§ 3.50 p.m.
§ LORD REIGATErose to ask Her Majesty's Government whether they will set up an inquiry into the workings of the Whitley machinery in the National Health Service. The noble Lord said: My Lords, I beg leave to ask the Question standing in my name on the Order Paper. It is a simple and straightforward question, and really demands but a simple "Yes" or "No" from my noble friend. If I thought I was going to get the answer "Yes" I would sit down very quickly but, judging from a reply given in another place a few days ago, I am very much afraid that the answer is going to be "No". I must therefore express in advance my disappointment, unless there has been a sudden overnight conversion in the Department of Health and Social Security.495
May I remind those who are interested in this subject that on August 17, The Times newspaper published a letter from Mr. Henry Brinton. Mr. Brinton is a friend and colleague of mine who has very long experience in all matters relating to the Health Service. Perhaps I may stress the bipartisan approach to this matter by saying that Mr. Brinton is also a life-long member of the Labour Party. In his letter, Mr. Brinton gave his reasons for resigning as a member of the Administrative and Clerical Whitley Council. It was a letter which contained many cogent reasons, which I will paraphrase—perhaps inadequately—as follows: First, he had a sense of futility in that the real authority, and the decisions of the Whitley Council, lay outside the members of the Council. Secondly, nothing over the years had really been done to redress the obvious anomalies and inequities that exist within the rates of pay and salaries inside the National Health Service, and which flourish under the present Whitley machinery. If I may quote Mr. Brinton's own words, he said:
The Whitley machinery is now obsolete. If it is not swiftly revised, there is a danger of a breakdown in the Service.
I would not take quite such a gloomy view as that. I have never known a time when the immediate breakdown of the National Health Service was not prophesied from one quarter or another.
§ The fact is that Mr. Brinton's outburst unleashed a flood of correspondence which shows the degree and the amount of dissatisfaction there is in all ranks and quarters inside the Health Service on this matter. Many of the complaints that were made related to the writer's own salary or rate of pay. In many cases. the dissatisfaction was justified—although I have never known anyone write to The Timesto say that they considered that they were adequately paid. The bulk of criticisms about the working of the Whitley machinery are and were justified. It is cumbersome and slow; the membership is often unrepresentative of either staff or management. It produces inequities and anomalies within the National Health Service and often takes inadequate cognisance of conditions outside the Service. Correspondence confirmed that dissatisfaction was widespread—a fact about which 496 many of us have been aware for many years.
§ Mr. Brinton was not original in his attack. I raised the question of the need for an inquiry into the Whitley machinery, in another place in 1965, in 1966, and in May, 1970. Mr. Kenneth Robinson attacked the Whitley machinery in a speech in the other place in 1962. Mr. Robinson is a good friend of mine, and was an admirable Minister; but I am sorry to say that when he went to his Department his view was that the machinery was satisfactory and we heard no more of the need for an inquiry.
§ An inquiry has been asked for from other quarters within the National Health Service. We cannot all be wrong in our view that the machinery could be improved. I should like to give some small examples of the faulty working of the Whitley machinery from my own experience as a chairman of a teaching hospital. Some years ago there occurred a shortage of pharmacists in the Hospital Service, due to the attraction of the higher salaries outside. This hit mainly the hospital services in the big cities, particularly London. There was a claim before the Whitley Council; it was considered by the Council with its usual thoroughness (but also its usual slowness), and the hospitals, short-staffed, unable to supply prescriptions to outpatients, had to give their out-patients "E.C.10s", which are the forms which indent on pharmacists outside the hospitals. That prescription is filled, quite reasonably and naturally, by the outside pharmacists at a far higher cost than it can be inside the hospital. Eventually there was an adjudication, and the salaries of pharmacists were increased. The hospitals were able to rebuild their pharmaceutical services. I think it is fair to say that the amount of the salary increase was far less than the actual cost incurred in having to farm out the prescribing through the E.C.10 forms.
§ The same story could be repeated many times over. Not long ago there was a great shortage of medical secretaries because, again, of the attraction of the pay outside. You cannot always depend on the job satisfaction that people get from working in the National Health Service, or on their loyalty. The Whitley machinery must be more responsive to outside circumstances. If I may refer to 497 another anomaly, the London weighting given for those who work in London is grossly inadequate, hence the shortages of staff which arise, nearly always first in London or the other big cities. What is the reason for that? It is because in the Whitley Council the actual London interests (if I may so put it) are a tiny minority; they are only a small part of the whole of the Hospital Service. There is another anomaly which my noble friend may like to take particular account of in this matter of the London weighting. The normal London weighting for, say, a hospital administrator is £ 90. But if he is a civil servant working within four miles of Charing Cross he gets £ 160. You get the anomalous position where a civil servant working at the Elephant and Castle is getting £ 160 because he is within four miles of Charing Cross, but the secretary of Charing Cross Hospital is getting £ 90. That cannot be justified.
