HL Deb 21 November 1973 vol 346 cc1163-88

8.7 p.m.

LORD REIGATE rose to ask Her Majesty's Government whether they are aware of the dissatisfaction and concern amongst various grades of staff affected by the reorganisation of the National Health Service. The noble Lord said: My Lords, I feel that, in the traditional phrase, I ought to apologise for detaining your Lordships at this late hour, and particularly my noble friend the Minister of State. Many of the remarks that I have to make are of rather a technical nature, and those who are not acquainted with the workings of the National Health Service may be a little baffled by some of my remarks. The reorganised National Health Service starts afresh in April, 1974. It goes without saying that all of us wish it well. It is to no one's interest that it should fail, or that the transition should not be smooth. I hope that my noble friend is not going to accuse me of being in any way unhelpful, as he seemed to suggest to one noble Baroness in a question and answer exchange the other day.

The smooth change-over on the appointed day depends not on doctors or nurses, or even ancillary workers, but, above all, on the administrative staff, using the word "administrative" in its widest sense—the nursing administrators, treasurers and so on. They, and they alone, can make or break the reorganisation. It is to them that my Question refers, because their morale at the moment is very low and there is frankly a crisis of confidence inside the Service. I am sure that my noble friend knows that I am not exaggerating and that it is not an occasion for any kind of cheery optimism that "It will all be all right on the day."

I know that the Secretary of State has received representations on various matters from the Royal College of Nursing, the Teaching Hospitals Association (not normally a very militant body), the Insti- tute of Health Service Administrators and the National Association of Local Government Officers, as well as individual protests from employing authorities and members of the staff. Many of these relate to the procedures of the Staff Commission, and it is to that that I wish to devote the first part of my remarks. The Staff Commission was set up— to take any steps considered appropriate for the purpose of selecting and recruiting to Regional and Area Health Authorities persons suitable for employment. It was agreed after consultation with various bodies that the Staff Commission should also do the job of short-listing for certain key posts. This was in the interests of a smooth and, above all, a swift transition. I cannot but feel that NALGO and some of the others who agreed may now regret their acquiescence in this procedure.

What is it that has gone wrong and caused the waves of criticism? Let me admit first of all that the Staff Commission had a very difficult job—an almost impossible one. They, after all, are not responsible for the timetable, the very strict timetable, which has to be adhered to. I am afraid that my right honourable friend the Secretary of State must bear the full blame for any difficulties which arise from the timetable. But there is much criticism of the decisions of the Staff Commission that followed.

In what may seem to be a slight digression, I should like to deal with the curious case of the postgraduate hospital staffs, which occurred last summer. The Staff Commission ruled that postgraduate hospital staffs were not eligible to enter into posts in the new, reorganised Health Service. The reason they gave was that the postgraduate hospitals are not being immediately reorganised. They are put on one side and reserved for what I might call "unhappy despatch" at a later stage, whereas, of course, the undergraduate teaching hospital boards of governors are being abolished now. But this decision to exclude them from competition forgets that this is, in effect, one single profession which is interchangeable. The average hospital secretary's career may involve transferring from an undergraduate teaching hospital group to an ordinary hospital group, to a postgraduate hospital group and so on. The result is that this small minority of staff is now precluded from participating in the reorganised Health Service, and they are, so to speak, left in limbo because it is unlikely that there will be very much change for some years after 1974.

This ruling of the Staff Commission seemed so unbelievable that counsel's opinion was sought and the advice received was that the Staff Commission's ruling could and would be overruled by any court of law. But, alas!, my Lords, no member affected by this was willing to jeopardise his career by taking the Staff Commission to court, and, what I think is more regrettable, no Board of Governors employing any of them was apparently prepared to support them in taking the Staff Commission to court. So the Staff Commission and the Department got away with it. There is a slight, curious sequel to which I shall refer later. But this, my Lords, is a minor issue affecting very few people, compared with the subsequent events. The major issue concerns the complaints which have been received about the short-listing procedures for the area appointments. For various reasons the regional appointments seem to have caused no difficulty and excited no criticism at all.

