§ 8.6 p.m.
§ LORD CROOK rose to ask Her Majesty's Government whether in the light of the current deficiency of staff in hospitals in the London area, accompanied as it is by the large "turnover" in staff, they will ask the appropriate authorities to examine the present rates for "London Weighting" on salaries with a view to bringing them into line with progressive public and industrial undertakings. The noble Lord said: My Lords, at this late hour, may a Cockney switch your minds back from the delights of the Highlands to the little problem of London represented in the Question which stands in my name on the Order Paper? We hear much of hospital staff shortage, and the doctors and nurses are those who more readily come to most people's minds. But those of whom I want to say something to-night are the huge staffs upon whom the running of the hospitals depends; and, in particular, I want in this Question to refer to the administrative, clerical, professional and technical staffs in the London area.
§ I want to make it clear that I am not trying to ask the Government any question on pay in general—that is dealt with on a national basis—but that does 835 not mean that I must be taken as agreeing that the pay they get is good enough. Nor am I trying to harry the Government or to cut across the normal lines of communication and negotiation; although I must say that it seems to me that the negotiating machinery is very slow. I think that slow action in the machinery of negotiation in the industrial world far too often leads to outbursts of unofficial strikes. The type of officer to whom I am referring would not dream of striking. But that is not a good reason for failing to do anything about his needs or his appropriate claims. Indeed, if I may say so, as one who has been in negotiations for 40 years, it may be that that is a better reason for the employing authority to think about the matter immediately.
§ Perhaps I should explain to noble Lords what is meant in my Question by "London weighting". In all the great public and industrial services, the remuneration of people employed in London is supplemented by an allowance of a weighting. This allowance is to compensate for all those factors in London, in this great sprawl, of which we are all so conscious. It is compensation for all those things which make employment difficult and less attractive in London than elsewhere, compensation for extra time involved in travelling, and compensation for the larger costs of travelling which, in respect of most of the people to whom I am referring, would normally never be less than £60 a year and might very well be twice that amount. And these costs are continuing to increase. I hardly need remind your Lordships (because of the debates in this House on the general subject) how much more housing in London costs than elsewhere.
§ All the great organisations and services in London give these London allowances. These are no new feature of the post-war world. I first knew London allowances when I was dealing with Civil Service organisation as long ago as 1925. The practice existed then and has continued ever since. I do not think the Civil Service get enough by way of allowances; but they get a great deal more than they would get in the National Health Service. Then there are the banks: they pay more than the Civil Service. Most 836 of the nationalised industries pay more; and, of course, among the insurance groups and some of the wealthy industrial groups, even more is paid.
§ An officer of Her Majesty's Civil Service employed within four miles of Charing Cross on a salary scale between £801 and £1,000, will receive London allowance of £70. Banks are paying £150. Insurance groups have been paying £125 for a long time. The Daily Telegraph of June 7 reported details of a further increase of London weighting allowance by the Prudential Assurance Company to £150 a year, and that despite the fact that new pay scales were introduced last July, a 5 per cent. increase was given in January and everyone has been promised a 2½ per cent. bonus to come in November of this year. As I have said, I am not raising the general question of pay levels; I am asking, in the interests of good, efficient and sensible administration, that the London weighting in the National Health Service shall be adjusted.
§ Why do I refer to efficiency? Let me give one example which must be known to Her Majesty's Government. In one year one of the London teaching hospitals, with 48 members of the staff in the kind of salary range to which I am referring, lost 14 of its staff, who left either for better pay in the centre of London or in order to take up offers of employment nearer home where their daily costs would be lower.
§ Similarly, why do I refer to sensible administration? Again I wish to refer to facts which must be known to the Government. The difficulty in holding the essential staffs to run the day-to-day services in hospitals is causing the hospitals to resort to the use of staff recruited from agencies. Shorthand typists from these agencies cost from £19 to £21 a week. Even then such people do not give a really efficient service. That is not to decry the general nature of the people recruited from agencies. A person from a general agency, accustomed to general shorthand typing, will not be experienced in the kind of service desired by the National Health Service. Accordingly their output, even when they are efficient, is less than would be obtained from properly recruited staff. I wish to quote the costs of hired clerical help to two London teaching hospitals for the last year for which figures are 837 available—1963–64. In one it was £4,700 and in the other £5,500. There is every reason to believe that the figures, which we are shortly to see, for the next complete year will be very much higher.
