HC Deb 30 July 1982 vol 28 cc1457-67

10 am

Mr. William Hamilton (Fife, Central)

I have extra time, and I greatly welcome it. The Under-Secretary of State for Scotland should be prepared to wait for a fairly lengthy speech, because the subject is of great importance to the future of not only the nursing profession but all the other professions and workers in the Health Service. Indeed, the principle of the Health Service is at stake.

On Thursday 15 July, in answer to a question from the hon. Member for Cheadle (Mr. Normanton), the Secretary of State for Social Services gave a written answer, printed in column 458 of the Official Report, about the effect on health services and staff numbers in the National Health Service following the Government's recent decisions on pay. It was a planted question, which enabled the Secretary of State to give a detailed reply without being subjected to a grilling in the House. It was clear from the answer that the Government were cutting the cash given to regional health authorities to enable them to carry out their responsibilities. It was also clear that the Government were determined to reduce staff levels in the Health Service.

The answer made a mockery of the Prime Minister's answers at Question Time yesterday, when she said that Health Service workers had great security of employment. She said that a few days after the Secretary of State had warned the regional health authorities that they must reduce staff. That was the clear implication of the written answer. The written answer from the Secretary of State makes the right hon. Lady's claim ring fairly hollow.

It was also clear from the Secretary of State's written answer that he could Snot get Cabinet support to allow the pay increase offered to nurses to be met by the Treasury in the next two years. The consequence of that will be that pay awards will have to be met out of the strictly limited funds that are available to the regional health authorities. Cuts in staff, cuts in services to patients and cuts in hospital building will be a direct consequence of that written answer. There will be a decline in the quality of services provided to patients as a result of that answer and the circular that was sent out to the regional health authorities.

The Secretary of State also gave detailed figures of the cash to be available to each of the 14 regional health authorities in England. There were revised and reduced allocations of cash for 1982–83, plus provisional assumptions for each of the next two years. The Minister also told the authorities that he had issued planning assumptions to the regions for the years 1983–84 and 1984–85, asking them to produce plans covering the next two financial years in the light of those provisional assumptions. He said that copies of the Department's circular on those matters had been placed in the Library. In other words, details of the proposed cuts affecting the regional health authorities were placed in the Library on 15 July.

On Friday 16 July a further statement was made in the House by the Secretary of State, which was not directly related to his previous day's answer, but was about the threat of industrial action then being made by the Health Service unions. As a consequence of that statement the Secretary of State had a roasting in the House for about half an hour.

In the exchanges on these matters with the Prime Minister in the House yesterday, reference was made to Mr. Albert Spanswick, the general secretary of the Confederation of Health Service Employees, in fairly scathing terms about his threatened increased industrial action, which, it was alleged by the Prime Minister and her colleagues, would jeopardise the well—being of patients in the Health Service. I am sponsored by COHSE. Mr. Spanswick is a personal friend of mine. I know all the officials of COHSE and large numbers of the members of that union. They need no lectures from the Prime Minister or from any Tory Minister or Tory Member of Parliament about the importance of safeguarding the health and welfare of the patients in their care. Many of them have given a lifetime of service, underpaid and overworked, to the National Health Service, and it ill-becomes the Prime Minister or anyone else to chastise them for their action.

Mr. Kevin McNamara (Kingston upon Hull, Central)

Is not my hon. Friend's case underlined by the vigil that is taking place beside the Pankhurst statue adjacent to the House of Lords, where four nurses from Hull are giving up their leave time to keep a vigil merely to point out the desperation of the position of all Health Service workers and their desire only that the matter go to arbitration, and no more than that?

Mr. Hamilton

My hon Friend and his colleagues introduced me to those ladies yesterday. They are gentle and unmilitant nurses who have been driven to this action by the meanness and callousness of the Government. The responsibility for any inconvenience that may be caused to patients in the Health Service lies exclusively at the door of the Prime Minister and her Ministers, who have driven the Health Service workers to this position. I shall return to that matter in detail later in my speech.

