the service at the age of 18 was paid £2,967 in April 1978. A staff nurse, not coming in green but having trained, received on becoming a staff nurse a minimum of £2,775—a difference of £192 a year. By April 1980, the fireman aged 18 received a minimum of £4,365 and the staff nurse received £3,715. The difference had risen from £192 to £650 a year.

A station officer—again keeping to minimum salaries—received £4,799 in April 1978. A senior nursing officer, grade II, received £4,832—that is a little more than the station officer which is, on the salary scales, the nearest equivalent I could get. However, by April 1980 the station officer was getting £7,065 and the senior nursing officer, grade II, £6,446. So the difference between their salary scales had risen from £33 in 1978 to £619 in April 1980.

I come to the highest salaries. The salaries of regional nursing officers have remained static in the two-year period between April 1978 and April 1980. The regional nursing officer was receiving £10,629 minimum in April 1978. The senior divisional fire officer was getting £6,840. But by April 1980 he was receiving £10,074, while the regional nursing officer's pay stayed precisely at £10,629.

I put those facts and figures on the record because I think that it is important for the public to know just how the nursing profession, from the bottom to the top, is being grossly exploited and played down in terms of social importance compared with the police, the Army, and the fire service. I do not begrudge those services anything that they have, but I think that by comparison the nursing profession has been treated as if we were living in the age of slavery. It simply cannot continue.

I received a letter from a staff nurse in the Glasgow Royal infirmary the other day. The letter, dated 2 June, read : I am a staff nurse working at present in Glasgow Royal Infirmary. My parents live in Dunfermline, and because of the distance involved, I find it necessary to be resident in the nurses' home. My reason for writing to you is this : should the proposed 100 per cent. increase in our rents go ahead then we nurses will find ourselves living below the bread line. Our accommodation has few amenities, virtually no privacy, and we find ourselves forced to share a canteen with our on-duty colleagues because of the lack of cooking facilities. This means that most nurses do not eat a well-balanced diet as the prices in the canteen are extortionate. What angers us most is the fact that nurses living in sub-standard accommodation will be paying the same as nurses living in modern accommodation. We cannot understand this and we refuse to tolerate it. A meeting was held in the nurses' home and we agreed that our dilemma should be brought to the attention of the public. Many people believe that we receive board and lodging free, and we are launching a campaign to highlight our situation. We hope to hold a rally against the rent increases in Glasgow on 14 June. It is our wish that as many people as possible should be there to support us. If you can come along, you will be made very welcome. Meanwhile we would be very grateful if you could raise questions in the House and give us help in any way. We are trying to contact as many MPs as possible, as only an exceptional effort can prevent the nurses being robbed again.

I have written already to that nurse—she signed herself Joan Cameron—and told her that I will be there, and that if they want me to speak at their rally I shall do so. I invite the Minister to do the same. It is not for me to invite him, of course, but I hope that he accepts the invitation that I hope he has received to go along and talk to these young ladies.

Mr. Moyle

I draw my hon. Friend's attention to the fact that when Ministers promised to treat the nurses on the same basis as the police and firemen the date was 15 March, 1979. That was shortly before last year's general election. Most of the discrepancies between the pay rates of nurses and firemen and police have developed since the general election of last year.

Mr. Hamilton

My right hon. Friend knows which side I am on in these matters. I suspect that a lot of the nurses might have voted Tory in the last election. If so, they have not learnt their lesson over the years. It was a Tory Government way back in the early 1960s that first imposed a 2½ per cent. wages restraint on the nurses. They were the first to suffer as a result of the policies of the late Selwyn Lloyd when he was Chancellor of the Exchequer. The nurses seem to learn the hard way.

