National Health Service Pay

HC Deb 10 June 1982 vol 25 cc410-50 4.20 pm

Mrs. Gwyneth Dunwoody (Crewe)

I beg to move, That this House notes that the Health Service workers have been offered a totally inadequate increase in their wages, on the basis that this Government believe the lowest paid should be the worst treated; and condemns the Secretary of State for his refusal to refer this dispute to ACAS in the interests of both patients and Health Service workers.

Mr. Speaker

I have selected the amendment in the name of the Prime Minister.

Mrs. Dunwoody

Any debate on National Health Service pay must take account of one or two basic facts. No one enters the National Health Service to make a fortune. If one wants to make money, almost any other profession is preferable. I assure the House that there are no newsletters circulating with advice on the high rates of pay, the good hours and acceptable perks of the jobs available to technicians, porters, nurses or midwives. No recruiting agencies publish glowing advertisements on the conditions of work and marvellous surroundings. If they did, the Trade Descriptions Act would compel them to say something like "Jobs available in low-paid posts with very long hours in largely substandard buildings, with routine overtime and awkward shift work. Apply to the Minister for Health, who will undoubtedly pay you less than the poverty line and lecture you on the need to be responsible."

The appalling truth is that the Government have precipitated the industrial action in the National Health Service. During the general election the Conservative Party made great play of its commitment to free collective bargaining and the right of workers to negotiate the rate for the job. The reality for public sector workers has been different. National Health Service workers have suffered a direct attack on their standard of living since the Government came to office. Unlike other groups in the public service, they have not received even the catching-up rate that could enable them to keep pace with inflation.

It is salutary to examine the history of the present dispute. The Labour Government, who made mistakes on pay, were concerned with the problems of the widening gap in pay between National Health Service workers and other professions. They set up the Clegg commission at the behest of my right hon. Friend the Member for Norwich, North (Mr. Ennals) on 7 March 1979, with the express remit: to examine the terms and conditions of employment … in agreement with the employers and unions concerned, and to report in each case on the possibility of establishing acceptable bases of comparison, including comparisons with terms and conditions for other comparable work, and of maintaining appropriate internal relativities."—[Official Report, 7 March 1979; Vol. 963, c. 1252.]

Because the commission was asked to report by 1 August 1979, there is no doubt that it did not have the opportunity to produce a perfect scheme. Nevertheless, it concluded that there were workable methods of examining National Health Service pay in relation to outside analogues. Given time, it is obvious that one could now produce machinery that would be sensitive enough to produce a number of realistic comparisons.

The Clegg commission also recommended a catching-up exercise on behalf of the nurses, which was equal to 19.6 per cent. over two years. However, when the Government came to office, almost their first action was to destroy the Clegg commission and to remove any remaining external links with outside wage rates. Furthermore, the Secretary of State has been extra-ordinarily ambivalent even about the role of the Whitley councils as a means of negotiating pay. He announced that they were independent bodies, but he made it clear that, when it suited him, he intended to intervene directly in pay bargaining by insisting that National Health Service pay should be contained within the Treasury's limit of 4 per cent.

Although the Secretary of State subsequently announced that a further £81.9 million would be available to be divided unequally between various groups of workers, by ruthlessly using the cash limits that he has imposed, he has ensured that National Health Service pay awards have been lower than those to other public sector workers. Although the Secretary of State has paid lip service to the need for long-term arrangements for pay, he has made little real attempt to offer comparable terms in the interim. He has appeared to be waiting for the outcome of the Megaw report on Civil Service pay.

Listening to the Minister of State this morning on the radio, I thought that he was wrong to imply that the trade unions in the National Health Service were deliberately dragging their feet in seeking the means for setting up the machinery. He knows that that is definitely not true and that, ever since the setting up of the Royal Commission on the National Health Service, they have been seeking to find suitable machinery. He should not in any way imply that that is not so.

The Secretary of State for Social Services (Mr. Norman Fowler)

Will the hon. Lady explain why, when my hon. and learned Friend's predecessor as Minister for Health wrote in August 1980 offering discussions on the long term, it took over 12 months for a response to come from the unions? That was the point that my hon. and learned Friend was making. We need a reply from the hon. Lady on that matter.

Mrs. Dunwoody

The Secretary of State knows that he, and no one else, was responsible for that delay. The delegation from the TUC that saw the Prime Minister agreed that it would take time to find suitable machinery, so the right hon. Gentleman must not persist in trying to mislead the House in that absurd way.

The difference in treatment between National Health Service workers and other public sector workers is noticeable. Both the police and the fire services have proved conclusively that indexation of pay does not automatically mean a restriction on the number of jobs available. The TUC health committee responded positively to a means of setting up new machinery, and it has been seeking urgently to proceed with that work.

However, I must make it clear to the House that the setting up of the machinery cannot in any way be regarded as an alternative to a proper pay increase this year. Even if some suitable formula is found and the Government are sufficiently realistic to agree on suitable machinery, it is obvious that, in the first year of its implementation, a considerable sum will be required to bring existing wage rates in the National Health Service up to a reasonable level.

There is no doubt that pay in the National Health Service is at a completely different level from that of other comparable jobs. Sometimes there is a complete misunderstanding of the wage rates that are received by those who work day in, day out, in the National Health Service. There are 270,000 ancillary staff, 70 per cent. of whom are women and 50 per cent. of whom work part-time only. They have been offered 4 per cent., although the Government admit that 63.9 per cent. earn £80 or less in gross earnings and only 19.5 per cent. earn more than £100 per week. Their last pay rise was in December 1980, when they were awarded 7.5 per cent. to run for 15 months.

I shall consider some of the other people whom the Secretary of State: mentions rarely when talking about the National Health Service. Ambulance men are vital Health Service workers. They have been offered 4 per cent., with an extra 1 per cent. for a salary change that was agreed in their pay round last year. Many of those men and women do a dirty, dangerous and largely unappreciated job. For an average week of 46 hours they receive £128 compared with the police who receive £171.60 for a 39-hour week and firemen who receive £137.80. The much maligned administrative staff, about whom the Conservative Party always seems to be complaining, who face considerable job losses not only because of reorganisation but because of deliberate Government policy, earn in the clerical grades the magnificent sum of £88.50 while their opposite numbers in the Civil Service earn £94. A similar comparison holds good for senior administrators.

It is not only those groups of workers but the professional, scientific and technical grades, for whom the attempt to restrict the wage bill to an increase of 4 per cent. has produced some extraordinary anomalies, are already suffering from acute staff shortages. The pay in the National Health Service is considerably lower than for equivalent jobs outside. Scientists can earn £188.10 in industry, whereas radiographers earn £99.70 after long, professional training. Those comparisons can be repeated right across the professional and scientific grades of the National Health Service. Some of the workers in those grades will receive absolutely nothing if the Government adhere to the 4 per cent. rate.

The shocking thing about the Government's attitude towards the joint pay claim—the first that has ever been submitted by all the Health Service unions for a common core claim—has been the deliberate attempt by the Secretary of State to divide one section of the Health Service from another. I refer specifically to the attempt to suggest that the nursing profession was acting responsibly by refusing to take any kind of strike action while somehow or other implying that the Health Service unions did not have the same attitude to patients or the same strength of feeling for the National Health Service. I deplore the need to take industrial action. I believe strongly that, had the Secretary of State responded to the initial overtures from the TUC health committee, the position need not have deteriorated to the point where industrial action has been taken.

Mr. Michael Morris (Northampton, South)

Is the hon. Lady advocating that the various unions in the National Health Service should join and become a single union, thereby presenting a common front, or does the Labour Party continue to seek separate divisions?

Mrs. Dunwoody

The hon. Member for Northampton, South (Mr. Morris) has not extended to me the elementary courtesy of listening to what I am saying. It is the first time that there has been a common core claim with all the unions working together and realising that, even with the differentials that exist between one union and another, they can nevertheless combine in a demand for a 12 per cent. increase and work closely together in the pay negotiations. That has been a remarkable development.

Everyone who works in the National Health Service wishes desperately not to damage the patients' interests. That is why the TUC health committee issued its code of conduct and yesterday rejected the call for an all-out strike. The Secretary of State may like to pay tribute to the TUC health committee and to all the unions, not try to suggest somehow that one group of Health Service workers is worried about the impact of industrial action on patients and another group is not. That is not true and he knows it.

Throughout the dispute, the TUC health committee has sought to behave in a responsible manner. It is extremely important that the Government should respond.

The Minister for Health (Mr. Kenneth Clarke)

The hon. Lady has used a rather ambiguous phrase. She said that she deplored the need for industrial action. Does she support the present industrial action?

Mrs. Dunwoody

It is clear that if people whose entire lives are spent caring for the sick and in some cases for the mentally ill and handicapped, are forced into taking industrial action, they have been driven almost to the point of desperation. I do not in any way agree that they should be forced into that position. I am extremely sorry that the Government have not made some effort to produce the machinery that would obviate any such move. That has been obvious from the beginning.

Unfortunately, the Secretary of State has been deliberately procrastinating in the hope that the ballot of the Royal College of Nursing would show acceptance of the 6.4 per cent. offer and that he could then use that to drive a wedge between the Royal College of Nursing and the other unions. The Government and the Secretary of State reckoned without the fact that nurses can do arithmetic. Any Government who pretend that they are giving them a special increase should explain why they simultaneously allow their lodging charges and national insurance charges to rise.

It is ironic that the same Government who refuse to give nurses a pay increase in line with outside jobs are, nevertheless, insisting on increasing their rents in line with the Secretary of State for the Environment's £2.50 tax on council houses. The Royal College of Nursing, in spite of what the Minister hoped, actually voted decisively to refect the offer. The nurses and midwives side of the Whitley council supported the unanimous rejection of the 6.4 per cent. offer.

The stage has now been reached where the full staff side of the Whitley council, acting unanimously, has rejected the insultingly low increase. It made clear to the management that it required not a realistic, but a fair and just offer. The Secretary of State cannot seriously imagine that, by boasting of the number of extra jobs that he has created in the National Health Service, he has somehow convinced the workers that they must accept a future of low-paid jobs and imposed pay settlements. Not even the most sophisticated rearrangement of pay statistics to prove an illusory 76 per cent. increase since May 1979—a calculation that can be reached only if pay settlements entered into by the previous Government in April 1978 are included—will convince those who have to deal with the effect of low pay that they are being properly treated. It is the height of hypocrisy for the Government—elected on a platform of free collective bargaining—abitrarily to impose an incomes policy on one of the lowest paid sectors in the public service.

By contrast with the police, the fire service, the water workers, or, even more strikingly, senior judges, NHS workers have been offered a derisory amount. Compared with civil servants—badly treated though they have been—NHS workers have been offered a smaller percentage. Meanwhile, this Janus-faced Secretary of State, like some Victorian ironmaster lecturing the poor on their duty, has sought to exploit the real sense of responsibility of National Health Service workers at all levels.

Mr. Tom Benyon (Abingdon)

I thank the hon. Lady for giving way. I must say that I admire her splendid rhetoric. Having shared a platform with the hon. Lady on the subject of nurses' pay, on which she did so well, I know that she will appreciate that it is not a new problem that we face. Nurses concede that their pay has increased by 44 per cent. since the Government came to power. The problem is that they were exceptionally badly paid in May 1979. Would she care to enlarge on that point?

Mrs. Dunwoody

The hon. Member for Abingdon (Mr. Benyon) conveniently forgets that the whole purpose of the Clegg commission was to provide a catching-up increase for low-paid NHS workers and to set in train machinery—that is the important part of Clegg—that would allow comparable pay rates to be established without all this constant bother. The Secretary of State's first action on taking office was to destroy that machinery.

It is essential to the lives of all of us that the Health Service should provide the highest possible level of health care, and those who, day in, day out, week in, week out, often in depressingly inadequate premises, provide that care, are entitled to decent rates of pay and to expect our support and admiration. Most workers in the NHS realise that this may be our last chance to stop the slide of the Health Service into the slough of despond, where it will remain an under-funded, over-stretched repository of low-paid workers and under-privileged patients.

The Secretary of State should stop being so appallingly pig-headed and avail himself of the good offices of ACAS. He should immediately seek assistance from ACAS and reach an equitable and urgent solution of this problem. His intransigence is not in the interests of the patients. If he is seriously concerned about patients' welfare, he will not want industrial action to continue.

The Government have the remedy in their own hands, if only they will respond. Health Service workers are not, in spite of what the Government have sought to convey, the natural material from which militants are made. Only their very real desperation has driven them to this atypical response. Let the Minister today announce that he accepts that they have an unanswerable case for an increase that is at least commensurate with the rate of inflation. Let him acknowledge his responsibility and put the Health Service back to work in the way that everyone desires. That is what the patients want, that is what the workers seek, and that is what the House has the right to demand.

4.41 pm

The Secretary of State for Social Services (Mr. Norman Fowler)

I beg to move, to leave out from "That" to the end of the Question and to add instead thereof: this House deplores any industrial action in the National Health Service especially that which puts at risk the health and safety of patients; notes that present offers will give increases of over six per cent. to about half the work force in a service which enjoys secure and growing employment; and urges the trade unions to reconsider their position before taking any further action which could damage the National Health Service and the patients it serves.".

I had hoped that there was one thing on which we could agree, because the Government deplore not only the need for industrial action, but industrial action itself within the National Health Service. Having listened to the hon. Member for Crewe (Mrs. Dunwoody), I see that the position taken by the Opposition Front Bench is still remarkably equivocal in that regard. We must be clear on the matter. Industrial action in the Health Service is potentially dangerous. It puts patients' lives at risk. The distinction that is drawn between emergency and non-emergency is often, in practice, a distinction that it is impossible to make. A patient who is referred by his doctor to a specialist may well need urgent attention.

