HC Deb 25 March 1985 vol 76 cc187-94

Motion made, and Question proposed, That this House do now adjourn.— [Mr. Major.]

1.20 am
Mr. Allan Rogers (Rhondda)

It will be interesting to speak in a debate in which Arthur Scargill cannot be blamed. I am pleased that we have with us the Minister for Health, on whose shoulders the blame for this travesty of justice can squarely be put.

I applied for this debate because of the anxiety in the National Health Service and the country about the Government's niggardly, mean and spiteful approach to the settlement of the nurses' and midwives' application for a pay increase. The Government's response is yet another example of their reneging on promises and sliding and twisting out of their responsibilities.

The 500,000 nursing staff in the NHS play a vital role in that service. Their dedication, good will and service to the community are widely recognised. It is a skilled, demanding and responsible job, which requires high personal commitment. Because of their commitment and dedication, however, they are the workers most vulnerable to an unscrupulous Government. If the nurses and auxiliary nurses took industrial action in pursuit of their claim, the whole Government propaganda machine would come into action, with the Prime Minister posturing on television saying that nurses were putting patients at risk.

It is the Minister and the Prime Minister who are putting patients at risk with their deceitful actions. I use the word "deceitful" advisedly, as it is the worst form of deceit to tell nurses and midwives that they deserve realistic pay levels, to set up a pay review body to deliver that promise and then to turn round and tell them that they must pay for their pay increases by accepting reductions in the standards of care for the patients they look after. If an independent body set up by the Government says that nurses deserve far more than a 3 per cent. pay increase this year, the Government should fund it. It is an act of criminal negligence to NHS patients and an abdication of responsibility to set up the pay review body and then to ask nurses, midwives and patients to fund a pay increase.

Staffing levels and the level of care for patients should be determined by the demand put on the Health Service. Pay rates are independent of those factors. Hence, the funding of all awards made by the Government-established pay review body should be treated as a separate matter. To link them is unfair, inequitable and deceitful. Affordability is a political, not an economic, decision. Money to fund what the Government believe to be politically important has been found in the past — examples are too numerous to mention.

The NHS and its staff are essential if we are to have a healthy and economically productive nation. The political will and commitment should be there to fund fair levels of pay determined by an independent body set up by the Government to assess fair levels of pay. The Government's attitude is mean, spiteful and niggardly towards a group of workers in the NHS who cannot adequately defend themselves.

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

I congratulate my hon. Friend the Member for Rhondda (Mr. Rogers) on initiating the debate, because it gives us an opportunity to discuss a matter of great anxiety to our constituents. The treatment of National Health Service staff generally has been outrageous.

At the general election in 1979 the Government set certain objectives. The first was to reduce the rate of auxiliaries' pay by threatening privatisation with its reduced pay and conditions. The second was to reduce the comparative position of professional nurses and midwives against that of other groups, such as the police, the military and many in the private sector. I am sure that the Minister will wish to address himself to that when he replies. The third was to apply cash limits with such vigour as to force health authorities, which implement nationally agreed settlements that exceed the cash limit increase, to cut their budgets and reduce services and patient care. That is certainly the position this year. The Treasury stated clearly in November 1984 that there would be an overall increase in the NHS budget of 5.5 per cent. for 1985–86. Provision for pay is 3 per cent. and for additional staff 2 per cent. on the pay bill. Taken together, pay and non-pay elements come to 5.;5 per cent. across the board. The Treasury made it clear that, if pay increases exceeded 3 per cent., the extra money would have to come from money allocated for providing more staff and/or improvements in services. What is the value of the 3 per cent. offer? With predictions of an increase in inflation to 6 per cent., 3 per cent. must mean a cut in real pay.

To turn to the immediate issue of the nurses' and midwives' claim, which is covered by the pay board review and which represents more than one third of all health authority costs, if the Government keep to their proposed change in policy of keeping to their cash limits and refuse to fund pay awards above the 3 per cent. cash limit for the NHS, it will have dramatic implications for nurses' and midwives' pay.

The professions have become increasingly suspicious of the Government's motives. Those suspicions were reinforced by the fact that the Minister led the team which gave evidence to the pay review board—obviously to enable him to stress the Government's cash considerations. When the Minister attended those discussions, he placed not the case for the value and contribution of nurses and midwives but exclusively the Government case in securing their cash limit objectives. Yet the profession wants only an objective, fair, independent and realistic assessment of its position. That is why the pay board was set up. It is an act of criminal negligence of the users of the NHS and a complete abdication of all responsibility to set up a pay review board with clear terms of reference based on independence and then to ask nurses, midwives, patients and auxiliaris to fund increases when they exceed Govenment cash limit increases.

