HL Deb 24 January 1962 vol 236 cc920-69

2.55 p.m.


rose to call attention to the grave shortage of qualified dietitians, occupational therapists, physiotherapists and radiographers in the National Health Service; and to move for Papers. The noble Baroness said: My Lords, I propose to ask your Lordships to-day to consider the serious effect upon the Health Services caused by the grave shortage of those employed in the professions supplementary to medicine. Your Lordships will recollect that it was in 1960 that there was introduced a Bill, which subsequently became an Act of Parliament, putting these various groups of workers in what were known as professions ancillary to medicine on to a register. I have no doubt that these excellent women (most of them are women) thought at that time that in consequence of that change in their status society would recognise their worth and increase their salaries. Unfortunately, that has not happened, and I am quite sure that on both sides of this House to-day there is a feeling that more attention should be paid to these women who have made such an important contribution to our medical services. I shall direct my remarks chiefly to the conditions of work of the physiotherapists and radiographers, for I understand that the noble Lord, Lord Geddes, who is President of the Association of Occupational Therapists, will deal specifically with their problems.

Your Lordships will recall that yesterday a White Paper called A Hospital Plan was published. I do not want to anticipate a debate on this matter, which I believe will come within the next few weeks, but I think your Lordships will all agree that, whatever form of organisation and structure is proposed, in the final analysis it is the human fabric which determines the success or failure of any institution, whether it be that of a hospital or of your Lordships' House. It is generally agreed, I think, that the effectiveness of modern medical diagnoses and treatment of many patients is dependent upon the skilled work of members in what we call the ancillary medical profession. Yet since the introduction of the National Health Service their salaries have never been related to their responsibilities or to their economic value to the community. The position is now sufficiently serious for the Guardian on Monday to have a headline, "Physiotherapy Faces Crisis".

I know that your Lordships do not like many figures to be mentioned in debates, but I would ask you just to make a mental note of these. For physiotherapists the current salaries under the Whitley Council agreement of July, 1961, are £525 to £650. The maximum figure they can attain is that related to a superintendent, a matter with which I shall deal later on, which is £1,060; but I think I shall be able to prove that that is rather difficult to achieve. For radiographers the salary is £500 to £600, and again the maximum which the superintendent can attain is £980.

In the first place, there is no lack of recruits. We have these enthusiastic, well-educated girls dedicated to a profession, who say to their fathers, "I should like to do this job because I believe that it will make a great contribution to society." Of course they are absolutely right. But, curiously enough, after a short time it is discovered that there is an acute shortage of teachers to train them. This is due to the fact that the prospective teachers, who must put in a further three years' training, do not remain in the profession because of the miserably inadequate pay.

I do not want your Lordships to think that the enthusiasm and dedication of these young women wanes, but when they find that the maximum they have to stay in London, and to find a place to live in, amounts to £500 a year, naturally after a time the strain begins to tell; they refuse to go on for a further four years in order to qualify as a teacher, and they go into some other kind of employment. Indeed, it is a most curious thing that in this important field of work there is little reward for experience. These professional women may work for 25 years, but there is no financial gain except for those who become superintendents, the only promotion which merits a rise in salary; and promotions to this level are few. I believe I am right in saying that there are only six superintendents in the field of physiotherapy in this country, and therefore all these excellent women have to remain on more or less the basic grade throughout their working life. Is there a need for them? Of course, there is a growing need for physiotherapists in geriatric departments, and I hope that my noble Lord, Lord Amulree, will develop this side of the work.

My Lords, the result of these shortages has tragic consequences. Birmingham General Hospital and other hospitals in that city find that hemiplegic discharges from hospital may have to go on a waiting list for three or four months for treatment in out-patient departments; thus the value of the treatment they received as in-patients is lost. Most noble Lords will know that hemiplegia generally follows a stroke. The man or woman with a stroke has a grave physical defect, but, apart from that, the mental depression of these people is terrible, and it is very important from the medical point of view that their treatment should continue. But in many hospitals they have to tell these patients that they must wait for perhaps three or four months before the treatment which has been started immediately following their stroke can be continued.

The shortage of physiotherapists in the Hull area is acute. Here the accident rate in the docks is very great, and the recent polio epidemic has made heavy demands. And this, of course, is all in addition to the demand for the work of physiotherapists in respect of the sick and the aged. I was of the opinion that things were a little better in Wales. However, I am told that the Welsh Board of Health are refusing to allow the appointment at a rheumatism clinic of a superintendent-physiotherapist, because no basic-grade physiotherapists can be found.

The shortage of radiographers is equally serious, and girls who undertake this course are to be congratulated upon not holding back because of the danger of sterilisation, though this can result from massive doses of radiation. And many noble Lords will recall from their student days that it was commonplace for a radiographer to be affected by doses of radiation. I am pleased to say that the protective measures today are so good that the risk of sterilisation for these girls is almost negligible. Nevertheless, there is at the back of their minds this risk, though, despite this, they are prepared to undertake what may appear to their parents to be a rather hazardous employment.

The reason for the shortage of radiographers and the ultimate effect of it was given by Mr. Stanley Lee, the Senior Surgeon to the Westminster Hospital, in a letter he wrote to The Times on October 24, and I think that what he said will probably impress noble Lords more than anything I might say, because he still is in a position where he sees radiographers every day of his life. He says, among other things: References to 'vocation' and 'serving humanity' are mere face-savers, concealing the truth that these workers are being grossly under paid. The radiographer must look at the hard fact that she needs more money and can obtain it in industry or commerce for far less onerous work. Speedy action must be taken to attract new recruits who regard radiography as a career and not a stop-gap. Otherwise members of the public requiring X-ray examinations will be faced with restrictions and long delays; and sufferers from treatable cancer will see chances of cure fade while the therapy machines stand idle. When one finds a shortage of this kind, sometimes abuses creep in. In London there are now several private X-ray firms who employ radiographers and hire them out to the National Health Service, the hospitals paying them £20 to £25 per week for the service of these radiographers, as against £11 or £12 for National Health Service staff. I need not remind your Lordships that this is hardly conducive to a happy relationship in a department where National Health Service and private-firm radiographers are working side by side at a very different rate of pay. And the tragedy here is that so much of the money which these women are earning goes into the pockets of the agency.

The position differs all over the country. In the Midlands area one of the main difficulties is that girls are being attracted to much more lucrative work in the car and allied industries. The shortage in the North-East area seems to centre mainly around Middlesbrough, where hospitals are again fighting for staff against individual firms such as I.C.I. There is a great shortage of properly qualified senior staff. Consequently, many hospitals are promoting radiographers who have not been qualified for the requisite four years, and this seems to indicate that a great many radiographers are leaving the service in the first few years. The greatest single reason for this is the high marriage rate. Many married women radiographers and physiotherapists would gladly return to therapy part-time, but the low rate of pay would not cover the expenses involved.

Again, I would remind noble Lords, who I am sure read the interesting correspondence on this subject in The Times at the end of last year, how a husband puts the case. The husband was Mr. E. F. Roscoe of Vicarage Drive, East Sheen, and he said this: I often wonder how many members of the public realise that all over the country radiographers are forced after a full and strenuous day's work to spend several evenings a week (and also weekends) glued to the telephone without stand-by money. They are called out at all hours of the night and some hospitals will not even provide transportation. May I indicate to your Lordships how a married woman sees the situation? Mrs. Susan Guest wrote from Hunters Road, Chessington, and she said: As a chartered physiotherapist with two small children I would welcome the chance to take part-time employment. However, I find that if I pay a 'sitter', fares and extra laundry, I will be out of pocket; thus, like many of my friends, I sit at home as do the many patients who are on the waiting list for treatment. My Lords, do not think I am decrying marriage. The official word for marriage in this context is "wastage". I think that this can only have been coined by a bachelor who had been crossed in love! Marriage and childbirth represent a physical and spiritual fulfilment. However, this situation focuses attention upon a social problem which even the most intelligent men find it difficult to examine objectively. The question—and it will have to be faced when our universities are full of active, intelligent women—is this: can modern society afford to use the brains and expertise of trained women upon domestic work in the home? So far as I know, in this country nobody has assessed the amount of professionally-trained female labour which is engaged upon household chores. I should not like it to go out from this House that I do not value the contribution a woman in the home makes to the family, but I ask every noble Lord here whether, when there are patients suffering from cancer who need the work of a radiographer like this woman who says that she is sitting at home, we as a society are efficiently sharing out our available labour in letting her spend perhaps two or three hours cleaning a floor, while her children are at school and her husband is out of the house, when she is needed by a patient, perhaps in the same road.

This is a subject which we must face up to, and I feel that it is a subject which men should consider very carefully, because so many men, who are perhaps in those positions where they can issue memoranda on the subject, are a little emotional about just how a wife should share her services. I would ask those who argue that the women in the nursing and auxiliary medical services are following a vocation and therefore the rate of pay is of no great importance, to reconcile this attitude with a well-organised medical profession which demands and receives remuneration commensurate with the services they provide. Why should those who serve in professions supplementary to medicine be penalised because they have chosen to help the sick and aged? Florence Nightingale is often quoted in this context as a woman who had a vocation, but I would remind your Lordships that Florence Nightingale had an independent income. At no time was she dependent on the completely inadequate nurses' pay of her day.

There are probably many noble Lords in this House who have been ill and who, like other patients, have felt profuse gratitude to those who serve. All patients express their gratitude but, unfortunately, gratitude is short-lived; and I say, after most careful thought on the subject, that the nation exploits the services of nurses and auxiliary medical workers, secure in the knowledge that these women would neither go slow nor strike to obtain justice.

