HC Deb 19 December 1988 vol 144 cc258-64

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

9.1 am

Mr. William O'Brien (Normanton)

I am pleased to have this opportunity to express concern about staffing procedures and staffing in general at the Stanley Royd hospital, which is situated in my constituency.

Stanley Royd hospital is part of a major hospital complex. The site area of the total facility is 100 acres, of which three quarters form the grounds of Stanley Royd hospital. It serves the population of Ossett, Stanley, Wrenthorpe and Wakefield city area, and it accommodates the mentally ill and elderly severely mentally infirm. It provided a full range of psychiatric services, a clinic, a day hospital and occupational and industrial therapy, and included a regional secure unit.

In 1936, the hospital could accommodate 2,678 patients, but in 1984 there were only just over 830. In August 1984, there was a severe outbreak of food poisoning that affected just: over half the patients a nd resulted in the deaths of 19.

A public inquiry was held to investigate the outbreak of food poisoning, which took over a year to report. The report was presented to the Secretary of State in January 1986. The cause of the food poisoning was the preparation of food in an old, unworthy and unhealthy kitchen in the hospital. The kitchen was significantly criticised by the inquiry, and reference was made to the lack of capital to improve facilities, which was the true problem. If only a proportion of the money spent on cook-chill had been spent on the kitchen, that outbreak of salmonella food poisoning could have been avoided.

The inquiry recommended that the regional health authority should consider withdrawing funds from Stanley Royd hospital as population decreased. It also criticised understaffing in the hospital. The kitchen was understaffed, with the result that cleaning schedules fell into arrears. Considerable evidence was given to the inquiry about staffing levels, and Stanley Royd has had the lowest staff-patient ratio in the district. In 1984, there were 38 fewer qualified nurses than were allowed on the establishment. Because of unqualified nurses and student nurses, that deficit was reduced to 29. It has always been hard to recruit qualified staff at that hospital. The present management are not working in the best interests of the hospital with the application of the present grading structure.

I ask for a full investigation into the way in which regrading has been applied at Stanley Royd hospital, particularly in view of the comments that were made in the inquiry report on staffing levels and the food poisoning outbreak. That investigation should also cover the proposed cook-chill system and its implementation. The Minister advised of amendments to the original 1980 guidelines for the application of cook-chill food processing, but the amendments have been withdrawn because of the listeria case that has come about in the neighbouring district health authority area of Leeds.

Because of the history of Stanley Royd to which I have referred and the public inquiry's recommendations, I ask the Minister to assure me that the cook-chill food process which is proposed for Stanley Royd hospital will not be implemented until the amended guidelines to the 1980 guide are issued by his Department. The new guidelines should be applied when the change in food preparation and distribution system is in place in Stanley Royd hospital. Failure to give me that assurance today will show a lack of compassion on the part of the Minister towards people in my constituency who suffered from past mismanagement, and feelings in my constituency will be heightened if the new Department of Health guidelines are not applied. Will the Minister address that matter?

Staff at all levels at Stanley Royd hospital have not only suffered the trauma of 1984, when much publicity was given to the salmonella outbreak, but been under immense pressure. Morale was low on that occasion. Morale is low now because of the way in which grading structures have been applied.

Paragraph 118 of the inquiry's report states: we heard a considerable amount about nursing levels from Mr. McEnroe, the District Nursing Officer, who agreed that Stanley Royd had one of the lowest staff-patient ratios in the district. It goes on: In 1984 the aim was to have a ratio of qualified to unqualified staff of 60/40, at that time it was 52/48.

On the night shift of 30 November this year, the funded establishment was 114.5 full-time equivalent nurses. In post were 99.5, a shortfall of 15 staff or 17 per cent. of the establishment. Of those 99.5 staff, 43.25 were nursing assistants. In addition to the 17 per cent. shortage of nurses, 43 per cent. were unqualified. They are the very people who significantly carry the work load in the 26 wards of Stanley Royd hospital.

All those nursing assistants are paid on the lowest possible grade—grade A—and because of their grading as laid down by the Department of Health, all of them must be supervised. On the night of 30 November—a typical working night—only 6.25 of the other 56 staff were sisters or nurses in charge. Because on the night shift there is no senior management, two of the 6.25 nurses were acting as care group managers, leaving just over four nurses or sisters or nurses in charge on duty for the 26 wards.

