§ Mr. Nigel Spearing (Newham, South)
(by private notice): To ask the Secretary of State for Health if he will make a statement on the policy of Her Majesty's Government concerning the use of additional personnel and vehicles during the ambulance dispute.
§ The Secretary of State for Health (Mr. Kenneth Clarke)
The Government's overriding duty in the industrial dispute affecting the National Health Service ambulance service is to maintain an adequate accident and emergency service for the general public.
If action is taken that threatens the adequacy of that service in any part of the country, the NHS will call upon the services of the voluntary bodies, private ambulances and police. If the threat to accident and emergency services is sustained for any length of time, the Government will be obliged to use military ambulances and personnel wherever necessary to maintain those essential services to the public.
The sole intention of the Government in asking police and military personnel to prepare themselves and their vehicles for ambulance duties if necessary is to protect injured or seriously ill members of the public. I hope that common sense will prevail and that NHS ambulance staff will not take action that threatens the emergency services.
It is entirely a matter for NHS management to decide whether, and to what extent, to use voluntary or private sector personnel and vehicles to provide non-emergency services for patients affected by industrial action. I expect the management to take all reasonable steps to ensure that the NHS provides as full a service as possible to all its patients for as long as industrial action persists. I hope that the staff sides will quickly decide to take up the management side's offer to resume negotiations in the relevant Whitley councils to settle the outstanding issues between them.
§ Mr. Spearing
That is not a reassuring answer. Does the Secretary of State recall the trauma in London exactly a fortnight ago today and tomorrow, when the ambulance management diverted all 999 calls from ambulance personnel who were standing by with vehicles to respond to them? Is the right hon. and learned Gentleman aware that as a consequence, in Canning Town a Mrs. Lander of Berwick road and a Mr. Lambert of Fox close waited more than one hour for an ambulance and that Mrs. Lander has since died? Will he assure the House that wherever ambulance crews in the United Kingdom are ready and willing, and are standing by, to respond to emergency calls, their services will not be dispensed with, and neither will calls be diverted? Will he also assure the House that any additional personnel and vehicles that he may have assembled will be used in such a way that the services of ambulance crews will not be dispensed with?
§ Mr. Clarke
The hon. Gentleman will recall that the problems in London were discussed in the House about 10 days ago. I pointed out then that the unions had drawn up 14 points of their own, which were designed to damage the ambulance service. Some of them were put into effect in such a way that it was impossible to guarantee an accident and emergency service. As a result, for 36 hours or thereabouts the police and voluntary bodies had to 678 provide the service. Fortunately, on that occasion the unions also withdrew some of their points—in particular, their refusal to use radio telephones and to crew up emergency vehicles, with the result that the accident and emergency service could be restored. As the unions continue to say that they have no intention of threatening or withdrawing accident and emergency services, I hope that they will stick to that intention in all parts of the country.
§ Dame Jill Knight (Birmingham, Edgbaston)
May I assure my right hon. and learned Friend that his action in making certain that our emergency ambulance services continue to function has strong public backing? Will he do all that he can to pursue the ideal that those who hold the lives of others in their hands do not go on strike?
§ Mr. Clarke
I am grateful to my hon. Friend. Obviously, no one wants to use the police, the Army or any other unsuitable service to carry patients to hospital, but it is plain common sense that when industrial action threatens to go too far and puts the services at risk it is necessary to ask the police—or, in extremis, even the Army—to step in.
I certainly dislike the whole concept of industrial action in the Health Service. We all feel great respect for what the ambulance men do, and I think that it is high time that the action was stopped and the dispute returned to the Whitley council, where I am sure that it can be negotiated. So far, the management has made offers—including a two-year deal bringing forward some of next year's money—to try to help to resolve the dispute. As yet, however, the unions remain intransigent, and are taking action against patients in support of a double-figure percentage pay claim.
§ Mr. Stanley Orme (Salford, East)
Is it not about time that the Secretary of State took positive action to resolve the dispute? It is no good his telling the House that it should go back to the Whitley council, when he is preventing the council from meeting the demands that the amulance men are quite rightly making. They say that they want to go to arbitration. Why will the Secretary of State not allow that?
§ Mr. Clarke
About 95 per cent. of Health Service staff have settled this year, and all those whose pay is negotiated in the Whitley council have reached agreement, with the exception of the ambulance men and a few other small groups.