The Chartered Society of Physiotherapy has now drawn up a memorandum on the subject, and is asking for an independent inquiry into the salary structure and the conditions of service. As I explained in my opening remarks, these conditions, of course, apply to other professions supplementary to medicine; and, of course, this is not new. Only just recently a powerful Royal Commission was set up to investigate the pay and conditions of doctors; similar committees have discussed similar questions for administrators and clerical workers within the National Health Service. Therefore, I say that this modest request should be granted immediately. There are those who point a finger at the Whitley Council, but it is the Minister of Health who must make this decision. He has failed to recognise that the present critical position is undermining the efficiency of the National Health Service, and any plans for new hospitals can succeed only if well-trained and responsible staffs are available. I beg to move for Papers.

Moved, That there be laid before the House Papers relating to the grave shortage of qualified dietitians, occupational therapists, physiotherapists and radiographers in the National Health Service.—(Baroness Summerskill.)

3.15 p.m.


My Lords, there is little to which I can add, but much that I can support, in what has been said by the noble Baroness, Lady Summerskill, in introducing this Motion. It is never quite clear what is included in the interest which it is proper to disclose when any matter is before your Lordships' House, but I should like to confirm, as the noble Lady has said, that I have the honour to be the President of the Association of Occupational Therapists, and what I have to say is with the members of that Association very much in mind.

After what has already been said, it would appear to be unnecessary to develop the point that the professions supplementary to medicine are a necessary part of medical care, in general, and of the Health Service, in particular. The care of the sick can reasonably be divided into three main stages; diagnosis, treatment and cure, and rehabilitation. While all three stages are the responsibility of the doctor, his need for the help of the supplementary professions increases progressively. In rehabilitation he depends to a large extent on their co-operation and, more particularly in the mental field, it seems likely that this dependence will increase with the passage of time and the growth of knowledge.

Against this background these professions—and I repeat that I speak with particular knowledge of occupational therapy—are deplorably short-staffed. In a recent survey of over 1,000 hospitals with a total establishment of over 1,700 qualified occupational therapists, only just over 1,000 were available. The shortfall has had to be filled by unqualified staff, and now it has become necessary to consider the establishment of shortened courses for those candidates who already hold analogous qualifications.

Why, my Lords, should this be the case? There is absolutely no doubt that it is because of an inadequate flow of recruits coming forward to train. Here I may appear to disagree with what the noble Lady has said, although I do not; but the flow must be sufficient to man the profession and meet the wastage through marriage. That fact is so often misunderstood. And this wastage, in turn, is due to the miserable financial prospects. After obtaining the General Certificate of Education at "O" level in five subjects, and after three further years of training, an occupational therapist starts, as with the other professions, at a salary of £525 per annum. It may be argued that this is reasonable, and a few years ago perhaps it was reasonable, for a girl in her early twenties; but it only just compares with the pay of a shorthand-typist after one year of training. What is far worse is that no matter how well an occupational therapist may progress, no matter how skilful she may become, the maximum salary at the top of the profession is £1,060.

My Lords, in several of these professions we as a nation have led, and still lead, world thinking. Other countries have not made the same mistake as I submit that we have, in undervaluing. One serious effect of the present position is that, from even an inadequate intake of candidates for training, those who have qualified here find that abroad they can earn a living wage which they are denied at home, and they emigrate.

The fundamental mistake in assessing these salaries has been in the attempt to use the Whitley Council machinery for two quite separate functions. In dealing with the problem of pay in such cases as these, it is necessary first to establish where these professions fit in the national economic scale, giving full account to the rate of recruitment, to the conditions in other, similar occupations, and so forth. That is almost a once-and-for-all operation, and, being done, leaves for periodic attention the second operation, which is the running adjustment of detail within the agreed, broad pattern. For this latter function, the Whitley Council machinery is eminently suitable; but it was never designed for the principal review, and is, I sumbit, quite unsuited for it.

My Lords, these are little professions of people whose shout is but a whisper in the national scene, but this is no reason for them to be subjected to the bureaucratic bullying which they have suffered in the recent past when seeking a basic review of their remuneration. If these professions are to play their part in society, there is nothing for it but a complete reappraisal such as became necessary in the case of doctors' pay, and I do urge Her Majesty's Government to grasp this nettle before the present attrition has brought these professions to a stage of starvation where they can no longer play their part.

3.22 p.m.


My Lords, I do not want to follow too closely what the noble Baroness said in discussing the meagre salaries paid to the members of these unfortunate professions. She has certainly told us an extremely unpleasant story, and one of which I trust Her Majesty's Government will take very good notice. I want first to confine my words to what will happen in the future, when there will be a greater demand than there is now for the services of these people. If these people are not available, because their pay is not sufficient, it will not be possible for the Health Services to expand in the way they should. Before I begin, I should like to associate myself with what the noble Lord, Lord Geddes, has said about the Whitley Council machinery. I preceded him as the President of the Association of Occupational Therapists. I was involved in a great deal of that negotiation, and I should certainly like to support him very much in his plea that some change in that machinery be made.

One has heard what poor salaries these girls (and they ate mostly girls) start with, and one has seen to what poor salaries even that very few who become superintendents attain. One is shocked, too, by the smallness of the differentials between the newly-qualified girl and the middle-aged woman who is in charge of a large department in a big and important hospital. But what I want to put before your Lordships is what new demands there are going to be upon these people if we are to do our work properly.

One of the most important features to-day is the new attitude towards mental health. The new Mental Health Act is now on the Statute Book, and has been running for some time. I think that one of the most important things which is realised in the care of the mentally ill is that there should be things for them to do, so that mental and other patients therefore require the services of occupational therapists and physiotherapists. Radiographers and dietitians do not come very much into this field, but certainly the first two classes are required on a very large scale if we are to restore our mentally sick to some kind of normality.

For some years now I have been associated with a hospital which is known to some of your Lordships—the Royal Home and Hospital for Incurables at Putney. It takes care of people for whom the prospect of cure, in the sense that they will be restored to normal health and able to leave hospital, is extremely small. When I first went there, immediately after the war, it held about 250 people, kept permanently in bed because they were regarded as incurable, and had a large nursing staff changing and returning from time to time. Now we have a reasonably large physiotherapy department; many of the patients can get up; a large number can look after themselves, and the change in morale in that institution is enormous.

Your Lordships may say, "Why should one worry about people who can never play their part in life again?" I think that is a very narrow view. These people are happier and far more con- tent; and they feel that life still holds something for them. At the same time it has been possible to cut down on the nursing staff, because the patients have been able to do far more for themselves. We are having great difficulties in recruitment for the occupational therapy and physiotherapy departments. We do not need many at the present time, but it is a perpetual struggle, and one wonders whether we shall be able to carry on in the future the work we are doing at the moment. I am sure that the shortage of these people is due to the fact that they are not paid properly.

Then there is the further challenge which the hospitals are taking up, and that is to re-train disabled persons, whether they are housewives or whether they are not housewives, to their normal walks of life. For example, they go and learn to cook; they go and learn simple things, like turning on taps, and so on—whatever is appropriate to their disability. That is all done by the occupational therapy department, which shows the long way that occupational therapy has come since it was first started, I think, in the First World War as a means of rehabilitating people who had been wounded. That, again, is a direction in which we should progress and it will mean that more people can be discharged to their homes, so there will be less of a strain on the National Health Service. But even there we are having great difficulty in finding people for these posts.

There is a third branch of physiotherapy which I was rather doubtful about at one time, and that is the physiotherapy taken to the homes of people who would not come up to hospital for it themselves. There was one time when it was thought that there was something quite mysterious about this treatment—some kind of mysterious ray or lamp which could be turned on every day for six months or eight months—and that nobody could check on it; but now that feeling has been changed into encouraging people such as the noble Baroness talked about to continue their exercises in their own homes so that they can once again take their place in life and become normal householders, so far as they can with their disability. There, again, that work has been seriously hampered by the shortage of staff. I was inquiring in my own department about the number of old people coming up for treatment in the department there. We try to bring people up because we cannot afford to visit them in their homes. They told me that between 50 and 60 per cent. of people who could be given treatment—they are mainly the elderly folk—give up because they find the journey is too much, or they find it is too cold: there may be all sorts of reasons, but they do not come, whereas they could be treated in their own homes if there were enough trained people to go round.

The last matter I have to mention is the need for hospital facilities whereby elderly people living with their families, and where the families need to go out to work, can come to hospital during the working day, where they can be given something to do and can be given some treatment. That certainly keeps their minds going and relieves the burden on the families. There is difficulty with old people at home all day long. That, again, I think is a very proper aim; but, of course, more staff is required to provide the work for these people to do, and such staff is becoming increasingly difficulty to obtain.

The final point I want to make concerns another drawback with some of our older hospitals, and that is the lack of reasonable facilities for their work. In some of these hospitals work is carried out under very bad conditions. There are departments there now which were not there when the hospital was originally planned. They are housed in somewhat ad hoc accommodation which is not very suitable or very convenient and does not encourage efficiency. I think the accommodation has been made rather unsuitable, and this makes it difficult for someone with little training. I should like to support very warmly indeed the Motion put forward by the noble Baroness.

3.31 p.m.


My Lords, I should like, with my noble friend Lord Amulree and the noble Lord, Lord Geddes, to add my support for the Motion that my noble friend Lady Summerskill has moved. She mentioned particularly that this question of pay applies to women; but it also applies to a number of men, especially laboratory technicians, to radiographers to some extent, and also to a number of physiotherapists. These rates of pay are, of course, the same rates for both men and women. This means that a male radiographer is expected to keep his family on £530 to £630 a year, whereas women are very often married. If so, this is fortunate, because if a woman is not married she could not afford to do it at all. These rates of pay really are scandalous. The result is that people are leaving the profession in very great numbers. I have a letter here from a physiotherapist in Liverpool. He says: In our branch of the Chartered Society we have lost since 1950, 60 per cent. of the men in our area. They have gone off to become representatives in the pharmaceutical industry", which is not really a very useful human occupation. In fact, some people say it is the most awful nuisance ever devised by man. But that is what some of them are doing, divorcing themselves from their original desire to be physiotherapists, and they are just forced to do it for simple cash reasons.