The prospect of pickets turning back ambulances bringing what the pickets regard as non-emergency patients to hospitals is repugnant—just as it is intolerable that anyone who is not professionally qualified should attempt to decide who does or does not need urgent treatment. Certainly I should not seek to make that kind of judgment.

Even worse, regrettably there have been reports of instances where emergency cover has simply not been provided. On Tuesday, for example, 18 ambulance stations in Northumbria went on strike. The emergency service was left to the police and voluntary ambulance services to provide as best they could. We were, of course, ready to support them with military ambulances if this had been required—in the event it was not—but even then the absence of trained and fully equipped ambulance men would have exposed the public to unnecessary risk. That is the reality of industrial action in the Health Service.

Mrs. Dunwoody

Will the Secretary of State give way?

Mr. Fowler

Perhaps I might continue for a moment, and then I shall gladly give way to the hon. Lady.

In 1979 the then Secretary of State for Social Services, the right hon. Member for Norwich, North (Mr. Ennals), said: I believe that we should condemn industrial action that does damage to the Health Service, whether it comes from doctors, nurses or anyone else who works in the Service."—[Official Report, 1 February 1979; Vol. 961, c. 1684.] He also said: I am sure that hon. Members in all parts of the House will not support the withdrawal of emergency services."—[Official Report, 18 January 1979; Vol. 960, c. 1955.] I hope that that remains the view of the Opposition. I now give way to the hon. Lady.

Mrs. Dunwoody

I thank the Secretary of State for giving way. We do not support the removal of emergency services. However, in citing a specific case the Secretary of State might have made an effort to explain exactly what happened with that group of ambulance men and exactly who exacerbated the situation to the point at which they went out.

Mr. Fowler

The hon. Lady keeps making the point—sometimes one sees it, and sometimes it disappears, but it has to be made clear to the hon. Lady—that industrial action in the NHS does cause and has caused, damage

In this dispute we have seen Mrs. Castle, the predecessor of the right hon. Member for Norwich, North, indefensibly appearing on a picket line in support of industrial action which, when she was in office, she unequivocally condemned. I hope that that does not represent the new position of the Labour Party, and that by the end of this debate we will hear from the Opposition Front Bench just what its attitude is, in plain words that the public can understand.

Mr. Reg Race (Wood Green)

When the right hon. Gentleman talks about the withdrawal of emergency service cover in Northumbria and elsewhere in other industrial disputes, does he not realise that when ambulance men informed their local health authority that they were to take limited industrial action, while providing emergency cover, some managements told them that they would all be sent home if they went on strike at all? Therefore the management is responsible for the removal of emergency cover.

Mr. Fowler

I do not accept for one moment what the hon. Gentleman says. If people withdraw emergency cover, which is a deliberate act, certain consequences must flow from it. If the hon. Gentleman wants further examples of where that has happened, I shall be glad to ask my hon. and learned Friend to give them.

I pay tribute, as the hon. Lady asked me to do, to the many thousands of people who have continued working in the Health Service—nurses and doctors, and many others who, as the hon. Lady said, are continuing to care for patients. They, I believe, are the people in the Heath Service who are rightly attracting the support and sympathy of the public. They are the people with whom the Government are most concerned to deal fairly.

Since this dispute started I have reported to the House on two occasions. There are, some further developments which I should like to set out a little later. I should like to start with what I hope will be an agreed basis.

The National Health Service has a budget of over £12 billion a year. This is higher, both in cash and in real terms, than it has ever been in the history of the National Health Service. By the end of this financial year provision is expected to be 6 per cent. in real terms over the level of services in 1979. We are therefore not dealing with a service which has been cut, but one which has been deliberately increased, and increased against the background of world recession. The result has been new hospitals; new wards; waiting lists down, and perhaps most important for some people a 47,000 increase in whole-time equivalent staff. The biggest increase has been in staff providing direct patient care.

Self-evidently, the National Health Service is a labour-intensive service. A 1 per cent. increase in pay costs about £65 million. In England the pay bill is now about £6½ billion. The pay bill for nurses and midwives is over £2½ billion. That money has been used to provide, first, more pay—pay, on average, has in fact increased by 60 per cent. since 1979—and second, more staff. Nursing and midwifery staff have increased by about 34,000 during the past three years. The result is that the pay bill itself has increased by 80 per cent. since 1979.

There is no staff group inside the Health Service that has not increased—including significant increases in administrative, clerical and works staff. Clearly, there is an obligation on the Government to secure the greatest possible efficiency of this service, and that is what we are determined to do.

What these figures demonstrate is that there is a choice for the Government and a choice for the taxpayer. The National Health Service has a budget. By any standards that budget is massive. If, as this Government have done, we add new resources and increase the budget even further, we have to choose where those resources go. If all our extra resources go on pay to existing staff, there will not be the resources for new services. It is simply not possible to provide massive new pay offers plus new hospitals and wards, and plus new staff. We have to make a choice.

Mr. Laurie Pavitt (Brent, South)

Will the Minister confirm that, in real terms, nurses pay is 80 per cent. lower than in 1974.

Mr. Fowler

I am coming to the details of nurses' pay. Over the past three years the average pay for nurses and midwives has increased by—

Mr. Roland Moyle (Lewisham, East)

What about Clegg?

Mr. Fowler

Of course it includes Clegg, because the Government financed Clegg.

Mr. Moyle

We set up Clegg.

Mr. Fowler

It may seem extraordinary, but the right hon. Gentleman was a member of a Government, and even he must accept that pay increases have to be financed.

Mr. David Ennals (Norwich, North)

rose—

Mr. Fowler

Those who argue for a 12 per cent. pay increase must say where the money is to come from. Even before that we must be clear that the 12 per cent. pay increase is only one part of the total bill that the Health Service unions are putting to the taxpayer.

Mr. Race

rose—

Mr. Fowler

I shall give way in a moment to one or other of the hon. Members. Perhaps they will fight it out between them. I must make some progress.

When we take into account the other improvements that are demanded by the trade unions—longer holidays and reduced hours—all told the value of the demands is 20 per cent. The Government's current offer will cost £320 million. The unions are claiming an extra £700 million. That is the size of the increase about which we are talking. I do not believe that anyone seriously thinks that we can provide that kind of money out of the resources of the Health Service.

Mr. Ennals

Is the Minister now taking credit for the Clegg award? The Clegg Commission was set up by the Labour Government. It was agreed that the awards would be accepted. The first action by the present Government was to abolish the Clegg Commission. Is the Minister now taking credit for the awards that were granted by the Clegg Commission?

Mr. Fowler

The Government provided the resources for it. If the right hon. Gentleman is not careful, I shall quote what the former Chief Secretary said about his behaviour at that time. As a former Secretary of State, the right hon. Gentleman should appreciate that, above all, the Government have to provide the resources in these situations. The Government are entitled to take credit for providing the resources.

Mr. Terry Davis (Birmingham, Stechford)

The Secretary of State lost the thread of his earlier remarks—no doubt because of the interventions by my hon. Friends—and did not finish his sentence. Will he make clear what percentage increase in National Health Service pay the Government claim has taken place during the past three years?

Mr. Fowler

The pay bill for nurses and midwives has increased by 80 per cent. That is partly made up of pay and partly by increased staff. That is the figure that I have just given. The pay increase within that amount is 60 per cent.

Mr. Michael Morris

Is not the real nub of the problem that when my right hon. Friend and his predecessors came to power in the Department of Health and Social Security they found that there was no control over the number of staff in the Health Service? The seventeenth report of the Public Accounts Committee gives that as the situation. Moreover, the increase for the nurses over the period 1971 to 1979 was 24.6 per cent., whereas for technical ancillary staff it was 47.4 per cent. and for administrative ancillary staff it was 45 per cent. That is the nub of the problem inherited by my right hon. Friend to which an answer must be found in the months ahead.

Mr. Fowler

I agree with my hon. Friend. Those are the points that the right hon. Member for Heywood and Royton (Mr. Barnett), who was Chief Secretary to the Treasury in the Labour Government, was making in referring to a previous Secretary of State for Social Services, the right hon. Member for Norwich, North in his book "Inside the Treasury". The right hon. Member for Heywood and Royton wrote: He had a case, not one with which I necessarily agreed, because I felt there was substantial overmanning amongst Health Service ancillary workers who, through strike action, had won a clearly excessive settlement. That is the point that my hon. Friend was making.

Basically, what this amounts to is a call to increase the contribution made by the taxpayer. Here we come to a crucial issue. The National Health Service is not an island. It is not divorced from the rest of the economy, and it never can be. It can expand only in so far as resources are available to allow expansion to take place. It relies on the wealth creation of industry, and the health of industry relies on us getting inflation down and keeping it down. It would be madness at this point to turn our backs on the successes that we have achieved there—madness for industry and madness for the National Health Service. Therefore I repeat that the 12 per cent. claim—or, to be more accurate, the 20 per cent. claim—that has been put forward is totally unrealistic.

Let us be clear on what has actually been offered. Since the 4 per cent. pay factor for the public sector was first announced by my right hon. and learned Friend the Chancellor of the Exchequer last December, an additional £82 million has been made available to increase the pay offers for specific groups within the NHS responsible for the direct treatment of patients and a further £22 million to finance the Government's decision on the report of the Doctors and Dentists Review Body. As a result, more than half the total work force are being offered more than 4 per cent. Nursing and midwifery staff, the largest group, have been offered increases averaging 6.4 per cent.

A similar offer has been made to the professions supplementary to medicine. The doctors and dentists have been offered increases of about 6 per cent. on average. Ambulance men have been offered 5 per cent. as part of a settlement which would include the introduction of a salaried structure. Overall, on the present offers the paybill would increase by about 5.5 per cent.

Other groups, such as the Civil Service—this is a fair comparison—have received increases for individuals of 5.9 per cent., but they have had to live within the 4 per cent. pay factor. The difference will have to be made up by savings in administration, notably a reduction in the number of staff. That is in direct contrast to what is happening in the National Health Service.

It is true that substantial numbers of staff are still being offered 4 per cent., and some of those staff are relatively low paid. I do not seek to dispute that fact, but there are also two important points to be made.

First, I make no apology for seeking to make some distinction between groups on grounds of recruitment, the degree of skill, qualification and training required. That is why we have offered more to nurses and midwives than to some other groups of staff, and I believe that that is supported by the public generally.

Mrs. Elaine Kellett-Bowman (Lancaster)

On which point has my right hon. Friend put the physiotherapists, who are also highly trained and refrain from striking?

Mr. Fowler

They are also offered 6.4 per cent., are included in the professions supplementary to medicine and are at the top of the list.

Secondly, many of the figures—the hon. Lady put forward her own figures—are quite misleading. One that has been used is the figure of £82 a week and the so-called poverty line. As I am sure the hon. Lady knows, £82 a week is the level of family income supplement payable to a married couple with two children.

The real comparison should be, not with the basic rate, but with earnings. Average male ancillary earnings are £104 a week, and average full-time female ancillary earnings are £84 a week. That compares with a private sector average of £74. Nor are those differences largely accounted for by excessive overtime. The average for the male ancillary worker is 5½ hours a week, and the full-time female ancillary worker does less than 1½ hours overtime on average.

This dispute is between a Government who have increased expenditure on the Health Service, provided secure and increasing employment for the staff and have offered about half the work force more than 6 per cent., which will cost about £320 million this year, and trade unions which have made a claim that will cost another £700 million.

I agree with the hon. Lady that it would not be right simply to leave it at that. I am sure that the House will share my desire to do everything possible to try to bring this dispute to an end, but this must be done within the resources available.

Because of our desire to make progress, and also because of the key role of nurses in maintaining patient care—[Interruption.] I want to make two points, and I advise hon. Members not to jump to too many hasty conclusions—I responded immediately to the request by the leaders of the Royal College of Nursing to see me following the ballot of their membership. We had a constructive discussion and it is clear that the Government and the Royal College are close together on a number of points. In particular, we both want to see a new permanent arrangement for determining pay introduced next year. We agree that we want progress on this as quickly as possible, and the first meeting on the subject took place today under the chairmanship of the Minister for Health.

I repeat to the hon. Lady that any delay that has taken place is in no way the responsibility of the Government. If the hon. Lady checks the letters and the facts she will see that the Minister for Health wrote on 28 August 1980 and did not receive a reply from the staff side until 12 August 1981. That was the first reply. Those are the facts, and I hope that the hon. Lady will not pursue her point, which is wrong and totally dud.

We also agree with the Royal College argument that settlements between now and the longer-term arrangements should continue to recognise the special position of its members, who have not taken industrial action. We have already recognised that special position in the 6.4 per cent. offer that we have made. Obviously the Royal College wants to see that offer improved, and it puts its case strongly on that point. At this stage the problem is that we must find the money from the resources available. That problem still remains. None the less, we had a helpful discussion. I promised to consider all the different points that the Royal College made, and I have asked its representatives to have a further meeting with me, I hope next week.

There is much common ground between the Government, the Royal College of Nursing and its members. We admire and respect their dedication to patient care, and it was on that base of common ground that the meeting took place.

I very much regret that at present no such common ground appears to exist between the Government and the Health Service unions affiliated to the TUC. They are committed to a continuing campaign of industrial action which puts patient care at risk, and that fact must constitute a barrier between us.

