§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Dorrell.]11.47 pm
§ Mr. Sam Galbraith (Strathkelvin and Bearsden)
I welcome the fact that all concerned in the dispute in the Greater Glasgow health board are now getting round the negotiating table. We should not, however, let that distract us from examining why the dispute arose and who was responsible for it.
We are not here to debate definitions of "continuing responsibility" or "supervision". Like the Minister, I accept that there is a national dispute in which health boards, quite properly, cannot be involved. I also accept that there always were going to be nurses who would be unhappy with their grading. I also accept that there are many who have benefited considerably. If the Minister's brief deals with those issues, I suggest that he puts it aside as there is no dispute between us on these matters.
What we want to debate is not the national dispute but the regrading "shambles" at Greater Glasgow health board, which everyone now accepts was totally out of line with the results of every other health board in the country. While, for example, most health boards put 60 per cent. to 70 per cent. of their ward sisters on a G grade, Greater Glasgow health board had half that number—30 per cent. I accept that absolute comparisons cannot be made, but whatever the differences—there are reasons for differences between boards; they will not all be the same—I am sure that the Minister agrees that the difficulties should not be as big as 30 per cent.
Why was there such a huge discrepancy, which has continued the downward spiral of morale and despair in the health board area? I believe that it is due to a combination of incompetence and indifference, fuelled by a drive for cheapness that pervades the health board from top to bottom. No one can escape the blame, and I am surprised that the Minister—who is normally free with his condemnation—has been so remarkably silent on this case.
Before considering the events in detail, may I tell the Minister that I was forewarned of what was likely to happen. Several senior members of the Health Service in Scotland, centrally involved with the implementation of the gradings, told me that what Greater Glasgow health board was doing was a disgrace. Those people are closer to the Minister than they are to me, so he must have been aware of the problem. Why did he not step in sooner to rectify the position? Why did he wait until the shambles had broken? The Minister bears some responsibility, too.
The gradings were announced on 11 November, one day after the Govan by-election. Paid-up members of the conspiracy theory would make great play of that, but I shall pass over it for the moment. I was prepared for some dissatisfaction, but not for the overwhelming anger that followed the gradings. Rather than going round stirring up trouble, the trade unions were trying to keep it as low as possible. I attended many meetings where union representatives, especially those from the Royal College of Nursing, were taken to task by their members and told that they had better adopt a more positive and militant approach. 573 Instead of responding to what was clearly a shambolic injustice, Greater Glasgow health board compounded its error when it said in a press release on Monday 14 November:We are completely satisfied that the gradings have been awarded fairly and that the decisions were taken by professionals. Any apparent anomalies can be accounted for quite simply.That is a sign of the board's utter incompetence on this matter. Not only did the board get it wrong in the first place, but it then refused to admit it. The phrase "any apparent anomalies" means no sister in a theatre suite getting a G grade, no maternity sister in a labour suite getting a G grade and some single ward sisters being given an F grade. They were not apparent anomalies; they were anomalies. We are here tonight to try to discover why they occurred.
On 14 November, the general manager said that he was happy that a "professional and fair" clinical grading exercise had been carried out. Clearly, the Minister was not, because on 16 November he met representatives of the RCN and the Royal College of Midwives and, in what for him was a fairly reticent interview, he hung out the Greater Glasgow health board to dry. I imagine that the telephones were buzzing, because by the following morning, without any appeals, suddenly the apparent anomaly that had resulted in all sisters in operating suites being given F grades was rectified. Suddenly this "fair" clinical grading exercise was crumbling.
Perhaps the sudden turnround was also because I and my colleagues were due to meet representatives of the health board that day. At that meeting, we were amazed by their ignorance of the regrading, although the complacency and contempt that they usually display and that got them into trouble in the first place was missing.
At that meeting we raised with the board what the Minister will agree was the crux of the dispute—the Nick Gurney letter from the Department of Health on 18 August 1988, especially the last paragraph on the second page, which concerns the grading of sisters who work in accident and emergency departments, theatres, delivery suites and intensive care units, including neonatal units. It states:We would expect a significant proportion of such sisters to be graded at G or above.
