National Health Service

HC Deb 20 October 1982 vol 29 cc372-454 3.54 pm

Mrs. Gwyneth Dunwoody (Crewe)

I beg to move, That this House expresses its deep concern at the Government's stubbornness in the current dispute with the health service workers; deplores the consequent impact on patients who are waiting for hospital treatment; condemns the Government's refusal either to enter into serious negotiations with the representatives of health service workers or to go to arbitration; and calls for the replacement of the Secretary of State by a Minister with a more compassionate approach to the problems of low pay in the National Health Service and a genuine belief in the welfare state. I had hoped that the Prime Minister would be present today, because we are always told that she is in complete control of her Cabinet and that her personality is stamped upon its policies. We are told that her colleagues disagree with her at their peril. I have never automatically thought of the Prime Minister as a great humorist. She may be a purveyor of myths or a regaler of fairy stories for gullible girls, but on the whole she is not a funny lady. However, see made the sickest joke of the conference season when she intoned that the NHS is safe with us. Safe? Does the right hon. Lady mean safe until after the next election, or until she has succeeded in twisting the arms of her wets? The record of three years of Conservative Government shows that the NHS is about as safe in Conservative hands as the Mint would be in the hands of the Mafia. Putting the present Prime Minister in charge of the NHS is like putting Madame Sin in charge of a convent.

The Prime Minister's attitude to the Health Service is like her attitude to so many other essential services—simple if not simplistic. Not for her those professions of service to the community or commitment to the under-privileged, which for many years was the parrot cry of successive Conservative Governments. She is not interested in that nonsense. She does not use the Health Service, so why should anyone else? She does not have a mentally handicapped child or a chronically sick relative, so why should anyone else need State hospital services?

Therein lies the Prime Minister's real objection. She tells the faithful: We have rolled back the frontiers of socialism further than any previous Conservative Government. We shall get back to the golden age—back to the workhouse, the dame school and the poor law institution. If the right hon. Lady does not manage to achieve that now, we should not worry, because she soon will. What is her answer to the unemployed? Is is a 5 per cent. cut in benefit. If one is sick, one is creating waste. A private insurance scheme would cover sickness and would discipline one by charging higher premiums each time one requires medication.

For the Prime Minister the provision of health care is not the responsibility of a caring community to those least able to help themselves, but a gross indulgence that encourages idleness and waste. The Think Tank report summarised her philosophy perfectly. The Economist of 18 September, which told us that the report was presented to the Cabinet on 9 September, spelt out the problems simply: The paper suggests replacing the national health service with private health insurance: this could save £3 billion-£4 billion a year from the 1982–83 health budget of £10 billion. The problem is that the less well-off might underinsure, so the paper suggests that there might have to be a compulsory minimum of private insurance for everyone. In the meantime savings could be made by charging for visits to the doctor and more for drugs. That is the future planned for the National Health Service by the Government—an underfunded, lowly paid and reduced, second-rate service as a substitute for universal health care. Instead of a service that is free at the time of use and in which the assessment should be on need alone, we shall be offered a different assessment—the assessment of our ability to take out high-quality private insurance. That is the only way in which we shall be judged.

The Secretary of State not only knows that, but intends to put it into operation. Perhaps he does not intend to do so too openly before the next election, but he will certainly do so in a quiet way by the imposition of charges for hospital services—which he has already introduced under the guise of charges for overseas visitors—by the imposition—[Interruption.] Why does the Secretary of State need this complicated machinery for charging under 1 per cent. of those who use the NHS unless it is to be used in future to charge ordinary patients? The right hon. Gentleman has imposed rigid cash limits and, above all, he intends to humble and defeat the NHS unions in their present pay claims.

The history of the dispute is one of constant provocation and massive mismanagement on the part of Ministers. From the moment when the Secretary of State announced the figure of 4 per cent., in advance of the Whitley council negotiations, his aim has been to divide and dishonour the Health Service workers and to suggest that their actions—and theirs alone—are damaging patient care. originally, the Government claimed that any increase in pay of over 4 per cent. would lead to a cut in jobs or patient care. Then, on 8 March, when the pay offer was increased to 6.4 per cent. for nurses, at a cost of £81.9 million, it was claimed that only £27 million would come from regional health authority funds and that no damage would be done because the money would be saved through greater efficiency. That was despite the fact that the Government had already imposed an arbitrary £17 million cut in the existing budget in the name of efficiency.

What followed was a series of desperate manoeuvres by the Secretary of State, whose ever-more frantic gyrations resembled nothing so much as a disoriented eel. After a mass lobby of the House of Commons, two days of action and a further statement, he was still attempting to procrastinate until he knew the result of the first Royal College of Nursing's ballot. However, when the nurses decisively rejected the offer of 6.4 per cent., Mr. Pat Lowry was asked to work unofficially to see whether there were any grounds for negotiation. Not surprisingly, since Mr. Lowry had absolutely no new offer to make, it was an entirely abortive exercise. Nothing daunted, the Secretary of State arranged separate talks with the RCN, the health visitors and the midwives in the hope of cobbling together some sort of deal. As a special exercise in good industrial relations the Minister arranged, at the same time, to keep the health services committee of the TUC waiting elsewhere in the Department while talks took place. He even told it that he had been detained in a Cabinet Committee.

However, the Society of Radiographers was treated in an even more cavalier fashion, because after it had been summoned to the DHSS it was told that there would be no talks at all that day. When the offer of 7.5 per cent. was finally announced, the RCN—on whom the Secretary of State had been relying—was deluged with complaints from furious members. Even it had to agree to boycott the Whitley council on 9 July.

Meanwhile, the chorus of criticism of the Secretary of State's behaviour had grown to deafening proportions. However, he was not in the least interested in the fact that the complaints came from those who worked in the Health Service, who were expert in its affairs. They ranged from the British Medical Association to several regional health authority chairmen. The right hon. Gentleman's response was simple: he ignored those over whom he had no control and he sacked the RHA chairmen who disagreed with him. So the chronicle of incompetence continued.

On 6 August the Secretary of State spent at least £79,000 on advertising to try to head off industrial action. Despite that, on 13 August the RCN voted for a second time to reject the 7.5 per cent. offer, and on that occasion more members voted than in the previous ballot. Indeed, the RCN's annual conference took an unofficial vote to end the no-strike rule, which had been maintained in its constitution since the RCN's inception.

Throughout these negotiations it has been clear that the Secretary of State intended to exacerbate relationships with the trade unions working in the Health Service. It is clear that no negotiations can take place without trust. How can those involved place any trust in a man who, from the beginning, has sought to misrepresent the situation and who has often come to the House and given inaccurate information? The Secretary of State should be aware that when "secret meetings"—a phrase that lie used—with trade union members are held, it must not be publicly announced that they have given undertakings which, by definition, they are unable to give.

As early as this week the right hon. Gentleman stood at the Dispatch Box and said that the chairman of the health services committee and the secretary had had their suggestions incorporated in the provisions that he put forward and had not then carried them out. The right hon. Gentleman is well aware that any suggestions that they made were made without prejudice. In addition, in case the right hon. Gentleman did not understand, they made it clear to him that they would have to go back to the TUC health committee. Indeed, that committee could not accept any negotiations, but could only make individual recommendations to its unions. I hope that today the right hon. Gentleman will make it clear that he does not intend to suggest that the chairman of the health services committee or the secretary gave commitments which he knows very well they could not have given in any circumstances.

We have recently had the famous offer of a rearrangement of funds for the two-year period.—[Interruption.]

Mr. Dick Douglas (Dunfermline)

The Secretary of State should ask my hon. Friend to give way instead of mumbling.

Mrs. Dunwoody

The subject is extremely serious, and I trust that those who are in the Chamber to debate it seriously will be allowed to continue.

The TUC health services committee has never rejected an offer. It has simply made it clear that it is impossible to enter into negotiations when one partner says—irrespective of the facts—that only one sum of money is on the table. The Society of Radiographers said that it was willing to use the two-year offer as a basis for negotiation provided that there was more money. The Minister then told it that there was no point in continuing the talks. Therefore, it is not a question of "if the TUC were prepared to return to the table there would be negotiations." The Secretary of State's definition of negotiations is that he tells everybody what they must accept, and that is the extent of the discussion.

Throughout the saga the Government have maintained one constant theme. We were told that the unions were damaging patient care, in the face of generous offers of pay and a Government who were spending more money on the NHS than ever before. In the early summer the Secretary of State claimed that 5.8 per cent. more in real terms would be spent on the NHS in 1982–83 than in 1978–79. The truth is rather different. In the last three years of the Labour Government, NHS spending increased by 6.8 per cent. in real terms, net of charges, compared with 5.8 per cent. under this Administration, and it was 3.6 per cent. even after allowing for demographic and technological change. That figure compares extremely well with the 1.7 per cent. by 1982–83, which is the sum being allowed by the Conservative Government.

Even if the latest pay offers were accepted, they would have an immediate effect on all RHA budgets. For example, there would be a direct cut in the four Thames regions and all regional hospital authorities would face a cut of £59.2 million overall. Already the consequences are being spelt out by the individual treasurers. The South West Thames regional health authority, in a press release dated 8 September, said: Contributions to this year's increased pay offers to health staff, redistribution of funds from the four Thames Regions to other parts of the country, and efficiency savings—all ordered by the Government—could leave South West Thames with £10 million less spending power over the next two-and-a-half years. It also said: The Region faces cash reductions as follows: £2,526,000 in 1982–83, a further £4,961,000 in 1983–84, a further £2,660,000 (making a total of £10,147,000) in 1984–85. That pattern is repeated across the country.

Much publicity was given recently to the Oxford region, which said that it was no longer in a position to provide services comprehensively to DHSS norms while giving emphasis to priority care groups. The Oxford region has spelt out what it calls the broad options. These are, a steady reduction in the levels of services to the value of several millions of pounds each year, which could be continued, as it has in the last two or three years, a process of gradual erosion, by which the services could be diminished, a single radical reduction of services in one year or a replanning of all services.

The Oxford region said: The National Health Service principle of equality of opportunity for, and access to, services would certainly be broached for the first time.

Mrs. Elaine Kellett-Bowman (Lancaster)

Both the hon. Lady and I come from a part of the country that has consistently been under-funded in terms of health care. It is high time that the balance was redressed in favour of spending in the North and the North-West. Will the hon. Lady please examine the figures, which show that the North-West is now receiving a higher proportion of funds than ever before?

Mrs. Dunwoody

If that is so, I am sure that the hon. Lady will join me in complaining to the Secretary of State that Merseyside will be most affected by the cuts.

Mr. David Ennals (Norwich, North)

Will my hon. Friend confirm that the process of a faster rate of growth in deprived regions was initiated by the Labour Government and that that is not happening today, partly because of the extra demands on the regions, even in terms of the offer already made?

Mrs. Dunwoody

I am grateful to my right hon. Friend. He is saying that the four Thames areas, which have some of the greatest problems, and Merseyside, which experiences the problems about which the hon. Member for Lancaster (Mrs. Kellett-Bowman) spoke, will be most affected by the Government's policies. None of us can accept that. We are told that the Oxford authority is alarmist and therefore not to be trusted.

The Conservative Government have many unique records to their credit. At one time, pensioners were admitted to hospital to recover when they were freezing to death. Recently we heard of one of the first recorded cases of a pensioner dying from hypothermia in a ward. That is an illustration of the standards adopted by Conservative Health Ministers.

The Royal Marsden hospital has a world-wide reputation for dealing with carcinomas. It is to close its breast cancer screening facilities, which are used by 10,000 women a year. Hospitals such as Tadworth court, which provides care for terminally ill and severely mentally handicapped children, are being shut irrespective of the damage that such closures will inflict on families.

The Secretary of State for Wales has told Welsh health authorities that they must draw up plans for zero growth. He said that they will face an unprecedented squeeze. That will be when the Welsh Office, not the Health Department, is making prior allocations from the authority's revenues for schemes such as new hospitals. The Secretary of State has denied that 9,000 jobs in Wales—that is 17 per cent. of employees—are to go in the next six years, but the Under-Secretary of State for Wales, the hon. Member for Conway (Mr. Roberts) has told authorities that they should plan for the worst possible scenario. When pressed to say what the other scenarios were, he said that there were none.

The South Glamorgan authority has been told by its officers: The size of the cuts is quite unacceptable. It would mean cuts in all services, including all priority areas, for example, the Welsh National School of Medicine facilities—all postgraduate training as well as other functions such as regional services like the blood service and orthopaedics. It is unreasonable to attempt to redress inequities by equalising down within such a short period. Other developments should not now be proceeded with if it means significant cuts in existing services. It appears to be a paradox to promote development funds when existing levels of those same services are having to be contracted.

Mr. Mike Thomas (Newcastle upon Tyne, East)

For how long will the hon. Lady pretend what her right hon. Friend the Member for Leeds, East (Mr. Healey) would never have pretended, namely, that everyone can win and have prizes and that there will be a 3 per cent. real increase in the Health Service? The hon. Lady knows that not to be possible. It is part of a massive bluff.

Mrs. Dunwoody

That will teach me not to give way to the push-me-pull-me party, which has adopted a policy of looking both ways at once and finds it difficult to understand facts. Twice the Government have claimed that they have produced new moneys for the pay offer. On both occasions large chunks of the money—in the first instance £30 million and in the second £59 million—came from regional hospital authority budgets. That was on top of a £17 million efficiency cut and a clawback.

Mr. Douglas Hogg (Grantham)

Will the hon. Lady give way?

Mrs. Dunwoody

I am sorry, but this is a serious debate. That was on top of a clawback of £58 million and higher insurance contributions by employers. Although the Government specifically allowed private industry to benefit from the incentives offered in the Budget, the whole of the public service was deliberately penalised. Now we learn that the Government may renege on their commitment to pay even that part of the bill which they said they would meet.

The Government have refused to give a firm undertaking to honour their share of the current pay offer beyond this year, even though they are aware that such a decision will cripple the regional hospital authorities. For example, in the West Midlands this year the pay offer will cost £8 million, of which the authority will probably receive just over £5 million. However, if the Government do not honour their commitment, the authorities will have to find a further £16.5 million, with a consequent effect on all services. At a meeting of the chairmen of health authorities in Wales it was recorded that there would be dramatic increases in waiting lists and a deterioration of services to patients if the cuts were allowed to go ahead.

So who is really damaging patient care? Is it the unions, who want a living wage for their members, many of whom already earn well below the Government's own assessment of the poverty line, or is it the Government, who have delighted in their attempts to squeeze those who give most to the community?

What a decline there has been in even the attempted presentation of Conservative policies—not even a pretence that Conservatism means some sort of fair treatment for those who serve the community, but just crude union-bashing and a desire to destroy a fundamental State service. It is no matter that no country in the world gets anything like the standard of health care that the NHS provides, and no matter that no alternative private health insurance scheme could ever cover geriatrics, the chronically ill, the mentally ill or the mentally handicapped to anything like the extent that the NHS covers them. No, the Government seek only to hive off profitable services to the private sector wherever that is possible and, where it is not, to abandon the rest of the population to a dispirited and deteriorating State service.

The Government will positively encourage private medicine, but only if it is sited alongside expensive NHS facilities where it can have access to the services that it does not intend to pay for, but which it wishes to provide for privileged private patients. In the spurious name of choice, the Government will offer tax incentives to private companies, while simultaneously under-funding the NHS and encouraging consultants to do more work in the private sector, at the expense of their NHS duties.

The National Health Service has been treated with open contempt by the Secretary of State for Social Services. He has deliberately tried to misrepresent the pay campaign as a cynical political manoeuvre, but he is aware that the cynicism is all on his side and so is the manoeuvring. He has failed utterly to represent the serious problems of workers in the NH S or to demonstrate any compassion for or understanding of the problems facing patients. He could easily have solved the dispute early on by agreeing to go to arbitration. He could have shown a willingness to negotiate, which he has never done at any point. Instead of defending the Health Service, he has attacked it: instead of trying to improve it, he has tried to dismantle it.

The NHS was created to ensure equal treatment throughout the country for those most in need. It is a service paid for by direct taxation, which should be free at the time of use , with its priorities decided only on the basis of patient care. Instead of that, we have a vital service where those who work in it, far from being convinced of their importance to the community, are given to understand that the Secretary of State, who should represent them in the Cabinet, cares little for their problems and is not prepared to fight for a correct share of the resources.

The NHS is a service to everyone in this country. The Secretary of State must do his best. If he is not capable of solving the dispute, he must at least stand out of the way and let others who can do so take on that responsibility.

Mr. Speaker

Order. Before I call the Secretary of State for Social Services, I should tell the House that I have selected the amendment in the name of the Prime Minister.

4.24 pm

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

I beg to move, to leave out from 'concern' to the end of the Question and to add instead thereof 'at the refusal of the Trades Union Congress Health Services Committee to discuss the Government's fair and realistic pay proposals; pays tribute to all those staff who have continued to care for patients but condemns the irresponsible industrial action being taken in the health service which has led to the cancellation of more than 130,00(1 operations and an increase in waiting lists of more than 140,000; and congratulates the Government for increasing the resources available to the National Health Service to an all time record figure of £14½ billion and introducing measures to ensure that these resources are used as effectively as possible for the care and treatment of patients'. Having listened to the speech of the hon. Member for Crewe (Mrs. Dunwoody), 1 lain not surprised that she could not even carry an audience of Labour women with her at the recent Labour Party conference. Her speech was unworthy of her and certainly unworthy of the subject.

I should like to put three points that I believe are basic to the debate. First: 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. Those words are not mine. They are the words of the right hon. Member for Norwich, North (Mr. Ennals), the former Secretary of State for Social Services, and 1 agree with him.

Secondly: it is not acceptable in any community that sick human beings, be they adults or children, should be denied food and proper attention forbidden to them by the actions of people…I trust very much that all those concerned in this dispute will return to work and allow negotiations to continue on a proper basis." — [Official Report, 1 February 1979; Vol. 961, c. 1667–84.]

Those words are not mine. They are the words of the right hon. Member for Cardiff, South-East (Mr. Callaghan) when he was Prime Minister, and I also agree with him.

Thirdly: The present Government have made it clear that they are not prepared to finance inflation by printing money. I reassert that determination today. We shall stick to the monetary policy which we have already announced. We shall not accommodate excessive wage increases in the public sector by increasing cash limits accordingly." —[Official Report, 25 January 1979; Vol. 961, c. 754.] Those were the words of the right hon. Member for Leeds, East (Mr. Healey), the then Chancellor of the Exchequer and the first of the monetarists. I agree with him also.

Mr. Ennals

Before the right hon. Gentleman starts his own speech, which he will no doubt do eventually, does he recall that there has been an industrial dispute in the NHS for six months and that he has apparently made virtually no attempt to resolve it? Although there was an industrial dispute in the NHS when I was Secretary of State, it was negotiated, settled, and ended within two months.

Mr. Fowler

The right hon. Gentleman has only to look around him to see the House's reaction to that intervention. He has only to read the memoirs of the former Chief Secretary to the Treasury to learn how his part in that dispute was regarded. I hope that the right hon. gentleman is not recanting the words that I quoted.

It is extraordinary that, throughout the dispute, we have not had from the Opposition Front Bench one word of condemnation of the industrial action which has affected patients. Certainly, we did not have it today from the hon. Member for Crewe, who adopted her normal hectoring tone. If she represents the compassionate face of the Labour Party, as she appears to claim in the motion, we can only hope that it never puts up any of its real hardliners to speak against us.

We have also had no condemnation from any of the weightier figures on the Opposition Front Bench, yet the quotations that I have given come from the winter of 1978–79 when the Labour Government were faced with widespread industrial action, including industrial action in the Health Service. Then they condemned the effect of industrial action on the NHS and we, in Opposition. condemned it also. Our attitude has not changed, but the view of the present Opposition has changed from condemnation to encouragement.

I believe that that is a discreditable position for the Opposition to be in, for no one can doubt the effects on the Health Service that industrial action is having. Our latest figures for England show that, since the beginning of this dispute, more than 130,000 operations have been cancelled, more than 120,000 outpatient appointments have been cancelled and waiting lists have grown more than 140,000. That is the toll of industrial action.

I have a long list of examples of the effect on patients, but I shall give just one—the case at King's Mill hospital near Mansfield where a three-year-old boy had been given a preliminary anaesthetic for an operation but porters then refused to wheel him to the theatre and the operation had to be postponed. That cannot be blamed on the Government, the management or any outside body. It was a decision taken by the individuals at the time—and it was an indefensible decision.

Mr. J. D. Concannon (Mansfield)

In that instance, the management apologised to the family and everyone else.

Mr. Fowler

That in no way disposes of my point that individuals in the Health Service who take actions of that kind cannot then blame outside bodies. It was their own individual decision, and I believe that it was indefensible.

I hope that when the right hon. Member for Leeds, East winds up the debate, he will make the Opposition's view of industrial action in the Health Service clear. That has not so far been done. We are entitled to ask that their position on this be made absolutely clear.

The Opposition motion condemns the Government's refusal…to enter into serious negotiations with the representatives of health service workers". That is palpably absurd, on at least two counts. First, we are in negotiation with more than a quarter of a million workers in the Health Service. As I told the House on Monday, I am talking with representatives of the Royal College of Nursing, the Royal College of Midwives, the Health Visitors Association and the Association of Nurse Administrators. They accepted the invitation to talk which was sent to the TUC and the professional bodies on 16 September. Those discussions are still continuing and the latest took place only yesterday. A further meeting is to be arranged, and I believe that the whole House will hope that those talks will be successful.

I can also tell the House that in the last 24 hours we have been approached by the chairman of the staff side of the Whitley Council representing professions supplementary to medicine such as physiotherapists and radiographers. They, too, would like to have exploratory talks with the Government on the basis of the 16 September proposals, and those talks will begin tomorrow.

The motion reveals the Opposition's views about who constitute the representatives of Health Service workers. They actually mean that talks are not going on with the TUC, but they fail to say that the fault for that lies fairly and squarely with the TUC.

When I reported to the House on Monday, I outlined the steps that the Government had taken during the recess to resolve the pay dispute and end the industrial action. The facts are that in June we increased the resources available for pay in the current year for the second time. We were able to increase the offer to between 6 per cent. and 7½ per cent. at a total cost of £418 million. Those offers followed arbitration awards in the Civil Service and for the teachers of about 6 per cent. and they compared favourably with settlements for millions of other workers in the public and private sectors. At the same time we offered talks on new pay arrangements for determining the pay of all Health Service staff.

We made it clear in June that no further resources were available for pay this year, but even when this offer was turned down by the nurses of the Royal College who voted in the ballot, we continued to look for a way forward which would bring an end to the industrial action. We produced proposals which provided for a two-year settlement leading to new arrangements in April 1984 and almost £1,100 million was put on the table for negotiation. The professional bodies are discussing those proposals with us, but the Health Service unions refused even to come to the Department to talk about them. A sum of more than £1 billion did not amount to a worthwhile agenda in the view of the full TUC health committee. That is extraordinary because these proposals were discussed in great detail with Mr. Spanswick and Mr. Jacques, the chairman and secretary of the TUC health services committee.

Let there be absolutely no doubt about what happened. First, preparations for the meeting with the health services committee had been going on for some weeks. The aim was to find a framework for negotiation which could lead to a settlement. Of course, no one seeks to claim that we could have achieved a settlement at that small meeting. We were trying to find a framework for negotiation and that process involved meetings between my officials, Mr. Spanswick, Mr. Jacques and myself.

Secondly, it was agreed that the proposals should be set out in a note which would be sent to the health services co-ordinating committee as a basis for negotiation between myself and that committee. We also recognised in the discussion, and therefore set out in the note, that no further money would be available for 1982–83, but that we would discuss a two-year pay arrangement. Those facts are incontestable. It is therefore both tragic and indefensible that the committee was not prepared even to talk about those proposals.

Mr. Bob Cryer (Keighley)

It is also incontestable that the Government have consistently refused to go to arbitration. If they think that they have such a strong case, why are they so hesitant to go to arbitration and to allow a third party to decide who has the stronger case—the Government or the trade unions?

Mr. Fowler

The Government have to make the final decision about the resources that are available. Moreover, we moved to the 6 per cent. and 7½ per cent. after arbitration awards in the public sector. However, I was replying to the hon. Lady's point about the careful discussions that took place. My account of what took place is incontestable.

It is no use the Opposition pretending that what they said in 1979 does not apply in 1982, because in 1979 the Government were willing to negotiate, but in 1982 the Government are not willing to negotiate. That is simply untrue. The facts in this dispute show that we have three times brought forward new proposals and that the Health Service unions have not budged one jot from their original claim.

I am not the only person who finds the attitude of the unions inexplicable. Last Friday, Mr. Lewis Waterhouse, the chairman of the convenors committee of the London ambulance service, said: All the TUC health services committee seems interested in is getting the Government out. All we are interested in is our pay claim…The situation is so confused now that the majority of men and women do not know what is on offer…Since the 4 per cent. offer we have not been asked anything abut whether we want to accept or reject. This is not the way we see democracy working. I believe that that view is shared by an increasing number in the National Health Service and that their voice is becoming ever louder on this issue, for the following reasons.

It is becoming clear that the issue itself is being used by people who have no interest in the Health Service. I do not mean only Mr. Scargill. An editorial in Labour Weekly on 10 September said that the whole movement must line up behind the health workers in their battle with the Government because a victory in that fight would do irreparable damage to the Tory Government's overall credibility and set the scene for a major boost in support for Labour in the run-up to the next election. It is becoming clear that, although the TUC tells the public that it supports the nurses, it is telling the Government that it cannot contemplate a differential offer for the nurses.

It is becoming clear that this dispute is in the interests neither of the patients nor of the people working in the Health Service.

Let us remember that, although industrial action has scarred the Health Service, the majority of the staff have continued to care for patients. The public owes all the staff who have continued to work—medical staff and nurses, managers and ancillaries and all the others—a great debt.

The Opposition motion also refers to the problem of low pay. No one doubts that there are low paid workers in this country or in the Health Service. No one doubts—or should doubt—that one of the reasons for that is that many relatively low paid people have to pay tax to support our level of public spending. That problem will not be helped by the policies now being advocated by the Opposition, who call for ever more public spending and, therefore, even higher taxes. But, even given that general problem, some of the propaganda put out by the TUC in support of its campaign has been deliberately intended to deceive.

