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§ Mr. Alfred Dubs (Battersea)First, I declare an interest as I am sponsored by the Confederation of Health Service Employees, which represents many workers in the National Health Service. However, I would wish to put my case whether or not I was sponsored by COHSE, because it is of interest and concern to all people who believe in the NHS and want it to have a successful future
Like all those involved in the NHS, I believe that it is highly desirable that it should be run efficiently and that maximum resources should go into the care of patients, while NHS workers at all levels are assured adequate pay and proper working conditions.
The Rayner scrutiny, which gives rise to the debate, dealt with NHS accommodation. My purpose is to examine that review and various problems that have risen as a result of it. It was published in August 1984 and was implemented, in a sense, by a DHSS circular last year called,
NHS Residential Accommodation for Staff.The Rayner scrutiny and the circular basically encouraged health authorities to dispose of a large proportion of their residential accommodation for all grades of staff.According to the scrutiny, at present there are 112,000 units of accommodation, which comprise houses, flats and a large number of bedsitters and places in hostels, occupied as follows: 35,000 units by student nurses, 29,000 by other nurses, 11,000 by junior doctors, and 20,000 by ancillary staff. That makes a total of 95,000 units. Rayner claimed that the balance of 17,000 was unoccupied. However, he did not simply say that those 17,000 units should be occupied or disposed of, but suggested a much more drastic cut. The report suggested that first-year student nurses would occupy 29,000 units, junior doctors 8,000 and other staff 2,000, making a total of 39,000. That suggests that 73,000 units should be disposed of. Rayner made a fairly arbitrary distinction between essential staff—those who are to be given NHS accommodation—and non-essential staff who are to be encouraged or forced to find accommodation elsewhere.
The Rayner figures resulted from a survey based on a sample of a quarter of health authorities, of which only two were considered in detail. There are major doubts about the reliability of the figures, and, therefore, the reliability, of the results, conclusions and recommendations. I understand that there is 95.5 per cent. occupancy of the health authority's accommodation in Wandsworth. Therefore, if the Wandsworth health authority, which I am sure is typical of many health authorities, should get rid of a large proportion of its accommodation that would have devasting consequences, to which I shall refer later.
Rayner should have asked how along the properties had been standing empty, and why? Given that a fair proportion of the property is used by trainee Health Service staff, there is bound to be a certain turnover. Inevitably, therefore, some property will be empty for a short time when staff leave to go elsewhere in the NHS and in turn are replaced by other staff. If that information had been available, it would have been easier to decide whether there was any basis for the change in policy. I regret very much that that information was not available to Rayner.
691 When the Rayner report and the following circular were published, there was a storm of protest from many people in the Health Service. I have yet to find those who, other than the Minister and Rayner, support this policy change.
Under pressure, the Secretary of State for Social Services gave a guarantee in the House of Commons on 25 March that no district health authority would resort to the courts to force nurses to leave accommodation in which they wished to remain. The Secretary of State's words were:
I can give that guarantee."—[Official Report, 25 March 1986; Vol. 94, c. 779.]That is all very well, but there is one other matter to take into account.Under Crown immunity, the Crown or its agents have immunity from many laws. A few weeks after the assurance of the Secretary of State for Social Services, the West Surrey and North-East Hampshire health authority took court action against a nurse because it wanted to acquire the property in which she was living. The nurse was offered alternative accommodation, but she felt that it was inadequate. In the event, I believe that she is being offered better and more satisfactory accommodation, which she may accept.
However, after its assurance that no court action would be taken, the health authority claimed that Rent Act protection did not provide security of tenure to the nurse and did not even make it necessary for the health authority to use court proceedings to acquire the property. In other words, Crown immunity means that people can be chucked out of their accommodation and that there is no longer the safeguard of the courts having to approve the decision that somebody should be ordered out of their home. That is very odd — the more so as, during the proceedings, the health authority changed the plaintiff. The plaintiff became the Secretary of State for Social Services.