The Minister has previously said that he sees no evidence of declining morale in the Health Service. If he has not seen such evidence, it is because he does not want to. In the Glasgow Herald of 29 April—it is my favourite newspaper, so I quote from it again—is an article headed : Morale in hospitals a casualty of health cuts. It reads : Scotland's health Minister, Russell Fairgrieve, gave his assurance that there would be no financial cuts in the Health Service this year on the same day that the Greater Glasgow Health Board announced the closure of four hospitals. The hon. Gentleman's timing is admirable. The article continues : It is that kind of apparent doublethink (although patients and staff from the closed hospitals will be accommodated elsewhere) which underlines the gloom shared by doctors and domestics. Every grade of worker reports : 'Morale is very low.' The thrift imposed by a general shortage of money is beginning to bite in small but demoralising ways. ' Our patients are suddenly given continental breakfasts' "— and we all know what that means. 'some of them after 50 years of traditional breakfasts,' says Angus McCorkindale, a charge nurse at Dykebar Hospital. He admits that it won't seem very important to most people, but to the elderly or the mentally handicapped, it is not the sort of sudden deprivation that is easily explained by a general lack of money … Financial stringencies are beginning to create their own backlash of problems in our hospitals. 'We like to turn long-term patients every two hours, but with staff shortages, that becomes every four hours. Leaving them for so long creates pressure sores, which makes even more work for us and means those patients have to stay longer in hospital' … The Clegg Commission, currently causing wrath among Scottish teachers, has left a trail of despondency in the Health Service. 'There's no point in comparing your wage with other people who are low paid if you want a living wage' ". There is abundant evidence throughout the length ond breadth of Scotland that the Health Service is grossly underfinanced. Cash limits will impose even greater burdens on health boards. They will be unable to provide living wages for the staff in the Service at the same time as increasing the quality of service. They will not be able to do both. The limits will not take account of inflation and other rising costs. The Service must deteriorate, and patients will be increasingly driven into the private sector, which is precisely what this Government want.

I move the amendment in the hope that we may have some flexibility from the Government, but I have no hope that they will remove the cash limits altogether to allow the degree of flexibility under previous dispensations. We wish to highlight the problems in the Health Service. We deny that there is a shortage of resources, in view of Government spending in other less worthy directions. If we can encourage flexibility and highlight the problems, the amendment will have served a useful purpose.

1 am

Mr. Robert Hughes

My hon. Friend the Member for Fife, Central (Mr. Hamilton) has made a devastating attack on the Government's strategy on pay policy and has revealed the disparities that have grown up between the pay of those in the NHS, particularly nurses, and other groups such as the police and the fire service.

The Minister owes us an explanation of how the Government are calculating the money that they are to allot to the NHS under the Bill. The cash limits that the Government are imposing on health boards are based on the proposition that both inflation and wage increases will be 14 per cent. over the year.

No one, not even the Minister, believes that we shall average 14 per cent. inflation over the year. As the hon. Gentleman has been told before, the mathematics do not stand up. We have a current inflation rate of over 21 per cent. and it is generally believed that it will be shown in the next couple of days that inflation has increased yet again. The official forecast by the Chancellor of the Exchequer is that the RPI will continue to increase until about August, when it may slacken off.

If we are to achieve an average of 14 per cent. inflation over the budget year, the rate will have to be down to below 7 per cent. by April, and no one believes that that is a possibility. Indeed, there is some evidence—I do not pretend that it is conclusive—that inflation in NHS costs, especially in the hospital service, will be higher than the level of inflation measured by the RPI. The cost of essential materials such as X-ray film, drugs and equipment appears to be increasing faster than the general level of inflation. That is serious and the Government must tell us where the health boards are to get the extra money to meet the increased costs that they are facing.

As for the proposition that wage rates will not increase by more than 14 per cent., I do not want to be dramatic or to have a dig at the doctors, but in the current year—ignoring any catching up—the doctors' increase is about 18.6 per cent. Those in the rest of the NHS—nurses, porters and others—have been held to 14 per cent. They are rightly pressing for at least parity with the doctors and sooner or later the Government will have to give way and grant them their 18 per cent. so that they have at least the same percentage increase as the doctors, though I do not believe that that is enough. The trouble with percentages is that 1 per cent. of a nurse's salary is a damn sight less than 1 per cent. of a doctor's salary.

If there is an increase in the salary of NHS workers, the extra cost will have to be met somehow. If the Government insist that they will not budge on cash limits, the patients will have to suffer a reduction in services. No one else can meet the bill.

