§ 11 am
§ Mr. Robin Cook (Livingston)
(by private notice): To ask the Secretary of State for Health what action he proposes to take to end disruption in the Health Service following the breakdown of talks through ACAS.
§ The Secretary of State for Health (Mr. Kenneth Clarke)
That is in the hands of the trade unions, particularly the two unions that are attempting to organise industrial action. I regret that they made it clear in the talks at ACAS that they were unwilling to end industrial action and seeking to reopen the basis on which the regrading exercise was carried out. That exercise has been completed and the largest real pay rise for nurses and midwives in the history of the National Health Service will be in this month's pay cheques. The majority of nurses and midwives will receive all their back pay in December.
The overwhelming majority of nurses and midwives are working normally. Although there can be no question of reopening the basis of the new career structure, I shall discuss remaining issues with the Royal College of Nursing at its request on 5 December. I am not prepared to talk to NUPE and COHSE unless they call off their attempts to organise industrial action.
§ Mr. Cook
Is the Secretary of State aware that last night I, with other hon. Members, met all members of the nurses' staff side, including the unions and the royal colleges? Does he accept that, contrary to the statement that he has just made to the House, all members of the staff side made it plain that they had been willing to call off all industrial action if the management side had been willing to enter into discussions on the points in dispute? Why does he not admit that the talks broke down yesterday because the management side refused to enter into talks even if industrial action was called off, and made it clear that in doing so it was acting on ministerial instruction.
Does the Secretary of State accept that the representative of the RCN made it plain yesterday that the college went to ACAS only because the other unions were willing to call off industrial action, and described the management response as a kick in the teeth? Does he accept that all members of the staff side, including the royal colleges, informed us last night that it will now be difficult for each of them to restrain their members from industrial action? Is he really prepared to do nothing when what should have been an historic improvement in the nursing structure degenerates into a major crisis of morale in the wards and disruption in the hospitals?
Will the Secretary of State concede that the guidelines on supervision and responsibility were not part of the April agreement and have never been negotiated? If he is so confident that he is right in this guideline, why has he refused the invitation of all unions, including the royal colleges, to submit that to binding arbitration? Why is he so afraid to take a second opinion on his unilateral interpretation?
Will the Secretary of State confirm the extraordinary letter that he sent me yesterday in which he admitted that two letters from the general secretary of COHSE had not been replied to by him due to "a clerical oversight"? How does he expect the nurses in our wards to take seriously his lectures on the need for commitment to the job from them when he is so incompetent in running his office that he 359 twice loses a letter from a leader representing 150,000 nurses? Does he not understand that our Health Service is fated to experience mounting disruption so long as it is in the hands of a Secretary of State who, since his appointment, has never met the leaders of the nurses who work in the wards and who now makes it a point of pride to snub them?
§ Mr. Clarke
In answer to the hon. Gentleman's first point about the decision of the various trade unions, I can do no better than to quote from a statement issued this morning by Mr. Trevor Clay on behalf of the RCN—
§ Mr. Clarke
From Korea. That is right. A statement was also issued in London by Mrs. Gillian Sandford. Mr. Clay, the general secretary of the RCN, said:Perhaps it is time the other unions recognised that the RCN does not regard industrial action as negotiable. ACAS provided a way back into the discussions and they"—the trade unions—have chosen not to take it.
§ Mr. Clarke
If the hon. Gentleman will not accept that, perhaps he will accept what Gillian Sandford said. She stated:The RCN meeting with Kenneth Clarke to discuss the problems in the clinical grading dispute is going ahead on 5 December. As we have warned, industrial action will not take us forward. Patients are already being affected. The RCN is not surprised by the outcome. We believed that the ACAS route was worth the effort. We now know that the courage to call off industrial action is not strong in the other unions despite everyone recognising that it is a dead end.I shall meet the RCN on 5 December at its request when I hope that we can make reasonable progress.
As the hon. Member for Livingston (Mr. Cook) made clear, COHSE and NUPE wish to discuss the basis on which the exercise has been conducted, particularly for untrained auxiliary nurses, and he wishes us to take that to arbitration. Some, but not many auxiliary nurses are taking part in industrial action of a kind which the unions are trying to foment. They wish to discuss a complete reinterpretation of the grading for the auxiliaries who have all received a pay increase of between 7.6 per cent. and 9.4 per cent.—a little under £500.
The meaning that the unions are now attempting to put on grade A would, in effect, abolish it because they argue that to work under supervision means that a trained nurse must be present and watching an auxiliary when making a bed, taking a patient to the lavatory or any other such duty. They want to move all those nurses on to a grade which will give them up to £1,500 a year more, which would be a 33 per cent. pay increase. The unions are prepared to foment industrial action by misleading their members into believing that that is properly their due.
