§ The Secretary of State for Health (Mr. Kenneth Clarke)
With permission, Mr. Speaker, I wish to make a statement about the ambulance dispute in the National Health Service.
The situation in the London ambulance service is that the trade unions have reimposed their 14 conditions for the operation of the accident and emergency service, which means that the management of the London ambulance service are unable to provide a guaranteed accident and emergency service for London. The unions have in effect called out their accident and emergency service members in sympathy with non-emergency men who have been required to work normally if they are to be paid in full.
Nearly all accident and emergency services in the area served by the LAS are now being provided by the St. John Ambulance brigade, the Red Cross and the Metropolitan police.
Following earlier discussion with my right hon. Friend the Secretary of State for Defence, I have now asked him if the armed forces would assist the police and voluntary services in providing an accident and emergency service in London. In view of the gravity of the situation and the need to maintain an essential service to the public, my right hon. Friend has agreed to my request. He has given instructions to the armed forces to provide assistance in London and they will be deployed with the police and voluntary services from tomorrow afternoon.
The Government have taken this step with the greatest reluctance. We would very much prefer to see a full accident and emergency service provided by trained ambulancemen but that is impossible while the unions continue to insist on all the 14 conditions which they have imposed. I must stress that the involvement of the armed forces, the police and the voluntary services will cease once the trade unions agree, as they did two weeks ago, to provide a normal accident and emergency service.
§ Mr. Robin Cook (Livingston)
Yesterday the Secretary of State advised the House that he resented the allegation made by my hon. Friend the Member for Copeland (Dr. Cunningham) that he had made unpleasant comments about the ambulance staff. Is he aware that every broadcasting bulletin this morning quoted him as describing ambulance staff as "pretending and posturing"? Can he confirm that he used those words? Does he really believe that that kind of language helps to resolve a dispute which has reached the crisis and severity that prompted this statement?
We have just heard a statement which reminded the whole House of the debt that we owe to the emergency services because the report praises the courage and professionalism of the emergency staff at the Clapham accident. In the light of those words, how can the Secretary of State invite ambulance staff to settle for 6.5 per cent. when firemen have been awarded 8.6 per cent. and the police 9.2 per cent.? Is he aware that yesterday both the police and the firemen gave their complete support to the ambulance staff in their demand for parity?
Is the Secretary of State aware that at this moment in every ambulance station in London ambulance staff are ready and waiting to provide emergency cover? Is he aware that in those stations it is management that has now 851 refused to put through the emergency calls? Is it not clear that it is not ambulance staff who have withdrawn emergency cover from London but the management of the London ambulance service?
The Secretary of State said that from tomorrow the Army will be called in to provide cover in London. Can he confirm that many of the Army personnel who will be providing the cover have been trained on the basis of a refresher course lasting 48 hours? Was it really possible in those two days to train them in the techniques of defibrillation, incubation or infusion? Why rely on men who are not trained for the trauma that they will have to meet and who have no experience of meeting it when we have trained ambulance staff waiting at stations to do the work?
Can the Secretary of State confirm that in the eight weeks of the dispute he has never once sat down with the staff side of the ambulance men? Would it not have been better to talk to the ambulance staff before he talked to his colleagues at the Ministry of Defence?
Finally, can the Secretary of State answer the question that has remained unanswered since the dispute began and that remains its central mystery? If he is so right in offering ambulance staff 6.5 per cent. and if the ambulance staff are so unreasonable in rejecting it, why is he so afraid to go to arbitration which would end the dispute this afternoon? Instead of calling in the Army, why not call in the arbitrators and give back to London a proper ambulance service?
§ Mr. Clarke
It is quite obvious that the hon. Member for Livingston (Mr. Cook) takes the view that was taken by some of his hon. Friends about an hour ago in Question Time that the people of London will get their accident and emergency service back when the ambulancemen are given the money that NUPE demands, whatever that may be.