The problem of supervision at Stanley Royd is dramatically highlighted by an examination of the composition of the staff on duty. In addition to the hospital being 17 nurses short and to 43 of the 99 nurses on duty being nursing assistants, a further 41 nurses were enrolled nurses on grades C and D, the lowest grades in the structure. The staffing malaise at Stanley Royd, with particular reference to the night shift, is such that out of 99 nurses—of whom two were taken to manage the hospital leaving 97—84 are in the lowest paid majority and are untrained to attend to patients in 26 wards. According to the formula set by the Department of Health, all those 84 nurses require supervision by the 13 or 14 charge nurses and staff nurses—of whom 10 are staff nurses—who are also paid the D and E grades, which are minimum grades in the supervisory area—the lower grade in the grading structure. It is significant that, because of the shortage of staff, nurses are having to work their shift without a meal break, with no extra pay for the extra work. It is diabolical that in 1988 people should have to work through their meal breaks because the authority will not recruit extra qualified staff.

The imperfect staffing is cruel to those employed in Stanley Royd hospital, and should not be allowed to continue. I ask the Minister to take a personal interest in the concern that I have expressed, with a view to reviewing the staff grades at Stanley Royd, which are abysmally inadequate to reward people for the work that they are doing. I make that request because the management has failed in its duty to carry out a proper and fair assessment of gradings.

If the Minister would agree to investigate the matter, I would rest my case there. If he does not agree to do that, I must remonstrate and place more of the cruel anomalies of mismanagement on the official record. I am determined to continue to highlight what is happening at Stanley Royd hospital until justice is obtained for the people who work there.

The Minister will undoubtedly refer to the new chairman, who was appointed recently, and tell me to give him a chance. But I say to the chairman of the Yorkshire regional health authority and the Minister that they have deserted the cause of the Wakefield health authority. I make that allegation because the Department of Health accepted the report and findings of the regional inquiry of July this year into the management of Wakefield district health authority.

That report recommended that Sir Jack Smart should be replaced as chairman by a person who had no connection with the authority as at present constituted. It must be made clear that Mr. Brian Hayward, who is now the chairman, has been involved with Wakefield district health authority because he was chairman of a very important committee which reported on the controversial cook-chill system of providing meals in the Wakefield district health authority area. It is strongly suspected that the appointment of Mr. Brian Hayward is to ensure that the cook-chill system is applied, so as to justify the enormous sums spent on this project, to which the regional health authority, of which Mr. Hayward was a member, is committed. The scenario involving Wakefield district health authority continues.

The appointment of Mr. Hayward signifies how much of a travesty of justice that regional inquiry was, and what a charade were the gradings of nurses under the recent wage awards. No negotiations with the nurses' representatives took place. Letters were sent to nurses informing them that they would be paid on grade E, but a few weeks later they were informed that they would be downgraded to grade D.

Morale is low. People are working under great stress. There is a shortage of trained nurses, and people are doing the work but are not paid adequately. Meal breaks cannot be taken because there is no one to cover. At times, supervision is wholly inadquate. There is no provision to replace nurses off sick or on holiday. The training programme is being cut. On the short-term mental illness training programme for 1989–90, there is a cut of 15 people. How can any Government or authority endorse such a programme of devastation, particularly in view of the public inquiry into salmonella food poisoning in 1984, which on page 112 recommends: efforts to improve the ratio of qualified to unqualified staff must continue and the recruitment of all staff to at least the presently permitted establishment should be pursued with vigour. Two years after the report was presented, the hospital is still not staffed to establishment.

What is the Minister doing about that? Will he investigate staffing levels and the work load of nurses who have to care for patients in hospital in order to give families at home a rest? These patients are not hospital-orientated, and they require more attention. Will he investigate the management structure of the hospital on the night shift when charge nurses are withdrawn from supervisory duties? Will he give an assurance that, before the cook-chill meals system is applied by Wakefield district health authority, the guidelines amending the 1980 Ministry of Health guidelines will be applied? Will he consider the matter to be serious? Finally, will he visit the hospital and listen to the views of all those involved in its running and management, and those of the nurses?

9.17 am
The Minister of State, Department of Health (Mr. David Mellor)

In looking for something kind to say at Christmas, the best thing I can say about the speech by the hon. Member for Normanton (Mr. O'Brien) is that it was not as outrageous as that to which the hon. Member for Wakefield (Mr. Hinchliffe) treated us the last time this matter was discussed in the House as recently as 25 October.