The task of the Staff Commission was. among other things, to safeguard the staff interests and to ensure that the senior staff of the reorganised National Health Service were of the highest possible character. If that was their task, never can the outcome have been greeted with so much dismay, as the representations to the Secretary of State show. The choices for these short lists seem to follow a very haphazard pattern. Many with heavy present responsibilities have not been short-listed; others with far less experience and responsibility have been accepted for short lists. I have had altogether about 20 cases drawn to my attention, and no doubt there are many more. I should like to cite a few, but in most cases I shall have to do it in a form obviously in which they are not identifiable. Most of the people concerned are not personally known to me, but they are vouched for by those in whom I can have confidence.

The first case is of a teaching hospital secretary not short-listed for the administrator's post in the teaching area in which his teaching hospital will be absorbed. He is a man outstanding in his career, of sterling work. The second case concerns a hospital group secretary who is the secretary of the joint liaison committee, the body preparing for the transition. He was not short-listed for his own area, which was a single district area; in other words, it coincided more or less with the catchment area of his present hospital. In this particular case the circumstances were even more extraordinary. He was only two or three years from retirement, and would therefore have been the ideal person to see the new area through the transitional period. The sequel is quite interesting. The new authority was so horrified at the treatment meted out to him that they have not appointed anyone from the short list, and are hoping, I imagine, to be able later to appoint this particular man.

The next case is that of a chief nursing officer, Grade 10a, which is almost as high as one can get, not short-listed for any area at all, including his own area, although the latter—that is to say, his own area—was listed in a Staff Commission circular which said that more applications would be welcomed from this area because there had been so few. Another case is that of a big city with four hospital groups. Three of the hospital secretaries have been short-listed, but not the fourth —who, as it happens, was the one who was chosen by universal consent to be the secretary of the joint liaison committee and who has therefore been preparing in advance for his own exclusion. The last case I would cite is that of a group secretary who was not short-listed for his own area, where there was a short list of five only, although the Staff Commission had decided that the short list should be seven. He was very dismayed and disappointed. However, there is a happy sequel. He was then short-listed for a teaching, hospital area—that is to say, a post of a higher grade than the one for which he had not been short-listed in his own area—and I am glad to tell your Lordships that I heard yesterday that he had been appointed.

I could cite many more cases; and I should like to emphasise that it is not only those who have not been short-listed who are dismayed, but that many of those who have been short-listed (indeed, who have been successful) are I concerned at the treatment that has been meted out to their friends and colleagues in what is, as everyone knows, a very small and close-knit profession. They are dismayed at the absence of rhyme or reason in the very methods by which they, the successful ones, have been preferred over their fellows.

My Lords, the volume of protest was so considerable that the Staff Commission, at the Secretary of State's instigation, decided to review its own proceedings. It issued a document which was startling in its complacency. It said that it had consulted the assessors and found nothing wrong. I can say that the only parallel in complacency is to be found in the first chapter of the Book of Genesis, where—and I quote: And God saw everything that he had made, and, behold, it was very good". But God was lucky: there was no one to argue with him or to put an Unstarred Question clown in your Lordships' House.

What has in fact gone wrong? The gravamen of the Staff Commission's apologia is—and I quote their words: These assessments relate to new posts bearing greater responsibilities, and therefore the assessments are in no sense a reflection on the way in which these officers who have not been short-listed perform their duties". But it is if you have borne nearly comparable responsibilities and are passed over for others with less experience and less responsibility—and particularly if you do not know the standards by which both of you have been judged.

My Lords, there is one small point. The Staff Commission chose seven as the maximum number of candidates to whom an appointing committee might do justice in one day. But why "seven" and why "one day" ? Surely that is for the appointing committee themselves to decide. And why should not anyone with local experience have been short-listed and the matter left to the new authority's discretion? What really did go wrong? I have consulted many people, including some of the assessors, some successful candidates and some unsuccessful candidates, and the consensus of opinion expressed to me gives a variety of reasons. First, the timetable, for which the Secretary of State alone is responsible—and he was warned. Second, the impersonal nature of the procedures. All these assessments are done on paper records and not by personal interview. Third, the size of the task and the timetable increase the danger of being misled and swayed by the references received—a hazard which is normally diminished by informal and discreet enquiries, as it were, behind the scenes. In some cases even the judgment of the assessors appears to have been overruled.