Let me take the leaflet that the TUC published for its 22 September march and rally. The leaflet repeats specific claims that it has made about pay levels in the National Health Service. It says, for instance, that four out of five ancillary workers earn less than £75 per week. That is simply untrue. The only way that it can get remotely near to that figure is by putting together ancillary workers working full-time with those working part-time. The TUC might reflect that even a Labour Government are probably unlikely to pay part-time workers the same as full-time workers. So what are the true figures? They are that, on average, 23 per cent. of full-time ancillary workers earn less than £75 a week. That is a difference of 57 per cent. on the TUC figures. That is the difference between its claim and the truth.

Secondly, it says that 50 per cent. of nurses earn less than £82 a week. Again, it has put together full-time and part-time staff. If one looks simply at the full-time staff, the number earning less than £82 a week is 31 per cent. But nine out of 10 of those nurses are pupil and student nurses and nursing auxiliaries. Of course, at no stage does the TUC's document add that, under this Government, pay for nurses has increased by on average 61 per cent. The Government have found the money for those increases which are above, not below, inflation.

What the leaflet says instead is that the increases on offer of 7½ per cent. and 6 per cent. are worth only coppers on take home pay". That was certainly not true of the 6 per cent. and 7½ per cent. offer. Under those offers, the increase in estimated weekly earnings of a staff nurse would range from £7.50 to more than £9, and for a full-time male ancillary worker from more than £5.50 to more than £8.50. The effect of the 16 September proposals, about which the unions are refusing to talk, would be that from the end of January 1983 under either of the options the estimated weekly increase in earnings for a staff nurse would range from almost £12 to more than £14; and for a male ancillary worker from almost £10 to more than £14.

Of course, the Opposition have now added a further point in their attack. That is the charge that somehow the Government are out to destroy the Health Service itself. Let me just remind the House of the actual position on health spending. Health spending in Great Britian will have been raised from £7¾ billion in 1978–79 to £14½ billion today. In real terms, that is an increase of 5 per cent. By any standards those are significant increases, and they have been made in the teeth of the worst recession that the Western world has known since the war.

Mr. Mike Thomas

What would that figure be if the right hon. Gentleman excluded from it the Clegg settlements, which were merely a catching-up exercise for a period that had gone before?

Mr. Fowler

I do not see why the Clegg settlements should be excluded. The Government had to find the resources to pay for them. The increases in spending have meant considerable improvements to patient care, and in particular they have meant an increase in the number of doctors and nurses employed. Today there are 41,000 more nurses and midwifery staff employed in the Health Service than in 1979. That is not the action of a Government who are out to destroy the Health Service. It is the action of a Government who are determined to sustain and develop it.

As to the question of capital cuts, I certainly hope that the right hon. Member for Leeds, East is not preparing to lecture the House on that. The largest cuts in capital spending in the Health Service took place when he was Chancellor between 1976 and 1978, when there was a cut of 25 per cent. Under this Government, capital spending has increased, and more than £1,100 million is now committed to 136 major new hospital developments throughout the country.

The Government are, therefore, committed to the Health Service. We do not, however, simply rest our case on the extra resources provided. There is the additional vital question of how effectively we are spending our resources. Any Health Service in any country will always face problems of resources. It is absurd for the hon. Member for Crewe to pretend otherwise. We have only to read the recent survey of the Nuffield Provincial Hospitals Trust or the latest edition of The Economist to know the problems that are being faced in other countries round the world.

There are also difficult decisions on priorities. No one who occupies my job can be unaware of the massive problems that the Health Service faces. They range from major increasing problems, such as the rising number of elderly people in Britain, to the smaller but crucial problem of the small number of mentally handicapped children who are being looked after in hospital when they should be in the community. Those problems will not simply melt away, and any politician who pretends that he has an immediate cure-all is simply deceiving the public.

One thing is clear. We must ensure that every pound of the £14½ billion budget is well spent. That means that it is spent to the maximum benefit of patients. By the nature of much of its activity, the Health Service is labour-intensive. Some £7 billion out of £10 billion spent on the hospital and community health service budget goes on staff costs. We must therefore make the best use of manpower and seek the highest possible efficiency in the Health Service itself. During the past few months the Government have set in hand a whole range of initiatives. They include a new system of regional reviews whereby checks are made on the progress being made in each of the regional health authorities. We are introducing new arrangements for the supply of manpower information and the setting of manpower targets. We are developing a system of performance indicators and introducing a programme of Rayner scrutinies and setting up a small team to help us carry through our manpower initiatives, drawing on the experience of people in outside industry.

That is not an attack upon the Health Service. That is an attempt to get a better Health Service. As any good manager knows, increased efficiency means, and must mean, a better service for those he serves. Nor is it meant to detract from what National Health Service managers themselves have already achieved or are capable of achieving. However, in my view, there are very few people inside the Health Service who seriously believe that there are not improvements which can be made and improvements which can be made which will lead to better patient care.

The purpose of our policies is to secure better value for money in the Health Service and to give priority to patients. The clear duty of the Government and of society is surely to mobilise every available resource to that end.

Mr. Alexander W. Lyon (York)

rose—

Mr. Fowler

I shall not give way.

That is why—unlike the Opposition—the Government welcome the contribution of the private sector. We should be clear about the nature of the private sector, about which the hon. Lady clearly is not. It is a mixture of voluntary, charitable and commercial enterprises, ranging from nursing homes to modern hospitals, capable of undertaking major surgery. A number of hospitals and nursing homes are run by religious foundations. Health authorities use some of the facilities on a contractual basis. Many beds in long-stay private nursing homes are, for example, occupied by patients paid for by the National Health Service. Substantial numbers of doctors work in both the National Health Service and private hospitals.

The size of the independent sector is comparatively small, but the benefits to the National Health Service of there being a partnership between the State and the private sector are out of all proportion. The development of private facilities draws on other sources of finance, increases total health care provision in the country and, therefore, helps to bridge the gap between the supply of health care and demand.

There is a further advantage. Dangers are always inherent in being a monopoly supplier or a monopoly employer. The NHS is certainly not free of that danger. The private sector provides an alternative. It shows that there are different ways of doing things, and that can be a stimulus to an improved NHS. As a matter of principle, I believe that however good a State service is, people should have an alternative. However, I see the two services as essentially complementary. I believe that there are opportunities for co-operation, and no Government can afford to neglect them.

I want the private and public sectors to work in partnership. The Government have already shown their commitment to the NHS by the resources that we have committed. We want to see further developments, but words are not enough to secure that further development. The National Health Service is not separate from the rest of the economy. Resources do not come out of thin air.

Four years ago, on 1 November 1978, the right hon. Member for Cardiff, South East, the then Prime Minister, said: To those who want to improve the Health Service, as I do, and those who want to improve education, as I do, I say the first test is to keep inflation down. Inflation cuts away at jobs. It reduces the attraction of our goods to other countries and lessens the opportunities for export." —[Official Report, 1 November 1978; Vol. 957, c. 50.] The right hon. Gentleman was right on the point—although he learnt it the hard way from the IMF, and never achieved that goal.

The Government have achieved the lowest inflation rate for 10 years. That is good news not only for industry, but for the Health Service. Contrary to the Opposition's motion, we care for the sick and all the other people in this country in need. We do not take lessons from the Labour Party on that concern. However, we press the Opposition to dissociate themselves from the industrial action which is now damaging the Health Service and harming patients.

I urge the House to reject the Opposition's motion.

4.55 pm

Mr. Tom Pendry (Stalybridge and Hyde)

I am a Member sponsored by the National Union of Public Employees, and I am secretary of the NUPE-sponsored group of Members of Parliament.

I spoke on this matter on 10 June last, when we debated the same problem. At that time, the dispute had already been allowed to drag on for an unnecessarily long time and, in common with many others on this side of the House, I pointed out that the Secretary of State was directly responsible for the disruption within the National Health Service. If that was true in June, as I believe it was, and my colleagues agreed with me, and if it was the result of incompetence rather than of wrong-headed wilfulness, as I prefer to believe, how much clearer is the Secretary of State's incompetence today, how much more incompetent he is than he was four months ago.

During these sad months we have heard the arguments at length, and in my view it would be wrong to dignify the statements of the Secretary of State and his side-kicks by describing them as arguments. The justice of the health workers' case, for both nursing and auxiliary grades, has been overwhelmingly accepted by the British people. I think that that is beyond dispute. No matter how much bluster we hear from the Secretary of State and the Minister for Health, and no matter how they try to cobble the figures, there is one telling fact that throws their whole act into the disrepute that it deserves. Health Service workers of all grades are among the lowest paid in the country, undertaking jobs that are difficult and demanding, which they carry out with considerable patience and dedication.

We were not long into the dispute before Ministers accused the Health Service unions of ulterior political motives, of sinister machinations against a Government who merely had the interests of the National Health Service at heart. That is patent nonsense, and the House knows it, and it is unworthy of Ministers of the Crown. Low pay is, of course, a political issue, but it is one that should transcend party politics, and it is directly related to basic decisions that our society has to take about itself. It would be ignoble for any party to tolerate levels of pay in an essential public service that failed to provide for the basic needs of the families of the employees of that service. It is base of this Government to ignore the problem in the hope that it will go away when the case has been so clearly and convincingly made.

On a more ironic note, the House could hardly expect me, as I have already declared my interest, to agree with the Government's statements about the dispute having a party political motivation when the memory of the Labour Government's difficulties in negotiations with some of the same unions is still fresh. The Health Service workers would never allow themselves to be used as pawns. They have been forced to take action because of the sheer desperation of their plight. They are conscientious and dedicated people who have a real sense of vocation. Suggestions that have emanated from the Conservative Benches that those workers embarked on their present course wilfully or mindless of the discomfort that they cause patients is nothing less than a grave insult to their integrity, one that can only be profoundly counterproductive in the present situation.

Mr. Peter Bottomley (Woolwich, West)

I should like to ask the hon. Gentleman two short questions in the tone in which he is addressing the House. First, does he agree that the family needs of people at work are best met by child benefits rather than by pay increases to everyone? Secondly, has not a union, whose members earn more at present than the lowest paid of the Health Service workers, said publicly that it will accept an offer lower than what might eventually be accepted by the National Health Service staff?

Mr. Pendry

I hope that I shall carry the House with me when I say that I hope that the hon. Gentleman will catch your eye, Mr. Speaker, in order to make those points. It would take longer for me to answer them than I intend to keep the House for my short speech.

The contempt with which the Government have treated the unions negotiating on behalf of the Health Service workers over the past six months can be judged by looking at the history of the Government's offers which have been made in so flagrantly a misleading way and the way in which they have misused statistics in their arguments. Fortunately, I car. say on this occasion—not often—that most journalists have treated the Government's selective use of those statistics during the dispute with the scepticism that it deserves. On every occasion that the Secretary of State has attempted to convince the public that not every National Health Service worker is on the poverty line—which he often does, and we have heard a little of it today—the press, to its credit, has published the details of scores of genuine—not abstract—cases which prove conclusively that even those who are not on the lowest rates of pay are currently suffering real deprivation and hardship.

The Government's pay offer has come in three phases. The initial offer of a blanket payment of 4 per cent. was so derisory as to be unworthy of consideration. For years Health Service workers have suffered declining standards of living relative to those in the rest of Britain. Being a soft option in the Government's view, they were at the bottom end of the pay tab. e in 1980–81. This year's pay claim of 12 per cent. was, in my view, and I am sure in the view of the majority of Labour Members, if not of all hon. Members, a realistic claim to compensate for their fall in living standards only since April 1981. The full extent of the union's social responsibility can be gauged from the fact that it would have required a pay claim of about 39 per cent. to re-establish the relative levels of pay awarded as a result of the catching-up exercise undertaken by the Clegg commission.

The second offer, made in June this year, was for 7.5 per cent. to nursing staff and 6 per cent. to ancillary staff. Leaving aside the obvious fact that that was a blatant attempt by the Government to divide and rule, one which shows the scurrilous tactics that the Secretary of State has been deploying, it still fell well short of a figure that was even negotiable.

The Secretary of State compounded his incompetent and insensitive handling of the dispute by insisting that the health authorities find £69 million from the existing budgets to pay for the 1982–83 offer. In the light of the grave financial position in which the Government have placed the National Health Service, that can only be calculated to have been inflammatory.

As is well known, that offer was subject to a ballot by the Royal College of Nursing. If by that move the Government hoped to split the non-TUC affiliated nurses from their brothers and sisters, the nurses saw through the Secretary of State's intention and decisively rejected the offer by a ratio of two to one. Thereby, 175,000 nurses with the RCN unequivocally declared their solidarity with the 210,000 nurses within NUPE and COHSE. That should be recognised.

Subsequently, the Secretary of State has tried to manipulate his offer to try to make it more attractive. Under the guise of a two-year scheme he has rearranged the figures hoping that his crust will be more appetising with a promise of a smattering of jam tomorrow. The truth of the offer is that no new money has been made available and it is hardly surprising that it has been treated with such contempt by the unions when it provides no extra cash for 1982–83, commits the unions to accept 4 per cent. next year and, most significantly, puts off until April 1984 the introduction of any long-term formula for dealing with NHS pay.

This offer is the latest display of incompetence by the Secretary of State. I know that he must be sick of hearing me call him incompetent. [Interruption.] I am sure that in other situations he is not a bad lad. [Interruption.] However, with his long catalogue of disasters in his handling of industrial relations, it must be time—not long anyway—for the Prime Minister to recognise that she must move him on. After all, it is doing her image no good and it must be sooner rather than later. Sometimes I get a clear message that the Secretary of State would like to be moved on.

To be fair—as the House knows, I am a fair chap—we should not blame the Secretary of State for everything. The question of pay is merely one aspect. The fact is that there is in the Conservative Party and the Government a move to unsettle the whole of the National Health Service. Its survival is at stake. The Secretary of State's colleagues have been guilty, as has he, of fostering hints and speculations about the future of the Health Service. The notorious Think Tank effectively laid bare the ugly and brutal face of modern Toryism and was commissioned on the Prime Minister's insistence. The House should recognise that as one of the many indications that the nation has received of the grave threat to the National Health Service posed by the Government's continuing existence.

The Prime Minister's protestations that the Health Service is safe in her hands rings hollow. It is so hollow that it has fooled no one. I have it on good authority that when the Prime Minister dropped the political hot potato of the Think Tank report and placed it in Treasury hands there was a good deal of righteous indignation in that Department.

Mr. Geoffrey Dickens (Huddersfield, West)

rose—

Mr. Pendry

No. I shall not give way.

After all, the Treasury was indignant because it was not its baby. It was a product of the Prime Minister's destructive obsession with creating a nation easy for the rich and grindingly harsh for the poor. The Prime Minister's public relations manoeuvres were a clear demonstration of how readily she abandons collective responsibility when she wants to and loyalty for the sake of political expediency.

Over and above the Government's economic incompetence which has shattered Britain's industrial base and ensured that mass unemployment is experienced in almost every corner of the nation, they now propose to dismantle one of Britain's most precious assets. The implications of such a move—

Mr. Dickens

rose—

Mr. Pendry

No, I shall not give way. I gave way to the hon. Gentleman's colleague, the hon. Member for Woolwich, West (Mr. Bottomley), and that was a mistake.

The implications of such a move for the daily lives of working people in Britain would be profoundly disturbing. The Oxfordshire regional health authority went to the Department of Health and Social Security earlier this year to explain the scale of the problems facing it as a result of Government-inspired economies. It was given short shrift and told to go away and think "radically"—that is the Government's pet word for "dismantle", "abandon" or "cut"—and to return to the Minister.

The Oxfordshire RHA did think radically and it returned with a report that should have horrified all hon. Members. I know that it will have profoundly disturbed those Conservative Members—I believe there are one or two of them still left—who are currently lying low, but who have a compassionate nature. I know that some of my colleagues will think that I am being too fair, but I think that they are waiting, hoping that the Government will burn themselves out on such issues.

The report was detailed and well researched. It patiently explained that at current levels of funding health care provision would be reduced to a low service, incapable of coping with even some of the basic health needs of the population. Of course, we should not be surprised at that. It is what the Secretary of State has been planning for some time to force on the regional health authorities. It coincides precisely with the Government's plans to encourage the private medical sector. Such moves are outrageously regressive. They fly in the face of volumes of detailed evidence showing that a tax-funded system is a great deal more efficient than an insurance-based one. It flies in the face of experience of poor patients in other Western countries who suffer the haphazard, inhuman and frequently inadequate medical provision of systems that rely on the private sector.

The nations's health is much too precious to be left to the vagaries of the market. Over many years, this country has had a National Health Service that has provided excellent health care at reasonable cost. It would be criminal to let that service disintegrate as a result of inadequate funding and Government negligence.

The Government proclaim themselves to be alarmed at the percentage of GNP accounted for by the NHS and other public spending. They have only themselves to blame, because as the economy contracts as a direct result of economic mismanagement, the proportion of public spending needed to retain a basic level of services grows. The Government are now preparing to sacrifice the NHS, a system of which the nation is justifiably proud, at the altar of their own savage and discredited economic dogma.

The nation will have no trouble seeing through the mystical rhetoric with which the Government seek to cloud their ugly machinations. It will rightly clamour for a proper resource allocation for the NHS to ensure its future. It now rightly insists that a proper pay offer be made to the Health Service workers as the essential first step in this vital process of regeneration.

5.11 pm

Mrs. Jill Knight (Birmingham, Edgbaston)

What-ever one's opinion of the justice or otherwise of the health workers' case, it cannot be right to use helpless, frail and sick people as pawns. It cannot be right to inflict needless suffering on innocent people.

In an excellent speech, my right hon. Friend the Secretary of State drew the attention of the House to the difference in utterance of Labour Party spokesmen during this strike compared with the things that they said during a strike when they were in office. He quoted specifically what was said by the then Secretary of State for Social Services, the right hon. Member for Norwich, North (Mr. Ennals), and the then Prime Minister. Both right hon. Members clearly stated that it was utterly wrong in every circumstance to make sick people suffer needlessly. The Opposition of the day—the Conservative Party—backed them all along the line, because we believed that then and we believe it now.

The hon. Member for Stalybridge and Hyde (Mr. Pendry) talked about transcending party politics. I should have thought that making sick people suffer was an issue that should transcend party politics.

I should like to make two other points about the Labour Party's change of direction. When Labour Members were so roundly condemning the suffering that was inflicted on sick people, the pay of the Health Service workers was a jolly sight lower than it is now. Along with his right hon. and hon. Friends, the right hon. Member for Cardiff, South-East (Mr. Callaghan) has executed a total somersault, because whereas he used to believe that it was wrong to make people suffer, he now believes that it is perfectly all right. Furthermore, he believes that it is right to incite people to break the law and to go against the law of the land with regard to picketing. I am not surprised that the public are showing such lack of respect for the Labour Party when they see this total turn around in the attitude of Labour Members. That does no credit whatever to the Labour Party.

We have heard that 110,000 operations and 105,000 outpatient appointments have been cancelled. From our constituency experience we also know that waiting lists have been increased since the dispute began. The sum total of human misery encapsulated in those cold figures should be clearly understood.

I have with me a letter from the chairman of the medical executive committee of the Queen Elizabeth hospital in my constituency. He says: It might be thought that non-urgent cases could quite reasonably be asked to wait without appreciable risk or suffering but this is unlikely to be true. Many patients are in considerable distress and pain although not being strictly `urgent'. I believe that it is totally unacceptable for non-medical people to define what is or is not an urgent medical condition.

The letter continues: Accurate diagnosis, and therefore the degree of urgency, cannot always be accurately assessed as an out-patient. A Neurologist describes five patients who are currently awaiting investigation of symptoms which could be due to a degenerative change in the spinal cord or could equally well be explained by the presence of a tumour. The patients are aware of that. They are not sure what is wrong with them The doctor continues: The emotional trauma for the patient resulting from uncertainty about the diagnosis cap be easily envisaged. About three weeks ago, the urgent waiting list at the Queen Elizabeth for neurological patients stood at 330. I am afraid that that figure includes several people with an undoubted malignant disease. A general surgeon at the Queen Elizabeth reports that because of the strike his waiting period ha .s gone up from three months to nine months. Those who throw accusations at my right hon. Friend the Secretary of State should at least acknowledge that under his care and charge, until the Health Service strike began, waiting lists had been substantially reduced.

A gynaecological surgeon at the Queen Elizabeth tells me that in May his waiting period was down to three to six weeks—six weeks at the outside. It is now eight months.

Like my right hon. Friend, I shall not quote from the large number of cases of explicit suffering that have been reported to me, but I shall cite the case of a mother, with two young children, who had a lump in her breast. Three times her operation has been cancelled. Three times she has plucked up her courage to go into hospital to have the operation. Three times her children have been told that their mother was going into hospital but would not he away very long, and three times arrangements have been made for the care of the children and have had to be cancelled. Labour Members seem to think nothing of that, although it would have been a different matter had they been in power. That is what I find so reprehensible.

I must also comment on the fact that outpatients attending for appointments have been subjected to abuse and fear. An elderly constituent told me that when he went to the hospital for his outpatient appointment he was too afraid to go inside because of the demeanour and attitude of the pickets and their remarks to him. That cannot be supported by anyone, and there are scores of cases on record—[Interruption] If Labour Members do not believe that, either no one bothers to write to them about their genuine fears or those Members ignore the letters that they receive. There are many cases on record of the cruel effect of the strike on those who are unable to hit back. All this suffering is entirely pointless, because it is getting the health workers absolutely nowhere.

There used to be an accepted convention that no talks of any sort would take place while people were on strike. That was accepted all the way through industry and elsewhere. It was accepted that the resumption of work was the signal for talks to begin. I do not know what has happened to that convention, but the militants who are masterminding the strike must now be aware that all their bullying is to no avail. The moderates know it perfectly well. The moderates are more and more disinclined to join in the strike action, because they know that they are inflicting suffering to no purpose whatever.

I say to my right hon. Friend that it must be seen that all the bullying is unavailing, for if he were to give in to the demands of those who have the ability to inflict suffering, no one in Britain would be safe. Every time those concerned wanted more money they would simply have to deny care to sick people. It is a fatal mistake ever to give in to the kind of cruel bullying that we have seen in the course of the strike.

Mr. David Stoddart (Swindon)

I have been listening for a long time to the hon. Lady's catalogue of complaints and have been hardly able to contain myself. Does she recall that before the general election her right hon. Friend the Prime Minister—the greatest militant in the Cabinet—promised the country that she would find a better way of dealing with pay in the National Health Service, so that health workers would not have to resort to industrial action? When all that the Secretary of State has to do is to agree to arbitration, why will he not agree to it? If the hon. Lady is as concerned about the welfare of patients as she says she is, and as we all are, why does she not tell him to go to arbitration?

Mrs. Knight

It is all very well for the hon. Gentleman to ask such questions. Does he condemn the suffering that is caused to sick people? My right hon. Friend the Prime Minister has not inflicted any suffering upon a single soul. If she were to suggest to the Secretary of State that the bully boy tactics should be allowed to prevail, I must tell the hon. Member for Swindon (Mr. Stoddart)—apparently he was not listening—that not one frail or sick person in Britain would be safe. That is what would happen if extra money could be obtained every time cruelty was meted out.

There is another respect in which the TUC is culpable. It pretends to care to a great degree for the welfare of the nurses, but if my right hon. Friend were to give way in the dispute, there is no doubt that every public sector workers' union in the country would be out on strike and after more money. There is far too much militancy in the trade unions today and I am very sad that so much of it has crept into the Health Service. In too many instances, even doctors are scared to speak out about what is happening. Those who have spoken out have been attacked in the most vicious and unkind way. Freedom of speech no longer completely exists because of the fear within the Health Service, and that is also due to the bully boys.

As my right hon. Friend said, many thousands of workers have not taken strike action, and much credit is due to them for their realism. The hon. Member for Stalybridge and Hyde mentioned the nurses' ballot. Does he know how many of the total number of nurses bothered to vote in it? It was very far from the sort of percentage vote that I hope he would get at a general election. It was very low. They have taken a decision to stay at their work because of their realism. They know that the offer is fair. They have loyalty to the job that they do. Above all, they have compassion, and that is what is so badly missing elsewhere. They refuse to put their pay before their patients, and we should hold those nurses in high regard.

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

rose—

Mrs. Knight

Some people in the NHS could never be paid enough. A few are paid too much. Some should not be paid at all, because they are supernumerary.

Hospitals used to be run in a very simple and far more efficient manner. Some years ago I worked in a hospital. The matron ruled the place with a rod of iron, and how effectively she did it. We had one administrator, whereas today there are six, all with their secretaries. In those days the hospitals were much happier places and the patients were better looked after. Certainly the hospitals were much cleaner.

We all want to give more money to the deserving workers in the NHS, but it is useless to pretend that we can find the money just by wishing. I hope that we shall see more privatisation schemes, particularly in cleaning and in catering. If we want to have more money available for the needy cases, private health care should be encouraged. Those Labour Members who are so fond of denigrating private health care should remember that in a free country people should be allowed to spend their money as they wish, after paying their due rates and taxes. When anyone goes for private health care, there is an immediate alleviation of the burden on the National Health Service.

Mrs. Kellett-Bowman

Is my hon. Friend aware that the National Health Service workers in my constituency have voted to re-admit private patients into our NHS hospitals? That brings in £5,000 a week, which can be used for the improvement of services and the employment of more staff.

Mrs. Knight

I am grateful to my hon. Friend for making that point. The Labour Government, in their action against private beds in NHS hospitals, effectively cut off many millions of pounds which could have been used for the NHS as a whole. Therefore, it is very important to encourage private health care.

There should be a much closer examination of the domestic expenditure of hospitals—expenditure on the drugs cupboards and the expenditure that filters away because of the pilfering that still goes on in hospitals. Only this week I was given an example of the amount of money expended by people who use hospital telephones for private calls and hospital stamps for private letters, and so on. Those matters should be examined, although I do not suppose that the Opposition would like it.

Those Labour Members who talk about the Conservative Government destroying the Health Service are saying, in effect, "I have made up my mind, do not confuse me with the facts", for all the facts show the truth to be exactly the opposite. [Interruption.] Labour Members do not like the facts. They prefer the "Alice in Wonderland" notion that the Conservative Government are trying to destroy the Health Service. The facts are entirely different, and I advise them to look at the facts before they reiterate that stupid untruth.

The cost of the National Health Service has substantially increased. As my right hon. Friend reminded us, it has gone from £7.7 billion per annum in the last year of the Labour Government to £14.5 billion today. Does that support the argument that the Conservative Government are trying to destroy the Health Service? This morning on the radio I was unfortunate enough to hear the hon. Member for Crewe (Mrs. Dunwoody) refer to that as "crumbs from Mrs. Thatcher's table". All that I can say is "Some table and some crumbs".

Labour Members have no concept of the notion that money has to be found from some source. They think that it is sufficient to say "Give everybody more money and somehow the extra money will materialise." They live in cloud-cuckoo-land. I invite the House decisively to reject the motion.