The 6.5 per cent. offer that the hon. Gentleman complains about is not what is on offer to the men taking the industrial action that I have described. Qualified men in London are all being offered at least 9.3 per cent. under the existing offer. The 6.5 per cent. is available to the rest of the service. When judging the present action it is worth recalling that NUPE and the other trade unions recommended the 6.5 per cent. offer to their members for settlement. They are entitled to change their mind, but I get increasingly irritated by Mr. Poole describing as appalling an offer that he recommended only a month or two ago and regarding the rejection of that offer as justifying such dangerous action against the general public in London as he is proposing.
We are talking about last year's pay settlements in the course of which NUPE settled the claims of many of its members in the National Health Service for 6.5 per cent.
The men from the Army who will be coming in tomorrow afternoon are in many cases less well paid than the ambulancemen whose jobs they will be taking. They took a 6.8 per cent. settlement, as did the nurses and some other groups. If people wish to discuss the issues of the amount, they should be discussed, as management has been suggesting throughout, in the Whitley council. Mr. Duncan Nichol, the chief executive of the National Health Service, has constantly tried to reopen negotiations. There is nothing in the case that NUPE now claims in rejecting an offer that it commended to its men only a month or two ago that justifies such disgraceful action as it is organising in London at the moment.
852 The hon. Member for Livingston asked about my comments this morning. I have not heard any of the media, but I hope and trust that I have been reported more accurately than in the potted version given by the hon. Gentleman. I referred to the fact that the men although doing no work are at the moment still in the ambulance stations. It is the case that they are pretending to be prepared to operate the accident and emergency service when—
§ Mr. Clarke
That is not disgraceful. The men know perfectly well—[Interruption.] It is no good the hon. Gentleman exploding with rage on the strength of his briefing from NUPE.
§ Mr. Speaker
Order. It is very unseemly to shout in this way. It is not the way that we conduct ourselves here.
§ Mr. Martin Flannery (Sheffield, Hillsborough)
On a point of order, Mr. Speaker. I looked at the 1 o'clock BBC news and it was made quite clear that Mr. Nichol was not telling the truth, and that the men were there to carry on emergency work, if asked to do it.
§ Mr. Clarke
The 14 points to which the unions have reverted include a refusal to use the radio telephone sensibly, a refusal to crew up, and other points on which they have not been insisting, such as the adequate provision of red blankets. Last week or two weeks ago, they withdrew some of those points to restore the accident and emergency service and the claim that today's difficulties have somehow been caused by the management is a sick joke being perpetrated by the unions and plainly believed by some Labour Members.
I have no desire to see Army personnel being used on the streets of London to assist the public. That has not had to be done since the last Labour Government did it 10 years ago. The men should now resume accident and emergency working, and honour the promise that NUI'E keeps giving, that the accident and emergency services will not be threatened by the industrial action. We can then return to the business of the industrial dispute, which can be settled if the unions are as willing to enter into sensible negotiations as the management has made it clear for the past two or three weeks that it is.
§ Sir Geoffrey Finsberg (Hampstead and Highgate)
Does my right hon. and learned Friend recall that the same union, NUPE, allowed the dead to remain unburied in the winter of discontent? Does he also understand that the people of London recognise that, if there are any deaths, the blame for them should be laid at the door of Mr. Poole and NUPE?
§ Mr. Clarke
I share my hon. Friend's indignation that union leaders face the prospect of risk to the public and then make heated statements saying that it is not their fault, when the origin of the whole problem is that the 853 members—the ambulancemen—are obeying instructions from the union, which were drawn up with the purpose of disrupting the service to the public. I also recall the activities in the last year of the Labour Government, when they gave in to so many of the strikes in the Health Service that eventually all of them went on strike for ever bigger claims, and NUPE was at the forefront.
My hon. Friend the Member for Solihull (Mr. Taylor) reminded me of the occasion when he was a local authority leader under the last Labour Government, and Ministers in the Ministry of Defence came to see him to organise the use of the Army and of the Green Goddesses. We know that all that happened was that the then Government gave in to the pay claim, with the result that yet more people went on strike a month or two later.