When we asked health board representatives about the letter, their initial response was that they knew nothing of it. Then they admitted that they knew something about it, but it did not apply to Scotland. But when we pushed them a dispute arose among the members present as to whether it applied to Scotland. I know for a fact that health boards were instructed on this matter by the Department, yet the Greater Glasgow health board chose to ignore those instructions. Perhaps the Minister will let us know why.
Evasions and half truths from the Greater Glasgow health board are unacceptable. The general manager then stepped in to tell us that the letter was to trade unions and not to health boards. I disabused him of that, and I am sure that the Minister has done likewise. I am sure also that he will agree that his ignorance and incompetence in this matter are breathtaking.
The Greater Glasgow health board officials then met representatives of the Royal College of Nursing and the midwives in London on 22 November, following which, 574 without recourse to normal appeals procedures, major concessions were made, mostly relating to the G2 classification contained in the Gurney letter. The apparent anomalies that were originally talked about, which could be accounted for quite simply, were reversed.
Although the issue over the Gurney letter was clearly incompetence by the Greater Glasgow health board, there is a more sinister element in this dispute, which brings me back to what I was told by those close to the Minister—that what Greater Glasgow health board was trying to do was a disgrace, because it was trying to make the exercise as cheap as possible. In other words, it was finance-led.
The Minister will have been apprised of the minute from the health board of 28 June 1988, item 73, headed "Clinical Grading Review", which states:… the General Manager explained that until such time as the Scottish Home and Health Department advise of the financial parameters within which the Board should carry out the review, no substantive progress could be made with the Review.
Why could no progress be made? I can interpret that passage in no other way than that the whole exercise was to be finance-led. If not, why wait to see how much money the health board was being given? Incidentally, it also seems that Greater Glasgow health board did not believe the Minister's assurances on funding. As the Minister will remember, on three separate occasions beginning in May, he reassured me that the award would be fully funded. Clearly Mr. Laurence Peterken did not believe him.
The cynical delay, waiting for the "financial parameters", then led to a rushed exercise which has further contributed to the shambles and once again confirms my charge of incompetence.
I am sure that the Minister will agree—he has implicitly accepted it by his actions of 16 November, when he met the royal colleges—that Greater Glasgow health board has managed this whole affair badly. It has been a mixture of meanness, incompetence, evasion, with a not inconsiderable ingredient of spite.
It is symptomatic of the working of the board. It is a board in which management does not ignore advice, it simply never asks for it. It has a management totally isolated from its staff, closeted in distant offices, paralysed and unable to make decisions other than those related to financial cuts. In Glasgow we do not ask what the decision will be; we ask when, if ever, it will be made. It has produced a health board of low morale and accumulated despair which lacks any sense of direction. I fear the solutions to it will have to be drastic, and I shall return to them in the new year.
Meanwhile, I ask the Minister to set up a full inquiry into the running of Greater Glasgow health board that will take as its starting point the nurses' regrading.
We are entitled to know who was responsible for ignoring Government advice contained in the Nick Gurney letter of 18 August, why it was ignored, and what action should be taken to prevent such an event occurring again.
That inquiry should go right to the top, because the whole ethos and practice of a health board is determined by its general manager. If he says that money comes first, to ingratiate themselves, those under him will naturally be keen to follow his philosophy. When that happens, cash always comes before care and money before medicine. It is 575 a practice that we have to stop, and I can think of nowhere better for initiating the process than in the Greater Glasgow health board.
§ Madam Deputy Speaker (Miss Betty Boothroyd)
Order. Do I understand that the Minister has agreed that there should be an intervention at this time?
§ The Parliamentary Under-Secretary of State for Scotland (Mr. Michael Forsyth)
Yes, I have, Madam Deputy Speaker.
§ Mr. McAvoy
I thank my hon. Friend the Member for Stathkelvin and Bearsden (Mr. Galbraith) for allowing me some of his valuable time in this Adjournment debate. I also acknowledge and appreciate the Minister's co-operation.
I associate myself with my hon. Friend's remarks about Greater Glasgow health board. I was one of the party of hon. Members at the meeting with the board and I confirm my hon. Friend's account. Along with everyone else, I welcome a relaxation of the board's intransigent attitude, but it is not negative to examine why this situation arose in the first place. I accept that it was always going to be a difficult exercise, but Greater Glasgow health board exacerbated a sensitive issue by inept handling.