I return now to the statement made by the Secretary of State on 16 July. On that day, although my hon. Friend the Member for Pontypridd (Mr. John), the shadow Secretary of State for Social Services, was in the Chamber, there was no Scottish Minister present, although the dispute affects Scotland just as much as it affects any other place. I made inquiries in the Library to find out whether a circular on these important matters had been placed there by the Scottish Office. None had been and, so far as I know, that is still the position today.

I asked the authorities in the Library to contact the Scottish Office on this matter. The note dated 29 July that I received from the Library states: No similar circular to the one sent to the English regional health authorities has been sent to Scottish authorities. Last night, a letter was sent to Scottish health boards giving revised allocations, but there are no copies of this letter in London yet—according to the Scottish Office in London. As I am sure the Minister will concede, the Library is a very reliable source. That is further evidence to support the view that the Government treat the House with much contempt and indifference.

I have given the Minister notice of some of the questions that I now intend to ask. Others will be asked in due course. The questions of which I have given him notice will be put in slightly different terms, because of the developments to which I have already alluded.

Will the hon. Gentleman now say what revised revenue allocations have been sent to the regional hospital boards for 1982–83? Have those allocations been revised as a direct consequence of the Government's so-called final pay offer to the nurses and ancillary staffs? Has the hon. Gentleman asked the health boards to revise their staffing plans this year and in subsequent years so that they can better pay their share of the increased pay offer? If that is so, what staff reductions does he expect from the health boards? Will they amount to an overall reduction of 5 per cent., 10 per cent. or more?

In line with his counterpart south of the border, has the Minister sent planning assumptions to the boards covering the next two financial years? What proportion of the total wage increase offered to the nurses and ancillaries will have to be met by the boards from their own resources? What does that amount to in both percentage and cash terms? Will that affect adversely the quality of the services provided? There can be no doubt that the greater the amount that must be found for wage increases out of the Government's reduced allocations to the health boards, the more the deterioration in the services provided.

I should be grateful if the Minister could quote the Fife figures. I have been in touch with the health board in Fife, but as yet have received no detailed information. That is understandable, and I do not complain about it. If the Minister cannot give the figures today, perhaps he will do so in writing.

As the Government claim that no more money is available for nurses' pay, how can cash be found to pay the police another 10 per cent. this year? I believe that the Secretary of State is in Scotland this weekend discussing this matter. However, there can be no doubt that the police will get 10 per cent., whereas the nurses, who as members of society are just as important and make an equally important contribution to our welfare, will have to be satisfied with 7 per cent. Why should that be so, bearing in mind that nurses and ancillary staff have been treated more meanly than either the police or the Armed Forces during the last three years?

The Minister should know that many nurses, particularly nurses in residence, will be worse off, net. They will be taking home less pay as a direct result of the so-called pay increase. The Minister must know that student nurses in particular, but also ward sisters, will be worse off in money terms after they have paid increased lodging allowance. Where is the justification and fairness in that?

I have with me the pay slip of an NHS storeman, who after 26 years' service takes home £45 a week. He could get more on the dole or on supplementary benefit. This is sweated labour, which occurs throughout the Health Service and affects nurses, ancillary staff, ambulance men, storemen, part-time cleaners and everyone else.

In the last few weeks I have received many letters on the NHS pay problem, not only from nurses, but from physiotherapists, radiographers and other employees of this great public service. A physiotherapist from Lochgelly states: I wish to bring to your attention the deterioration in salary of physiotherapists employed in the NHS. In real terms what we are being offered as an increase is a pay cut—8 per cent. below the rate of inflation—and this for the third year running. In each of the last three years these worthy citizens and conscientious workers have had their standard of living cut. That physiotherapist ends her letter: Please note that more and more of us feel that we are treated unfairly simply because of our reluctance to take action which would harm patients. It is deplorable that this dedication to the sick should be taken advantage of by the Government. That is not a letter from a member of Militant Tendency or the Communist Party. It is from a gentle woman doing a service to the community.