5.30 pm

Mr. Clement Freud (Isle of Ely)

I added my name to the official Opposition's motion because I felt that the health workers' pay dispute was a condemnation of the Government. That it was ever allowed to take place is shameful; that it has gone on to become the longest-running dispute in the public sector—longer than the miners' strike, the Civil Service strike and the seamen's strike—is worse. It has done lasting harm to more people than will ever be identified.

I have two principal reasons for my criticism. First, the Government are crippling the National Health Service, to which they claim to be committed and claim to show their commitment by the symbolic shelving of the Think Tank report. When the Prime Minister announced at Brighton that the National Health Service was safe with the Conservatives, did she take "safe" in the Rupert Brooke context— Safe though all safety's lost; safe where men fall; And if these poor limbs die, safest of all."? The Government say that NHS expenditure has risen in real terms since they came into office. They could have fooled me, and they could have fooled my constituents. If they have spent more money, it has been on making the well-paid better paid, on golden handshakes for Health Service administrators.

The Minister for Health (Mr. Kenneth Clarke)

Nonsense.

Mr. Freud

In Glasgow, the number of Health Service administrators has doubled in the past 18 months. Perhaps the Minister will stop saying "Nonsense". It is to be noted that not even they claim that the service has improved.

I respectfully suggest that money is not enough. I know that the Government will consider that to be a heretic statement. However, as Ministers have said when dealing with other problems, difficulties do not go away merely by throwing money at them. What is needed is a display of real concern for those involved—patients, medical staff and health workers—as people and not as statistics.

In my region it has been decreed that there is to be no provision of capital expenditure for anything new. Resources must be used by those concerned to retain the status quo as best they can. It is the dictates of the Government that have forced the health authorities to adopt this stance. If ever there was an uncaring concept, this is it. In effect they are saying "Never mind if there is increasing need. If there is a new epidemic and a new breakthrough in preventive medicine, there should be no resources to create anything that was not there before." If that is not a condemnation of Government policy, I should like to know what is.

Mr. Dickens

rose—

Mr. Freud

To encourage, rightly, the scrapping of the old and to make no financial provision for the creation of the new must be entirely wrong.

Mr. Dickens

Will the hon. Gentleman give way?

Mr. Freud

I shall not give way. I signed the Opposition motion and I should like to show solidarity with the Opposition in not giving way to the hon. Gentleman.

Mr. Mike Thomas

There are other ways of doing that.

Mr. Freud

I wonder whether it is what the Prime Minister calls "cashing in on the white heat of technology" when the Government are providing the resources to invest in a magnet and an abacus?

The Government are attempting to sneak in a selective pay policy by the back door, with no consultation. They are trying to impose it on one of the lowest-paid sectors in the labour force while letting other groups, which they consider to be more of a threat, get away with pay increases of higher percentages than the offer to the health workers, and higher percentages of a larger original sum. It is time to recognise that workers who have received no formal training are as vital to the efficient maintenance of higher standards in Britain as those who have served long apprenticeships. The accumulation of letters after one's name does not necessarily denote soul or a special aptitude for caring.

I have in mind the Government's attitude towards those who stay at home and care for others. I have in mind the married women to whom the Government deny the invalidity pay allowance on spurious grounds. Their attitude to health workers can be described only as one of casual disregard. Many of us on the Opposition Benches fear that their disregard is more calculated than casual, bearing in mind tie Prime Minister's passion for the private sector. We know, and she knows, that the lower she keeps National Health Service pay the more incentive there will be for workers to go into the private sector. That will give Britain two classes of medical care. There will then be a first-class service for the "haves" and what must become a genuinely second-class service for the others, who are often those with the most need.

The dispute has shown to all with eyes to see and the will to look that Health Service workers are as vital to the type of National Health Service that we want, and the Government say they want, as any other medical staff. The recent letter to The Times by the medical staff of St. Thomas's hospital, London, demonstrated the dangers to a hospital and its patients of trying to operate without the health workers' support and loyalty.

There are abuses. Of course there are. There is no large organisation in which we will not find abuses. However, if the staff are not there to devote their full attention to the patients, that is as much the fault of the Secretary of State as it is of the health workers.

The Government claim to care about the "Why work?" syndrome. The workers are surely in the category where it does not benefit them tremendously to work. Instead of trying to help them to sustain their motivation, the Government are offering them a paltry sum on top of an originally miserly wage. They are seen to behave differently towards High Court judges and senior civil servants. The best and possibly the only way to eliminate the "Why work?" syndrome is to put extra cash in the pockets of those who need it most, and not to make exhortations or appeals to party loyalty and the Falklands spirit.

We need to end the dispute. That is what the patients want, what the public want and what the health workers, the doctors and all of us want. If the Government are too out of touch with life outside their ivory monetarist tower, they should emulate the example of other sectors and bring in independent arbitrators. If the Secretary of State's case is as good as he would have the House believe it is, I do not know why he is so frightened of going to arbitration. The pay dispute has dragged on for six months and still such moves are being strenuously resisted.

The end of the dispute is in sight if what we read in yesterday's edition of The Daily Telegraph can be believed. Even if it is, and the Government are doing what they said they would never do, we need to ensure that this sort of dispute never happens again. We need an incomes policy for the lowest paid and for those in vital services. There is one of sorts for the police. Why should there not be such a policy for the health workers? The person who arrests an assailant is an important part of society and has an important place in society. Is he more important than the person who bandages the wounds?

Burke once observed that it was a mistake to regard the loudest complainers for the public good as most anxious for the public welfare. I contend that it is time for the Government to stop talking and to get down to negotiation. This damaging dispute has gone on for too long and we need action. If the Government will not act, let them at least bring in independent arbitrators.

5.39 pm

Mr. Roy Hughes (Newport)

My constituency of Newport is in the county of Gwent. In the north of the county there is the little town of Tredegar, where Aneurin Bevan was born. In that town, as a youth, he witnessed the Tredegar medical aid scheme, which was an embryonic National Health Service. What cannot be disputed is that Aneurin Bevan introduced the National Health Service into this country, pioneered it through the House and was its top administrator in the early years. It was an imaginative scheme, one that was admired the world over. Now, however, this wonderful scheme is left to the tender mercies of the most reactionary Government that this country has experienced for the past 50 years. It is a tragedy of the first order.

For any Government, the health of the whole nation should be a major consideration. I repeat, the "whole nation", not just those who can afford BUPA subscriptions, although it is rumoured that the Chancellor of the Exchequer is considering tax reliefs for people making those contributions. Privatisation is undermining the National Health Service, as would subcontracting schemes, by taking away work from people in the service and probably getting it done less efficiently.

The Government's rigid cash limits are the cause of the present dispute. Several thousand Health Service workers live in my constituency, and I have talked to them. I admire the courage and resolve that they are showing. They are responsible people, who have undertaken their present action with the utmost reluctance. It is noticeable that the TUC health committee has refused to call an all-out strike. It is this sense of responsibility that the Government are exploiting.

People are being inconvenienced. I speak with some personal experience. My wife is at present in hospital. Her operation was put off for a week because of the dispute. I do not blame the Health Service workers. I put the responsibility squarely at the feet of the Government. If they have any moral conviction left to back up their rigid stand, why do they not put the matter in the hands of ACAS? I feel sure that Mr. Pat Lowry could soon find a formula to settle the dispute. But the Government shrink from listening to an independent impartial voice. It is all very well to talk about establishing new machinery. Why did they get rid of the Clegg commission, which was established for the very purpose of avoiding the sort of dispute that we are now experiencing?

New procedures for the future will not solve the present dispute. The only real initiative from the Government has been a crude attempt to separate one section of the service from another. They tried to settle separately with the nurses. Now, according to what the Secretary of State stated today, it is to be the radiographers. The Government exploited the reluctance of the nurses to take action, because of their close relationship with the people whom they nurse.

The National Health Service is essentially an integrated service and should be treated accordingly. I ask the House to consider the pay of ambulance men, many of whom are represented by my own trade union, the Transport and General Workers Union. They are vital to the service. In emergencies, the life of a patient is in their hands. Yet, for a working week of 46 hours, they recieve £128. The pay of the police for a 39-hour week is £171.60. Is not 12 per cent. for ambulance men a reasonable settlement?

The pay of a student nurse is £63.09. A new entrant to the police receives £107.88. Comparisons are perhaps odious. I appreciate that the police have a difficult job. However, what we are calling for is parity, a bit of wara teg, as we say in Wales, a bit of fair play. Low pay is endemic in the National Health Service. Yesterday, one of my constituents, a senior lay officer in the construction workers union, UCATT, visited the House. He told me about the grievances of craftsmen in the National Health Service. The bitterness has gone deep, and the Government have much to answer for, yet they gave 18.6 per cent. to the judges, and that was defended by none other than the Lord Chancellor as a very deserving case. My contention is that if there are to be sacrifices, at least they should begin at the top.

The 12 per cent. claim of the National Health Service workers is modest and reasonable. One has to compare the Scrooge-like attitude of the Government towards the Health Service workers with their enthusiasm to waste millions of pounds on the new Trident project. All that the Health Service workers are asking for is an increase commensurate with the level of inflation last year. Their pay has fallen behind. Their position should not be allowed to deteriorate even further.

It appears, however, that more Health Service cuts are on the way. People in Wales are frightened about the Government's proposals, some of which have come to light. My hon. Friend the Member for Crewe (Mrs. Dunwoody) raised the matter from the Front Bench.

The Under-Secretary of State for Wales (Mr. Wyn Roberts)

I am sorry to hear the hon. Gentleman follow his hon. Friend the Member for Crewe (Mrs. Dunwoody), who was, of course, talking nonsense about the situation in Wales. This was made clear by my right hon. Friend the Secretary of State in the House on Monday, when he stated that we had not decided the allocations for the Health Service in Wales next year. If we have not decided what the allocations are to be, how can there be cuts? What have been described as cuts are, in fact, moneys being set aside for essential developments in the Health Service in Wales.

Mr. Hughes

I am glad to hear what the hon. Gentleman the Under-Secretary of State has to say, because a Welsh Office document on Health Service resources in Wales in 1983–84 talks about a cut of £56 million in the service, together with substantial job losses of up to 9,000 in the immediate years ahead. That is the truth of the matter—

Mr. Wyn Roberts

rose—

Mr. Hughes

No, I shall not give way.

Mr. Deputy Speaker (Mr. Bernard Weatherill)

Order. Interruptions lengthen speeches, and there is a long list of hon. Members who wish to take part in the debate.

Mr. Hughes

According to the chairman of the area health authority in Gwent—I have this in writing from him—a meeting took place last Friday between area health authority chairmen in Wales and the Secretary of State to discuss possible cuts in the service. I am still waiting for the reply of the chairman of the AHA of Gwent about what is proposed for our county.

Wales, and the country as a whole, need not cuts but increased expenditure on the NHS. After all, the Government receive tax revenues from North Sea oil that are estimated at anything between £2 billion and £4 billion, according to Mr. David Lipsey of The Sunday Times in his article on 17 October.

What is happening to the Health Service is nothing short of a tragedy. I feel that it can be resolved only by a general election. What Britain needs is a Labour Government to put those 4 million people back to work so that they can make a contribution to the wealth of the nation. That is the way to provide a National Health Service of which the nation can be proud.

5.51 pm

Mr. Tom Benyon (Abingdon)

It is with a sense of deja vu that I make a humble contribution to yet another debate on the subject of the National Health Service. I congratulate the hon. Member for Crewe (Mrs. Dunwoody) who, each time she reads her brief, does it better. It is nice to hear it for the fourth time. I hope that I did not put her off because my lips were moving in time to hers as she read.

The motion obscures the real crisis that faces the NHS. This happens because the truth of these matters has been obscured. The symbol of this matter is the wholly bogus motion, culled from Labour's prime collection of cliches, using every cliche, such as "the Government's stubbornness" and the Government's refusal…to enter into serious negotiations". Before I read much further I should point out that I knew that the Labour Party would call in the old hoary word "compassionate", and it has.

All these cliches obscure the real problems that face the NHS. The problems are also obscured by the union's obduracy, shown during the dispute, and the use by the unions of the natural sympathy generated by the case of the nurses and the health workers. This has been used as a political manouevre by the unions and the Labour Party who want to do their utmost to damage the Government.

The real problems that face us are overmanning and waste in the NHS. They are the chronic problems of what to do with the old, the geriatrics, and the mentally ill. It would be nice to have a debate on these weighty and important matters. Instead, we have a debate on the matter that I have outlined, with the Labour Party, yet again, attempting to put short-term political advantage before the real problems of the NHS.

Mr. Freud

rose—

Mr. Benyon

The truth is that at one point £1.1 billion was on the table for discussion with the health workers. They know, and everyone now knows—the public understand a great deal more than the Labour Party gives them credit for—that the nurses' and the health workers' cause is being used to attempt to crush the Government 's cash limits. Opposition Members who talk about the Conservative Member's lack of ability to negotiate and arbitrate are wrong . Had the Labour Party been in office, it would have taken the soft option, which would have led to the inflation that we are attempting to squeeze out of the system.

Thank goodness that people know the truth. They know what the unions and the Opposition parties are trying to do. They do not believe that we are trying to dismantle the NHS. That is the biggest lie of all. It is hauled out at every conceivable debate and it embarrasses us to such a degree that, for instance, when a Think Tank report proposes options for us to look at—and we must surely look at some options to save money to improve health care—we have to withdraw it.

The health unions are not prepared to negotiate, but the nurses and the midwives are. They recognise that there .is a unique offer on the table for them.

The problem of low pay is not new. It is remarkable that we have done so well for the health workers in the face of the worst recession that the country has seen. We accept that there are some in the Health Service who are low paid.. This has not occurred since May 1979. It was a problem when the Labour Party was in Government. The Labour Party did something about it, but not enough. We have increased the pay of health workers by 61 per cent., which is 12 per cent. ahead of inflation. The offer on the table looks better week by week and month by month as inflation drops.

There is chronic overmanning in the NHS. There were about 400,000 full-time workers in 1949. There are now 806,000, but we have not doubled patient care Bed occupancy has dropped from 389,000 in 1949 to 293,000 in 1979. The waiting list is up from 401,000 to 611,000, and there are many more examples.

I hope that the Government will find time to have a manning levels inquiry, because much of what has gone on, despite the Government's attempts to introduce sanity, is due to trade union obduracy. There are 5,000 grades of staff in the NHS. We must try to rationalise that.

There may be attempts to have a further day of action. The original day of action did not serve well the cause of the health workers. The worst thing that the nurses and other health workers have done is to accept the embrace of the other unions who are trying to squeeze popularity out of them, in the hope that some of that popularity will rub off on their extreme unpopularity. The day of action cost cash and introduced yet another downturn in the level of unemployment. How could it have helped the health workers?

The cynical way in which other unions look on the health workers is best shown by the fact that the miners, bless them, are prepared to support the nurses and health workers over the 12 per cent. increase, but want 31 per cent. themselves. The Ford workers are prepared to support a 20 per cent increase for themselves and support the health workers in their 12 per cent. claim. They are all attempting to jump on the bandwagon.

I should have liked just one union leader to tell us which group of workers will accept less if the nurses want more. Will they say who would be prepared to accept less in the public sector for the nurses' higher pay? Do they wish higher pay for all—

Mr. Stoddart

rose—

Mr. Benyon

I cannot give way. I am following Mr. Deputy Speaker's directions to be brief.

Do the unions wish to have higher pay for all? I cannot think of a single strike threat that has been wielded to blackmail the Government that has not received the support of the Labour Party. If the Secretary of State decides to pay more, what evidence is there that other groups will settle for less? There is already £1.1 billion on the table. The 3.35 million unemployed and the recession are still behind the argument.

Is it possible for inflation to be reduced further if all the unions' claims are met? If we meet this pay claim, it will be at the expense of the facilities that are available for those who need the National Health Service and it will increase inflation. Inflation is the biggest enemy of the low-paid. Health workers are the low-paid. If all the claims were met, inflation would come in their wake and the nurses and health workers would be worse off.

The misleading, short-sighted tactics and campaigns of the TUC in its support for the health workers is disastrous for them, because the bulldozing of the Government's cash limits by the trade union movement would bring increased inflation and create further unemployment. It is not monetarist madness to adhere to cash limits; it is compassion for the lower paid. The TUC is not giving the health workers fraternal support; it is giving them a slap in the face. Short-term economic claims contribute to further misery and economic disaster in the long term.

I call upon the health workers to return to the negotiating table and to listen to what the Government are offering. Although they are offering two years in one, I am sure that the Government would be prepared to talk about allocating the £1.1 billion on a cash rather than a percentage basis. That would reward those in the Health Service who are badly paid. We are prepared to listen. We do not have our eyes shut; the trade unions do. Let us unplug our ears and return to the negotiating table to settle the strike.

6.2 pm

Mr. William Hamilton (Fife, Central)

I want to refer to the statement by the Secretary of State on Monday, to his speech today and to the Prime Minister's remarks yesterday when she talked about laying the blame on "ill-motivated" trade unionists. Those statements reveal the Government's strategy for dealing with this dispute. From the Government Benches we have heard several expressions of compassion for patients. At their Brighton conference the key word was "compassion", and I shall return to that.

The second arm of the Government's strategy—as the Prime Minister said—is to condemn what they portray as the irresponsible, uncaring trade unions.

Thirdly, they wish to split the trade unions—that is NUPE and COHSE—from what the Minister calls the professional members of the Health Service—the Royal College of Nursing, the Royal College of Midwives, the health visitors and others.

The fourth arm of the Government's strategy is to persist with the claim that the present offer is generous and that there is no more money. There will be more jam tomorrow, or at any rate in 1984 if not tomorrow.

I shall look at each of those four arms of the Government's strategy. The first is compassion and care for patients. No sight is more grotesque than the Tory Party posing as the party of compassion. At their Brighton conference Ministers and delegates kept hissing out the word like snakes in a cage. Nobody—not even hon. Members on the Tory Benches—thinks of compassion as the outstanding trait of the Prime Minister or the Secretary of State for Employment. They cannot talk about compassion in relation to the National Health Service. We established it, and we shall defend it from their depredations.

Of course patients are suffering. People suffer whenever industrial action is taken. Let us look at some newspaper reports that show Tory compassion. Last Sunday the Sunday People talked about the imminent closure of Great Britain's top cancer screening unit. At the Royal Marsden hospital in London, 10,000 women are screened yearly. That hospital is threatened with closure within months. I hope that the Minister will tell us that the £100,000 needed to keep it open will be provided forthwith. If the Minister guarantees that the hospital will not be closed, that will show his compassion. The newspaper says: It will shut in March unless the £100,000-a-year running costs can be found from public donations. That is a horrifying and disgusting proposition.

Let us look at the comment in The Guardian of 14 October, which my hon. Friend the Member for Crewe (Mrs. Dunwoody) mentioned. It said that cuts announced by health boards in England, Wales and Scotland were likely to reach £100 million. That cannot be done by reducing staff. It can be done only by reducing services, if not abolishing them altogether.

The hon. Member for Abingdon (Mr. Benyon) said that staff savings could be made, but the Glasgow Herald said yesterday: The Government is standing firm over the £6 million 'cost-cutting' battle with Greater Glasgow Health Board which the latter claims could lead to sweeping reductions in hospital services. The board chairman said later 'the health service in Glasgow is entering a very traumatic period'. The newspaper quoted examples of closures and added: The board agreed last month to seek the meeting with Mr. Younger"— that is, the Secretary of State for Scotland— after recommending savings of £3 million ranging from the loss of 250 beds from Glasgow hospitals to closing the chest and tuberculosis wards at Mearnskirk hospital and 60 non-surgical beds at Duke Street hospital. The Government should not talk to us about compassion for patients when that sort of action is going on all the time.

Under the headline in The Observer of 10 October, Cabinet bans new hospital building", the article said: An immediate freeze on all new hospital building has been ordered by the Government. The Minister said that that was merely in the pipeline and did not mean anything. That circular has gone out, and the Minister had better deny it and state categorically that all new and projected hospital building is continuing.

Mr. Kenneth Clarke

I apologise for intervening, in view of the pressure on time. I have not intervened previously, although we have heard a stream of inaccuracies from Labour Members. The hon. Member for Fife, Central (Mr. Hamilton) described the letter as a freeze on capital building, but we have approved contracts for two new district general hospitals in England alone since that letter was sent out a month ago. The hon. Member is relying on an inaccurate newspaper report and then colouring it himself.

Mr. Dickens

Withdraw.

Mr. Hamilton

I shall certainly not withdraw. I asked the Minister whether that letter has been sent. [Interruption.] Of course it has, and we should see it.

The Prime Minister is trying to put the blame on what she calls irresponsible and uncaring trade unionists. I know most of the trade unionists personally, and they are much more devoted to the Health Service and its principles than the Prime Minister ever was or will be. She cannot talk to us about compassion. The Northern Echo, which is a Tory paper in the North-East of England, stated: Health Ministers talk as if they were conducting a war against Argentine conscripts. It simply isn't good enough to lay the blame, as the Prime Minister did in the Commons yesterday, on 'ill-motivated' trade unionists. Is she thinking of the hyper-moderate Royal College of Nursing? Is the Welfare State really safe with Mrs. Thatcher? She hasn't been too convincing so far this year but there's still time in which that assurance can be backed by action. She should tell Mr. Fowler to put new money on the table or agree to go to arbitration, which is what he should have done at least 27 weeks ago. The Government's fourth justification—that the offer is generous, that there is no more money now and that there will be jam tomorrow—does not bear investigation. Even if the new package is accepted, the fact is that for the past two years Health Service staff, including the nurses, have been asked to accept a reduction in their standard of living. In each year since the Government came to power, pay increases have been less than the increase in inflation. This especially affects nurses who live in nursing hostels, where the lodging allowances have increased.

As to the argument that there is no more money, I repeat what I have said many times in these debates—that there is plenty of money available. When the Falkland Islands war broke out—largely because of the Prime Minister's incompetence—she came to the Dispatch Box and said "No matter what the cost, we shall see it through." We do not know how much money the war cost, but we know how many lives Lt claimed. However, it will cost not less than £1 billion and probably much more.

I hope that after the next general election the Labour Party will make a similar commitment to the Health Service. We shall say "The Health Service is so precious to our people that, no matter how much it costs, we shall ensure that it becomes a first-class service that is once again the envy of the world." If the Tories win the next election, the Health Service will disappear. The Think Tank and Treasury Ministers have said that. The Prime Minister knows the score and says that the matter is on the shelf. However, if she gets her clammy hands on the Health Service after the next election, we can say goodbye to it, which will be a great disaster.

6.14 pm

Mr. David Crouch (Canterbury)

I must declare an interest. I am a director of a pharmaceutical company and a member of a regional health authority. I say to the hon. Member for Fife, Central (Mr. Hamilton) that if the Health Service were to disappear, I, too, would disappear. I have worked in the Health Service for 12 years. My heart is in it and I believe in it 100 per cent. I shall defend it to the last and always fight for its improvement. The House knows where I stand.

I stand today, as usual., behind my Front Bench. I remember being in such a position almost 10 years ago when I showed sympathy with the miners over pay. I believed then that the miners had a case and that they performed a vital task. I condemned their industrial action, but I argued that their case should be heard. I knew the industry and I knew miners, both in my constituency and during the Second World War. I must tell the House and my Front Bench that I also have some sympathy with the nurses and others in the Health Service over pay. They have a case. They all perform a vital task from top to bottom in the Health Service. But I condemn absolutely their industrial action and the support that they have received from the TUC and the Labour Party.

I know many health workers and I have great admiration for them. A case can be made today for investigation and sympathetic understanding—a case for talks, not strikes. The House has an opportunity today to set an example of understanding both sides of the dispute, which has continued for seven months, and of understanding the reality of pay slips and the cash limits that must apply in every Government Department. We should do that rather than try to turn the issue into a political fight. Hon. Members on both sides of the House believe that all low -paid workers have a grudge. Their pay slips are evidence of the grievance. Arguments about percentages and job security will not pay fuel and rates bills or cover mortgage repayments. To the low paid, arguments about the falling rate of inflation are only a dream of tomorrow amid today's reality.

The Government must appear to be inflexible to the low paid, but they have their reasons. As there is a case to be heard on both sides of the dispute, let us bring the sides together to talk not only about pay but about the future of the NHS. Where should we start when we talk about the future? We must start with the patient, because we must find out what he needs. We must go to the front line to find out what the Health Service staff believe that they need. We must show there that we are interested, ask questions and work back from there. We must again inspire the Health Service troops, from the surgeons and physicians to the kitchen staff and cleaners because they are all vital members of the team that makes up the National Health Service.

We all use the Health Service. We know that clean hospitals and clean laundry are vital and that highly trained and experienced surgeons and physicians must make important decisions to save lives. Everyone is vital, but not everyone in this massive service that employs 1 million people appreciates that. The NHS is the biggest "industrial" and business operation in Britain today. Those working within it need to feel that they are vital to its success. They must not be allowed to feel that they are pawns in an unofficial pay policy. They should never be taken for granted or forgotten.

How can the task be achieved? I speak from experience. It is desperately difficult to get to grips with anything in the NHS. I sit on a regional health authority, which is big enough, and I know that that is so. From the Elephant and Castle, where the Secretary of State and the Minister sit, it is difficult for them to appear to the 1 million people beneath them as the bosses and as those who can achieve something. The organisation is too diffuse and wide. Today the NHS is a bureaucratic morass. Management is monolithic. We are all so busy dealing with endless papers, reviews, seminars, studies, budgets and priorities. Everyone seems to be overworked. No one is slacking and somehow, despite the fact that they are overworked, the people cope and still give a remarkable service.

The task is becoming bigger every day. People now live longer and cost more to the Health Service. They want the most modern and expensive treatment. They are entitled to that. As I have said, the NHS is our biggest business. The Government have increased their funding. I shall not bore the House with more figures because we are all aware of them, but the Government have increased their funding enormously. I should like it to be increased still more, but I should like first to see an improvement in the management and a radical change in the way that everything is managed. In the past 10 years there have been two reorganisations. I am talking not perhaps about another complete reorganisation but about new leadership and control and about the new dynamic management that must be introduced. Perhaps an Edwardes, even a Weinstock, and—if the SDP will forgive me—even a Harvey-Jones is needed. I am talking about introducing such people not to privatise the Health Service but to cut the cackle, the red tape and the overmanning and to cut across the artificial barriers as a result of which patients are left on trolleys, in draughty corridors on the way to the operating theatre, because the porter is not there and the young doctor dare not push them. Those are the barriers that must go.