When the Minister replies to the debate and tells us that it is important that the Government keep to those cash limits because they do not have the money, I hope that he will address his mind equally to areas where the Government have managed to find the money. Nurses, midwives and ancillary workers should know that, although this year the NHS is costing £17,000 million—the additional amount that we believe should be allocated in this offer is substantially less than that—in two and a half years the Falklands war has cost £2,400 million to secure the future of 1,600 people in the south Atlantic. Furthermore, when the Government were confronted with the need to make a £250 million economy in the National Coal Board, they spent — on their own admission — £2,500 million to secure that benefit. In the view of some, they may have spent as much as £5,000 million or £6,000 million. Equally, in this Budget, they are cutting capital transfer tax, capital gains tax and other forms of taxation where the beneficiaries will be exclusively the better off in society. Yet, at the same time, they repeat their view that they must keep to the cash limits, and they refuse to pay what we believe is a small increase when one measures the worth of NHS workers.

I hope that, when the Minister replies, he will set out clearly the Government's priorities. Are they to ensure that National Health Service workers are reasonably and fairly remunerated for the contribution that they make to Britain? Does he believe that that is the priority, or does he believe that the Government should persist in handing over large sums of money to small groups of people, and expending their resources on matters that could and should have been avoided, if only the real public interest had been pursued?

1.31 am
The Minister for Health (Mr. Kenneth Clarke)

First, may I congratulate the hon. Member for Rhondda (Mr. Rogers) on raising this important and serious subject. The hon. Gentleman usually enjoys, as far as I can tell, rude good health, but I realise that this evening he is not as well as he usually is. Therefore, I congratulate him on making the effort to get here at 1.30 am to discuss nurses' and midwives' pay, a subject on which he obviously feels strongly. He received strong support from the hon. Member for Workington (Mr. Campbell-Savours).

This is not the right moment to consider in great depth the merits of this year's pay claim on behalf of nurses and midwives, because we still await the advice of the independent review body. As the hon. Member for Workington said, I gave evidence on behalf of the Government to the review body, because its advice is of considerable importance to us and to the National Health Service and its development during the next 12 months. All those with responsibilities in this matter — the Government, the health authorities and the review body which advises us—must ensure that we deal fairly with key and dedicated workers in the Health Service. But at the same time we must ensure that resources are available for the development of patient services.

What I shall say now is that the Government have an extremely respectable record on nurses' pay. It is important that the House recognises that. Since 1979, nurses' basic pay rates have increased on average by 94 per cent. That is 26 per cent. more than the increase in prices during the same period. In addition to increasing the pay rates, the Government found the necessary resources — it cost about £116 million— in 1980–81 to reduce nurses' 'working hours from 40 to 37.5 a week, without any loss of pay to the nurses. That was equivalent to a further increase of 6.5 per cent. on basic pay. As well as giving pay increases to the staff, the numbers of nursing and midwifery staff in the NHS have increased steadily during the period of office of the Government.

We estimate that in England, an extra 39,500 whole-time equivalent staff in these grades were employed between September 1979 and September 1984, of which 24,000 were additional staff necessary to maintain services following the reduction in hours, and the remainder were additional staff for service developments. Those figures speak for themselves, and show the increase in the pay of nurses and midwives, and the increase to numbers in service.

Most important of our actions, we set up the independent review body to advise us on future pay. We did so because the nurses and midwives did not go on strike in the Health Service strike. It is important that those who do not go on strike are dealt with fairly vis-á-vis those who do take industrial action, such as teachers, miners and others.

The Labour party, to which both the hon. Member for Rhondda and the hon. Member for Workington belong, supported the Health Service strike which continued into its last months because the TUC affiliated unions would not accept that we should make what they called a differential offer, offering a larger percentage increase to nurses and midwives than to their members, who had gone on strike against the patients. Therefore, the Government have an excellent record vis-á-vis the nurses on pay and numbers, and giving them a review body because of their dedication to their patients.

Mr. Campbell-Savours

Why has the pay of the military and the police risen more than the pay of the nurses since 1979? Is the contribution of those groups greater or less than that of others?

Mr. Clarke

The pay of those groups has risen more because their pay fell behind during the period of the Labour Government, because they were not affiliated to the TUC. The hon. Member knows that he is using two unrepresentative groups for an unrepresentative period to make the comparison. The pay of nurses compares well with inflation during our period of office and with the pay of most other groups.