I have received another letter from the Society of Radiographers, which is not noted for its militancy. It states: It is logically, economically and morally indefensible that our members, along with other NHS employees, should suffer poor living standards in order to retain a national health service. The Society very much regrets the industrial action currently being taken but feels that the Government's attitude towards employees whose commitment to the Service and normal reluctance to take industrial action has provoked this situation. Those statements do not come from revolutionaries, people who want to stir up trouble or people who want to harm patients in their care. They come from people who, in desperation, have been driven to the measures that they are now taking.

The Government's assertion, which the Minister repeated on 16 July, is that there is no more money".—[Official Report, 16 July 1982; Vol. 27, c. 1281.] The cost of meeting the NHS pay claim in full would just allow employees to maintain their existing standard of living, given that inflation is about the same level. It is said that it would cost an extra £380 million, but that is far less than the cost of replacing the ships lost in the Falklands Island adventure. There is no doubt that the Government will find the money for that. They will not say "We cannot afford it". there is no question of the Government telling the Ministry of Defence "There is no more money". The Government are saying that the money will be found. When the Prime Minister found herself in the Falkland Islands mess, she proclaimed almost within seconds "There is no limit to what we shall spend on the Falkland Islands". Although the Minister has challenged my figure, I wager that when the full bill is paid for the Falkland Islands it will be not less than £1,000 million, and probably much more.

Mr. McNamara

Will my hon. Friend accept that the Prime Minister did not find herself in a mess over the Falkland Islands? Does he agree that she made the mess?

Mr. Hamilton

We shall return to that issue in due course, but not in this debate. Whatever caused the mess, we were in it. The Prime Minister declared that we would find the money. When she was saying that, Health Service Ministers were bleating that there was no money to pay nurses, physiotherapists, radiographers, cooks and ambulance men a living wage for working to save life rather than to destroy it.

Whenever I participate in debates of this sort, I have with me a copy of the Defence Estimates. On page 11 of the 1982 Estimates there is a short list of the projects on which we are embarking or on which we have already embarked. The estimated programme costs of the Harrier GR5 offensive support aircraft are £900 million. The estimated cost of the new heavyweight torpedo is £775 million. I am a member of the Public Accounts Committee, and I know that the new heavyweight torpedo is in addition to the new lightweight torpedo, Sting Ray, which has cost us £1,000 million. There are half a dozen or more projects in that range of expenditure. Let no Minister tell me, anyone who works in the Health Service or anyone who enjoys the service of the NHS that there is no money. There is plenty of money. What is wanted is the will to redistribute it between one Department and another.

The Government have already announced that they are determined to go forward with the expenditure of £7,500 million on Trident. To claim that there is no more money is a rather hollow protestation. The Government are really saying that they have made deliberate policy decisions to spend more of our scarce resources on military weapons of destruction and that because of those decisions there is less money available to spend on a life-saving service like the NHS.

It is a crying shame that the least militant and probably the most dedicated group of workers in Britain—those employed in the NHS—should be admired so much by so many and paid so little for so long. They have been driven to the action that they are now taking, which Ministers and Tory Members of Parliament are exploiting as ruthlessly as they can.

On 16 July the Secretary of State spoke about his visit to St. Thomas's hospital a day or two before. He said that at St. Thomas's hospital … As a direct result of industrial action, more than 1,000 operations have been cancelled and cancer patients among others are now waiting for treatment"— [Official Report, 15 July 1982; Vol. 27, c. 1283.]

We could almost see his heart bleeding for those people. The fault lies at the door of the right hon. Gentleman who shed those crocodile tears on behalf of patients at St. Thomas's hospital.