It appears that the Opposition would turn to a third party—they mention ACAS—to arbitrate in these circumstances between the Government and the Health Service unions. As I said before, that is a course that I reject. The essential issues in this dispute are how much the nation can afford to spend on the Health Service and how, within that total, the money is to be distributed. Those decisions cannot be contracted out to anybody outside the Government, and certainly not to a forum of the kind with which we are all familiar, in which the arbitrator or conciliator sets out to fix it and ends up splitting the difference. I have given the House the figures, and I do not believe that that is the way forward.

The health services committee of the TUC has now indicated that it, too, would like to see me. It said so in the statement that it issued after its meeting last night. I should welcome such a meeting, provided I thought that we could, as I and the Royal College did, proceed from some common ground.

In the light of the various reports of the TUC health services committee meeting yesterday, it is anything but clear that there is yet sufficient common ground to make such a meeting worth while. But it is very much the Government's wish that there should be such a meeting, so that without misunderstanding, and with a realistic recognition of what can be afforded, we can bring this dispute to an end.

It was with that in mind, and with a view to removing any misunderstandings and finding common ground, that earlier this week I asked Mr. Pat Lowry, the chairman of ACAS, to act as an intermediary and go-between. Mr. Lowry has agreed to do this in a personal and private capacity as a channel of communication acceptable to both sides. Whether his explorations will prove fruitful remains to be seen. We are grateful to him for agreeing to do this job, which he is just starting, but I owe it to him and the House to make his position clear. It will not be his responsibility to make proposals, still less to make offers. These matters must ultimately be settled by the Government.

It may be that no progress can be made. I should regret it if that were the case. But if his explorations succeeded in finding common ground for useful discussions between the Government and the representatives of the other unions which would enable us to end this dispute, no one would be better pleased than I. However, I am bound to warn that the present claims made by the trade unions, and their actions, are a substantial barrier.

Mr. Stephen Ross (Isle of Wight)

I warmly welcome what the Minister has just announced. However, as one who owes his life to the National Health Service I beg him to understand the feelings, as I have discovered from being in hospital, of the Royal College of Nursing and nurses in general. I could have predicted the outcome of the vote. The right hon. Gentleman's information is not very clever if he expected them to vote in favour of the pay offer.

The right hon. Gentleman must not split the Royal College and the other health unions. If the role of ACAS, or, rather, of Mr. Lowry, is to prevent that, I warmly support it. I marched with the unions in my home town of Newport yesterday, because they have a strong case. They do not wish to be on strike. I am sure that the Minister can bring them together if he acts in the proposed way.

Mr. Fowler

I am grateful to the hon. Gentleman for his response. No purpose is served by driving a wedge between the two. That was the hon. Gentleman's fundamental point. I hope—I do not want to raise false hopes—that matters will proceed from that.

The amendment makes three points. First, it deplores the industrial action that puts at risk the health and safety of patients. No one should be in any doubt that that is the result of industrial action in the National Health Service. Secondly, it points both to what has been offered in pay and to the increased employment within the Health Service. That circumstance is exceptional in both the public and the private sector. Thirdly, and most importantly, it asks the unions to reconsider their position before taking further action that could damage the NHS and, above all, damage the patients whom the service is there to care for. I urge the House to support the amendment.

5.11 pm

Mr. Roland Moyle (Lewisham, East)

I declare an interest. I am a Member sponsored by the National Union of Public Employees which is one of the unions that are taking industrial action. I have also been a Minister of State at the Department of Health and Social Security. I nearly did not bother to declare my interest, as when the Secretary of State answered a question last week he was good enough to declare my interest for me. This is his kind way of admitting indirectly that no matter how long he holds his high office I am more likely to know more about both sides of the problem than he ever will. Added to that is the fact that I spent 10 years practising industrial relations before I came to the House. Moreover, my family and I make full use of the Healh Service. We have no private health insurance. I hope that the right hon. Gentleman can say the same.

I admired the way in which my hon. Friend the Member for Crewe (Mrs. Dunwoody) put the case on behalf of the Opposition. It was first class. I have been through fire on this subject as the Government of which I was proud to be a member ended up on a head-on collision with the union of which I am also proud to be a member. As a result, I have thought a great deal about the problem before the House.

I should like to give the Secretary of State the benefit of my advice. It is simple. If he feels that, as a result of his losing face, he cannot increase an across-the-board offer to all workers in the NHS, he should take the advice of the TUC health services committee and refer the matter to ACAS. ACAS could then discover a special scheme of arbitration that will cover the current problem and settle it. The right hon. Gentleman told us of one or two steps in that direction, but they are not enough. We want a full-blooded commitment to arbitration if the right hon. Gentleman cannot find a way in which he can increase his offer to all NHS workers without loss of face.

There is an abhorrence of industrial action within the NHS. The right hon. Gentleman said so today, and my right hon. and hon. Friends have said it in the past. The Government amendment says it. That abhorrence is fully shared by every employee in the NHS. That should be taken on board. The right hon. Gentleman and his colleagues are deliberately exploiting the reluctance of NHS employees of every grade to take industrial action to hold down to the lowest possible level—comparable only with Members of Parliament—the offer that he has made, on his own admission, to more than half of the NHS employees.

That is the Government's tactic. The right hon. Gentleman is intending the natural consequences of his act. It is a cynical exploitation of the natural reluctance of Health Service workers to take industrial action. It is designed to save the Government cost and trouble. The right hon. Gentleman ought to admit it. We have seen, as a result of preliminary exchanges on the matter before the debate, that the Government's case in no way rests on justice or on any attempt to provide it. It is based on power, cost-saving and the numbers involved. That much is clear. The right hon. Gentleman has not attempted to pretend that the offer to ancillary workers depends on anything else.

That position guarantees a continual temptation, even among the most noble-minded Health Service employees, to have full industrial action. One can only think of what would have happened if, on the first day of limited industrial action, all the Health Service unions had withdrawn all their labour permanently. One has only to grasp that possibility—perhaps it is impossible to grapple with its full horror—to realise the way in which all Health Service employees are pulling their punches. The time has come when all hon. Members must cease to exploit that sense of unity among NHS employees.

We must return to the machinery—perhaps not in exactly the same form—that the Labour Government bequeathed to the present one in the form of the Clegg commission. The Clegg commission was set up so that there should be a permanent, regular and scientific study of pay movements and the cost of living throughout the economy to see how it affected pay in the NHS. It was also intended to ensure that there was appropriate information, without strike action, to allow Governments and unions to pay fair wages in the Health Service, relative to the rest of the economy, rather than the country getting into the ghastly position with which we are now faced yet again.

Even at this early stage in his career, the right hon. Gentleman is suffering from a massive credibility gap. Although he says that he wants to introduce pay comparability into the NHS, he must first explain why the Government abolished the comprehensive machinery that they inherited from the Labour Government; who set it up. The right hon. Gentleman is not necessarily personally responsible for that prompt abolition, apart from any vote that he may have cast in Cabinet.

Morover, during the limited time for which the Clegg commission lived under the present Government, the Government nobbled its operations so that it did not give the answer that many people in the Health Service expected. Therefore, if the right hon. Gentleman makes a proposal that is based purely on Clegg it will be received with mixed feelings in the NHS because of the memory of that experience. Apart from the inherited credibility gap into which the right hon. Gentleman has had to insert himself, he is beginning to dig a credibility gap of his own. He seems to be interested only in the pay of nurses and midwives.

Over and again we hear the right hon. Gentleman refer to the pay of nurses and midwives. He put the matter succinctly on 27 May. He said: We are trying to devise a long-term arrangement for determining the pay of nurses and midwives … We would then expect that to have an implication for the professions supplementary to medicine … There is nothing especially strong there. He went on: I am also prepared to consider the implications that that would have for the rest of the workers in the National Health Service."—[Official Report, 27 May 1982; Vol. 24, c. 1061.] I see the Minister nod, so I need not produce further quotations from his speeches in the past few days which have tended to reinforce that line.

Nurses and midwives certainly form a vital part of the National Health Service, but all the other workers—ambulance men, cooks, cleaners, laundry people and porters—also form a vital part of the service. If they did not, they would not be there. Their pay is therefore just as important as that of nurses, doctors and dentists. The Secretary of State must take that on board in setting out his plans for the future.

Mr. W. R. Rees-Davies (Thanet, West)

I entirely accept that they all have to be paid, but two aspects must be borne in mind. First, a number of the jobs, especially among the cleaners, contractors and some but not all of the porters, could well be dealt with by subcontract so that the burden would not fall so directly. Secondly, where there is a dramatic increase in certain of those aspects as there has been—[HON. MEMBERS: "No, there has not.]—there would be a good deal more money if there were a decrease in subsidiary and ancillary services.

Mr. Moyle

I do not wish to start a long debate about the morality of subcontracting, but I have noticed that subcontractors demand to be paid and they also pay their employees, so I cannot see how that would be a saving to the National Health Service. The hon. and learned Gentleman's arithmetic is about as good as the Secretary of State's. Indeed, the Secretary of State said today that if everyone received the same percentage increase differentials would be reduced. That is not true, of course. If both nursing sisters and hospitals cleaners received an increase of, say, 8 per cent., 10 per cent., or 12 per cent., the cash value of the differential would in fact increase.

The other employees in the Health Service besides nurses and midwives are equally necessary and the right hon. Gentleman had better treat them all on that basis. Otherwise a continuing sense of unfairness will develop in the Health Service, and, if the situation this year is bad, it will be worse next year and even worse the following year.

5.22 pm

Mrs. Sheila Faith (Belper)

I acknowledge the experience of the right hon. Member for Lewisham, East (Mr. Moyle), but I cannot agree with his argument. I agree that the debate is important as it takes place at a time when industrial action is already prejudicing patient care in the Health Service and health workers have decided to intensify their current campaign of industrial action.

The Government cannot ignore the undoubted fact that nurses and ancillary workers in the National Health Service feel that they have been let down by successive Governments and that the public have great sympathy for them. I am glad that my right hon. Friend the Secretary of State is giving the matter further consideration, has called in a go-between and is supporting new methods for determining nurses' pay.

Although the Royal College of Nurses, which represents the majority of nurses, has turned down the Government's original offer, its members, in accordance with their usual high principles, will not strike. The ancillary workers should bear in mind that if they continue their industrial action they will lose a great deal of support if it leads to a situation similar to that which arose in 1978–79 when many patients' lives were endangered and a great deal of suffering and discomfort ensued. For hospital ancillary workers to place themselves in the position of deciding which patients are seriously ill enough to be considered as emergencies is wholly unacceptable. As a dentist, I have a certain amount of medical knowledge, but I certainly could not rest happily if I thought that people 's lives depended on my estimation of the seriousness of their condition.

Of course we cannot say that we are satisfied with the salaries received by Health Service staff, but in every trade and profession people in this country are being paid less than their counterparts in other countries because we have not created a proper climate for industrial prosperity. We must bear in mind that the National Health Service is the largest single employer in the country and that £12 billion per year of public money is spent on it—an increase of 6 per cent. in real terms since the Government took office—and that more than half of the total expenditure consists of wage costs. Every concession by the Government has a real effect on the economy as a whole. Therefore, it is understandable that the Government do not wish to do anything that might halt the improvements in the economy that are now becoming more and more apparent.

It is interesting to note that the Select Committee on Social Services, in its third report on public expenditure in the social services in the 1980–81 Session—in this context, I acknowledge the presence in the Chamber of my hon. and learned Friend the Member for Thanet, West (Mr. Rees-Davies)—recommended that, because the cost of providing jobs in the Health Service was not high, the Government might create opportunities for people to take up work in areas of the country where there is a low Health Service provision coupled with high unemployment. Although as a member of the Select Committee I must accept responsibility for that recommendation, I was sceptical about it and not surprised when the Government decided that the Committee had not taken overheads fully into account, nor the fact that it would be difficult to limit recruits to men who would otherwise be receiving maximum benefits, as would be necessary for the scheme to be economically viable.

I have always supported the Government's overall strategy of trying to provide real jobs in the private sector, and I accepted the Government's reply to the Select Committee's recommendation. Nevertheless, the Government must have been influenced to some extent by the Committee's argument, because, unlike other areas of employment in the public sector, the number of jobs in the Health Service has increased considerably and there are now many more nurses and significantly more ancillary staff. I do not believe that the Health Service unions have taken that fully into account, or the fact that, unlike employees in the private sector, their members have security in jobs that are sought after and highly prized. I acknowledge the remarks of the hon. Member for Crewe (Mrs. Dunwoody) on this point, but when these jobs are advertised there is no shortage of excellent applicants, while many other job advertisements do not achieve a great response.

It is sad that decent people are taking collective action in the name of their unions, which, in the Health Service, could be cruel and dangerous. Anyone who has been associated with business in the private sector knows that people in this country are loyal and extremely conscientious. In the past few years of economic difficulty, we have seen that they are prepared to make real sacrifices for the sake of the economic viability of the businesses for which they work. Yet the same type of people working in the public sector are prepared to endanger lives and are behaving in a way that could never have been envisaged—and this has happened whether the Government have been Labour or Conservative.

Therefore, greater impetus must be given by the Government to increase the contracting out of catering and laundry services to private firms. I know that the Government have offered advice and encouragement to health authorities, but the response has been unsatisfactory. The Government should also be instrumental in setting up a pilot scheme at one large hospital whereby laundry and kitchen space and equipment are rented to private firms. This would mean better and possibly cheaper services and would be to the advantage of all concerned. Patients would have better services, because if, for example, meals were below standard, the contract could be terminated. Most important, the union monopoly would be broken and hospitals would not periodically be hostages to bullying unions.