Again, as I think the noble Lord, Lord Geddes, said, people are emigrating. A friend of mine told me that his bank manager told him this morning that a niece of his had emigrated to Canada, where she was now receiving a salary two to three times larger than the amount she earned here as a physiotherapist in the Health Service. I know of another girl who has gone off to Australia to become an optician for just the same reason. And in another case, a very attractive physiotherapist has turned herself into an air hostess. That is a very desirable thing to do: air hostesses are very desirable. But so are physiotherapists.

Last night my family sat down and tried to think of a single job in which there is not a shortage at the moment, and we could not think of a single occupation where there was not a shortage. This is a most remarkable state of affairs. We have in fact almost reached the position where we are getting a human inflation, as opposed to a cash inflation. We have more jobs in almost every category of human achievement than we have people to fill them.


My Lords, does my noble friend mean a human deflation?


Yes, my Lords; a human deflation, a job inflation. The situation is that we desire to have about 6,000 or 7,000 physiotherapists: that is the potential establishment. But they just are not there. And that is the same all the way through the Health Service, all the way through industry, and all the way through a vast range of human occupation.

There are many good things about this situation. It means that people can change their jobs in a way they never could before if they find that they are unhappy in them. But it also means that we have to think about social priorities when we are working out wage structures. That is what we completely fail to do. The noble Lord, Lord Geddes, was absolutely right when he said that we have been asking the Whitley Council to do two separate jobs, for one of which it is completely unsuitable—that is to say, the basic building up of a wage structure for these professions, which must be related to a great many factors, as has been done in the case of medicine by the Royal Commission on doctors' pay, but which has never been done for the supplementary professions. The sooner it is done the better, but it is not a job for the Whitley Council.

My Lords, why is there this shortage? Some of the reasons we have heard already, and they are quite correct. But one of the reasons of which we have not heard which I am sure the noble Lord, Lord Newton, will mention, is the enormous increase in the number of posts for physiotherapists. Over the past twelve years since the National Health Service came into being there has been a tremendous increase in hospital posts for physiotherapists. However, something is going on which is very wrong here, and that is a wages structure inside the profession which encourages inefficiency and inflation. To take the case of a female physiotherapist, at the moment her basic pay, as my noble friend Lady Summerskill has said, is £530 to £630. That is the rate of pay for a physiotherapist, and she can work for 20 years and never get any more. The only way she can get more is by becoming the head of a department, and the bigger the department the more money she gets. The obvious thing for the intelligent physiotherapist to do is to get three or four more physiotherapists working for her. In that way she can get more money, and it is the only way. That, of course, is what happens.

Every physiotherapist, and everyone in this sort of situation throughout Britain, does exactly the same thing. We reward inefficiency. It happens the whole time throughout the Civil Service. The way to get more money in the Civil Service is to build up a big department. If you cut down your department to zero and show that it is not really needed, you will get the sack. If you show that you can do your job with only two people you do not get rewarded for it, I can assure you. I have done it myself many a time. If you show that you can do a job with two people instead of five, then you get less pay. In the little organisation that I run, I say that if one or two persons can do the work of five I will pay them the worth of three, which seems to me common sense. In that way I get the work done very much better because it is being done intelligently. The fewer the number of people to do a job, if they do the job properly, the better.

My Lords, that is what we have to do in these professions supplementary to medicine; it is the only way in which we can get the jobs done. We have to build a wage structure which will encourage efficiency. That is why it is a vital thing to have a committee to look at the whole matter, otherwise we shall just get more and more inefficiency throughout. We find a department of physiotherapy with one superintendent physiotherapist getting the higher rate, with not a single junior and with a blanket establishment of seven people. It is absolutely farcical. Something is seriously wrong there, so the sooner we have the inquiry the better.

About married women, I agree with my noble friend Lady Summerskill on this matter, except that I do not agree about the housework question—but we always have some little point where one does not quite agree with the other. What I am against is thinking that housework is a frightful sweat. I think that every modern woman with a modern home can get through the work ever so quickly if she is intelligent, and can have lots of time left over for doing lots of other things. For example, my noble friend mentioned scrubbing. I do not think that one has to scrub now: you have a "squeezy mop," and you can do the floor in no time. The problem today is whether a wife should work. I have always sent my wife out to work, and I do not see anything particularly wrong in that. Provided wives enjoy it it is all right. However, as physiotherapists are very attractive, as the noble Baroness said—perhaps she did not say it, but I will say it—there is a tremendous marriage rate. There are various statistics. Some say that 90 per cent. are married within three years of qualification. Another figure says that 60 per cent. have family commitments before the age of thirty. Either way, they are a great credit to the profession. But when it comes to going back to work on a part-time basis after the children are sufficiently grown up to go to school, which is what we ought to be encouraging in every possible way, the situation is disastrous, ghastly and bizarre.

The National Health Service pays £1 5s. for one afternoon session of 3½ hours, for the treatment of approximately twenty patients. Your Lordships can work out how much a patient's treatment is valued at by the Government. Certainly if patients were paying they would willingly pay a great deal more for the help they get. They do not mind paying 6s. for chiropody treatment. I do not say whether that is a good or a bad thing, but I do say that these rates of pay for a physiotherapist are absolutely scandalous. Moreover, they do not attract women back to the profession. In industry, where we employ a certain number of physiotherapists, though not very many, and try to use them intelligently, industrialists say that this is a monstrous rate and the standard pay for physiotherapists there is three guineas a session. That is a reasonable rate of pay for an afternoon's work for the care of twenty patients.

Our industrial health service provides physiotherapeutic work for three or four sessions. We cannot afford to employ a physiotherapist for more time than that—and she does not want to come for more time because she has her home and children—but what a jolly good way of employing her! And what a silly thing to offer this miserable rate, which is the lowest possible rate! The rate for part-time work is always calculated at the lowest possible, but part-time workers ought to be paid a little more, because they do not get pension and other benefits. I assure your Lordships that if doctors are part-time they do get a little more.

So we have everything conceivable wrong in the calculation of these rates. We want to have attractive rates for workers; certainly not this enormous differential between the superintendent and the rest, and this incitement to inefficiency in the building up of departments as the only method of promotion. We do not expect the Government to do all this straight away. We say that they have to use their intelligence and appoint a committee to go into the whole question of pay, exactly as the Royal Commission on doctors' pay examined the position of doctors. I am sure that that is the right thing to do and the sooner it is done the sooner we shall have this appalling muddle cleared up.

3.44 p.m.


My Lords, the noble Baroness, Lady Summerskill, has drawn our attention to an important subject with a great deal of fairness. This is one of the most pressing questions in the whole medical profession, which at the present time is full of urgent needs. I want to say first a word about radiographers. We all recognise the importance of new drugs and of new forms of treatment, but illnesses still have to be diagnosed, and it is the job of the radiographer to assist in finding out what a patient is suffering from. This is a job with a great responsibility, for the word of the radiologist can carry immense weight.

When I look through the pay scales which I have here, it seems to me that there are few, if any, radiographers in this country earning £1,000 a year. On the other hand, there are a great many clerks in offices, with only a fraction of their responsibility, earning that salary. I am not going to deliver a diatribe on the differences between clerks in offices and radiographers and other ancillaries in the medical profession, but this does seem to me to be a fair comparison. I think that the Government should look into this position very seriously.

The noble Lord, Lord Taylor, in his forthright speech—I do not intend to follow him in his observations about housewives; that is another matter—mentioned the importance of men in physiotherapy. That, indeed, is a very important matter. Frequently there are instances where the, services of a male physiotherapist could be put to more advantageous use. A patient may be specially burly or muscular or an awkward customer, in which case a man can handle him with more ease and comfort than can his feminine counterpart. It is a scandalous state of affairs where a man has to support a wife and perhaps two or three children on a salary of less than £1,000 a year. At a hospital at Epsom, a very talented physiotherapist left recently just because he could not afford to carry on.

I should like to follow what the noble Baroness and other speakers said about the shortage of physiotherapists by quoting a few more examples. Leicester Infirmary has an establishment of twenty physiotherapists. I understand that in early December there was a staff of four full-time and three part-time physiotherapists. The hospital at Epsom to which I have referred has an establishment of eight physiotherapists—there were two before the war—but there is no training school for them, either for new practitioners or for refresher courses for the present staff. Since last October they have been short of one full-time physiotherapist, replacement is extremely difficult, and the waiting list for physiotherapeutic treatment continues to grow. I myself have carried out a comprehensive tour of the physiotherapy department of this hospital. I know the head physiotherapist extremely well and I talked to her and others who serve under her. I may add that one girl serving under her is totally blind and she does especially good work. I should like to ask the Government whether they are making full use of the blind physiotherapists and whether there are sufficient facilities for training them, because, having been round St. Dunstan's and also the London School for the Blind and seen some of these people, I am sure that many of them could be put to excellent use in this sphere.

Another hospital which is suffering difficulties is a large hospital in Hertfordshire, the Lister Hospital at Hitchin, which deals with a lot of casualties, many requiring physiotherapy treatment. As a matter of fact, they are not nearly as badly placed as some others, but I should like to quote from a letter sent to me by the secretary of this group of hospitals. He says: We are dependent for physiotherapists on young married women coming to the area, who work until they have a family, and on married women with children who are prepared to work part-time during term. Young unmarried women hardly ever apply for a post as it seems they prefer to work in London. Accommodation in this area is difficult to find and expensive. This is a growing area. Stevenage New Town already has a population of something like 50,000 people. It is an industrial area where accidents at work can, and do, happen and need treatment by physiotherapists; and radiographers will be called on more and more.

It is true that accommodation in that area is expensive, but how much more expensive is it in London! As I remarked, that area is not nearly as hard hit as same of the areas mentioned by the noble Baroness, Lady Summerskill; and as I said just now, the radiographer position there is easy. They have an establishment of nine and at present it is full up. But at the Stevenage Outpatients Centre, which opened in May, 1961, an advertisement attracted only one applicant, and during the last four years one of the positions has been vacant for a period of nine months.