§ Why do hospital administrators, and others in the National Health Service, have to contribute to their pensions, whereas their opposite numbers in the Department have a non-contributory pension? The result of some of these curious differences and anomalies is that I find that a hospital secretary of a 1,200 bed hospital, employing 3,000 people with a budget of £ 61 million per year, is on a salary scale below an assistant secretary in the Ministry, and only just above the scale of the private secretary to the Secretary of State. I do not think that the responsibilities are necessarily comparable. I could cite many other instances of discrepancies—and, indeed, straight injustices—but I have cited those in particular which have come to my notice fairly recently.
I do not want to detain the House too long, but I should like to make it clear to my noble friend that no-one wishes to abolish the Whitley machinery—that would be a recipe for chaos—at any rate not until an alternative and better means can be devised for negotiating salaries and pay. There have been many suggestions put forward for improvement and reform in the correspondence, particularly in a letter, which I hope my noble friend read, from the secretaries of the London undergraduate teaching hospitals. If I may quote from the very good leader in The Times for September 7, the position is this:
It is not, however, necessary at this stage to make an immediate choice between the improvement or replacement of Whitley. The best course would be to set up an independent official review of the procedure for settling the pay and conditions of hospital staffs.
I cannot better that as a summary of what I wish to ask my noble friend to do.
§ I have a feeling that my noble friend is going to say something on the lines that he would expect the need for any changes to be considered in the first place by the two sides of the Whitley Council, in accordance with its agreed constitution. That is fair enough, so far as it goes, but I ask for a little more than that. Flow can the Whitley Council satisfactorily examine itself? It needs an independent and outside inquiry. I would remind my noble friend that history tends to repeat itself, and we had a similar situation in regard to doctors' pay in 1957. I should know: I was at the Ministry of Health at the time. On that occasion the Government of the day took the courageous step of going outside the Whitley machinery and setting up a Royal Commision to consider doctors' and dentists' pay. They did a very thorough job; they produced a great Report and, as a result, we now have the Review Body, which I think one can say has, by and large, brought peace in the negotiations in the medical profession—at any rate, comparative peace; there will never be absolute and complete peace.
§ In his Introduction to the Consultative Document which he recently published my right honourable friend the Secretary of State said that his proposals differed from earlier proposals because the emphasis was on effective management. He stressed the importance of good management. How right he is! One can plan a brand new Health Service in a consultative document which looks terrific on paper; but it will not succeed, and it will not indeed be good management, unless it is based on a fair treatment of those employed. It is putting the cart before the horse to neglect this issue of staff relations when reforming the National Health Service.
§ 4.2 p.m.
§ LORD GARNSWORTHY
My Lords, before I begin dealing with the Question may I say that I notice that the name of the noble Lord, Lord Grenfell, is on the 499 list of speakers and that he is in his place? As he has so recently been in hospital, may I say that I am sure the whole House is delighted to see him here this afternoon and that we await with interest and pleasure what he has to tell us.
The Question tabled by the noble Lord, Lord Reigate, gives us a desirable opportunity of looking at an issue which has received, as he said, a good deal of publicity following the resignation of Mr. Henry Brinton from the Administrative and Clerical Whitley Council, which is a part of the National Health Service Whitley Council system. That system consists of nine functional councils and a general Council at the top. I doubt whether anybody thinks the set-up is perfect, and certainly it has been the subject of considerable and responsible criticism on a number of counts. As the noble Lord, Lord Reigate, said, there has recently been a considerable correspondence, particularly in The Times and the Guardian, and articles in both these papers, so there can be no doubt that public interest was indeed aroused by Mr. Brinton's resignation. To that extent, at least, he has been partially successful in some of his intentions. I speak as one who for some years served on a joint industrial council for local government employees and I served as an employer's representative. I there learnt that the Whitley system can produce results—good results, reasonably quick results. If I may say so as a life long trade unionst also, I know from experience in my own occupation that the system can work.
Having read the correspondence in the national Press and the articles that have been mentioned, and having discussed with some of the people involved the issues that are concerned in the Question, I find it impossible to avoid the conclusion that there are the strongest possible grounds for dissatisfaction with the way the system is working at the present time, and the demand for a review of the existing Whitley machinery in the National Health Service is therefore understandable. I have no doubt at all that the letters which have been written, including that by Mr. Henry Brinton, to which reference has already been made, in the Lancet of September 25 of this year, have been studied in the Department. They provided a very good basis on which any 500 review might be based, for they covered many, if not all, of the different types of skill employed in the Hospital Service.
Many of us are familiar with the position in regard to nurses. I am chairman of a residential school, and we have a pretty good sanitorium. We have difficulty at times in recruiting nursing staff. but we can always get nurses through an agency. I understand that in the Hospital Service much the same position obtains with regard to typists. I have been told pretty authoritatively of one hospital board that has an establishment of 27 typists. At one time it had three on the staff and seven from agencies. I am told that the agency typists fell far short of the standard requirement, but they were paid half as much again as the established ones. The complaint here is that there is far too much rigidity, and within the Department for which the Minister will be speaking this afternoon too little recognition of difficulties encountered at district level, where problems are particular and local. It is no exaggeration to say that, although the worst has never yet happened, the situation is at times explosive—highly explosive.