The majority of people would be deeply grateful to the Government if this were put into effect, as they seek reassurance that they would not be subject to the possibility of being caught up in a dispute when they need hospital treatment. As soon as the industrial action is settled, I hope that the Government will make every attempt to move towards this privatisation measure. I believe that it would bring significant benefits in future industrial relations.

5.30 pm

Mr. Robert C. Brown (Newcastle upon Tyne, West)

Like my right hon. Friend the Member for Lewisham, East (Mr. Moyle), I should declare an interest. I am a Member sponsored by the General and Municipal Workers Union, many members of which work in the Health Service. In addition, I had been Under-Secretary of State at the Department of Health and Social Security for only a few weeks when, asked by Mrs. Barbara Castle to take responsibility for staff and industrial relations across the board, we had the first industrial stoppage in the Department. However, I do not accept responsibility for that.

The Falklands crisis and events in Poland have distracted attention from the National Health Service workers' battle on the home front. However, the significance of the fight that the Health Service workers are putting up today may well outweigh that of other battles in the long term. I shall return to that point later.

The Government have turned a co-operative and caring work force into an increasingly militant one through their rigid and insensitive attitude. Even the traditionally docile Royal College of Nursing, which has until now refused to sanction industrial action, has voted overwhelmingly to reject the paltry offer made to it. Does the Minister feel any pride in the fact that he has caused that historic decision to be taken by nurses of the Royal College?

The Government's response to the health workers' legitimate demand has been in marked constrast to their tax handouts to the highly paid and their latest round of huge increases to the top paid in the public sector. Some of the rises due to top public officials amount to as much as the lowest paid Health Service worker will take home in a year.

To deny Health Service workers the right to a living wage without recourse to industrial action is nothing short of a national scandal. Their speed of thought and action daily save the lives of scores of people.

The assault on the living standards of nurses and other National Health Service workers should not be seen in isolation from the overall attack on the NHS that has been carried out by the Government. The Government reduced the real level of expenditure on the NHS by half of 1 per cent. in real terms in their first year of office. The Treasury Select Committee estimates that over the next two years spending on the NHS will decline by over 2 per cent. in real terms.

The impact is far greater. Even if spending was maintained in real terms, expenditure would be inadequate to preserve existing services and to cope with the growing numbers of ill people imposing demands on the Health Service. A real growth in spending of 1 per cent. a year is needed to preserve existing services alone and to meet the demands of the increasing number of aged people.

At the same time, the Government have sought every possible means to undermine confidence in the NHS. Private medicine has been encouraged and supported. There have been attempts to introduce private medical insurance in the public sector. The principle of health care provided on the basis of need and not wealth is once more at stake. The concept of a Health Service funded from general taxation has also been threatened. There have been persistent rumours of Government attempts to introduce an insurance element, despite the almost universal condemnation of the medical profession and the trade unions in the National Health Service, as well as that of many other interested parties.

The Government have done everything possible to promote the privatisation of aspects of the Health Service through the contracting-out of its work. In that context, the Government's harsh and intransigent attitude to the lower paid in the NHS has been the final straw for the Health Service workers. The Government's pay policy in the public sector has long since revealed itself as no more than placating the strong and punishing the weak. Because of their reluctance to take industrial action, Health Service workers are in the weakest bargaining position in the public sector.

The Government's response has been to impose settlements on the NHS that have been successfully resisted elsewhere. I do not need to remind the House that in the public sector workers generally have not been restricted to increases of 4 per cent. The miners had an increase of 8.6 per cent., local authority manual workers 6.9 per cent., water workers 9.1 per cent. and civil servants achieved an increase—true, it was via arbitration—of 6.9 per cent. Meanwhile, higher paid public servants, whose pay is settled by an independent review body, have had rises of up to 18.9 per cent. Judges had an increase of 18.9 per cent. and senior civil servants had one of 14.3 per cent.

There are 270,000 ancillary staff employed by the NHS, half of whom are part-time. Almost 55 per cent. of the full-time workers, including 41,000 women, earned less that £75 a week in 1981. The average gross earnings for all ancillary workers in 1981 was £87.96 compared with a figure for the country as a whole of £140.50. Four per cent. of very little is indeed very little. I will not use the expression that a certain trade union leader used outside the House, but it is, nevertheless, true.

In spite of what the Secretary of State has said, the Government offer of 6.4 per cent. to the nurses was a blatant attempt to divide and rule Health Service workers. Even so, the gross increase for a staff nurse would be £5.46 per week, resulting in a net rise of £2.34.

For many years ambulance men have argued for the same status and pay as the two other branches of the emergency services, the police and the fire brigade. On 31 July 1981 the Secretary of State recognised ambulance men as an essential part of the emergency services. Despite that recognition, their pay remains far behind that of their colleagues in the emergency services. In the police, ranks below police superintendent earn on average—

Mr. Rees-Davies

rose—

Mr. Brown

No, I will not give way. This is a short debate and I must continue.

Mr. Rees-Davies

It is easy to read the TUC brief. It should be put in the Library.

Mr. Brown

I am not reading a TUC brief.

The Government should now summon any compassion that they have to meet the demands of the Health Service workers. They are asking for 12 per cent. and even that will leave many o f them earning a miserable pittance. The Government must look to a longer term arrangement—which I understand they intend to do—not just for nurses' pay but for ancillary workers and everybody else who works in the NHS.

If the Government do not do that, I must warn them that there might be terrible consequences in store. Health Service workers are rightly reluctant to take the ultimate action that could cost lives. However, powerful allies are now coming to the aid of Health Service workers. The miners took action this week and now my union, the General and Municipal Workers Union, has threatened to call on its public sector workers to show solidarity with the nurses' cause. My union effectively controls gas, water and electricity workers, who have great industrial muscle. If the Secretary of State continues to resist the Health Service workers' claim, he may find himself tackling a far tougher nut then the NHS workers whom he originally decided to treat with such contempt.

5.39 pm

Mr. W. R. Rees-Davies (Thanet, West)

I have already read the TUC brief carefully. We have just heard the hon. Member for Newcastle upon Tyne, West (Mr. Brown) read out its brief, not the GMWU' s brief. It would be perfectly good policy to leave the brief in the Library, so that other hon. Members can read it. It is well drafted, but it unfortunately misses the point. It fails to understand the background and why so many NUPE workers and others are not relatively highly paid. I shall paint the picture so that those concerned can understand it. [Interruption.] There will not be any laughter when hon. Members have heard the figures, because they are remarkable.

There is little party political capital to be made out of my remarks, because they will hit both sides. In 1979 the Conservative Party manifesto stated: In our National Health Service standards are falling; there is a crisis of morale; too often patients' needs do not come first. It is not our intention to reduce spending on the Health Service; indeed, we intend to make better use of what resources are available. So we will simplify and decentralise the service and cut back bureacracy A Select Committee has not yet had time, or has not chosen, to deal with one of the most important questions. Will the National Health Service be allowed to grow and grow without any control over its eventual size, or will it be contained within reasonable limits, so that high standards and good pay can be maintained? That is the issue.

I shall pose three simple questions, which I shall then try to answer. First, given that today there are 200,000 more nurses than the 236,000 that were employed in 1960, do we still need to increase the number of nurses by over 11,000 per annum? In 1960 there were 236,711 nurses and midwives. In 1970 the figure had risen to 343,682 and by 1980 it had risen to 448,870. That information can be found in column 270 of Hansard of 23 November 1981. The number of medical and dental staff has increased from 20,000 in 1960 to over 46,450 in 1980. We must ask ourselves whether the figure for nurses is to increase every year by about 11,000.

The second simple question is: why did the number of administrators increase by over 3,000 between 1979 and 1980? That was a large increase. It occurred not under a Labour, but under a Tory Government. Why was there such a big increase?

The third question is: why did the number of ambulance personnel need to be increased by nearly 1,000 between 1979 and 1980? Were there suddenly more accidents in 1979–80 than in 1978–79? There were not.

In the past 20 years we have steadily failed to alter the general direction of overmanning, restrictive practices and falling standards. In 1960 the population was 52,559,000. By 1980 it had risen to 56,010,000, but the population covered by the National Health Service had fallen from over 98 per cent. to 93 per cent. during those 20 years. The proportion covered has fallen because the British United Provident Association and other organisations now provide private care for 4 million people. In 1960 only 1¼ million were covered in that way. The number of those who look after themselves through private health care is rapidly increasing. In addition, the trade unions, particularly the electrical unions, have their own hospitals and cottage hospitals. Not only employers, but good union members recognise the need for private health care. The cost of the National Health Service is large and rising. Because the number of nurses, administrators and ambulance men has doubled in the past 20 years, difficulties arise over pay.

I shall now mention a figure which you, Mr. Deputy Speaker, with your great knowledge of these matters will fully appreciate, but I do not believe that the House appreciates it. Do hon. Members realise that in the past year or so a reduction of just over 56,000 has been laboriously achieved in the Civil Service, through redundancies and so on? At the same time there has been an increase of 67,000 in the number of National Health Service personnel.

I do not say that we have not gained a lot. In many respects we have, but my hon. and learned Friend the Minister for Health and my right hon. Friend the Secretary of State must face the problem that the figures for operations performed and for hospital waiting lists are not good. Given all the additional expenditure, and the additional nurses, administrators, porters, radiologists, and so on, one would have thought that the numbers on our hospital waiting lists would have fallen rapidly, but what is the truth?

In 1960 there were 401,000 people on hospital waiting lists. In 1970 the figure had risen to just under 500,000, and in 1980 it had risen to 611,000. There is no sign that the figure has significantly dropped. However, recently there has been some sign that we may be beginning to tackle hospital waiting lists. I hope that the Government will make that a top priority. We need more operating theatres. For example, many hip operations need to be done and people sometimes have to wait for two or three years.

What is our priority? My priority, and that of those whom I represent on the Isle of Thanet, is to reduce hospital waiting lists. If extra money is to be spent, it should be spent for the benefit of the patients. I do not believe in strikes in the NHS, and I do not believe that the nurses will strike. Many years ago I represented a large body of nurses. I still have a great regard for them and know that my right hon. and hon. Friends also hold them in high regard. It is time that they were categorically told that there has been a good increase.

Nowadays, many nurses are agency nurses, because it pays them to work part-time. They do not work as they did years ago. They tend to go for agency work, particularly in the London hospitals. That is a pity, and I hope that the trend will be reversed. Obviously they must be able to increase their opportunities for work, and there are many opportunities to do that, not only in the NHS, but in the private sector and in hospitals and services at home and overseas. There is no real reason for complaint about their pay and conditions.

There are far too many ancillary workers. There are too many cleaners at the Westminster hospital in London. The number of hours worked is too high. The work could be done in fewer hours, without the need to employ them on a full-time basis. I hope that the contracting services will come in and that great care will be taken to save money by making reductions in the National Health Service. I hope, then, that those who remain in the service—95 per cent. of the total—will be able to get an improved standard of pay. I should like to have seen a slightly higher rate, as I should have liked to see a slightly higher rate for Members of Parliament. Four per cent. is on the low side for both groups. I might have opted for 6 per cent., but I do not see any case for a large increase at any point in this sector. They have had a growing and improving service, and we now want to see that that improving service improves the service for the patient. The patient must come first and foremost in all our considerations.

5.51 pm

Mr. Clement Freud (Isle of Ely)

This is the fourth Parliament of which I have been a Member. While I have sat on the Liberal Bench I have been accompanied on this side of the House by colleagues in Opposition who were sometimes of one political party and sometimes of another. Yet in one case they were totally consistent. When they were in Opposition, they blamed the Government for the shoddy treatment that was meted out to nurses. When they appeared on the Government side of the House, they defended their action.

Nurses—I have checked my figures with great care—have had pay within 5 per cent. of 60 per cent. of national average pay. Ward sisters have been within 6 per cent. of 75 per cent. of national average pay. Over the years we have seen the Halsbury and Clegg reports. One welcomes the Secretary of State's request for the chairman of ACAS to come in, but I wonder for how long anyone will be satisfied until we have an incomes policy and we stop trying to score party political points in one way or another.

On Tuesday, after a private notice question, I asked the Minister to be generous, to adopt an incomes policy, and to recognise the many nurses and physiotherapists who continue to work regardless of the dispute. The Secretary of State, in a traditional shirty reply, said: I do not know what is the hon. Gentleman's definition of an incomes policy—and I am not sure that he does either."—[Official Report, 8 June 1982; Vol. 25, c. 21.] In his speech today the Secretary of State said that we needed new machinery for dealing with pay issues in future years. I should simply like to tell him that that is what I meant by an incomes policy, and clearly he now understands. We need new machinery for dealing with pay issues. We need an incomes policy to take away the specific case and to go for the general concept.

We welcome ACAS. I repeat the plea made by my hon. Friend the Member for the Isle of Wight (Mr. Ross) that ACAS must be asked to cause no division between the component parts of the National Health Service. That would be invidious. What worries us predominantly is that the Government could have been so out of touch as to have thought that the poll among members of the Royal College of Nursing would be anything but a massive rejection of their offer.

The Governent, like all Governments, referred to the decency and integrity of the nursing profession. The nurses have spoken loudly and clearly. They do not want to strike. The House would say to the Secretary of State "Do not force them to do something so alien to their nature". We all admit that workers have the right to withdraw their labour, but what on earth are they to do other than to withdraw their labour? I ask the Secretary of State to give them a reasonable increase now—one that will at least retain their position on the higher scale of the percentage. Then, in good time, an incomes policy should be brought in, as the Secretary of State intimated and as we, on the Liberal Bench, have advised him since the Government came to power.