Rutherglen maternity hospital is situated in my constituency and many of my constituents are employed there in various capacities. All who work there are dedicated to their jobs and I can testify to the standard of service there as I am an expectant father. My first two sons, Thomas and Michael, were born in Bellshill maternity hospital, my third son in Calderbank and my fourth son, Brian, in Rutherglen. He is a true Ruglonian, having been born within the boundaries of the royal burgh of Rutherglen. So I am not speaking in the abstract about the hospital.
When the regradings were issued, many of the midwifery sisters were graded F—despite the Gurney letter which specifically stated of sisters who work in delivery suites:we would expect a significant proportion of such sisters to be graded G or above.The position has been largely rectified, with many midwifery sisters now graded G.
I will never forget the distress of those sisters and their feeling of outrage. They felt that their whole worth was being questioned. No employer, never mind a health board employer. should drive employees to such a state of mind. It was disgraceful.
There was also potential for division between people who take great pride in working harmoniously. Most of us believe that harmony and co-operation in a hospital staff is an essential ingredient in the standard of care provided. Without being vindictive, I suggest that any individual or organisation causing potential damage to the morale of such a key work force as nurses deserves the severest public stricture.
I certainly have no desire to intervene in negotiations between work force and management, but I must alert the Minister to the position of those working at staff midwife grade at Rutherglen maternity hospital. Too many staff midwives have been graded E, despite the fact that they do the same sort of tasks as some sisters. That has not been 576 recognised and there is a need for more staff midwives at that hospital to be graded F. That will merely reflect the experience of those extremely valuable people.
I strongly support my hon. Friend's call for a full inquiry into the running of Greater Glasgow health hoard with particular emphasis on its handling of the nurses.' regrading exercise. It is a public body, subject to public scrutiny, and it should be fully accountable to the public.
§ 12.2 am
§ The Parliamentary Under-Secretary of State for Scotland (Mr. Michael Forsyth)
I am grateful that the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) has given me this opportunity to put on record the substantial improvements in nurses' pay and conditions which have been introduced under this Government. This year's pay settlement is the highest the nursing profession has ever had. It is in marked contrast to the treatment nurses received under the policies of the Labour Government, when in the 1970s nurses' pay fell in real terms. In the five years between 1974 and 1979, Labour cut nurses' pay in four of them; in the financial year 1976–77, a real terms cut of over 10 per cent. was imposed, and over the period as a whole, nurses' pay fell in real terms by 21 per cent.
Contrast those figures with what has happened since 1979. In this period, nurses' pay has gone up by 45 per cent. in real terms. In recognition of the special position of nurses, their dedication to patients and their stand against strike action, the Government set up an independent review body to determine their pay fairly and to ensure that their loyalty was not traded on or taken advantage of. The Government have accepted all five of the review body's awards and have funded over 90 per cent. of the cost of those awards. The current award—the biggest of all —has been funded in full, with an extra £1 billion of public money. That is an achievement matched by no previous Government and reflects the underlying strength of an economy which permits such massive investment in service to the public.
Despite all the claims to the contrary, substantial pay increases have been awarded at every grade of nursing. For nursing auxiliaries going to the basic scale of the new structure, increases in the range of 7.6 to 9.5 per cent. have been awarded. These are substantial increases in real terms. Those auxiliaries whose jobs have merited the higher B grade will receive increases between 19.1 and 33.1 per cent., which in cash terms is between £1,120 and £1,510.
Enrolled nurses have seen their pay and prospects improve out of all recognition. Those on scale C have received increases of 7.1 per cent. to 11.6 per cent., but almost half have gone to the higher grade of D, with increases of £1,450 to £1,775, taking them to a scale ranging from £8,025 to £9,200. A number have even attained grade E—
§ Mr. Brian Wilson (Cunninghame, North)
On a point of order, Madam Deputy Speaker. I wonder whether the Minister was misinformed about the title of the Adjournment debate. He has been talking for about five minutes, and he has not mentioned the Greater Glasgow health board.
§ Mr. Forsyth
I shall be coming to the position of the health board. If the hon. Gentleman is representative of the courtesy that is shown by his party, I shall know in future not to be accommodating when his hon. Friends wish to contribute to Adjournment debates. I have given some of my time, and I am trying to cover the ground.