With better dynamic management we could produce a better service for the patient, and the staff would welcome it, however strange and difficult it might seem when introduced. It is those on the spot and at the sharp end who will eventually pull it off if given the chance—the PBI of the NHS. First, they need not just a pay settlement, but—above all—leadership. They need a boss they can find and talk to. There must be fewer committees and less committee management and, most importantly, less paper and much more action. We could also do with a good deal more real democracy and a little less snobbery. Unfortunately, snobbery is endemic in this profession. Consultants and doctors would do well to listen to the views of their assistants, not only the junior doctors and nurses, but the porters, cleaners and cooks. They are all specialists in their own ways.

Where do we come in? We have the nerve to debate this great service, with the nation taking note perhaps of what we say. Until now we have been seen as little more than a rowdy debating chamber. That is no way to help the sick. Today we have a duty to be more responsible. We should be giving a lead and we should all condemn the strikes and days of action and should disown such action. There is no room for party bickering on this subject. Cannot we be a united House and call for an end to the strikes and, instead, demand that talks should begin?

Mr. D. N. Campbell-Savours (Workington)

Arbitration.

Mr. Crouch

I cannot agree to arbitration, because it can be open-ended and we cannot be open-ended in a severe economic crisis. However, there is enough money on the table—£1,100 million—and enough room for negotiation and flexibility. A settlement must be reached on pay and position—not forgetting the patient—that does not leave a legacy of bitterness. We have reached a turning point in the history of the medical profession. If people work in it because they are dedicated to the service of others, for goodness sake let all parties show that they recognise the dangers and are prepared to lead the way towards peace and progress in this great service. Then perhaps we shall rekindle the spirit that still flickers in the minds of those who choose to work for the sick—the spirit of service.

Let us snuff out the spirit of strike now, today, before it sets fire to one of the proudest achievements in our modern civilisation.

6.27 pm

Mr. Mike Thomas (Newcastle upon Tyne, East)

There is no question but that the nurses and health workers have a good case. I do not think that there is any hon. Member, including the occupants of the Government Front Bench, who would not concede that.

However, I was slightly worried when I heard the Secretary of State talking about the TUC leaflet and the definition of low pay. He seemed to suggest that he confined his support to the notion that £75 to £80 a week gross was in some way low pay. However, at the time of the Labour Government's ill-fated 5 per cent. incomes policy, the right hon. Member for Leeds, East (Mr. Healey) and the then Prime Minister the right hon. Member for Cardiff, South-East (Mr. Callaghan) defined low pay as £44.50 for a normal full-time week. Even then, under pressure, they made special arrangements for those earning less than £70—the so-called £3.50 provision. I do not recall the Conservative Party challenging that definition of low pay.

Let us be clear about it. In today's terms, £44.50 is equivalent to about £70 when inflation is taken into account, and to about £74 when the movement in earnings since the early part of 1979 is taken into account. Therefore, £70 is probably worth about £105 to £110 today. On any standard, many health workers, probably all nurses below the grade of sister and about three-quarters of ancillary staff—those in the bottom four grades—are low paid. Indeed, they are low paid despite Clegg, for which the Secretary of State seemed so anxious today to claim credit. They are low paid because, after Clegg, the Government abandoned the idea of fair treatment for health workers. In addition, the Government have exacerbated their sense of unfairness by effectively having a tight cash-limited incomes policy for the public sector, while there is no policy whatever for the private sector. My God, how will they sustain that if ever a little expansion comes along?

They have exacerbated the sense of unfairness by giving in to union muscle, even within the public sector—the power workers, water workers, and miners. They have also exacerbated it by giving in to privilege in the public sector—the judges and others—and by keeping their word to the police and the Armed Forces but not to the nurses.

Another way in which the Government have exacerbated a feeling of unfairness is by trying to divide the nurses from the other grades of health workers. We saw the Secretary of State at it again today. It is no use the Government seeking to abdicate their responsibilities, as the Secretary of State does in all his handwashing performances in the House. The Government have a totally cynical policy, which is to give in to workers who have muscle and to exploit those who have not, regardless of their worth to the community. The Government are now actively trying to bully and cheat the health workers. Why otherwise would the Government be referring to the current year-on-year inflation when they know that the tax and price index—their own construction—rose by 15.6 per cent. in the 12 months covered by the settlement? The Government also know that £l.1 billion spread over two years for this group of workers represents a substantial real decrease in pay on even the most optimistic assumptions about inflation in the next 12 months or so.

The Government must take their share of responsibility for the short-term effect of the dispute on patients, waiting lists—referred to in the amendment—cold surgery, and the effect on the present ballot among Royal College of Nursing members. If rule 12, the "no-strike" rule, were to be thrown out by the ballot as a result of this dispute, that would really be to throw the baby out with the bath water. How crazy that would be.

The Government must also accept responsibility for the effect of the dispute on the prospects of a long-term settlement. I listened with great care to the hon. Member for Canterbury (Mr. Crouch). I share his feelings. The Government must accept responsibility for the legacy of bitterness which will remain in the Heath Service and which will make it a worse place in which to work and be a patient.

The trade unions must also accept their responsibilities. I exempt the RCN from some, but not from all, of what I shall say. As the Government say—and the Opposition are foolish not to accept this—industrial action in the Health Service cannot be taken without harm to the patients. We all know that even the code of practice that was formulated by the TUC health services committee in 1981—"Improving Industrial Relations in the NHS"—has its roots in the winter of discontent.

I illustrate how far we have gone down this slippery slope by referring to the code of practice which was issued as part of the "Concordat" with the TUC in February 1979 by the Government in which the right hon. Member for Leeds, East was the Chancellor. It said: the General Council advise that for the duration of an industrial dispute, the unions involved should, where necessary, make arrangements in advance and with due notice, in consultation and preferably by agreement with the employer, for the maintenance by their members of supplies and services essential to the health or safety of the community or otherwise required to avoid causing exceptional hardship". By the time that the code for the Health Service was issued just two years later in 1981, the provisions generally applied in the code under the "Concordat" negotiated by the right hon. Member for Leeds, East and his right hon. and hon. Friends had been reduced by the TUC so that they referred only to "emergency and high dependency patients". The code has moved not to agreeing to protect the community and all patients, but to protecting only "emergency and high dependency patients".

The stark contrast becomes even clearer if one examines the original code in the "Concordat". I refer to item No. 8 in which the TUC agreed with the Government that trade union members should . . ensure that systems essential to their wellbeing continue to function and that supplies of foodstuffs are maintained. That is what in 1979 the TUC was prepared to do for livestock, not human beings. The TUC code of practice in 1981, which I admit is better than nothing, does not provide that which it provided for livestock in 1979. That means that food and supplies may not now necessarily reach patients in National Health Service hospitals unless "emergency and high dependency patients" are involved.

I do not suggest that trade unionists are behaving like evil men who are starving patients and attempting to do them down. I mention that simply to illustrate the way in which industrial action in the Health Service has accumulated a corrosive quality which has become more and more acceptable in the last two or three years. We must recognise that we are on a slippery slope. If we move down it further as a result of the RCN ballot, grave long-term consequences will ensue.

I understand that the right hon. Member for Leeds, East will speak for the Opposition tonight. We should examine how the Labour Party's attitude has changed. When the right hon. Gentleman presented the Sara Barker memorial lecture on 8 September 1979 he said: I fear the reason why we lost the last election is the same as the reason why we lost the election in 1959—that 'working people voted against the consequences of their own irresponsibility'. Harsh words perhaps—but they are not mine. They are those used by Aneurin Bevan about that earlier defeat. Those words are right. It is a measure of how the Labour Party has changed that I doubt whether the right hon. Gentleman could make such a speech today. Indeed, the last person who said anything remotely like that about the changed attitude of the Labour Party and the way in which it is prepared to condone and encourage actions on behalf of the trade unions in the health and other life and death services was Sid Weighell who spoke about the TUC's pay restraint policy on 8 September. He warned: If you carry this resolution you will destroy at a stroke the possibility of winning the next election. Our people will not believe that you are capable of governing. I believe that the Labour Party is now not capable of governing. One of the critical signs is its unthinking support—[Interruption.]—of dangerous industrial action in the Health Service and another is its incapacity to do anything other than to shout down opinions which it does not wish to hear. The unions must ask themselves a central question: is there more public support now for the dispute than before industrial action began? I believe that by that crucial test the industrial action has failed. The public now have grave reservations about the propriety of the dispute. I do not believe that the health workers are doing anything now other than to attrite an originally high level of public support.

The unions are slowly giving the Government a bigger and bigger stick with which to beat them. They are creating an atmosphere among patients and workers in the Health Service that will do great damage.

Mrs. Dunwoody

How will the hon. Gentleman vote?

Mr. Thomas

With a heavy heart, I shall vote for the Opposition motion. However, I thought the personal innuendo with which the hon. Member for Crewe (Mrs. Dunwoody) moved the motion was not at all helpful. If the hon. Lady wishes to engage the support of other Opposition parties, she should be careful that she does not try us too far.

What should be done? I agree with the hon. Member for Crewe that the Government should do what they should have done at the outset—to send the dispute to arbitration. If the Government are worried that an arbitrated settlement would produce a split-the-difference arrangement—they may be right; that is what some Labour Members and some trade unionists want—I suggest that they should appoint an arbitrator who is acceptable to both sides, ask the unions to submit a new claim, submit a new offer themselves and instruct the arbitrator that he may choose only one or the other. That would make sure that the union claim is realistic—we all know that 12 per cent. is not realistic—and that the Government's offer is realistic.

If the Government want a practical and imaginative way forward, that process of arbitration, which has been used elsewhere and is not unduly complicated, even for some of the less elevated minds on the Tory Benches, could produce a solution.

In the longer term, we ought to have a system of arbitration for the NHS and all the life-and-death services as a matter of course before strike action in pay disputes is even comtemplated. We should aim to extend the "no-strike" commitment of nurses to the rest of the NHS work force and have it underwritten by acceptance in ballots. In return, we should provide a fair system of pay determination to maintain their living standards in relation to comparable groups. There should be no reluctance to go to arbitration if the outcome of fair comparisons is challenged by either side.

The acceptance in a ballot of a "no-strike" commitment would mean that if union negotiators in the life-and-death services wished to reject the outcome of arbitration, they would be obliged to ballot on the arbitrated award before a strike could be called.

That would be a sensible way to proceed, and the Government are making the critical mistake of being prepared to trade the long term for the short term. They can probably beat the health workers into sullen submission, but the House is entitled to ask whether it is worth the long-term price. I wholeheartedly believe that it is not—for the patients, the taxpayer or the country.

Every speech like that of the Secretary of State today contributes to ensuring that this dispute will profoundly damage the NHS and the altruistic principle on which it was founded and which used to motivate most of those who work in it.

6.43 pm

Mrs. Renée Short (Wolverhampton, North-East)

It seems that there is agreement on both sides of the House, except on the Government Front Bench, that action should be taken to go to arbitration to settle the dispute. I hope that by the end of the debate the Minister for Health will be able to tell us that he has accepted that good advice.

I listened carefully to the Secretary of State and I was disappointed that he was so intransigent. There was no give at all, the right hon. Gentleman was not prepared to concede that he had made mistakes and he would not accept the advice of my hon. Friend the Member for Crewe (Mrs. Dunwoody). That sort of attitude will not get us anywhere. There must be a meeting of minds and a coming together of both sides.

As my hon. Friend the Member for Fife, Central (Mr. Hamilton) said, the Labour Party is proud of the NHS. We introduced it. The service has been deprived of adequate resources and, although I do not claim that Labour Governments have not sinned in that regard, the NHS has never been so deprived as it is under the present reactionary Government who are dedicated to reducing public expenditure, irrespective of the cost or the damage that is caused.

The Prime Minister said at the Conservative Party conference: We have done more than any previous Tory Administration to push back the frontiers of Socialism and in our next term we intend to do even more. The whole country has been warned what is in store if the Tories win the next election. A few sentences later, the Prime Minister said: The National Health Service is safe with us. I wonder how the Prime Minister can reconcile those two statements. No one else can; they are highly contradictory.

The Government have allowed industrial relations to deteriorate and levels of pay to decline so that 62 per cent. of NHS workers earn less than £100 a week. No one can say that that is a high salary for those who work as hard as NHS workers.

The Government are apparently willing to put lives at risk rather than meet the just claims of those who care for the sick, and that is despite the massive support for the NHS workers from a wide section of the community. The medical profession has given massive support in some areas. The Medical Practitioners' Union has publicly and openly supported the NHS workers, some doctors have supported the picket lines in several parts of the country and it may surprise some of my hon. Friends to learn that the treasurer and chairman of the BMA have supported the pay claim. The hospital junior doctors carried by a substantial majority a resolution in support of the health workers. It is not true to claim that there is no support for the claim except among the health workers themselves. There has been considerable support from other areas.

The only groups that seem not to support the health workers are the Tory Party and the SDP. The SDP's conference chairman said at one of the three circus performances—I forget which—that NHS workers were "seeking a confrontation" with the SDP in order to embarrass the party and that it was a "deliberate act of provocation". It is interesting that she feels threatened by workers doing an important and often tough job, many of whom get rates of pay that are comparable only to social security benefit levels. They are among the lowest paid in the country.

Mr. Mike Thomas

Will the hon. Lady give way?

Mr. Doug Hoyle (Warrington)

The hon. Gentleman would not give way to anyone.

Mrs. Short

The hon. Member for Newcastle upon Tyne, East (Mr. Thomas) should do as he would be done by if he wants hon. Members to give way to him.

It is significant that all other groups of public sector workers have done better than the NHS workers, from the senior judges—I suppose that one can call them public sector workers—with their magnificent 18 per cent. on top of a generous salary, to the police with 13.2 per cent., the firemen with 10.1 per cent., water workers with 9.1 per cent., miners with 8.6 per cent. and local authority manual workers with 7.5 per cent.

The increases offered to nurses range from 39p a week for an auxiliary nurse to 89p a week for the most senior nursing officer in the nurses and midwives Whitley council agreement. The proposed increased board and lodging charges mean that a ward sister would get £36 less than her current salary, even with the 7½ per cent. increase that has been offered. Let the Minister for Health work out the mathematics and see how he can improve on the offer.

So far, 1981–82 has been the best year since the Government came to office for current spending on hospital and community health services. There was a growth rate of 2.1 per cent. compared with 0.9 per cent. in 1980–81 and zero growth in 1979–80. But those levels were lower than the rates in 1977–78 and 1978–79, under the Labour Government, when the increases were 2.9 per cent. and 2.4 per cent. respectively.

When the Select Committee on Social Services was considering the White Paper on public expenditure, the Secretary of State told us: Here is the base line—that is the minimum and I would not like to see any further cut in that. What, then, has he said to the Chancellor of the Exchequer, who was reported in The Guardian of 11 October as demanding further manpower savings of 10 percent? How much more damage is to be done and what is the Secretary of State doing to prevent it?

The last Budget made it clear that there would be nothing for the National Health Service from the Government. None of their pre-election promises has been fulfilled. During the election campaign we heard a great deal about a "caring society". The Government's second upheaval in NHS administration was supposed to bring further democracy and more local responsiveness with less bureaucracy. Has it done so? If not, what do the Government intend to do about it? The Secretary of State has certainly been ruthless in removing a number of Labour chairmen in the regions and replacing them with his political friends, practically all of whom are innocent of any great experience of the National Health Service.

The White Paper on expenditure expects health authorities to find at least £17 million for further development by increasing efficiency. That is 0.2 per cent. of their budget. In 1983–84 and 1984–85, they are expected to push that up to 0.5 per cent. If they can do that, well and good—they will have some more money. If not, as is far more likely in the present situation, their resources will decline still further. As the Select Committee said, for "efficient savings" one might well read "expenditure cuts".

Part of the so-called dynamic Tory dream of which we heard so much before the election was to find alternative sources of finance. That has not happened. What does the Minister of State, the hon. and learned Member for Rushcliffe (Mr. Clarke), intend to do about the scandalous situation in Nottingham? I am not sure whether the new Nottingham hospital is actually in his constituency, but it is certainly in his part of the country. How much longer must his constituents go on using old hospitals that should have been closed years ago while at the new hospital, which was started in 1971 as a partnership between the university and the Trent regional hospital authority, 700 of the proposed 1.400 beds remain unopened, 25 wards are empty and it is costing £300,000 per year to keep them closed? What a marvellous way to use resources in the National Health Service! To open them would require a further £2 million. Nottingham would then have a splendid modern teaching hospital with 1,400 beds in operation.

Like all other medical schools, Nottingham has had to suffer cuts imposed by the University Grants Committee and will therefore face a rapid decline in its clinical departments. Surgery, paediatrics, obstetrics and gynaecology and radiology will all face a 15 per cent. cut. That is an enormous cut in terms of patient care. In December 1980, the Secretary of State for Education and Science told the UGC that cuts were to be imposed on universities with no protection for any department in the future. It was therefore clear that clinical medicine was in jeopardy. The chairman of the UGC met the permanent secretary at the DHSS in May 1981 and warned him that clinical medicine was in such serious difficulties that budgets were being cut by between 11 and 12 per cent. and many posts were to be frozen.

Thus, the problems are being faced not only by the ancillary and nursing staff but right across the National Health Service. No part of the Health Service is exempt. In Leeds, 18 clinical posts have been lost. It might be a good idea if the Secretary of State for Education and Science visited his own medical school. Aberdeen has suffered a 23 per cent. cut in grant, while Birmingham, Dundee, London and Wales have faced 17 per cent. cut s. Leicester had the lowest cut of 9 per cent., so all the medical schools have suffered cuts of at least 9 per cent. As a result, about 300 clinical posts will be lost by 1983–84. That is an extremely serious situation and the Minister should be very concerned about it.

As well as having serious effects on teaching, this has far-reaching implications for medical research and for patient care. Clinical staff treat NHS patients as well as teaching undergraduate and postgraduate students. Thus, many new research projects as well as considerable contributions to patient care will disappear. Britain has made a most important contribution to medical research and practice and our influence in medicine is world wide. Students come from all over the world to train here and our research and our postgraduate institutions have an ongoing influence through the postgraduate students who have worked here that is unsurpassed elswhere in the world. The Government are bent on throwing away that asset for the sake of a saving of £10 million. It is incredible that they are prepared to cause so much damage to clinical medicine for such a small sum of money. It is an act of unbelievable vandalism even for this Government.

Hon. Members have referred to the problems of Westminster hospital in treating children who require bone marrow transplants and who are now at risk because of lack of money. What has the Secretary of State to say to my area health authority about the cost of maintaining sophisticated technological equipment? The Government seem not to understand that as medical science progresses and becomes increasingly reliant on highly sophisticated technological equipment, the cost of servicing that equipment has to be met by the Health Service. Additional resources have not been found to meet that. The new hospital in my area has a CAT scanner and a linear accelerator. The cost of servicing these has increased dramatically. It now costs £28,000 a year to maintain the scanner, £9,000 for the accelerator and £7,000 for the planner that links them. What are we to do? Do we rob Peter to pay Paul—or, rather, rob Peter to maintain and service Paul—or do we stop treating cancer patients? Perhaps someone on the Government Front Bench can tell us. Is Westminster hospital to tell the 150 children needing transplants that they cannot be treated because there is no money?

What are the Government doing to face the greatest challenge that now faces us with the increase in the numbers of the oldest and most frail members of society? This was mentioned by the hon. Member for Canterbury (Mr. Crouch). According to Professor Acheson's extremely forthright article in ,The Lancet recently, by the year 2000 there will be an increase of 250,000 in each of the age groups 75 to 84 and 85-plus, with a slightly greater reduction in the number of fitter men and women aged 65 to 74. That will present extremely serious problems for the National Health Service. Geriatrics is already an acute shortage specialty. What is the Secretary of State doing to ensure that we can meet that situation in just 18 years' time when the NHS will have to deal with those major burdens? What is being done about a co-ordinated policy to meet the health and social needs of those groups? The Government have not begun to think about these very serious problems.

My hon. Friend the Member for Fife, Central referred to the disgraceful situation at the Royal Marsden hospital. Is the Prime Minister interested in the thousands of women who have been saved through the detection of breast cancer before the disease could spread? Is she aware that that service costs only £100,000 per year to run? Does she realise the cost of closing that clinic in terms of the increase in the number of very serious cases of breast cancer and in the number of women who will die but who would not die if the clinic continued its work in the early diagnosis of breast cancer? People do not die from varicose veins, but they die from breast cancer if it is neglected. When the Chancellor wants to cut another 10 per cent. from the Health Service, when the Secretary of State for Education and Science refuses to find the £10 million needed to safeguard clinical teaching in Britain, we know what credence to give to the Prime Minister's statement at the Conservative Party conference.

There is no doubt that the National Health Service—from research and teaching to the treatment of patients and the training and employment of staff at all levels—faces a crisis such as it has never faced before. There is a great responsibility on the Government to ensure that resources are made available. I hope that the Minister will tell us tonight that, to resolve the immediate problem, he is prepared to accept the proposal put to him from both sides of the House and immediately seek arbitration.

7.1 pm

Mr. Geoffrey Dickens (Huddersfield, West)

When I was advised that the Opposition had taken a Supply day to discuss the National Health Service, I thought that it would be a debate with some muscle and bite, with a few good facts presented to the House. Like many other subjects chosen for debate by the Opposition, such as employment, there is only a sprinkling of the old guard, the ever faithful, sitting in the Chamber. That is absolutely despicable. If the Opposition cared as much as they pretend to care about the National Health Service workers, or if they cared as much as the Government care, more Opposition Members would be joining in the debate.

Mr. George Foulkes (South Ayrshire)

rose—

Mr. Dickens

I shall not give way to the hon. Gentleman. No one gives way to me, so he can sit down.

Most of the nation knows that there are many political undertones to the NHS dispute. The tremendous sympathy for the nurses and midwives is being used for political advantage. The Secretary of State, in his brilliant opening response, made some play with that. The hon. Member for Crewe (Mrs. Dunwoody) is laughing at me. She had a great opportunity earlier today to put her view to a packed Chamber, Press Gallery and Strangers' Gallery, but her material was so ineffective that there was no case to answer. But, in accordance with parliamentary practice, it was answered—and answered jolly well.

Many people are asking whether the dispute is being used for political purposes. We all know that the dispute is about wages and conditions, but there are some who wish to use it for other purposes. As long ago as June, our old friend Mr. Scargill—the president of the National Union of Mineworkers—said in The Sunday Times: The best way to oppose the Tebbit Bill is to support the nurses and health workers. On 10 September, the official journal of the Labour Party stated: A victory in the NHS fight would do irreparable damage to the Tory Government's overall credibility and set the scene for a major boost in support for Labour in the run-up to the next election. Let us not mince words, but get down to brass tacks. Of course the NHS workers have a case. The smart union leaders are those who keep their members at work while continuing to press for a satisfactory deal. There is no merit in taking people out of work. Of all the workers in the NHS who came to lobby me yesterday, none wanted to strike. They thought the strike was futile and wanted a settlement—

Mr. Foulkes

Pay them the money then.

Mr. Dickens

We heard earlier of the misery of a three-year-old child who suffered because of the dispute. That was disgusting. Mr. Scargill has endeavoured to get his members to strike for a 30 per cent. increase, which would put up the price of coal and also the price of electricity as the power stations are fuelled by coal. He is inflicting misery on people by being a pig and putting his nose in the trough while pretending to be sympathetic towards others. That is political, and has nothing to do with nurses or the NHS.

We have heard the Opposition refer many times to the future of the NHS. They are trying to create the myth that the NHS is not safe in our hands. Yet we have recruited many doctors and nurses and have poured money into the NHS. Does that sound like a Government who do not care about the NHS? How can Opposition Members come to the House and tell such stories?

People say that too much money is spent on administration and too little on the patients, and that is fair enough. We agree with that, which is why we have abolished the area health authorities in England and have taken other measures that will save about £30 million. We can use some of that money to help the mentally handicapped and the geriatrics, an area of the NHS which is a Cinderella world which people forget. We are seeking to do the very things that we have been called upon to do. We are being criticised for not doing the very things that we are doing.

There appears to be a war between the Opposition and ourselves about the private sector—yet 4 million people take advantage of it, which takes away a great deal of pressure from the NHS. Trade union members in their thousands are pleased to take private beds. Many Opposition Members and their families have been pleased to take private beds—[HoN. MEMBERS: "Name them."] I have a reputation for naming names, but I shall not do so now—[HON. MEMBERS: "Name them."] Why should I tarnish people's careers? I was kind in my remarks about the hon. Member for Crewe. I hope that Opposition Members will not press me.

At one time there were bridges of co-operation between the private sector and the NHS. What has happened to them? The right hon. Member for Plymouth, Devonport (Dr. Owen) and the former Member for Blackburn, Barbara Castle, smashed the bridges. We must rebuild them, forge a link and find a balance between private health care, which should be available, and the NHS. It is vindictive to attack a private system. People are entitled to a choice.

The future of the NHS is absolutely secure under this Government. The Secretary of State said that expenditure on the NHS in 1978 and 1979 was £7¾ billion. The current expenditure is £14½ billion—5 per cent. better in real terms. It is the greatest increase in real terms under any Government since the Beveridge report. How can the Opposition say that the Government do not care about the Health Service? Where has that additional money gone? The pay of nurses and midwives has risen by 61 per cent. since we took office. New hospitals are being built and additional staff are being employed—and that is job security. Many Opposition Members may be surprised to learn that since we took office we have increased the staff of the NHS by 57,000—

Mr. Peter Hordern (Horsham and Crawley)

The figure is 67,000.

Mr. Dickens

I shall stick at 57,000, but whatever the figure it is very good. I see the Minister nodding, which assures me that I am, as usual, right.

The number of nurses and midwives has increased by 41,200; medical and dental workers by 2,300; ancillary workers by 600; ambulance men by 1,300; and others by 11,600. So 57,000 was right. The largest part of that increase, 41,200, is for inpatient care, which is important. The hon. Member for Isle of Ely (Mr. Freud), who unfortunately is not in the Chamber—I hope that Hansard will record the fact that no SDP or Liberal Members are present—said that no money was being spent in his area. How can there be an increase in staff of 57,000 on patient care and the whole of the Isle of Ely get no help during the past few years? All I can say is that the hon. Gentleman does not know his constituency very well.

I shall be brief, because many right hon. and hon. Members wish to speak. We are proud of the National Health Service, which was initiated in 1947, following the Beveridge report. If we had been in power then, I am sure that we should have introduced it.[Interruption.] When a party is in opposition it is supposed to oppose, but we have not had much of that from the Opposition today.