5.55 pm

Mr. Richard Alexander (Newark)

First, I apologise to my right hon. Friend the Secretary of State and to the House for having to leave the Chamber shortly after I make my speech. I had a duty arranged before I knew the subject of the debate.

There can be hardly anyone in the House or in the country who is not deeply concerned about the dispute. Almost all of us will have been cared for by the nursing profession at some time in our lives. Their reluctance to take strike action should not be a reason for taking tough action over their pay now. My concern is wider than concern for nurses and midwives. I should like to express concern today for those who need treatment inside or outside hospital but who are not receiving it. Operations and treatment for non-urgent cases are being delayed by the dispute at a time when hospital waiting lists have been significantly reduced in accordance with the pledge that we made at the 1979 general election.

In cold print, an operation for an arthritic hip replacement for the relief of back pain or an operation for an hernia might be regarded as non-urgent, but for the person concerned it is extremely urgent. Such people are at the heart of, and are hurt by, the dispute.

There is undoubtedly widespread sympathy for the nurses and midwives. They are skilled, dedicated and underpaid. In contrast to what we have heard from some Opposition Members, I do not believe that whenever we talk about nurses' and midwives' pay we ought automatically to be talking about ancillary workers' pay at the same time. I do not seek to drive a wedge between the claims of the two groups, but I suggest to my right hon. and hon. Friends that they be dealt with separately and on their own merits. That seems sensible.

The ancillary workers do an essential job, but often their militancy, their growth in numbers, and their unwillingness even to consider the possibility of their work being done by the private sector with consequent savings to the Health Service budget means that they do not have the sympathy of the general public at this time.

When ancillary workers have an average take-home wage of £104, albeit including overtime, it is difficult to justify the argument that they are on the poverty line, and that they are justified in taking the strike action with the results that I have mentioned. We talk about take-home pay and overtime. Most jobs involve overtime, and overtime payments must be considered when we talk about the average pay package. Many hon. Members work overtime. Many of my hon. Friends, including myself, and some Labour Members worked a 19-hour day yesterday. We do not always expect overtime for what we do.

Mr. Race

We get paid for that.

Mr. Alexander

Therefore, we must take into account what ancillary workers take home, including a reasonable amount of overtime.

It is difficult to feel sympathy for those now engaged in strike action when my constituents know that many in the private sector have gone without pay increases, and that many others have settled for increases within 4 per cent. to 6 per cent. However, those in the National Health Service continue with their secure jobs and inflation-proofed pensions.

Mrs. Dunwoody

That is not true.

Mr. Alexander

It is true. They have secure jobs compared with the jobs of the majority of those who work in the private sector. Security of employment is a factor that must be taken into account. Furthermore, we must not forget that since 1979 the Government have been spending more on the NHS in real terms. The number employed in the NHS has increased. Some may thimk that that is a blessing because hospital waiting lists have been reduced. This is not a picture of a Government who care little for the Health Service or for patient care.

Those employed in the NHS must accept that there is a limit to the money that is available for increased wages. If the Government accede to the demand for a 12 per cent. increase, the cost to the nation will be an additional £780 million. That sum could be raised by extra taxation, a reduction of the service or a reduction in the number employed in it. Those are the options that my right hon. Friend must bear in mind when he considers the 12 per cent. claim. No other options are open to him.

Since 1979 an additional 50,000 have been employed in the Health Service. Has it been entirely necessary to employ each one of the 50,000? The NHS work force has doubled since 1960. As my hon. and learned Friend the Member for Thanet, West (Mr. Rees-Davies) said, a significantly greater proportion of the public are taking their health care needs out of the public sector.

A few days ago there was a television interview outside a hospital and a picketing nurse was asked "Are you leaving your patients at risk in the ward?" The young lady properly replied "Not at all. They are perfectly adequately cared for and we are well staffed in the ward without my presence today." Overmanning, the non-separation of nurses' and ancillary workers' pay structures and the lack of acceptance that the private sector has a part to play in the NHS are the difficulties that are facing the Health Service. If my right hon. Friend faces them, there will be a decent level of pay for all in the service, and that will automatically follow.

Mr. Nicholas Winterton

Does my hon. Friend recall that in the Conservative Party's manifesto of 1979 it was promised that a Conservative Government would treat the nursing profession as a special case? It was the party's intention to bring them out of the party political wage round negotiating procedure. We have done that for the police and for those in the Armed Services, so why cannot we do it for the nurses and the paramedical staff, who are suffering quite severely and are being treated very differently from the two other special cases? Do they not merit the same consideration, and now?

Mr. Alexander

I entirely agree with my hon. Friend. That is exactly the argument that I have been advancing. We must treat nurses and the paramedicals on their own merits. Let us not become bogged down with the numbers who are involved in the ancillary services. I support my right hon. Friend's amendment.

6.5 pm

Mr. Michael Meacher (Oldham, West)

Two days ago, during the latest one-day stoppage, I joined the picket line outside the Oldham and district hospital in my constituency. I did so because I believe passionately that the nurses and other Health Service workers have a rightful case. I talked to them, and it was clear that they did not want to take industrial action. They were forced into doing so because they could see no other way of getting their just claim met.

Mr. Kenneth Clarke

Will the hon Gentleman tell us how many patients he prevented from getting medical care in the course of his stint with the union that he supported?

Mr. Meacher

No patients were prevented from getting medical care. All those who approached the hospital were told of the reasons for the dispute. Those who insisted on going in, and certainly all the urgent or emergency cases, were allowed through. There was no disruption of proper medical care in Oldham, and I am sure that the same goes for other places.

One of those on the picket line was Mr. Robert Paterson, a kitchen porter at the Oldham and district hospital. He showed me his pay slip, and I have it with me. I shall be pleased to show it to the Minister at the end of the debate. He works a 38-hour week, for which he is paid £57.10. After enhanced payments for working all day on Saturday and Sunday, a 25 per cent. bonus because of the redundancies that were achieved in a previous self-financing productivity deal and after all stoppages, he took home £58.90. That must be compared with the national average wage of about £150 and the sum that the Secretary of State took home last week, which must have been about £550.

Mr. Paterson is not an exceptional case. I met a porter who did not receive the bonus because his section had not been part of the self-financing deal. He was paid £49 for a 40-hour week. I can validate every one of the cases to which I shall refer with the appropriate documentation if the Minister wishes to see it. I met a female full-time clerk of 20 years of age who worked 37 hours and received £43 a week. I was told of a theatre technician who is required to be on call for five nights a week for 12 hours per night, for which he receives the princely sum of 50p per night.

I met a mortuary technician who receives £60.13 for a 40-hour week. He gave graphic details of what it is like to strip the body of a lice-ridden tramp. I shall spare the House the details. I met some student technicians and junior path-lab officers under 21 years of age. The Government believe that they deserve no increase, because they have been awarded a zero increase.

These details show that the debate is about poverty. It is not about a public sector norm that is built on money supply targets. I wonder how many Conservative Members, including the Secretary of State and his well-heeled colleagues, have any idea of what it is like to live on £50 to £60 a week—little more than one-third of the average national wage. How many Conservative Members would want their sons or daughters to take on the jobs to which I have referred at the present levels of pay? It means having to skimp on food, walk a couple of miles to save a 30p bus fare, not being able to afford a holiday and having to refuse treats for children that other children expect and normally get. It means poverty, and a 4 per cent. or 6 per cent. increase will not take these people out of poverty.

Mr. Fowler

The hon. Gentleman has given a number of figures. Is he disputing the average figure that I have given to the House of £104, for example, as the average for a full-time male ancillary worker?

Mr. Meacher

The figures that I have show that the average wage of an NHS ancillary worker is £99.30 a week. That means that many are paid more and that many are paid less than that. The right hon. Gentleman said that relatively few hours of overtime were worked. To get up to that sort of figure, the hours of overtime must be considerably more than those that he mentioned. I have here some pay slips that I should be glad to show to the right hon. Gentleman. He cannot deny that there are many people paid at this level.

Mr. Fowler

The figure of £99 is wrong. It is £104. Does the hon. Gentleman dispute the five and a half hours average for overtime that I mentioned?

Mr. Meacher

The figure that I have is £99 but the difference between £99 and £104, when the Minister earns £550, is not that much. I do not dispute the five and a half hours average overtime, but many ancillary workers do not have the opportunity to get up to the £99 mark. That is the average figure. The distribution on either side is considerable. Many are being paid at an exceedingly low level. I hope that the right hon. Gentleman will accept that fact.

The one clear lesson from this dispute—and this was made clear to me on the picket line—is that the nurses will not settle for better pay if their even lower paid ancillary colleagues do not get the same increase.

The Secretary of State said that the money is not available. In his speech he laid great emphasis on affordability. What is so insulting about this attitude is the values that are revealed. The Government will happily shell out £1 billion—or will it eventually be £2 billion—on a military regaining of territory 8,000 miles away, but they cannot find the money to provide a Health Service to save people's lives in this country.

Not only that, but the Government have made it offensively clear in the current pay round that, even within the public sector, they are willing to enhance further the high living of the already well paid. At the same time, they are steadfastly determined—this is the meaning of what the right hon. Gentleman said today—to enforce the cut in living standards of the manifestly poor, such as the full-time nurses, who even after overtime, earn a weekly wage below the family income supplement poverty line of £82 a week.

In this dispute we are seeing the ugly face of the Government's social values—a recipe for two nations with a vengeance. That is even more so if one looks at the money rather than the percentages, but it reveals only partly the Government's priorities. They have already awarded 18.6 per cent. to judges and 14.3 per cent. to senior civil servants, but they have refused to offer more than 6.4 per cent. to nurses, and only 4 per cent. to ancillary workers, when inflation is running at 9 per cent. to 10 per cent.

Percentages do not buy goods in shops. In money terms, the average gross earnings of full-time female nurses—the vast majority of nurses are women—was £99.70 in 1981. Those are the official figures from the Employment Gazette. The increase proposed by the Government works out at £5 to £6 a week, depending on overtime work. In comparison, judges, already on £673 a week in 1981, have just been awarded an extra £144 a week. Top civil servants on £689 a week last year have been given an additional £119 a week. Both groups are already well heeled, but they have been awarded pay increases in excess of the total new annual salary proposed for nurses.

The Secretary of State argues that nurses in the NHS should not resort to industrial action. We suggest that if he really believed that, he would not exploit them. They are being exploited when we consider the awards already given to other groups and the promises that were made to them. In 1980, nurses accepted 14 per cent. when inflation was 20 per cent, because they were told that they would be treated as a special case in 1981. In 1981, they accepted 6 per cent. when inflation was 12 per cent., because they were told that they would be treated as a special case in 1982. In 1982, they have been awarded 4 per cent. to 6 per cent. when inflation is 9 per cent. to 10 per cent. It is time that the Government respected their promises and treated the nurses and other Health Service workers as the special case that they deserve to be.

6.16 pm

Sir Albert Costain (Folkestone and Hythe)

Nurses' pay is an emotional subject. The point that needs to be made is that if we are to run a hospital efficiently we need to have an efficient staff of nurses. I have found in my conversations with nurses and ancillary staff that the reorganisation has not been in the pattern that they have expected. Many of those who joined the nursing service to do a nursing job are now being made to do administration work. We must appreciate that they would rather be nursing.

I know nurses who have been promoted to jobs which they do not want to do, yet if they get not get that promotion they do not get the increase that they deserve. The Public Accounts Committee, of which I am a member, has heard of many examples of money having been wasted on hospital building. Often, that money could be better spent on providing better facilities for nurses.

This morning I received a number of letters from constituents who are physiotherapists, claiming that they are getting only 4 per cent. I was delighted to hear the Secretary of State tell the House that they will be receiving the same increase as nurses. If I am not correct in that, I hope that the Secretary of State will give the reason why.

6.18 pm

Mr. Tom Pendry (Stalybridge and Hyde)

I must first, as my right hon. Friend the Member for Lewisham, East (Mr. Moyle) and my hon. Friend the Member for Newcastle upon Tyne, West (Mr. Brown) did, declare my interest. I am secretary of the National Union of Public Employees group in the House. Before entering the House I spent 10 years in the service of that union, helping, among others, Health Service workers. Thus, to some extent, I share the background of my right hon. Friend. While I am concerned in particular with the 300,000 workers in the Heath Service who are NUPE members, I am interested and concerned with the whole dispute.

The Secretary of State has been guilty of a great deal of hypocrisy. He speaks of his concern for the welfare and safety of patients, yet the discomfort experienced—there is no doubt that there has been discomfort and there may be more—by patients and would-be patients is his responsibility. If it is not his responsibility, perhaps more accurately it is the responsibility of his right hon. Friend the Prime Minister.

This dispute should never have reached the stage where the Health Service workers were driven into taking industrial action. The Secretary of State has been unreasonable to refuse to entertain the proposal of the TUC health services committee that the matter should go before ACAS or another independent arbitration body. The formula has been before the Secretary of State for about five weeks, yet he has ignored it in his usual blinkered fashion.

The right hon. Gentleman's apparent determination to make the NHS pay settlement the arena for a trial of strength between a Government still petulantly calling for pay increases of no more than 4 per cent. in the public sector and NHS workers—whose dedication and commitment is unquestioned—has been an of folly bordering on incompetence.

I am being generous by using the word "bordering". However, I am a charitable man and perhaps the Secretary of State is secretly reluctant to preside over this scandalous turn of events. In that case, he should be ashamed of allowing himself to be tied to the apron strings of the Prime Minister and of being her creature in yet another of her vainglorious postures of ferric stubbornness.