The ambulance men are asking to be allowed either special arrangements by way of arbitration or a much higher settlement figure than other groups, and in support of that claim are pressing their industrial action, mainly against patients. I entirely understand why the management does not find such action in pursuit of a double-figure pay claim acceptable, when the rest of the staff settled for much less at the relevant time—last April. I see no reason why a settlement should not be negotiated sensibly, if only the union would settle down to talks and stop believing that threatening the well-being of patients will somehow gain them an advantage.
§ Mr. Michael Shersby (Uxbridge)
Will my right hon. and learned Friend encourage the negotiators to regard the ambulance men and women of London as providers of an emergency service for which they should be properly renumerated if account is to be taken of the often dangerous job for which they undergo substantial 679 training? Will he use his influence not only to bring about an acceptable solution to the problem, but to incorporate in it a no-strike agreement?
§ Mr. Clarke
The ambulance men of London are at present turning down a 9.3 per cent. pay offer. That was part of the April 1989 offer and is a higher percentage increase than the police received in the relevant settlement, and a much higher increase than those granted to most other NHS staff—including nurses, who received 6.8 per cent. I therefore feel that it is not an unreasonable basis on which those who represent the ambulance men might consent to continue to negotiate a way out of the dispute.
Unfortunately, at a time when the management did not regard the negotiations as being at an end, the National Union of Public Employees decided to turn the whole thing into industrial action. The sooner the union decides against continuing such action and goes back to holding sensible talks in which it takes a flexible line, the sooner the whole worrying problem can be resolved.
§ Mr. Charles Kennedy (Ross, Cromarty and Skye)
Surely the Secretary of State must recognise that progress will not be made if he keeps talking about NHS management as though holding it at arm's length, and adopts a Pontius Pilate role in his office of Secretary of State. Is not the central question—which follows from what was said by the hon. Member for Uxbridge (Mr. Shersby)—that of resources being made available by central Government to enable a fair settlement to be achieved? How can it be fair to say—and how can any hon. Member avoid skating on thin ice if he says it—that the figures being suggested are justifiable, especially in the light of the firemen's settlement? How can we say that, when we enjoy comparability with the Civil Service—and, indeed, when we read in the newspapers that we are to be awarded a pay settlement above the rate of inflation? How can that be justified when the Secretary of State will not talk positively about the ambulance dispute?
§ Mr. Clarke
The Government make the resources available, but in any sensible world it must then be for the Health Service management, through the Whitley councils, to decide how to distribute those resources between the various groups and also how to distribute the resources between pay increases on the one hand and the development of patient services on the other. It is wrong to claim that a Minister should be answerable to the House for the pay of nurses, clerical staff, electricians and ambulance men and should negotiate each pay claim in detail. A sum of money has been given to the Health Service, out of which it is meeting perfectly reasonable pay settlements for all its groups of staff. This attempt to politicise the dispute will undermine the mangement and the proper adminstration of the Health Service. It will also threaten patient services if people take industrial action, turn it into a political issue and get money that had been regarded as being for patients.
Comparisons are now being made with firemen. To make a proper comparison, one has to compare the pay of ambulance men with the pay of firemen after the two pay settlements that the ambulance men will get. They have to be counted before that comparison can be made. We are talking about the April 1989 settlement. If one wants to compare ambulance men's pay with the relevant fireman's pay, it is no good counting the current settlement. One has to look back to what the firemen got last year. Ambulance 680 men compare quite reasonably with firemen. The reason that comparisons are made with fifth-year fire fighters is because they are paid a higher hourly income than third and fourth-year fire fighters.
As for the pay of Members of Parliament, again we are looking at this year's proposed settlement for the House of Commons, which is tied to civil servants with London weighting. What we are talking about is last year's ambulance men's settlement of 9.3 per cent. I must admit that I cannot remember what on earth Members of Parliament were given last year, but London ambulance men have been given 9.3 per cent. That is not a particularly unfavourable comparison to draw with Members of Parliament, either. All these matters should be resolved by discussions. They cannot be resolved by strikes.
§ Mr. Edward Leigh (Gainsborough and Horncastle)
Would it not be reassuring for the future of our country if just once, if on just one occasion, one Labour Member of Parliament could be found to support the public against outrageous pay demands and restrictive practices? What does this say for the grim reality behind the facade of the new model Socialism? Labour Members of Parliament are still in the pockets of the trade unions. When will they start to stand up for the public?
§ Mr. Clarke
If any group of staff in the National Health Service decided to take industrial action tomorrow in support of any pay claim, the Labour party would give them its wholehearted support. That has been its consistent policy for years. The Labour party has no regard for patients or for the safety of the public. It has no responsibility on the subject at all.