It is extraordinary that a senior Government Minister should have given such an assurance and that later Crown immunity should have been used, which meant that his assurance became virtually meaningless. It has caused enormous consternation. The implication is that Health Service staff have no safeguard and that they can be thrown out of their accommodation, the courts being unable to provide basic protection for them. It makes nonsense of what was said by the Secretary of State.
Towards the end of April the Minister for Health gave an assurance that nobody would be required to move from his or her accommodation without being offered suitable alternative accommodation. That assurance is to be found at column 774 of the Official Report for 29 April 1986. That is an assurance of sorts, but it depends upon what is meant by suitable alternative accommodation.
I have two main concerns. The result of trying to get rid of the bulk of NHS accommodation will have a damaging effect on the effectiveness and efficiency of the NHS. It will also have a detrimental effect on the conditions and the work of the staff. We are not dealing with warehouses or with an accountancy exercise which is what Rayner seems to be doing, but with the homes of many thousands of Health Service workers. The Health Minister and the Secretary of State have engendered a feeling of anxiety and insecurity.
692 The Minister gave an assurance about alternative property but alternative property may be too far away. It is unsettling for someone to be told that he has to go and that the accommodation found for him is some distance away. In any case, the Health Service may find itself in difficulties because there may not be any alternative accommodation. It is certain that in many areas where there are housing shortages local authorities will not be able to provide alternative accommodation.
No doubt the Health Service would like to negotiate about alternative accommodation, and I understand that the Royal Marsden hospital put in a bid for some property that the council was selling. In my view, the council was wrong to sell it, but in any event the hospital did not make a high enough bid and the property was sold to a private property company. The hospital bid was just a little bit lower than the one placed by the property company. The difficulties are enormous.
Another problem is that alternative accommodation may have high rents. We know that in many areas of London and in many inner city areas the rents are very high and we are dealing with some of the lowest paid workers in Britain. Despite the announcement yesterday about pay rises for nurses and other people, many Health Service workers do not have enough pay to be able to move to alternative accommodation. The Rayner report took note of that because it said that higher pay cannot subsidise housing. The Government did nothing about that because it would have meant pay at quite a higher level.
There is a danger that the Health Service under the new policy would provide accommodation for training staff and certain grades of staff and when the trainees have qualified they will have to find other accommodation. That means that many of them will be living under the threat of homelessness. The policy will exacerbate recruitment to the Health Service because some hospitals get their staff because they can provide homes. When there are no homes, even with high unemployment people cannot accept jobs in those hospitals.
Although assurances were given that there would he proper consultation on all these matters, as far as I can tell there has been no consultation, and the measures that I am talking about were diktats by the Secretary of State and the Minister and were approached in an insensitive manner.
Because of Crown immunity, there are difficulties about getting the Health Service, as the landlord, to carry out decent repairs when such repairs are necessary to the type of accommodation that I am talking about. The Rent Act 1977 scrutiny of which other people have the advantage if they want to see whether their rents are set at a reasonable level, is not available to Health Service tenants. The only people to whom Health Service staff can appeal are people in the Health Service itself. There ought to be some independent method, preferably that which applies to other types of accommodation, which would allow rents to be set in an impartial way. There are health and safety risks in accommodation, especially in hostels and other multiple accommodations in the Health Service, and Crown immunity prevents legislation coming into play as it should.
The issues that I have raised are of major concern to many people in the Health Service and I fear that the Government are making a mistake. I think they hope to save some £170 million, but perhaps the Minister will come up with a different sum. The Government are saying, "We want to save money, and in order to do that we will 693 make a major change to the way in which certain types of Health Service staff can find accommodation." This policy is causing great confusion and is not clear to the health authorities. At the least, a further circular is called for in order to sort matters out.
That is only a minor point. The main point is that the policy is mistaken. It is based on false facts and on a misunderstanding of the serious housing difficulties in the areas adjoining many of our hospitals. The Health Service will be damaged if the Government insist on proceeding with this policy. I hope that they will change their mind.