7.11 pm

Mr. Laurie Pavitt (Brent, South)

I shall not waste time on the speech of the hon. Member for Huddersfield, West (Mr. Dickens}—[HON. MEMBERS: "Hear, hear."]—but I wish to take up four points that have arisen in the debate. I commend the contribution of the hon. Member for Canterbury (Mr. Crouch), who unfortunately is not in the Chamber. I did not agree with a number of the points that he made, but he always displays considerable knowledge. At one time, he was one of the few Conservative Members who knew anything about the National Health Service. I have now reached the conclusion that he is probably the only Conservative Member who knows anything about it.

I am sorry that the hon. Member for Newcastle upon Tyne, East (Mr. Thomas) is not here. His was one of the most sick-making speeches that I have heard for a long time. I am sorry that he is not in the Chamber to hear me say that. He was a friend of mine many years ago, before he came to the House.

I want to comment on two points in the Secretary of State's speech. He, like the hon. Member for Canterbury, talked about the possibility of a Utopian future, provided that we could move along the paths of management. I remind the House that the last Conservative Minister who thought that that was the be-all and end-all of the Health Service was the right hon. Member for Leeds, North-East (Sir K. Joseph). He reorganised the Health Service on what were supposed to be good management lines in 1973, and the first thing that this Government had to do when they came to power was to unscramble it, because it was the biggest mess that had ever been made.

Secondly, the Secretary of State said that he was very worried to hear no words of condemnation of the industrial action from these Benches. I confirm that. The hon. Member for Birmingham, Edgbaston (Mrs. Knight) and the House in general know that I am not unknowledgeable about the NHS. I tell the right hon. Gentleman that I do not condemn the industrial action, because of the circumstances in which the Health Service workers find themselves. The Secretary of State gave them no option. He pushed them against the wall. As a result, from the start his negotiations have been phoney.

I want to say a word about the figures. On Monday, following his statement, the Secretary of State and I bandied figures. Perhaps the Minister, in winding up, will confirm the following figures. According to the Royal College of Nursing, the current salary of a ward sister could be £6,000 per annum. That depends on her grade, of course, but let us take the figure of £6,000. The offer of 7.5 per cent. that was rejected would have given that ward sister £6,450, with perhaps some hope for the next round in April 1983. However, the two options now being discussed by the right hon. Gentleman—the first would give £6,439 per annum, and the second would give £6,465 per annum—would be frozen until April 1984. I should like to know whether these two offers, which in weekly take-home pay are almost nothing, are a serious means of negotiation.

As my hon. Friend the Member for Wolverhampton, North-East (Mrs. Short) said, it is robbing Peter to pay Paul. That is what the Minister has been doing throughout. From the time that he said that there was no more money on the table, it has been a matter of deciding "From whom do we take it and to whom do we give it?" If one grade or category is given more, another has to have it taken away. There is no other way, once the decision of no more money is taken.

I come to the much wider issue—the core of the problem—which has been touched on by several hon. Members. Morale in the Health Service is at the lowest that it has been for 30 years. That is caused by a number of important factors. The pay dispute in only one factor. I accuse the Government of creating despair and uncertainty, either deliberately for bigoted, doctrinaire reasons—the Secretary of State had to say "I believe" about monetarism to his right hon. Friend the Prime Minister this afternoon—in which case it is a crime of titanic size against the welfare of the community, or through sheer incompetence, ignorance and lack of understanding of what our National Health Service is all about. In either case there is no comfort from the Prime Minister.

I come back to what was said earlier in the debate about the Prime Minister's comments at the Conservative Party conference: The Health Service is safe in our hands. Does the House recall the election campaign during which the right hon. Lady, when accused of intending to raise Health Service charges said: I have no plans to do so"? One Back-Bench Member talked about the "big lie". Does the House recall the front page of the Daily Mail claiming to nail the big lie that, under the Conservative Government there would be no increases in Health Service charges?

I remind the House that, during the five years of the Labour Government, prescription charges were 20p and remained 20p. Since then, we have had five increases. That 20p is now £1.35, and it is likely to go up again in April. Routine dental charges have nearly doubled, and there has been a 300 per cent. increase in the overall maximum charge. Previously it was £30; now it is £90. There have been two jumps in the prices for glasses from what were three flat-rate charges to 30 different cost-related charges. The cost of two lenses, which before the Conservatives came to power was £5.80, could now be as much as £30. When Conservative Members talk about things being safe in the hands of this Prime Minister, who assured us that there would be no rises in Health Service charges, they should not be surprised if we have little confidence in what they said, because the proof of the pudding in this case is in the eating.

My major charge is that the Government have made a complete muddle of the National Health Service. Qualified State registered nurses—the senior nurses in the Health Service—after 15 years of service do not know what will happen. They do not know whether they have to apply for posts, or whether they will retain their posts. I was a member of the Standing Committee considering the Bill. We warned the Government that this last reorganisation could be worse than the previous one in 1974. Senior nurses in posts are in a state of uncertainty about their future. That also applies to chiropodists, doctors, all the medical staff, the professions supplementary to medicine, and all the members of committees. Although the change took place on 1 April, six months later, qualified people who have given a lifetime of service do not know where they are. Nobody knows. Each region has a different rule. All the rules are different. Each district has variations of timing and various stages of post to be filled.

Decentralisation was part of the Government's decision upon which they gave minimum guidance. Therefore, some appointments are now being made on a geographical basis and others on a unit basis. Some areas have adopted an integration of posts called "slotting in". However, slotting in also means slotting out. Uncertainty and demoralisation accompany that process. The nursing service is being clobbered not just on pay, but by Government maladministration. The trauma of insecurity is compounded because, unlike 1974, the NHS is contracting and fewer posts are available. Despite what has been said, the number of posts is contracting, whereas, after the 1974 reorganisation, the number of posts was expanding. So, in the reorganised structure, fewer posts are available.

Another problem is that the chairmen of the district health authorities have been in their posts only since 1 April. In consequence, they are uncertain and are delaying decisions. There are problems about all chairmen. I ask the Minister to assure the House on this matter. The House has already heard how the man in Whitehall knows best. The Minister has sacked regional health chairmen who have not supported Government policy.

Brent district health authority has a family practitioner committee. The Department of Health telephoned the Secretary to ask about the political affiliations of its members. It is no secret that the new Session of this House is likely to see another health Bill in which the family practitioner committee will move from where it now is and be placed entirely under the control of the Secretary of State. Why is it necessary to know now the political affiliations of members who are serving on this committee? It will have a demoralising effect at local level similar to that which has already been experienced by some regional health authority chairmen?

The right hon. Member for Leeds, North-East had a national organisation to deal with the problem of changing posts under the previous reorganisation. When the present reorganisation took place, the Whitley Council asked the Government whether, because of all these uncertainties, they would do the same as in 1974. They refused to say. The result is complete demoralisation and uncertainty in the middle ranks of nursing. That, as anybody who knows anything about management knows, is crucial to the way in which the service will run.

A saving of £30 million was mentioned. That saving has already been more than swallowed up in the new arrangements for the larger number of district health authorities compared with the area health authorities. There has been an increase, not a saving, in administrative costs. Will the Minister give the House the real figures?

I am pleased to see the hon. Member for Canterbury, about whom I have already said a few kind words. I do not agree with everything that he said—I never do—but I commend the House to listen to him more frequently. As I said before, he knows what he is talking about.

The Minister has quoted nursing staff figures to support his case. I remind him that the last answer that I had from the Department of Employment shows that there are 7,411 qualified nurses on the dole? Why? My district has 108 vacancies that cannot be filled. We employ 61 agency nurses. Is that good management? Is that what we mean when we talk about health care?

I want to compare the Minister's glorious figures with a recent report from Europe. The only country in Europe spending less of its GNP on health than Britain is Spain. When I look at the number of nurses employed in Common Market countries, I see that France, for example, has 57.4 nurses for every 10,000 of its population compared with 37.4 in Britain. Why? Cash limits mean that nurses cannot be employed in areas such as mine where they are needed, because of lack of funds. When one looks at the headlines of the North West Thames regional hospital board's paper, one sees: Districts share £8 million squeeze. My local health authority—Brent—had its papers presented last week. In 1983–84 it is to suffer a cutback of £1,090,000, which it must somehow find. That is before the £59 million in the pay claim, of which a large percentage must now be found from the district health authorities. The only way that that can be found is by cutting something else out. What a choice to give a compassionate committee—perhaps in the region which the hon. Member for Canterbury serves. In order to give a fair deal and pay to workers in the health service, it will have to decide that there will be no kidney machine this year. The Government have got themselves into a fantastic position.

Obviously, the pay settlement will make a tremendous inroad. What is worse is that the uncertainty that that engenders means that there is no way in which the new district health authorities, or the regional health authorities which command their funds, can plan for 1983–84. It means that joint committees of the NHS, on the one hand, and the local authority social services on the other, which jointly have to look after the needs of the elderly, the frail and the disabled, cannot plan their work. There is no way in which anyone will know what is possible and what is not during the next 18 months. If that is not mismanagement of the highest order, I do not know what is.

For the past 30 years every family in Britain can put on record its personal and grateful thanks for compassionate and successful health care. You, Mr. Deputy Speaker, and many of my hon. Friends know that I have had a cancer. My wife came out of Westminster hospital last week after a highly successful operation. Thank God for the NHS.

The Government always fall back on the same excuse for cutting back the NHS. They say that it is necessary to consider what the country can afford. I say that the nation cannot afford to allow this demolition squad to continue its ravages, which go to the foundation of our great National Health Service.

Unfortunately, the Tory Government have no Ministers of the calibre of the late Minister of Health, the right hon. fain Macleod. He knew something about the NHS, and for many years he kept the Tory Party on an even keel of consensus in a great service. Our only hope is for this heartless crew to get out, and to stay out.

7.28 pm

Mr. Ralph Howell (Norfolk, North)

I should like to preface my remarks by expressing gratitude to the great majority of Health Service workers who are doing their best to keep the Health Service going in this difficult time while the dispute is on. They are suffering considerably by being unable during the dispute to give the service that they would like to give.

I support the Secretary of State and the Government's firm monetarist policies which they must pursue if we are ever to get inflation under control. That will do more than anything to help the British people.

However, I am critical of the Government, not for being too bold but for being too timid and cautious. After six months of this dispute it is time that we stopped having sterile supplies and laundry held up and people being prevented from getting the treatment that they need. The Health Service belongs to the nation, not to any specific group that is employed in it. The Government have a duty to free these supplies so that the operations can be carried out.

Let me put the dispute into perspective. We are arguing about £400 million. One of the greatest mistakes made by the Government since they took office has been to allow the numbers employed in the Health Service to expand by 67,000. When we took office, the Health Service was overmanned even then, but we are now spending about £600 million in wages and so on for the extra people we have engaged.

The NHS issue has been shrouded in a great smokescreen for the past 20 years. The arguments about pay began when the right hon. Member for Down, South (Mr. Powell) was Minister of Health in the early 1960s. We have spent too much time thinking about pay and not enough about the structure of the NHS. The NHS is totally out of control. There is no overall manning plan. How can it be kept under control when no one is in charge? We have a chairman for British Rail and the Secretary of State for Transport. It is high time that we considered the control of the Health Service under any Government. I am not being critical of my right hon. Friend the Secretary of State, because this problem has been with us for a long time.

I also believe that there is no proper inventory or audit control within the NHS. The Health Service is suffering from appalling losses and from the open-door manner in which we conduct its affairs. The recent leaflet published by the National Association of Health Authorities for England and Wales supports that view. It has expressed extreme concern at the losses which, while not recorded in the accounts, are doing great harm to the NHS.

The time has come to think seriously about overmanning. It is in the interests of everyone working in the Health Service as well as the nation as a whole to put a stop to overmanning. How long can we go on increasing the NHS work force? Since 1970, NHS staff has increased at a greater rate than the population. The population of the United Kingdom has risen by fewer than 500,000, whereas the number of NHS staff has increased by more than 500,000.

Many hon. Members have talked about the excellence of the NHS in 1960. At that time, 565,000 people were employed in it. The number today is more than 1,250,000—an increase of about 700,000. In 1960, 487,000 NHS beds were occupied each day. Today the figure is only 370,000 beds. In other words, the ratio of staff to beds has increased nearly threefold since 1960.

In our manifesto we said that we would reduce the number of administrators, thereby saving money to be spent on patient care. Why, therefore, in our first year of office did we increase the number of administrators by nearly 3,000? Why, at a time when the population level was static, was it necessary to increase the number of ambulance men by about 1,000? These questions must be answered.

It is generally believed that the main problem confronting the NHS is overmanning in administration. That is not true. Since 1960, the number of doctors and dentists employed by the NHS has increased by 130 per cent., the number of nurses by 90 per cent. and the number of ancillary staff by 50 per cent. We should question all manning levels and ensure that we are getting value for money. Why have we needed 11,000 extra nurses each year since 1960? Since the Government have been in office, the figure has increased to 14,000 a year.

This year, we shall spend £14.5 billion on the NHS, 70 per cent. of which will go on wages. A great saving could have been made had we had the good sense to maintain the recruitment moratorium that existed in the first three months of our taking office. Through appalling levels of overmanning, I believe that we are wasting about £4 billion, yet we are worrying about a pay increase amounting to £400 million.

The hon. Member for Isle of Ely (Mr. Freud) was wrong to suggest that we could help the low paid in the NHS and elsewhere by increasing pay. The best thing we can do, particularly for the low paid, is to save the billions that are being thrown away, not only in the Health Service, but in education and other areas of the public sector. Instead of taking £17 away from modest earnings, we should raise tax thresholds, thus restoring the incentive to work and ensuring a satisfied work force in the Health Service and elsewhere.

The Government should take urgent steps to review the problem of overmanning. I am glad that certain measures have been taken, but I am not yet satisfied with the Government's sense of urgency. It is high time that we set up an independent inquiry to look into all aspects of manning, auditing and control of supplies within the NHS.

Next, we should do everything possible to privatise any section of the Health Service that can be privatised. That would help considerably.

Finally, I ask the Secretary of State to urge the Government to let the Think Tank think, to stop being influenced by the weak-kneed counsellors of caution and get some fresh thinking into the whole area. It has been stagnant for far too long. It will be in the interests of everyone in Britain—and in particular of everyone employed in the Health Service—if some fresh thinking is not only done but put into operation.

7.40 pm

Mr. Doug Hoyle (Warrington)

First, I must declare an interest as the vice-president of the Association of Scientific, Technical and Managerial Staffs. I think you will understand, Mr. Deputy Speaker, if I do not follow the speech of the hon. Member for Norfolk, North (Mr. Howell).

I congratulate the hon. Member for Isle of Ely (Mr. Freud) on an admirable speech and also on signing the Opposition motion.

Once again the hon. Member for Canterbury (Mr. Crouch) showed his compassion and care for the National Health Service. He stands out like a beacon on the Conservative Benches. In the debate so far, he is the only conservative Member who has not attacked the Health Service workers. However, although he made an excellent case, he did not follow it through by urging arbitration. That is the way forward out of the dispute.

We now know why the Secretary of State is known as the "Abominable no man". He showed again how hard-nosed, inflexible, rigid and arrogant he is, and how uncaring he is about the Health Service. Tremendous damage is being done to morale in the NHS. Morale has never been lower, yet nothing that the right hon. Gentleman has said today has taken us any nearer to a solution. He only repeated what he has said before.

When I listen to the arguments of Conservative Members, I realise that they are not talking of the Health Service that I know in any of the regions, particularly the North-West. Their arguments do not reflect the position in the Warrington district, where Winwick hospital is dilapidated, with old buildings, and where the patients are cared for by compassionate staff. The hospital is hopelessly understaffed. Last weekend I had to make a complaint about a ward of 30 old people in which the heating had broken down. There was no heating at all. At the Warrington general hospital there are wards which are not open because of lack of staff. Yet all the time we hear from Conservative Members that too much is being spent and that there are far too many staff in the National Health Service. That does not correspond with the truth.

The staff in the Health Service did not want to go on strike. They have never wanted to go on strike. They have been driven to go on strike because they have been ignored for far too long. They have been showing their compassion and their care for their patients. If they had really wanted to bring the dispute to a speedy end they could have done so, but they care for the patients and they are not in the business of destroying the Health Service. That is the dilemma that the staff face. That is why they need people in this House to speak for them.

There is not a trade union leader in the Health Service who is not compassionate and caring and who does not dislike what has happened, but for far too long the workers in the Health Service have seen their salaries being eroded. It is not good enough.

I despair of ever seeing someone replacing the present Secretary of State and beginning to fight in the Cabinet for more spending on the Health Service. Perhaps in the hon. Member for Canterbury we have found someone who will not follow the Prime Minister in all that she says and who will not follow her monetarist dogma. That sort of thinking has to come to an end if we are to begin to pick up the pieces. It will take a long time to do that and to repair the damage that has been done to the Health Service.

The Secretary of State referred to the professions supplementary to medicine and to their representatives going back to the table to meet him. The ASTMS represents those professions. We are certainly not going back to any table; we are staying out for the 12 per cent. I ask the House to consider the salaries of people in those professions.

Medical photographers, who have to pass professional examinations, get £83 a week. Medical laboratory scientific officers, who must have a higher national certificate or a degree, get £95 a week. In the junior grades they get only £52 a week, but they have to take responsibility in the laboratories. Speech therapists must take a four-year honours degree course, and they get £89 a week. Much has been said about the radiographers, but they get £87 a week. That is why people are fed up, right across the Health Service. That is why they have been sticking together and fighting for a 12 per cent. increase.

It is no use the Government's saying that there have not been exceptions; of course there have. The exceptions have been mentioned—judges, senior civil servants, the police, the fire service, water workers and miners. They have all been exceptions. The Health Service workers need the same kind of consideration.

For three years, Health Service workers have fallen behind. In 1979–80 the average increase for manual and non-manual workers was 25.5 per cent. In the National Health Service it was 13.14 per cent. In 1980–81 the average for manual and non-manual workers was 16.7 per cent. In the National Health Service it was 6 per cent. So far in 1981–82 the average increase for manual and non-manual workers has been 10.5 per cent., yet in the Health Service the workers are offered 6 to 7 per cent. It is not something that has only just arisen; it has been going on for three years, ever since the Government abolished the Clegg commission.

The Government have been condemned by nearly everyone in the Health Service. They have been condemned by The Lancet. The Secretary of State in particular was singled out by The Lancet for condemnation. The Government have been condemned by the administrators. They were condemned by the regional chairpersons, who were removed by the Secretary of State for showing their dissent. Medical opinion has been against the Government.

It has been claimed that the Government have increased spending on the NHS since 1979 by 5 per cent. The truth is that in the Government's first year of office there was a 0.5 per cent. cut in real terms. The Select Committee on the Treasury and Civil Service has reported that there will be a 2 per cent. cut in real terms in the next two years. Yet we know that when a Royal Commission examined the demographic change that was taking place it found that there was a considerable increase in the number of people over 75. These people require four times as much from the Health Service as is required by others. For that reason, the Royal Commission recommended that simply to stand still there would have to be an increase of 1 per cent. in real terms year upon year.

That has not been done, and that is why we find ourselves in the present mess. From January 1980 to January 1981, 6,000 beds were closed, 2,300 beds being closed in newly opened hospitals. This is the real picture of the Health Service. We know that whenever the salary increase comes the budget of the Health Service will be inadequate to meet real needs. We know that the Secretary of State has asked the regional health authorities to earmark £74 million as their contribution to the salary bill, and this from budgets that are already inadequate to meet the needs of regional health authorities.

It has been said repeatedly by Conservative Members that we are spending too much on the Health Service. Far from spending too much of our gross national product on it, we are spending far less than other countries. We are spending 5.8 per cent. of our GNP, while France is spending 7.7 per cent., Australia 7.9 per cent., West Germany 8.7 per cent. and the United States 9.1 per cent.

Conservative Members have also said repeatedly that there is a lack of productivity on the part of Health Service workers. An article in the Financial Times of 4 October stated that to judge from research carried out for the Secretary of State in his own Department, British Health Service workers are 25 per cent. more productive than those in the United States. However, the United States is being presented to us as the bastion of free enterprise. We are told that we should be running our Health Service and treating our Health Service workers in a similar way, but our Health Service workers are 25 per cent. more productive than their American counterparts and 10 per cent. more productive than those in Canada. It is time that Conservative Members stopped maligning Health Service workers and started to praise them for the job that they have done in caring for the sick.

Most of the occupants of the Government Front Bench do not go to the public sector when they need hospital care. We know that they go to the private sector. The Prime Minister cocked a snook at Health Service workers and received treatment for varicose veins in the private sector. If an ordinary person wants his or her varicose veins treated, it will be necessary for him or her to remain on a waiting list for three or four years. The Prime Minister showed, as she does in everything else, that privilege counts. She jumped the queue. That is why many of those on the Government Front Bench do not care about the Health Service and Health Service workers.

It is time that we stopped exploiting the dedication of Health Service staff. The Minister for Health has listened to the arguments that have been advanced on behalf of the Health Service workers and I hope that he will recognise that they are underpaid. I contend that all Health Service workers are underpaid. They are not paid for their qualifications, and every one of them is important. We cannot begin to differentiate. No differentiation can be made between, for example, nurses, doctors and hospital cooks. They are all necessary if our complicated Health Service is to be kept running, and they all deserve a 12 per cent. increase.

If the Minister cannot agree with my contention, let him say that he is prepared to go to arbitration. We have heard time and time again from him and his right hon. Friend that they believe that the Government have a strong case. Why cannot the hon. and learned Gentleman say that he will go to arbitration and abide by the findings? I believe that the Health Service trade unions would say "If the Government agree to go to arbitration, we on the trade union side will agree to abide by whatever emerges from that process." Unfortunately, the Secretary of State is not statesmanlike. He is not big enough to take that approach. He cannot get rid of his political prejudice arid he is tied to the apron strings of the Prime Minister. Finally, he is not concerned about the Health Service.

Immense damage being done to the Health Service and it will take many years to get rid of the bitterness. Responsibility rests with the Secretary of State. If he will not agree to go to arbitration, it is time that he himself went.

7.55 pm

Mr. Peter Hordern (Horsham and Crawley)

The hon. Members for Warrington (Mr. Hoyle) and Fife, Central (Mr. Hamilton), the latter being seemingly somewhat overcome by the exercise—

Mr. William Hamilton

I was deeply moved by the speech of my hon. Friend the Member for Warrington (Mr. Hoyle).

Mr. Hordern

Both hon. Gentlemen made an aggressive attack upon the Government and directed it especially to the level of the pay award that has been offered to Health Service workers. I recollect that in the last year of office of the previous Labour Government Health Service workers were subject to a pay award of about 5 per cent. I certainly do not remember then any great opposition from Labour Members, with the possible exception of the hon. Member for Warrington.

If the hon. Member for Warrington says that every Health Service worker is underpaid, what was the position in 1979? It was the present Government who had to meet the cost of the Clegg commission's recommendation. That award followed the winter of discontent. I find it difficult to understand how the hon. Member for Crewe (Mrs. Dunwoody) and her colleagues have the nerve to introduce the subject of Health Service workers' pay and to launch a debate of this sort considering their own inept performance when in office.

As I understand it, no branch of the Health Service, either on basic rates or average earnings, will have received less than 50 per cent. more than it was receiving at the date of the 1979 general election. In some instances—this applies especially to nurses—they have received substantially more. I may be wrong, but I do not think that there has been another three years since the war when wage awards have been higher.

The record level of recruitment since the Government took office has led to an additional 67,000 people working in the Health Service. The cost of wages and salaries—this is the only accurate measurement of the Government's contribution to the Health Service—has never risen so greatly in the history of the NHS. In the first year of the Government's term of office the cost rose by over 20 per cent. In the second year it increased by more than 30 per cent. In 1981–82 it seems that it will have risen by more than 15 per cent. It ill becomes the Opposition to criticise my right hon. and hon. Friends for setting such a record, especially in view of their own performance.

My right hon. Friend the Secretary of State said during a powerful speech that the number of Health Service workers has increased by about 57,000. It is important to recognise that that figure is based on full-time equivalents. The actual number, if carried out on the basis of a head count, which the Central Statistical Office does once a year, is 67,000. This is an important point. In no other part of industry or business are numbers worked out by full-time equivalents. What matters is the number of people employed and for what reason. We ought to know what people are doing in the Health Service.

I am aware that some Opposition Members take great interest in these matters. I wish to inform them that my concern and that of some of my hon. Friends about the numbers is that we believe that the Health Service should be efficient. It is not right simply to advance the level of expenditure on the Health Service and not be concerned with where the money goes. That feature of the Health Service has not been observed until recently. My right hon. Friend is acting in sharp contrast to his predecessors of both major political parties.

From the start of the National Health Service, nobody bothered where the money was going. I give the House an example. Until my right hon. Friend took office, no Secretary of State ever thought it important that he should know who was being recruited or for what purpose until at least 18 months after recruitment had taken place. Now the position is a great deal better. The period is down to six months. In this age of technology it must be possible to discover from the district health authorities how many people are being recruited and for what purpose.

We are spending £80 million a year on information technology, telling firms how best to promote technology. If the Government spent even a fraction of that amount buying data processing and information receivers, they would have this information much more readily to hand and the Health Service would be much the better for it.

Another unfortunate feature of the Health Service is the fact that there is no staff inspection. The hon. Member for Warrington says that every branch of the Health Service works well and that the system is more efficient than health services in other countries. I do not know. I cannot speak about health services in other countries. It is not possible to claim any great benefit for our Health Service if there is no form of staff inspection at least to satisfy people that what is being done is necessay. Staff inspection exists throughout the Civil Service, but not in the National Health Service. I cannot see any reason for this.

I am not one of those who believe that free access to the Health Service should be changed. It would not be right to move to a form of insurance such as operates in France, Australia, the United States and other countries. We have made a major advance in the sense of providing a free health service at the point of demand. That was a major social advance. We should not go back on it. However, that does not invalidate the requirement for making certain that health services are provided as efficiently as possible. I wish to give an example to show what I mean.

Between 1965 and 1979, the proportion of administrators to doctors in the NHS moved from 1.07 to 1.95—that is to say, it nearly doubled. In the six years to 1980, the number of administrators in England alone increased by 30 per cent., to 105,000. It is claimed that this was the responsibility of my right hon. Friend the Member for Leeds, North-East (Sir K. Joseph). Certainly my right hon. Friend was responsible for the reorganisation of the Health Service. That is no excuse for not seeing why or how that reorganisation should operate or for making sure that people are recruited for the right purpose. A change in organisation does not mean that it should be run inefficiently. Following reorganisation, the Labour Party came to power. It was not concerned with who was being recruited or for what purpose. During the past 10 years, as the figures show, we have been careless about recruitment. The number of administrators and the proportion have increased.

