HC Deb 20 December 1989 vol 164 cc509-29 1.59 am
Mr. Dave Nellist (Coventry, South-East)

As we move into the 15th week of one of the most serious national industrial disputes that has occurred in Britain, people outside this place will be amazed that this is only the second debate on the issue in the House of Commons.

I am particularly pleased that my hon. Friend the Member for Livingston (Mr. Cook), who managed to secure the first debate some weeks ago, is here at 2 o'clock in the morning. I am not surprised that the Government are afraid of a debate on the ambulance dispute. They did not provide one in Government time because the shameful role played by the Government team has now plummeted to new depths. They are responsible for deaths in Coventry, Birmingham, London and elsewhere.

The Army is on the streets of Coventry. I received a telephone call from the mother of one squaddie saying that the Army have a carrot-and-stick approach. The carrot is £30-a-day standby money and the stick is the threat of the glasshouse. One staff sergeant in Welwyn Garden City who showed an affinity with the ambulance workers and spent seven hours on the picket line outside their station was returned to Gloucester barracks and threatened with disciplinary action.

The Government can pay squaddies £30 a day; they can spend £200,000 on advertising in the press; they can watch directors get 28 per cent. pay increase; they can allow Members of Parliament to get an 11 per cent. pay rise—yet still they insist that ambulance workers must take a pay cut. Frankly, that is scandalous.

In 1986, ambulance workers were due parity with fire fighters. There is now a £60 difference between their wages. I could read out the statistics, but I can do better than that. I shall quote a letter from the Minister for the Environment and Countryside, the hon. Member for Rossendale and Darwen (Mr. Trippier), to the Secretary of State saying that he was not previously aware … that the pay difference … is now £60 a week, and … there are striking differences in conditions of service between the ambulance personnel and their counterparts in the fire service. For example the latter group is eligible for free prescriptions, and dental and optical treatment, their retirement age is 55 as opposed to that of the ambulance service which is 65. He concluded his letter: Firemen and policemen have all received increases above inflation, and ambulance personnel feel embittered that they should be asked to settle for only 6.5 per cent. I have to tell you that I have to see the logic of their claim, and would ask you to look at this one again because there is a dedicated ambulance service out there, and it is a pity they feel constrained to take industrial action to draw attention to their grievances. After writing such a reasonable letter, it is a pity that a few days later the Minister felt that he had to apologise, crawl away and say that he did not really understand the ramifications of the dispute. Although he had written a letter some 10 weeks into the dispute he then tried to deny it. He is not here tonight, so I have read out his letter.

Unfortunately, the hon. Member for Harlow (Mr. Hayes) is not here either. The dispute reveals a split in the Tory party because of public pressure and support for the ambulance workers. The only Tory Members present are the Under-Secretary of State for Health and, presumably, his parliamentary private secretary. No other Tory is willing to come to the House and defend the Government's shameful record.

It is little wonder that ambulance workers are fired up and angry. There is no doubt that they have public support. According to opinion polls it is between 83 per cent. and 95 per cent. They have the support of 3,500 controllers and they certainly have the support of the control assistants who are paid even less than they are. They even have the support of the Police Federation. At a press conference, the chairman of that federation backed the action of fellow emergency workers. The opinion polls show that they have the support of the public, and would have that support even if they were taking strike action, which they are not.

In that context, I want to nail one lie tonight. No ambulance worker is on strike. The ambulance workers have been locked out throughout the country. They are not taking strike action and, where they are allowed to do so, they are working without pay to provide a service which, as dedicated professionals, they are committed to give.

The Tory Government have contemptuously rejected arbitration. I am not the greatest fan of arbitration, and there is probably a little between my hon. Friend the Member for Livingston and myself about that. Arbitration, by definition, involves a compromise, and I believe that the ambulance workers' claim is fully justified and that they should not have to give up any part of that claim. In 1977—78, the fire fighters did not win their pay formula—to link their pay to the top 25 per cent., the upper quartile of British earnings—through arbitration. They won it through action.

But any half-decent person, on having the ambulance workers' case put before him, would not fail to provide justice to those workers. That is why the Tory Government will not go to arbitration. They know that the workers' case is unanswerable.

The result is that we get half-truths and lies from the Government and their spokesmen. For example, the Secretary of State for Health said, in effect, "The trade union leaders recommended acceptance, yet these members have rejected that advice." But the Conservatives have been saying for years, "Give the unions back to their members because the members know best." When the members reject a pay offer, suddenly they do not know best.

We hear that 95 per cent. of staff in the National Health Service have settled. Many have settled above the 6.5 per cent. figure, and many have not. They include midwives, speech therapists and other professional groups who feel decidedly upset about having to take a pay cut, as the ambulance workers are being asked to take, and they are still in dispute with the management.

In today's "PM" programme, the Secretary of State for Health said that, if the money was given to the ambulance workers, it would have to come out of patient services. In other words, there would have to be another cut in the NHS. How despicable for the Government to trade off inadequate health services to maintain the wages and conditions of those in emergency services such as the ambulance workers.

I remind the Tory Members who are not here tonight that it did not bother the Secretary of State for Health and his colleagues when, in July 1987, we debated the pay linkage formula for Members of Parliament. When I forced a Division on that, the Secretary of State for Health and each member of his ministerial team went into the Aye Lobby to give themselves an £80 a week rise in 1988, £30 a week rise in 1989 and a £50 a week rise from next January —an increase of £160 in 24 months. That is more than the take-home starting salary of an ambulance man for a whole week. If that is not hypocrisy, I do not know what it is. The Secretary of State for Health has the security of getting £1,000 a week, yet he demands that other workers take pay cuts.

Whatever arguments are adduced by the Secretary of State and his health team, or by Duncan Nichol, the general manager of the NHS, that there is no compatibility between the jobs of those in the emergency services of ambulance, fire and police, on previous occasions, I have given the House personal examples of such occurrences in Coventry. Consider what is said by those in the front line. Ambulance man Peter Cole reported about Deal: All the emergency services—ambulance, fire and police —dug together in the rubble knowing there might be another bomb. Ambulance man of the year, Malcolm Woollard, reported from Brighton: We were at the scene of the explosion where a whole hotel floor collapsed minutes after we dragged the bodies clear. The Prime Minister, the right hon. Member for Chingford (Mr. Tebbit) and the present Secretary of State for Energy should hang their heads in shame for having the temerity to say "Thank you" to the ambulance workers five years ago in Brighton, and then treat them like dirt now over their pay claim. The Prime Minister was happy to chase ambulances and praise workers for their efforts at Clapham and King's Cross, yet now she is prepared to treat them in a despicable manner.