It is not usual to have exchanges across the Floor during industrial disputes, but occasionally they take place. Exchanges are not always helpful, and the hon. Gentleman and the Labour party are not trying to be helpful. They are taking every opportunity to encourage industrial action, which is not widespread in our hospitals. That is plainly his approach today.
Finally, the hon. Gentleman descended from the sublime to the ridiculous by raising the embarrassing matter of the handling of correspondence. I have 360 apologised to the hon. Gentleman and Hector MacKenzie. Indeed, I was grateful to the hon. Gentleman for pointing out to me in a radio interview that these letters had been received. It was a clerical oversight because Mr. MacKenzie's letters had been diverted into the part of my Department which deals with routine correspondence from the public, and I must admit that the Department had not been dealing with it with excessive speed. The moment I discovered the letters I replied to them. [Interruption.] They merely told the general secretary what he already knew from our public exchanges, which was that I was not prepared to have discussions with trade unions while they were attempting to organise industrial action against patients in hospitals throughout the country. That remains our position.
§ Sir Barney Hayhoe (Brentford and Isleworth)
Is my right hon. and learned Friend aware that there is no justification for members of COHSE and NUPE taking industrial action now which is damaging to patients? Does he agree that it is a searing indictment of the Labour party that it seems to be more intent on encouraging such action in the interests of its own sordid politics than on being concerned with patient care? Does he agree that in the interests of patient care the Labour party should urge its friends in those unions to get back to work and to settle the outstanding differences in discussions with the Department?
§ Mr. Clarke
I agree with my right hon. Friend. Opposition spokesmen have made no attempt to condemn industrial action against patients. They have taken the reverse view. A spokesman for the Opposition has deliberately visited hospitals where he has discovered, from the newspapers, that action is taking place, with the obvious intention of encouraging more people to join it. That is an irresponsible approach to the well-being of patients.
§ Mr. Menzies Campbell (Fife, North-East)
Does the Secretary of State accept that many nurses have no desire to take industrial action but have a real sense of grievance about the results of the grading procedure? Should not their sense of responsibility be rewarded by sympathetic consideration? If not, there is a serious risk of provoking a long-lasting crisis in the National Health Service.
§ Mr. Clarke
I agree with the hon. and learned Gentleman, and I accept that many nurses and midwives have been disappointed. There was bound to be disappointment when some nurses and midwives discovered that they were on lower grades as compared with colleagues with more skill and responsibility who are receiving spectacular increases. Unfortunately, some unions have made no attempt to explain to their members the basis upon which the grading was carried out. They have encouraged nurses to appeal who plainly have been graded correctly, with the result that the appeals system must deal with thousands of cases.
I am prepared to discuss with the Royal College of Nursing, and any other organisation that calls off industrial action, ways in which the appeals procedure can be operated so that legitimate grievances are dealt with fairly and in a civilised fashion. I am grateful to the hon. and learned Gentleman for making it plain that his party supports that view.
§ Mr. Ray Whitney (Wycombe)
Does my right hon. and learned Friend agree that at a time when, because of their economic success, the Government have been able to devote billions of pounds to expanding the Health Service, with £2.2 billion promised for next year and nearly £1 billion devoted this year to an historic pay rise for the nurses, a minority of nurses, the leaders of COHSE and NUPE and the Opposition parties are making so much political trouble that you, Mr. Speaker, have been persuaded to allow a private notice question—[Interruption]—in the middle of a debate on foreign affairs and defence—
§ Mr. Speaker
Order. We are in the middle of a debate on foreign affairs, and hon. Members should ask questions of the Secretary of State, not of me.
§ Mr. Whitney
It was not a question to you, Mr. Speaker. I was pointing out that, despite all those resources being made available, the political noise that is being made calls into question the fundamental structure of the National Health Service which Aneurin Bevan forced through the Labour party in 1946. In his review of the NHS, will my right hon. and learned Friend take account of those matters and consider the remedy, proposed by Mr. Herbert Morrison, of locally controlled hospitals as an alternative to the present system.
§ Mr. Clarke
My hon. Friend has raised a very wide issue. The exercise this summer showed some of the weaknesses of centralised pay bargaining, especially involving six different nursing unions and especially when we are trying to negotiate the extremely complicated division of a huge sum of money. We have had to take into account the skills and responsibilities involved in almost 500,000 nursing and midwifery posts, and we must rely on local management and representatives to carry that out. I believe that the exercise has been carried out well. It required considerable commitment for local management to carry it out so quickly and to get the money into the hands of the nurses, with the pay rises coming by November and the back pay by December.
Almost all the gradings have been done correctly, but inevitably some mistakes have been made. That is why we have an agreed appeals procedure, which should now be used. No system involving such a huge service and such huge sums of money could work entirely smoothly, but there are some mischievous people about trying to make political capital out of the fact. COHSE was organising industrial action during the summer while we were still in the early stages of the process, and it has lost no opportunity to do so ever since. In that, it has had the encouragement of the Labour party. Two unions are not helping matters by giving misleading information to their members and by trying—not very successfully—to organise disruptive action in hospitals.