If the Government were to face this problem with the same enthusiasm, determination and generosity in using taxpayers' money as they showed in the South Atlantic, the matter could be resolved overnight. That does not happen because the Prime Minister and the Government—the right hon. Lady especially—do not believe in the basic principle on which the NHS was based. The principle was that each citizen should get the health treatment that he required irrespective of his means. That is a form of practical Christianity and practical Socialism which the right hon. Lady neither understands nor likes.

Mr. Selwyn Gummer (Lords Commissioner to the Treasury)


Mr. Hamilton

I agree that it is disgraceful, but it is true. It is disgraceful that the right hon. Lady should take such an attitude, but it is true that she does. She even described aid to the Third world as handouts.

All the evidence shows that the Government are swinging the pendulum as far as they can towards the extension of private provision for health services. We see private hospitals being erected all over London. They have reached Glasgow, and they are going more and more to Scotland. Less and less provision is being made for the Health Service. Low pay is driving Health Service workers into the private sector. The present strife in the Health Service concerns pay, but more importantly it concerns the future of the service itself. That is what the debate is about and I wish that more Members were present to hear it. However, we shall hear more of these issues in the next few months and years.

The British people regard the Health Service as one of the supreme examples of social progress since the end of the Second World War. They will fight to the death to preserve it, and so will we. When the Minister replies to the debate, I hope that he will give some assurances that the Government will reverse the machine that they have put in operation. Almost daily we see abuses of the Health Service by private practice in Scotland, and to a much greater extent in England. If more resources are put into the NHS, the problems will be resolved.

The Scottish Office must not turn its back on the nurses and other Health Service workers after saying "You had better be satisfied with the existing offer that is on the table." They will not be satisfied with that. I shall be taking part with them in continued industrial action, because we care for the Health Service and the patients in it. We shall not see it destroyed by the present Government, or any other Government.

10.29 am
The Under-Secretary of State for Scotland (Mr. John MacKay)

Perhaps it is a pity that I did not spend longer on the previous debate because the hon. Member for Fife, Central (Mr. Hamilton) might have shortened his speech. The longer that he continued, the more damage he did to his case. However, I accept that the hon. Gentleman is once again demonstrating his well-known interest in the National Health Service and the pay of its workers. This is the second Adjournment debate on National Health Service pay in 10 days and it gives me the opportunity to state clearly the Government's view on the 1982 pay round at the end of the Session, so that during the recess Health Service unions are not tempted to assume that the absence of parliamentary statements means a weakening of the Government's position.

The Government have gone some way in providing additional resources aimed at securing pay settlements in the NHS, which makes sense, against our need to keep public expenditure under close control as a key part of our economic strategy. Wages account for no less than 75 per cent. of the expenditure of Scottish health boards. It added up in 1981–82 to £850 million. That is the Scottish figure alone. The offers made in recent weeks by the management sides of the various Whitley councils ranged from 6 per cent. to 7Ċ5 per cent. for nurses and professions supplementary to medicine. The offers represent money on the table payable from last April. If the unions would return to the negotiating table and accept the pay offer, the increase will be paid as from 1 April 1982. The offer compares well with other public sector settlements—5.9 per cent. for civil servants, 6 per cent. for teachers and 6.1 per cent. for the Armed Forces.

We are subject to constant criticism that the increases offered are not fair. I believe that they are reasonable in our present economic circumstances and they are comparable with other increases in the public sector. Local authority workers could be added to the group that I mentioned. The offer is certainly comparable with wage increases in the private sector, where many people have received increases of no more than those on offer. In some cases there have been no wage increases. The constituents of every right hon. and hon. Member know that what I am saying is true.

The Government are in no position to be constantly bid up on the matter. We have made no less than £25 million available for additional pay increases in Scotland—£16 million from central Government and £9 million from the allocations to the health boards. In 1982–83, the health boards are receiving £18 million more than in the previous financial year to allow for the expansion of the service. Those are large sums, but there should be no misapprehension that the Government have more money tucked away to meet the 12 per cent. claim. As my right hon. Friend the Secretary of State for Social Services emphasised, we cannot provide more money to improve the offers which, by present standards, are reasonable and realistic.