There is now a lock-out in many regions, including the Coventry area. Yet it is interesting that it was not the Army which was asked to provide ambulances for the State Opening of Parliament. It seems that the Army is not capable of looking after Members. There were two paramedic training officers from the Woolwich ambulance station in a Woolwich ambulance station ambulance on standby here on 21 November. Why was that? That arrangement was made because of the incapability of Army medics, with a couple of days' refresher training, with police escorts and assistants, to provide anything like the service that is given by the professionally trained ambulance personnel.

I shall give some examples. I have a form which was completed by a professional ambulance person on 22 November as a result of an incident that took place in NW9. A one-and-a-half-year-old child—I shall not give the child's name because that might be a breach of confidentiality—was badly scalded. Under the section headed "Nature of illness" there is the following entry: Patient found lying on bed, with wet burn to chest and neck area (9–14 per cent.) approx. Under "Ambulance aid rendered" there appears: 1 × No. 3 bandage with sterile water applied to burn area. Baby carried in arms to ambulance in burns sheet. We are then told that the mother accompanied the baby in the ambulance. There is the driver's name and the attendant's name. There are the exact times when the ambulance was called, when it left, when it arrived at the hospital, when it left the hospital and when it returned to the station. There are numerous pieces of other information. This enables a hospital accurately to treat a patient.

The adjoining postal district is NW10. I have a form which relates to an incident that took place on 29 November. There is the time of the call, which was 20.21. The time of arrival at the scene was 20.35, so the response to the call took 14 minutes. There are the times when the ambulance left the scene and when it arrived at the hospital. The patient's name is supplied, but there is no address. The injury suffered is described as "Head injury". The entry against "Treatment given" is "None". There is no other information supplied on the police ambulance report.

I have a second police ambulance report of an incident that took place on 10 December. There is the date, the time of call, the time when the ambulance left the scene and the patient's name. The incident again took place in the NW10 area. Under "Injury suffered" there is the entry "High temperature". The treatment given is described as QT102. That is the call sign of the officer who attended the call. What use is that information to an accident and emergency department at the hospital to which the patient is taken?

I have another form which does not state where the patients is from. Against the section marked "Remarks" there is written "Collapsed". How can people in London or elsewhere have any confidence in that sort of information? That is one reason why we need the dedicated emergency staff of the ambulance service.

What is the effect of using inadequately trained personnel with inadequate equipment in their vehicles to provide a substitute service, be they from the Army, the police or voluntary services such as the St. John Ambulance Service or the Red Cross? In normal circumstances, I have the greatest respect for workers who, after a day's work, give their services to the St. John Ambulance Service or the Red Cross. They are not, however, bringing this dispute to a close. They are being used as strike breakers and they are prolonging the dispute.

Did the Minister listen to the "PM" programme at about 5.40 pm on 15 December? Did he listen to Dr. David Williams, the senior consultant across the water at St. Thomas's hospital, who claimed that the number of patients now arriving dead at the hospital, or who died at the accident and emergency department at his one hospital during the time that the Army have been used in London, from 7 November to 13 December, had increased by 70 per cent. over the equivalent period for each of the previous three years? Dr. Williams is no insubstantial commentator. He is the president of the Casualty Surgeons Association. When he says that there is a substantial increase at one hospital, we can believe that throughout London and in other parts of the country there have been unnecessary deaths because of the Government's attempt to crack the resolve of ambulance workers.

Mr. John Hughes (Coventry, North-East)

Does my hon. Friend agree that, because of the latest disgraceful policy of preventing ambulance crews from responding to emergency calls, the lives of thousands of seriously ill citizens are being put at risk every day? Was not my hon. Friend present when ambulance crews belatedly received a call to assist Mr. John Downes, a senior citizen who lived at 170 Almond Tree avenue in my constituency? Does he agree that Ministers and senior ambulance administrators are guilty of a most heinous crime by preventing ambulance crews from responding to emergency calls?

Did not that inhumane policy deny Mr. Downes urgent medical attention for 59 minutes? Unfortunately, even with the skilled attention of the ambulance crew, who responded to the call within three minutes, he died in hospital. I know that the House will join me in offering sympathy to the bereaved family, but does that not pose this question? Would Ministers and senior administrators prevent their wives, children and parents from having urgent—

Madam Deputy Speaker (Miss Betty Boothroyd)

Order. The hon. Gentleman is making a long intervention.

Mr. Nellist

My hon. Friend refers to a serious recent tragedy. I join him in offering sympathy to Mr. Downes's family.

I was at the Foleshill ambulance station in Coventry on Sunday visiting ambulance workers who, because of the actions of management—I know that they are "only obeying orders"—are having to provide a service without the normal telephone lines. At 12 o'clock, the doctor telephoned 999. At 12.56—an Army ambulance had not arrived 56 minutes later—he telephoned the special council hot line connected to the ambulance station in Coventry and asked for help for his patient, who had been unconscious for an hour. Within three minutes, an ambulance arrived at the patient's house. He was taken immediately to hospital and given oxygen treatment. The Army ambulance arrived at 1.45 pm—one hour 45 minutes after the call was made, despite the fact that it is only three or four miles from Woodend to the police station in the centre of Coventry. As my hon. Friend the Member for Coventry, North-East (Mr. Hughes) said, tragically, Mr. Downes died on Monday.

I am not medically qualified to judge whether the one hour that Mr. Downes had to wait unconscious for the Army ambulance was the sole cause of his death, but I can say without fear of contradiction that if he had had a proper ambulance three minutes after the doctor had called, and if the Army and police had not been on the streets of Coventry, he would have had a better chance of life.

Mr. Bruce George (Walsall, South)

I visited the ambulance station in Walsall. Experienced crews were waiting for 999 calls, but they were being diverted to the Army and police. All telephone lines to the station had been cut off. The ultimate insult was that insurance had been withdrawn from ambulance men. Is there not a degree of malevolence in that? If anyone dies as a result of it, does my hon. Friend appreciate, as I do, that the finger of suspicion and guilt will clearly be pointed at the Government?

Mr. Nellist

I fully agree with my hon. Friend. Telephone lines to ambulance stations throughout the west midlands and Coventry have been cut. That applies not only to the control rooms but even to the coin-operated boxes in the locker rooms and social clubs. What will happen if there is a fire? What will happen if ambulance crews want to phone out to the emergency services? It will be impossible.