There are already severe financial stresses on the Health Service. The Grampian area health board overspent last year. The figures are not precise, and estimates vary between £¾ million and £1 million. The board has been told by the Minister that that money will have to come off this year's budget. It is £1 million down before it starts. Pressures are building up in the Health Service in the areas represented by the Minister and me that are compelling. It is no use arguing that money is tight and that if essential services are to be provided the public must meet the cost other than by taxation through the Exchequer.

My hon. Friend the Member for Fife, Central mentioned the issue of a tonsel-lectomy, or an operation for adenoids and children's hearing. I know from personal experience what can be the effect of delay in such operations. Even starker choices face some people. They face the choice between life and death depending on the amount of money made available by the Government. The newspapers are dying to have a mass campaign to raise money for heart surgery. It is obscene that the Government who claim they have compassion should face people with the choice of raising money by charity.

The Minister, who has temporarily left the Chamber—I do not complain—should know that I view as appalling and ridiculous his suggestion that money could be found for the Health Service through a weekly lottery. There is insufficient time now to examine all the details. Every citizen of the city of Aberdeen would have to buy £1 worth of 10p tickets every week to sustain one acute bed in hospital. Yet the Minister talks about raising money through private subscription.

This is not simply a question of ideological purity. Once one starts to raise money by private subscription, one immediately distorts the priorities within the Health Service. One can always raise money for kidney machines and for specialist heart services and for children's hospitals. As those who have worked for charities and friends of hospitals know, it is much more difficult to raise money for mentally ill people and for elderly patients in geriatric hospitals. One can raise money to some extent by playing on people's heart strings in emotional matters of life and death. One cannot raise money for the elderly, confused or mentally ill, and the forgotten parts of society.

Ministers must stop going about the country saying that the Health Service is not suffering cuts. There are cuts. I would have much greater respect for the hon. Member for Aberdeenshire, West (Mr. Fairgrieve) and his colleagues if, like other Government Departments, they would admit, or even glory in, the fact that they are cutting public expenditure. They should be consistent and admit that they are cutting the Health Service severely. They will have to answer for it sooner or later.

I hope that the Government will come clean and explain what will happen if their forecasts of inflation and wage increases are grossly mistaken, as I believe they know, in their hearts, they are mistaken. It is impossible for health boards to carry out existing services within the cash limits provided by the Government. How will the Government find the money? It will not be through public subscription. The service will be funded by patients suffering badly. The Government will go down as one of the most shameful who have ever had office due to their treatment of the Health Service.

Mr. George Robertson

This is a late hour to be discussing an important issue. My hon. Friends have drawn attention to one of the essential issues. The Government have a major asset on their side when discussing cash limits. No more than a tiny proportion of the population know what we are talking about when we refer to cash limits. Vague references to cash limits by the Government cloud the fact that that is how the Government are cutting back on the resources available in all sectors financed by the Exchequer.

The claim made by Ministers that they are supervising an expansion of the real resources of the Health Service is a subterfuge. Cash limits are the insurance for public authorities which spend public money that that money will retain its value against rising inflation. If inflation runs at 20 per cent. and cash limits are fixed at 14 per cent. anybody with a basic knowledge of arithmetic will know that that means a cut in resources. For Ministers to pretend that there is a 2½ per cent. increase in the budgeted figure for the Health Service is an elaborate con. The reality is that the Government are supervising a massive reduction in the amount of money available to fund the National Health Service.

Against an inflation cover of only 14 per cent. there has been an increase in VAT, salaries, gas, other power prices and interest rates which has overtaken the allowance that the Government have made in cash limits. As a result, hospital wards remain closed, hospital beds cannot be brought into use and resources for required treatments are not available. The British public will not be conned and will not be confused by the Government's use of the sharp-practice arithmetic involved in the cash limit concept.

Scotland's health problems are greater than those in the rest of the United Kingdom. Earlier the Minister agreed with that. We have special problems involving heart complaints, dental and optical problems and difficulties arising from alcoholism and cigarette smoking. Such problems are greater than those experienced in most of Western Europe. The Government are complacent about how their policies will affect the treatment available to the people of Scotland.