A policeman under the new pay scales can now earn £900 a year; a teacher under the Burnham scales can earn something like £1,000 a year. Physiotherapists and radiographers work long hours, they have much responsibility and their job requires a great deal of skill. I should like to ask the Government two things. First, I would ask them at least to ensure that the men in particular going into this branch of medicine are adequately remunerated. To expect a man to keep up a responsible position, to educate two childen and keep a home going on something like £600 a year seems to me to be nonsense. I am not saying that the remuneration for women should not be increased, too, because they have as much responsibility. The second point is that there is a growing need for more training schools. The new hospital plans announced by the Minister of Health make impressive reading: certainly we need new hospitals and improvements to old hospitals. But all this will go for naught unless we can get not only the doctors and nurses but the ancillary grades of physiotherapists, radiographers, dietitians and the like to staff them.

I would say just a word or two on occupational therapists. There is also a growing need for these, because a long-term patient in a hospital often needs his morale to be kept up, and those trained as competent occupational therapists can frequently accomplish this. I think this debate to-day has been fully justified and the Government have much to do.

3.57 p.m.


My Lords, I wish to make only a brief intervention in this debate to support the pleas put forward so admirably by my noble friend Lady Summerskill. All those connected with the Hospital Service and who are interested in the welfare of hospital patients will be grateful for the simple but skilful way in which she has placed these problems before your Lordships' House. I should like to say also how much I am sure my noble friend appreciates the fact that all those who have taken pant in the debate have agreed with what she has said and have lent support to the pleas she has put forward.

In Scotland we suffer from all the difficulties that my noble friend has indicated exist further South, and, as is often the case, in Scotland we have our own peculiar local problems added to those, such as salaries, which are common throughout the country. The basic fact is, as my noble friend has said, that in all these medical auxiliary grades the number of entrants is insufficient to meet the needs of the hospitals and clinics where the services are so much in need. In two of the grades, namely, physiotherapists and occupational therapists, the Scottish training schools are located in Glasgow and Edinburgh, and the output of these schools has tended to be absorbed largely in the two regions concerned. The Government have made arrangements for opening in due course, when premises are available, training schools in Aberdeen and Dundee, and when that takes place I have no doubt that more physiotherapists and occupational therapists will be available in the Dundee and Aberdeen regions: but unless something takes place in the interval it will be only at the expense of Edinburgh and Glasgow, because the same number of students will probably be trained in four schools instead of being trained in two.

I obtained some figures from my own local region—not that I thought the problem would be any more acute there than elsewhere—but I do not propose to quote them, except to mention that they compare with the sort of statistics which the noble Lord, Lord Auckland, has given about places in England. I did, however, receive a letter from a male physiotherapist in my own town who is very much concerned not only with the service but, quite naturally, with his own personal position and the complete inadequacy of the salary he receives. I do not propose to read the letter, but I think it is worth while telling your Lordships some of the consequences, not only for the hospital but for the people who ought to be getting attention at the hospitals, that deficiencies such as this cause.

He says that a rough resum) of what the shortage means in Dundee alone may be of some use. The Dundee Royal Infirmary—that is the principal training hospital of the Eastern Scottish region—have no staff to service the geriatric unit of the Victoria Hospital: no ante-natal exercises are done; and there are no ward classes in the maternity wing. In Mayfield Hospital they suffer generally from a curtailment of physiotherapy services. The Dundee Orthopædic and Rheumatic Clinic has a long waiting list, and in order to keep that waiting list down as much as possible there has been no physiotherapy staff available for the limb-fitting centre for over a year. There has been a curtailment of physiotherapy for handicapped pupils at Fairmuir School and at King's Cross Hospital. This is a school for children who suffer in many cases very severe physical and other handicaps, and at King's Cross Hospital there are handicapped children who are there for a long time who have no assistance at all.

The letter also states that at Ashludie Chest Hospital there are no physiotherapists, although the establishment provides for two. The only physiotherapeutic work which is done in this long-term hospital is one or two hours' work weekly given by the depleted staff of the orthopædic and rheumatic clinic. I do not believe that these sort of examples of real human suffering amongst people who are most in need of care which ought to be given to them by the community are any greater in the Dundee area than they are in other parts of the country.

There are, I believe, possibilities of recruiting a great number of more staff to these departments, and obviously, as has been brought out so skilfully by those who have spoken before me, there is an opportunity of attracting into active work those who could work part-time, provided it was at least placed on the basis that they were not going to be out of pocket as a result of it. It seems to me that this is perhaps the worst thing that has emerged in this debate. People who are willing to give their services can do so only by substituting for the suffering of the patients who are calling for attention the suffering of their own families as a result of financial hardship. I hope, therefore, that sufficient has been said to make the Government, even in a period of so-called "pay pause", realise that this is a case where they would be serving the community well by making an intervention in this matter for once in the direction of encouraging a rise of salary standards rather than the pattern of the present moment of trying to keep them down.

4.4 p.m.


My Lords, on intervening very briefly in this debate, I should like to commence by expressing my own appreciation to the noble Baroness, Lady Summerskill, for initiating our discussion on this subject this afternoon, because I feel it to be a vitally important one. I have no specialist medical knowledge myself, so I cannot speak with the authority with which some noble Lords have spoken this afternoon. But I think it is quite clear, even to a layman, that the position in our ancillary medical services is reaching a critical state.

A number of statistics and figures have been quoted this afternoon, and I am reluctant to add to them to any great extent. I have a personal knowledge of the situation as regards physiotherapists in one important area of the country, the area of Nottingham. Until recently, the Nottingham General Hospital was 45 per cent. under-staffed with physiotherapists; the City Hospital is 66 per cent. under-staffed; the Harlow Road Orthopædic Hospital is 60 per cent. under-staffed, and Park Road Clinic is 50 per cent. under-staffed. Nottingham General Hospital has fewer than nine physiotherapists out of an establishment of seventeen, and the City Hospital has under four, out of an establishment of twelve. As a result, there is a waiting list at Nottingham General Hospital of no fewer than 380 patients awaiting physiotherapeutic treatment. These figures, of course, concern physiotherapists, but I am advised that the position in regard to occupational therapists and radiographers is no less grave.

If we accept the position of the Nottingham area as being typical of the country, and if we accept that Nottingham General Hospital would serve a population of about 500,000 people, I think we can calculate that there might be a total number of patients awaiting treatment throughout the country running into five figures—not far short of 50,000. I think this is a tragic state of affairs.

Although the medical profession, greatly to their credit, have made immense strides towards the prevention and cure of disease in recent years, I am inclined to think that incapacity and injuries arising from accidents are on the increase. We live in violent times. We not only have a large legacy of war injuries which require treatment, but we have also hazards to face on the roads, hazards in industry, and even hazards in our leisure pursuits. Speaking personally, I regard myself as exceptionally fortunate in my life so far in regard to accidents. Nevertheless, I have had at different times to seek treatment by physiotherapists following accidents, initially at games on the football field, and more recently following motor accidents, horseriding accidents and accidents just through sheer misfortune or carelessness at work or at home.

Very often in these cases the medical problem is not a difficult one: it may be straightforward and simple. It means, perhaps, fifteen minutes consultation with a doctor and an X-ray, but then, so often, long sessions afterwards under the physiotherapist to get the injured limb or muscle working again. All of us who have had this treatment are, I am sure, conscious of a great debt of gratitude to the skilled personnel who have got our injured limbs and muscles working again, and got us fit and back to work. Again speaking personally, I have been lucky in being able to secure prompt and thorough treatment, first from the Army Medical Services, as an Army officer, and more latterly at my own expense outside the National Health Service.

In all these circumstances, my Lords, one cannot but feel a profound sympathy for the victims of accidents whose only recourse may be the National Health Service, and who may not be able to obtain the therapeutic treatment they badly need. It is a great handicap to them personally, of course, and in total it is a great waste to the economy of the country if they cannot get treatment quickly. It is a great waste, in that large numbers of people are off work, or not working at full efficiency, owing to incapacity, which may be serious or minor, but which will take a long time to heal in the absence of the right treatment given quickly. Much publicity is given nowadays to the working days lost in industrial disputes. But I think we must always remember that there are a far greater number of working days lost through sickness and injury. Anything which can be done to obviate this state of affairs will surely be of great benefit to the economy of the country as a whole. This, of course, is recognised in the Armed Services. In the Services anyone who is hurt, whether in peace or war, receives prompt and thorough treatment and is thereby spared personal distress, and the Service concerned is spared the waste of manpower.

My Lords, how can this serious position of the National Health Service be remedied? I think the remedies are fairly obvious. They have already been discussed fully this afternoon, and I have to admit that I have no new suggestions to make. On this matter I am in complete agreement with the speakers who have spoken earlier. I am sure it cannot be sustained that the salaries of physiotherapists are generous. I think that they are quite the reverse, and it seems evident that the salary scale of £525 to £650 a year—or to put it another way, £11 to £13 a week—is not enough to retain the service of many who are already in the profession or to attract sufficient new recruits to the profession.

I know that this is not perhaps the moment to plead for increased salaries or wages for any sections of the community, but when the time does come for that I believe that there will have to be some straight thinking on the matter. It is anomalous, to say the least, when the rewards to be earned in skilled professions which require a good education and long technical training are less than those which can be earned in semi-skilled, unskilled or, shall I say, secondary occupations. After all, if we place the average salary of a physiotherapist at about £12 a week, that is less than the average earnings in industry throughout the country as published in the last Ministry of Labour returns. And let us not forget that we are speaking of a skilled profession.