In the past seven years, I have had one or two harsh things to say about the Labour-controlled council in Coventry. But within hours of the phone lines being cut in Coventry, my Labour-controlled council installed a special hotline to the city engineers building on the other side of the road from the ambulance station. It also made a room available for the stewards and advertised in the local paper and on the radio the special hotline number —Coventry 832208—which has allowed the people of Coventry to call the ambulance service directly.

In Birmingham, such lines have been cut; the depths are being plumbed there. Racal has given the Birmingham ambulance service Motorola phones, a base station and three radio sets. At least the ambulance crews could then cover the centre of Birmingham. Over the weekend, 30 life-saving missions were carried out.

That has now stopped, because on Monday the regional general manager of the regional health authority, Mr. K. F. Bales, who was "only following orders", issued a letter to all ambulance personnel. I have a faxed copy of that letter which will probably be sent out to crews in Coventry today—Thursday 21 December. He wrote: Management therefore had no other alternative other than to determine that 999 and emergency calls should be directed only to the Army, Police or Voluntary services and certain Professional Staff … It is, therefore, my responsibility to point out to you that if you carry any patients in an ambulance when not authorised by the Authority or use an ambulance for any other purpose, you may be liable to the following:—

  1. 1. Prosecution for driving a vehicle that is unisured—section 143 Road Traffic Act 1988.
  2. 2. Prosecution for driving a vehicle without road tax—section 8 Vehicle Excise Act 1971.
  3. 3. Using a vehicle without the owners consent. Both driver and any passengers"—
that is the patient, remember— may be prosecuted under section 12 Theft Act 1968. Can anyone imagine a more craven or worse example of moral blackmail on the ambulance workers in Birmingham and elsewhere—to try to make ambulance workers choose between saving a life and prosecution?

I have had some research carried out into the claims in that letter. I am not sure whether prosecution under the Road Traffic Act 1988 for driving an uninsured vehicle can be enforced by the Government. From my reading of the regulations and of the consolidated measure, it seems that the argument that anyone driving an ambulance outside the rules governing a particular ambulance authority or contrary to management instruction, rests on the assumption that such use would not be in accordance with the terms in which it is so made available. I happen to think that ambulances are there to save lives. It would be interesting to test in a court of law whether an ambulance is the personal plaything of a regional health authority manager, a Minister or a Secretary of State for Health, or whether it is public property intended to save lives.

Mr. Nigel Spearing (Newham, South)

My hon. Friend has been outlining the impediments placed before voluntary ambulance crews fulfilling an act of skilled mercy. Is it not appropriate that, when the Minister replies, he should tell us the extent to which the impediments—whether they be telephones or insurance or any other threat—have been created on the instructions of Mr. Duncan Nichol or the Minister or with their connivance? If so, the direct link between risk to life and Government instruction will have been made. If no such instructions have been given, is it not time that the Government said that such instructions should not be issued?

Mr. Nellist

I believe that my hon. Friend's alternative of direct connivance is right.

Four or five weeks ago, there was a similar example of moral blackmail in London. The acting chief ambulance officer, Mr. Tom Crosby, issued a letter to all 71 ambulance stations in London. I raised that matter at 3.30 pm on 14 November, in the presence of the Secretary of State for Health, in an application for an emergency debate. One hour later, the Secretary of State went to a press conference, withdrew that instruction and, according to The Independent of 15 November had not 'contemplated launching into the area of prosecution.' The Government have had four or five weeks to consider the withdrawal of the initial introduction of that letter into London. The fact that it went out on Monday —nearly 60 hours ago—in Birmingham, leads me to the conclusion that it has been checked all the way up the tree to the Secretary of State, and that political permission has been given to the regional health authority to remove the professional crews from the streets of Birmingham, and possibly Coventry tomorrow, by the threat of criminal prosecution if they drive ambulances. It can be described only as moral blackmail. Such an escalation of the dispute can be done only on the political authority of the Secretary of State. The Government are using the sickness of old folk and bairns as a political weapon to try to beat a group of workers into submission.

I do not exaggerate very often—hon. Members may not think that that is the case—but I can now see little difference in moral terms between the Government's tactics in the ambulance dispute and the Stalinist leadership in Romania. There may be a difference in scale or degree between thousands of deaths by bayonet and, so far, only dozens of deaths by denial of facilities, but the same tactic is being used to try to beat a group of working people into submission by the use of physical force. The Minister will not break the resolve of ambulance crews by those tactics. He will not cut the umbilical cord by which they are linked to overwhelming public support, which was evidenced last week when my hon. Friend the Member for Livingston attempted to present a petition signed by 4.5 million people.

We know that tens of thousands, if not hundreds of thousands, of pounds are daily being collected from working people in the streets of this country. If the dispute is not settled within days—I do not know why I should be warning the Government and giving them advice; perhaps I should direct my remarks to those who will read my speech rather than to Ministers who never listen to Opposition Members—there will be even greater pressure, such as that evidenced on 6 December when 5,000 workers took industrial action in London, or in Bedford or Manchester today, when other workers will support the ambulance workers.

I have watched worker after worker put a day's pay into the ambulance workers' collection boxes. It will only take someone with a little more clout than I—perhaps someone on or even leading the general council of the TUC—to ask all workers in this country to give up a day's pay on the same day and have a national day of action, such as a 24-hour stoppage, to defend ambulance workers and the NHS. If 500,000 people can demonstrate in Wenceslaus square, we can certainly put 500,000 in Trafalgar square in support of the ambulance workers and the NHS.

No Socialist or trade unionist is asking ambulance workers to go on strike, but the pressure is building up inside their ranks for an escalation of action. Our folk would be denied an essential service if the ambulance workers went out on a lengthy strike. It is not their job alone to defend their wages and conditions and the service that they provide. Our job, as working people who rely on the service, is to go to their aid. We must stand shoulder to shoulder with them, and I remain convinced that working people will do so.

That support for the ambulance workers is widespread is evidenced by a letter that was faxed to the Secretary of State today by the Coventry city council, stating: The City Council is amazed at the deliberate acts of provocation which ambulance management here are taking, presumably with your knowledge and consent, that can only serve to escalate friction and deepen the dispute. Army ambulances, supported by Police, are already on the streets of Coventry. They are no substitute for the trained professional ambulance service which the public has the right to expect. We would be failing in our duty to our citizens if we did not demand that the Government immediately ceases what appears to be a clear policy of escalating confrontation, and instead concentrates every effort on resolving the dispute. In those sentiments, my Labour council represents the overwhelming majority view of the 300,000 citizens of Coventry and, I am sure, of working people throughout the country.