Again, the procedures for selection seem to have been very amateurish. Detailed job descriptions were sent out. These were of the simplest and the guidelines were very scanty. For example, for an area nursing officer the job specification said: The person appointed should be a registered nurse and have extensive experience at a senior level in nursing management". All I can say is: "So I should hope!" Any Grade 10 nursing officer would qualify under those conditions. Lastly—and, indeed, the most important—is the total failure of the Staff Commission, no doubt deliberately, to publish the criteria on which assessments were made and candidates were judged. There have also been complaints about the failure to inform the candidates in time and there were many other minor matters with which I shall not bother your Lordships.

My Lords, what can be done to redress the position and repair some of the damage to morale? First, I think the Staff Commission must be made to publish the criteria on which its decisions were based, in fairness, if for no other reason, to the assessors who are sharing the odium of some of the very odd decisions. When my noble friend comes to speak, I wonder whether he could inform us how many of the top area positions have not been filled as of the day before yesterday. I am told that it is between 20 per cent. and 25 per cent. This leads me to suggest that the Area Health Authorities should be told at once that if they are dissatisfied with the short-list they can re-advertise and include on the new short-list anyone with local experience who is thought to be suitable. One area has rot, to my knowledge, appointed its administrator. The sequel is rather curious: they have found themselves in a rather difficult situation. They must have an administrator; so they have invited a hospital secretary in the area to act in this capacity. The fascinating thing is that in fact he is the hospital secretary of a postgraduate hospital and, as such, is excluded from applying and will not be available to fill the post even if he is required to do so.

I can say one word of consolation to your Lordships and to all those in the administrative staff of the Health Service. There is no fear of any unemployment. With earlier retirement, when the conditions are known, and with the interpolation of an extra tier in the Health Service, there are likely to be far more jobs than ever before. None the less, the administrative staff are not happy alt the present time. The discontent at the work of the Staff Commission extends even to those who have been successful. This malaise occurs at a bad moment. For ten years reorganisation has been talked about. Three years ago the pace quickened; and for the last two years it has been fast and furious. This has involved many administrative staff in particular in extra work. This is the moment when the Pay Board make the following astonishing statement: …the officer is doing work in the course of his employment to facilitate a smooth transfer of functions to the new authorities as part of his duty to ensure the efficient administration of the National Health Service. That statement is wrong in logic and in fact. The administrative officer's duty is to his present employers who now run the National Health Service. Hospitals and Health Services do not stop dead while a Government Department chooses to re-shuffle the hierarchy. What he does for the new authorities is over and above the detailed duties and tasks that he has to carry out. I think that the statement that I have quoted is as misleading as any that could be made.

Why, then, is the National Health Service administration to be deprived of the bonus that has been allowed to their opposite numbers in local government? The reason is that the National Health Service has got caught tip with the Pay Board. I am not in any way criticising Government policy; but why was the National Health Service caught up with the Pay Board? It is because when the local government staff bonus was agreed 18 months ago, the National Health Service Whitley Council staff side was facing an unacceptable and reduced offer from the management side. Why did not the Secretary of State intervene at that moment—we know that he can—point out the parallel between the two services and say to the management side of the Whitley Council that the local government settlement would be acceptable so far as he was concerned for the N.H.S. staff? Such intervention would have brought the matter to a conclusion at the right moment 18 months ago, and this unfortunate incident would not have happened.

The ultimate irritant to the staff is the bland circulars which come out at almost every post from the Department telling all those concerned what to do in the interests of smooth reorganisation—forgetting that the old authorities are already overworked and understaffed, that the new authorities are dependent on the staff they are borrowing from the old authorities and that the existing task of running the National Health Service continues regardless of reorganisation.