As I said, I am a lifelong trade unionist. I am proud to hold life membership of one trade union and to enjoy a very close association with another, NALGO. Your Lordships will therefore appreciate that it occurred to me to get in contact with a number of trade unions catering for those who serve in the national Hospital Service. I can summarise what they have conveyed to me by way of criticism of the way in which the negotiating machinery works, as being (a) too rigid; (b) too slow, and (c) too unresponsive to local needs. I am told that in the years from 1947 to 1962 the position used to be a great deal worse. Indeed, I recalled, before the noble Lord, Lord Reigate, reminded the House, that in 1957, as Mr. John Vaughan-Morgan, he was Parliamentary Secretary at the then Ministry of Health. So he will have been aware of the difficulties that, as I am informed, were even worse then than they are at the present time.
On the criticism of rigidity, the strong hand of the Treasury seems to be always apparent. As was stated by Mr. Stanley Mayne, Chairman of the Staff Side of the Professional and Technical"A"Whitley 501 Council, in The Times of August 21 this year:What ought to be realised is that as the whole expense of the National Health Service falls on the Exchequer, then the whole control of salaries is a matter of Government policy.He went on further in his letter to say:The proposal over the years from the staff side of this Whitley Council, that in order to obtain a fair share of the available men and women at this level requires that these professions should be given salaries and a career value roughly equivalent to that of teachers. This has always been rejected notwithstanding powerful support from influential medical men and women who realise the grave difficulties occasioned by the serious shortages in each of these professions supplementary to medicine. This refusal by the management side of the P.T.A. Whitley Council to agree to the staff side proposition has never been ascribed to the natural wickedness of the management side but has derived quite clearly from Government policy and Government decisions against which the management side could make no useful impression.While it is appreciated that the Treasury is bound to be involved, it is felt by the trade unions that management representatives should be able to enter into negotiations and be empowered to make counter offers to the staff side without having to ask for an adjournment, which again, as I am told, can mean, in some cases, several weeks' delay.
On the subject of delay, I might refer to the Pharmacy Technicians Committee of the Professional and Technical Council "B". The staff side submitted proposals for the regrading of pharmacy technicians arising out of the Noel Hall Report in February this year. A joint meeting to consider these proposals was not called until Friday, October 15. and when the staff side arrived they had to wait well over an hour because the members of the management side, apart from the departmental representatives, had not been supplied with the staff side's proposals, nor with the Department's counter proposals.
On the criticism of being too unresponsive to local needs, a letter in The Times of August 23 from Mr. P. W. Dixon, House Governor and Secretary of the Hospital for Sick Children, I think is not irrelevant. I have little doubt that the Department will have taken note of it.Mr. Milne"—Mr. Dixon points out, writing in a letter dated August 19—rightly, in my view, recognises that the Whitley Council system is open to criticism, … 502 We have unhappily learnt to live with it, but our real criticism is not that it is obsolete, but that it is totally unrealistic and unnecessarily inflexible;He continues:There are two further points to which I would draw the attention of your readers"-—which raised the point made by the noble Lord, Lord Reigate, and I refer to it only because Mr. Dixon gave not the figure of £ 160 but of £ 175, which makes matters even worse. He also drew attention to the fact that the Civil Service enjoys a non-contributory pension scheme whereas all grades of staff in the Hospital Service arc compulsorily superannuable at 6 per cent, per annum. Six per cent. per annum, my Lords, is a pretty substantial difference from nothing.
Mr. Dixon went on:One could make many other points; let one suffice. The salaries of para-medical workers—the so-called professions supplementary to medicine—are basically and outrageously inadequate. Upon the love, loyalty and devotion to the hospitals—my own included—of these and many other grades of staff we are totally dependent. It is time that the rewards were more adequate, that the books were opened, the frustrations revealed. What we ask is for a more flexible system within which to operate; the skills of management are no less in the hospital service than in other fields; the restrictions appear to be greater and the service to the patient consequently impeded.There have been some suggestions that the Whitley machinery in the Health Service should be abandoned, and I should like to give a brief quotation from a letter written by Mr. Geoffrey Drain, the staff side secretary of the Health Service Administrative and Clerical Staffs Whitley Council, in The Times on August 18. He said:It is not Whitleyism itself which is at fault but the way in which it is operated in the Health Service, with its undue rigidity and incapacity to respond to change of circumstances and local needs.As The Times of September 7 put it:… there is a danger that simply to sweep away the Whitley machinery would be a gesture rather than a policy.Whatever is contemplated, I think it is essential that the confidence and trust of the trade union movement is ensured. As I understand the attitude of the trade unions, at least those with whom I have been in contact—and I have been in contact with quite a number—it is that 503 Whitleyism can be improved. Its weaknesses can be remedied. It can be made to work effectively and reasonably speedily. What is required is a constructive and co-operative approach, and I can say that the trade union side are prepared to play a full part in seeking that. I think it important to remember that, in any negotiating machinery, when the two sides go into the room to discuss, both sides should possess bargaining powers: one side ought not to go in with its hands nearly always fettered.