The amendment is a means by which we can draw attention to the problems of the National Health Service in Scotland. It is not good enough for the Government to shuffle shamefully with figures, nor for them sordidly to pretend that they are protecting the NHS when they encourage increases in the cost of almost every feature of hospital and medical life. Yet they are providing only a minimal 14 per cent. cover for the increased charges.

The reality is that the health boards have to cover the increased charges that the Government are imposing without giving them the money to do so. The consequence that will arise from that state of affairs is that the treatment that people often desperately need will not be available to them. The Government will have to cope with the consequences and take full responsibility for that state of affairs.

1.15 am
Mr. Fairgrieve

We have had a debate lasting almost an hour thanks to the industry and assiduity of Scottish Members. I am grateful for the various points that have been raised, though at times emotion and philosophy possibly outran the facts. I shall try to deal with the points raised to the best of my ability.

The hon. Member for Fife, Central (Mr. Hamilton) said that clause 6 was the most important clause in the Bill. It is certainly a very important clause ; there is no doubt about that. He mentioned the difficulty that health boards find in hitting their targets exactly and spoke of the previous carry-forward arrangements. I do not deny that we are now making such arrangements more strict.

However, I could not in any way accept the hon. Gentleman's idea of getting rid of cash limits. He was on ground from which he regularly preaches to us on the issue of resources from the taxpayer to the private purse. He said that it was the ability to buy scarce resources that mattered and that that meant that the poor were disadvantaged. I remind him that people who still use the National Health Service are looking at the possibilities of supplementing the service perhaps with private health care. After all, everybody in Mr. Chapple's electricians' union is not a rich man, but the union decided it was worth looking at the question of private health care.

I accept that Scotland has particular problems, but I think that the hon. Member for Fife, Central goes a bit too far when he suggests that diets are insufficient in Scotland because of poverty. I think that many people in Scotland eat the wrong things. If they ate the right things, they might have better health. I do not believe that diet deficiencies and excesses in Scotland are caused by poverty.

The hon. Gentleman spoke of the under-financing of the Health Service compared with what he virtually described as the over-financing of defence. The hon. Gentleman knows well that the first duty of any Government—including Labour Governments—is the defence of the realm. If that were not so, there would be no point in talking of education and health.

What is the biggest bill that we pay today? It is not for defence, it is not for education and it is not for health. The biggest bill is the interest that we pay on the national debt, and that doubled during the period of office of the previous Labour Government.

The hon. Gentleman would not expect me to reply in detail now to the emotional question that was raised in Committee concerning the 14-year-old boy and the adenoid operation. We discussed that matter in Committee, but I shall certainly recheck the correspondence on the matter. I did not know about the anonymous writer who contacted the hon. Gentleman about the problems at Yorkhill, but I suggest that he asks the person concerned to write also to the chairman of the Greater Glasgow health board so that he can investigate the points made by the hon. Gentleman.

I do not think I need comment upon waiting lists again. We do not want to get involved in party and parochial matters. The hon. Gentleman knows as well as I do what happened to the waiting lists between the period of the last Conservative Government and the end of the period of his party's Government.

It is easy to be emotional about how money might be raised and about the whole question of nurses' pay, on which the hon. Gentleman gave us a long diatribe, comparing nurses' pay with that of others in the community. It is not the case that the nursing pay bill will increase in 1980–81 by only 14 per cent., because the Government are also providing an additional 116 million this year to enable the 37½ hour week to be introduced up to a year earlier than expected, or to allow additional payments to any nurses who continue to work more than 37½ hours.

I think that every hon. Member accepts and recognises the great job done by all nurses and their dedication. We all appreciate the fact that they so value the integrity of the profession that they have decided against any form of what is now termed industrial action. There was some mention of the wages of the police and of firemen. I believe that a chap called Clegg has recently been looking at comparability.

With regard to pay and services, we have to remember always that in the United Kingdom the cost of each 1 per cent. rise in NHS salaries is around £45 million, and that a new district hospital of 500 beds costs around £25 million in broad terms. So each 1 per cent. on the wage bill for one year only could mean cutting out two complete new hospitals.