§ There is an even worse feature of the London weighting in the National Health Service. It is the maintenance of a relationship to age in the earlier years of service. Most of us dealing in negotiation with this kind of problem—I have been connected with it for forty years—abandoned the concept of age a long time ago. The lower ages are where the recruitment takes place and where difficulty is being experienced in recruiting people. The lower age is that at which the officer must come in to settle down to a career with a sense of satisfaction. If you go into the Health Service at under 21 years of age, you will be given an allowance of £15. If you are over 21, your allowance will be raised to £25. If you stay until the age of 26—a lot do not—the amount will be raised to £40. My Lords, it costs just as much to travel and to eat in London when one is a day less than 21 years of age as it does two days after the 21st birthday. It is completely impossible to understand this old-fashioned approach which has been imposed by either the Health Service or the Ministry of Health—or perhaps the Treasury.
§ Even the Civil Service will give up to £65 a year on that salary within four miles of Charing Cross. The Coal Board, by arbitration award, will give £88. A number of industrial organisations near to this Chamber are giving £100. Insurance will give £120 and a bank £150. This is in respect of the junior ages, because they do not differentiate regarding age. They are people who are competing for staff with the National Health Service.
§ Because I wish to pitch this question on a low note regarding recruitment, I have not tried to develop any facts about higher paid staff, and I am not suggesting that the Minister should try to reply to me about this. In fact, in the National Health Service, however high a service salary a person gets, he will receive only the £55 as London allowance. The Coal Board arbitration award of as long ago as 1957 gave the staff £114 per annum. I am credibly informed that the National Coal Board is about to reach another 838 settlement on further negotiation. The loyal National Health Service staff know these facts as well as I do and they have been waiting for something to turn up.
§ The last thing in the world that I wish to do is to "rock the boat" about wage rates in general. Anyone who has negotiated, as I have, will know how wrong and bad is the vicious spiral caused by remuneration and prices chasing each other. I am not asking the Government to give money. As one who has great respect for negotiating machinery, I am not asking that the Government throw overboard the appropriate machinery. It is for that reason that I have most carefully worded the question which I now ask, that the Government will ask the appropriate authorities to examine the present rates for London weighting with a view to bringing them into line with progressive public and industrial undertakings.
§ 8.17 p.m.
§ LORD AUCKLANDMy Lords, the House will be grateful to the noble Lord, Lord Crook, for having raised this very important subject. He has, in fact, raised what is a technical question and dealt with it so fully that there is little for me to say. The problem of personnel in the National Health Service in London and in the London weighting area is not, of course, confined to the implications of the question. I had a long letter from the Chartered Society of Physiotherapists in connection with this matter. It is not entirely relevant, so I will not quote from it. I shall refer only to the disappointment expressed that the Question is concerned only with London. I think that the noble Lord, Lord Crook, was right to mention London, because, of course, the cost of living, quite apart from travel, is higher in London than, say, in Glasgow, Birmingham or Leeds.
The question I should like to ask the noble Lord, Lord Taylor (and I have mentioned this to him), bears on the matter to some extent. I wish to know how these London weighting areas are arrived at. I have mentioned this matter before in your Lordships' House in respect of Epsom, where there is a hospital to which the London weighting applies. At Leatherhead, a mile away, there is another hospital where there is an 839 extremely busy physiotherapy department, and other departments, which do not come within the London weighting area. Yet the value of the work and the amount of travel involved is just as great. I ask the noble Lord to consider this question, and I hope that the noble Lord, Lord Crook, will get the result from this Question which he rightly deserves.
§ 8.20 p.m.
§ LORD AMULREEMy Lords, I should like to intervene briefly in this debate because I am very pleased that the noble Lord, Lord Crook, saw fit to raise this matter. I know the great difficulty which hospitals in London have of keeping their younger staff, particularly on the administrative side, and when one sees what the London weighting position is, one cannot be surprised. I was told to-day that even the new local authorities appear to be competing with the National Health Service. In the new boroughs, people doing this class of work are not only paid more but are getting a larger weighting allowance than those working in hospitals. One wonders whether this is one more example of how NALGO has managed to cope for the people it takes under its protection. Like the noble Lord, Lord Crook, I cannot understand why the weighting in the National Health Service for those under 21 should be less than the weighting for those over 21. Before I sit down, I would thank the noble Lord once more for having put this Question forward, and say that I am sure most of us working in the London hospitals would support him fully in what he said this afternoon.