Mr. Dennis Canavan (Falkirk, West)

Does the right hon. and learned Gentleman remember the Halsbury committee report, which was implemented by the Labour Government over a decade ago? That gave the nurses and other Health Service staff the greatest increase—30 per cent. — that they had ever received. How can the Minister justify a position in which a policeman can go along to a picket line and bash people over the head, and is paid more than twice as much as the poor nurse who has to pick up the bloody battered pieces of the person who lands up in hospital as a result of the policeman's violence? If the Government can find the money to give the police a pay rise, why can they not find the money to give the nurses and the midwives an equivalent pay rise?

Mr. Clarke

I do not think that the average nurse would welcome the hon. Member's use of the police as a contribution to the argument for his or her claim for a pay rise. I have just explained that nurses' pay rates have gone up substantially ahead of inflation during the Government's period of office, and nurses are among the groups of staff that have done well while we have been in office.

The hon. Gentleman spoke of Halsbury in relation to the claim. This is not the stage to argue the merits of the claim, because we do not know what the review body will recommend. When it has produced its recommendations, we shall discuss what we shall pay nurses this year. The staff side has based its claim on Halsbury. As its bid to the review body, the staff side has put in a claim for just over 20 per cent. for various grades of the staff. That will cost £650 million and is based on the belief that it would take them all back to the Halsbury level set in 1974.

Such an approach to setting pay should be obsolete. We cannot return to it, first because double figure pay settlements have to be a thing of the past if we are to maintain the low inflation that is necessary as part of the means for restoring our economy.

Mr. Canavan

What about the police?

Mr. Clarke

The police will not get a 20 per cent. pay increase this year.

The idea that a particular professional group chooses one year in which it believes that it achieved a level of pay vis-á-vis other people to which they are automatically entitled to return is a fallacy. Every group chooses a different year. For the nurses it is 1974, for the doctors 1975, while the police will choose current years. Teachers go back to Houghton—I forget what year that was—and Members of Parliament could no doubt choose their favourite year. If historic levels of pay are gone back to and a professional group insists that it is always entitled to go back to that position in the league table, there will be the leapfrogging in pay rises which in the past led to hyper-inflation.

Mr. Rogers

The right hon. and learned Gentleman mentioned that nurses' pay has improved dramatically since 1979. May I refer briefly to the summary of the staff side evidence presented to him:

We focus on the low level of nurses', midwives' and health visitors' pay. We show that the shortfall in earnings between nurses and other professional workers is around 20%. We show that increases of between 15% and 22% would be needed for the main grades to restore the purchasing power of the Clegg award made in 1979. We show that 38.5% of nurses and midwives earn less than £101 per week". To achieve the low pay figure of £110 per week, which is the supplementary benefit equivalent for a two-child family of £115, staff nurses would need a 6 per cent. pay increase and enrolled nurses a 17.7 per cent. increase. In view of these figures, will not the right hon. and learned Gentleman accept that nurses have a very strong claim? This is the evidence not of a raving Left-wing union but of the Royal College of Nursing. This is what it feels about the right hon. and learned Gentleman's pay award.

Mr. Clarke

I know that that is the evidence of the Royal College of Nursing. The Government's respect for the college is demonstrated by the fact that we set up an independent review body to advise us on pay, largely because it is part of the constitution of the Royal College of Nursing that its members do not take strike action. The fact is that the Opposition preferred to support unions which took strike action against patients three years ago. This Government are in a much better position to speak as the friend of the Royal College of Nursing and of those nurses who belong to professional bodies. I have already said that it is not a useful guide in pay determination to take one year as setting a level which determines what is to be aspired to thereafter for each professional group. It leads to each professional group leapfrogging over one another. It is as foolish for the teachers to cling to their favourite year as it is for the nurses and other professional bodies to cling to theirs.

I shall not deal in detail with the evidence. However, one has to work through the figures without knowing whether one is talking about qualified nurses or unqualified nurses, or about student, full-time or part-time nurses. Without arguing about all the comparisons read out by the hon. Member for Rhondda from the evidence, I do not believe that comparisons that are necessarily selective because they are seen to be convenient to the claimant are the only or even the main determinant of pay. A crucial determinant of pay must be the need to deal fairly with one's staff and also the need to recruit and retain staff of adequate quality. That we are doing. There is no difficulty about recruitment.

Mr. Ted Rowlands (Merthyr Tydfil and Rhymney)

What about the recruitment of midwives?