If one listened to the end of the hon. Gentleman's speech, one could be forgiven for believing that the Government spent less on the National Health Service than the previous Government, of which he was a supporter. I must remind him that we are spending more this year on the National Health Service than has ever been spent. Our commitment to the NHS is clear and can be seen from the figures. In Scotland, in 1978–79, £646 million was spent via the health boards on the hospital-based service. The sum envisaged for this year is £1,176 million. One does not need a pocket calculator to work out that that is a significant increase and the continual suggestions that we are downgrading the NHS are made in blind ignorance of simple arithmetic.

We walked down, as I could have predicted, the Falklands road. Before Labour Members suggest that we should not have spent that money defending the Falklands and restoring freedom to the people, may I tell them that those in my constituency who came from the Falkland Islands said that their freedom was worth defending. It is indivisible from our freedom, but that is another argument. Every time that I hear a Labour Member talking about public expenditure, the same £1,000 million supposedly spent on the Falklands is spent today on the Health Service, yesterday on something else and the day before on yet another item. It is the most elastic £1 billion that has ever been spent by a Government. Labour Members should get together and decide their line before they continue to spend the money in other ways. They must square it with their hon. Friends and many of their supporters, who believe that the money was well spent.

The hon. Gentleman asked me whether I had issued revised reserve allocations to the health boards for 1982–83 as a consequence of the Government's final pay provisions announced on 23 June. I have done that now. The Scottish Office informed the health boards on Wednesday of their 1982–83 revenue allocations that take into account the most recent pay offers. Copies of that letter have been placed in the Library together with the figures that accompany it. The table shows that the revision takes into account the reduction in national insurance payments because of the reduction in surcharge announced by my right hon. and learned Friend the Chancellor of the Exchequer, the increased allowances to the health boards for the first stage of the negotiations and the revised cash limit total for the Health Service in Scotland of £1,776 million. Fife will be given about £659,000 extra for the wage settlement that is currently on offer. That is out of a total budget of nearly £56 million, which is Fife's revised cash limit allocation for this year.

The hon. Gentleman asked me whether we have asked the boards to revise their staffing plans for the rest of the financial year. We have not done so. The Department of Health and Social Security asked its local health authorities to devise staffing plans in their regions. We work rather more directly with the providing authorities and have not felt it necessary to call for individual plans, because the size and expenditure of the Scottish boards vary widely. No specific rules have been laid down to help boards, but they must examine staffing as well as other expenditure within the context of their new allocations.

There is another figure that is greatly at variance with the theory that the Government are running down the Health Service. Since the election, we have employed about 5,000 more nurses and midwives in Scotland, which once again shows our commitment to that service. The hon. Gentleman asked me by how much I expect the health boards to reduce staff in the current year and what my targets are. I have no such expectations of the health boards. No targets have been set for the boards. They must meet their part of the pay settlement out of the revised allocation. That is £9 million, out of a total allocation for Scotland of £1,176 million, which is a small percentage of that large sum.

I was asked whether I had issued planning assumptions to the boards for 1983–84 and 1984–85. I have not done so. The DHSS felt it necessary to provide such assumptions for its regional health authorities, but the Scottish Office deals with the basic authorities and is reviewing the future resources available for NHS expenditure.

It is too soon to arrive at a sudden decision about the operation of the SHARE arrangement—Scottish health services allocation of resources—for 1983–84 onwards which, as the hon. Gentleman knows, is an arrangement that was started by the last Government and continued by this Government to try to equalise the amounts of money that go to the different boards in Scotland.

Health boards in Scotland have been asked to produce by the autumn priorities and programmes in response to the SHARE report in Scotland. That report asks them to plan the direction in which they see the service going. As the hon. Gentleman knows, we have particularly pointed out demographic changes such as the increase in numbers of elderly people which we feel the health boards must take into consideration when planning future services.