§ Mrs. Gwyneth Dunwoody (Crewe and Nantwich)
Can the Secretary of State point to any predecessor who has succeeded in forcing many midwives to resign en bloc from the NHS or to make clear their indignation at being placed, after many years of training, on the same grade as people who have lower qualifications? Have any of his predecessors then exacerbated the problem by making rude comments? Is that a positive contribution to industrial relations?
§ Mr. Clarke
I have made no rude comments about midwives, and I shall make none. I am told that 26 midwives have announced their intention of resigning from a hospital in north London. Those midwives have received a pay increase of 25 per cent., or about £2,000 a year, but they believe that they should receive more. I am sorry about that. I accept that a genuine sense of grievance is felt by the Royal College of Midwives and by many individual midwives. I regret that, because they are dedicated people and it is a non-striking trade union.
I believe that the sense of grievance is based on a misunderstanding and is separate from the COHSE and NUPE dispute which the Labour party supports. The Royal College of Midwives has a long-standing claim that midwives should have a separate grading structure. That is not agreed by the other trade unions or by management, and it has not been accepted by the review body or the Government.
§ Mr. Clarke
There are no midwives graded C. This year the midwives put to the independent review body a claim for a separate higher grading structure, which was not accepted. But midwives and their union persist in saying that that structure should be applied. Unfortunately, it is not the one that the review body recommended or that was agreed earlier this year, so if they wish to persist with the claim they will have to return to it in the future.
Midwives as a whole have done much better than the generality of nursing staff, and nine out of 10 staff midwives are on the higher of the two grades available to them. They received a pay increase of one quarter, which is worth about £2,000 a year, and a much better career structure has been established for them.
§ Mr. Speaker
Order. As the House knows, this is one of the rare occasions on which the House can debate foreign affairs, and there is great pressure on time. I shall allow questions on this private notice question to continue until 11.25, and I ask for brief questions.
§ Mr. Tony Baldry (Banbury)
Is it not time that we started to tell the truth on this matter? Is not the truth, as reported by Oxfordshire regional health authority, that the majority of clinical nurses in the Oxford region will receive substantial salary increases averaging 20 per cent., that they will receive their new salaries and back pay by Christmas, that the new grading system rewards clinical skills, has been carried out fairly and will assist the recruitment and retention of nurses and that the Government have honoured their commitment fully to fund the pay increase?
Is my right hon. and learned Friend aware that Oxford district health authority had no hesitation in describing the pay awards as "angels' delight", that nurses praised the grading review process and that the Oxfordshire chief nursing officer described it as a major step forward? Is it not time that the press and the media in general started to talk about the truth rather than the synthetic broth that has been promulgated by the Opposition?
§ Mr. Clarke
My hon. Friend has described views that are shared by the great majority of nurses and midwives and the position as it exists in most of the country. Most 363 nurses and midwives regret the attempts of those two unions and the Labour party to organise action that can only damage the reputation of the profession at a time when its reputation deserves to stand high. The Government have recognised that reputation in the pay award.
§ Mr. Jeremy Corbyn (Islington, North)
Does the Secretary of State accept that the basis for the dispute lies in the devious statement that he made in April when he cash-limited the nurses' pay rise by introducing this spurious grading exercise? Since then he has tried to set one group of nurses against another. Does he understand that grade A nurses are experienced and do a vital and responsible job and that the rate of pay recommended for grade A is disgraceful? The Secretary of State should stand by the statement that he made in April, that all nurses were to get a substantial rise in their basic pay, rather than threatening COHSE and NUPE members with legal action and, on top of that, refusing even to discuss the case with them.
§ Mr. Clarke
The pay increases are almost unique in my experience of pay settlements, in that they are not cash limited. Our original estimate that it would be a 15.3 per cent. increase had to be revised when we had finished to 17.9 per cent. I had to announce further funding in October to keep to our commitment that we would fund the increase in full. It cost more when the grading exercise was carried out and we did not cash limit it at all. The root of the dispute is Left-wing politics.
§ Mr. Sydney Chapman (Chipping Barnet)
Given that a necessarily complicated regrading exercise affecting hundreds of thousands of nurses and midwives must lead inevitably to at least a few mistakes being made, does my right hon. and learned Friend agree that it was for that reason that the unions agreed to the appeals procedure? Further, given the fact that the settlement is rightly the most generous pay settlement ever to be given in the history of the NHS, is not the attitude of the leadership of COHSE and NUPE in apparently trying to suggest to every nurse that he or she must be regraded upwards one of the most irresponsible and hypocritical acts of lack of leadership?