The basic remedy for the problem we are discussing is, in my view, to improve salary scales and terms of service of these ancillary medical services, to publicise the interest and value of the work, and then to increase training facilities for it. To this I would add one more point which is I think of very great importance. Let us try to make it easier and more worthwhile for married women to continue practising in these professions. The work concerned does lend itself to part-time practice. At the moment it is often just not worth a married woman's while to continue in her old profession. She may earn £5 10s. 0d. for five mornings' work a week at the hospital, but against this she will have the cost of her travelling; she may have to buy meals away from her home, extra laundry expenses; and, above all, she may have to find domestic help to care for her children or to run her home in her absence. The outcome, of course, is that so often she feels that the effort is just not worth while. I conclude, my Lords, with these suggestions. They are not in any way original, but they are our main hope for improving the situation, which I believe is at the moment critical.

4.15 p.m.


My Lords, I would join with every noble Lord who has spoken in this debate in thanking my noble friend, Lady Summerskill, for giving us the opportunity of discussing this very important subject and also for the manner in which she proved her case, a case which has been overwhelmingly supported by every speaker. It is the fact also that in the last three-and-a-half years, since I have been in your Lordships' House, this subject has been raised six or seven times, and it is a measure of the indictment of Her Majesty's Government which we must make on this subject that virtually nothing whatever has been done. I can only hope that when the noble Lord comes to reply to the debate there will be a change of heart and that we shall hear that the Government intend to take the advice which has been tendered to them and to take action at once.

I think there were three outstanding points which my noble friend made in her speech: one was the fact that it would be quite fantastic to envisage spending the £700 million mentioned in the plan for hospitals unless we had adequate and properly trained staff to man the hospitals. A fine building does not make a hospital; it is the quality, skill and enthusiasm of the people in the hospital which does that. The second point made by my noble friend was that the nation exploits the known devotion of the ancillary professional workers, knowing that they will neither strike nor desert their posts. Finally, the Minister has failed to recognise that the present position is undermining the efficiency of the hospital service, as, indeed, it is.

I should like particularly to deal with the second point raised by my noble friend about exploiting the known devotion of these people. This debate is on a somewhat narrow front, in that it mentions only four particular kinds of ancillary hospital workers, but I think my noble friend would agree that the same arguments apply to almost the whole of the ancillary professions—pharmacists, laboratory technicians, dietitians and hospital almoners. Indeed, I hope it will be agreed that the arguments that have been put forward in detail on behalf of those serving in particular ancillary professions in fact apply to all of them. I speak on this matter of exploitation—because that is what it is—as an employer. I think I am the only one who has so far spoken who is chairman of a hospital management committee. I can assure noble Lords that we feel very keenly indeed our position in being obliged to go on exploiting these people, because we must rely on their devotion to continue the services at all.

My noble friend, Lord Taylor, gave examples of the working of Parkinson's Law, but I can assure him that in hospitals within my knowledge that law is not operating, because, as my noble friend pointed out, they have no physiotherapists. They have to employ private enterprise ones at 25 guineas a week, and the department has been extinguished. In my own hospital every summer we have to employ locum pharmacists at 18 guineas a week, and that is considered to be a very low figure. We were supposed to pay only 16 guineas a week, but the Pharmacists' Journal would not even accept advertisements at that figure, so we advertised at 18 guineas. Thereafter, after eight weeks, we are supposed to discharge them and advertise again. In my own group, at least, we close our eyes to that stupid and fantastic rule; but at the same time as we are paying these people 18 guineas as locums our own people are getting about 12 guineas.

One of the worst evils of this is wastage. When we have not enough physiotherapists to do a proper job we are keeping people in bed longer than would otherwise be the case. Those beds are costing £28 to £35 a week. It does not take long—two days extra in bed, two days more before a patient goes home—to pay the salary of a physiotherapist. So it is not economy, but an absolute waste of the nation's money not to have these departments properly manned. Anyone who has been in hospital in the last ten or twelve years and had an operation, especially, say, twelve years ago, and this year, will know that in many operations there is a difference literally of weeks in the time that the patient spends in hospital. That has come about within the short span of ten years. It has been achieved not only by the skill of the surgeons and physicians but by the skill of the members of the ancillary professions. If we are talking in terms of hard cash, that is economy. Without them our costs would be far greater; we should not now be thinking in terms of fewer hospital beds; we should need more hospital beds.

How do we reward these people? Again I speak as an employer. My noble friend mentioned the salary scale of a radiographer as beginning at £500 a year. That is £9 12s. 4d. a week; on a 42 hour week that is 4s. 6½. an hour, after passing five subjects at "O" level and training for three years. Before I came here to-day I asked in my own factory what we paid a woman production worker when she started work with no training at all. If she has worked for six months we are obliged to treat her as a production worker and pay her a minimum of 4s. 8¾d. an hour. I am not saying that that is too much; I am not saying she is not entitled to it. But is it not fantastic that you pay a woman worker with no skill whatsoever, on a five day week, with no responsibility, 4s. 8¾d. an hour and then pay one of these highly skilled people less than that?

That is merely the women's rates. In the same factory the minimum rate for men is 5s. 9d. an hour. The actual earnings in that factory vary between £15 and £20 a week for men. So now look at the comparison—£9 12s. 0d. a week for the radiographer, 4s. 6½d. an hour; 5s. 9d. an hour minimum in industry and earnings of £15 to £20 a week. I am not going to attempt the task of suggesting that one person's work is of greater value to the community than another's, but I will say to the noble Lord, Lord Newton, that it is impossible to suggest that the work of the radiographer, the pharmacist, the occupational therapist or the laboratory technician, is worth only two-thirds that of a semiskilled male worker in industry. It can be described as nothing else but exploitation if we go on treating these people in this way.

For a very long time this matter has troubled everyone who has anything to do with hospitals. I have in my hands a report which was issued a month ago by the Association of Hospital Management Committees, of which of course my group is a member. It does not deal with Scotland, with which my noble friend dealt so ably, but with the whole of England and Wales. We have been making representations now literally for years, without any effect at all. At March 31 last year we sent a questionnaire to all the groups throughout England and Wales, and it is a mark of the importance which they attach to this subject that all but six out of nearly 400 groups replied, giving the very full detail needed.

The first conclusion come to by the Hospital Management Committees of England and Wales, who are all voluntary workers, not paid workers—they are the people actually responsible for the job of administering the hospitals —was this. They assert that the main reason—and I am quoting—for the shortages of ancillary staffs is inadequate remuneration. That is the very first paragraph. Then they go on to give the figures. I have here a table of figures for the whole of England and Wales, showing the numbers of posts unfilled of ancillary workers, radiographers, physiotherapists, pharmacists, orthoptists, psychiatric social workers. remedial gymnasts, and so on. At March 31 last in regional non-teaching hospitals no fewer than 481 auxiliary medical posts had been unfilled for more than a year.


My Lords, could I ask the noble Lord where these figures come from?


I thought I made that clear. They come from the Association of Hospital Management Committees and they were the result of an inquiry addressed to every hospital management committee throughout England and Wales. All but six replied and gave the information, so this is virtually, as at March 31 last, an accurate summary of the position. I am surprised that the noble Lord has not seen it, but I will hand him these figures afterwards. This is my own addition. There were 481 medical auxiliary posts in English and Welsh hospitals which had been unfilled for more than a year or filled by the employment of unqualified staff. That again, is a serious matter. This Association draws particular attention to the fact that even these figures must be accepted with question in relation to need, because the present establishment figures, in their view, are unrealistic. It is no use saying you need more radiographers or more physiotherapists when you cannot fill your present establishment, and to that extent it is an answer to the argument raised by my noble friend Lord Taylor. When we are sitting round a committee table and suggesting we want a new radiologist, the next question is: "What is the use? We could not get a radiographer". That is why these establishment figures are unrealistic.

Another serious matter which has been revealed by these figures, apart from the number of unfilled posts, is the unevenness throughout the country. I have the figures here for all the different specialties in the 15 regions of the country, and it is extraordinary how badly off in some of the professions are different districts as compared with others, although all suffer from a severe shortage. For example, with physiotherapists, compared with an establishment of 3,908 there were 825 posts unfilled. That is a 21 per cent. national shortage. In occupational therapists the shortage was nearly 24 per cent., orthoptists 20 per cent., psychiatric social workers 28 per cent. It is in all cases one in four, one in three, who is not there; and that is all over the country. That relates to the full time staffs. If you look at the part-time staffs the shortage is three out of four compared with the establishment. In fact, there is a note on this Report which says: There are instances where the shortage of part-time staff exceeds the total establishment for part-timers—this is probably because part-time auxiliaries are sometimes employed in the place of full-time staff.


My Lords, may I interrupt my noble friend for one moment? He said that there were great regional or area differences. Can he tell the House where things are worse? Is it places like Birmingham, where there are many alternative jobs? Or what is the type of place where the situation is actually worse?


My Lords, if the House would bear with me, I should, of course, be pleased to give that information from the Report. My noble friend Lord Hughes has shown us how appallingly bad it is in Dundee, and generally speaking it is in the Provinces where the position is so bad. The curious thing is that it is not uniform. For example, in Wales there is a shortage of only 7 per cent. of pharmacists, and yet Wales has a shortage of 41 per cent. of psychiatric social workers; indeed, that is one of their greatest shortages. In Leeds, there is a shortage of 55 per cent. of psychiatric social workers—they have less than half of what their establishment should be. In Newcastle it is 38.7 per cent. In the North-East Metropolitan Region of London it is 40.6 per cent. But there are some places—for example, Sheffield —where in that specialty there is only a 12½ per cent. shortage compared with the establishment. When it comes to orthoptists, in Leeds again there is a 41.6 per cent. shortage. That is the biggest shortage in that particular specialty. When we come to almoners, we find that in East Anglia the shortage is 47.6 per cent.—nearly one out of two. In Wales it is 58.5 per cent.—getting on for two out of three; they have only just over one person where they ought to have three. That is in comparison with the establishment.