This dispute is unnecessary. It could be resolved in the Whitley council and it ought to be resolved by sensible negotiation. Nothing in the claim justifies the kind of action that is being taken today.
§ Mr. Charles Kennedy (Ross, Cromarty and Skye)
Does the Secretary of State recognise that public opinion is behind the ambulancemen, because it is clearly seen outside this place, and apparently everywhere except in the Department of Health, that the offer to the ambulance men is unjust, in comparison with offers to the other emergency services? It is a question of political will for him, as the Secretary of State, either to encourage arbitration or to make the funds available to the NHS management to enable a fair settlement. Why will not the Secretary of State respond to that reasonable request? That would do away with the need for industrial action. If he did so, he would be entitled to accept a sensible basis for all the emergency services that would involve no strike agreements and pendulum arbitration. Why does he not adopt that approach?
§ Mr. Clarke
As I have just said, the 6.5 per cent. offer, as it was then, was negotiated in the Whitley council and was recommended to the men by their own trade unions. Since it was turned down, it has been improved to 9.3 per cent. in London. The ambulancemen negotiated a lower level of settlement than other NHS staff because they received a particularly generous settlement in 1986 and had an hour taken off their working week last year. For all those reasons, the management is justified in saying that any further discussions must start on the basis of that deal, which has been commended so recently by the unions.
I do not accept that comparisons can be made with other emergency services, when only one tenth of the mileage of the ambulance service is taken up by emergencies. We have never had the same pay system for the police, firemen and ambulancemen in Britain under any Government.
I accept that there are paramedics, and people who provide particular parts of the ambulance service, who ought to be appropriately rewarded for those skills. I have seen no sign that the unions are prepared to make that distinction in the settlement that they seek. I find the point of view of the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) surprising, because he is not in the Labour party. He said that, because the ambulancemen are on strike, we should turn away from the system of negotiation and give them the money that NUPE says that it wants to 854 restore a vital service to the public. If I were to encourage the management to concede that, NUPE would have a lot more people out on strike in the winter, as it has proved capable of in the past.
§ Mr. Jerry Hayes (Harlow)
Does my right hon. and learned Friend agree that, due to the regrettable and irresponsible behaviour of the unions, one man's pay dispute could soon degenerate into another man's loss of life? Will he consider the importance of taking the negotiations out of the political arena? I do not want him to commit himself in any way, shape or form, but will he please not rule out the possibility of a pay review body for the ambulance men?
§ Mr. Clarke
I am conscious of the first matter that my hon. Friend raised. My prime responsibility and that of my colleagues in the Government, including the Secretary of State for Defence, is to try to ensure public safety as far as that is possible, using the resources available to us in the armed forces and the police. We are bringing in those services because we see the need to protect the public against the consequences of the action now being taken.
As I have already explained, the management view seems to me to be the only view that a truly responsible management could take. There are review bodies for some staff, but we cannot have group after group of Health Service workers taking industrial action, and getting arbitration or a review body after initially being attracted by offers made to them. That way lies chaos.
In the Health Service the management has to weigh up pay claims with services to patients. It is all right for the railways to pay out 8.8 per cent. when railway workers are on strike—they wind up putting the fares up, which nobody likes. It is all very well for Labour councillors to give 8.8 per cent. to their manual workers because they wind up increasing the community charge. If the management of the Health Service starts paying more to people who take individual action against patients, it has to close wards and reduce patient services. A responsible management should not do that.
§ Mr. Tony Banks (Newham, North-West)
I thought that the Secretary of State's statement was absolutely despicable, and I have heard many despicable statements since 1983. Is the right hon. and learned Gentleman aware that to say that ambulance workers are not prepared to provide emergency cover is a monstrous perversion of the truth, and he knows it? Will he explain to the House how we can justify a 10.7 per cent. increase, dating from January, for Members of Parliament when ambulance workers will get only 6.5 per cent.? Is he prepared to organise a vote in the House so that we may see whether Conservative Members are prepared to vote in favour of their wallets rather than of saving lives?