The glister on the right hon Lady's iron image is looking very tarnished. To date, no other group of public service workers has been pegged to 4 per cent. in the current pay round. The pay offers over which the Government have control have so blantly been on the "favoured son" principle—with judges receiving a monstrous 18.6 per cent. and the police 13.2 per cent.—that the country is right to react with scorn and derision to the Government's insistence on 4 per cent. for the majority of Health Service workers.

The Secretary of State has conducted the affair despicably acting on behalf of a Government who have been shown to be rigid on pay only with those who they know are reluctant to take industrial action. However, his actions have been seen by the country for the dirty tricks that they are and the longer he persists with his present course, the more ardent will nation-wide support for the Health Service workers become. No crocodile tears on the part of the Secretary of State or the Prime Minister can disguise the fact that the offers made to nurses, ancillary workers and others in the Health Service are derisory and insulting to the dedication that those workers have always shown to the sick.

Happily, there is complete unity within the National Health Service on the inadequacy of this offer. The Secretary of State has miscalculated once again in believing that the professional services within the NHS—not only nurses, but radiographers, physiotherapists and others—could be bought off by a mere 2.4 per cent. over the 4 per cent. offer to ancillary grades. Correspondence sent to Members on both sides of the House will bear out the fact that the professional bodies have rightly agreed that the offer is both highly insulting and divisive.

It is important that the Secretary of State understands the extremely harmful and divisive nature of the Government's offer. Within the National Health Service the workers, ranging from consultants to ancillary workers, have always been mutually dependent, working together as a team. The Government's strategy in attempting to sunder this complex pattern of relationships by means of differential offers demonstrates their lack of understanding. If the offer were to be successful it would go a long way towards breaking up the vital team enterprise on which the nation's health is built. Given the Government's health policy during the past three years, one ought not to be surprised.

Another of the Secretary of State's miscalculations is that he has completely misjudged the mood of the general public, who are solidly behind the health workers' claim. Even the media have seen the justice of the health workers' case, although perhaps they have not done so in the past.

The Secretary of State has perhaps misjudged his own area health authority, because the district authorities in Birmingham have already sent him telegrams asking that the matter be referred to arbitration. The regional authorities have done the same. He is on dangerous ground even on his own patch.

I urge the Government even now to recognise that they have misjudged the mood of the country, the medical profession and the National Health Service workers. They had better not tamper with matters by bringing in the former chairman of ACAS, but should respond to the TUC's demands that ACAS be brought in, that a just claim be met and that we return to a proper Health Service where the Government are seen to recognise the worth of those who work in it. All the points made by my hon. Friend the Member for Oldham, West (Mr. Meacher) are true. One could give more illustrations about the work that is done at below poverty line rates. The Government must respond, because they have missed out on this one.

The right hon. Member for Sidcup (Mr. Heath) misjudged the mood of the miners when he took them on. If the Government are not careful they will find themselves in the same position by taking on the Health Service workers when the general mood of the country is behind those workers.

6.25 pm

Mr. Mike Thomas (Newcastle upon Tyne, East)

I was glad to hear what the Secretary of State said earlier, because until now the Government's position in this dispute has been near to indefensible. Successive attempts by Ministers to turn the gun of public approbrium on Health Service workers have been disreputable in the extreme and the amendment on the Order Paper today is a classic example. There is no doubt that the Health Service workers have a case. Since their pay was last properly reviewed, a gap of about 10 to 20 per cent. has opened up between their treatment and that of other comparable workers. If we consider the going rate in the public sector, their case clearly merits an increase of between 7 and 10 per cent. Many groups of workers have had "special case" pay increases of between 10 and 14 per cent.

That must lead us inescapably to the conclusion that the Government's policy is totally cynical. They give in to those who have muscle and exploit those who do not, regardless of their work for the community. That cynical calculation is further compounded by the Government's crude and blatant efforts to divide and rule. There can be no other justification for the terms of the amendment. It refers to half of the Health Service workers. What about the other half, amongst whom are some of the most poorly paid people in Britain? The Government have forgotten that their job should be to restore a sense of commitment to the National Health Service.

The disputes arise from a genuine sense of grievance and unfairness. If we are not careful, they will leave a damaging legacy of bitterness within the service. That is why we are determined to deal with Health Service pay within the context of an incomes policy for the entire non-trading public sector. It may be that an NHS pay board, including doctors and dentists as well as other health workers, is an answer to the problem. Certainly the Government's offer of a continuing mechanism simply for nurses and midwives is no answer. It is more "divide and rule".

Sadly the approach of the Labour Party and of some trade union leaders is little better. How can the Bennite Left and the hon. Member for Crewe (Mrs. Dunwoody) continue to preach the virtues of free collective bargaining when they should know that free collective bargaining has left NHS ancillary workers at the bottom of the pay league? The best increases that they had were during periods of incomes policy.

The right hon. Member for Lewisham, East (Mr. Moyle) made an excellent case. Unfortunately, it was a case with which the National Union of Public Employees and the Labour Party officially do not agree.

While I understand and sympathise with the plight of the health workers, I counsel them to exercise some caution, too. Industrial action is a dangerous road to embark on, however outrageous the treatment being meted out by the Government. This is not just because inevitably claims will be made—the Government already make them gleefully in their own cause—that the health and safety of patients will be "put at risk" but also because their greatest asset in achieving a better settlement is public sympathy.

The health workers will not serve their own interests best by running the risk of forfeiting that sympathy. Indeed, they play the Government's own "divide and rule" game when they allow such a stark distinction to be drawn, for example, between the Royal College of Nursing with its no-strike commitment and the industrial action of NUPE, CoHSE and the General and Municipal Workers Union. It would be much better if all the workers in the NHS could rely on the Government to respond to a total rejection of industrial action on their part with a proper and continuing arrangement for all of their pay.

The most damaging aspect of the dispute is that it will destroy any faith the workers might have had in the Government's capacity to pursue that approach. At the next election we shall offer them that possibility once again.

6.31 pm

Mr. Nicholas Winterton (Macclesfield)

I shall be extremely brief. [Interruption.] I have caught Mr. Deputy Speaker's eye and I am permitted to participate in the debate. Just because I had other commitments earlier and was not able to hear the whole debate does not prevent me, I hope, from participating.

Mr. Deputy Speaker (Mr. Bernard Weatherill)

Order. I should point out to the hon. Gentleman that I have just taken the Chair. I understand that the wind-up speeches were to begin at approximately 6.30 pm, so I hope that the hon. Gentleman will be brief.

Mr. Winterton

I shall be extremely brief, Mr. Deputy Speaker.

I am gravely worried about the Government's attitude to nurses and the paramedical professions; they have been badly let down. The fact that the Royal College of Nursing has for the first time in its history turned down a wage award by the Government clearly shows the level of dissatisfaction and concern felt by an historically moderate and responsible group of workers. I have met nurses and members of the paramedical professions in my constituency and I have never found among these people, who are among the most responsible groups of workers, such a feeling of concern, dissatisfaction and frustration.

I may be the only Conservative Member to reflect the views that I am putting forward. There is no harm in that. The Government are not honouring an election commitment. I accept fully the views expressed by my right hon. Friend the Secretary of State for Social Services that he wants to find a permanent mechanism to ensure that the nursing profession has a satisfactory level of wages which will be geared to a particular qualified group within the community.

As I pointed out in an intervention during the speech of my hon. Friend the Member for Newark (Mr. Alexander), if the Government can make an arrangement for the police and for the Armed Services there is no reason why they cannot do it for nurses and paramedical groups within the National Health Service. These are vital workers who deserve the support not only of the Government but of all hon. Members.

It is my intention to abstain in the vote because the Government have failed to honour their election manifesto commitment, something which I cannot tolerate. I cannot go along with the motion in the name of the official Opposition.

There is no reason for my hon. Friends on the Front Bench to say to the House that we are spending more on the National Health Service and on the nursing profession when we all know why. There are indeed more nurses, but they are working shorter hours; that was the reason for more nurses being employed. We all want to see nurses working more reasonable hours so that they can give better attention to the patients in our hospitals.

This is an important matter. My hon. and learned Friend the Member for Thanet, West (Mr. Rees-Davies) was right when he said that we need to look at the rationalisation of ancillary workers. I hope that those hon. Members who represent CoHSE and NUPE appreciate that there will have to be a reduction in the number of ancillary workers. Like many other hon. Members on both sides of the House, I want them to get a fair deal. At the same time, there should be fewer of them.

I hope that the Minister will appreciate the depth of feeling on this subject among people who are supporters of the Government. They think that nurses deserve a better deal, not next year in 1983–84 but in 1982–83. I hope that he will turn his attention to this and give them the increase which will justify my again being able to support the Government if there is a motion put forward on the subject.

6.35 pm

Mr. Terry Davis (Birmingham, Stechford)

Like many of my hon. Friends, I must begin with a declaration of interest. I, too, am sponsored, by the Association of Scientific, Technical and Managerial Staffs, which represents some people who work in the Health Service.

The Secretary of State began differently, with a lecture about the effect of industrial action on the Health Service. He deplored not only the need for industrial action, but the industrial action itself because it is potentially dangerous and puts patients at risk. That is to state the obvious. I know it, the House knows it, and the staff know it. That is why the staff have always been so reluctant to take industrial action.

The Opposition do not approve of industrial action in the National Health Service, but we do not join the Government in condemning it because we understand why the staff feel that they have no alternative, and why they feel that all Governments have always taken advantage of their reluctance to take industrial action and have exploited their dedication to patients. We understand that this year the staff in the Health Service have simply been taken for granted once too often.

The Secretary of State paid tribute to the thousands who have continued to work normally. It is significant that he did not pay tribute to the trade unions for having decided against calling an all-out strike. Better still, instead o I paying tribute, why will the Secretary of State not pay them more money?

In regard to the new and permanent arrangements for next year, the Labour Party welcomes the conversion of the Government. After all, it was this Government who abolished the Clegg Commission. Now they have changed their mind, but what about this year?

As my right hon. Friend the Member for Lewisham, East (Mr. Moyle) said, the Secretary of State kept talking about nurses and not ancillary workers. Of course, the Secretary of State treats them differently. He also distinguishes between the Royal College of Nursing and the trade unions of the Health Service. He has already met the Royal College of Nursing. Why has he failed to meet the Trades Union Congress health services committee? He denies that he is trying to drive a wedge between the Royal College of Nursing and the trade unions. What, then, is his motive?

The Secretary of State gives the impression that he is refusing to meet the TUC health services committee because industrial action is taking place. Anyone who knows anything about industrial relations will tell him that this is one of the most serious mistakes anyone can make in trying to settle an industrial dispute. He said that he would welcome a meeting with the TUC health services committee, provided that Mr. Pat Lowry could establish that there was enough common ground between him and the trade unions. I am not sure what common ground exists between the Secretary of State and the Royal College of Nursing that does not exist between him and the trade unions. Surely the common ground should be a common concern about the well-being of patients.

Why will the Secretary of State not go to the Advisory, Conciliation and Arbitration Service? He refuses because he says that the decision cannot be contracted out to someone outside the Government. What is the basis of his decision that 4 per cent. is enough for ancillary workers and that 6 per cent. is enough for nurses?

The Secretary of State mentioned three factors that he had taken into account. First, he said that there had been an increase in spending on the Health Service and therefore the staff should expect a smaller increase than other people. What is the logic behind that statement? Why should people accept a smaller increase in their wages because the Government are spending more money on the service in which they work?

What about other groups? Are the National Health Service workers unique? What about the police? By my calculations, the Government's expenditure on the police has increased during the past three years by the same proportion as expenditure on the National Health Service. How does the Secretary of State justify offering only 4 per cent. and 6 per cent. to National Health Service workers, when the police have rightly been offered 13 per cent?

The same argument applies to the second factor listed by the Secretary of State—the increase in the number of staff. The right hon. Gentleman forgot to mention that a major part of that increase comes from the change in mathematics. The National Health Service has always employed a large number of part-time staff, who are converted to full-time equivalents. Three years ago there was change in the basis of that calculation. Previously, the calculation was done on the basis of a working week of 40 hours. It was then changed to 371/2 hours. Therefore, there were more full—time equivalents in the National Health Service than before, without any increase in the number of people working in the National Health Service or the hours that they were working.

The Secretary of State said that other groups had been offered more and that those other offers must be financed by reductions in staff. Does that mean that the Government are planning to employ fewer policemen and firemen? Of course not. I do not for one moment think that they have any intention of doing so. However, those people have had higher increases than the 4 per cent. and 6 per cent. offered to those who work in the National Health Service. If there were any logic in the Government's argument, there would have to be reductions in numbers in those groups in order to finance the increases in wages.

Thirdly, the Secretary of State says that the nurses should accept 6 per cent. and the ancillary workers 4 per cent. because there has been a 60 per cent. increase in nurses' pay in the past three years. That is the Secretary of State's figure. I have tried to check that figure. My calculations have been confirmed by statisticians working in the Library, and I believe that the correct figure is 33 per cent., based on information that the Government have published in the Official Report. The only way in which we can achieve a figure of 60 per cent. is by including the settlement agreed immediately before the general election in 1979. To judge from the expressions on the faces of the Ministers, that must have been included in the Government's calculations. The Government had no alternative but to honour the agreement that was made before the general election, but paid afterwards, so they cannot take the credit for it. That settlement was for the 1978–79 pay round. The figure of 60 per cent. is for four years, not for three years.

The Government have no case. Their attitude is as illogical as it is unfair. They are therefore forced to rely on a mixture of specious arguments and slick statistics.