It is fair to say that the trade unions take the view that a thorough review of Whitley machinery should not be undertaken on an ad hocbasis: they think it ought to be a part of the examination being given to the whole Service. It may be that the existence of nine different councils is too many, but it could be that one council might be too few and could produce a situation in which there were interminable delays, even with the best will in the world. I am positive, and a great many people involved in the Health Service, and certainly on the staff side—and we have heard it from the noble Lord, Lord Reigate—feel, that there is an urgent need for son-le relaxation of Treasury control, for more flexibility to be permitted in negotiation, and for greater trust and responsibility to be given to those representing management at local levels. There needs to be a close look at the make-up of those representing management. May I make the suggestion that the Government should look at the possibility of setting up within the Department a section which should be designed to ensure that those working in it find good career prospects. Urgent attention might well be given to the training and to the development of staff in this particular field, with staff participation being secured in change and reorganisation as these may be under consideration.
There is a strong feeling that there is need for some greater permanence of Departmental and management representation on Whitley Councils. Greater permanence there would be of particular value because part of the difficulty today seems to lie in too frequent changes of personnel, due to promotion which necessitates the loss to the management side of the experience which has been 504 gained. I would not think that some changes, some developments, such as the one I have just been touching on, need wait for a very thorough examination. The problems of rigidity and inflexibility could be dealt with; many delays could be avoided. The Department can hurry when it is under severe pressure, and I hope that now that this matter has been raised in this House the pressure will be maintained. I would emphasise that there should be the closest consultation with the trade unions at every stage whenever there is talk of change being made, and, most vital of all, discussions with the trade union side at a very early stage at the very outset of consideration.
On this side of the House I think I can say that there is a recognition that the Service is suffering badly from the defects which have been mentioned. A solution must be found. Whatever form an inquiry may eventually take, the Staff Side must be involved; their views must be fully taken into account, again I repeat, from the very outset. I hope that when the Minister comes to reply he will be able to give the House some pretty clear indication of the Government's intentions. I hope he will not ride away by saying briefly that this can all be left for consideration when we are looking at the whole set-up. I hope that the Minister will be able to tell us whether the Government have any ideas, and if so what they are, in regard to the integrated service foreshadowed in the Consultative Document where the local authority element will be coming together with the hospital element. I think it is reasonable to suppose that the Government should have given some thought to that. If they have not, I beg them to be in consultation with the trade unions fairly shortly.
With regard to the short term, can the Minister tell us whether the Government have under consideration practical proposals to remedy any e the defects that have been mentioned, and to improve negotiating procedures, with less rigid Treasury control, to give departmental and management representatives real scope for bargaining and negotiating? I believe again, if I may say so, that the Government would find the trade unions, if asked to help, not only willing but ready to make constructive proposals. But of the urgency of the question there can be no doubt.
§ 4.23 p.m.
§ LORO AMULREE
My Lords, before 1 commence the few words that I propose to address to your Lordships I should like to join with the noble Lord, Lord Garnsworthy, in saying how pleased I am to see the noble Lord, Lord Grenfell, looking as well as ever and that he is going to say a few words to us later on.
For some time past I have been talking about what I consider to be the evils of the Whitley machinery in the National Health Service; that is why I am so pleased that the noble Lord, Lord Reigate, has put down this Question and given us a chance to talk about it. Surely one of the fundamental troubles with the Whitley machinery is that it was started a very long time ago with quite a different purpose. Then it was for employers and employees in the true sense of the word, whereas with the present system in the National Health Service the employers' side is not free to bargain they have always, as the noble Lord said, the feeling of the Treasury at their back, and they are not very free agents. I have attended two meetings of the Whitley Council, having gone with the Staff Side of an organisation with which I was then involved. I was most depressed at the effect, because although we were pleasantly treated, fairly treated, kindly treated, we knew from the start that the fiat had gone forth as to what we could do and that nothing we could do was going to change it.
The machinery is too ponderous and slow, and is not efficient at the present time. Why should it not be possible, as I think the noble Lord, Lord Reigate, suggested, that some body should be set up, like the review body dealing with members of my profession, which works, on the whole, pretty well? I know that some doctors do still come under the Whitley machinery, but they are the few employed in the public service and not those engaged in practice of any sort dealing with patients outside the public service. I am quite sure that something like that could be set up without a great deal of difficulty, covering, shall we say, the nurses and the various professions subsidiary to medicine, the para-medical people who do such a great deal of work for the service. A body of that sort I think might get rid of several anomalies in the salary scales. I am thinking par- 506 ticularly of the case of a large hospital where the salaries depend on the number of beds, and particularly of the mental hospitals. This means that the staff have no encouragement to treat their patients properly and to discharge them into the community, because that would mean a reduction of beds and therefore a reduction of salary. That is one of the great drawbacks. The purpose of a hospital should be gradually to reduce the number of beds it requires as it treats more people efficiently and well.
