Nurses (Accommodation) (Hansard, 9 December 1983)

§ Mr. Willie W. Hamilton (Fife, Central)
The last debate on this subject was on 29 July, when the hon. Member for Suffolk, South (Mr. Yeo) made a speech based on information provided mainly by the Royal College of Nursing and the Nursing Mirror. My facts emanate from the same source and from the union that sponsors me as a Member of Parliament — the Confederation of Health Service Employees.
In replying to that debate, the Minister did not deny any of the facts disclosed by the hon. Member for Suffolk, South. He sought to argue, however, that because only one nurse in 10 lived in the inadequate accommodation complained of, such a small scandal—the way in which 48,000 of our nurses lived—need not cause too much anxiety. He said that student nurses formed the larger part of that total and automatically received an abatement of 40 per cent. of any lodging charges, plus a further 40 per cent. abatement if the accommodation was substandard, so that there was a clear link between charges and value for money in the accommodation provided.
The Minister's argument on that occasion must be heavily qualified in two respects. First, I understand that the additional 40 per cent. abatement is available to a nurse only if she or he is willing to share a bedroom with another nurse, which hardly any of them do. If the Minister has figures to contradict that, I shall be glad to hear them.
Secondly, it is no excuse to say that the rent is abated if the accommodation is substandard. As the Minister said, the majority of people concerned are students. They are also cheap labour in our hospitals because they work on the wards. I speak from long family experience in these matters. The accommodation in which they are expected to eat, sleep and study must be adequate for all those purposes.
The Minister said in July that 70 per cent. of the nurses covered by the Nursing Mirror survey said that their accommodation provided fair to excellent value for money."—[Official Report, 29 July 1983; Vol. 46, c. 1472.] The implication was that the majority of nurses thought that their accommodation was pretty good. The facts are rather different. Only 5 per cent. of the respondents said that their accommodation was excellent, 30 per cent. thought that it was good, 35 per cent. described it as fair, 24 per cent. said that it was poor and 6 per cent. said that it was intolerable. In other words, far from 70 per cent. regarding it as OK, 65 per cent. described their accommodation as fair to intolerable. I suspect that that is a far more accurate assessment of the figures than that which the Minister sought to convey. It is no use the Minister shaking his head. I have the facts and figures from the Nursing Mirror survey, so he cannot deny them.
The figures show how foolish it is to treat any statistics given by any Minister on anything with other than the greatest suspicion and cynicism. They never tell downright lies, but without exception, from the top to the bottom, they never ever tell the whole truth about anything.
The point is further highlighted by the fact that the Minister failed to mention in July that the Nursing Mirror survey was carried out before many health boards had had time to implement backdated rent increases. The hon. 650 Member for Cheltenham (Mr. Irving) intervened in that debate to remind the House that whenever nurses received a modest pay increase the charges for their accommodation were increased, often taking half or even more of the wage increase. Those increased charges do not relate in any way to the value or quality of the accommodation provided.
Further to buttress his arguments in July the Minister passed the buck to local health authorities. He said that they were responsible for providing the accommodation, for keeping it up to standard and for inspecting it. Meanwhile, he said, new guidelines on these matters would be put to the health authorities next year and the Rayner study on National Health Service accommodation in the Oxford and north-west Thames regions should be published within the next few weeks."—[Official Report, 29 July 1983; Vol. 46, c. 1474] That was four months ago. The Minister can look that up. He will find those exact words.
I inquired in the Library for the Rayner study. I was asked, "What Rayner study? There ain't one." The Library rang the Department which said, "Yes, we have it, but we have not published it." A copy is not available in the Vote Office. It is not available to any Member of Parliament. I suspect the reason is that the proposition will be put that all this accommodation should be privatised and that, instead of nurses or doctors being accommodated in National Health Service accommodation, they will have to apply to speculative landlords. Indeed, that point is well made in the report of the inquiry into underused and surplus property in the National Health Service, dated 1983, which says: We suspect that for historical reasons the NHS provide too much residential accommodation and that the need for such provision requires scrutiny. We are aware that the Oxford regional health authority are undertaking a Rayner scrutiny 'to review the policies and management methods of residential property region-wide, with the aim of reducing work and improving efficiency.' The report continues: Valuable though this study will no doubt prove, we recommend that a further study should be instituted to examine the extent that NHS residential provision is necessary. The terms of reference for such a study should be wide enough to encompass an examination of whether the NHS or another organisation should provide residential accommodation. I hope that the Minister when he replies will give a firm undertaking that there is no thought in the Government's mind of privatising this accommodation.