6.44 pm

The Minister for Health (Mr. Kenneth Clarke)

I understand that there is a depth of feeling about the level of pay for the various people who work in the National Health Service. Before the debate started, I hoped that there would continue to be bipartisan agreement on the role of industrial or strike action in the National Health Service. During the debate it has become clear that there has been a significant change of policy in the Labour Party, expressed by Back Bench and Front Bench members.

I remind the House of the position taken by the Labour Government on 1 February 1979. The then Secretary of State, the right hon. Member for Norwich, North (Mr. Ennals) said of trade union leaders: I deplore their policy of calling any form of industrial action in the NHS."—[Official Report, 1 February 1970; Vol 961, c. 1672.] The hon. Member for Birmingham, Stechford (Mr. Davis) has just said, only three years later, that he does not condemn industrial action in the National Health Service. The hon. Member for Oldham, West (Mr. Meacher) said that he went on a picket line. The hon. Member for Newcastle upon tyne, West (Mr. Brown) said that he supported the action of the miners and others in politicising the dispute by going on the picket lines during the dispute. I should have thought that in three years Opposition Members would not have moved so far that they now cannot bring themselves to utter a word of disapproval of condemnation of industrial action that comes between patients and the treatment that doctors believe they should recieve.

The hon. Member for Wood Green (Mr. Race) usually goes far beyond the position of most members of the labour party. He supported the ambulance men in Northumbria who withdrew emergency services. He sought to excuse them by giving an account of the way in which he thought the action had been provoked. The management in Northumbria said that it would pay 50 per cent. of the ordinary pay if the men carried out only emergency work, which in most ambulance services is less than half of the work that they carry out. However, because they wanted full pay for doing less than their normal work, they walked out and Northumbria was left with no emergency ambulance service. I understand that the hon. Member for Wood Green excuses even that.

Mr. Race

As usual, the Minister has misinterpreted the action that employees in the National Health Service are implementing. In certain ambulance authorities the management is taking a much tougher line towards those who agree to provide emergency cover. By its actions, the management is undermining the provision of emergency cover. If the Minister had opened his ears, he would have heard me say that those men had offered to make available emergency cover, but the actions of the management undermined it.

Mr. Clarke

The tougher line to which the hon. Gentleman refers, which the Government wholly approve, in the case of the chief ambulance officer, was refusing to pay the men their full pay when they were proposing to carry out only a fraction of their duties. What mattered was that the men walked out and failed to provide any emergency services for road accident victims and others. The hon. Gentleman cannot bring himself to condemn that. Other hon. Members did not go that far, but there has not been a word of effective criticism by the Opposition of those who are taking industrial action.

I shall not deal with the extreme cases. The hon. Member for Oldham, West said that he did not come between patients and the care that they required, although what on earth one is doing on a picket line trying to reduce the number of patients going into a hospital other than coming between individuals and health care I cannot understand.

I shall give a description not of an extreme case but of an ordinary case. In the Financial Times on Saturday 5 June there was an article about incidents at Leicester, where the TUC code has not broken down. A journalist, Mr. David Goodhart, who saw how the picket lines were going said: The ruthless union thugs of Lindsay Anderson's film Britannia Hospital were nowhere to be seen as the hospital administrator and the police discussed with pickets how best to order the proceedings. Therefore, that was not a bad or extreme case. I shall quote from another part of the article referring to what went on on the picket line: A tearful old lady was turned away from visiting a sick friend and there was a bit of car-bonnet thumping. Apart from a few minor incidents like these, however, the atmosphere inside and outside the hospital was quiet and accommodating. The article also stated: It was a good day for the pickets. To claps and cheers they turned away the majority of the non-emergency out patients. The hospital administrator admitted that the 1,000-bed teaching-hospital, the biggest in Leicestershire, was reduced to weekend coverage. If that is the average of industrial action in the country, I think that the Opposition should do what we always did in Opposition when there was industrial action in the National Health Service. We did not need to be challenged. When asked by Secretaries of State, from Barbara Castle onwards, Conservative Members always condemned industrial action in the National Health Service. So did the Labour Party until today—

Mr. Race

The Government are responsible.

Mr. Clarke

So did the Labour Party until the hon. Member for Stechford said that it did not condemn industrial action.

Mr. Terry Davis

Will the Minister for Health understand that the Opposition believe that for this Government to condemn the effects of industrial action in the National Health Service at this time is like President Galtieri condemning war in the Falkland Islands?

Mr. Clarke

The House will have to judge who is taking an extreme position. It has always been our position that, whatever people feel about the right level of pay in the Health Service, in something so vital as patient care there is no room for industrial action and responsible politicians should condemn it as politicians in the last Labour Government condemned it. They no longer do apparently.

I turn to the merits of the case. I do not want to trade figures with the hon. Member for Oldham, West whose use of figures is always elaborate. He has earned the reputation of using Meacherisms, which lead on into rather curious interpretations of pay claims.

The pay of nurses and midwives has moved ahead of inflation since the Government took office. The pay offer that we have made is fair and reasonable and in line with other groups of workers. The main argument between us—how the Government have dealt with the employees—has arisen from the attitude taken towards the settlements in 1979 and 1980 following the Clegg commission report. Those payments were made in 1979 and 1980. The resources were found by this Government. The previous Government made the promise, but we fulfilled the commitment. Workers' earnings increased as a result and we found the resources to pay for them. The details are set out in a written answer by my right hon. Friend the Secretary of State on Monday 10 May. Over the past three years the average earnings of nursing sisters have increased by 63 per cent., staff nurses 60 per cent., nursing auxiliaries 49 per cent., full-time ancillary staff 52 per cent. for men and 51 per cent. for women. The retail price index has not moved ahead of that during that time.

The Opposition's position, when they say that that is not an adequate response to the problem, is somewhat weakened by their record. The Social Democratic Party and the Liberal Party say that the answer is to have a pay policy.

During the last three or four years of the previous Government, when there was a pay policy, the real earnings of everyone employed in the Health Service actually fell until the 1979 dispute when the then Government offered a flat 5 per cent. to everybody and fought an extremely bitter industrial dispute which they resolved by setting up the Clegg commission.

Mr. Moyle

rose—

Mr. Clarke

We have a substantially better record since we came into office of moving nurses' pay ahead of inflation. The record of the right hon. Member for Lewisham, East (Mr. Moyle) was a decline in the living standards of Health Service workers and it ended with an appalling dispute.

Mr. Moyle

If the Minister seeks to put the facts on record, will he not agree that on 22 January 1979 the Health Service employers' side offered 9 per cent. to the ancillary workers?

Mr. Clarke

I believe that was the final unsuccessful move that the Government made before setting up the Clegg commission. That is my recollection. The recollection of the right hon. Member for Lewisham, East may be better than mine as he was in the thick of it. I should like to know whether his first commitment was to his union or to the Health Service. The right hon. Gentleman has referred to one of the offers made unsuccessfully during that dispute.

Another point has been made about increased expenditure. There ought to be a wider measure of agreement between us on that subject. Opposition Members must make their minds up about the purposes for which we increase expenditure on the Health Service and the way in which such increased expenditure is to be divided between improvements in patient care, on the one hand, and improvements in the living standards of the staff, on the other. Both are desirable objects, but there must be a balance between them in any policy pursued by the Government.

There should not be an issue between us over increased expenditure. Despite the recession and the difficulties of the past two or three years, the Government have not cut expenditure on the Health Service. It will have increased by 6 per cent., in real terms, by next year. That is in line with the plans that the previous Labour Government proposed. Total expenditure has reached about £12 billion.

The Government's case is that part of that increased expenditure must result in improved patient care, better wards and facilities, and, as my hon. and learned Friend the Member for Thanet, West (Mr. Rees-Davies) said, shorter waiting lists in hospitals. The money has begun to show some improvement in that feature of the Health Service. The numbers on the waiting list have fallen from 752,000 in March 1979 to 628,000 in March 1981. One of the consequences of improving services for the patients in such a labour-intensive service is that one actually increases the numbers of staff and improves employment opportunities.

I dispute the point made by my hon. Friend the Member for Bromsgrove and Redditch (Mr. Miller). There was a real reduction in the hours worked in the Health Service. There has been an increase in the number of people in the Health Service. Our full-time equivalent is 34,000 for nurses. The figure of 47,000 for all staff still applies.

One of the effects—we insist upon this—of devoting a proportion of increased expenditure on the Health Service to improve patient care is that, if those plans are allowed to proceed, the number of staff employed in the Health Service over the next year would still increase. That has had the effect of producing an 80 per cent. increase in the pay bill while the Government have been in office. That is a combination of an increase in living standards for staff and improved services for patients.

The Opposition are in serious danger when they advocate that where there are increased resources available for the Health Service—where we are broadly in agreement—they should go to improving the pay of the staff at present in post. That is impossible.

Mr. Pavitt

rose—

Mr. Clarke

I know that the hon. Member for Brent, South (Mr. Pavitt) has been in his seat throughout the debate, but I have only five minutes left.

I believe that the House must address itself to the important point, made by a number of hon. Members, that somehow it is wrong to draw a distinction in this or any other pay settlement or arrangement between, for example, nurses and midwives and any other staff group in the Health Service. The argument coming from Opposition Members, again sponsored by trade unions where the substantial body of the membership is ancillary workers, is that it is divisive to make any distinction between the various groups because they all form part of a health and care team.

I can think of no industry or service where one can actually adopt the principle that the present relativities and pay structure for all groups must be frozen rigid for all time so that one cannot react to the needs of the service and the need to recruit and retain the right level of trained and skilled—in this case—medical staff.

If we are ever to do anything substantial to raise the position of nurses and midwives in the earnings league, no progress will be made if, every time the Government—as this Government have attempted to do—want to make a special case of the nurses and find the extra money and offer them 6.4 per cent., exactly the same offer must be made to the gardeners, cooks, window cleaners, laundry workers, porters, and so on.

I defend the distinction that the Government have made purely on the ground of the needs of the Health Service. I believe that it is a distinction that is widely applauded in the country. We abandoned the first cash limits we set and found extra money to offer 6.4 per cent. to nurses and midwives and also to the professions supplementary to medicine, including the physiotherapists, radiographers, speech therapists and occupational therapists. It is wrong to argue that it should follow automatically that, whatever figure is arrived at for those professional groups, exactly the same money must be given to all the other groups in the Health Service. No service could be run on that basis.

I should like to comment not only on this offer, which I have defended and, I hope, made the Government's position clear, but on the Government's expectation for the future. My hon. Friend the Member for Macclesfield (Mr. Winterton) appeared to believe that we are breaking some kind of election commitment by not having sorted out better arrangements for the people employed in the National Health Service. My right hon. Friend said that the Government first offered a better and lasting arrangement in a letter from my predecessor, my hon. Friend the Member for Reading, South (Dr. Vaughan). That letter was sent in the middle of 1980. That offer was reaffirmed at a meeting with the Prime Minister before Christmas 1981. Today I chaired the first substantial meeting that has taken place between all involved to achieve a new permanent arrangement. I am glad to say that all parties agreed on the desirability of a new permanent arrangement. All the unions which were represented, and the Government, too, desired to make rapid progress. That is the more constructive part of the Health Service.

Industrial action and the blind demand for 12 per cent. Coming from the Opposition Benches have no room in a modern Health Service.

Question put, That the original words stand part of the Question:—

The House divided: Ayes 219, Noes 281.

Division No. 200]	[7.00 pm
NOES
Abse, Leo	Forrester,John
Adams, Allen	Foster, Derek
Allaun,Frank	Fraser, J. (Lamb'th, N'w'd)
Alton, David	Freud,Clement
Anderson,Donald	Garrett, John (NorwichS)
Archer, RtHon Peter	George, Bruce
Ashley, RtHon Jack	Gilbert, RtHon DrJohn
Ashton,Joe	Ginsburg, David
Atkinson, N.(H'gey,)	Graham, Ted
Barnett, Guy (Greenwich)	Grant, John (IslingtonC)
Barnett, RtHon Joel (H'wd)	Grimond, RtHonJ.
Benn, RtHon Tony	Hamilton,James(Bothwell)
Bennett,Andrew(St'kp'N)	Harrison, RtHon Walter
Bidwell,Sydney	Hattersley, Rt Hon Roy
Booth, RtHon Albert	Healey, Rt Hon Denis
Bottomley, RtHonA.(M'b'ro)	Heffer, ErlcS.
Bradley,Tom	Hogg, N. (EDunb't'nshire)
Brocklebank-Fowler.C.	HomeRobertson,John
Brown, Hugh D. (Provan)	Hooley,Frank
Brown, R. C. (N'castle W)	Horam,John
Brown, Ronald W. (H'ckn'yS)	Howell, RtHon D.
Buchan,Norman	Howells,Geraint
Callaghan, RtHon J.	Hoyle,Douglas
Callaghan, Jim (Midd't'n&P)	Huckfield, Les
Campbell,Ian	Hughes, Mark(Durham)
Campbell-Savours,Dale	Hughes, Robert (AberdeenN)
Canavan, Dennis	Hughes, Roy (Newport)
Cant, R. B.	Janner.HonGreville
Carmichael,Neil	Jay, RtHon Douglas
Carter-Jones, Lewis	Jenkins, Rt Hon Roy (Hillhead)
Cartwright,John	John,Brynmor
Cocks, Rt Hon M. (B'stolS)	Johnson, Walter (DerbyS)
Cohen,Stan ley	Jones, Rt Hon Alec (Rh'dda)
Coleman,Donald	Kerr, Russell
Concannon, Rt Hon J. D.	Kilfedder, JamesA.
Conlan,Bernard	Kilroy-Silk, Robert
Cook, Robin F.	Lambie,David
Cowans, Harry	Lamborn,Harry
Craigen, J. M. (G'gow, M'hill)	Leadbitter,Ted
Crawshaw, Richard	Leighton, Ronald
Crowther,Stan	Lewis, Arthur (N'ham NW)
Cunliffe,Lawrence	Litherland,Robert
Dalyell,Tam	Lofthouse,Geoffrey
Davidson.Arthur	Lyon,Alexander (Yorty)
Davis, Clinton (HackneyC)	Lyons, Edward (BradfdW)
Davis, Terry (B'ham, Stechf'd)	McCartney,Hugh
Deakins,Eric	McDonald, DrOonagh
Dean, Joseph (Leeds West)	McElhone,Frank
Dewar,Donald	McGuire,Mlchael(Ince)
Dixon, Donald	McKay, Allen (Penistone)
Dobson,Frank	McKelvey.William
Dormand,Jack	MacKenzie, RtHon Gregor
Douglas,Dick	Maclennan,Robert
Dubs,Alfred	McNamara, Kevin
Duffy, A. E. P.	Marks,Kenneth
Dunnett,Jack	Marshall, D(G'gowS'ton)
Dunwoody, Hon MrsG.	Marshall, DrEdmund (Goole)
Eadie.Alex	Marshall, Jim (LeicesterS)
Edwards, R. (W'hampt'nSE)	Mason, Rt Hon Roy
Ellis, R. (NED'bysh're)	Maxton,John
Ellis, Tom (Wrexham)	Meacher,Michael
English,Michael	Mel lish, RtHon Robert
Ennals, RtHon David	Millan,RtHonBruce
Evans, loan (Aberdare)	Mitchell,Austin (Grimsby)
Evans, John (Newton)	Mitchell, R.C.(Sotonltchen)
Ewing,Harry	Morris, Rt Hon A. (W'shawe)
Field,Frank	Morris, Rt Hon C. (O'shaw)
Flannery,Martin	Morris, RtHonJ. (Aberavon)
Fletcher,Ted (Darlington)	Moyle, RtHon Roland
Foot, RtHon Michael	Newens, Stanley