I am extremely pleased that the noble Lord has put down this Question. But I was rather sad when I read in Hansard that the Secretary of State in another place said, in reply to a recent Question that he would expect the need for any change to be considered in the first place by the two sides of the Whitley Council in accordance with its agreed constitution. If that is what we have to wait for, we shall wait until the world has come to an end before we get anything new. I am quite certain that the problems we are confronted with now are far too serious to wait for a long time. I very much hope that the Minister will be able to give the noble Lord, Lord Reigate, a rather more encouraging reply.
§ 4.28 p.m.
My Lords, before I begin may I give my deep and grateful thanks to the noble Lord, Lord Garnsworthy, and the noble Lord, Lord Amulree, and indeed to everybody from all sides of the House who has so kindly sent messages to me in what has been rather an anxious time. In passing, may I humbly and with deep gratitude say "Thank you" publicly to the surgeon, the doctors, the nurses, at King's College Hospital. I think they have completely saved my eye and I shall be all right in about two or three weeks' time. I am deeply grateful to them. I was very proud when I left the hospital to feel that I play a small part in the National Health Service and the Hospital Service.
I have been unable to write a speech, but if I may talk for a moment in the line of a parable, a hospital is rather like a ship in the Navy, a group of hospitals like a flotilla, and the Hospital Service like a fleet. This ship has many cogs in it, it has many men and women who work together, and if by any chance any one of them lets the ship down it 507 may not only cause inconvenience but it could cost life. The only difference between the Royal Navy ship and the hospital "ship" is that when there is a pay rise in the Royal Navy everybody gets it, whereas, in the Hospital Service, under the Whitley Council, some people get a pay rise from one of the councils and some do not. Pay rises are not coordinated. Pay rises are not allowed on a certain common date, and, according to the different councils, there are also differences in overtime rates. This does not help to make what we all know we need, both in the Navy and in our hospitals, a happy ship. It causes difficulties and misunderstandings; above all, for the ordinary people who work in the hospitals, it causes bewilderment, which is not a good thing.
May I mention one small anomaly which struck me when I was thinking over these few words. For some unknown reason one of the points relevant to the pay of a building supervisor in a hospital or group of hospitals is the number of outpatients in that hospital or group of hospitals. For instance, in a general hospital which has a great number of outpatients the building supervisor will get his pay calculated on that number of outpatients. Next, take a group of hospitals such as the one of which I am proud to be chairman, which are hospitals for the long stay mentally subnormal. We have very few outpatients. Therefore, although our buildings are spread a great distance apart, the building supervisor cannot attain the pay of the person doing exactly the same job in a general hospital. This seems to me to be one of the unfortunate anomalies which cannot really be explained to the person concerned. I have no idea of the attitude of the trade unions to this situation, except from what the noble Lord, Lord Garnsworthy said, but I feel sure in my mind that, if possible, we should have an inquiry to try and produce some form of sensible framework for pay, et cetera, throughout the whole of the Hospital Service, so that we can have a coordinated service and, above all, an understood and a very happy ship.
§ 4.34 p.m.
§ BARONESS SUMMERSKILL
My Lords, may I join with those who have welcomed the noble Lord, Lord Grenfell, 508 back to our flock. Having listened to him, I must say that his operation and his illness have not marred his fluency, and that what they have done, if it is possible, is to increase his compassion. The contribution which he has just made is what we might have expected from him, having heard him on debates similar to this over the years.
The noble Lord who put down this Question and I sat in another place for many years, and we have sat through debates like this over and over again. We have heard the same expressions of opinion; we have seen Ministers getting up and making half-promises. But the years have gone on and nothing has been done. What is happening now is a result of the failure to remedy the operation of the Whitley Council. We are now seeing the end products, and I am very depressed when I see so often in the papers criticisms of the National Health Service. We see foreigners coming over here, going round and then making a lukewarm comment when they leave our shores. Every now and then there is a scandal. It appears that a young nurse in her first year has been left all night looking after a ward of patients; or mental patients are ill-treated; casualty departments are closed and, in consequence, accident vicitims from the cars on our roads fail to find a doctor in charge. This all stems from one thing only: the matter that we are talking about to-day.
The fact is, my Lords, that the people who serve in our National Health Service are unique inasmuch as they have a sense of vocation and are reluctant to ask for adequate remuneration; and the Whitley Council exploits this. What we have heard to-day has been going on for years. All that is happening now is that these people who are being exploited in our hospitals—and I would say, broadly, that everybody below the consultant status is inadequately paid—are now becoming resentful: resentful to the extent that the consumers of the National Health Service come out of our out-patient departments, come out of a group practice, come from their doctor and have a complaint, and we hear for the first time the suggestion that an Ombudsman should be produced for the National Health Service. What a reflection on this wonderful Service to suggest 509 appointing an Ombudsman to inquire into the complaints about the doctors!