§ Mr. Clarke
I ask the hon. Gentleman to go away and check the facts. I think that he believes what he says—I accept that he normally does. However, he is lending credibility to the myth that management is causing the present difficulties.
If the hon. Gentleman genuinely wants the accident and emergency services to be maintained, he should advise his constituents who work in the service to operate it normally. They are operating it not normally, but 855 according to conditions which make it impossible to guarantee a service because there is no proper communication with the vehicles.
Last year, the pay increase to hon. Members was equivalent to the ambulance men's offer, which was 6.7 per cent. As Ministers got less I have to gaze around the House to see if any hon. Member can recall the exact percentage increase. This year the pay settlement has been based on the Civil Service settlement in August which was 6.5 per cent. By a quirk of the resolution of the House it happened that the third stage of a deal of 4 per cent. paid earlier was added to that figure for hon. Members. Therefore, the settlement for Members of Parliament is based on the 6.5 per cent. that civil servants accepted in August or September this year. We could carry on arguing about that and about its merits, but it is a matter for the management to settle with the unions in the Whitley council.
The idea that the ambulance men's pay claim justifies risk to life and limb on the streets of London is a grotesque exaggeration.
§ Mr. Nicholas Winterton (Macclesfield)
While I believe that my right hon. and learned Friend's statement has been both factual and honourable, will he not pursue the point made by my hon. Friend the Member for Harlow (Mr. Hayes)? In a civilised country, is it not time that those who work in life-saving public emergency services should have their pay taken out of the political arena? They should forgo the right to strike, and the pay for all the emergency services should be dealt with by an independent pay review body as is nurses' pay. That is long overdue.
§ Mr. Clarke
One could make that case for everyone who works for the Health Service, and many other people who work in public services. The result would be that the management of the National Health Service would have responsibility for the pay and conditions of more than I million people taken out of its hands, and arbitrators would dispose of the resources. Managers would be left to see what they could provide by way of patient services as a result.
These issues can be settled by sensible negotiations. We introduced a review body for the nurses when they refused to take industrial action, while NUPE and other unions had all the other staff out in an industrial dispute. My hon. Friend the Member for Hampstead and Highgate (Sir G. Finsberg) remembers that because I think that he was in the Department with me at the time.
It is false to say that ambulance men, in the middle of an industrial dispute caused by NUPE, should be given a review body as a reward. The situation is different from that under which the nurses were given a review body. They have always had a no-strike deal as a part of their constitution and they were given a review body when they refused to take industrial action.
§ Mr. Jeremy Corbyn (Islington, North)
Is the Secretary of State aware that he and his friends are undertaking a massive conspiracy to deceive the public about the true nature of this dispute? Ambulance men and women are underpaid. They have put in a claim for parity with the fire service, which ought to be met. The Secretary of State has misled the House by claiming that the 14-point statement by NUPE in London is anything other than an agreement absolutely and totally to maintain 999 services. It is on his instructions that the ambulance officers this morning were 856 told to stop staff going out on 999 calls. It is the Secretary of State's decision that is preventing the people of London from getting a 999 service.
Members of the unions concerned have made it clear, at every turn, that they will maintain an emergency service. The responsibility for not maintaining the service lies with the Secretary of State and with him alone.
§ Mr. Clarke
The unions are claiming parity not with firemen but with fifth year firefighters. They do not like first, second, third or fourth year firefighters because that would not make the claim as big. It is an arbitrary choice to link pay with fifth year firefighters, with whom there has been no formal link in the past.
We shall have an accident and emergency service as long as the men who are in that part of the service work it in the ordinary way.
§ Mr. Clarke
No, 14 points have been invented that do not normally apply. The hon. Gentleman is maintaining the debate vigorously from a sedentary position, but he cannot deny that those points are not points which usually apply in the service.