Mr. Race

As the Minister is now defending his Government's record on nurses' pay, would he care to tell the House why, at the general election last year, the Conservative Party was forced to make a commitment to implement the findings of the Clegg Commission on nurses' pay and the pay of other workers in the NHS, and yet as soon as Clegg reports this year on nurses' pay and the 1 April negotiations for the annual increase come along, the Government immediately say that they are not prepared to keep in real terms the value of the Clegg settlement? They have shown that they intend to undermine it, because they will be paying nurses 14 per cent. rather than the rate of inflation, which will be 20 or 22 per cent. How can the Minister possibly justify accepting the Clegg Commission's findings as a proper rate of pay for nurses and then immediately undermining that settlement by having one that is 6 or 8 per cent. less than the rate of inflation?

Mr. Fairgrieve

I cannot accept what the hon. Gentleman has said. The Government, since coming into office, as he knows full well, have been accepting and paying out on the postdated pay cheques of the Clegg Commission. Whether we like it or not, we cannot escape the facts. If we spend more on pay, there is less left for services, and 1 per cent. on the National Health Service bill could provide for 80,000 in-patients or could build 1,000 hospital beds or buy 6,000 kidney machines. The trade-off between pay and services is evident.

I have been going round the health boards. I have been meeting every health board in Scotland. I am now three-quarters of the way through that programme. I am not getting these stories of declining morale. When we talk about the closure of four hospitals in Glasgow, we do not mention the opening of another one. At the present time we are maintaining and even slightly increasing our 2.5 beds per thousand of population. Were we dropping below that figure, then the switch of hospitals between one closing and another opening would be relevant. But that is not the case because we are maintaining the figures accepted within the Service. I find the hon. Gentleman's picture of the Health Service somewhat different from what I find as I go around the health boards and hospitals.

I turn briefly to the contribution of the hon. Member for Aberdeen, North (Mr. Hughes). We both represent constituencies in the same part of Scotland and know its problems. He said that our figures were based on 14 per cent. inflation and 14 per cent. wage increases. He also mentioned the difficulty of what he called raising money by lotteries and how in the more emotional cases it was easier but that when one came to the mentally ill and the geriatric it was not so easy. But again, as we did in the last debate, we came to the question of cuts in the Health Service.

I must again repeat to hon. Members—and the hon. Member for Aberdeen, North knows this quite well—that in the past year there was a definite squeeze on the Health Service as a result of the previous Administration not funding fully or properly their inflation and the Clegg awards and as a result of this Administration not funding the VAT increase. No one is denying that there was a squeeze on health board expenditure in the year just gone by. But in the year that we are now in, we have put back that squeeze and are allowing for a 2.5 per cent. increase in real expenditure, subject to 14 per cent. inflation in the wage increase.

Mr. Race

Is not the Minister aware that the Chancellor of the Exchequer told the House that the shortfall on the cash limits for the whole of the public services in this financial year would be £700 million, and that in response to parliamentary questions from myself he refused to tell the House of Commons precisely the proportion of that £700 million attributable to the NHS because he wanted to protect himself against a charge from the Labour Benches that even more money would be ripped off from the NHS in this financial year?

Mr. Fairgrieve

Perhaps the hon. Gentleman will contain his enthusiasm and allow me to finish what I was saying. He knows as well as I do that our 14 per cent. inflation is based on a year-to-year figure. Therefore, we are talking about the year commencing 1 April 1980 and ending 30 March 1981. The previous Administration as well as this one took a judgment on this matter. We had better see what the position is at this time next year. If we do not control inflation, it is not only the Health Service which will be in trouble. A lot of other organisations will also be in trouble.

As I listened to the remarks of the hon. Member for Aberdeen, North, I wondered what happened to the speeches that I did not hear 18 months ago. One would think that the amount of money being spent on the Health Service in Scotland had been halved. About the same is being spent—in fact, slightly more. Yet I never heard all these moans, groans and attacks on the previous Administration with regard to what they were doing to the Health Service. At present, very little different is happening. I hope that Labour Members will remember that.