I ask these questions because I do not know the answer and I doubt whether anyone else in the House does. We cannot, however, be satisfied with the fact that half the hospital beds are at present occupied by elderly patients not because they are awaiting operations but because it is difficult for them to find anywhere else to go. This raises the question of the adequacy of our provision of early diagnosis. I recognise that Opposition Members do not like the existence of a private health service. I cannot, however, understand why they do not demand that the facilities that exist in the private health service should also be available to trade unionists who would very much like to take advantage of them.

There are, for instance, health tests of various kinds. I do not believe that it is possible to defend the very small amount of diagnostic screening and health checks that are available for people who work in factories. I do not believe that enough money is spent—I speak in a subjective way—on discovering illness before it happens. It is right to raise these questions. We have to ask whether the Health Service is being used in the best way.

It is important to consider the cost of some services—for example, hospital cleaning and hospital catering. I am not saying that the private sector can handle these matters more effectively. A simple test would be to put them out to tender. If the private sector can cope with catering, laundering and cleaning at a cheaper cost, what is the point of continuing these functions within the Health Service? It must be right—there has always been a budget in the Health Service—to concentrate expenditure where it is most needed. That is not happening at the moment.

The House must reconcile itself to the fact that there will never be a finite end in the search for better health or the demand for it. It is essential that resources, low though they may be, should be spent as effectively as possible. I regret to say that all the evidence shows that the money spent on the Health Service is not effectively used, has not been so used for a long time, and should now be properly directed to the service of patients throughout the country.

8.7 pm

Mr. David Young (Bolton, East)

I declare two interests. I am an ordinary Member, not one sponsored by NUPE. The second and more important interest is that I and my family depend for our health care on the National Health Service. Like millions of men and women in this country who do not carry BUPA cards, we are concerned about what is happening to the Health Service. This is not simply an issue of pay. The issue is the future of the Health Service.

If somebody were to ask what right we have to be concerned, I should refer him to the Think Tank report. I know that the report has been shelved, which I take to mean that it has been put somewhere where it can conveniently be brought out at the appropriate time, but if it does not indicate Government policy, I should be interested to know how a Government Think Tank starts on such an issue without at least the agreement of the Prime Minister. If that happened, it shows an independence of mind and resolution that is not apparent among members of the right hon. Lady's Cabinet. If it is claimed that the Think Tank went ahead with this project without the knowledge of the Prime Minister or the Cabinet, one must assume that it was carried out on clear indications.

We have seen with some concern other accounts that appeared in The Times about the awkward regional authority, its approach after meeting the Minister and its reflections on the effect of Government policy. We cannot be expected to dust this away and say that all these things happen without the knowledge or support of the Government.

What are the Government's intentions? One thing is clear. The Health Service, which the Labour Party created, with Nye Bevan as the major political architect, is being removed. The Health Service as we knew it in 1947 is gradually being eroded by deliberate Government policies. The system that is now being evolved appears to depend not on the need created by the health of the patient, but on the health of his bank. More and more private schemes, which are virtually parasites on the NHS scheme, are coming in. The Minister argues that this is to give freedom of choice. What he omits to say is that freedom to choose BUPA will largely stem from the deliberately calculated running down of the NHS.

One reason why people choose to join BUPA is the long waiting list in the NHS. They go to the private hospitals for earlier treatment. If that is not true, why did the Conservative Party leader not use the NHS for her varicose vein operation? If we are on equal terms and can get everything quickly and with the same results on the NHS as in the private hospitals, why did the right hon. Lady not show a lead by going to a NHS hospital?

Much has been said in the debate about the pay claim. Without bandying figures, one can say that the National Health Service is labour-intensive and that a high proportion of those who work in it are the lower paid. The average wage is only £82 a week. A rise of between 4 and 7 per cent. of that figure is very different from a similar proportion of the salary of a Member of Parliament or a Minister. Conservative Members say that the Health Service workers should accept the Government's offer, but I wonder how many of them could manage on a Health Service worker's pay. It is easy to criticise and argue that somebody who i3 earning £82 a week, and perhaps supporting a family on that, should accept the offer, but hon. Members are not in a similar position.

I do not wonder at the resentment of the health workers, who are ordinary people. I reject the argument that NITS workers are a crowd of militants, trying to exploit the patients. It is the workers who are being exploited by the Government. It is easy to extend sympathy, but sympathy does not pay bills. These are ordinary men and women on whom the nation depends for its health. Yet Her Majesty's Government are saying to them "You, the lower paid, must pay for the resources of the NHS".

Some Conservative Members have suggested that the trade unions are exploiting the situation, but I can tell the House why the people of Bolton and their various trade unions demonstrated with me on 22 September. They have no other Health Service to go to. They are not members of BUPA. What is more, one of our hospitals is based on a workhouse. It is out of date and antiquated. The people of Bolton know that in the Black report Bolton was recognised as a danger area.

We thought that our hospital problem was remedied when, after an Adjournment debate, the hon. Member for Ealing, Acton (Sir G. Young) gave the go-ahead for a £24 million hospital, but in The Guardian last week there was a report that new and projected projects were under threat of cancellation. I gather from the Government Front Bench that it is alleged that there has been a misunderstanding, but, even after last Friday, my district authority could not clarify the matter. If the Minister denies that that is so, will he tell us the position? If he is not prepared to say it tonight, will he write to me in detail, not with generalisations, and tell me what is the future of that hospital?

Mr. Kenneth Clarke

The letter makes it clear that new hospital projects can go ahead as long as we are satisfied that the resources for opening them have been planned and prepared. On that basis we have approved two hospitals since the letter went out. As long as Bolton satisfies that condition, the hospital will go ahead. Suggestions that we should allow people to start building hospitals before they have the resources to open them will lead to more white elephants of the kind that the Labour Government left behind when they allowed people to build hospitals without having the resources to open and maintain them.

Mr. Campbell-Savours

The hon. and learned Gentleman means "No".

Mr. Young

I understand that the Minister has access to all the information on Bolton. Will he say now, or write to me eventually and say, whether we meet his criteria? I look forward to hearing from the Minister in clear terms whether we can open, or, if not, how we are to be held up.

Mr. Kenneth Clarke

If and when Bolton approaches me and asks for permission to do so, it will be allowed to place the contracts for the new hospital as long as it can satisfy us that it has sufficient resources to open. As long as it can satisfy the terms of the letter, it can go ahead.

Mr. Young

This raises problems, because it is a long-term project. The Minister has answered nothing. The Conservative Party has been lecturing us about "terrible workers". A vague statement such as the Minister's undermines confidence over the health provisions for one town. Therefore, will the Minister make investigations, state specifically the conditions, and say whether we shall take it phase by phase?

Mr. Kenneth Clarke

I do not sit here to be accused of undermining the Health Service. The Opposition have made a stream of factually inaccurate accusations all evening. The Health Service is undermined by their talk of cuts and freezes, which are either pure invention or misinterpretation of documents that are freely available to hon. Members.

Mr. Young

I am not accusing the Minister of anything. I am reporting the feelings of the Bolton health workers. If the Minister was misquoted, he took a long time to clarify the position through the regional and district hospital boards. If he has been misquoted, will he put the minds of those health workers at rest?

Mr. Derek Foster (Bishop Auckland)

I wonder whether my hon. Friend is as puzzled as I am by the Minister's reply that he will give permission for building projects to go ahead provided that the health authority can be seen to have allocated sufficient funds for when the project is completed. Presumably we are talking about revenue expenditure, which is decided year after year. A district authority cannot possibly guarantee three years ahead to have the amount of money for which the Minister is asking.

Mr. Young

That is what worries us. I do not know, and nor does the district authority or the regional authority. We are worried that it is departmental gobbledegook for further cuts.

The Labour Party has been accused of using the strike for political purposes. If the Minister's decisions are not political, I do not know what they are. It is my job to fight anyone who seeks to destroy the Health Service that we created. I shall continue to do that, and I apologise to nobody. If I am accused of attacking the health-apartheid policy of the Government, I am guilty.

If the Minister has a case, let him go to arbitration. The outcome should be decided there. There was no great discussion of the Health Service problems at Brighton. Perhaps the Tory Party should use the abilities of the Secretary of State for Employment to democratise its own conference, so that ordinary Conservatives may have an opportunity to express their views. I hope that the opportunity to reply to the debate will be used not to score further points off the trade unions, but to deal with the crisis in the Health Service.

8.23 pm

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

During 25 years' membership of the House, I have never heard such a tissue of falsehoods from the Opposition as we have heard today. It is curious that the powerful media have taken a great interest in the National Health Service. Unfortunately, a number of people, and certainly a number of important trade unionists, have decided to make this dispute into a party-political contest to try to get rid of the Tory Government. In pursuit of that objective, they have uttered and repeated ad nauseam a tissue of falsehoods.

I regret that I was not called to speak after the hon. Member for Wolverhampton, North-East (Mrs. Short), who is Chairman of the Select Committee of which I am proud to be the majority leader. I should have liked to take up a number of matters that were raised. Tant pis, I shall deal with a few of them now. We must get the facts correct.

If the Health Service is as appalling as the Opposition have made it out to be, and there are to be all those alleged cuts, and if it is in such a state of malaise that everybody is too unhappy to join it, how is it that over the past three years we have recruited over 41,000 more nurses, about 2,000 more doctors and dentists, 16 per cent. more ambulance men and considerably more ancillary workers? My hon. Friend the Member for Norfolk, North (Mr. Howell) pointed out the enormous increase in staff that there has been over the past 20 years. Since 1960, the staff has increased by well over 50 per cent. and yet there are fewer beds. Beds are empty not because of Health Service cuts, but because of drugs. As a result of the efficient use of drugs, particularly with mental health patients, a great many beds are no longer required. It is absolutely essential, as the Minster for Health has pointed out, that before a new hospital is built one needs to know that finance will be available and there will be patients to fill it.

I want to confine my remarks to the public accountability of the district and regional health authorities, and how they can cut a substantial part of their expenditure and yet be able to use their resources, as we have been promised, for the benefit of the other sectors of the Health Service.

I agree entirely with the view of my hon. Friend the Member for Canterbury (Mr. Crouch) and others, that the Health Service should be maintained. It is sheer gobbledegook and poppycock to give the impression that either the Prime Minister or anybody else has any intention of disbanding it. We intend to utilise it in the most efficient manner possible, and it is that aspect to which I wish to draw attention.

Within the National Health Service budget the current expenditure on hospitals is £8 billion of the £14.5 billion. Of that sum, £3 billion, or 37.5 per cent., is accounted for by the separate services—catering, domestic, laundry, portering and ground and building maintenance. The primary function of the NHS is the care and the cure of the sick. Non-patient functions could be contracted out to suitable companies in the private sector without changing the basic principles of the NHS. The Health Service does not depend for its existence upon the fact that those services must be provided by the public sector.

The Department of Health and Social Security provided the Select Committee with a note on its work and on the future organisation of supply. It suggested a widening of the role of the regional health authorities, but I hope that we can decentralise supply even further to the district health authorities so that those services can be considered at district level. On 15 June my hon. Friend the Under-Secretary of State said that only 0.31 per cent. of catering and 2.54 per cent. of domestic cleaning were performed by private companies. The Department said that plans were well advanced for the regional health authorities to take over many national contracts from the Department. In many countries private companies are used in the pursuit of efficiency and the maximisation of resources. It makes no sense to condone cuts in the NHS without first examining the alternatives. If it can be shown that private companies are more efficient, the savings that result could be used to maintain and improve patient care.

In August 1981 the former Minister for Health wrote to the regional chairmen emphasising the value of using commercial contractors. He mentioned domestic and laundry services, maintenance of buildings and vehicles, security services and transport services". The Department's evidence was that £135 million was spent on those services in 1980–81, which was an increase of 11 per cent. in real terms compared with 1980. There was no question of cuts. We do not yet have this year's figures, but it is clear that the amount spent on buildings, engineering and maintenance was increased. The amount spent on laundry contracts has decreased.

In his evidence to the Select Committee my right hon. Friend the Secretary of State said, not arrogantly: If there were savings to be made in contracting out then an authority should look at this and see if it met their particular circumstances. I do not believe there is a national blueprint one can put down and use to show that in every circumstance and every situation you should have a contracting out situation, but what I do think is that contracting out is an option that authorities should look at quite objectively and not in any party sense to see if it makes sense. One cannot be fairer than that.

The private sector has the resources and expertise to perform all the ancillary services. Special contractors could carry out all the catering—I am not talking about special diets—in hospitals and clinics. Today there are infinitely more porters than in the old days—they are tumbling over themselves. I am sure that the portering system could be examined and dealt with through contract services. In Westminster hospital, which we all know well, domestic workers are supposed to work 38 hours a week, but they do not do anything like that number of hours. They work about three days a week and there is massive time off. That happens all the time. Everyone knows that if a contractor were handling the domestic and housekeeping services he could cut the cost consideral3ly and employ the people more effectively, on a far better time scale and with far greater savings.

There is desperate wastage in the laundry and linen services. Much of the laundry is not properly marked and so there is immense wastage. Moreover, the purchase and supply of laundry and linen needs to be studied. It might be asked whether the ground and plant maintenance services must employ their own people. Surely maintenance would be better dealt with by private contractors.

There is also security and pest control. If we could achieve a mere saying of 10 per cent. on each of those we would save approximately £200 million, which would take care of the salaries of more than 30,000 nurses. In that way, we could begin to obtain some of the money which everyone wants for the low paid. The advantage is that of cost effectiveness. In the contract with the contractor who assumes the responsibility for supplying the equipment necessary to carry out the service, the authority may, in certain instances, reserve capital resources for use in the purchase of medical equipment.

There is a further advantage. In industrial relations the contractor will assume responsibility for the staff, including the responsibility for disciplinary procedures and liaison with the trade unions. Consequently, the worker is employed on the contractor's payroll and there is a reduction in the numbers employed on the public payroll. There are .more than 207,000 full-time equivalent employees performing such functions in the National Health Service. Many of those people, perhaps 50.000 or 60,000 of them, could come off the public payroll and go on to the private payroll. That would provide further money for the care of the sick.

The Department should play an important role in helping the authorities to re-examine the allocation of its cash resources and objectively to assess the options and to examine the costs of benefits in instances when authorities have decided to contract out. The Secretary of State indicated in a non-partisan way that he has given his blessing to the merit of examining such a case. The Department does not yet have the information which it should have. However, I appeal to the Secretary of Stale and his Department to examine projects on the costs and benefits of a policy to make greater use of commercial contractors. The results should be made immediately available through the National Health Service and the public accountability of health authorities should require them to demonstrate how to achieve the best value from public money in this connection.

Mr. Deputy Speaker (Mr. Bernard Weatherill)

I remind the House that the concluding speeches are due to start at nine o'clock and a series of short contributions would enable me to call more hon. Members than would otherwise be the case.

8.38 pm

Mr. Michael Meacher (Oldham, West)

Most of the Secretary of State's opening speech was taken up with what can only be described as an intemperate outburst against National Health Service workers for daring to engage in industrial action. That is pretty galling when one considers the figures given in his speech—that no less than one-quarter of full-time ancillary workers earn less than £60 a week and no less than one-third of full-time nurses earn less than £82 a week. That is a cynical attack when one recalls that the Secretary of State takes home approximately £650 a week.

However, the nub of the Secretary of State's argument lay in his preening himself, as he so often does, on his claim that there had been a large increase in resources in real terms in the National Health Service under this Government. It is a boast that certainly does not stand up to examination. One could leave aside the fact that the total budget of the National Health Service is not £14.5 billion or £15 billion, as the Secretary of State said that it was again today, but £13.1 billion.

The rest is spent on personal social services. I am less willing to leave aside the fact that the Secretary of State now tries to make a virtue out of something that his predecessor and his Cabinet colleagues vigorously resisted at the time. I refer to the Clegg award.

Another fact that cannot be ignored is that the National Health Service has marginally increased its share of GNP by a fairly modest 0.5 per cent. since 1978, but, far from reflecting a faster increase in the National Health Service, that figure reflects a faster contraction in other areas of the public sector. That is the main explanation. As the Secretary of State said, the raw figures show a 5 per cent. real increase in health expenditure over the past three years, but he neglected to say that a 1 per cent. to 2 per cent. increase is necessary even to stay level.

Mr. Rees-Davies

On a point of order, Mr. Deputy Speaker. Has the hon. Gentleman omitted to say something to the House that he should have said at the start of his speech?

Mr. Meacher

If the hon. and learned Gentleman is referring to the fact that I am sponsored by COHSE, I apologise to the House for not saying so, but that is widely known and in no way influences the accuracy of my remarks.

A 1 per cent. to 2 per cent. increase in real terms in NHS expenditure is necessary because of the increasing proportion of NHS patients over 75 years of age who have to be cared for and whose medical and nursing needs are the most expensive of all. When that trend is taken into account, as it has to be by any Government, it becomes clear that, despite the increased expenditure, there has been no improvement in standards. Indeed, the reverse is true.

Another fact that the Secretary of State did not find it convenient to mention is that health expenditure today as a proportion of total public expenditure is no greater than it was in 1950. So much for all those expansive claims about greater resources. The record tells a different story' that we must consider when discussing the crisis in the Health Service.

In July 1979, the Chancellor of the Exchequer acknowledged that the refusal to increase cash limits in the National Health Service meant a cut in real terms in the NHS of at least £100 million. Then, in the March 1980 Budget, cash limits were set at 14 per cent. when inflation was 19 per cent. The Government were effectively enforcing a real cut in pay for NHS staff—or a reduction in staff—and a cut in services.

In November 1980, the Chancellor announced further spending cuts of £11 million, including a requirement for the National Health Service to find a 0.25 per cent. saving in total expenditure by increasing what the Chancellor liked to call efficiency measures, which is a nice euphemism for further cuts.

In March 1981, strict cash limits were again imposed on the NHS, allowing for 6 per cent. increases in pay and 11 per cent. in prices when inflation was 12 per cent. This inevitably meant a further reduction in employment or further cuts in services.

Again, in the latest Budget in March 1982, the Chancellor imposed strict cash limits on the NHS, and the expenditure increase was expected to be kept at 5 per cent.—half the projected rate of inflation. Additionally, a saving of up to 0.5 per cent. was expected from increased efficiency—in reality, another cut. It has been a constant story of cut and cut and cut again under this Government. What those cuts meant in practice was not spelt out by the Secretary of State. I have used the Government's figures.

In the Government's first two-and-a-half years—which is as far as the figures go—182 hospitals were completely closed. A further 345 hospitals were partly closed, had wards or departments closed or their uses changed. Therefore, up to a year ago, no fewer than 7,500 hospital beds were lost or redistributed.—[Interruption.] It is up to hon. Members if they want to make a virtue of that, but the facilities have not been replaced. We are talking of a net loss.

It is estimated that as much as £4 billion is needed to bring our hospitals up to standard. The Secretary of State said that he has not the money for that purpose or to make National Health Service workers a better offer. We say that if Britain can afford £2 billion to regain by war some tiny islands in the South Atlantic and apparently an additional £½ billion to rehabilitate those islands, we can certainly afford to spend less than half that to pay National Health Service workers a reasonable wage. The Government should at least agree to the wide call by the House tonight to take the issue to arbitration.

The Secretary of State spoke of further moves to promote private health care and to achieve a better balance between the private sector and the NHS. I do not doubt the Secretary of State's sincerity, but, whatever he may think, it is clear from the Think Tank leak and the constant insistence by Treasury Ministers that, if the Tory Party wins the next election, the Prime Minister and the Chancellor of the Exchequer will abolish the National Health Service and replace it with a private health care system in addition to de-indexing pensions and benefits and, no doubt, dismantling other parts of the Welfare State.

If the Secretary of State or the Minister of State deny that, may the House have a guarantee that no such proposals, nor anything resembling them, will be introduced by a future Conservative Government under the present Prime Minister's leadership? Until we have such a guarantee, millions of people will suspect that that will be the result of a Tory victory at the general election.

The real crisis in the National Health Service is not just that it is under-financed, rather than over-spent, but that it is the greatest post-war monument to a civilised community—an optimal service, free at the point of service and universally available—which is increasingly put at risk by the death of a thousand cuts. That is the story of the past three years. The service is also the greatest single symbol of compassion. Its threatened elimination by the Prime Minister and her hard-nosed colleagues will be one of the major causes of the Conservative Party's election defeat.

8.48 pm

Mr. Peter Griffiths (Portsmouth, North)

The title of the debate--"Crisis in the National Health Service"—may cause disappointment inside and outside the House because we have addressed ourselves to the narrow issue of the pay dispute and to party political in-fighting. Both aspects are relatively unimportant in the context of the crisis in the Health Service. If the pay dispute were solved tomorrow, the National Health Service would still have basic problems and there would be a crisis to discuss. If there were a general election and a change of Government tomorrow, there would still be a crisis in the NHS. The fundamental problems involved in the provision of health care are so important and complex that they cannot be solved by anything that could happen in a matter of hours or days.

Like many other hon. Members, I met the lobbyists yesterday. I say to my right hon. Friend the Secretary of State and my hon. and learned Friend the Minister for Health that I did not find those people militant, though I fear that there is a danger that they may be pushed into militancy if the dispute drags on for longer than is necessary.

The workers told me not only that they wished their low pay to be raised and that they wished the dispute to go to arbitration, but that the ordinary NHS workers did not stick firm on 12 per cent., and they asked me to give that message to the Secretary of State. They hope that there will be meaningful negotiations, and I recommended that they should make those points to their union leaders.

I was told that a hospital porter with years of experience and, say, a wife and two children would take home only £74 for a 54-hour week. I agree with the suggestion that there seems to be something radically wrong with the pay levels in the lower ranks of the NHS.

However, another worker told me that his wife was a cleaner for Marks and Spencer on an hourly paid rate that was one-and-a-half times what he was paid. He suggested that that showed that NHS workers were badly paid, but I suggest that it shows that when labour is used efficiently and effectively it can be well paid. There would be great advantage in radical thinking within the NHS about how money is spent. If workers were better deployed, equipped and trained, and perhaps managed by private enterprise, they could hope to obtain increased income through increased productivity.

The major issue in the NHS, which I should like to have had time to discuss at length, is how we are to afford the ever-increasing cost of long-term stays in hospital by geriatric and psychiatric patients. Most live in old buildings that need rapid improvement, and the quality of life would be improved more for those patients than for others if the necessary work were carried out.

The Opposition seem to assume that the funds must come from the public sector—from taxation or contributions. Why can they not come from payments by patients for the services that they wish to receive? One of the reasons why business men choose private treatment is that they need facilities to carry on their businesses. Why cannot such facilities be offered on the NHS at a premium price?

If we offered more facilities within the NHS, so that those who wished to use them put their money into the Health Service, we would not need a dual system of private health services side by side with the NHS.

I gave up my membership of a private health insurance scheme before I became a Member of Parliament, because I concluded that it was essential that the resources of both the State and the individual should go into the NHS. That is one of the ways in which we could improve service for everyone.

We should have addressed ourselves to the real issues today. Many in the country will be disappointed by what they have heard in the debate.

8.54 pm

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

At the risk of being accused of repetition, I reiterate what I said on Monday. The Government stand condemned for having been completely uncaring and inactive in their approach to a dispute which has been allowed to continue for six long months when it could and should have been settled in less than that number of weeks. I say that without fear of contradiction. If the Government had cared about the sick of this country—those who cannot buy their way into hospital beds through private schemes—they would have shown the necessary urgency. Even at this late stage the dispute could be ended and good will restored throughout the Health Service by a fairly small movement on the part of the Government.

I accept that the Government have spent 5 per cent. more in real terms on the Health Service since 1977, but that is no reason why they should now deny a fair wage settlement to NHS staff. Far from spending too much, we are spending far too little on the Health Service. In the marvellous new Freeman hospital opened three years ago in Newcastle, about a quarter of the wards have yet to be occupied. This is because of staff shortages caused by lack of resources. It is no use the Minister saying that authorities should plan ahead for such expenditure, because he well knows that their allocations are made year by year.

We in the North-East are grateful that we are to have a whole-body scanner for cancer patients. That has cost more than £1 million, but the money did not come from the Government. It came from charitable donations organised by a cancer sufferer, Daisy Bell. I think that the Charlie Bear appeal is well known even nationally. In my view it is disgraceful that cancer patients have to work like that to obtain a whole-body scanner for their region.

Since 1979 the Government have spent 12.3 per cent. more in real teens on law and order. They have considerably—and rightly—increased police manpower, but that has not prevented increases in the current round of wage negotiations, of which the Health Service dispute is a part, of 13.2 per cent. for the police and 18.6 per cent. for judges.

Government spokesmen have played a confidence trick in claiming that there are now 47,000 more whole-time employees in the Health Service than there were in 1979. Of that number, 34,000 are nurses and midwives, and that figure is largely attributable to the fact that in 1980 nurses' hours were cut from 40 to 37½. It is therefore a confidence trick to claim that there has been a real increase of that size.

Without any doubt, nurses have suffered badly since Halsbury set their pay levels in 1974. Between 1975 and 1981, average earnings nationally increased by 133 per cent. but nurses' pay increased by only 118 per cent. To maintain the Halsbury level, average pay for nurses should now be about £118.98 per week, instead of the present £.108.62.

It is fair to compare movements of pay in other groups between 1975 and 1981. The pay of a police constable at the bottom point rose by 244 per cent., a fireman's pay by 151 per cent., a junior doctor's pay by 149 per cent. and a teacher's pay by 144 per cent. The pay of Members of Parliament rose by 142 per cent.—God knows, it was badly needed—and the pay of a private in the Armed Forces rose by 140 per cent., but a staff nurse's pay rose by only 110 per cent. I do not intend to burden the House with more statistics. However, the non-nursing staff, such as ancillary workers, cleaners, domestic assistants, catering assistants, caretakers, porters and cooks, through to scientists and laboratory technicians, could argue the same case. Do not let anyone assume that we can maintain an efficient Health Service without each and every one of them.

If the Secretary of State is not prepared to end the dispute now by the application of common sense and compassion, in the name of God let an independent arbitrator give him the answer. Let him give the House an undertaking before the end of the debate that he will accept the advice of an independent arbitrator.