§ Mr. Clarke
They have been invented to disrupt the service and they have succeeded in doing so. The ambulance service cannot discharge its duty to the public until the men agree to work normally, and certainly agree on key matters such as using the radiotelephone.
I tell the House categorically that I did not give instructions to anybody to take the action that the management of the London ambulance service has taken. The managers of the service notified the NHS management executive, and me through the executive, of what it was proposing to do. In my opinion it had no choice if it was to discharge its responsibility to the people of London, except to ask the police and eventually to ask me to ask my right hon. Friend the Secretary of State for Defence to ask the Army to maintain essential services.
§ Mr. Speaker
Order. I must have regard to the business that is before the House. There is a Standing Order No. 20 application and a ten-minute Bill. In addition, the House must deal with a long list of amendments to the Local Government and Housing Bill. I shall allow three more questions from each side of the House and then we must move on.
§ Mr. Michael Shersby (Uxbridge)
Is my right hon. and learned Friend aware that, although the Police Federation is not especially happy that police officers should have to perform the duties of ambulance staff in an industrial dispute, its chairman has stated publicly today that it would be wrong for an emergency service to feel obliged to take industrial action to secure a pay agreement? The federation has not expressed any view on what should be the appropriate level of pay for ambulance men and women.
§ Mr. Clarke
I am grateful to my hon. Friend. I tell him and the Police Federation that I contemplate the use of the police to maintain the ambulance service only with the greatest reluctance. They are being diverted from other tasks. They are not as well trained as the ambulance men 857 and they cannot provide as good a service as that which could be performed by the accident and emergency service, although they all do their manful best. I can assure my hon. Friend and the federation that the Government will use policemen or, if necessary, military personnel only to protect the life and limb of citizens at risk. There is no question of our using the police force or the armed forces for the purpose of strike breaking. To return to the industrial dispute, which I think should be settled, the action taken by the unions should at the very least not threaten life and limb by withdrawing the accident and emergency services.
§ Mr. David Hinchliffe (Wakefield)
Only this afternoon I was looking at the British Empire medal that was awarded to Mr. Brian Murray, the ambulance man who dragged the right hon. Member for Chingford (Mr. Tebbit) from the Grand hotel at Brighton. Mr. Murray is on hunger strike for 60 hours on the embankment further up the river from this place in protest at the way in which he, as an ambulance man, is being treated by the Government. Is it not a disgrace that brave people such as Mr. Murray should be humiliated and insulted by the Government, who are intent on cutting their pay?
§ Mr. Clarke
I accept entirely that the ambulance service carries out its duties conscientiously and well and that the performance of the service in recent tragedies of all sorts has been exemplary. Indeed, it is almost the only emergency service in the country that has not come in for any criticism, directly or indirectly, for its response to industrial action. Having said that, the proper level of pay for ambulance men should be settled by a process of civilised negotiation, which has worked for many years in the Whitley council and which produced a result this year which was commended to Mr. Murray and his colleagues by the negotiators who were responsible for it. It is a great pity that he feels obliged thereafter to take part in a hunger strike. It is a gesture, but it does not seem to be frightfully relevant to the issues in question. It is wholly undesirable that the men in London—Mr. Murray does not work in London—should suddenly introduce 14 extraordinary points, which include some that put the lives of Londoners at risk.
§ Mr. Robert G. Hughes (Harrow, West)
Will my right hon. and learned Friend confirm that the negotiating procedure for the salaries of ambulance men has not yet been exhausted? Surely each ambulance man should reflect to himself that in not returning to negotiation and by taking the present action he is potentially harming the people of London, and that he should return to work and carry out his duties.
§ Mr. Clarke
The Whitley council management side takes the view that the negotiations were never completed in the Whitley council. It began to increase its offer to the London men after the first ballot of the members of the unions. It increased the London men's offer to 9.3 per cent. There has been a remarkable change of attitude on the part of union leaders between the spring or summer of this year and now. In my opinion, that has far more to do with the political climate than with differences in negotiating a proper level of pay for ambulance men for the next year or two.