The Scottish provisions in clause 6 are, with minor variations to take account of the different structure of the Health Service in Scotland, the same as the English provisions. I cannot accept that there is a case for not applying the new provisions equally in both countries. Clause 6 is concerned with financial control and is designed—there is no secret about this, as I have said—to strengthen the Secretary of State's hand in making sure that health boards contain their expenditure within the cash limits approved by Parliament. We have a uniform financial control system in England and Scotland, and unless there are powerful arguments to the contrary it is right that changes should proceed in parallel.

1.30 am

It may be an objection that no Scottish health board has sought deliberately to break its cash limit and that the powers are therefore unnecessary. It may be a further objection that the new system will cause extra work for the boards, particularly in its first year, and that it is therefore undesirable. I am aware of those objections, and we took account of them before bringing these proposals before the House. I am grateful to the health boards for the way in which they have co-operated in managing expenditure within the cash limits. I have also been grateful for the responsible attitude that every health board in Scotland has taken towards this matter. I look for-

ward to the continuation of that co-operation.

As an earnest of the Government's determination to hold public expenditure within the limits set, and as a means of securing that, I have no doubt that the balance falls clearly on the side of keeping legislation within the same framework as that operated by our English colleagues.

The transition to the new system may produce some awkwardness, but my officials are in consultation with health board treasurers and I do not expect the new arrangement to represent any appreciable new burden.

It has also been said that services will suffer because the boards will now have to budget for an underspend to be sure of staying within the limit. Boards will need to budget carefully and ensure that they stay within the limits, but I do not accept that this is tantamount to a cut in services. Everyone needs to observe the discipline of a budget. We have, as our election manifesto pledged, given a large measure of protection to the Health Service when other services have had to absorb substantial cuts. I reject any notion that a proper service can be provided only by overspending.

The new powers are not a radical departure from what has gone before. They make explicit what has been implicit—that once set, the financial limits should be observed—and the new measures give the powers necessary to achieve that. They are sensible measures, and I ask the House to reject the amendment.

Question put, That the amendment be made :—

The House divided : Ayes 76, Noes 129.