I should like to refer to the precise nature of the complaints. I shall give a few examples of the specific inadequacies of the accommodation in which 48,000 nurses live. There are six major areas of discontent and I shall enumerate them, although I cannot, in the time available, go through them all in detail.
The first area concerns the lack of secure provision. The second concerns fire hazards. The third and most common complaint made by student nurses concerns the poor facilities available for study in off-duty hours, with few reading lamps, desks and even chairs available to these girls, for whom one of the main purposes of going into the job is to gain qualifications, which entails considerable and intensive study at different hours and in different conditions. Evidence was given to the Nursing Mirror—this concerns the fourth area—that nurses were prepared to pay more for accommodation but they felt that the principle was being accepted by the Department that rents were low because accommodation was awful and there were no prospects of immediate improvement. If that is the 651 case, it is intolerable. The fifth area of complaint is that there appears to be an unsatisfied demand for short-term residential accommodation for trained nurses undertaking post-basic and shortened courses, often in parts of the country many miles from home. The sixth area is that, as an alternative to on-site residential accommodation, trained senior staff would appear to favour joint ownership schemes — for example, through housing association accommodations or perhaps through joint mortgage facilities with nursing friends. In the short time available to me, I shall deal only with security, fire hazard and the generally inadequate living and study facilities for student nurses.
On security, I can do no better than quote specific examples, in particular a letter received by the Nursing Mirror on 31 July from an SRN at the Great Ormond street hospital for sick children. It says: This letter concerns security, or lack of it, in staff residences at The Hospitals For Sick Children, Gt. Ormond Street. To date forty burglaries of nurses' rooms have occurred within the past three weeks. Reputedly someone in possession of a 'master' key to the staff residence is perpetrating the crime. I understand that the security officer at the hospital has been sacked. I make no comment on that, because I do not know the facts. The letter goes on: The action of one nurse has met with deadlock. On the return to her room she discovered the loss of some money and possessions. Immediately she called the police. Next morning security and administration were notified. The same afternoon, while on duty on a busy surgical ward, a security officer saw her. A rather pointless conversation followed in the middle of the ward. Eventually the nurse was able to see an administrator. Her request for locks to be changed and improved security were met with the perennial answer of 'There's no money.' Nor are we permitted to pay ourselves for new locks, because security must have duplicate keys. That is a typical example of the security problems that nurses are facing. Another example concerns the Gartloch hospital in Glasgow. A nurse wrote that the fire escape doors in the nurses' home were all bolted in the interests of security. So the nurses can burn to death, but at least no one can get into their rooms.
There have been many letters from the Alder Hey children's hospital nurses' home in Liverpool. I shall quote only one which speaks of rooms left wide open whilst being cleaned by domestics. Also, when the corridor was being repainted, doors were left open without supervision. I complained of not being able to lock my window and blocks were put into the frames. Surely this does not meet with fire regulations. Fire hoses don't reach all the rooms. No facilities for an electrical fire. So it goes on.
Probably the most worrying complaint concerns fire hazards in nurses' homes. I had first-hand experience of that in November 1981 when the nurses' home in Kirkcaldy in Fife was burnt down and a nurse died. There was an inquiry and the Fife health board has decided to restore the home and remedy the fire defects.
The cost will be about £1 million and the nurses who were accommodated there have been put up in neighbouring hotels at a cost of £120,000 a year. The board asked the Scottish Home and Health Department to foot the bill. The Department replied, "Not on your nelly. You finance it out of your general budget." As a consequence, that £120,000 has to be taken out of money that would otherwise be spent on patient care. I hope that the Scottish Office is proud of its record. The Under-Secretary of State for Scotland is present and I give him 652 notice that I shall raise this matter at the meeting of the Scottish Grand Committee in Edinburgh on Monday. I hope that he will have an adequate response.