I do not know how long we are going to wait before something is done. I suppose we shall have to wait until there is such an appalling scandal, or until the under-staffing of our hospitals and clinics is such that the closures are so great that they cannot be overlooked. At the moment, of course, maternity wards which are needed cannot be opened because there are not enough nurses; casualty departments are closed; new hospitals are built but cannot be opened because there are not enough nurses. The fact is that we know that the girl who is prepared to nurse is generally a jolly fine child—or little more than a child. She is prepared to go and do jobs which many people in this House to-day would refuse to do; jobs which are unpleasant, jobs which are not congenial. She is prepared to do these for a miserable wage. But even these girls, after the first year, find the position unendurable, and one-third of these marvellous young women resign in the first year. They cannot start until they are eighteen—and many of them, after leaving school, fill in the years doing some sort of a job waiting for the time when they can go into a hospital ward—and then we find that in the first year we lose one-third of them; and this is, in my opinion, because we exploit their sense of vocation. It all comes back to the failure of the Whitley Council.
Somebody asked just now, "What about the agencies?" I went to the Nurses' and Midwives' Conference on Monday and, to my amazement, an ex-sister came up to me and said, "Could you do something to close these agencies?? Of course I will not close the agencies. I think one of the noble Lords who has spoken said that when hospitals are short—and all hospitals are short now—they have to go to an agency where they may have to pay a nurse from the agency twice the amount they pay nurses on the ward—and, indeed, perhaps more. I was asked to help to close these agencies which this sister—of course she was quite mistaken—thought were taking the nurses from the hospitals. The reason the agencies exist and prosper is because the Whitley Council fails to do its job in the first place. If the Whitley Council saw to it that these nurses were adequately paid, the nurses would not go 510 to an agency and say, "Get me a job where I get better conditions." It is the very failure of the Whitley Council that enables these agencies to exist and prosper. I would not try to close them. Their nurses are fully qualified; the agencies are not using people who are not qualified. But what they are doing is seeing that their nurses are adequately paid; and perhaps this, in itself, will force those in authority to see to it that the Whitley Councils do their job better.
I have only to remind your Lordships of what is happening. As I mentioned, the wards and casualty departments are overcrowded and understaffed. In the field of mental health,45 per cent. of our beds in the country are filled with patients suffering from some mental disability, and just a picture of those wards seems a disgrace to the National Health Service. The beds have hardly a foot between them; the wards are crowded, and they are so understaffed that these poor unfortunate creatures who are removed from our midst—perhaps thereby saving our consciences—have to sit like cabbages around the wards because there are not enough nurses to entertain them or keep them alive. Every now and then we have a scandal, and we hear that a male nurse has ill-treated somebody. But we must not simply say that the male nurse was a savage. How far are these nurses aggravated not only by the patients but by the knowledge that their skill and their vocation are being exploited? They are underpaid, and the only weapon which the under-paid worker has in this country is the strike weapon, which we hear about. But the only people who cannot and will not go on strike are the worst paid in the country; and they are the workers of our great National Health Service.
§ 4.42 p.m.
§ BARONESS HYLTON-FOSTER
My Lords, a large number of anomalies have been mentioned and I should like to refer to another covering a very important member of the National Health Service; that is, the nurse. I do not know whether it is a general practice in all hospitals—it is certainly so in a hospital which must be very well known to the noble Lord, Lord Reigate, who has asked this Question—that a student nurse in her first year will get a certain salary; in her second year she will, with luck, get a little more 511 but will probably be obliged to move into a better room; and in her third year she will have no option and must move into a much better room. That means that although her salary is increased she loses a large proportion of it, because she has to pay a much larger amount for her room. This is really not an incentive for the nurses to stay on—a point made by the noble Baroness, Lady Summerskill—and it contributes to the wastage of nurses. I feel that there must be a very real lack of contact and communication between those on the spot, who are doing the job, and the Whitley Council.
§ 4.44 p.m.
§ LADY RUTHVEN OF FREELAND
My Lords, may I add my delight at seeing the noble Lord, Lord Grenfell, back again with us looking so well? May I say how much I support the request of my noble friend Lord Reigate for an inquiry into the workings of the Whitley machinery in the National Health Service. I agree with what has been said on this subject this afternoon. I could give many further anomalies, but the most important is that in the Health Service nobody is paid at the same rate for the same work in civilian life. In the last week I have had two examples of this. The first example concerns catering officers. A complaint was made about the food in a great teaching hospital in London, and the answer was, "We cannot get the catering officers because we cannot compete with the outside world in the amount we pay them." The second example is that of technicians in teaching hospitals. We all try to put our technicians into a school, because they get higher pay than the technicians working in the hospitals. Those are two very broad statements of fact; and I know them to be true because I have heard about them in the last few days. Therefore, I beg the Secretary of State to change his mind and make some inquiry into the workings of the Whitley machinery, to see how improvements can be made for all the many people in the Health Service who are dealt with by the Whitley Council.