9 pm

Mr. Denis Healey (Leeds, East)

When the Secretary of State opened the debate, he quoted, with some approval, the findings of the Nuffield Trust as reported in The Economist last week. I wish to remind him of its conclusion. After condemning as naive and unhelpful the remarks made by the Chancellor of the Exchequer and the Chief Secretary about the private health market, the Nuffield Trust said: the National Health Service constitutes a unique and precious national asset which provides basic services of a high standard at a very low proportion of gross domestic product compared to other countries. The NHS is a priceless national asset, and the Secretary of State has failed in his prime duty to protect it. That is why our motion calls upon him to make way for someone with a more compassionate approach to the problems of low pay in the NHS and a genuine belief in the Welfare State.

All the evidence shows that the NHS provides by far the most cost-effective health service in the world. It uses only 5.6 per cent. of our gross domestic product, while Germany, Sweden, France and the United States use between 8 and 10 per cent., and they have a substantially higher GDP per capita than Britain. The NHS budgetary control is much better than in other countries. Its workers show 25 per cent. more productivity than those in the United States, which Tory Members so often ask us to imitate. The quality of health in Britain is well above that in the United States, France and Germany. Among those studied in Mr. Maxwell's seminal work on the subject, Britain's NHS record in producing quality in health is surpassed only by Sweden, Switzerland and the Netherlands, all of which spend a great deal more on health than does Britain.

The Government have done everything possible to damage the operation of the NHS. Consequently, they have been responsible for the most prolonged industrial dispute that the Health Service has ever known—one which has provoked even the Royal College of Nursing to consider amending its constitution to allow its members to join the dispute.

Many hon. Members on both sides of the House have regular contacts with those who serve in the NHS. None could deny that morale in the NHS is lower than it has ever been. Yet all the Minister for Health could offer by way of comment when that was pointed out to him was to compare the NHS with the Italian State. He said: The National Health Service, like the Italian state, is always being described by people as being on the point of collapse…neither the NHS nor the Italian state is anything like this and never will be, and the sooner people realise this the better. When I read that remark, I thought it betrayed the same sensitivity and understanding as the Minister showed when he described COHSE and NUPE as being on the hard Left of the trade union and labour movement. I suspect that that remark may somewhat surprise Mr. Albert Spanswick and no less Mr. Rodney Bickerstaffe.

The treatment of the pay claims in the National Health Service during recent years rewards study. The NHS received a fair deal from the Labour Government—9 per cent. in 1979, when inflation was under 10 per cent., and the establishment of the Clegg commission, as a result of which it received 21 per cent. in the following 12 months. The Government now take credit for what we did in 1979 and the Clegg commission award thereafter. In any other context, however, Conservative Ministers never fail to attack the Clegg commission and its awards as being responsible for all the economic evils from which Britain is now suffering. Of course, they abolished the commission at the first possible moment.

Then Conservative Ministers became responsible for awards. In 1980, when inflation was 21.8 per cent., they gave the Health Service 14 per cent. and promised to treat it as a special case the following year. The following year came. In 1981, inflation was 12 per cent. and they gave the Health Service 6 per cent.—only half the rate of inflation—and promised to treat it as a special case in 1982. Here we are in 1982. Inflation is now 9.4 per cent. Originally, the Health Service was offered 4 per cent., and now they have raised it to 6.4 per cent. That, of course, is only half the rate of inflation, as defined in the Lawson index. I am sorry that the Secretary of State for Energy is not here, because I shall have a word to say about him later in another context. This year, the Government were not content to put off special treatment for the Health Service for 12 months; they put it off for 24 months, and now we are told that it will get special treatment in April 1984.

The Government's excuse for this appalling treatment of the National Health Service is that the public service should make the same sacrifices as workers in the private sector. So let us have a look at that. As many of my hon. Friends have said, the police got 13.2 per cent. this year, the firemen 10.1 per cent., the miners 8.6 per cent., local authority manuals 7.5 per cent.—and of course I hesitate to mention the judges, who got over 18 per cent. this year.

Yet the workers in the National Health Service are the very people to whom the Secretary of State referred this afternoon when he said that we owe them a great debt. He also told us this afternoon—I shall use the figures that he gave—that nearly one-quarter of the ancillaries are now earning under £75 a week, and nearly one-third of the nurses under £82 per week, which is the poverty line that has been set by the Government themselves, although my hon. Friend the Member for Brent, South (Mr. Pavitt), in one of his notable contributions to our discussions on these matters, pointed out that these estimates were grossly over-optimistic for the National Health Service.

If we are to believe the newspapers, it appears that the Government will publish tomorrow a new national earnings survey which will show that all the figures on which the Government have based their case were false. We now have reports in the Financial Times, and I hope that the Minister, in winding up, will tell us whether they are true. We get so many leaks with this Government that there is no harm in their confirming what has already appeared in two of our leading national dailies.

According to reports in the newspapers today and yesterday, the increase for the National Health Service covers a year in which average public sector earnings were up 8.4 per cent. and private earnings, which were supposed to be so much lower, rose 10.9 per cent. Those figures paint exactly the opposite picture to that on which the Government have based their whole approach to the National Health Service's claims. I hope that when the Minister replies he will have the courage to confirm or deny that the figures that I have quoted are those which will be published tomorrow. We shall, of course, be able to read them for ourselves tomorrow afternoon.

The Government promised to pay a debt and to treat the nurses and health workers as a special case. However, they have been treated as a special case only in the sense that they have been treated worse than the average in the public sector and far worse than in the private sector. That is how the Government are paying the debt which the Secretary of State told us this afternoon was a substantial one.

That record is a disgrace to the Government, but to the Secretary of State above all. I put it to him that he should resign. [HON. MEMBERS: "Hear, hear."] I am glad to see that he confirms the accuracy of my advice by the conventional gesture. The advice that I have just given to him is not from me alone. That advice was given by The Lancet on behalf of the medical profession. It is certainly the advice which would be given by the British people because the only survey on this matter, which was published in The Sunday Times a few weeks ago, showed that 83 per cent. of those polled believed that the Government should give the Health Service workers more and 44 per cent. believed that they should give them the whole of their 12 per cent. claim.

I pass now to some of the broader aspects of the matter. Even if the Health Service workers were to accept the Government's offer, which the Secretary of State for Employment told us again yesterday cannot and will not be improved whatever the circumstances, 34 per cent.—£59 million—will not be paid by the Government but will have to be found by the regional health authorities. The Government admitted the other day that that means that growth in the Health Service this year, after taking account of demographic and technological change, will amount to under 1 per cent. In Merseyside and the four Thames regions, there will be an absolute fall in regional health authority spending in the current year. Indeed, on the basis of cuts already announced by several health authorities, it looks as if the total cut in programmes will be well over £100 million. The Treasury is already asking for more on top of that. We heard the Chancellor doing that on "Panorama" the other day.

The appalling consequences which are bound to follow if the Government pursue this course have already been illustrated by the plans published by the health authorities in Oxford and Wales. For example, in Wales the conclusion was reached that the only way of meeting the Government's demands would be to have zero growth for the next six years and to sack 8,000 Health Service workers.

The Secretary of State for Wales (Mr. Nicholas Edwards)

As the consultative paper that was issued by my Department said in its first sentence that no decisions had been taken about the money available for the Health Service, and as every other statement that arose from the false assumption made by the right hon. Gentleman is therefore false, I hope that he will withdraw the nonsense that he has just uttered.

Mr. Healey

I hope that the right hon. Gentleman will withdraw that silly and otiose intervention, because what I stated is the literal truth and I have by me the quotation of the Welsh health authority published in the Welsh newspapers. That is the view that it took of the implications of what the right hon. Gentleman put to it, and that he cannot deny.

Mr. Reg Race (Wood Green)

Is my right hon. Friend aware that the minutes of the meetings attended by officials from the Welsh Office have now been handed in a plain brown paper envelope to the trade unions and health authorities 3n Wales, and confirm the reports that have been made about proposed redundancies, closures and cuts in Wales? Is he further aware of the Treasury's attitude to next year's pay claim, where in the PESC exercise it is asking that none of it should be funded by the Treasury and that it would all have to come from local funds?

Mr. Healey

Let me perhaps surprise my hon. Friend by first thanking him for his support. I was aware of both points, but I felt that it would be unfair to intrude on the Minister's private grief by repeating them. However, I too have seen the record of the meetings to which he referred.

Mr. Nicholas Edwards

As the papers setting out the proposals were placed by me in the Library of the House, I do not understand all this nonsense about plain brown envelopes. As during the discussions the health authorities agreed that we were discussing not numbers but the general principles of financial planning because no decisions had been taken, I must again ask the right hon. Gentleman to stop talking nonsense on this issue.

Mr. Healey

The right hon. Gentleman has sunk slightly deeper into the mud, but I stand by everything that I said, and I am grateful to my hon. Friend the Member for Wood Green (Mr. Race) for confirming it.

All these problems in the Health Service have been compounded by the Government's bigoted determination to pass the more lucrative areas of the Health Seri, ice to private insurance c companies such as BUPA. The right hon. Gentleman may feel that I am complimenting the Government when I describe the Health Services Act 1980 as a charter for private medicine, yet private medicine costs much more both in administration and treatment than the NHS. That is the finding of the British Medical Association, reported earlier this year in The Guardian, and of the Nuffield Trust in the study to which the right hon. Gentleman referred.

Mr. Fowler

indicated assent.

Mr. Healey

I am glad to see the right hon. Gentleman nod his head yet again. He has been extremely cooperative this evening. I hope that he will take the final step and resign, but that may be too much to ask for. I also understand that that was the finding of a DHSS working party. Perhaps the Minister will say whether that is so.

The proof that what I have said is true is evident to us all, because BUPA has increased its premiums by 20 per cent. for private individuals—twice the rate of inflation in the previous year and three times the offer to the NHS workers. For private companies using BUPA, the premium has been increased by up to 200 per cent. in some cases. Many private companies, because of the straits to which they have been reduced by other aspects of Government policy, are quite incapable of paying the new premiums and an increasing number are liable to bow out. We now hear that the Government are looking for new ways to subsidise inefficient private medicine at the expense of further cuts in the NHS.

The same story lies behind the Government's attempt to hand over aspects of the NHS, such as laundry, to private enterprise. I understand that a working party from the right hon. Gentleman's own Department has discovered that private laundering is far less cost-effective than doing the work in-house. On top of all this, there are the proposals of the quixotically, Pickwickianly—called Think Tank to dismantle the NHS altogether, leaving it just a shell to provide an inferior service for the poor.

If we are to believe the newspapers—what other source have we under this Government, but what a good source it is—it was the Prime Minister herself who put the Think Tank proposals to Cabinet, with the support of the Chancellor of the Exchequer. It was her opponents in the Cabinet, the so-called wets—those without guts and gumption—who refused to discuss it. I do not yet know which side was responsible for leaking it to The Economist but I know that the Prime Minister ran away at the first whiff of grapeshot and has ever since been trying to throw the blame on to someone else. That is one of her less engaging but more familiar habits.

The reason why the paper was withdrawn was made pitifully clear by the chairman of the Conservative Party. When he was asked the other day by Mr. Terry Coleman of The Guardian whether he was alarmed when he saw the report leaked in The Economist, he replied: Yes, I was, because I felt it would concern a lot of people who had no reason to be concerned". Mr. Coleman then said: It would lose the Tories the whole of the working class vote? The chairman of the Tory Party replied "Yes, yes", with that engaging and breezy juvenile manner that we have come to love so much.

With that background, it is not surprising that the Prime Minister told the faithful in Brighton a week or two ago: Let me make one thing absolutely clear. The National Health Service is safe with us. Those of us who can remember the statements of that nature and the promises of that nature that she made before the last general election will know how much trust to put in that statement. The record of the Health Service under her Administration, which I have been describing, speaks louder than words. Moreover, the Chancellor of the Exchequer and the Chief Secretary have both made it clear since the Brighton conference that they plan to return to the attack on the Health Service at the first possible moment—and the Chancellor will be in charge of policy for the next Tory Government, if there ever is one.

The Chancellor of the Exchequer in the fascinating speech that he made to the Bow group in Cambridge last June, made it absolutely clear that his thinking was behind the Health Service report.

Mr. Crouch

I know that the right hon. Gentleman is here tonight to give weight to the Opposition's argument about the Health Service. It is not altogether clear to us whether he really appreciates the problem facing us in the Health Service at the moment. As a very senior member of his party, will he say where his party stands today with regard to strikes in the National Health Service on this issue? Does he condemn them or not? That is what we want to know, and nothing else.

Mr. Healey

I deplore the necessity for industrial action in the Health Service, as I deplore it whenever it arises, but I cannot honestly blame the Health Service workers for taking action in a situation in which they have been treated in the way that I have described, and in a situation in which they have still renounced the full use of their industrial power because of their care for the patients concerned.

Mr. Mike Thomas

rose—

Mr. Healey

As an honest and dispassionate observer, I think you will bear witness, Mr. Speaker, that I have given way a good deal already, and I should like an opportunity to finish my speech.

Mr. Thomas

rose—

Mr. Speaker

Order. The right hon. Gentleman has made it clear that he will not give way again, so he must be allowed to continue.

Mr. Healey

The question that we must ask ourselves is: why are the Government so determined to ruin the Health Service? One reason must be the theological hostility to all aspects of public enterprise. So far the Government have made an exception only of the Armed Forces, but given a chance the Prime Minister will be handing over defence in the next Government, or the one after that, to the Mafia and the Kray Brothers. I suspect that there are some Conservative Members—possibly the Leader of the House is one, if I recall correctly the views that he has expressed over the years—who believe that it makes economic sense to hand over these activities to private enterprise despite the fact that they cost more in private hands and that an inferior service is likely to be provided.

The key statement on this issue appeared in a fascinating article in The Times—I refer to the new version of The Times under Rupert Murdoch—by the Prime Minister's previous chief policy adviser at No. 10, who I believe is now Sir John Hoskyns, who was surely the most bizarre intellectual ever to serve at No. 10. The recent chief policy adviser at No. 10 spilt the beans. He told us that the person responsible for all this was the Secretary of State for Energy, who invented the medium-term financial strategy. Can anyone remember the MTFS? Sir John stated in the article in The Times—

Mr. Mike Thomas

What about the Health Service?

Mr. Healey

This is about the Health Service. This is Sir John Hoskyns's explanation of the Government's attitude to the Health Service pay claim. He stated: The MTFS was not a simple-minded promise of economic success…The MTFS was never designed to deal with the issues of real growth…Its much criticised rigidity was, and is, its most important characteristic. Therefore, the Government—I truncate slightly for the sake of Conservative Members the full beauty of the argument—must not give in to the unions on any pay claim whatsoever.

The medium-term financial strategy was another invention of the Secretary of State for Energy, who was then the right hon. Member for Blaby (Mr. Lawson). He is the man who gave us the Lawson index and the monetarist mumbo-jumbo which was interred the other day by the Governor of the Bank of England.

Mr. Tim Renton (Mid-Sussex)

On a point of order, Mr. Speaker. Has the right hon. Member for Leeds, East (Mr. Healey) forgotten that he is the shadow Chancellor?

Mr. Healey

The hòn. Gentleman's point of order is as bogus as his professed interest in trade unionism.

Mr. Mike Thomas

What about the Health Service? Mr. Healey: I am talking about the Health Service.

Mr. Anthony Beaumont-Dark (Birmingham, Selly Oak)

Let us hear it.

Mr. Healey

If Conservative Members think that the Government's economic policy has nothing to do with their attack on the Health Service, they have another think coming. That is the view of distinguished Conservatives. The right hon. Member for Sidcup (Mr. Heath) said: The real battle is not about the correct apportionment of resources. It is whether we are going to accept stagnation, falling production and cutting back…this is an entirely unjustifiable attitude of negation, of restriction and one which gives no hope to anybody. The right hon. Gentleman's view is reinforced by the Minister of Agriculture, Fisheries and Food, the right hon. Member for Worcester (Mr. Walker), who said: the Conservative Party had to rededicate itself to rekindling the hopes of the undefended for a better life. This is what the Health Service is for. He continued: We accept too readily that stagnation must be our lot in the 1980s. It leads to some esoteric and unhelpful exercises in how to scrap part of our welfare system in order to live within our means. The root cause of the problems faced by the Health Service and the dispute that has wracked it in the past few months is the fact that the Government are committed to a policy of steadily increasing unemployment and steadily increasing public expenditure cuts. They cannot make the sums add up without destroying the Welfare State. It is because the Secretary of State for Social Services is a conspirator in that plot that we ask him to resign tonight.

9.30 pm

The Minister for Health (Mr. Kenneth Clarke)

The first person for whom hon. Members should feel sympathy, after listening to the speech of the right hon. Member for Leeds, East (Mr. Healey), is the hon. Member for Birmingham, Stechford (Mr. Davis), the official Labour Front Bench spokesman on the Health Service, who conducted a great part of the Opposition's contribution to the proceedings on the Mental Health (Amendment) Bill on Monday in a very capable manner. I have no doubt that had the hon. Gentleman spoken he would have said many things with which I would have disagreed, because he is a forceful advocate, but he did not deserve to be elbowed aside by the shadow Foreign Secretary.

There are two fundamental differences between the hon. Member for Stechford and the right hon. Member for Leeds, East. The first is that the hon. Member for Stechford knows something about the Health Service. I wondered, no doubt like every hon. Member who has attended the debate, why the right hon. Member for Leeds, East vanished following the Front Bench speeches at the start of the debate and absented himself until 20 minutes before the closing Front Bench speeches. I thought that it was because of the grandeur that goes with being the Deputy Leader of the Labour Party. In fact, he had gone to read—

Mr. George Foulkes (South Ayrshire)

The hon. and learned Gentleman was not here when the hon. Member for Huddersfield, West (Mr. Dickens) was speaking.

Mr. Clarke

From all that I have heard, I greatly regret having missed the speech of my hon. Friend the Member for Huddersfield, West (Mr. Dickens). The right hon. Gentleman went away to read a Nuffield Trust study and a NUPE briefing before returning to tell us what he had discovered about the Health Service.

A second and more fundamental problem distinguishes the hon. Member for Stechford from his right hon. Friend. The right hon. Member for Leeds, East has a record in Government, unlike his hon. Friend, of being responsible for these matters. The right hon. Gentleman has to answer for his record as Chancellor of the Exchequer, its effect on the Health Service and the views that he then expressed on strike action, which he has not repeated this evening. The right hon. Gentleman has already been upbraided by my right hon. Friend the Secretary of State and reminded of the fact that he introduced swingeing capital cuts in the Health Service in the aftermath of the IMF crisis and the Budgets that followed.

The right hon. Gentleman also presided, from 1975 co 1979, over declining earnings in the Health Service. which led to the outburst that became known as the winter of discontent. He cited figures at us for movements in pay under this Government. I remind him that between 1975 and 1979 the retail price index went up by 63 per cent. The maximum rate for a ward sister went up by 25 per cent., the maximum rate for a staff nurse by 28 per cent. and the maximum for an enrolled nurse by 29 per cent. As the hon. Member for Newcastle upon Tyne, East (Mr. Thomas) reminded the House, the nurses and others have suffered a great drop in pay since the Halsbury commission. They did not suffer that drop under this Government. Since we have been in office, their pay has gone up ahead of inflation. They suffered that drop under the last four years of the Labour Government.

The declining living standards of the health workers under the right hon. Gentleman's Government caused the strike action of the winter of discontent. As my right hon. Friend the Secretary of State said, the then Prime Minister, the then Secretary of State for Social Services and all their colleagues unreservedly condemned that strike action against patients, and they had our support. They do not repeat that today. I had thought that the right hon. Member for Leeds, East, as a statesman, would take the opportunity today to become the first Labour Member of Parliament since the strike began to say a word of criticism about strike action, but he did not.

The right hon. Gentleman said that he regretted the "necessity" to take strike action, but while we have been in office the living standards of Health Service workers have been maintained and those of the nurses have been increased. In 1979 the right hon. Gentleman condemned strike action by those whose living standards had declined. We now know what the condemnation of the Labour Party meant in 1979. It was condemning not strike action against patients, but strike action against the Labour Government. That was what upset the Labour Party. Now that the Labour Party has left office it has decided to strengthen the call for strike action and to prolong this dispute by its support for intransigent trade unionists, as I hope I shall demonstrate.

Mr. Ennals

rose—

Mr. Clarke

I shall give way, but the right hon. Gentleman is repeatedly reckless in intervening to give his advice on Health Service disputes.

Mr. Ennals

I do not intend to give any advice to the Minister, because I know that he will not take it. Has the hon. and learned Gentleman heard of the trade union code of conduct that has been established? When any trade unionist has gone beyond that code of conduct, the chairman of the TUC health services committee has condemned that action.

Mr. Clarke

The hon. Member for Newcastle upon Tyne, East said that changes took place in that code, presumably because of the change in Government, so that strike action was more extensive. If the right hon. Gentleman thinks that his intervention is an answer to what we have illustrated—a three-year-old child denied an operation, a woman wanting a hip operation who had to use her crutches to walk past a picket line where the ambulance drivers would not pass, the woman in labour who could not get an ambulance to attend her—he does himself less than credit.

Mr. Mike Thomas

rose—

Mr. Clarke

I cannot understand why the right hon. Gentleman cannot bring himself to force out the words that he used in 1979. He will not repeat and quote himself because the unions are taking strike action against a Government whom he hopes will be damaged by that action.

Mr. Thomas

On a point of order, Mr. Speaker. The hon. and learned Gentleman has referred to me twice, and it is the custom of the House to give way in those circumstances.

Mr. Clarke

I shall return to the hon. Gentleman, in favour of him, later in my speech.

My hon. Friend the Member for Portsmouth, North (Mr. Griffiths) and my hon. and learned Friend the Member for Thanet, West (Mr. Rees-Davies) referred to the crisis in the NHS. That crisis exists and people outside expect us to address ourselves to it. No one on the Government Benches has denied that there is that crisis in parts of the Health Service. As my hon. and learned Friend the Member for Thanet, West said, there has never been a debate in which there was a wider factual gap between the two sides, or a wider difference between the assertions being made by hon. Members on both sides of the House. I fear that the assertions from the Labour Benches were inaccurate and based on misunderstandings, and, in some cases, on misinterpretations of bits and pieces of documents that they have picked up from around the Health Service.

If we wish to understand the nature of the crisis of the Health Service, and if a responsible Opposition wish to address themselves to the choices that have to be made, there has to be an essential basis of fact, accepted by both sides of the House. One embarrassing stream of facts which the Opposition will not face, and which they try to disprove by sideways allusions, is the growth in resources and staff under this Government. Talk of "cuts" and "freezes" is an attempt to evade the fact that resources for the Health Service have grown in real terms by over 5 per cent. since the Government took office.

The Health Service has never had more resources at any time since 1948. There are now more doctors and dentists working in it than ever before—over 2,000 more since we took office. There are more staff than ever before—57,000 more since we took office, of whom 41,000 are nurses. We have maintained the capital programmes and provided more Health Service capital-7½ per cent. more in real terms than in the last year of the Labour Government. There are 136 hospitals under construction.

As a result of the falling inflation rate, there will be a windfall for the Health Service, because everybody has been working on price and pay assumptions which have been disproved by the Government's success in reducing inflation. That is the background to the crisis. The problem is to fit the infinite demands for more resources within the finite, though growing, level of resources that the Government can make available.

We all know that there is an infinite, growing and wholly justified demand for better services in many parts of the National Health Service. My hon. Friends the Members for Horsham and Crawley (Mr. Hordern) and for Portsmouth, North addressed themselves to that problem. I can produce a list of priorities for further development in the National Health Service. We need beter services for the elderly and greater provision for geriatrics, the mentally ill and the mentally handicapped. We need a shift of resources to community services, not just hospital services, to keep many elderly, mentally ill and mentally handicapped people in better surroundings.

We need a fairer distribution of resources throughout the country, as my hon. Friend the Member for Preston, North (Mr. Atkins) said. We need better primary care in our inner cities, and for all sorts of neglected small areas where money needs to be spent, such as drug abuse. We need to find money for the advanced thresholds of medicine—heart transplants, bone-marrow transplants, dialysis and so on—for which demand grows because of the success of our doctors. All that has to be fitted into the growth of resources that the Government have provided, but it needs a choice of priorities and planning to fit the improvements to the services within that growth.

What is the Opposition's reaction? They have gone round Wales, every region and district, and read every piece of paper they can find—in brown envelopes or wherever else they can find them—and made use of parts of documents. Every time an attempt is made to shift resources or to judge priorities—when my right hon. Friend the Secretary of State for Wales holds back money from districts for development of services in Wales, or the Thames regions hold back money for the mentally handicapped and begin to shift resources out of inner London areas, which the Labour Party agrees are over-resourced, and transfer them to Medway—the Opposition snatch at little bits of documents, quote them out of context, and say that there are cuts and freezes and other things around the country.

Mr. Race

rose—

Mr. Clarke

I shall not give way. Interruption.]

Mr. Speaker

rose—

Mr. Race

rose—

Mr. Speaker

Order. It is clear that once I rise I have something to say. It is clear that the Minister is not giving way.

Mr. Clarke

The Oxford regional health authority officers' document was one of the most popular documents chosen. It is not a document approved by the regional health authority, nor is it accurate. For the sake of campaigning for more resources for Oxford, it exaggerates the financial problems. The cuts it describes represent less additional money than Oxford would have liked. It is getting 1.6 per cent. growth this year making a total of 5.3 per cent. growth over the past four years. The document describes as cuts provision for higher pay that it is believed the Government will concede in this strike, and for which it is claimed cuts will have to be made. The Government will not concede higher pay. A development pool of £4 million has been put aside for new services, and that is described as a cut. The officers of the Oxford regional health authority have provided ammunition which has been leapt upon by the Opposition. The report exaggerates the serious problems that that authority is facing. It deflects the argument away from where we should put growth money in the Health Service and turns it into a shameless political argument alleging cuts and freezes in a service which has been exempt from the recession and is expanding.

How can a serious Opposition undertake an exercise of that kind if we have a former Chancellor, who invented and maintained rigid cash limits against the Health Service, sitting alongside someone who normally goes around urging ever greater spending? The Opposition have run away from the real problems of the Health Service.

Mr. Mike Thomas

The official Opposition.

Mr. Clarke

It is difficult to satisfy every demand at once when there is a limit to resources. It causes problems as different hospitals and districts lobby for a greater share of the resources. How do the Opposition run away from all those choices in development?

Mr. Mike Thomas

The official Opposition.

Mr. Clarke

They pluck a figure out of the air and talk about money that they have not given and are not likely to give to the Health Service. They announce at their party conference that there will be a 3 per cent. real increase in resources that will solve all the problems of the Health Service. Attempts have been made to cost the programme put forward by the official Opposition for the Department of Health and Social Security alone. It depends whether one believes them when they say that there will be no unemployment, but the estimates range between £10 billion and £20 billion. That is not a commitment; it is a straightforward deception in order to exploit the real problems faced by Health Service managers.