At that time the hon. Member for Wakefield made what may turn out to he the highly expensive mistake of choosing to disseminate some of his outrageous allegations to the press before speaking in the Chamber. As a result, what he said is now the subject of legal action. So I have nothing further to say on cook-chill and nothing further to add to what my hon. Friend the Member for Derbyshire, South (Mrs. Currie) said in reply to that debate.

It is an interesting starting point for this debate that the hon. Gentleman should be trying to stir the pot about what is happening in the Stanley Royd hospital. He knows of the schisms and difficulties in Wakefield district health authority. I notice somewhat disobliging references to Mr. Brian Hayward and it is evidence of the way in which politics has so catastrophically intervened in the affairs of that authority that he should speak so of Mr. Hayward, notwithstanding Mr. Hayward's career throughout his working life as a trade union official. One would have expected that the hon. Gentleman would want to work with Mr. Hayward to improve the situation within the district health authority, instead of which, he and his hon. Friend the Member for Wakefield appear to be siding with dissident elements in the district health authority with the aim and impact of perpetuating the schisms and difficulties that have caused everyone who cares about the Health Service so much distress in Wakefield, and which I hope the appointment of Mr. Hayward will do much to rectify.

Suffice it to say, before we turn to the detail of the situation at the Stanley Royd hospital, which I am more than content to do, I must point out to the hon. Gentleman that this appears to be the last stand—the Alamo—for COHSE militancy. It is one of the last places in the country where COHSE militants are maintaining industrial action. It is regrettable that the hon. Gentleman, who would not normally be regarded as one of the more militant Members of the House, should feel that his duty to his constituents is not to advise people to get on with their work in accordance with the professional standards that the community so respects and admires in nurses, and to eschew industrial action, but feel that he should act as the spokesman for a narrow and sectarian trade union view—a view which by no stretch of the imagination could be thought to be either in the best interests of the Health Service or of his local community, who would like to see the Wakefield district health authority respond perhaps rather better to some of the challenges that face it than it has in the past.

None of us wants the Wakefield district health authority to lag behind what is happening in the rest of the country, where there is not this political dogfight. Apparently, that even extends to the local authority having lost confidence in two of the members of the authority which it nominated, including one of those most prominent as a COHSE official, who no doubt briefed the hon. Gentleman for this debate. We want to see an end to some of this nonsense. We want the Wakefield district health authority to be well run. However, it will only achieve that if community-elected representatives are prepared to rally round and be responsible.

I would like to spend the rest of the time available to me saying a little about the nurses' new grading structure, because we speak in a month when the largest pay rise ever paid to the nursing profession in the history of the NHS is arriving in nurses' pay packets, including in most cases substantial sums of back pay. As with the greatly improved industrial relations climate nationally—alas, not entirely shared at Wakefield—nurses, too, are realising what an outstanding deal this is, not only because of the cash benefits, but because the new structure allows nurses for the first time a proper career ladder in clinical medicine.

Of course, one understands—it is inevitable—that the picture throughout the country will vary. It was never envisaged that every nurse would get the same increase as the next. That would have been a straightforward pay award. We were petitioned by the Royal College of Nursing and others to carry out a regrading exercise, and everyone knew that there would be a good spread. Inevitably, the mental institutions, where there is a high level of dedicated, but nevertheless unqualified nursing staff—nursing auxiliaries—obviously will not see as many large rises as has been the case in a number of the acute units. That is an inevitable consequence of the way in which medicine is structured today.

I point out to those nursing auxiliaries who remain dissatisfied that, notwithstanding their unqualified status, all of them have received between 7.5 per cent. and 10 per cent. this year. That compares with the average increase for ancillary workers in the NHS as a whole—who are not deemed to be part of the nursing profession, as nursing auxiliaries are—of between 5 per cent. and 5.9 per cent. The mere fact that, in receiving 7.5 per cent. to 10 per cent., they have not received the large increases that have been determined for many sisters and staff nurses, should not disguise the fact that they have done far better than any other ancillary workers within the Service and have benefited enormously from the Government's decision, first, to have an independent pay review body and, secondly, to treat auxiliary nurses as part of the nursing profession, which is of great assistance to them in establishing their status. Overall, we believe that this is a good deal for nurses and that the hospital service is working efficiently and effectively as it has always done.