§ 4.45 p.m.
§ THE MINISTER OF STATE, DEPARTMENT on HEALTH AND SOCIAL SECURITY (LORD ABERDARE)
512 My Lords, I am grateful to my noble friend Lord Reigate for raising this matter this afternoon and for giving rise to a debate which has been of great interest. A number of your Lordships have contributed from your personal knowledge of the working of the Whitley Council, and I will certainly undertake to look at the various points that have been made. It goes to show the immense complication of the matter that so many difficulties have been brought to light this afternoon. There can be no doubt at all about the importance of securing that the National Health Service should have effective machinery for settling these terms and conditions of service. There cannot be any doubt, either, that this is a subject on which it is possible to hold many different views, as emerged in The Times correspondence which has been mentioned this afternoon and from which the noble Lord, Lord Garnsworthy, quoted. I appreciate the trouble he took to find out the reactions of the various unions concerned—he is connected with some of them—and although we do not always see eye to eye, certainly the unions concerned play a most helpful part in the Whitley negotiations. May I also add my word of welcome to the noble Lord, Lord Grenfell, on his return? I may say that I hardly noticed his absence, because he managed to conduct a very spirited correspondence with me even from his hospital bed. But I am delighted that he is now back in person. In the course of my remarks, I will try to touch on some of the points that have been raised.
I do not want to go into any detail about agency nurses and agency typists, but I should like to touch on the subject to start with. We are naturally very concerned, but I do not think it can really be said that it is only a matter of pay. There are a number of nurses who find it a far more convenient way of working and they prefer not to be tied down in the Service. They like the freedom which is given them by an agency contract. They may be married women who want greater freedom and there are other considerations which enter into the matter. As I said, I do not want to go further at the moment into the agency situation, other than saying that we regret very much that there are so many agency nurses who have to be employed, especially in London.
§ LORD GARNSWORTHY
My Lords, does the noble Lord suggest that the same consideration applies to typists?
BARONESS SUMMER SKILL
My Lords, if I may say so, the noble Lord has tried to gloss over this subject, but the nurses' profession in the hospitals is very much concerned with it. He said that it is not a question of pay, but of course it is. These days, most hospitals are prepared to take married women on a part-time basis and all the conditions offered by the agencies are acceptable in the hospitals. The hospitals are now in such a desperate plight that they will take anybody.
§ LORD ABERDARE
My Lords, I have not tried to gloss over the matter. I have simply said that this is a problem. As the noble Baroness will find out an agency contract suits many women better and it is not only a question of pay. If you put up the pay for nurses in the Service, the agencies raise the pay of the nurses working for them. None of these matters is simple. The criticism of the Whitley settlements varies according to the viewer's standpoint. Some say they are too complex, some say too rigid, some say too broad, some say too detailed, some say too infrequent and some say too many, but a pay system covering some 700,000 staff in all parts of England, Wales and Scotland, belonging to hundreds of professions, trades and occupations and in the service of several hundred different employing authorities, can hardly be other than complex. I found my noble friend Lord Grenfell's comparison with the Royal Navy very tempting, but I am afraid that the National Health Service is rather more complex, though I am sure the Secretary of State would like to be in the position of the Commander-in-Chief. But if the pay system is unnecessarily complex, any of the parties can seek to change it—and changes have been made. There has been considerable reorganisation and simplification of pay structures for administrative and clerical staff, for senior nurses in connection with the introduction of the Salmon structure, and for ancillary staff following a comprehensive job evaluation.
514 It is clearly the concern of management that pay structures should fit the needs of good organisation. Those who negotiate pay structures need guidance from those concerned with organisation, but it is by no means clear that National Health Service employers in the past have given their Whitley representatives coordinated guidance on the general objectives that they should pursue in negotiation. Objectives should, however, be easier to define when we have an integrated service, and better guidance for the future should flow from the expert study into the management arrangements of the proposed new health authorities. The composition of the Whitley Councils has reflected the special features of the National Health Service, in which the staff are in the employment of hundreds of separate authorities although they are all in fact engaged in providing the same national service. The three Secretaries of State have responsibility to Parliament for the National Health Service as a whole, for achieving high standards, constructive policies, good management and sound finance. It is therefore appropriate that their officials should serve with representatives of the employing authorities on the management sides of the Whitley Council. Their function is not one of negative financial control, and, indeed, the financial constraints observed by National Health Service management are much the sane as those that have to be observed by any public service.