All the grievances about fire hazards stem from the fact that all NHS property, including hospitals and nurses' homes, is regarded as Crown property and is, therefore, protected by Crown immunity, which means that owners or managers cannot be prosecuted, even for the most flagrant breaches of health and hygiene regulations.
The Crown's exemption from fire and safety laws highlights the grave implications of the high incidence of fires and electrical wiring defects which are recorded in the Nursing Mirror survey. The survey speaks of fire doors being locked on security grounds, unchecked fire fighting equipment, irregular fire drills and faulty alarm bells. That evidence points to a horrific state of affairs, which simply cannot be allowed to continue.
When the Government say that there is no money, or insufficient money, to put matters right, I repeat what I have said many times. When we were faced with the cost of a military expedition to the Falkland Islands the Prime Minister said from the Dispatch Box that, no matter what the cost, we would see it through. The cost of that expedition, now and for the future, is measured in thousands of millions of pounds. No Government can say with any credibility that the money is not available. When the Government want it, they can get cash for anything. I echo the Prime Minister. Whatever the cost, urgent and immediate steps must be taken to protect 48,000 nurses from the danger of being burnt alive in their hospital accommodation. The absurdity of Crown immunity must be ended quickly as it is a matter, literally, of life and death.
I shall now give a few examples of the living conditions that we inflict on nurses. I shall quote from a report on findings resulting from inspection of the east Glamorgan staff residence in March 1983. About the ground floor it said: Married couple's fiat. Sitting room — decorative order poor. Inadequate electrical sockets. Window frames rusting with large damp areas around. Bedroom — tiny and in poor decorative order. No kitchen. Still on the ground floor, the report refers to a kitchen, which is obviously not available to the married couple. It continues: Kitchen: Very large with one domestic refrigerator and one domestic cooker in kitchen. Two domestic refrigerators in pantry area both old and dirty. Walls in state of decay with large areas of damp. No ventilator or extractor. The report then describes the kitchen on the first floor: One domestic cooker, one domestic refrigerator to serve one hundred people. Of the bathrooms it says: Large cast-iron baths, none containing a plug. Baths discoloured where surface had worn away. Side inspection panels loose or missing. Tiles chipped. Light cord two inches long. Decorative order dismal. Of the laundry it says: One industrial washing machine, one tumble dryer for one hundred people. No plugs in the three sinks, and water taps loose from wall. Of the lavatories it says: Several without seats, but otherwise clean. How nice. That is an example from south Wales. The Alder Hey nurses home in Liverpool has one cooker for about 50 nurses and I am told than it hardly ever works. There are two fridges which are overcrowded and padlocked. To cap it all a letter from the Confederation of 653 Health Service Employees spelt out how easily nurses can be evicted from their NHS accommodation, arbitrarily and unfairly.
The Nursing Mirror quoted an example in Scotland of three nurses being chucked out of their accommodation because of certain irregularities which the hospital authority alleged that they had been engaged in. The nurses have no security of tenure although such accommodation might be the only place where they can live. COHSE has given me several examples.
I apologise if I am taking a long time but it is important to put such facts on the record. I do not apologise for raising these issues. I have presented only a few of the facts because time is short. I hope that the Minister will not accuse me or anyone else who is associated with the campaign of exaggeration or engaging in alarmist rhetoric. I also hope that he will not subject us to the type of complacent speech which I understand that he made to the debate of 29 July. Nor will it be sufficient for the Minister to try to pass the buck to the health authorities.
It is the Government who must provide the cash necessary to enable health authorities to bring the accommodation up to civilised and acceptable standards. Ministers—I include Scottish Ministers—should conduct a national survey to ascertain the cost of such a programme and to provide additional resources to implement it. Apart from anything else, such a scheme would provide new jobs. If the Government will not do that job, I hope that the appropriate Select Committee will do it.
There is no excuse for delay. It will be wholly unacceptable if the Government use any argument to delay the exercise to make sure that all Health Service property —hospitals and nurses' homes—has the best possible fire security arrangements and that Crown immunity for that property is ended forthwith. I hope that the Minister will give us a responsible and reasoned reply, saying that this subject must have urgent consideration and immediate action.