The hon. Gentleman asked me what the total burden of the final wage offer was expected to be for the health boards. I have already answered that, but I emphasise that £9 million is required from the health boards themselves. That is less than 1 per cent. of the money that will be given to the boards this year. Different authorities will be affected in different ways. It may be that those that are only likely to receive a small increase under SHARE will have to review existing staff levels. Others may have to reconsider future increases. It is for each board to assess its circumstances and how the cost of the pay settlement will affect its development plans and prospects.

I was not surprised to be asked about the police. Negotiations on police pay have not yet begun. The police negotiating board adjourned until 5 August in order to enable the official side to clarify certain points on the future levels of local authority funding.

The hon. Gentleman made much play of the number of nurses in residence whom he claimed would be worse off as a result of the 7.5 per cent. increase. There are four categories of lodgings used by nursing staff and the charges are graded accoring to their standard and amenities. Only a small minority of nursing staff live in such accommodation. It is estimated that about 10 per cent. of the total staff do so. Those students and learners who live in qualify for a reduction of 40 per cent. of the standard charge.

An agreement was reached in 1981 with the staff side for a staged increase in charges towards realistic levels related to the cost of providing accommodation in place of the old system in which, as the hon. Gentleman knows, the charges for accommodation were related to salary. It was envisaged that the full realistic charge would be implemented in four stages. The first stage has already been implemented and the second is due to be implemented from 1 April 1982. However, the new charges will not be implemented until the 1982 pay agreement is settled.

It is not possible to argue that all nurses quoted will be worse off after the increase of lodging charges. I have requested some figures. If I take a typical nurse who lives in, probably a first-year student, her existing salary of £63 a week would be increased by £4Ċ73 with the 7½ per cent. pay award. The second stage increase on her lodgings for this year would be £2Ċ07. By anybody's arithmetic, that does not come to more than the increase that she would receive on the 7Ċ5 per cent. As I said before, only 10 per cent. of nurses pay for living-in accommodation. The remainder of the nursing staff pay for their accommodation as other people do.

Mr. Albert McQuarrie (Aberdeenshire, East)

My hon. Friend said that the second stage would come into effect on 1 April 1982 but that it would not be operative until the pay settlement had been reached. Will the charge that should be made on 1 April 1982 be backdated once the increase has been approved or will the nurses pay the increased charges only after the settlement date?

Mr. MacKay

The charges should have come into effect on 1 April 1982. In fact, they will not come into effect until the settlement has been argreed. There is no question that arrears will be recovered for the current financial year in advance of arrears in salary being paid. I hope that that answers my hon. Friend's question.

The hon. Member for Fife, Central asked about the storeman with 26 years' service. It is difficult to answer such individual questions because many other matters must he taken into account, such as whether a person is single, because that would affect the tax that he pays and consequently his take-home pay.

Many of the figures that are given are highly selective. I do not complain that the unions do that. I expect them to be highly selective because it helps their case. The basic pay of the vast majority of full-time workers in the Health Service is more than £60 gross per week. The earnings of many employees, especially ancillary staff, are enhanced well beyond that level by overtime payments, incentive bonus allowances, unsocial hours payments, and so on.

The gross earnings of a full-time male ancillary worker average out at £104 a week. That inevitably means that, while some are receiving more than £104 a week gross, others will be receiving less than that.

Mr. William Hamilton

The Minister is being selective.

Mr. MacKay

I am not being selective in the average. The average is the average. There is no selection in that figure. The average is £104 a week, and even a basic knowledge of arithmetic tells one that one does not select when one computes an average. All the wages paid are taken into account.

The Government have ultimate responsibility for deciding levels of public expenditure. They cannot hand over the responsibility for that decision to another body to allow it to arbitrate and perhaps to come to some compromise decision which will pay out more than the Government judge the country and the Health Service can afford. That is the position on arbitration.