I say through you, Madam Deputy Speaker, to the Minister, if he will listen, and to anyone else who may read or hear of this debate that the ambulance workers of Britain—all 22,500 of them—will not be bullied into submission. Every time they are kicked in the teeth, they are brought closer together. They have learnt the true meaning of solidarity, of relying on each other and of the generosity of ordinary folk with the 50ps and £5s from pensioners and the bigger donations from better-paid workers.

I heard one ambulance worker from Liverpool say about a month ago that he wanted only two things out of the dispute—an 11 per cent. pay offer and a tobacco pouch made from Duncan Nichol's scrotum. I cannot deliver the second item, but I advise the Minister that those workers will win their just desserts. They will not be deserted by the working men and women of this country.

The Government will rue the day when they took on a section of the emergency services in an attempt to crack their union and in an attempt to bring in the privatisation and sale of the service of taking people to hospital, or to bring in the opt-out and the two-tier structure. They will rue the day they began this course, because ambulance workers will stick together and working people will back them. They will get their pay award.

2.31 am
Mr. Nigel Spearing (Newham, South)

My hon. Friend the Member for Coventry, South-East (Mr. Nellist) has mentioned Mr. Duncan Nichol. One of the less pleasing aspects of this sad affair is the extent to which people who are, in effect, civil servants are being put up by Ministers to protect them. I have asked a few questions about this practice. The Minister may wish to correct me if I am wrong, but it seems to me that this trend has been instituted in the National Health Service. I question whether it is right and proper for the political decision of Ministers to be produced on television or at a press conference by a senior civil servant who is not responsible for the policy. We should look into this trend as a Parliament. Perhaps the Select Committee on the Treasury and Civil Service might wish to turn its attention to this matter.

This is the fifth debate on ambulance services since 1986. Up to 1987, we had four on the London ambulance service alone, which has been in crisis for the past four years. Indeed, in the proceedings on the Consolidated Fund on 8 December 1987, my hon. Friend the Member for Islington, North (Mr. Corbyn) and I outlined the serious condition of the London ambulance service and warned the Minister what would happen. In earlier debates that Minister, the hon. Member for Derbyshire, South (Mrs. Currie), boasted of a 40 per cent. cut in non-emergency calls, apparently completely unaware of the human suffering and distress that that caused three summers ago.

The London ambulance service, which is the biggest municipal service in the world, has been starved of money. It is clear that it has not been demand-led. Whether an ambulance service is taking people to hospitals or clinics or providing an emergency service, it must be demand-led. The excuse that the then junior Minister made was that the cuts in the non-emergency service, which were reprehensible and wrong, were being made to keep the front-line services up to scratch. However, since then the front-line services have not been kept up to scratch. There has been a so-called efficiency saving every year. The funding arrangements between the Department of Health, formerly the DHSS, and the extremely awkward South West Thames regional health authority and its London ambulance board, which has wrongly remained anonymous throughout this terrible time, is murky in the extreme. It is clear that that service, its executives and senior officers have to cut their coat according to inadequate cloth.

The Government do not seem to understand that the ambulance service must be demand-led. They have provided it with less money and fewer resources than it needs. The result has been a running down of the service, especially in respect of human skills.

The Government do not appear to understand that capital is more than cash. Let us take the example of this House. It shows the importance of experience, of building up skills over a number of years, of dealing with problems and of passing on that experience to new Members. That is what happens in the ambulance service. Skills and experience are acquired as people face more difficult porblems. Those skilled people should be retained, but that does not happen.

I quoted the relevant figures during our debate under Standing Order No. 20, and I shall quote them again. The total number in the London ambulance service is 2,379. In the two years 1987 to 1989, no fewer than 572 people left the service. Some 166 people retired, but of that number 148 had to leave on medical grounds. Only 18 people in two years retired at the normal retiring age. The pressures on the crews—psychological, physical and financial—were and are too great. Coupled with that is maladministration of the service on a grand and terrible scale.

The Government were warned four times, and they are now reaping the whirlwind. The Minister, who has been listening intently, will, I am sure, do his best to reply to the debate. However, in view of the importance of the matter, it would have been more appropriate if the Secretary of State had appeared. This is no ordinary debate; it is no ordinary industrial dispute. If we believe in the Parliament of the United Kingdom, we must also believe in the accountability of those who take the decisions. I do not think that the Minister is in that category. Indeed, perhaps the Secretary of State is not in that category. We can guess where some of the decisions are made.

These events are following a now familiar pattern. We have only to think about the public services that have been handled so badly during the past five years or more. First, they have been under-funded, then under-equipped and then morale has been undermined through the introduction of new systems of grading and pay. Such actions provoke some form of industrial dispute, patience gives out, the service declines, and someone says, "We must privatise the service to make it efficient."

One of the most terrible aspects of the dispute is the leaked information that the Government intend to privatise the major part of the ambulance service—the so-called non-emergency service. That process has been applied to our railways, our teachers—who do not even have a negotiating machinery—our nurses, our midwives, and our doctors; and, dare I mention it, the Government have even tangled with the lawyers. The process is worthy of old Nick himself; it is satanic because it removes trust, confidence, skill and all those abstract qualities that make up the quality of life. In referring to old Nick, I do not specifically mean the Secretary of State for Trade and Industry, although he is more than capable of thinking out a sequence that has, alas, been so effective.

The problem is that the Government and all who sail in it have no concept of public service. It is a concept which was to be found within the Conservative party with which I grew up. I disagreed with it about the extent to which service and matters of commerce, production and exchange should be publicly owned, but we could have a reasonable argument about it. The Victorians built many of our town halls. The Victorian heritage in many of our cities is enormous. Many of the Victorians were Conservatives. The old style Conservatives at least said, "If it is to be public, let us make it good." I have no doubt that Grantham public library was very good. At least certain people wanted it to be better than it was.

Mr. Jeremy Corbyn (Islington, North)

It is a pity that they did not read more in it.

Mr. Spearing

Indeed, there is a great lack of understanding in that respect and a great deal of ignorance, particularly about the non-emergency ambulance service, which it is the Government's intention to privatise. If they have changed their mind, I should be glad if the Minister will tell us when he replies.

A circular has gone out from the South West Thames regional health authority under the terms of the White Paper. One would not have thought from the White Paper that the Government were going to privatise the non-emergency ambulance service. However, its broad terminology covers that.