§ The Minister for Health (Mr. Barney Hayhoe)I am glad that the hon. Member for Battersea (Mr. Dubs) has chosen this subject for his Adjournement debate. I welcome the opportunity that it gives me to set out the Government's policy on NHS residential accommodation, for there has been, as the hon. Gentleman said, unnecessary anxiety about it.
As the hon. Gentleman said, the background to the policy is a Rayner scrutiny undertaken in 1983 as part of the programme that has covered sectors as diverse as ambulance services and arrangements for advertising for staff. These are not crude, cost-cutting exercises. They represent part of the Government's stategy for achieving the best value possible from resurces spent on the NHS. As the House knows, the Government have allocated £18.75 billion to the NHS in the current financial year, more than has ever been allocated by any of their predecessors, but there will never be enough money to meet all the demands on the services. Therefore, there is a duty to ensure that both revenue and capital resources are used as effectively and efficiently as possible. I welcome the hon. Gentleman's comments to that effect.
In the current year, the overall cost improvement programme, of which the Rayner scrutinies form an important part, will release about £150 million in cash, which can then be devoted to other aspects of the service. In addition, there will be productivity gains by better use of available resources.
The senior Health Service officers who undertook the scrutiny into residential accommodation examined the position in about 40 health districts, and their report contains some striking figures. In particular, they found that
authorities have approximately 112,000 units of accommodation … more than 20,000 houses and flats and more than 70,000 residential places in bedsitter and hostel-type blocks … at any one time nearly a fifth of the total accommodation stock is unoccupied; in individual authorities the vacancy rate ranges from 4 per cent." to 33 per cent.The hon. Member quoted the example of Wandsworth, which is at the low end of that scale, and may even have been the authority that the officers had in mind when talking about 4 per cent. The report continues:few, if any, authorities had a considered policy on accommodation. Rather, the level of the present stock and the categories of staff living in it, are in large measure the result of historical accident and ad hoc decisions.Anyone who has surveyed this scene will appreciate the force of that remark.This report showed clearly that residential accommodation represents a valuable and expensive resource which was not being managed effectively or efficiently, quite separately from the scrutiny, there has been longstanding concern about the state of sonic of the property, and the conditions in which some staff have to live.
694 Following consultation on the scrutiny report, authorities were asked to draw up explicit local plans for the future, within an overall national policy. There are four aims. The first is to ensure that health authorities have sufficient accommodation for junior doctors, student nurses and other professional trainees. Secondly, to enable authorities to provide accommodation for other groups of staff where, for example in inner city areas, the lack of accommodation would make recruitment impossible. Thirdly, to bring staff accommodation up to a reasonable standard, as a priority charge on the proceeds of sales. I accept what the hon. Gentleman said about the poor standard of a significant proportion of the accommodation.
The fourth aim was to sell surplus property to existing tenants at discounts of up to 60 per cent. whenever practicable, the proceeds being used to develop health services. The Department has now studied most district health authority plans, which show that the alarmist stories about substantial reductions in the stock of accommodation available for student nurses and other professional trainees are untrue. Indeed, some authoriies have plans for increases to take account of the rising number of trainees.
The plans also show that, in some cases, even now, nearly three years after the scrutiny report was prepared, a significant proportion of the existing stock is empty. Authorities have been asked to sell any such properties which they regard as surplus to requirements by the end of 1986, unless to do so would jeopardise the later sale of a larger site of which such property forms part. Authorities anticipate proceeds of about £30 million from the sale of residential property during the current financial year. Most will be from the sale of properties that are currently empty. Every penny will stay within the NHS, and will be available to improve the standard of the residential accommodation that is to be retained and to expand health services.
Some property that authorities have identified as surplus is currently occupied. Authorities have been asked, when practicable, to offer such property to the present tenants or licensees on concessionary terms which match those available to council tenants under the right-to-buy scheme. They thus provide for discounts of between 32 and 60 per cent. off market value to occupiers of two or more years' standing. This must be good news for the tenants concerned.