§ 8.22 p.m.
§ LORD TAYLORMy Lords, first of all, I should like to thank my noble friend Lord Crook for having raised what is an important subject at a very suitable time. The administrative and clerical staffs of our hospitals are an absolutely essential part of what I suppose would now be called the infrastructure required to make hospitals run efficiently. Anybody who has had experience as a doctor of receiving patients from hospital will know that one of the most important things to receive is a doctor's letter from the consultant, stating the treatment the patient has been receiving. I am afraid that these have not always been received as they should, and the poor general 840 practitioner does not know what medicines to prescribe to continue the treatment. Without clerks and shorthand-typists these things do not get done, and, of course, there are many other administrative jobs every bit as important.
I could give my noble friend a very short answer to his question of whether the appropriate authorities will examine the present rates for London weighting. It would be, "Yes". But I do not think that is quite enough for him, and I hope to give a little more explanation of what has been happening. My noble friend implied that this is not a subject for national negotiating machinery, but in fact it has been dealt with through national negotiating machinery because it is a differential between one part of the nation and another, and I think that this is right. My noble friend criticised this machinery for being slow. I must say that I, too, have often criticised it for being slow, but I will show him in a minute that it has not been slow in this case.
My noble friend gave his interpretation of London weighting as the differential in payment to make up for the unattractiveness of working and living in London. I agree with him: I much prefer to work and live outside London when I have the chance. But there are many people, particularly young people, who prefer to work in London; London has its attractions. But that is not a case for doing away with London weighting. London weighting is necessary because undoubtedly the cost of living in London is more expensive. London weighting has become customary in almost all national organisations and I will say something about the comparative rates which different organisations pay, because there does not seem to be a great deal of rhyme and reason in the many differential rates which are paid. I think that a philosophy for them needs thinking out.
My noble friend said that the N.H.S. staff have been waiting for something to turn up. As a matter of fact, something did turn up for them recently. On April 14, only two and a half months ago, the Health Service administrative and clerical staffs received a substantial rise in pay on the basis of a revaluation of their service, which was backdated to January 1. This rise was on average 841 about 14 per cent., which is a fairly substantial rise for these days. To give an example, a shorthand typist of 24 who received a salary of £588 had her salary increased to £660, which does not include London weighting. That is not a princely salary compared to those commanded by the modern shorthand typist, but it is substantially better than it was. This was not because they had not had a rise for three years. They had an award of an interim increase of 3½ per cent. only in July last. This was a true revaluation—and a very complicated job it was to do. Revalutions have also been carried out for other workers besides clerical and administrative staff.
It is true that that does not bear directly on what my noble friend wants me to talk about—namely, London weighting itself. Last summer a number of London hospitals, particularly in the centre of London, indicated that they were unhappy about the pay of administrative and clerical staff. I expect that my noble friend has seen a document prepared by the Teaching Hospitals Association. He indicates assent to that. That document is dated November 24, 1964, but it was not until April 22 of this year that the Teaching Hospitals Association formally submitted it to the Minister and to the Management Side of the Administrative and Clerical Staffs Whitley Council. So it has only got to the Ministry and the Management Side of the Whitley Council this April, and there has not been a meeting of the Whitley Council since then.
§ LORD CROOKMy Lords, I accept exactly what my noble friend says. Somewhere in this chain there is always a delay, but it does not appear to be his own Ministry.
§ LORD TAYLORMy Lords, I think that on this occasion there was a lapse of time in the submission of this paper by the Teaching Hospitals Association to the Ministry and to the Management Side, and until it was submitted the Management Side could not do anything about it. Normally this Whitley Council meets six times a year, but because in the previous period the Council had been doing this substantial study of the revision of remuneration they missed out one of their meetings, so 842 their next meeting is not until July 14. That is when they will be considering this document on the question of London weighting, and I am quite certain that they will take into account not only everything in the document but also what has been said in the debate. That is why I said at the beginning that it was so timely that my noble friend Lord Crook had raised it now.
As this is a Whitley Council matter, it would not be right for me to attempt to anticipate what the outcome of their considerations will be. My noble friend knows that very well. I have no doubt, however, that they will take into account the special problems of recruiting staff in London. I want to record, as a matter of interest, that there has as yet been no claim from the Staff Side for a revision of London weighting for any group of National Health Service staff. This seems to me a somewhat strange situation: that the request for a revision in the London weighting should come from a Management Side body, and not from the Staff Side—namely, the Teaching Hospitals Association who have made this request.