I talked about ignorance, which is massive in Whitehall and in the Government. My ambulance crews in Plaistow have hit it on the nail. They have said, "The non-emergency service requires a great deal of skill and effort. A high proportion of those we take to hospital or clinics are elderly, frail, ill—by definition—and probably frightened. They are worried, in particular, about how they will get home." In addition, the skills required to get them out of bed and their home into the so-called non-emergency ambulance—perhaps fitted with a tail lift if there are enough available—are not always easy. Imagine getting a 15-stone man out of a bedroom and down narrow stairs. In too many tower blocks in Newham, the lifts sometimes do not work.

What about the lady with the frame who shuffles down the garden path and is then guided on to the platform which raises her into the ambulance? What about people who need stretchers? The so-called front-line ambulances are used at times to take people for treatment who need to be moved lying flat on a stretcher. The Government do not understand the skill and risk lifting people. It is done by many who work in hospitals, and it is a difficult and skilled operation, particularly if the people they lift suffer from distressful conditions or have dressings which must be treated with care.

By cutting the non-emergency service three or four years ago by 40 per cent., the Government and the hon. Member for Derbyshire, South caused enormous distress. Many people have been taken to hospital and have not been able to get home. Sometimes they have called minicabs and have not arrived home until 1 o'clock in the morning.

The number of ambulances has not been increased. We all know about hospital closures and the need to travel further. We all know about transfers from one hospital to another. We all know about traffic conditions, particularly in London. All those factors put a greater demand on ambulance mileage and crew time. Crews and vehicles have not been increased pro rata.

What does the Secretary for Health say? He reminds me of Marie Antoinette. He says, "Let them use taxis." He has no knowledge of the service. If he had, he would not say what he says.

The Government say that we should have choice. As a citizen, I want the choice to pay taxes to stop people having to take taxis. The Government will not allow me to exercise that choice. They apply choice, as a philosophy, in a highly selective manner. While I am talking about manners, I make no apology for making some comments about the Secretary of State. I expected him to be here tonight.

Mr. Corbyn

He should be.

Mr. Spearing

I have no compuction about saying things in the right hon. and learned Gentleman's absence.

On 7 November, the right hon. and learned Gentleman accused ambulance crews in London of "pretending" to be available for service. On 24 October, I asked him to check his allegations about the use of radio. Time and again he implied or stated that the crews would not use the radio, but, later, he had to admit that they were using them in a particular manner. The arguments are difficult to follow, but it is accepted that it is important that radio contact should be maintained. It was. The Secretary of State used phrases to suggest that that was not so. It is, of course, the last refuge of political scoundrels to use what my hon. Friend the former Member for Bow and Poplar, Mr. Ian Mikardo, aptly described as verbal veritas sed suggestio falsi". In other words, they use true words from which false impressions and false conclusions can be drawn by the listener.

The Secretary of State has behaved in a boorish, rude and overbearing manner. He has questioned people's motives, and his manner has often been officiously offensive. Such behaviour is unbecoming and unacceptable from a Secretary of State and a member of the Cabinet.

The Secretary of State is a Queen's counsel, a professional. A professional is someone who is paid an adequate return for his services and then gives what is required. We try to do that here. It is the wish of ambulance crews throughout the country to do just that. One cannot undertake a time-and-motion study or a productivity study on ambulance crews and the Secretary of State, as a professional in the law, should know that. In my view, his behaviour is reminiscent of those who have been at the other sort of bar rather than at the legal one. I say that with some reluctance in the right hon. and learned Gentleman's absence, but anyone who has observed his behaviour here and elsewhere would say that it is broadly correct. I would go as far as saying that, now, he is one of the most disliked men in the country.

At root, the problem is a philosophical or a theological one. The ambulance crews and their equipment are corporate Samaritans. In that way they act on our behalf. I should have thought that even the Prime Minister would agree with that. I recall her comments on that parable. "Ah," she said, "the good Samaritan had to have the money to pay the innkeeper first." She forgot that, when the Samaritan went to the innkeeper, he gave him some money, but said, "If the needs of this man are greater, I shall come back later and pay you what I owe." In other words, his actions were demand-led; that is one of the important lessons from that parable. The Prime Minister claims that she understands such things.

In 1988 the right hon. Lady went to Scotland for the annual assembly of the Church of Scotland. She read them what has become known as "The epistle to the Caledonians." She claimed that our civilisation and many of our cherished traditions had a Judaeo-Christian basis. I do not detect any such basis in the way that the Government are handling this matter. Are not those principles of Judaeo-Christianity which the Prime Minister professes to hold made literally incarnate by the ambulance service? I shall not go further, or I shall be tempted to preach a sermon, and I finished doing that many years ago. The money is available—there is a £12,000 million surplus. The Government have at least £130,000 million which they have conned from people by selling them their own property. Therefore, there is no lack of resources for this matter.

Such questionable political morality would have been almost unbelievable 10 years ago. The Government must test their conduct in this matter against some of their professed principles. There is need for conciliation. The Government will not go to ACAS, because in doing so they will be seen to be climbing down. I have said some harsh things about the Secretary of State tonight. I have known him for a long time, and underneath that somewhat bullish exterior there are many redeeming features. It is not beyond his ingenuity to think of some method whereby something could happen so that both he and the Prime Minister could get off the hook and do something to bring this terrible, sad dispute to an end.

When the history books are written, this dispute will be featured as part of the demise of what, in this decade, we have called Thatcherism.

2.52 am
Mr. Jeremy Corbyn (Islington, North)

I start by declaring two interests in this dispute. First, I am proud to be a member of the National Union of Public Employees and to be sponsored by in this House. Most of the ambulance workers who are in dispute and have been so abominably treated by the Government are members of my organisation. Secondly, I live, and am happy to live, in London and am concerned about the future of emergency services there and the very safety of residents.

The dispute has shown who are concerned about ordinary people's safety and who are not. Ambulance workers who undertake a workers-controlled and workers-run 999 service have shown that they have at heart a concern for the ordinary people throughout the country. Those who are not concerned are those who have brought in the Army and the police, and heaped abuse on ambulance workers in an attempt to break their resolve and end the dispute so that they settle for the poverty pay to which they have long been accustomed.

It is disgraceful that the Secrertary of State is not here. He makes the decisions and the running, and appears on television all the time. He abuses the ambulance workers, but now he cannot be bothered to be here tonight to answer to the House. My hon. Friends' speeches have also shown the type of work that ambulance staff do and the pressures they fare.

Can people understand the pressures of trying to drive through London traffic, deal with an emergency such as picking up elderly people or people from car, train or air crashes and then go straight back out on the road? I was talking to a group of ambulance workers in an ambulance station about this. I compared their experiences to those of rail workers. If a train driver faces a fatal accident in which a passenger or, more likely, someone else steps onto the track and commits suicide in front of him, he is righty counselled afterwards. They are given considerable leave to try to get over the shock and trauma, and given whatever support is available.