Mr. McNamara

How does the Minister justify that principle against other public sector claims that have gone to arbitration?

Mr. MacKay

Each group must be taken on its merits and its background. The Government have offered a large sum of money to the nurses and other ancillary workers in the dispute. The Government's duty is to make difficult judgments and we judge that neither the economy nor the Health Service can afford to pay more in salaries than the extra money that we have put on offer.

National Health Service pay negotiations are neither simple nor straightforward. In Britain the National Health Service has about 1 million employees with a wide variety of skills and experience, all of which are required to run a modern and successful Health Service. We must make every effort to avoid damaging the interests of patients and causing distress and suffering. The unions' continued action is undoubtedly causing serious damage in Scotland and other parts of Britain.

There are many examples of actions by small numbers of workers in hospital laundries that are seriously curtailing the supplies of clean linen to hospitals. Glasgow has been one of the worst affected areas in recent weeks. A fortnight ago I visited the Yorkhill and Gartnaval hospitals and saw at first hand the effects on patients and on nursing and other staff who are striving to maintain a decent standard of care. Patients are having to manage with paper sheets on their beds day after day. Staff cannot change the linen as often as they would wish. In long-stay hospitals the lack of clean clothing has meant that patients must be kept in bed all day. Linen supply problems hit hardest the hospitals for the elderly and the mentally handicapped, because many of their patients are incontinent.

No one can argue that disruption of laundry work can be consistent with the aim of respecting patients' dignity enshrined in the unions' guidelines. I leave it to the House to imagine the effect of piles of contaminated laundry lying around hospitals during the recent spell of warm weather. There are not only piles of contaminated laundry but polythene bags with varying kinds of waste, including hazardous waste, piled up in the corridors of hospitals. That is not the way to run a health service.

The unions make much in public of their wish not to hit essential services and accident and emergency care, yet throughout the dispute there have been examples of all catering staff walking out of hospitals and leaving management to cope as best they can with feeding patients, using nurses and other volunteers to prepare and distribute food.

Occasionally, for example at Hairmyres hospital, it proved necessary to appeal to relatives and friends to bring in food for patients during the union's day of action. No one can argue that the unions are not interfering with essential patient care. They have forced the cancellation of routine admissions and the postponement of out-patient clinics. In addition, pickets have delayed the flow of mail between general practitioners and hospital consultants. It is not just a statistical probability that some patients will suffer from the delay in diagnosing and treating serious illnesses: it is a certainty. Many patients waiting for such operations as hip replacements are having to wait much longer than they should.

The other day I met one of my constituents whose admission to hospital was long overdue. He was not over-sympathetic to the unions' case, because it had led him to wait an unnecessary length of time. In the NHS, any form of so-called industrial action is bound to affect the health and well-being of those who are acutely ill, the elderly and the handicapped in need of hospital care. It is no use the unions trying to pretend otherwise.

Fortunately, most nurses and many other NHS workers have continued to put the interests of their patients first and have not taken part in the strike action or in the walkouts. Many of those staff have taken on work that far exceeds their normal duties in the attempt to sustain services to patients. We all owe them the greatest respect, because they have upheld the finest traditions of caring for the less fortunate in our society.

At this stage in the parliamentary Session, perhaps I might conclude by quoting from paragraph 5 of our circular to the Scottish health boards: I should emphasise that the Government does not propose to depart from the pay settlements now on offer and will not make any further resources available towards their costs. I do not know how many times my right hon. Friends and I will have to say that—

Mr. William Hamilton

Disgraceful. Shame.

Mr. MacKay

I do not know how many times we will have to say that before the unions will return to the negotiating table and negotiate within the amount of money available to settle the dispute. Let us get the Health Service back on the road so that the greatly increased sums that the Government have invested in the NHS since the last election and the increased staff that have entered the Health Service in the past three years can be put to the proper work of attending to patients and seeing to patient care.