There have been suggestions that the salaries of all Health Service staff, or at least major groups, should be determined by a body independent of management and staff. This was the suggestion of the noble Lord, Lord Amulree, comparing it to the pay review body for doctors and dentists. This would, of course, give local management less opportunity than now for securing their own objectives on recruitment and pay structures. Staff interests would also lose the direct say which they at present enjoy in the Whitley Councils. I have mentioned the wide range of occupational groups which all expect some voice in central negotiations. If we take the Nurses and Midwives Whitley Council, for example, which covers some 330,000 staff, we find that its staff side includes 12 professional organisations and trade unions representing every branch of nursing in the hospital and local authority services. I 515 think it is difficult to compare these Whitley Councils, negotiating on behalf of a number of different trades and occupations, with the pay review body for doctors and dentists.
One important fact which is often overlooked is that the Whitley Councils were not set up by Statute or Ministerial decree. They were established by voluntary agreement between the parties, and any departure from the principle of collective bargaining would not work unless it had the general support of both sides. It would be quite wrong, I suggest, to assume that changes of structure cannot be achieved by agreement. The General Council has only recently been reorganised on the management side to be fully representative of the functional council management sides, and this should enhance the possibility of its taking a more active part in the improvement of the Whitley system as a whole. As the noble Lord, Lord Garnsworthy, said, I think quoting from one of the letters to The Times,"Whiticyism can be improved". We very much hope that it will be, and we see the improved organisation of the General Council as one step in the right direction.
A number of criticisms made, both in The Times and in this House to-day, have centred on three main points: that Health Service salaries arc not comparable with salaries elsewhere, that London weighting is inadequate and that Whitley agreements allow too little discretion for local management. Perhaps I may deal with those three points. First of all, in an organisation as large as the National Health Service there is always someone's pay in need of review at any given time, and, of course, Whitley negotiations are a continuous process of comparison and adjustment. The pay of several key groups of National Health Service staff is kept in line with prevailing levels outside through links with the Civil Service and local government; and as a broad test of whether National Health Service pay is competitive, it is a fact that staff numbers continue to increase in almost every sector.
Secondly, there is the matter of London weighting, which was raised by my noble friend Lord Reigate. London weighting is currently under review in the National Health Service, but in fact it compares generally with levels in the Civil Service 516 and local government. Since the appointed day, London weighting in the National Health Service has followed the arrangements agreed for local government. Preliminary discussions on weighting for non-ancillary staff have taken place in the Whitley Council, following the recent agreement for revised allowances and a new inner weighting area for local government administrative, professional, technical and clerical staff, which is operative from May 1,1971; and discussions on a formal claim are expected to take place shortly. I think my noble friend may like to know the new local government rates, which are £ 144 in the inner zone and £ 105 in the outer zone. The previous local government rates, which are the ones which apply at the moment in the National Health Service, were £ 90 for staff aged over 18 and £ 50 for staff under l8. So I can assure my noble friend that there is movement on the front of London weighting. As for the question of local discretion, my right honourable friend the Secretary of State and I are anxious to achieve the maximum delegation of authority to local management. There are obvious difficulties in reconciling local discretion on salary levels with pay agreements applying to a national service, but we are considering how to get the right balance between flexibility and uniformity; and, of course, as my noble friend I know agrees, a complete discretion would be a recipe for chaos.
The noble Lord, Lord Amulree, also raised a question in connection with the adjustment of salary according to the number of beds—and this is indeed a problem. One obvious difficulty is that in many cases a large hospital with a large number of beds carries more responsibility than a small one, and therefore the man doing the job there should reasonably have a higher salary. But, of course, as the noble Lord pointed out, this may well have repercussions in the case of psychiatric hospitals, where they are anxious to cut down on the number of beds, although, as I am sure he is aware, the salary of existing staff is protected.
§ LORD AMULREE
My Lords, may I interrupt the noble Lord for one moment? They are affected when it comes to their pensions, and not in relation to their existing salaries.
§ LORD ABERDARE
My Lords, their existing salary is not reduced if the number of beds is reduced; although the post may be re-classified if they leave it and it is advertised. But the results of management study should help to provide a method of evaluating top posts which is not so dependent, we hope, on bed numbers.
The proposed reorganisation of the National Health Service will require sonic changes in the existing Whitley structure, if only to take account of the new pattern of employing authorities and the inclusion of former local authority staff. But I have to say to my noble friend that the answer, which I know he is expecting, is that we do not think it appropriate to ask an independent body to consider more fundamental changes at thin particular moment. In the first place, as I have said, reorganisation is under consideration. This will necessitate close consultation with the stall interests, and it would be advisable to preserve the established channels of communication in this important period. In the second place, the shape of the negotiating machinery for the reorganised National Health Service should match the new management structure which is still under consideration. In the third place, the existing Whitley machinery is based on voluntary agreement. Any new machinery should recognise the principle of collective bargaining and any changes would most appropriately be achieved through direct discussion between management and staff. That, I think, meets the point made by the noble Lord, Lord Garnsworthy.
In due course, we shall wish to consult the new authorities and the wider staff interests that will be involved in a reorganised service. Meantime, may I repeat how much we value the views expressed by existing management and staff bodies and by those of your Lordships who have spoken to-day and who have been so closely concerned and interested in the efficiency of the Service and the welfare of its staff.