I talked to a group of ambulance drivers who had spent two hours trying to help people get out from under a train crash. They had to spend the last half hour of a man's life talking to him because it was impossible to get him out. When they had finished that task, and the crash had been cleared up, they went straight out on other emergency calls. Ambulance workers suffer such trauma and tension all the time, yet they are told by the Secretary of State that they are no better than unskilled taxi drivers. These are the people who deal with care and concern with every patient —the drunk picked up off the pavement on a Saturday night and the child in a road accident are treated with equal compassion.

Continual abuse is heaped on the ambulance workers. It used not to be heaped on them when they were not complaining about their low wages—everything was fine then. As soon as they said that they were not prepared to accept such low wages, all that changed. Something must be done about low wages, however; they are one of the major causes of the problem.

Young ambulance workers in London, which I know best, have to travel enormous distances to get to work. Unless they are very high priority, virtually homeless people, they have no chance of council accommodation anywhere in inner or central London. No ambulance worker could buy a flat there on the wages he is paid. The minimum price of a small flat in the area is £60,000, so they live further and further away, or in bad and overcrowded conditions.

If we want to maintain decent public services in London, the housing problem must be resolved, and public servants such as ambulance workers, who do such a valuable job, must be given reasonable rates of pay.

On Thursday 14 December, I asked the Secretary of State for the Home Department to list the pay of leading firemen and police constables for each year since 1974. I asked for the answers in 1989 prices, but he said that that was impossible—the calculation was obviously beyond the Home Office. In 1974, leading firemen and women were paid £2,913 a year; by 1980 that had risen to £6,715, and by 1989, to £14,055. Police constables in the corresponding periods were paid in the range of £1,632 to £2,636, £4,956 to £7,848 and £9,900 to £16,521. The equivalent salaries for ambulance workers were: basic pay of £1,981, £3,994—and what the Secretary of State for Health describes as a final offer of £11,001.

This shows where the money has gone—not to the ambulance workers, who have clearly lost out. The police, fire and ambulance services all attend major accidents, but is a policeman worth twice as much as an ambulance worker? Is a fireman worth more? Ambulance workers are valuable members of a team and should be paid properly for the job.

The background to the dispute is one of continual underpayment and the continual imposition of new management methods. There has been continual cutting back on the service, a continual use of hospital cars and a continual threat of privatisation. People who take pride in their jobs could use their skills to fulfil that pride, but they are prevented from doing so by sharp-suited management brought in to introduce the methods of the supermarket to the service. That is not the proper way to run an emergency service. The right way is to use people's skills and dedication properly.

As my hon. Friend the Member for Newham, South (Mr Spearing) pointed out in a debate at this time of morning two years ago, London's heavy traffic was, as now, slowing response times, and there was also a major lack of vehicles. They remain significant factors.

When the ambulance workers refused the latest pay offer, there was widespead consternation, with the management aghast that the workers should dare to decline it. The ambulance men took a democratic decision, and ever since they have conducted their dispute with enormous dignity.

Every morning, at ambulance stations all over London, and in many other parts of the country, ambulance men arrive to work a shift. They receive a phone call asking whether they are willing to work according to the management's demands—and when they refuse, they are stood down.

The management know perfectly well that the ambulance men will not leave their stations but will remain to respond to emergencies—as they have already done hundreds of times. Had they not done so, many people would have received no attention because the Army and police are incapable of doing the job. They do not want to do it, and they are not qualified to do it.

The Secretary of State for Health is happy to rely on the good will of the ambulance station staff to undertake 999 duties, even when they have been stood down.

One morning when I was talking to workers at a Fulham ambulance station, a police car drew up outside and a nervous young constable got out and asked, "Are there any ambulance workers here?"—which was a pretty stupid question, as it was fairly obvious that there were, in uniform. The constable said, "We have a problem because we have been told to pick up someone with a back injury and do not know how to lift him." That policeman did the right thing in coming to the people qualified to deal with that situation. The ambulance workers' immediate response was to go to the scene of the accident and do what was necessary.

Last night. I was with a group of Camden ambulance workers, who described how they came across the crew of an Army ambulance picking up someone off the street who was in a bad state and vomiting. The crew laid the man out flat on a stretcher, where he could have choked. Fortunately, qualified ambulance workers happened to be at the scene and put the patient into the proper recovery position—then explained to the soldiers how to look after anyone they found in similar circumstances.

On a wet and miserable night, I was walking home along Stroud Green road in my own constituency when I saw an Army ambulance and two soldiers trying to carry someone out of a house on a stretcher, while the driver was scrutinising an "A to Z" by the dim light of a torch, trying to locate the nearest hospital. Is that a proper service? Is that safe? Is that the way that the public should be treated in this day and age? No.

The public know that the ambulance workers are on the public's side, which is why they are donating so much money to them. A month ago, the Secretary of State for Health told me that I was one of the few people in the country who supported the ambulance workers' pay claim —but last Friday, a petition of 4.5 million signatures was presented to the House, and goodness knows how many people have shown their support for the ambulance men by putting money into their buckets.

I have with me a list of the telephone numbers for all the ambulance stations around London, which are now providing a 999 service. They are well publicised, so the public can phone for a real ambulance when they need one, rather than suffer a lengthy wait for a police or Army ambulance.

There is popular support for the ambulance workers because the public realise that the Government are hellbent on destroying them with abuse. They recognise which side the abmulance workers are on: they recognise that those workers have shown their dedication to the community, the service and the people who rely on that service. That is why the ambulance men have received such enormous support throughout the country, and throughout industry and the service sector.

Every march that I have joined starts off with a few hundred participants, but grows and grows until a mass of people are showing their determination to support the ambulance workers. The Government will rue the day that they took them on, for I believe that the time will come very soon when they will be forced to settle the claim in full.

3.5 am

Mr. Robin Cook (Livingston)

I congratulate my hon. Friend the Member for Coventry, South-East (Mr. Nellist) on securing the debate, and on the vigorous and forceful way in which he introduced this important topic.

All my hon. Friends who have spoken so far have referred to the absence of the Secretary of State, and I shall not echo their observations; I shall content myself with saying that I am pleased that the Parliamentary Under-Secretary is to reply, as I have always found him more thoughtful and candid than his right hon. and learned Friend. This is the first opportunity that he has had to comment on the ambulance dispute, and I look forward to hearing, when he rises in 10 minutes' time, his answer to a question that is, I think, at the back of the minds not only of hon Members who are present tonight, but of the whole nation: what is the Government's present strategy to secure a settlement?