So, my Lords, it is not only a picture of an over-all shortage. It means that in some specialties in some areas, particularly in the North, the shortage of skilled staff is such that the departments can scarcely work at all, with the result that the hospitals cannot function as they should function. This proves how right and how free from exaggeration my noble friend Lady Summerskill was when she said that the present position is undermining the efficiency of the hospital services. That is the present position. But, as I have already indicated. services of this kind are expanding. We want to treat people at home. The whole of the ten-year hospital plan depends, in fact, on more domiciliary services; and we cannot have one without the other. We cannot have an efficient hospital service unless these people are properly trained. As I have said, this matter has been greatly concerning the hospital management committees, the groups; and, having considered it and having gathered, with a great deal of trouble, all this information for the whole of the country for every auxiliary medical specialty, we have come to certain conclusions.

The first of these is that the increasing importance of the part played by medical auxiliaries in present methods of healing and early recovery from illness emphasises the need for practical measures to acknowledge this in a standard of salaries and conditions of service high enough to attract and retain recruits of the right calibre. That is the considered opinion of this responsible lay body—the most actively concerned lay body in the administration of the Health Service. There is no politics about it—it is not a pressure group in that sense. The report is based entirely on the facts. It acknowledges that in the last twelve months there has been a slight improvement, perhaps one-half of one per cent., or in some cases one per cent., but there is no possibility of any real, radical improvement to cope with the tasks that lie ahead, unless there is a radical improvement in the salaries.

The Association make recommendations which, since the noble Lord apparently has not seen them, I should like to place on record, so that they can be thoroughly considered by the noble Lord and his right honourable friend. They make recommendations for dealing with this problem. The first point is that there should be a revision of establishment figures based on the reasonable standards of requirements of each hospital; secondly, that there should be a revision of training arrangements and grants. Steps Should be taken to ascertain the yearly intake of students necessary; whether existing training facilities are adequate; and whether the present financial inducements are sufficient to attract the required number of people. Thirdly, they emphasise the necessity for, or the feasibility of, setting up, in conjunction with teaching hospitals, regional training schools. Then they press for revision of salary scales, differentials and conditions of service, including extra financial inducements for posts in unattractive areas, which I think is the only answer in the areas where these people are in such short supply.

Then, finally—and this I think meets the point raised by the noble Lord, Lord Amulree—they urge the advisability of one Whitley Council for all medical auxiliaries. I think the choice is between one or none at all. While they have a number of Whitley Councils and their strength is divided it seems to be possible through Government machinery to frustrate their just demands. I hope that both the ancillary professions and the representatives of the Government will give consideration to the advisability of one Whitley Council which can correlate salaries in the different ancillary professions and also, I hope, substantially up-grade them. This question of salaries ought not to be subject to the pay pause, because they have been subject to the pay pause for three years, and obviously they have been pausing too long. It should not now be made the excuse for not giving these people justice.

I think we owe a great deal to my noble friend. The case that has been put forward is, in my submission, unanswerable; it is extremely urgent, and for the benefit of the patients whom we serve in our hospitals, for the benefit of the country as a whole, and in the interests of economy, I hope that the noble Lord will tell us that this case is now going to be effectively dealt with by the Government, and that at long last justice will be the reward of these worthy people.

4.39 p.m.


My Lords, I had not intended to take part in this most interesting debate—indeed, I should not do so but for the fact that I feel I have a contribution to make. Let us accept, as I think we can, that there is a shortage of physiotherapists and the like and that that shortage is costly to the nation, as the noble Lords, Lord Stonham and Lord Abinger, have so clearly explained. Let us accept that the majority of physiotherapists are women, and that the so-called "wastage" is great. Let us also assume that part-time service by married women should be encouraged and is of great practical value in the services which they render, but that the fees which they earn are small and that additional costs such as those mentioned by the noble Lord, Lord Abinger, are incurred by the individual. No speaker, however, has mentioned income tax. That is a point I should like to make.

Speaking "off the cuff", as it were, I must confess that I am short of my facts. But am I not right in saying that net amounts earned by married women in excess of £100 per annum are grossed up with the husband's earnings, both for income tax and for surtax? Would not some relief in this respect be worth considering, not only in regard to practitioners such as we have in mind at the moment? I think I am right in saying that this is a matter which is being considered in respect of other types of part-time employment particularly, in the interests of productivity generally. I feel sure, my Lords, and perhaps a number of your Lordships will agree, that some adjustment in this respect would have a bearing on the problem to which the noble Lady has drawn our attention in such an able manner.

4.42 p.m.


My Lords, the noble Baroness is an ardent feminist, and on occasions I think one might almost say that she is a militant one. So I think it was appropriate that she should open this short but valuable debate this afternoon, because, as she and a number of your Lordships have pointed out, the people who fill these positions are predominantly women.

As I understand them, the facts are that among the radiographers 80 per cent. are women; among the physiotherapists and occupational therapists, well over 90 per cent. are women; and in the case of the dietitians the figure is very nearly 100 per cent. That is why, of course, the problem of marriage does enter so greatly into the staffing calculations. With respect to the noble Baroness, I will not talk about "wastage" or "loss" when referring to marriage. I shall simply say that from the point of view of staffing it does present a problem.

Anybody who studies this staffing problem objectively (and I have done so for some considerable time, because of your Lordships' sustained interest in the subject) is bound to be struck by three things. The first is that most hospital authorities find it difficult to recruit as many medical auxiliaries as they would wish, the difficulties varying locally. That has be en borne out in nearly all the speeches to which I have listened this afternoon. My right honourable friend is, of course, equally well aware of this situation, and he is examining the possibility of evolving typical staff ratios by which hospital authorities could judge their requirements. I say that in answer to something said by the noble Lord, Lord Stonham, towards the end of his speech. This is not an easy thing to do because the demand is not a static one. That brings me to my second point.


Before the noble Lord leaves his first point may I intervene? He was speaking of his right honourable friend looking into the matter of staff ratios. I would point out that it is generally thought there cannot be any decision on that for about eighteen months or two years. Can he deal with what is going to happen before these staffing ratios are settled?


I merely said, in answer to the point raised by the noble Lord, that my right honourable friend the Minister is looking into the possibility of doing that.

The second point I want to come to is this. Last week, when my own doctor came to see one of my children, I asked him how he felt about the situation. His reply was this: "The whole trouble is that all the time we doctors are increasing our requirements for the services of these people. It must be very difficult for them." I am sure he is absolutely right about that. The demand for their services has grown with the changes in medical practice and with the growing realisation by doctors of the importance of the work of these ancillary staff. I think that was one of the points made by my noble friend Lord Geddes. I imagine that there was a time when some doctors, at any rate, thought that dietitians were new-fangled and unnecessary inventions; but equally I imagine that to-day the number of doctors who think on those lines must be very small indeed.

My Lords, nowadays many more patients are treated in the early stages of a disease rather than in the late or terminal stages. Moreover, the extension of specialist services from the main centres to 'the Provinces has increased the number of new centres which have to be staffed at a level previously maintained only in London and a few other centres. These points are exemplified by the relative growth in the number of relevant consultants. Between 1949 and 1960 the total number of consultants in England and Wales increased by 39.5 per cent. and I now want to draw your Lordships' attention to the numbers of consultants who are concerned particularly with the work of the classes of ancillary workers with whom we are concerned to-day.

The number of consultants concerned with radiographers practising in radiology increased between 1949 and 1960 by 61.7 per cent—which your Lordships can see is very much more than the 39.5 per cent., the figure for the total increase for all consultants. The number of consultants concerned particularly with the radiographers practising in radiotherapy increased in the same period by 61.5 per cent; the number concerned with occupational therapists in mental health rose by 67.7 per cent.; the number concerned with occupational therapists and physiotherapists in physical medicine rose by 81.6 per cent.; the number of those concerned with physiotherapists in orthopaedic surgery rose by 53.3 per cent.; and the number of consultants concerned with dietitians rose in the same period by 37.5 per cent.—that is the only increase in consultants which is not greater than the total increase in consultants over the period in question.

The third point which immediately strikes one when studying the staffing question is the great competition outside the Health Service for young people possessing the same standards of background, education, intelligence and character as are required by medical auxiliaries. This struck me so forcibly that I instituted an investigation into the extent of competition in the public service as a whole, in the professions outside the public service and in industry and commerce. I should like to tell your Lordships the result of that investigation.

The minimum educational standard required of an entrant into the professions supplementary to medicine is four passes at "O" level in the G.C.E. (generally including a pass in mathematics or a science subject or both). The same standard is required for the following careers. To take the public services first, in the home Civil Service, that is the standard required for clerical officers, postal and telegraph officers, scientific assistants, the Customs and Excise Pre- ventive Service, engineering apprentices in the Admiralty and War Department.


My Lords, on a point of fact, I think it is five and not four credits that are required for the professions supplementary to medicine. I think the noble Lord said four, which might easily change the whole pattern.


My Lords, I did say four, and that is my information. If I am wrong, I will certainly communicate with my noble friend. The same minimum standard is required for the following careers: the Foreign Service, Grade VI officers; the Armed Services, officers in the Women's Royal Army Corps; the Atomic Energy Authority, clerical officers, scientific assistants, and engineering apprentices; the Agricultural Advisory Service, posts for qualified staff; local government, librarians, public health inspectors, housing managers, rating and valuation officers and teachers. In the professional services outside the public service the same standard is required for accountants, solicitors, surveyors, land agents, auctioneers and estate agents, and quantity surveyors; while in industry and commerce this applies to company secretaries, draughtsmen and estate managements.

While the same standard is not rigidly insisted on in the following careers, there is keen competition for school-leavers with comparable qualifications: executive posts in advertising, managerial posts in agriculture, dairy farming, poultry farming and horticulture, banking, executive posts in building societies, managerial and technical posts in the building trade, managerial posts in catering, hotel management, housing management, and executive and managerial posts in insurance. This also applies in the following manufacturing industries: engineering, food, drink, chemicals, tobacco, textiles, plastics, and rubber; for laboratory assistants, technicians, technical executives and technical sales representatives.