Mr. Clarke

The recruitment of midwives is an important matter. The recruitment of midwives, for reasons which I do not altogether appreciate, is remarkably patchy. In some places it is difficult for midwives to get jobs, while in others it is difficult to recruit midwives. It is very difficult to match up the trained people with the jobs. Furthermore, about 50 per cent. of those who train as midwives do not practise as midwives. They prefer to go back into general nursing.

A crucial determinant of pay must be the availability of resources. That is not some new hardline cash limit discovery made by the Government, as the hon. Member for Workington implied heavily and emotionally throughout his speech. It is true in every major service and industry. One cannot set pay levels without regard to the level of resources available to pay the staff, certainly not when there are almost 500,000 staff.

Mr. Campbell-Savours

If the pay review board were to recommend a settlement of something more than 3 per cent., would the Government, even at this late stage, say that there might be some flexibility in their position and that they might make a contribution towards that settlement?

Mr. Clarke

I shall come to that in a moment. Let me try, without interruption, to answer the hon. Gentleman's points. He cannot keep on interrupting a flow of argument by asking a new question, as he is doing.

The hon. Gentleman asked me about the way in which we made resources available to finance the NHS, including the pay of all its staff, this year. That is an important question. Therefore, I shall not spend my time reminding him of the background to the issue. We have already doubled cash spending on the NHS. It has gone up by one fifth over and above that achieved by the previous Labour Government.

In 1985–86 we have made available an extra £500 million to health authorities in England alone. That is 5.5 per cent.—

Mr. Canavan

What about Scotland?

Mr. Clarke

An Adjournment debate on Scottish affairs would probably be a more relevant time to give those figures.

A 5.5 per cent. cash increase for the NHS is a substantial increase, over and above any current estimate of inflation for the year. It is also the most that we consider that the country can afford. It shows the Government's determination to increase spending on the NHS at a time when the totality of public spending is being restrained. It is not the only source of new resources for the NHS. That 5.5 per cent. cash increase is new money. The NHS will also be able to carry through its cost improvement programmes, increase efficiency and improve the cost-effectiveness with which it delivers services. Health authorities generated £100 million-worth of new resources last year alone doing that.

That is the source of money and resources from which the health authorities must, firstly, finance pay settlements, and, secondly, finance service developments. That is the kind of reality within which anybody must work when operating any major service industry. The maximum resources likely to be available must be worked out and out of those resources every bill must be met, including the pay of the staff, which is most important in a service where 70 per cent. of the costs are pay, and the development of the service.

It is true that this year we have made the matter more explicit than in the past. Last year we based the cash allocation to the health authorities on artificial pay norms set for the purpose of public sector financial planning by the Government. When they proved to be way out of line with Health Service settlements, the contingency fund had to be looked to for a contribution towards settling the award. That was unsatisfactory from everybody's point of view in the NHS and did not give anybody a clear guide about where we stood.

This time we have decided the maximum cash available to the NHS—5.5 per cent. It is not based, as the hon. Member for Workington said, on any 3 per cent. pay factor. That has not been applied to the NHS. There is a 5.5 per cent. cash increase, out of which we must meet all our bills, including any increases in pay.

The result is that all we are doing is facing everybody—Government, health authorities, staff and review body —with the reality that there is a relationship between pay and service provision. Were the pay bill for all groups of staff to go up by, say, 3 per cent. we would have a substantial amount of new resources for growth over and above anything the health authorities are expecting and it would enable them to develop the service even faster than they are doing.

On the other hand, if the pay bill goes up dramatically ahead of inflation and if the total pay bill were to go up by something of the order of 6 per cent. or more, it would wipe out all scope for the expansion of the service. Therefore, I hope that everyone will recognise the need to get the balance right and to come up with sensible recommendations and conclusions.

We now have to wait for the report of the nurses and midwives' review body. We have given evidence and so has the staff side. It is too late now to speculate about the content. It remains as independent as ever. We remain committed to implementing the review body's recommendations unless there are compelling reasons not to do so. Common sense is likely to prevail on all sides.

Mr. Canavan

Sit down.

Mr. Clarke

I trust that we shall get a sensible recommendation from the review body and that we shall be seen in the end to have dealt fairly with our staff and the service. If the Scottish matter is debated, I trust that it will be debated in a slightly more civilised fashion. Thanks to the Government's invention of the review body, these matters are debated in a civilised and reasoned way which is fair to a civilised and dedicated part of the NHS—our nurses and midwives.

Question put and agreed to.

Adjourned accordingly at ten minutes to Two o'clock.