Some authorities are clear that, in future, they will not need to retain all of the accommodation that they now provide for staff other than professional trainees, but the process of rationalising property holdings, which may well involve asking some staff to move, must be carried out with proper regard to the interests of the existing tenants and licensees.
My right hon. Friend the Secretary of State has already guaranteed that nobody will be made homeless as a result of rationalisation. The hon. Gentleman referred to exchanges in the House in which I reaffirmed that clear guarantee. Nobody will be required to move from his or her present accommodation without being offered a suitable alternative place to live. That guarantee has gone a long way to meet the genuine anxiety expressed by some staff about how the policy is to be implemented. The Government recognise that those anxieties flow from the rationalisation policy and from the lack of any well established procedures in the service which cover these matters.
695 The conditions under which staff occupy NHS accommodation and under which health authorities manage the residential estate requires examination with a view to establishing a code of practice or some similar set of arrangements. My right hon. Friend the Secretary of State has therefore asked the NHS management board to review these matters urgently and to consult health authorities and professional and staff interests. I am sure, from the general tenor of what the hon. Gentleman said, that he will welcome that clear undertaking.
Until the review has been completed and proper arrangements have been established, health authorities are being asked not to implement any part of their plans for rationalising property holdings which involve giving staff notice to quit residential accommodation.
However, if circumstances arise, for example, not paying rent or behaving in a fashion that is wholly unreasonable towards neighbouring tenants — this has nothing to do with the estate rationalisation policy that I have described — which make it necessary for an authority to consider giving staff notice to quit, the authorities are being advised that they must first seek the Department's approval.
The Government's policy is designed to balance the obvious need to manage the residential estate effectively with the need to treat Health Service tenants and licensees reasonably and fairly. We cannot tolerate a position where 20 per cent. of accommodation is permanently empty, which represents about £200 million or £300 million worth of resources tied up pointlessly in empty property. Nor can nurses or other health workers be allowed to become homeless as a result of seeking to rationalise the estate. I hope that the hon. Gentleman agrees that that policy, including the guarantee that has been given to the staff and the review that I have announced today, is sensible and fair.
The hon. Gentleman also mentioned the need for a circular which will update those arrangements for health 696 authorities. Such a circular will be issued during the next week or two. He also mentioned the incident in west Surrey, about which there was much publicity, in the context of the NHS residential estate. The incident had nothing to do with the estate. It is a separate matter.
The property at issue did not form part of the NHS estate. As I understand it, it was leased from another body, which considerably increased the rent that it was demanding. As a result, action was taken, with the individual nurse being offered alternative accommodation. I should be happy to write to the hon. Gentleman about that, because there have been grossly misleading accounts of the incident. That separate incident has been linked, misleadingly, with the general policy. There has been some awful, alarmist publicity. The hon. Gentleman mentioned the clear undertaking about no evictions given by my right hon. Friend the Secretary of State in the House on 25 March. It was extraordinary that, on 4 April—a week or more after that clear statement — a national daily newspaper produced this front page headline:
Sold out! More than 25,000 nurses are facing the boot from their houses in a shock, Government-backed plan.There would have been no excuse for producing such an alarmist story before my right hon. Friend gave that clear assurance on 25 March, but it is monstrously irresponsible for the newspaper to feed the anxieties of nurses and other staff who may have read the story and believed h. I appeal for those matters to be dealt with responsibly and sensibly.The hon. Gentleman also referred to Crown immunity in relation to action over rents and health and safety in this sort of accommodation. He will know that a Bill is going through the House which deals with Crown immunity for food regulations, hospital kitchens and the handling of food. I suspect that, on Report, provided that the Chair gives its permission and calls the appropriate new clause, those matters may well be debated again. Therefore, I shall say nothing further about them today. However, I hope that what I have said will reassure people that the Government's policy on NHS residential accommodation is fair, reasonable and sensible.