My Lords, although the list which the noble Lord is reading is very interesting, I cannot see what bearing it has on this matter.


My Lords, I hope my noble friend was here when I started speaking on this subject, and what I said was that one of the three things which immediately strike one when one investigates this problem is the extent of the competition outside the public service, and the National Health Service in particular, for young people possessing the same standards of background, intelligence and character as are required by medical auxiliaries. In order to try to elaborate that general statement I instituted this inquiry into the types of careers which compete for people with the same minimum educational background as entrants to the ancillary professions.


My Lords, did the noble Lard's inquiry go so far as to inquire what was the salary level after 25 years of service in those professions which he has read out, and did he then compare it with the £625 which a radiographer gets after 25 years of service?


My Lords, I am going to come on to discuss the question of pay in due course, but I should be obliged if the noble Lord opposite would allow me to get on with my own speech.


My Lords, I must say to the noble Lard that he cannot make any contribution to this matter unless he compares like with like. The noble Lord suggests that it is a question of the educational level, but if his argument is based on four passes he is wrong, because the physiotherapists and the others require five. The noble Lord cannot say that all these people are being paid the same amount, because if the salary were the same a number of these people whom he is now describing would become physiotherapists. They are attracted into estate management, and all the other things that he has mentioned only by the salary.


My Lords, I am comparing like with like. I am comparing the various, very large numbers of particular demands for young people with the same minimum educational standards, and that is like with like. The list which I have just read out to your Lordships is, in my submission, a pretty formidable list, but of course all those other professions do not get all the recruits they want, any more than the National Health Service does. Inquiries made by the Ministry of Labour in 1959–60, of the professional bodies concerned with those professions which require mainly non-graduates, showed that there are shortages in many of them, particularly accountants, actuaries, architects, company secretaries, librarians, solicitors and statisticians. A similar inquiry by the Ministry of Labour last year, which was particularly concerned with women, showed that there is a shortage of women in institutional management, personnel management, the prison service, the probation service, and as librarians, police and officers in the Armed Services.

All these careers which I have been enumerating to your Lordships are of value to the community, and it would be tendentious and invidious for me or anyone else to attempt to place them in an order of relative importance. After listening to his speech, I think that Lord Stonham would agree about that. My Lords, many of these careers require recruits with a vocation for personal service, in addition to the same educational background, and many of them are especially suitable for women.

So what it boils down to is this. There are not enough young people with the necessary qualifications to fill all the available posts, whether in the hospital service in particular, the public service in general, or the national economy at large. The pool is just not big enough. In saying that, I think I am merely saying very much what the noble Lord, Lord Taylor, said in his speech, and I was very glad to hear him say it. The National Health Service can expand its share of the pool only at the expense of other employments, many of which are, on any estimate, equally essential to the nation's well-being. Furthermore, within the Health Service itself a number of professions—nurses, other medical auxiliaries, and social workers—are themselves competing in the same market.

There is this further point: that opportunities for university education have grown substantially in recent years. Since 1953 the undergraduate population has risen by 30,000; that is to say, by nearly 40 per cent. This is a most welcome development, but it has, of course, had the side effect of reducing the number of recruits for those careers which are open to non-graduates.

These things being so, the realistic question to be asked, in my judgment, is this: Is the National Health Service getting a fair and reasonable share of the available pool? I think it is. Let us look at a few figures. First of all, may I take the numbers in post in England and Wales? At December 31, 1949, there were 3,186 physiotherapists, and on September 30 last year there were 3,906, which is an increase over the period of 22.8 per cent. As regards radiographers, in 1949 there were 2,102 and in 1961 there were 3,331, an increase of 58.4 per cent. Coming to dietitians, in 1949 there were 135 and in 1961 there were 178, an increase of 31.8 per cent. In 1949, there were 821 occupational therapists, and in 1961 there were 1,668, an increase of 103.1 per cent.—over twice as many.

Let me consider the figures of students in training. They are for those classes where all the training takes place within the hospital service. Physiotherapists: in 1957, 1,196; in 1960, 1,623—an increase of 36 per cent. Radiographers: 1957, 851; 1960, 1,290—an increase of 52 per cent. Figures of student dietitians are not available, but the professional body, the British Dietetic Association, have said that the number who started to train in Great Britain in the current academic year is higher than in any previous year. Figures of student occupational therapists also are not available, but the main qualifying body, the Association of Occupational Therapists, of which my noble friend Lord Geddes is the distinguished President, have said that the number who qualify in England and Wales has risen considerably during the last few years. As to physiotherapists, nearly all the places for new students were filled last year. In fact, 757 were filled out of 775. For radiographers, the numbers starting to train in 1960 increased by 133, or 22½ per cent., over the previous year. My Lords, these are encouraging trends, and I think that that fact should be recognised.

As for the future, it is hoped that the post-war increase in the birth-rate, the effects of which are beginning to be reflected in the number of 'school-leavers, will increase the numbers entering these four professions in the coming years. I have no doubt, too, that my right honourable friend's magnificent hospital plan will, as it comes to be implemented, contribute to the solution of staffing problems. But my right honourable friend is not content to leave it at that, and I should like to tell your Lordships about the steps that have been taken to improve recruitment. First of all, financial assistance to students. The time taken to train varies between two and four years. It is two years full-time for both diagnostic and therapeutic radiographers, and three years full-time for occupational therapists and physiotherapists. For dietitians, it is a three or four-year course for school-leavers or an eighteen-month course for older students who have acquired certain basic qualifications in domestic science, pure science, catering or nursing. For all types of training for dietitians, chemistry at "O" level, G.C.E., is a prerequisite—and, unfortunately, the number of girls who have it is small.

Training grants for radiography students were introduced in 1957. and they are paid by hospital authorities. The rates were increased in April, 1960. The maximum rates are £210 in the first year of training (£220 in the London area) and £250 (or £260 in the London area) for those who have passed Part I of the examination. For occupational therapists, training grants are at the discretion of local education authorities, and this was also so in the case of physiotherapists until last October. Since then, however, all physiotherapy students in England and Wales accepted for training are eligible for Ministry of Health bursaries, subject to parental income, and are assessed on the same scale as is applied to applicants for grants for university and similar courses. In the case of dietitians, training grants are the responsibility of local education authorities, but towards the end of this year a limited number of Ministry of Health bursaries will be awarded to students taking the eighteen months' vocational training courses.

I should now like to say a word about publicity, because every opportunity is taken to make known to school-leavers and their parents the openings in these professions. These careers have been included in a series of articles in the daily Press, in women's magazines, in careers programmes on sound radio and tele- vision, and in other relevant media. Advertisements have been inserted in careers directories and publications, with supporting editorial features. There have been produced and distributed to youth employment officers and careers masters and mistresses at schools Ministry of Health leaflets about these careers. There is a colour film—"The hospital team in action", it is called—featuring these and other careers, which may be hired from the Central Film Library. Exhibition display material was provided for Commonwealth Technical Training Week and subsequent use. I understand that in Scotland publicity has been on similar lines to that in England and Wales.

The noble Baroness and my noble friend Lord Auckland referred to training facilities. For physiotherapists the expansion of training facilities is hindered by a shortage of qualified teachers, and that has been brought out in the debate. A compressed emergency course was therefore started last autumn by the Ministry in conjunction with the Chartered Society of Physiotherapy to produce more teachers quickly. For radiographers, 45 more individual hospitals and three more hospital management groups have provided facilities for training radiographers since 1957. There are now training courses at 68 individual hospitals and at 25 hospital management or other groups.

My Lords, I should now like to say something about the advice which has been given or will be given to the National Health Service on the uses of these professions that we are discussing. In the case of dietitians, in November, 1960, a memorandum was issued to hospital authorities, based on the findings of a survey carried out by the Ministry in conjunction with King Edward's Hospital Fund for London, on ways of making more effective use of dietitians now in the service and of future recruits. These findings included a definition of the dietitian's duties and of those functions which could be carried out by catering staff under her guidance, and advice on the use of one dietitian for a group of hospitals.

In the case of radiographers, in April, 1960, a memorandum was issued to hospital authorities based on the conclu- sions of a study group appointed by my right honourable friend to investigate the shortage of radiographers and to deterine its causes. Measures recommended included the opening of new training schools; local publicity to school-leavers; countering apprehension about radiation hazards; improving working conditions, both physical and personal; the elimination of unnecessary emergency work, and the use of part-time staff. The Nuffield Provincial Hospitals Trust have completed a study on the organisation and operation of X-ray diagnostic departments with the object of finding out whether the present standards of organisation allow the best use to be made of expensive and short-lived apparatus, and of the skill of trained radiographers. This study is due to be published this spring.

In the case of physiotherapists there is in preparation an advisory memorandum to hospital authorities on the most effective ways of using their services. My right honourable friend is most anxious that their services should be used to the best advantage, and that their time should not be taken up in giving treatment of small therapeutic value at the expense of more effective treatment. He takes the view that all physiotherapy should be carried out under the supervision of a consultant, that it should be precisely prescribed, and that the necessity to continue treatment should be reviewed at regular intervals.

My Lords, perhaps I may now reply to a few of the smaller points raised in the debate. I should like to say to the noble Baroness that there are five grades of superintendent physiotherapist, and that there are many more posts than six in all the grades: but perhaps she was referring to the highest grade in charge of the largest departments. My noble friend Lord Auckland asked about blind physiotherapists. There is a school for them run, I think, by St. Dunstan's; but it is not really practicable to train blind physiotherapists at schools for those who are sighted.


My Lords, may I make a correction? The school is run by the Royal National Institute for the Blind, in Great Portland Street.


I am much obliged to the noble Lord for putting me right. I did say "I thought"; I was not absolutely sure.