The more often we listen to Ministers discussing how they think the dispute will be resolved, the clearer it becomes that they believe that the only solution is for the union side to surrender. The Secretary of State made it plain that there was no room for any meaningful negotiations on a new offer, because there would never be any more money on the table: he is willing to meet the unions—or, rather, for his management to meet them—only to accept their sword in surrender.

The problem with seeing that as the end of the dispute is that, to put it bluntly, the staff side and its members are in no mood to surrender. Any doubt about that was removed this afternoon, when the Association of Professional Ambulance Personal revealed the result of its ballot following negotiations with the Secretary of State's nominees—phantom negotiations with a phantom union, but negotiations that none the less produced a real and resounding no. The offer was rejected by 68 per cent. to 32 per cent.—a pretty convincing two-to-one majority.

Mr. Corbyn

Close!

Mr. Cook

Of course, it probably was much closer than it would have been had the ballot been held before the many hundreds of resignations took place. What we were left with was a two-to-one rejection by the rump that did not resign when the negotiations started.

If the Secretary of State really believes that the dispute will be resolved only by the surrender of the union side, he will have to wait a long time; in the meantime, the people who will suffer are the members of the public who have cause to call on the ambulance service. I congratulate my hon. Friend on securing the debate immediately before the seven days round Christmas and the subsequent seven round the new year, which are the busiest days of the year for the ambulance men. It is customary for the London service to receive 300 calls per hour over Christmas and the new year; at present, 50 police vehicles and 50 Army vehicles are available to them. How can they hope to deal with 300 calls per hour with such resources?

Not only must the ambulance men rely on such rudimentary resources, but, regrettably, the management appear to have done everything possible to frustrate the efforts of the staff side to maintain an emergency service even while suspended.

My hon. Friend the Member for Coventry, South-East and one or two of his colleagues from the midlands have drawn attention to—we should be quite blunt about it— acts of sabotage to destroy the telephone links to ambulance stations. There is no other adequate description. It was vandalism intended to sabotage attempts to provide emergency cover. There have been similar attempts to prevent the London ambulance service from receiving emergency calls that people want to put through to it.

Last Friday, my attention was drawn to what happened outside a private hospital, as it happened, in central London. The staff at that clinic were aware, as all the public in London were aware, that ambulance staff had taken the trouble to advertise the direct lines of their stations and were welcoming calls made on those numbers. Outside the private clinic, a window cleaner fell three floors to the ground below. He fractured his spine, a leg, his forearm, his pelvis and his ribs. The staff of the private clinic attempted to make a 999 call and were told to wait in the queue. They summoned two policemen from nearby and asked them for the number of the nearest ambulance station so that they could dial direct. The police officers advised the staff that they were under instructions on the highest authority not to release those numbers.

Is this the policy of the Government and the management side? If so, they are deliberately setting out to frustrate the service that could be available to the public when they have access to a police officer, who may frequently be on the scene of an accident and who would be able to summon skilled professional help. I do not think that it fair to force police officers to say, "No, we are not allowed to divulge this information." It took two hours and 10 minutes for an Army ambulance to attend to that patient, who was in great pain and had serious orthopaedic injuries. When it arrived, the people driving it were incapable of performing the skilled and proper lifting of the patient. That is serious because the improper lifting of a patient with a broken spine could result in paralysis for life.

The nation wants to hear the Government's strategy for resolving the dispute, and must increasingly view their intransigence with incomprehension. I shall give just two reasons for that. The first concerns the cost of maintaining the best professional ambulance service that we can hope to have. Three weeks ago, the Association of London Authorities produced figures which show that, in the first three weeks of the dispute, the additional cost of police cover was £1.25 million. Another three weeks have passed, so we can double that figure. The police vehicles alone have cost £2£5 million. There are also the Army vehicles, so we can double the £2.5 million. The additional cost of emergency cover in London for the past six weeks is therefore £5 million—all to avoid a settlement that would cost only £10 million. The Government have spent almost as much on providing emergency cover as they would need to settle the dispute.

The second reason why the public must regard the Government's stance with incomprehension is the political cost to the Government. The Minister, who is a sensitive and thoughtful man, must be aware of that. The truth is that the ambulance staff have received overwhelming support. My hon. Friend referred to the petition presented to the House on Friday. It is the largest petition ever presented to the House. I understand that 5 million signatures have been collected—including those presented last week and those collected since then. Every week, support for the ambulance staff grows, while support for the Government's case becomes weaker.

Ministers may be concerned about the political damage that they will suffer if they are seen to be defeated, but that will be as nothing compared with the political damage that will be caused to the Government if they are seen to defeat and humiliate the ambulance staff.

This is not the place to negotiate the dispute. I would not expect the Minister to attempt to negotiate the dispute and announce a settlement tonight, but I urge him and the Secretary of State to get round the table and negotiate directly with the ambulance staff, not through intermediaries who have no room for manoeuvre. If the Secretary of State continues to refuse to do that, the nation is likely to conclude that the Government are not interested in resolving the dispute but wish to play it through to the bitter end. I believe that that is a dereliction of their duty for which the nation will not forgive them.

3.15 am
The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)

The hon. Member for Newham, South (Mr Spearing) gave me quite an introduction when he said that he regretted the absence of my right hon. and learned Friend the Secretary of State as he thought that the Minister who was to reply to the debate was too junior to take any decisions. I shall try to answer some of the points that have been made and I hope that, on reflection, the hon. Gentleman will recognise that even the most junior Minister at the Department of Health shares responsibility with his Secretary of State for resolving such problems.

I share the view of the hon. Member for Livingston (Mr. Cook) that in any industrial dispute it is important to avoid humiliation. Cool heads and patience are needed on both sides to resolve what is essentially an industrial dispute. It is unfortunate that in this case, unlike many other industrial disputes, the people who are suffering are the patients. They are people like the hon. Gentleman and myself. That is why it is particularly important for cool heads to prevail in encouraging further constructive discussion between the two sides.

The hon. Member for Coventry, South-East (Mr. Nellist) said that no ambulance man or woman was on strike. He said that they had been locked out. On reflection, he will have to agree that the trade unions involved in the dispute promised to maintain emergency services throughout the country. That was a clear commitment.

Mr. Corbyn

That is what they are doing.

Mr. Freeman

If the hon. Member for Islington, North (Mr. Corbyn), who intervened from a sedentary position, reflects further, he will recall that that was not and is not the case in London. Some men and women in the London ambulance service have not agreed to operate normal radio procedures.