§ Mr. Laurie Pavitt (Brent, South)
rose——

§ Mr. Deputy Speaker (Mr. Harold Walker)
Does the hon. Member for Brent, South (Mr. Pavitt) have the consent of the hon. Member for Fife, Central (Mr. Hamilton) and the Minister to speak?

§ Mr. Pavitt
Yes, Sir. I am grateful to my hon. Friend the Member for Fife, Central (Mr. Hamilton) and the Minister.
I was interested to hear that the daughter of my hon. Friend the Member for Fife, Central (Mr. Hamilton) trained at Guy's hospital, where my daughter also trained. I underline his point about the importance of this issue to first-year students. He referred to whether they would continue their career after they had done so much hard work. It is important to sustain the involvement of nurses taking up that career.
My second point is about district and regional health authorities. I ask the Minister to conduct a pilot survey into minor capital works in one of the regions. In my region there has been a cut-back of £8 million. One area with low priority is minor capital works. At district level, the refurbishing of the conditions that my hon. Friend brought to the attention of the House is so low a priority that it will 654 not take place for at least another four or five years. I ask the Minister to consider the way in which minor capital works funds are being used.

§ The Under-Secretary of State for Health and Social Security (Mr. John Patten)
There is not a great deal of time left for me to reply, although I am glad that the hon. Member for Brent, South (Mr. Pavitt) has been able to raise two important points.
My hon. Friend the Under-Secretary of State for Scotland came to hear the speech by the hon. Member for Fife, Central (Mr. Hamilton). He has realised that on Monday, in the Scottish Grand Committee in Edinburgh, he might be asked questions and pressed by the hon. Gentleman on Scottish issues that the hon. Gentleman raised during his speech—that is, if the hon. Gentleman is fortunate enough to be called on Monday. I have no control over that.
The hon. Gentleman began his speech by making some generalised comments, that one can never trust any Minister. He did not discuss which Administration the Minister was from.

§ Mr. Willie W. Hamilton
Both.

§ Mr. Patten
The hon. Gentleman said that one can never trust Ministers to use statistics properly. He ended his speech with a charming and moderately phrased request for a moderate and responsible reply from me. I appreciate the hon. Gentleman's interest in the National Health Service and his detailed knowledge of the problems facing the nursing world, in which his daughter worked in the past, but he did not help his case by the exaggerated way in which he put some of the aspects of his argument. In the five minutes left to me, I cannot comment in any detail on the cases which the hon. Gentleman raised concerning certain specific nurses. The question of security is certainly very worrying. If the hon. Gentleman will write to me, giving details, chapter and verse, and the names of those involved, I shall reply immediately after I have looked into the cases. I welcome the hon. Member for Bolsover (Mr. Skinner) to the Labour Front Bench. The hon. Member for Fife, Central referred to the fact that just before the summer recess my hon. Friend the Member for Suffolk, South (Mr. Yeo), who is not in his place, raised this issue. This afternoon I have an opportunity briefly to state whate progress has been made since the summer. In the debate in July I said that we were looking forward to receiving the report of the Rayner scrutiny on residential accommodation not only for nurses but for other NHS staff. We received the report in October, and that report on the Rayner scrutiny is itself now subject to ministerial scrutiny.
The scrutiny covers all staff accommodation, not just accommodation for nurses. It is an interesting and thought-provoking document. I cannot give firm reactions to it at the moment, because we are in the early stages of considering it ourselves, but it raises some fundamental questions.
First, it asks why the NHS provides so much residential accommodation. That is not a bad question to ask, whether we are thinking of nurses or other members of staff such as doctors. We are statute-bound to provide accommodation for some junior doctors, but the provision far exceeds the statutory requirement.
655 Secondly, the report questions whether the provision of residential accommodation is always necessarily the best use of NHS resources and management time. Should the financial and management resources of the NHS be devoted to this provision to such an extent? We must address ourselves to those fundamental questions. The NHS does not have to remain a snapshot photograph of what it is in 1983.
I should make it clear to the hon. Gentleman, and to the specialist journals which are interested, that I am not announcing a new Government policy. I am simply telling the House about some of the questions raised by the scrutineers. We shall have to consider the answers to those questions. In scrutinising the scrutiny we will consider the six important points to which the hon. Gentleman referred in general terms, although he only had time to go into detail on three of them.
656 During the six months that I have spent at the Elephant and Castle I have received the impression that the provision of residential accommodation has not always been subject to a clearly determined policy, either national or local. The Rayner report will oblige us to take a fundamental look at the provision, including that for the 10 per cent. of nurses who reside in NHS residential accommodation and about whom the hon. Gentleman, his hon. Friend the Member for Brent, South and I myself are concerned.