§ Mr. Jeremy Corbyn (Islington, North)
Is the Minister aware that there is overwhelming public support for the ambulance workers in their pursuit of decent pay and that there is a full understanding that at no stage have any ambulance workers refused to answer radios in respect of 999 calls or to respond to 999 calls? Instead of this awful gap of £60 a week between firemen and ambulance workers and instead of heaping abuse on ambulance workers, the right hon. and learned Gentleman should ensure that they are properly paid and properly staffed and that there are sufficient vehicles to maintain a proper ambulance service rather than threatening to bring in the Army to try to destroy the dispute in that brutal way.
§ Mr. Clarke
I know of no member of the public who has yet approached me in support of an increase of over 11 per cent. for ambulance men, which is the claim that is being pressed by the unions and from which they do not appear to me to be prepared to resile. Most members of the public would prefer the dispute to be settled by negotiations, not by industrial action. It is not true that the unions did not threaten the accident and emergency services in London. They did. They drew up 14 points that were designed to do damage to the service. Some of those points made it impossible to guarantee a reliable accident and emergency service. There is no question whatever of using the Army or the police to break any industrial action, but if the unions are so irresponsible as to take action that puts the safety of the public at risk, the Government must obviously put the police and the Army in a state of preparedness so that injured or desperately ill people are not left without the help that they need.
§ Mr. Tony Favell (Stockport)
Is it not clear that a lot of skilled ambulance men's time is being wasted? Is it not time, therefore, for us to start to contract-out the service?
§ Mr. Clarke
The managements of ambulance services up and down the country are having to make other arrangements to carry non-emergency patients. They are using taxis, hire cars and private ambulances and there is no reason why they should not do so. In some parts of the country unions are refusing to take non-emergency patients unless they satisfy some fancy criteria drawn up by the unions. It is no good for individual patients to be told by the union convener that their appointments are not necessary or urgent for their health, and it is quite right that managements are looking for alternative methods of getting the patients the treatment they need.
§ Mr. Speaker
Order. This is a private notice question, which is an extension of Question Time. I shall take two more questions from each side and then I shall call the Secretary of State for the Environment to read his statement.
§ Mr. Merlyn Rees (Morley and Leeds, South)
Does the Secretary of State recall that when I was Home Secretary the last Labour Government were faced with problems concerning police pay which resulted in Edmund-Davies recommendations designed to make them a special case, and equally big problems with the firemen which resulted in their being treated as a special case and their pay being tied to the upper quarter of manufacturing wages? Is there not a case for the ambulance service to be treated as a special case, and if there is, whose job is it to see to it?
§ Mr. Clarke
That was a long time ago. My first recollection is that the then Government treated everyone who went on strike as a special case, turn by turn. But it was not quite so straightforward. It is not true that the last Labour Government recognised the claims by the police. They rejected the Edmund-Davies recommendations which were implemented by the present Government. The Edmund-Davies recommendations went out of their way to distinguish between the police and other emergency services and said that they were not comparable. We implemented the Edmund-Davies recommendations on that basis.
It is certainly true that the last Labour Government gave the firemen a special formula; they backed down in the face of industrial action by the firemen, and we shall not go back on those long-standing arrangements. The last Labour Government refused claims from the ambulance men to tie their wages to those of either the police or the firemen or any other emergency services and allowed their pay to go down compared with inflation in three of Labour's last four years. The last Labour Government let the ambulance men's claim go to the Clegg commission which reported that there was no comparison between police, firemen and ambulance men and that they all had some emergency duties, but in each case the emergency duties took a comparatively small proportion of their total time.
I certainly would not wish to emulate the record of the last Labour Government in regard to any of those groups. It gives no foundation to the right hon. Gentleman saying 682 that he has now suddenly decided that ambulance men should be treated in a special way because they are taking industrial action.
§ Mr. Richard Holt (Langbaurgh)
Does my right hon. and learned Friend accept that although many ambulance men in the north of England are just as upset by the Government's position as those in London, perhaps an offer of 9.3 per cent. outside London might settle the dispute? Are not the Government and those negotiating missing the opportunity being offered by the ambulance men of solving the present dispute and entering a long-term agreement for no strikes in the ambulance service in future?
§ Mr. Clarke
I agree with my hon. Friend that it is an irony that the most militant ambulance men appear to be those in London who have already secured a 9.3 per cent. pay offer. Ambulance men throughout the country are being offered the possibility of a two-year settlement with some of next year's money being brought forward; discussions on local flexibility on pay, which might help local ambulance services; a re-examination of the deal with the unions entered into in 1986, because they are now discontented with the way that affects overtime; and generally an invitation to talk. We all wish to avoid strikes in the ambulance service. To the best of my knowledge and belief, NUPE and the other unions concerned will make promises but will not enter into no-strike agreements with any credibility. More to the point, they are demanding a double figure pay settlement this year.