Mr. Corbyn

Will the Minister give way?

Mr. Freeman

No. I wish to finish the point I was making. I have some 11 minutes to answer the points made in the debate.

Mr. Corbyn

Name one station.

Mr. Freeman

Let me explain what I mean. When an ambulance service is provided for a region or a metropolis, it needs to be properly co-ordinated and run. An ambulance service cannot be run by individual crews from individual stations. It has to be properly co-ordinated, and it needs a control room with management who can use flexibly the crews at disposal.

Where that is not the case—where normal radio contact is not being operated and ambulance men and women are not prepared to work with qualified ambulance men and women from other stations—the service breaks down. Outside London, some crews in some places have taken patients requiring emergency treatment not to the right hospital but to the nearest accident and emergency department—not to where they were directed but where they wished to take the patient.

In that situation, the normal emergency service breaks down. It cannot be controlled properly from a central location and one has anarchy, in the organisational sense that individual ambulance crews may be willing to operate a service as they define it, but it is not properly run and co-ordinated.

That is what an emergency service is, and in certain parts of the country it is not being offered. That is why the police, Army and voluntary organisations are providing that emergency service. I regret it, but that is the position.

The hon. Member for Coventry, South-East also asked about the pay formula; by inference he wished the ambulance men and women, the unions, to have a pay formula linked to the fire fighters, and presumably to the fifth-year fire fighters. That was rejected by Clegg, as the hon. Gentleman will recall, and I have not heard the hon. Member for Livingston commit a future Labour Government to a pay formula that would link ambulance men and women to fire fighters.

Mr. Cook

I am happy to take this opportunity to make it clear that we have said, and are on record as saying, that we would accept the case for a mechanism which would provide for guaranteed annual increases for the ambulance service along the same lines as was resolved in the fire fighters' dispute. Whether that would provide a precise link with fifth-year firemen or with something else is a matter on which we have an open mind and about which we would wish to negotiate when we are in the Minister's position. But there is no doubt about our commitment to a mechanism, and I am sure that were the present Government to make the same commitment, the dispute could be resolved in time for Christmas.

Mr. Freeman

The hon. Gentleman will admit that that is not quite pay comparability using the fire fighters or the police as comparators. The hon. Gentleman spoke about some form of mechanism, but he did not commit a future Labour Government to the request of the unions involved for strict pay comparability through some kind of formula with the fire fighters.

The hon. Member for Newham, South said that the ambulance service was demand-led. The hon. Member for Livingstone, I am sure, accepts that the hospital and community health services are—and have been since the Labour Government of 1976—cash-limited, and that the pay and other operating costs of the ambulance service would be cash-limited in the sense that they would be funded from that part of the Vote which was cash-limited.

Hence, the argument of the hon. Member for Newham, South is not consistent with the position that the hon. Member for Livingston has taken and would be likely to take if he were responsible for the Health Service. It cannot be financed as a demand-led service such as unemployment benefit or the prescription of drugs by the family practitioner service. It is cash-limited because it is part of the hospital and community health services and a judgment must be made about the relative priorities within the Vote.

The hon. Member for Newham, South asked about privatisation. The Government have made no comment about policy towards privatising all or part of the ambulance service. But I draw the hon. Gentleman's attention to the Northumberland service. I think that he will agree that, where the non-emergency portion of the service there is provided by a private company under contract, it appears to work satisfactorily. I am not aware of any criticisms being advanced tonight about that service. There is a similar service in another district in England.

Mr. Spearing

Leaving aside the non-emergency service, surely the emergency service must be demand-led. The Orcon standards have been set by the Department and sufficient vehicles and personnel must be provided so that those standards are implemented. The same applies to the fire-fighting service.

The Minister has talked about privatisation. Is he telling us that what might work in largely rural Northumberland might be applicable to London? I take it that the hon. Gentleman is not denying that there are moves towards privatisation. South West Thames regional health authority has already sent out circulars, and he knows that it has done so on the basis of the White Paper.

Mr. Freeman

As the hon. Gentleman knows, the Health Service is not managed by the Department of Health. It is managed by—

Mr. Spearing

Mr. Nichol.

Mr. Freeman

No. It is managed by individual constituent units of the National Health Service. The hon. Gentleman knows that as well as I do.

The hon. Member for Livingston asked about the Government's strategy. In the few minutes that remain for this debate, I shall deal briefly with the pay offer that is on the table and our strategy. The hon. Gentleman is familiar with the offer made by Mr. Duncan Nichol, the chief executive of the NHS management executive. The offer has been rejected so far. The offer that emergency crews will be on full pay if they work to trade union guidelines over Christmas has been rejected.

It is said that there has been no new offer, so what is the strategy? The hon. Gentleman will know that the Government have moved significantly on pay since the 6.5 per cent. offer, which was accepted buy NUPE during the summer. It was agreed to by NUPE negotiatiors for 150,000 NHS staff and subsequently rejected by their members. Since the negotiations in the summer, there has been a significant movement by the Government and none in recent months by Mr. Poole, who is still asking, as I understand it, for 11 per cent. and a pay formula.

The improved pay offer, which is on the table, would increase rates of pay from 1 April 1989 by between 9 per cent. and 16.3 per cent. with an extra £500 for paramedics. It includes an agreement to negotiate by 28 February a national framework for paying the intermediate paramedics. These are the main elements of the improved offer. Other elements include the consolidation of standby allowances into one rate, a joint review of the 1986 salary structure in the light of three years' experience of its operation and new London pay rates, which would give increases of between 10.9 per cent. and 16.3 per cent, resulting in increases in overtime rates of over 22 per cent.

The hon. Member for Livingston concluded by referring to public attitudes. I have to agree with him—I have seen this in my constituency and I am sure that other hon. Members have seen it in theirs—that the British public value the ambulance service. They regard it, rightly, as I do, as posssibly a lifeline when someone is struck down and there is an emergency, or when someone has to move as an out-patient from one part of the hospital service to another.

I understand the public's attitude, but the Government have a responsibility. It is important that no NHS pay group is negotiated with on such different terms from others that they disadvantage other parts of the service. We employ 1 million people in the Health Service and it is important to remember that the majority of the staff have already settled for this year. The exceptions are the ambulance men and women.

I agree with the hon. Member for Livingston—I am trying to be constructive—that humiliation is an important consideration. The way to settle the dispute is not to put the ambulance men in a humiliating position but to get them back round the table, to negotiate properly and to do what we all want—care for patients properly.

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