Oakes, Rt Hon Gordon	Stoddart, David
Ogden,Eric	Strang, Gavin
O'Halloran, Michael	Straw,Jack
O'Neill,Martin	Summerskill,HonDrShirley
Orme, Rt Hon Stanley	Taylor, Mrs Ann (Bolton W)
Owen, Rt Hon Dr David	Thomas, Dafydd (Merioneth)
Park, George	Thomas, Mike (Newcastle E)
Parker,John	Thomas, DrR. (Carmarthen)
Pavitt, Laurie	Thorne, Stan (PrestonSouth)
Pendry,Tom	Tilley,John
Penhaligon,David	Tinn,James
Powell, Raymond (Ogmore)	Torney,Tom
Price, C. (Lewisham W)	Varley, RtHon Eric G.
Race, Reg	Wainwright, E.(DearneV)
Radice, Giles	Wainwright.R.(ColneV)
Richardson,Jo	Walker, RtHon H.(D'caster)
Roberts,Albert(Aformanton)	Watkins, David
Roberts,Allan(Bootle,)	Weetch, Ken
Roberts,Gwilym(Cannock)	Wellbeloved,James
Robertson,George	Welsh,Michael
Robinson, G. (Coventry NW)	White, Frank R.
Rodgers, RtHon William	White, J.(G'gowPollok)
Roper,John	Whitehead,Phillip
Ross, Ernest (Dundoe West)	Whitlock,William
Ross, Stephen (Isle of Wight)	Wig ley, Dafydd
Rowlands,Ted	Willey, RtHon Frederick
Sandelson, Neville	Williams, Rt Hon A.(S'sea W)
Sever, John	Williams, Rt Hon Mrs (Crosby)
Sheerman,Barry	Wilson, Gordon (DundeeE)
Sheldon, RtHonR.	Wilson, RtHon Sir H.(H'ton)
Shore, RtHon Peter	Wilson, William (C'trySE)
Short, Mrs Renee	Winnick, David
Silkin, Rt Hon J. (Deptford)	Woodall,Alec
Silkin, Rt Hon S. C. (Dulwich)	Woolmer,Kenneth
Silverman,Julius	Wrigglesworth, Ian
Skinner,Dennis	Wright,Sheila
Snape, Peter	Young, David (BoltonE)
Soley,Clive
Spearing,Nigel	Tellers for the Ayes:
Spriggs, Leslie	Mr. George Morton and
Stallard.A.W.	Mr. Frank Haynes.
Stewart, Rt Hon D. (W Isles)

NOES
Adley,Robert	Buck,Antony
Aitken,Jonathan	Budgen,Nick
Alexander,Richard	Bulmer,Esmond
Alison, RtHonMichael	Burden,SirFrederick
Ancram,Michael	Butcher,John
Arnold,Tom	Cadbury,Jocelyn
Aspinwall,Jack	Carlisle, John (LutonWest)
Atkins,Robert (PrestonN)	Carlisle,Kenneth(Lincin)
Baker,Kenneth(St.M'bone)	Channon, Rt. Hon, Paul
Baker, Nicholas (N Dorset)	Chapman,Sydney
Banks,Robert	Churchill,W.S.
Beaumont-Dark,Anthony	Clark, Hon A. (Plym'th, S'n)
Bendall,Vivian	Clark, Sir W. (Croydon S)
Bennett,SirFrederic(T'bay)	Clarke,Kenneth(Rushcliffe)
Benyon,Thomas(A'don)	Clegg, Sir Walter
Benyon.W.(Buckingham)	Cockeram,Eric
Best, Keith	CoIvin, Michael
Bevan, David Gilroy	Cope,John
Biffen, RtHon John	Cormack, Patrick
Biggs-Davison,SirJohn	Corrie,John
Body, Richard	Costain,SirAlbert
Bonsor,SirNicholas	Cranborne,Viscount
Bottom ley, Peter (W'wich W)	Critchley,Julian
Bowden,Andrew	Crouch,David
Boyson,Dr Rhodes	Dickens,Geoffrey
Braine,SirBernard	Dorrell, Stephen
Bright,Graham	Doug las-Hamilton, LordJ.
Brinton,Tim	Dover,Denshore
Brittan,Rt. Hon. Leon	du Cann, Rt Hon Edward
Brooke, Hon Peter	Dunn, Robe rt(Dartford)
Brotherton,Michael	Du rant,Tony
Brown, Michael(Brigg&Scn)	Eden, RtHonSirJohn
Browne,John(Winchester)	Eggar,Tim
Bruce-Gardynejohn	Elliott,SirWilliam
Bryan, Sir Paul	Emery, Sir Peter
Buchanan-Smith, Rt Hon. A.	Eyre, Reginald

Faith, MrsSheila	Kimball,SirMarcus
Farr,John	Kitson,SirTimothy
Fell,SirAnthony	Knight,MrsJill
Fenner, Mrs Peggy	Knox, David
Finsberg,Geoffrey	Lamont,Norman
Fisher, Sir Nigel	Lang, Ian
Fletcher, A. (Ed'nb'ghN)	Langford-Holt,SirJohn
Fletcher-Cooke,SirCharles	Latham,Michael
Fookes, Miss Janet	Lawrence,Ivan
Forman,Nigel	Lawson, Rt Hon Nigel
Fowler, Rt Hon Norman	Lee,John
Fox, Marcus	Lennox-Boyd,HonMark
Fraser, Rt Hon Sir Hugh	Lester, Jim (Beeston)
Gardner, Edward (SFylde)	Lewis,Kenneth (Rutland)
Garel-Jones,Tristan	Lloyd, Ian (Havant& W'loo)
Gilmour, Rt Hon Sir Ian	Lloyd, Peter (Fareham)
Glyn, DrAlan	Loveridge,John
Goodhart,SirPhilip	Luce, Richard
Goodhew,SirVictor	Lyell, Nicholas
Goodlad,Alastair	McCrindle, Robert
Gorst,John	Macfarlane,Neil
Gow, Ian	MacGregor,John
Gower, Sir Raymond	MacKay, John (Argyll)
Grant, Anthony (HarrowC)	McNair-Wilson,M. (N'bury)
Greenway, Harry	McNair-Wilson, P. (NewF'st)
Griffiths, E.(B'ySt.Edm'ds)	Madel, David
Griffiths, Peter Portsm'thN)	Major,John
Grist, Ian	Marlow.Antony
Grylls,Michael	Marshall, Michael (Arundel)
Gummer,JohnSelwyn	Marten, Rt Hon Neil
Hamilton, Hon A.	Maude, Rt Hon Sir Angus
Hamilton,Michael (Salisbury)	Mawby, Ray
Hampson,DrKeith	Mawhinney,DrBrian
Hannam,John	Mayhew, Patrick
Haselhurst,Alan	Mellor,David
Hastings,Stephen	Meyer, SirAnthony
Havers, Rt Hon Sir Michael	Miller,Hal (B'grove)
Hawkins,Paul	Mills, lain(Meriden)
Hawksley,Warren	Mills, Peter (WestDevon)
Hayhoe, Barney	Miscampbeil,Norman
Heath, Rt Hon Edward	Mitchell, David (Basingstoke)
Heddle,John	Moate, Roger
Henderson, Barry	Monro,SirHector
Heseltine,RtHonMichael	Montgomery,Fergus
Higgins, Rt Hon Terence L.	Moore,John
Hogg,HonDouglas(Gr'th'm)	Morris, M. (N'hamptonS)
Holland, Phttip (Carlton)	Morrison, HonC. (Devizes)
Hooson,Tom	Morrison, Hon P. (Chester)
Hordern,Peter	Mudd, David
Howe, Rt Hon Sir Geoffrey	Murphy,Christopher
Howell, BtHonD. (G'ldf'd)	Myles, David
Hunt, David (Wirral)	Neale,Gerrard
Hunt,John (Ravensbourne)	Needham, Richard
Hurd, Rt Hon Douglas	Nelson,Anthony
Irvine,BryantGodman	Newton,Tony
Irving,Charles (Cheltenham)	Nott, Rt Hon John
Jessel,Toby	Onslow,Cranley
JohnsonSmith, Geoffrey	Oppenheim, Rt Hon Mrs S.
Jopling,RtHon Michael	Page, John (Harrow, West)
Joseph, Rt Hon Sir Keith	Page, Richard (SWHerts)
Kaberry,SirDonald	Parkinson, RtHonCecil
Kellett-Bowman,MrsElaine	Patten,John(Oxford)
Kershaw,SirAnthony	Pawsey, James

Percival,Sirlan	Stewart,A.(EFtenfrewshire)
Peyton, RtHonJohn	Stewart, Ian (Hitchin)
Pink, R.Bonner	Stokes,John
Pollock,Alexander	Stradling Thomas,J.
Porter,Barry	Tapsell, Peter
Prentice, RtHon Reg	Taylor, Teddy (S'endE)
Price, Si r David (Eastleigh)	Tebbit, RtHon Norman
Proctor, K. Harvey	Temple-Morris,Peter
Raison, RtHonTimothy	Thomas, RtHon Peter
Rathbone,Tim	Thompson,Donald
Rees-Davies, W. R.	Thorne,Neil(llfordSouth)
Renton,Tim	Thornton,Malcolm
RhodesJames, Robert	Townend, John (Bridlington)
Rhys Williams, SirBrandon	Townsend,CyrilD,(B'heath)
Ridley,HonNicholas	Trippier, David
Ridsdale,SirJulian	Trotter,Neville
Rifkind, Malcolm	van Straubenzee, Sir W.
Rippon,RtHonGeoffrey	Vaughan,DrGerard
Roberts, M. (Cardiff NW)	Viggers, Peter
Roberts, Wyn (Conway)	Waddington, David
Rossi,Hugh	Wakeham,John
Rost, Peter	Waldegrave,HonWilliam
Royle,SirAnthony	Walker, RtHon P.(W'cester)
Rumbold, Mrs A. C. R.	Walker, B. (Perth)
Sainsbury,HonTimothy	Walker-Smith, RtHon Sir D.
St. John-Stevas, Rt Hon N.	Waller, Gary
Shaw, Giles (Pudsey)	Walters, Dennis
Shaw,Michael(Scarborough)	Ward,John
Shelton,William(Streatham)	Warren,Kenneth
Shepherd,Colin(Hereford)	Wells, Bowen
Shepherd,Richard	WelIs,John (Maidstone)
Shersby,Michael	Wheeler,John
Silvester, Fred	Whitelaw, RtHon William
Sims, Roger	Whitney, Raymond
Skeet, T. H. H.	Wickenden,Keith
Smith, Tim(Beaconsfield)	Williams.D.(Monfgomery)
Speller, Tony	Wolfson,Mark
Spence,John	Young, SirGeorge (Acton)
Spicer, Jim (WestDorset)	Younger, RtHon George
Spicer, Michael (SWorcs)
Squire,Robin	Tellers for the Noes:
Stanbrook, Ivor	Mr. Anthony Berry and
Steen,Anthony	Mr. Carol Mather.
Stevens,Martin

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 32 (Questions on amendments), and agreed to.

Mr. Deputy Speaker

forthwith declared the main Question, as amended, to be agreed to.

Resolved, That this House deplores any industrial action in the National Health Service especially that which puts at risk the health and safety of patients; notes that present offers will give increases of over six per cent to about half the work force in a service which enjoys secure and growing employment; and urges the trade unions to reconsider their position before taking any further action which could damage the National Health Service and the patient it serves.