§ LORD CROOKMy noble friend will no doubt appreciate that I deprecate inefficiency from whichever side it comes.
§ LORD TAYLORThe noble Lord, Lord Auckland, mentioned the question of physiotherapists and other staff. I think that I should say a word about London weighting as it applies to the other non-medical staff in the hospitals. The ancillary staff are one large group. This includes people who are absolutely vital to the hospital service—cooks, cleaners, porters and manual workers, as well as tradesmen of various kinds. They do not get London weighting, as such, but they get a London rate of pay which is 12s. a week more than is given elsewhere; and when they are paid overtime, this is calculated on their London rate of pay. I think that they prefer to have overtime on such a basis rather than have fixed London weighting. Their figure was increased last year from 8s. a week to the present figure of 12s. a week.
Since 1962 the rates of London weighting for salaried staffs (except doctors and dentists, who do not get London weighting) have been as described by 843 my noble friend Lord Crook; that is, from £15 a year to £55 a year, according to age and salary.
My noble friend Lord Crook and the noble Lord, Lord Amulree, drew attention to the fact that the rates for staff under 21 are different, and that there is an age differential in this London weighting. As a matter of fact it is more complicated than that, because for staff earning up to £806 per annum the actual rates are £15 a year for staff under 21, £25 a year for those from 21 to 25, and £40 a year for those of 26 or over. I confess that it is a little difficult to see why a person between the ages of 21 and 25 should get something different from a person of 26 and over. But the argument, such as it is, for a line at 21 is that there is a difference between young people living at home and those who have to set up home for themselves. That is the argument which is adduced, and I may say it does not apply only to the National Health Service. This is a feature of local government awards, and also of the gas and electricity industries. I think the conclusion of such an issue is very much better left to a Whitley Council to thresh out and think over, so that they can take into consideration what my noble friend has said, as well as their own wide experience over this particular issue.
My noble friend Lord Crook and the noble Lord, Lord Amulree, have criticised the actual rate of London weighting. National Health Service rates of London weighting have always been similar to local government rates; in fact, they are now slightly better at higher levels, and nowhere are they worse. How it has come about that new London boroughs are poaching from the National Health Service I do not know, unless it be that they have greater flexibility in the operation of their grades and are able to grade people higher than would otherwise be the case. The Ministry of Health and the National Health Service do not enjoy quite that same flexibility that a local authority enjoys.
I have not said anything about the pay of physiotherapists or the other non-medical professional classes who also enjoy London weighting at the same kind of rates as we have already been 844 discussing. One can only say that it is for their respective Whitley Councils to determine what these rates should be, and they have always followed the Administrative and Clerical Staffs Whitley Council. So if there were a revision of the rates for the Administrative and Clerical Staffs, it might be that the other Whitley Councils would follow the same pattern as regards London weighting.
The noble Lord, Lord Auckland, asked about line-drawing and the effects of line-drawing. It must happen, wherever one draws the line, that there will be some people on one side of it and some on the other; and one always has great sympathy with those just over the line. The normal way to do it is by taking a line, say, four miles from Charing Cross or fourteen miles from Charing Cross, or something like that. This line may go through a hospital management committee area. Therefore, in the case of the National Health Service, if any revisions take place, it may be necessary to refer to certain hospital management committee areas. But, even so, there will be anomalies at the edge. I do not see how, if one is to have London weighting at all, one can avoid having the Epsom/Leatherhead situation.
Finally, my Lords, I fully recognise, as my noble friend Lord Crook has said, that there is a high turnover of staff in the London area. There has been difficulty in obtaining enough staff of the right quality, though I am glad to pay tribute to the work that is done. There is more reliance on agency staff than we should like to see. At the same time, agencies do fulfil a useful purpose in filling in gaps when a member of the staff leaves and before one is able to recruit a permanent member. I should not like to deprecate the use of agency staffs for that purpose; but that they should have to be used on a permanent basis is an indication that something is not quite right. I should like to thank noble Lords who have taken part in this short debate, and I hope that it will prove to be of value.
§ 8.37 p.m.
§ LORD CROOKMy Lords, while we understand that anyone who asks a Question of this kind has no right of reply, this does not mean that he is incapable of thanking the noble Lord for his kindness and courtesy in the reply he has given. And that I do.