§ Mr. David Young (Bolton, South-East)
The Minister's excursions into history may be interesting, but they are hardly constructive. We require a just settlement that will not only resolve the present dispute but will ensure that we have a service in years to come. That requires examining the situation impartially. Why is the Minister afraid of submitting the claim to ACAS? He may wish to see himself as Pontius Pilate, but the public is beginning to see him as Lady Macbeth.
§ Mr. Clarke
I know that I am not famed for my sartorial elegance, but I am not accustomed to appearing in drag. On the serious parts of the question, Duncan Nichol and his management team held discussions at ACAS, and made various propositions but were faced with total intransigence by the trade unions. I have already said that I have every desire to see the dispute settled. Health Service pay will not sensibly be resolved by getting a third person from outside to make a ruling on the pay of groups that have taken industrial action against patients. Countless Whitley councils determine the pay and conditions of different grades of staff. It is not fair to the staff if one group is given special treatment by a chap who is called in to split the difference because that group has been prepared to take action against patients when other staff have not.
§ Mr. Harry Greenway (Ealing, North)
Will my right hon. and learned Friend confirm that he has effectively given a guarantee that 999 calls will be answered whatever happens in the dispute or under any other circumstances? Will he use the present position to try to improve the London ambulance service so that patients are not kept waiting hours to be collected for treatment or left for hours 683 at hospital before being returned home after treatment, which has happened all too often as a result of bad management?
§ Mr. Clarke
The steps that we have taken should enable us to maintain an adequate emergency service should ambulance men be so misguided as to take action that threatens it. Obviously, I hope that they will continue to provide a 999 service. I agree that the sooner that the service returns to normal the better. "Normal" includes continuing efforts to improve the quality of the service given by the London ambulance service and others.
§ Dr. John Cunningham (Copeland)
May I apologise for the unavoidable absence of my hon. Friend the Member for Livingston (Mr. Cook), who has a long-standing engagement elsewhere? Are we to see another premeditated management escalation of the dispute with the connivance of Ministers? Is that what the right hon. and learned Gentleman is asking the House to accept? Is not the obvious lesson of this long-running dispute the fire crews' acceptance last Friday of a deal of 8.6 per cent. after only two hours of talks and negotiations? Should not ambulance crews be given the same treatment?
As the Secretary of State gave us an excursion into history, does he recall that when the Prime Minister was the Leader of the Opposition in 1978 she was sending letters from her office recommending that the pay of ambulance crews should be treated exactly the same as fire crews? I have a copy of the letter here. If she believed that in 1978, why does she not believe it now, or has she done another U-turn over the past few days?
Why are the Government persisting with their mulish obstinacy when all reason and common sense point to comparable treatment with fire crews for ambulance workers or independent arbitration to resolve the deadlock? The Secretary of State has made some unpleasant comments about ambulance crews. If he is so convinced of his case, why is he terrified of independent arbitration, which ambulance crews are perfectly willing to accept?
§ Mr. Clarke
In 1978, the letter was written by my right hon. Friend the Prime Minister to a Government who were maintaining that there was no case.
§ Mr. Clarke
It was written to two members of the Association of Professional Ambulance Personnel, but at the time the Government were resisting any such arrangements. We have fought three general elections in which neither our manifesto nor that of the Labour party has returned to a formula for linking ambulance men's pay with the pay of anyone else. The only reason why the hon. Gentleman is arguing for it is that he believes that we should give in to a strike. I have dealt several times with comparisons with firemen's pay. This Government, the last Labour Government and the Clegg commission have all said that the job of a fireman is not exactly comparable. However, the comparison that is being made by the ambulance men's union is with fifth-year firemen. The hourly rates for ambulance men are better than those for first, second, third and fourth-year firemen. An arbitrary selection is being made.
I resent the hon. Gentleman's allegation that I have said anything against ambulance crews. I have not done so, today or at any time during the dispute. We have no desire to have a dispute with the ambulance men. We wish to see them resume their good normal service as quickly as possible.
On escalation, it is obvious when we look back over the past six or seven weeks that NUPE and the other trade unions have found their action ineffective. They keep finding fresh ways of trying to tighten the screw on the public in order to hype up the Labour party to give them more support, or to gain an advantage for their union. Every change in the dispute has come about because NUPE has decided on some new and dangerous action at the expense of the patients. I wish that it would stop that and return to the negotiating table.