§ Mr. D. N. Campbell-Savours (Workington)
The Secretary of State has said repeatedly in a number of answers that the ambulance men should return to a negotiation. Is there more money on the table to increase the core pay offer? Is he saying that potentially more money is on the table?
§ Mr. Clarke
I shall repeat to the best of my recollection what Mr. Duncan Nichol has said. He has talked about the possibility of a two-year deal that would involve bringing some more money forward from the second year. He has talked about the possibility of local flexibility to deal with parts of the country where there are local recruitment and retention problems. He has talked about a review of the 1986 deal with the trade unions, which was advantageous to ambulance men but which is now giving rise to arguments about the way in which overtime is calculated.
In advance of the unions either modifying their claim one iota or agreeing to return to the negotiating table, it seems that Duncan Nichol, the chief executive of the Health Service, has put forward several propositions. Unfortunately, the unions prefer their 14 points and getting the police on to the streets to do their work.
§ Mr. Tony Baldry (Banbury)
Does my right hon. and learned Friend agree that there are two facts on which any responsible trade unionist should quietly reflect? The first is that the central complaint of the ambulance staff is that they should have comparability with the police force and the fire brigade. That has been examined by an independent tribunal—the Clegg commission—and rejected. Secondly, all the National Health Service staff have their pay and conditions regarded by the Whitley council, and 94 per cent. of them have settled within the council this year. It seems extraordinary that when one group seeks to break that negotiating tradition the Opposition should rush immediately to its aid rather than support the established machine which has existed for a considerable time to settle pay and conditions in the NHS. Is not the bottom line in the dispute that we can see things becoming only worse until the ambulance staff go back to the Whitley council and start, with the NHS management team, to find a way out of the dispute through the proper and accepted negotiating machinery?
§ Mr. Clarke
My hon. Friend is right. Comparability with firemen and the police has been examined by successive Governments and rejected. The concept was examined by the Clegg commission and rejected. The ambulance men do not claim parity with the police, and to the best of my knowledge and recollection they have never done so. They are claiming that they should be compared with fifth-year firefighters, who happen to be a convenient grade for the purpose of getting the extra money that they are aiming at this year, which is 11.5 per cent. Review bodies are urged upon me. The nurses have a review body, and they took 6.8 per cent. last year. The Army has a review body, and it took 6.8 per cent. last year. The 6.5 per cent. that is on offer is not a million miles away from those settlements, but that is not what the unions are after. They are after a double-figure pay settlement as a reward for industrial action. They should modify what they say because, as my hon. Friend has said, 95 per cent. of the Health Service staff have already settled for about 6.5 per cent.
§ Mr. Robin Cook
Given the Secretary of State's replies to some of my hon. Friends' questions, may I help him to get it right on the use of radiophones? The only restriction in the 14 points on the use of radiophones is their use for non-emergency calls. There is no restriction in the 14 points—there never has been—on the use of radiophones to respond to accidents and emergencies. In the light of that clear position on the 14 points, how can the right hon. and learned Gentleman possibly use that as his strongest example of why it is necessary to suspend the entire accident and emergency service and bring in the Army?
§ Mr. Clarke
The hon. Gentleman is not describing accurately the restrictions that are being placed on the use of radiophones. If a radiophone is not being used normally, it is not possible to control an accident and emergency service. The unions are not prepared to use the system normally so that full communications are established between control and ambulance drivers.
The second key point is crewing up, which we covered last week. As I understand it, there are also foolish points about not collecting casualties because there are no red blankets. I am not aware yet that the unions are insisting upon that. It is absurd for the unions and their supporters to say, "We are prepared to operate the accident and emergency service" and then to say, "But there are these new conditions that we wish to apply to the way in which it should be operated." I know that the management of the service does not want to use the police or the Army any more than I do. It has called on us for assistance only because it cannot operate an accident and emergency service unless the unions agree to tell their men to operate it normally.