How can the Labour Party claim to have patient care or the development of the services that I have described as its first priority when it is pressing for an increased pay offer for Health Service staff above the present levels that have been achieved? The Labour Party moved the motion to give support to a campaign that says that the £1,100 million on the table is not enough for face-to-face negotiations between the Government and the trade unions.

Mr. Mike Thomas

Is there a real decrease or an increase for those two years? The hon. and learned Member knows perfectly well that it is a real decrease.

Mr. Clarke

It depends on the assumptions for inflation. The basis of the 12 per cent. claim was a mistaken calculation of inflation by the trade unions, and they have not adjusted their claim as inflation has fallen. The hon. Gentleman knows that we cannot make those estimates.

The Government have moved repeatedly to try to settle the claim, and we now have more than £1 billion on offer for a two-year deal. We wish to accelerate the move towards the long-term arrangements that could have been achieved if the trace unions had shown more urgency. The position of the Opposition—

Mr. Mike Thomas

The official Opposition.

Mr. Clarke

The position of the official Opposition is to support trade unions that believe that there is insufficient money on the table. They support trade unions that will not talk to the Government and that will not even consult the Health Services Whitley council negotiating machinery. They not only support silence and non-movement, but say that the trade unions are entitled to continue days of action against patients until they reach their chosen conclusion. That is an objective statement of the position of the two sides. [Interruption.] Every Labour Member who has spoken has supported the unions in not negotiating and in striking, so I have not misrepresented their views.

I assure hon. Members that we do remember the average Health Service worker. Hon. Members on both sides of the House have genuine respect for those workers. My hon. Friend the Member for Canterbury (Mr. Crouch) rivalled the hon. Member for Warrington (Mr. Hoyle) in speaking of the dedication and loyalty of Health Service staff. Any Minister for Health is bound to appreciate that, and anyone who believes that my right hon. Friend and I intended to enter a conflict with the workers upon whom the Health Service depends misunderstands our position. We spent a lot of time talking about their pay. We must consider their pay and personal positions.

My right hon. Friend the Secretary of State gave details about the extent of low pay in the NHS. We did not deny that there was low pay, but the figures that we produced showed that the extent of low pay is dramatically less than all the TUC's official literature. However, not all NHS staff are low paid. I have forgotten which hon. Member said that all staff—from consultants to cleaners—were underpaid. Some, quite rightly, receive a reasonable rate of pay. However, if staff are not paid enough, their pay is not far behind the going rate. The Government are making a preferential offer to the nurses—an offer of which the TUC disapproves. But, when judging the offer, hon. Members should remember that nurses are paid roughly the equivalent of those in the teaching profession—[Interruption.] Among others, the hon. Member for Oldham, West (Mr. Meacher) produced figures for nurses that relied on student and unqualified nurses in order to bring down the average. The national average earnings of a newly-qualified staff nurse are £95.85 per week. As a result of the two-year package that we have outlined, that will rise to £111.64 per week. The basic pay of a newly-qualified teacher is £94.59 with little opportunity for additional earnings. That differential rises with seniority. The pay of a ward sister already exceeds that of some deputy head teachers. At the top of the ward sister's pay scale, earnings are just 5 per cent. less than those of head teachers at the top of their scale.

Mr. Campbell-Savours

rose—

Mr. Clarke

Therefore, the pay of nurses is roughly comparable with that of teachers. NHS ancillary workers are on average paid more than local government manual workers.

Mr. Campbell-Savours

rose—

Mr. Clarke

I shall not give way. I have cited comparable groups of workers. We are making offers to nurses and ancillary workers that are in line with the wages of others. I am asserting only that the statement that all NHS workers are exceptionally low paid is a gross exaggeration of their position.

What about their personal position? Where have the Opposition taken NHS workers during this dispute? Most NHS workers have not taken part in any industrial action. Those who have taken part and followed all the calls have lost far more pay than they can conceivably hope to recover for a long time from any settlement that they are remotely likely to get.

Industrial action and a refusal to negotiate have delayed discussions. Even if we settled now, the mechanics of paying it would mean that the health workers would not receive any more money this side of Christmas. The claim goes back to April. With every week that passes payment is put off. Therefore, the health workers—the "poor bloody infantry", as my hon. Friend the Member for Canterbury described them—are having a hard time as a result of being urged on by the Labour Party. What are the health workers doing at the behest of the Labour Party?

Mr. Campbell-Savours

The health workers earn nothing, and the hon. and learned Gentleman knows it.

Mr. Clarke

How fair is the Labour Party being to the health workers? Those on the picket line chant "What do we want? 12 per cent.".

Mr. Foulkes

"Maggie, Maggie, Maggie—out, out, out."

Mr. Clarke

That as well. The hon. Gentleman is an ideal man for the picket line, but I am not so sure whether he is an ideal man for the House of Commons. As every Opposition Member knows, the slogans being chanted bear no relation to what the health workers will get. There is not an hon. Member facing me who believes that the health workers will receive 12 per cent., but they are quite happy to see the keener ones chanting that again and again.

The average Health Service worker does not know what he will receive. In addition, because the trade unions have not moved in the slightest from their claim, I am under the impression that trade union leaders and hon. Gentlemen do not have a clue what the Health Service workers might get at the end of the struggle. Money is being lost pointlessly, because in their hearts Opposition Members know that, after the latest two-year deal, we have reached a stage at which the longer the strike, the more likely it is that the dwindling number of health workers who are still backing it will not receive any more money from the Government than that put forward in the offers.

Because of the political struggle which some Labour Members want to maintain, they are content to see the health workers driven on in the dispute throughout the winter for much wider political motives. That was not vehemently denied, but no doubt it would be if I pressed it.

Some deny that we have now reached a stage where the dispute is being pointlessly extended by those who insist that the action should continue. The key moment in the dispute was when it turned from being a serious crisis and a grave risk to the Health Service to a pointless and protracted marathon and when the talks planned for 16 September did not take place. My right hon. Friend the Secretary of State described the careful preparation that went into those talks. On 16 September we summoned everybody. We did not divide. We asked the TUC, the RCN, the Royal College of Midwives, physiotherapists and everyone else involved to talk about a basis for negotiation, a two-year deal that had been most carefully worked out with the leaders of the TUC health services committee.

Many Opposition Members have been in more industrial disputes than I and have seen more resolved. They know that no industrial dispute can end unless there is contact between the two sides, preparation and a basis for negotiation. Finally they meet and discuss an eventual settlement. Such careful preparation was made and a basis for negotiation found—£1 ,100 million, a two-year deal, a number of options identified and discussions about long-term arrangements to continue thereafter.

The Royal College of Nursing, the midwives and others came, and they have been negotiating with us ever since. The physiotherapists, the radiographers, the chiropodists and other are coming tomorrow, and they are negotiating. All the non-TUC affiliates turned up, but at the last moment the TUC did not come, and they have not talked since.

Not only has no Labour Member condemned strike action against patients today, but no Labour Member has even advised the TUC to start negotiations. All careful preparations of the kind that must be infinitely familiar to ex-Ministers and by which a public sector settlement should have been resolved had been made by 16 September, but they came to an end.

After all that preparation, the TUC health services committee would not take part in discussions and it has not been back since. Why? Because it was in the middle of the TUC congress and Labour Party conference season, because the wider trade union movement wanted its day of action in the following week and because the Labour Party and the trade union movement wanted to hitch all kinds of unpopular political causes on to the back of what they perceived to be a popular Health Service cause. Plainly, the Labour Party's obduracy and refusal to negotiate or even to prod its trade union friends into negotiating is because it sees the dispute as part of a wider struggle to fight unpopular causes, such as what it calls "Tebbit's Bill". It is trying to bring the trade union movement together for a change, to achieve some unity and, heaven help us, even to reinstate the Shadow Foreign Secretary's claim to the leadership of the Labour Party if the long hoped for vacancy should ever occur. All those motives are now riding on the continuation of this dispute and, what is more, they are damaging the health workers' cause.

Of course, the health workers have some public support. Over the last few months we have felt the pressure of public sympathy for the nurses and Health Service workers. That is why we produced variations on our offers. We have increased our offers and tried to produce a basis for negotiation.

Sympathy for the health workers reached a peak a month ago—before 16 September. Ever since the Labour Party got into the act and since the days of action started and it became obvious that the strikers were exploiting the dispute for political reasons, public sympathy for the strikers and the health workers has begun to ebb and the demand that people should negotiate has grown. The Opposition's position is disgraceful.

The motion is shameless. The influence of the Opposition in the dispute is prolonging the difficulties and damaging the Health Service when they should be using their influence to try to resolve the difficulties. All that the House can do to show its contempt for their position is to reject the motion.

Question put, That the amendment be made:—

The House divided: Ayes 313, Noes 251.

Division No. 314]	[10.00 pm
AYES
Adley, Robert	Boyson, Dr Rhodes
Aitken, Jonathan	Braine, Sir Bernard
Alexander, Richard	Bright, Graham
Alison, Rt Hon Michael	Brinton, Tim
Ancram, Michael	Brittan, Rt. Hon. Leon
Arnold, Tom	Brooke, Hon Peter
Aspinwall, Jack	Brotherton, Michael
Atkins, Rt Hon H.(S'thorne)	Brown, Michael(Brigg & Sc'n)
Atkinson, David (B'm'th,E)	Browne, John (Winchester)
Baker, Kenneth(St.M'bone)	Bruce-Gardyne, John
Baker, Nicholas (N Dorset)	Bryan, Sir Paul
Banks, Robert	Buchanan-Smith, Rt. Hon. A.
Beaumont-Dark, Anthony	Buck, Antony
Bendall, Vivian	Budgen, Nick
Benyon, Thomas (A'don)	Bulmer, Esmond
Benyon, W. (Buckingham)	Burden, Sir Frederick
Best, Keith	Butcher, John
Bevan, David Gilroy	Carlisle, John (Luton West)
Biffen, Rt Hon John	Chalker, Mrs. Lynda
Biggs-Davison, Sir John	Channon, Rt. Hon. Paul
Blackburn, John	Chapman, Sydney
Blaker, Peter	Churchill, W. S.
Body, Richard	Clark, Hon A. (Plym'th, S'n)
Bonsor, Sir Nicholas	Clark, Sir W. (Croydon S)
Boscawen, Hon Robert	Clarke, Kenneth (Rushcliffe)
Bottomley, Peter (W'wich W)	Clegg, Sir Walter
Bowden, Andrew	Cockeram, Eric

Colvin, Michael	Hunt, David (Wirral)
Cope, John	Hunt, John (Ravensbourne)
Cormack, Patrick	Hurd, Rt Hon Douglas
Corrie, John	Irvine, Bryant Godman
Costain, Sir Albert	Irving, Charles (Cheltenham)
Cranborne, Viscount	Jenkin, Rt Hon Patrick
Critchley, Julian	Jessel, Toby
Crouch, David	Johnson Smith, Sir Geoffrey
Dickens, Geoffrey	Jopling, Rt Hon Michael
Dorrell, Stephen	Joseph, Rt Hon Sir Keith
Douglas-Hamilton, Lord J.	Kaberry, Sir Donald
Dover, Denshore	Kellett-Bowman, Mrs Elaine
du Cann, Rt Hon Edward	Kershaw, Sir Anthony
Dunn, Robert (Dartford)	Kimball, Sir Marcus
Dykes, Hugh	King, Rt Hon Tom
Eden, Rt Hon Sir John	Kitson, Sir Timothy
Edwards, Rt Hon N. (P'broke)	Knight, Mrs Jill
Eggar, Tim	Knox, David
Elliott, Sir William	Lamont, Norman
Emery, Sir Peter	Lang, Ian
Eyre, Reginald	Latham, Michae
Fairbairn, Nicholas	Lawrence, Ivan
Fairgrieve, Sir Russell	Lawson, Rt Hon Nigel
Faith, Mrs Sheila	Lee, John
Farr, John	Lennox-Boyd, Hon Mark
Fell, Sir Anthony	Lester, Jim (Beeston)
Fenner, Mrs Peggy	Lewis, Kenneth (Rutland)
Finsberg, Geoffrey	Lloyd, Ian (Havant & W'loo)
Fisher, Sir Nigel	Lloyd, Peter (Fareham)
Fletcher, A. (Ed'nb'gth N)	Loveridge, John
Fletcher-Cooke, Sir Charles	Luce, Richard
Fookes, Miss Janet	Lyell, Richard
Forman, Nigel	McCrindle, Robert
Fowler, Rt Hon Norman	Macfarlane, Neil
Fox, Marcus	MacGregor, John
Fraser, Rt Hon Sir Hugh	Mackay, John (Argyll)
Fraser, Peter (South Angus)	Macmillan, Rt Hon M.
Fry, Peter	McNair-Wilson, M. (N'bury)
Gardiner, George (Reigate)	McNair-Wilson, P. (New F'st)
Gardner, Edward (S Fylde)	McQuarrie, Albert
Garel-Jones, Tristan	Madel, David
Gilmour, Rt Hon Sir Ian	Major, John
Glyn, Dr Alan	Marland, Paul
Goodhart, Sir Philip	Marlow, Anthony
Goodhew, Sir Victor	Marshall, Michael (Arundel)
Goodlad, Alastair	Mates, Michael
Gorst, John	Maude, Rt Hon Sir Angus
Gow, Ian	Mawby, Ray
Gower, Sir Raymond	Mawhinney, Dr Brain
Grant, Anthony (Harrow C)	Maxwell-Hyslop, Robin
Gray, Hamish	Mayhew, Patrick
Greenway, Harry	Mellor, David
Grieve, Percy	Meyer, Sir Anthony
Griffiths, E.(B'y St. Edm'ds)	Miller, Hal (B'grove)
Griffiths, Peter Portsrn'th N)	Mills, Iain (Meriden)
Grist, Ian	Mills, Sir Peter (West Devon)
Grylls, Michael	Miscambell, Norman
Gummer, John Selwyn	Mitchell, David (Basingstoke)
Hamilton, Hon A.	Moate, Roger
Hamilton, Michael (Salisbury)	Monro, Sir Hector
Hampson, Dr Keith	Montgomery, Fergus
Hannam, John	Moore, John
Haselhurst, Alan	Morgan, Geraint
Hastings, Stephen	Morris, M. (N'hampton S)
Havers, Rt Hon Sir Michael	Morrison, Hon C. (N'hampton S)
Hawkins, Sir Paul	Morrison, Hon P. (Chester)
Hawksley, Warren	Mudd, David
Hayhoe, Barney	Murphy, Christopher
Heddle, John	Myles, David
Henderson, Barry	Neale, Gerrard
Heseltine, Rt Hon Michael	Needham, Richard
Higgins, Rt Hon Terence L.	Neubert, Michael
Hill, James	Newton, Tony
Hogg, Hon Douglas (Gr'th'm)	Oppenheim, Rt Hon Mrs S.
Holland, Philip (Carlton)	Osborn, John
Hooson, Tom	Page, John (Harrow, West)
Hordern, Peter	Page, Richard (SW Herts)
Howe, Rt Hon Sir Geoffrey	Parkinson, Rt Hon Cecil
Howell, Rt Hon D. (G'ldf'd)	Parris, Matthew
Howell, Ralph (N Norfolk)	Patten, Christopher (Bath

Patten, John (Oxford)	Stanley, John
Pattie, Geoffrey	Steen, Anthony
Pawsey, James	Stevens, Martin
Percival, Sir Ian	Stewart, A. (E Renfrewshire)
Peyton, Rt Hon John	Stewart, Ian (Hitchin)
Pink, R. Bonner	Stokes, John
Pollock, Alexander	Stradling Thomas, J.
Porter, Barry	Tapsell, Peter
Price, Sir David (Eastleigh)	Taylor, Teddy(S'end E)
Prior, Rt Hon James	Tebbit, Rt Hon Norman
Proctor, K. Harvey	Temple-Morris, Peter
Pym, Rt Hon Francis	Thatcher, Rt Hon Mrs M.
Raison, Rt Hon Timothy	Thomas, Rt Hon Mrs M.
Rathbone, Tim	Thompson, Donald
Rees, Peter (Dover and Deal)	Thorne, Neil (llford South)
Rees-Davies, W. R.	Thornton, Malcolm
Renton, Tim	Townend, John (Bridlington)
Rhodes James, Robert	Townsend, Cyril D, (B'heatj)
Rhys Williams, Sir Brandon	Trippier, David
Ridley, Hon Nicholas	Trotter, David
Ridsdale, Sir Julian	van Staubenzee, Sir W.
Rifkind, Malcolm	Vaughan, Dr Gerard
Rippon, Rt Hon Geoffrey	Viggers, Peter
Roberts, M. (Cardiff NW)	Waddington, David
Roberts, Wyn (Conway)	Wakeham, John
Rossi, Hugh	Waldegrave, Hon William
Rost, Peter	Walker, Rt Hon P.(W'cester)
Royle, Sir Anthony	Walker, B. (Perth)
Rumbold, Mrs A. C. R.	Wall, Sir Patrick
Sainsbury, Hon Timothy	Waller, Sir Patrick
St. John-Stevas, Rt Hon N.	Walters, Dennis
Scott, Nicholas	Ward, John
Shaw, Giles (Pudsey)	Warren, Kenneth
Shaw, Sir Michael (Scarb')	Watson, John
Shelton, William (Streatham)	Wells, Bowen
Shepherd, Colin (Hereford)	Wells, John (Maidstone)
Shepherd, Richard	Wheeler, John
Shersby, Michael	Whitelaw, Rt Hon William
Silvester, Fred	Whitney, Raymond
Sims, Roger	Wickenden, Keith
Skeet, T. H. H.	Wiggin, Jerry
Smith, Dudley	Wilkinson, John
Smith, Tim (Beaconsfield)	Williams, D. (Montgomery)
Speed, Keith	Winterton, Nicholas
Speller, Tony	Wolfson, Mark
Spence, John	Young, Sir George (Acton)
Spicer, Jim (West Dorset)	Younger, Rt Hon George
Spicer, Michael (S Worcs)
Sproat, lain	Tellers for the Ayes:
Squire, Robin	Mr. Anthony Berry and
Stainton, Keith	Mr. Carol Mather.
Stanbrook, Ivor

NOES
Abse, Leo	Campbell, Ian
Adams, Allen	Campbell-Savours, Dale
Allaun, Frank	Canavan, Dennis
Alton, David	Carmichael, Neil
Anderson, Donald	Carter-Jones, Lewis
Archer, Rt Hon Peter	Clarke, Thomas(C'b'dge, A'rie)
Ashley, Rt Hon Jack	Clocks, Rt Hon M. (B'stol S)
Ashton, Joe	Cohem, Stanley
Atkinson, N.(H'gey,)	Coleman, Donald
Bagier, Gordon A. T.	Concannon, Rt Hon J. D.
Barnett, Guy (Greenwich)	Conlan, Bernard
Barnett, Rt Hon Joel (H'wd)	Cook, Robin F.
Beith, A. J.	Cowans, Harry
Benn, Rt Hon Tony	Craigen, J. M. (G'gow, M'hill)
Bennett, Andrew(St'kp't N)	Crawshaw, Richard
Bidwell, Sydney	Crowther, Stan
Booth, Rt Hon Albert	Cryer, Bob
Boothroyd, Miss Betty	Cunningham, G. (Islington S)
Bottomley, Rt Hon A.(M'b'ro)	Cunningham, Dr J. (W'h'n)
Bradley, Tom	Dalyell, Tam
Brown, Hugh D. (Provan)	Davidson, Arthur
Brown, R. C. (N'castle W)	Davies, Rt Hon Denzil (L'lli)
Brown, Ronald W. (H'ckn'y S)	Davis, Clinton (Hackney C)
Brown, Ron (E'burgh, Leith)	Davis, Terry (B'ham, Stechf'd
Buchan, Norman	Deakins, Eric
Callaghan, Rt Hon J.	Dean, Joseph (Leeds West)

Dewar, Donald	Lyon, Alexander (York)
Dixon, Donald	Mabon, Rt Hon Dr J. Dickson
Dobson, Frank	McCartney, Hugh
Dormand, Jack	McDonald, Dr Oonagh
Douglas, Dick	McGuire, Michael (Ince)
Dubs, Alfred	McKelvey, William
Duffy, A. E. P.	McMahon, Andrew
Dunnett, Jack	McNally, Thomas
Dunwoody, Hon Mrs G.	McNamara, Kevin
Eadie, Alex	McTaggart, Robert
Eastham, Ken	McWilliam, John
Ellis, R. (NE D'bysh're)	Magee, Bryan
Ellis, Tom (Wrexham)	Marks, Kenneth
English, Michael	Marshall, D(G'gow S'ton)
Ennals, Rt Hon David	Marshall, Dr Edmund (Goole)
Evans, loan (Aberdare)	Marshall, Jim (Leicester S)
Evans, John (Newton)	Martin, M(G'gow S'burn)
Ewing, Harry	Mason, Rt Hon Roy
Faulds, Andrew	Maxton, John
Field, Frank	Maynard, Miss Joan
Fitt, Gerard Meacher,	Michael
Flannery, Martin	Mikardo, Ian
Fletcher, Ted (Darlington)	Milian, Rt Hon Bruce
Ford, Ben	Mitchell, Austin (Grimsby)
Forrester, John	Mitchell, R. C. (Soton Itchen)
Foster, Derek	Morris, Rt Hon A. (W'shawe)
Foulkes, George	Morris, Rt Hon C. (O'shaw)
Fraser, J. (Lamb'th, N'w'd)	Morris, Rt Hon J. (Aberavon)
Freeson, Rt Hon Reginald	Moyle, Rt Hon Roland
Freud, Clement	Mulley, Rt Hon Frederick
Garrett, John (Norwich S)	Newens, Stanley
Garrett, W. E. (Wallsend)	Oakes, Rt Hon Gordon
George, Bruce	O'Neill, Martin
Gilbert, Rt Hon Dr John	Orme, Rt Hon Stanley
Ginsburg, David	Owen, Rt Hon Dr David
Golding, John	Palmer, Arthur
Gourley, Harry	Park, George
Graham, Ted	Parker, John
Grant, John (Islington C)	Parry, Robert
Grimond, Rt Hon J.	Pavitt, Laurie
Hamilton, James (Bothwell)	Pendry, Tom
Hamilton, W. W. (C'tral Fife)	Pitt, William Henry
Hardy, Peter	Powell, Raymond (Ogmore)
Harrison, Rt Hon Walter	Prescott, John
Hart, Rt Hon Dame Judith	Price, C. (Lewisham W)
Hattersley, Rt Hon Roy	Race, Reg
Haynes, Frank	Radice, Giles
Healey, Rt Hon Denis	Rees, Rt Hon M (Leeds S)
Heffer, Eric S.	Richardson, Jo
Hogg, N. (E Dunb't'nshire)	Roberts, Allan (Bootle)
Holland, S. (L'b'th, Vauxh'II)	Roberts, Ernest (Hackney N)
Home Robertson, John	Roberts, Gwilym (Cannock)
Homewood, William	Robertson, George
Hooley, Frank	Robinson, G. (Coventry NW)
Horam, John	Rodgers, Rt Hon William
Howell, Rt Hon D.	Rooker, J. W.
Hoyle, Douglas	Ross, Ernest (Dundee West)
Huckfield, Les	Ross, Stephen (Isle of Wight)
Hudson Davies, Gwilym E.	Rowlands, Ted
Hughes, Mark (Durham)	Ryman, John
Hughes, Robert (Aberdeen N)	Sandelson, Neville
Hughes, Roy (Newport)	Sever, John
Janner, Hon Greville	Sheerman, Barry
Jay, Rt Hon Douglas	Sheldon, Rt Hon R.
Jenkins, Rt Hon Roy (Hillh'd)	Shore, Rt Hon Peter
Johnson, Walter (Derby S)	Short, Mrs Renée
Jones, Barry (East Flint)	Silkin, Rt Hon J. (Deptford)
Jones, Dan (Burnley)	Silkin, Rt Hon S. C. (Dulwich)
Kaufman, Rt Hon Gerald	Silverman, Julius
Kerr, Russell	Skinner, Dennis
Kilroy-Silk, Robert	Smith, Rt Hon J. (N Lanark)
Lambie, David	Snape, Peter
Lamond, James	Soley, Clive
Leadbitter, Ted	Spearing, Nigel
Leighton, Ronald	Spriggs, Leslie
Lestor, Miss Joan	Stallard, A. W.
Lewis, Arthur (N'ham NW)	Steel, Rt Hon David
Lewis, Ron (Carlisle)	Stewart, Rt Hon D. (W Isles)
Litherland, Robert	Stoddart, David
Lofthouse, Geoffrey	Stott, Roger

Strang, Gavin	White, Frank R.
Straw, Jack	White, J. (G'gow Pollok)
Summerskill, Hon Dr Shirley	Whitehead, Phillip
Taylor, Mrs Ann (Bolton W)	Whitlock, William
Thomas, Dafydd (Merioneth)	Wigley, Dafydd
Thomas, Jeffrey (Abertillery)	Willey, Rt Hon Frederick
Thomas, Mike(Newcastle E)	Williams, Rt Hon A. (S'sea W)
Thomas, Dr R.(Carmarthen)	Williams, Rt Hon Mrs (Crosby)
Thorne, Stan (Preston South)	Wilson, Gordon (Dundee E)
Tilley, John	Wilson, Rt Hon Sir H. (H'ton)
Tinn, James	Wilson, William (C'try SE)
Torney, Tom	Winnick, David
Urwin, Rt Hon Tom	Woodall, Alec
Varley, Rt Hon eric G.	Woolmer, Kenneth
Wardell, Gareth	Wrigglesworth, lan
Wainwright, E. (Dearne V)	Wright, Sheila
Wainwright, R. (Colne V)	Young, David (Bolton E)
Walker, Rt Hon H. (D'caster)
Watkings, David	Tellers for the Noes:
Weetch, ken	Mr. George Morton and
Wellbeloved, James	Mr. Allen McKay
Welsh, Michael

Question accordingly agreed to.

Main Question, as amended, put and agreed to.

Resolved, That this House expresses its deep concern, at the refusal of the Trades Union Congress Health Services Committee to discuss the Government's fair and realistic pay proposals; pays tribute to all those staff who have continued to care for patients but condemns the irresponsible industrial action being taken in the health service which has led to the cancellation of more than 130,000 operations and an increase in waiting lists of more than 140,000; and congratulates the Government for increasing the resources available to the National Health Service to an all time record figure of £14½ billion and introducing measures to ensure that these resources are used as effectively as possible for the care and treatment of patients.