My Lords, I apologise for the length at which I have spoken but I have tried to give something of the background to my Question. I spoke with some feeling but not, I hope, with exaggeration. I have been associated with the National Health Service for many years. I shall not be playing a part after the appointed day. In those years I have got to know many of those concerned in administration and I should like them to feel that there is someone in Parliament who can act as their spokesman, if not as their champion. Over the years I have got to know them and to admire very greatly the work they do. They do not enjoy the kudos and prestige of the doctors; they do not get the loving sympathy that the nurses rightly enjoy from the public; none the less they are the keystone of the National Health Service, and very much depends on their loyalty. In the past, their reward has been the knowledge of that fact. Their morale has always been high, and their enthusiasm great; but at the moment their morale is low—it is that of an army in retreat and that enthusiasm is ebbing. They are disillusioned with those in command. They are uncertain as to what has happened and who has blundered. They are uncertain as to where they are all heading. That is why I put this Question.

8.31 p.m.

LORD GARNSWORTHY

My Lords, the Question asked by the noble Lord, Lord Reigate, is indeed very timely. He has spoken in a very impressive manner, and I only wish that he had had a larger House to hear him, because the problem he has given us an opportunity of discussing is one of the greatest importance. He has spoken of the concern that exists, and the reasons for that concern among staff involved in the reorganisation of the National Health Service. He speaks as chairman of a very important teaching hospital and, as he himself has indicated, his long experience gives him undoubted authority, to speak on these matters. Since we all, as he said, wish the National Health Service to be a successful service, the whole House must surely be grateful to him for providing this opportunity not only to discuss the matters raised by his Question but to hear from the Minister such observations as will serve, if it is possible, to bring some reassurance to those who are greatly in need of it. As I think is very well known in your Lordships' House, I have an association with the National and Local Government Officers' Association, the largest organisation representing staff in the National Health Service. It is from that Association, and mainly from that experience—although not exclusively—that I speak to-night.

To the Question which is the subject of this debate the answer can only be in the affirmative: Her Majesty's Government must be aware of the concern that exists. The Minister, the noble Lord, Lord Aberdare, will, I am quite sure, be well aware of it. The noble Lord, Lord Reigate, has given a number of details, and I do not propose to give more. He has given the House an adequate number of cases. I shall, I think, be a little more general, and perhaps touch on one or two matters that he has not dealt with.

When the Bill for the reorganisation of the National Health Service was before the House I tried ,to be as constructive and helpful as possible; and I want, if I can, to be helpful to-night. I think I can best do this if I convey, as frankly as I can, what I know to be the feelings which are to-day far too prevalent among all too many who are employed in the National Health Service. There is intense irritation over the manner in which reorganisation is being carried out, as the noble Lord, Lord Reigate, has said. The manner in which the extra responsibility payment has been set aside is one element, and one element only. The Government may say—and I can appreciate their doing so, as was stated, I think, when we were dealing in the House with the Stirred Question tabled by the noble Lord, Lord Reigate—that the Pay Board is the authority responsible in that matter.

My Lords, that does not remove the irritation. If I may say so, there are a great many people in the National Health Service who believe that the Government cannot escape the responsibility for drawing up the incomes policy and for its phasing. To that extent I believe that note ought to be taken that the criticism is not merely of the Pay Board; there is a feeling that the Government carry some responsibility—some people feel a very considerable responsibility—and that consequently justifiable criticism is being voiced in this matter. The whole House, I think, showed its understanding the other day when the noble Lord, Lord Reigate, asked his Starred Question, as seemed to be obvious to all of us present. Beyond that issue, there is need for reassurance to staff at, I think, almost every level in the National Health Service; reassurance to staff who are desperately anxious not only about their transition to the new system, but also about their future in the next two or three years. I hope the Minister will have some words which will convey understanding of, and sympathy with, their anxiety, and indicate that problems, which have been touched upon already this evening, will be tackled with urgency and energy.

I would ask the Minister whether he feels that the Department are consulting sufficiently, and to serious purpose—because consultation needs to be meaningful. In discussing with those who speak for staff, I get the very strong impression of serious failure in consultation almost all along the line. It is this serious failure that is largely responsible, I think, for the very great frustration that exists not only among the present Health Service staff but, even more, if I may say so, among local authority staff who are due to be transferred to the new Health Service. Because, my Lords, they are used to having much more consultation than has ever been established within the Health Service itself.