The regrading exercise has not been confined to pay increases, important though those are. The new structure is the greatest change in the nursing profession since the National Health Service began. This change is something which the Royal College of Nursing acknowledges as having been needed these past 20 years. The previous structure had become archaic and no longer provided the career structure necessary to motivate nurses to remain on clinical work looking after patients. Nor did the old grades reward those with the most onerous duties and responsibilities.
§ Mr. Forsyth
The hon. Gentleman asks whether I listened to the debate. I had the opportunity to read his speech earlier today, because he released it, with gross discourtesy to the House, without embargo to the press. It was covered in the newspapers in Scotland today. I have had every opportunity to study the hon. Gentleman's remarks.
The new structure was born out of two and a half years of negotiations between unions and management, and painstaking analysis of job contents right across the clinical spectrum. In view of the many misleading comments of late in the media, I think that it is right to re-emphasise that the structure has been agreed nationally not only by the Royal Colleges of Nursing and Midwifery and by the Health Visitors' Association but by the trade unions, including COHSE and NUPE. However, COHSE and NUPE would appear to have failed to inform their members of what they had agreed to and to have used the disappointment and uncertainty among some to create an atmosphere of unhappiness and unrest.
It is disappointing that the hon. Member and his party have not condemned the actions of COHSE and NUPE. We are dealing with a national agreement to which they were full parties, a pay structure recommended by an independent review body, and a regrading exercise for which there are established grievance procedures.
Against that background, I turn to the grading outcome under the Greater Glasgow health board, to which the hon. Member for Strathkelvin and Bearsden has drawn attention. Throughout the regrading exercise, I have made it clear that individual nurse regradings are within the framework of the national agreement for health boards to decide and are not matters in which I would wish to intervene. I have kept to that policy. At no time, contrary to what the hon. Gentleman has asserted, have either I or the Scottish Home and Health Department issued directives to boards about the grading of particular posts; nor have any quotas been imposed. That extends also to finance. There has been no attempt to cap the award by limiting cash allocations. Managers were advised that money was not to be a determinant of grade. The fact that additional allocations had to be made to cover the cost of grades awarded proves that managers took this message to heart.
578 Greater Glasgow health board is the largest single employer of nurses in Great Britain. It had to regrade over 12,000 posts, in terms of whole-time equivalent, on a consistent basis, in its area while recognising that the grading outcome should reflect differences in working practices between hospitals and specialties. No mechanistic approach could be adopted, and, in common with every other health board in Scotland, Greater Glasgow assessed the posts of its nursing staff and evaluated their job contents against the grading criteria. The gradings which resulted, while producing a structure similar to those in other parts of the country, of necessity reflected local working practices.
In the case of Greater Glasgow these included two significant factors influencing the grading of hospital sisters. The first of these was the fact that the board employed a greater than average number of senior nurses. This meant that the degree to which responsibility for ward management was delegated to sister level was probably less than in other parts of the country.
Secondly, and more important, Glasgow had a significantly higher proportion of two-sister wards than any other board in Scotland. In these, the board felt unable genuinely to identify at 1 April which post was designated to be in charge, carry continuing responsibility and so merit the higher grade of G. I understand that 70 per cent. of Greater Glasgow's wards are staffed by two or more sisters.
Not surprisingly, these factors resulted in Glasgow assimilating a higher proportion of its hospital sisters to grade F than other Scottish boards. As a result, its grading profile for assimilation of staff, while almost identical to that for Scotland as a whole in terms of the proportion of staff on grades A to E and H to I, showed a higher proportion of staff on grade F and a lower proportion on G than Scotland as a whole. In Scotland the percentage on F was expected to be 7 per cent., but for the Greater Glasgow health board it was 10 per cent., and for G, the proportion for Scotland was 13 per cent. and for the Greater Glasgow health board it was 9 per cent. These differences could, as I have already explained, be attributed to previous staffing practices. The hon. Member makes much of Greater Glasgow's apparent failure to apply management guidance on the use of the G2 classification. In fact, unfortunately for him, the majority of ward sisters assimilated to the G grade related to the use of G2.
In turn, this meant that Greater Glasgow had to consider restructuring more posts than other boards so as to create a G post in each ward. I would emphasise that, by proceeding in this way, the board was sticking strictly to the terms of the national agreement to which COHSE and NUPE were parties. There was no question of the board attempting to restrict regradings artificially as at 1 April, and, by promoting people at a later date, to make savings from its allocation through not having to pay backdated arrears of salary.