Division No. 346] AYES [1.35 am
Alton, David Davis, Terry (B'rm'ham, Stechford) Howells, Geraint
Atkinson, Norman (H'gey, Tott'ham) Dixon, Donald Hughes, Robert (Aberdeen North)
Beith, A. J Dobson, Frank Lamond, James
Benn, Rt Hon Anthony Wedgwood Dormand, Jack McKay, Allen (Penistone)
Bennett, Andrew (Stockport N) Douglas, Dick McKelvey, William
Booth, Rt Hon Albert Dubs, Alfred Maxton, John
Bray, Dr Jeremy Eastham, Ken Maynard, Miss Joan
Callaghan, Jim (Middleton & P) Flannery, Martin Mikardo, Ian
Campbell-Savours, Dale Foster, Derek Millan, Rt Hon Bruce
Clark, Dr. David (South Shields) George, Bruce Morton, George
Cocks, Rt Hon Michael (Bristol S) Graham, Ted Moyle, Rt Hon Roland
Cohen, Stanley Hamilton, James (Bothwell) Orme, Rt Hon Stanley
Coleman, Donald Hamilton, W. W. (Central Fife) Palmer, Arthur
Cowans, Harry Harrison, Rt Hon Walter Pavitt, Laurie
Cox, Tom (Wandsworth, Tooting) Haynes, Frank Penhaligon, David
Crowther, J. S. Hogg, Norman (E Dunbartonshire) Powell, Raymond (Ogmore)
Cryer, Bob Home Robertson, John Prescott, John
Dalyell, Tam Hooley, Frank Race, Rep
Richardson, Jo Soley, Clive Woodall, Alec
Roberts, Ernest (Hackney North) Spearing, Nigel Woolmer, Kenneth
Robertson, George Spriggs, Leslie Wrigglesworlh, Ian
Rocker, J. W. Thomas, Dr Roger (Carmarthen) Young, David (Bolton East)
Ross, Ernest (Dundee West) Tinn, James
Rowlands, Ted Walker, Rt Hon Harold (Doncaster) TELLERS FOR THE AYES:
Sever, John Welsh, Michael Mr. Hugh McCartney and
Silkin, Rt Hon S. C. (Dulwlch) Wilson, Gordon (Dundee East) Mr. John Evans
Skinner, Dennis Winnick, David
NOES
Alexander, Richard Hawksley, Warren Page, Rt Hon Sir R. Graham
Ancram, Michael Heddle, John Page, Richard (SW Hertfordshire)
Aspinwail, Jack Henderson, Barry Parris, Matthew
Bendall, Vivian Hogg, Hon Douglas (Grantham) Patten, Christopher (Bath)
Benyon, Thomas (Abingdon) Hooson, Tom Patten, John (Oxford)
Berry, Hon Anthony Howell, Ralph (North Norfolk) Pollock, Alexander
Biggs-Davison, John Hunt, David (Wirral) Price, David (Eastleigh)
Blackburn, John Hunt, John (Ravensbourne) Proctor, K. Harvey
Body, Richard Jenkin, Rt Hon Patrick Rathbone, Tim
Boscawen, Hon Robert Jopling, Rt Hon Michael Rees-Davies, W. R.
Braine, Sir Bernard Kellett-Bowman, Mrs Elaine Renton, Tim
Bright, Graham Kershaw, Anthony Rhodes James, Robert
Brinton, Tim Kitson, Sir Timothy Rhys Williams, Sir Brandon
Brown, Michael (Brigg & Sc'thorpe) Knight, Mrs Jill Ridley, Hon Nicholas
Browne, John (Winchester) Lang, Ian Roberts, Michael (Cardiff NW)
Bulmer, Esmond Lawrence, Ivan Sainsbury, Hon Timothy
Cadbury, Jocelyn Le Marchant, Spencer Silvester, Fred
Canicie, John (Luton West) Lennox-Boyd, Hon Mark Sims, Roger
Carlisle, Kenneth (Lincoln) Lloyd, Peter (Fareham) Speller, Tony
Chapman, Sydney Lyell, Nicholas Spicer, Michael (S Worcestershire)
Churchill, W. S. MacGregor, John Squire, Robin
Clark, Hon Alan (Plymouth, Sutton) McNair-Wilson, Michael (Newbury) Stanbrook, Ivor
Clarke, Kenneth (Rushcliffe) McQuarrie, Albert Stanley, John
Colvin, Michael Major, John Stevens, Martin
Cope, John Marlow, Tony Stewart, John (East Renfrewshire)
Costain, A. P. Marten, 'Neil (Banbury) Stradling Thomas, J.
Cranborne, Viscount Mather, Carol Taylor, Teddy (Southend East)
Dean, Paul (North Somerset) Maude, Rt Hon Angus Temple-Morris, Peter
Dorrell, Stephen Maxwell-Hyslop, Robin Thompson, Donald
Douglas-Kamilton, Lord James Meyer, Sir Anthony Thorne, Neil (llford South)
Dover, Denshore Mills, lain (Meriden) Townend, John (Bridlington)
Dunn, Robert (Dartford) Mitchell, David (Basingstoke) Vaughan, Dr Gerard
Fairgrieve, Russell Montgomery, Fergus Waddington, David
Faith, Mrs Sheila Morrison, Hon Charles (Devizes) Walker, Bill (Perth & E Perthshire)
Fenner, Mrs Peggy Morrison, Hon Peter (City to Chester) Weller, Gary
Fisher, Sir Nigel Myles, David Ward, John
Fletcher-Cooke, Charles Neale, Gerrard Wells, Bowen (Hert'rd & Stev'nage)
Fookes, Miss Janet Needham, Richard Wheeler, John
Garel-Jones, Tristan Nelson, Anthony Wickenden, Keith
Grieve, Percy Neubert, Michael Young, Sir George (Acton)
Griffiths, Peter (Portsmouth N) Newton, Tony
Gummer, John Selwyn Normanton, Tom TELLERS FOR THE NOES:
Hannam, John Onslow, Cranley Mr. John Wakeham and
Haselhurst, Alan Page, John (Harrow, West) Mr. Peter Brooke
Hawkins, Paul

Question accordingly negatived.

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