The noble Lord, Lord Hughes, gave us the benefit of his knowledge of conditions in Scotland. I am advised that Scottish experience in recruiting these staffs in recent years has been, broadly, similar to that in England and Wales. In the opinion of my right honourable friend the Secretary of State, in Scotland they are not too badly off for medical auxiliaries. From time to time shortages are heard of, especially in some peripheral places, but there have not been any acute crises. I should like to add that I will certainly see that the attention of my right honourable friend is drawn to what the noble Lord has said.


My Lords, it will, of course, depend on what satisfies the Secretary of State. If a 50 per cent. shortage in physiotherapists is not acute, then all I can say is that the Secretary of State and I look at things in a different way.


Well, my Lords, that is the advice which I have been given.

The noble Lord, Lord Stonham, referred to the Report of the Association of Hospital Management Committees, which deals, of course, only with the non-teaching hospitals, not the teaching hospitals. I think he will agree with me that, with most of the classes of ancillary worker, it shows an improvement in staffing between 1960 and 1961. I will certainly see that what my noble friend Lord Ferrier said about income tax on married women's earnings is considered in the proper quarter.

Now may I come to the question of pay? I will not give your Lordships the current salary scales, because they have been referred to by a number of your Lordships. But I would just say this: the noble Lord. Lord Stonham, was quite wrong in saying that there has been a pay pause for three years, because the current scales for physiotherapists, occupational therapists, and radiographers became effective on January 1 of last year—and the current scales for dietitians became effective on March 1, 1961. There are claims for radiographers and physiotherapists currently under consideration by the appropriate Whitley Council. On the other hand, there is no outstanding Whitley agreement affecting the staff covered by this debate which is awaiting implementation. To Lord Taylor, perhaps I should say that the rates for part-time work are fixed by the Whitley Council in the same way that they fix the overtime rates, and they are interrelated.


But, my Lords—


That is in parenthesis. I shall be coming to the general point in a moment.

What I should like to do now is to repeat to your Lordships some observations which I made when we debated the hospital service on April 26 of last year, because I do not think I can improve on the clarity of the argument which I then used. This is what I said [OFFICIAL REPORT, Vol. 230 (No. 70), cols. 956–957]: The object of the Whitley negotiations is to determine salaries which are fair and reasonable, having regard to the duties performed, in relation to the salaries of persons doing comparable work elsewhere. As the hospital service is a public service the appropriate comparisons are with other public services. Industry is concerned only with its immediate needs. Salaries in the hospital service are determined on the basis that they are applied uniformly throughout the service as a whole. Any attempt to compete with the salaries offered by industry would have no other effect than to raise the bidding, and, in the end, the result would be to bring no benefit to the hospital service and to increase the cost put on the taxpayer. Those words are as true to-day as they were when I said them.


They are not true at all.


My Lords, they were true on April 26 last, and they are true to-day. The existing Whitley machinery for the National Health Service was set up by the post-war Labour Government after long consultation between representatives of the employers, the staff, and the Ministry. I would ask your Lordships, particularly my noble friends Lord Geddes and Lord Amulree, to note this: that none of the four bodies which we have been discussing this afternoon has proposed that the Whitley machinery should be abandoned. Indeed, it is not clear now how direct negotiations between the staff and the Minister would represent an improvement from anybody's point of view. It is true that there has been direct negotiation for general practitioners, but they, of course, are contractors and not direct employees of the State, and in future the level of their salaries will be the concern of the special Review Body. Moreover, hospital wages have also been within the ambit of the Whitley system, and will continue to be for minor matters not falling to the Review Body.


My Lords, might I interrupt the noble Lord?


Well, I am in the middle of my argument.


I thank the noble Lord very much. He says that the hospital doctors are within the ambit of the Whitley system. It was precisely because the Whitley system failed in respect of hospital doctors that we had the Royal Commission to examine the basic problem of doctors' pay, which, of course, included hospital doctors. They were the main element in it. Surely, it is exactly that point that the noble Lord, Lord Geddes, was making, that there are two elements here. There is the day-to-day negotiation, for which the Whitley machinery is appropriate; and there is the overall adjustment of a rate of pay in relation to the general social circumstances, for which it is utterly inappropriate. These people have come into the service having worked in a charity. They had no initial committee, such as the doctors did to determine what the doctors were earning outside the National Health Service before the start. They came by comparison with charity salaries, and they are still on that basis. And here they are, right at the bottom of the salary scale, right at the bottom of the enormous list that the noble Lord gave us, and there is no way of getting them up unless we have a special inquiry apart from the Whitley machinery.


My Lords, it might appear that my noble friend Lord Taylor is making a second speech, but I can only say again to him that the hospital doctors will continue to be within the ambit of the Whitley system for those minor matters which do not fall to the Review Body. I must also repeat—and this is really the striking point—that none of the professional bodies which we have been debating this afternoon has proposed that the Whitley system should be Changed or abandoned.


My Lords, if I might correct the noble Lord, nor has that been suggested here. It was proposed that the Whitley system should be retained, as the noble Lord, Lord Taylor, said, for the day-to-day adjustments, but that the overall review was not appropriate for the Whitley system.


I do not know whether my noble friend was present on April 26, but the request was made time and time again by those of your Lordships who spoke that the Whitley system ought to be abandoned. The noble Lord, Lord Taylor, was one who made that request; and the noble Lord, Lord Stonham, was another.


My Lords, let us assume that we were convinced by the noble Lord's argument. Surely this is a different issue, a fundamental issue of the basic rates of these people, which cannot be affected by Whitley.


My Lords, I am delighted to hear the noble Lord say that he, at any rate, was convinced by my arguments on April 26. If I may go on, I have looked very carefully into this particular question of direct negotiation and have found no reason at all to suppose that the professions supplementary to medicine might do better if the Whitley system were scrapped. I express no opinion as to whether they might do worse.


My Lords, I think that the noble Lord was a little inaccurate in his deductions when he said that hospital doctors would be still subject to the Whitley system, whereas in future the Review Body, which has been set up recently under the chairmanship of the noble Lord, Lord Kindersley, will be responsible for negotiating the salaries of doctors. Does he think for one moment that the British Medical Association, that well-organised body of doctors, will allow the salaries of hospital doctors not to reflect the salaries of other doctors? There cannot possibly be two categories of salary in the medical profession. What he has told us just now is a wrong interpretation of the situation.


My Lords, I cannot accept that. I did not say, nor did I imply, what the noble Baroness has said. What I said—and I said it twice—was that hospital doctors are to continue to be within the ambit of the Whitley system for those minor matters which do not fall to the Review Body. I certainly did not say or suggest the words which the noble Baroness tried to put into my mouth.

The noble Baroness referred particularly to the pressure recently for an independent inquiry into the pay of physiotherapists, occupational therapists and dietitians, but not radiographers. Their representatives are content, apparently, to leave things to the existing machinery. This request has been rejected by my right honourable friend for three reasons. First, it would be wrong to withdraw from the established negotiating machinery matters with which it has been specificially created to deal; secondly, such an inquiry could not be confined to those for whom it had been sought; and, thirdly, such an inquiry would seriously weaken the authority of the established negotiating machinery and therefore could be justified only by wholly exceptional circumstances, which do not in fact exist. That is the position at the moment. What I will do is to see that my right honourable friend is made well aware of the strong views which your Lordships have expressed on this subject this afternoon.

My Lords, I have been much longer than I intended to be, but not only did some of your Lordships interrupt me; I am afraid that also on one occasion I allowed myself to be provoked. I am grateful to the noble Baroness for initiating this debate and, among other things, for giving me an opportunity of saying some things which I think needed saying in a place in which they might

get some publicity. The people in the services we have discussed do work of great and growing importance. They are also very charming people, as the noble Lord, Lord Taylor, said, and happily for them, though unhappily for the National Health Service, they marry quickly and retire from their work. Fortunately, their number has been increasing, as I made clear in the figures I quoted, and there is reason to hope that in the coming years more young people will choose these professions in preference to the many other careers open to their talents.

5.28 p.m.


My Lords, I must say that I have never heard a more inadequate and unsatisfactory summing up of a debate. I think that the noble Lord will agree that on both sides of the House noble Lords felt that this body of workers, who are making an important contribution to the community, are inadequately paid. He has devoted the first half of his speech to material completely irrelevant to the debate, and in the end explained why an inquiry could not be held. The reason is that these women have not a pressure group equal to the British Medical Association. When the doctors wanted an inquiry held, a Royal Commission was set up. When the doctors say that their pay should be related to the pay in other professions, a Review Committee is set up, which is to continue year after year in order that the doctors shall be paid adequately in relation to other salaries. The fundamental point is that, whereas the doctors have been granted this by the Minister, he has completely swept aside the suggestion that an inquiry should be held into the pay of these women. In the circumstances, I feel that I cannot possibly withdraw this Motion.

On Question, Whether the said Motion shall be agreed to?

Their Lordships divided: Contents, 24; Not-Contents, 21.

Airedale, L. Lawson, L. Shepherd, L.
Amherst, E. Lindgren, L. Silkin, L.
Auckland, L. Milverton, L. Somers, L.
Boston, L. Morrison, L. Stonham, L. [Teller.]
Colwyn, L. Ogmore, L. Summerskill, B. [Teller]
Geddes, L. Peddie, L. Taylor, L.
Hughes, L. Rea, L. Williams, L.
Kenswood, L. Sempill, L. Wise, L.
Ailwyn, L. Fortescue, E. Morley, E.
Buckinghamshire, E. Fraser of North Cape, L. Newall, L.
Chesham, L. Hailsham, V. (L. President.) Newton, L.
Colville of Culross, V. Hastings, L. St. Aldwyn, E. [Teller.]
Denham, L. [Teller.] Kilmuir, V. (L. Chancellor.) Strang, L.
Devonport, V. Lambert, V. Teynham, L.
Ferrier, L. Lonsdale, E. Tweedsmuir, L.

Resolved in the affirmative, and Motion agreed to accordingly.