Mr. O'Brien

rose—

Mr. Mellor

The hon. Gentleman spoke for more than 15 minutes and I now intend to—

Mr. O'Brien

Answer the debate.

Mr. Mellor

The more the hon. Gentleman barracks me the less time I shall have—

Mr. Don Dixon (Jarrow)

Answer the debate, then.

Mr. Mellor

The hon. Gentleman can shout like a fog horn, but he is not in order. Such interruptions will simply give me less time to answer the debate.

I have dealt with the extremely relevant points that were raised by the hon. Member for Normanton and I shall now consider the effect of the regrading structure on the Stanley Royd hospital. There is no such thing as a national average that applies to all institutions. At Stanley Royd, more nursing assistants, enrolled nurses and staff nurses have gone on to the basic grade, but, on the other hand, many enrolled nurses have gone onto the higher grade of E than is true of the national average. In fact, 98 per cent. of sisters and charge nurses have gone onto the higher grade of G at that hospital, compared with 61 per cent. for England.

The difference between 98 per cent. and 61 per cent. is striking and it shows that the reason for dissension at Stanley Royd—that, somehow or other, staff have done worse than any other in the country—cannot be justified. It is inevitable that there will be different grading outcomes, but I believe that Stanley Royd has come out well.

Mr. O'Brien

What about the shortages?

Mr. Mellor

It is true that we have spent most of this decade trying to build up the pay and conditions of the nursing profession from the disgraceful state in which it was left by the last Labour Government. During the lifetime of that Government, who cared rhetorically but failed to care in terms of their practical policies, there was a fall—

Mr. O'Brien

indicated dissent.

Mr. Mellor

It is no good the hon. Gentleman shaking his head—they are facts that cannot be denied.

Under the previous Labour Government, nurses' pay fell by 20 per cent. in real terms. Under this Government, nurses' pay has increased dramatically and many nurses are now 50 per cent. better off in real terms than they were under the Labour Government. In 1979, a sister at the top of her scale earned £96 a week. That same nursing sister can now earn at least £270 a week and in many cases markedly more than £300 a week. Such pay relates well to the attractiveness of nursing within the job market.

There has been no block grading at Stanley Royd. On the contrary, the figures on the outcome of the regrading exercise for individual districts show that individual managers have gone about setting out the new grading structure in accordance with how they judge the local conditions. We have every confidence in the way in which the regrading exercise has been carried out at Stanley Royd.

If there are problems with the regrading structure at any individual hospital, there is a right of appeal that has been properly negotiated with the unions. It is a key part of the structure. It is absolutely—

Mr. O'Brien

No negotiations took place.

Mr. Mellor

The hon. Gentleman seems singularly uninformed even at 9 o'clock on a December morning.

Some two and a half years of negotiations were conducted regarding the new grading structure—Stanley Royd does not stand outside that two-and-a-half-year consultation.

The hon. Member for Normanton and his colleagues stand for the national bargaining sytem. It may well be that most people who look for sensible progress within the NHS no longer regard that national bargaining system as essential. It is no good the hon. Member for Normanton wanting home rule for Stanley Royd hospital, because he and his colleagues stand four square behind the national bargaining system. The regrading structure took two and a half years to negotiate and, as a result of the negotiations, there is an appeals system. In fact, such an appeal system existed for a long time before those negotiations.

What is disgraceful is that unions will agree to a regrading structure, which has an appeals system to pick up any anomalies and which exists to be invoked, but political agitators within COHSE and NUPE, supported by hon. Gentlemen such as the hon. Member for Normanton, are prepared to accept industrial action. That is a return to the bad old days of the 1960s and 1970s—the hon. Member for Normanton does not appear to have left those days. The unions seek a return to those days instead of going forward in a sensible way, geared to the good of the NHS rather than considering it a political battlefield.

As long as there is industrial action at hospitals such as Stanley Royd, there will be no satisfactory outcome for anyone. Certainly no one will benefit from any grading appeal while they are taking industrial action.

Even at this eleventh hour, I hope that the hon. Member for Normanton will try to play a constructive role in the affairs of his local health authority.

Question put and agreed to.

Adjourned accordingly at half-past Nine o'clock.