§ Mr. Clarke
I agree with my hon. Friend. As he said, the logic of the union's case, as put by the hon. Member for Islington, North (Mr. Corbyn), would ensure that nobody was on the lower of the alternative grades at the various stages. That is contrary to the spirit of the regrading structure that we first negotiated, taking two and a half years over it, with the self-same unions.
§ Mr. David Hinchliffe (Wakefield)
I spent last Friday evening listening to 200 nurses from the Wakefield district who are not militants or Left-wingers. They are members of the RCN as well as of COHSE and NUPE and they raised with me anomaly after anomaly in individual cases in respect of the settlement.
What should I say to five nurses at Stanley Royd hospital who were offered the highest grade by the management in Wakefield heath authority and were then told, "Sorry, we have made a mistake. You have got the lowest grade"? What should I tell the nurses who came to the meeting, who were informed that it would be at least five years before their appeals could be heard, many of whom told me that they would be retired by then? What 364 answer should I give those people? Does the Secretary of State accept that he has made a complete shambles of the issue?
§ Mr. Clarke
The hon. Gentleman is in no better position than me to settle the grade of any nursing or midwifery post. That must be settled by the management. If it is disputed by the individual, there is an appeal process that can properly resolve the problem. I should like to believe that the hon. Gentleman spent his time at the meeting explaining that and trying to ensure that those people discussed with their own health authority the handling of the appeals procedure, and that those who had appealed on the basis of false information from their trade union should withdraw the appeal and help us to get on with it. However, I suspect that that was not the tone of the hon. Gentleman's contribution to the meeting.
§ Mr. Anthony Nelson (Chichester)
Will my right hon. and learned Friend confirm that the regrading structure has been the result of two years' negotiations with the unions and, as my hon. Friend the Member for Chipping Barnet (Mr. Chapman) said, it provides for an appeals procedure? It would be wholly wrong if my right hon. and learned Friend were to enter into negotiations with the trade unions. Does not that raise a much more serious problem of precedent elsewhere in the public service, in that, if he were to concede, it would give succour and support to other unions in the public service to take industrial action after agreements had been reached and negotiated and to carry on doing so until they induced Ministers to come back to the negotiating table to renegotiate? That would be a dangerous and improper judgment to make. It would be an error of judgment that the Government as a whole would regret if my right hon. and learned Friend were to give way.
§ Mr. Clarke
I agree with my hon. Friend; it is extraordinary. It is important to remember that we have all entered into a no-strike agreement and everybody is a party to it. The Government set up an independent review body, which made recommendations contrary to the Government's own evidence, which the Government accepted and implemented for the nurses. In this case, I am glad to say that the independent review body confirmed the regrading and new career structure for nurses and put generous figures upon it for implementation. It would be wrong, above all in the NHS, where patients' well-being is at risk, if industrial action could be taken and, in the face of that, we started to alter the whole structure and abolished the lowest grade because the unions decided that all auxiliary nurses should get pay increases of up to one third.
§ Mr. Eric S. Heffer (Liverpool, Walton)
Is the Secretary of State aware that last Saturday morning I met only RCN nurses who came to see me at my offices, delegated by the RCN at Walton hospital? If the right hon. and learned Gentleman thinks that those nurses are Left-wing loonies, he should have been there. After listening to them, I was delighted that I was a Labour and not a Tory Member of Parliament because I am not sure that I would have got out in one piece if I had been a Tory. The nurses were very angry. They told me of 800 appeals—
§ Mr. Heffer
My hon. Friend is backing me up.
I heard that 800 of the nursing staff in Walton and Fazakerley in my constituency have appealed. They are very angry and will not be helped. They think that they have been conned by the Government. Some of the nurses said that they had stuck by their union all this time, but that sooner or later they would have to think differently unless the union took action.
§ Mr. Clarke
I do not mind nurses putting in appeals. It is predictable that there will be disappointed nurses when they find that they are on a lower grade than some of their colleagues and that they are getting less than the 17.9 per cent., which is the average settlement, because other people are getting 33 per cent. and 40 per cent. awards. Careful handling by all parties was required, and that was carried out by the management and some trade union leaders, but not other trade union leaders. The obvious thing to do now is to follow through the appeals procedure, not to take industrial action. We cannot start altering the basis of the grading structure because COHSE and NUPE keep threatening industrial action to force us to do so.
§ Mr. Dobson
On a point of order, Mr. Speaker. I apologise to the right hon. Member for Brighton, Pavilion (Mr. Amery) for slightly protracting the interlude in his speech, but you will recall, Mr. Speaker, that the hon. Member for Wycombe (Mr. Whitney) criticised you for accepting the private notice question tabled by the Opposition. It is a convention that, when the Opposition ask for a private notice question and it is refused, we do not refer to it publicly. Will you confirm, Mr. Speaker, that it is equally a convention for hon. Members on Government Benches not to object when you grant the asking of such a question?