On 16 November, I met representatives, as the hon. Gentleman said, of the Royal Colleges of Nursing and of Midwives. They expressed three main areas of concern about Greater Glasgow's handling of the regrading exercise. They were not convinced that an award of grade F had been appropriate in a number of single-sister wards. They were concerned that large-scale restructuring of sister posts should not commence in advance of appeals being resolved. They felt that the initial review of cases in 579 which staff had notified an intention to appeal could be a hindrance to the swift processing of appeals unless general managers were involved and powers of decision delegated.
These concerns were transmitted to officials of the Greater Glasgow health board by the Scottish Home and Health Department. As a consequence, board officials came to London so as to have the earliest possible meeting with the royal colleges. Following negotiations, the board made public its intention to review its policies on sister regrading and to award the grade of G as from 1 April to day sisters in single-sister wards. This has resulted in the proportion of staff on grade F reducing to 7 per cent. and those on grade G increasing to 12 per cent. These are almost identical to the Scottish proportions in these grades. So the hon. Gentleman's assertion that Greater Glasgow's result is out of line with the rest of Scotland is quite incorrect.
Once restructuring is carried out, these proportions will become 5 per cent. and 14 per cent. respectively. While I recognise the crucial role of sisters, the fact is that the change which has brought Greater Glasgow's profile almost exactly into line with the national average affects about 200 posts out of the 12,000 or so regraded by Greater Glasgow. Less than half of these, agreed with the RCN and RCM, are additional G2 posts, of which the hon. Member has made so much.
The board has also taken steps to ensure that its initial review of intentions to appeal can be conducted swiftly and that decisions can be taken at unit level through the involvement of general managers.
The hon. Member for Glasgow, Rutherglen (Mr. McAvoy) asked me about midwives. They have done extremely well from regrading in Greater Glasgow and in the rest of Scotland. All staff midwives have, in both cases, gone immediately to the higher grades, with increases of 23 per cent. or more. In Greater Glasgow, I understand that about 140 midwives—78 per cent.—will have moved immediately to the higher grades with increases of 16 per cent. or more. In Scotland as a whole, the proportion going to the higher grades is again around three quarters.
The nursing staff of Greater Glasgow health board has been treated equitably. Inevitably in an exercise of this scope and complexity, some mistakes are bound to have been made, but adequate appeals machinery is available to correct them. Throughout this exercise, Greater Glasgow has acted with care and has also demonstrated its 580 willingness to listen to responsible representations which, regretfully, have not come from the hon. Gentleman, and to react to them where appropriate. Equally, it has quite properly declined to deal with trade unions that have used industrial action as an instrument for putting pressure on management.
Already, the Royal Colleges of Nursing and of Midwives and the board have agreed changes as a result of calm and objective discussion. The so-called dispute has been largely manufactured by COHSE and NUPE which have even put patients into the front line in their attempts to disrupt the board's management of its affairs. Had they behaved sensibly and not sought confrontation, their members' interests would have been much better served. The hon. Gentleman is therefore raking over old coals. I do not believe that he has the interests of the nursing profession in mind in doing so. Indeed, given the record of the Labour party in government and the 21 per cent. cut in pay which nurses suffered between 1974 and 1979, I can only assume that his motives are to stir up unrest deliberately at the very time when agreement is being reached in order to bury the past.
The Government have, however, kept faith with the profession and have honoured their commitments to it. As I said at the beginning of my speech, the result is that pay has risen by 45 per cent. in real terms since 1979 and nurses have a career structure negotiated with the professional bodies and trade unions which represent them, which should serve them and the Health Service well in the future.
§ Mr. Galbraith
The Minister failed to answer a number of points, and was his usual ideological and spiteful self. Can he tell us why the Greater Glasgow health board graded the sisters in operating suites on the F grade which is contrary to the Nick Gurney letter of 18 August? That was centrally discussed by the implementation group in the Minister's Department, yet Greater Glasgow health board ignored it. I asked about the number of double-sister wards in the health hoards, and he said that the information was not available centrally. It is nice that he has suddenly found the information for the Greater Glasgow health board. Can he tell us what it is for the rest of the country?
§ Question put and agreed to.
§ Adjourned accordingly at seventeen minutes past Twelve o'clock.