As I understand the position, quite apart from the "extra responsibility" payment scandal, the failure of the appointment system of area staffs, and what is felt to be a general failure to reassure people that they will not suffer detriment in the new Service, the single greatest cause for what I can only call indignation has been the draft document entitled, Transitional Arrangements: Interim Management Arrangements for the new Health Authorities. This document is seen as summarising the attitude of the Department of Health toward the organisation, and suggests that they have long ago given up any hope of creating even the beginnings of a really reorganised Health Service by April, 1974. That view, my Lords, is widely held. What is clear is that senior appointments will be made and therefore everybody else will be "latched on", to use the jargon of the document to which I am referring, and for a long time to come no attempt will be made, so far as I can understand it, to provide the unified Service that, it was hoped, with improved staffing prospects and arrangements would be secured.

It seems clear, from the second paragraph of the document (I will not take your Lordships' time up by reading it) that strong central control is to be retained; that staff establishments are to be rigidly contained; and, in short, that no worthwhile amount of money is to be found for the sort of staff development which is surely so necessary if we are to have a successfully reorganised Service. It also seems clear that a beggarly amount of money is to be spent on new accommodation. Nobody would be more pleased than I if the Minister to-night could give us some figures to refute that belief. This again reflects on any serious intention to set about reorganisation and make April 1, 1974 a significant date.

My Lords, if I may sum up, too many of the staff of the National Health Service neither know where they are going nor what their prospects will be when they arrive. I think I ought to say that the trade unions which cater for the National Health Service are known to be considering what steps they might take to halt or to delay a reorganisation, as it has been put to me, with which they would express themselves as throughly disillusioned. The noble Lord, Lord Aberdare, who is to reply, will know that we all want an efficient and happy Service; I am sure that he does as much as any of us. I hope that in his reply he will be able to indicate that there is good reason for optimism as to the future of the Service, and, not in any spirit of complacency, as the noble Lord, Lord Reigate, said, will convey the message that problems are going to be dealt with urgently and with energy. But of this I am certain, that no useful purpose is served by ignoring the realities of the situation or by ignoring the strong feelings that exist. If criticisms can be made in a spirit of constructive good will, supported by a determination to build the new Service on the basis of willing co-operation, based on meaningful consultation with staffs and those who speak for them, the better for the future.

The noble Lord, Lord Reigate, put forward a number of ideas for consideration. I want to put forward one more, and I do so on my own personal initiative only. I think that great good could come from those at the Department responsible for dealing with this matter, including those at Ministerial level, meeting with those in the staff organisations, who are themselves having a very unhappy time because their members are so dissatisfied and thoroughly upset. I can see nothing but good coming from such a meeting, at which the whole issue of consultation, of looking at the future and securing a new approach, might be discussed purposefully and meaningfully.

My Lords, I hope that I have not spoken with any very strong feeling. I have tried to be as moderate as I can in conveying views that I know are strongly held. If I have spoken with any kind of feeling, it is rather one of sadness, because so many of us have spent so many hours in discussing the Act that has brought reorganisation about and we were hoping, although we knew that time was short, that it would be accomplished easily and happily. I hope that the noble Lord will be able to say something that will give encouragement where it is badly needed; but he will need to say a great deal if he is to achieve it.

8.45 p.m.

LORD PLATT

My Lords, we are all grateful to the noble Lord, Lord Reigate for giving us this opportunity to discuss what can only be described as an extremely sorry state of affairs. When anybody as moderate as the noble Lord, Lord Reigate, does this in no uncertain terms, we all listen with the greatest attention. Knowing what I do about the Health Service, I have my own reasons for knowing that he is not exaggerating in what he has said. I want to be quite brief. I could not possibly put the case before your Lordships as well as the noble Lord, Lord Reigate, has done, and I thought I would content myself with giving your Lordships a personal experience of the way the system seems to be working.

In June I received a large parcel, and after making certain that it was not a letter bomb, I opened it and found that it was a request for a reference from the Staff Advisory Committee. This was a reference not for a medical post, but for an administrative post, for somebody whom I knew well, or I should not have been asked. It was addressed in entirely impersonal terms. It was signed by nobody I recognised, a person whose name did not appear on the writing paper. It was initialled, and then came the surname, so I could not tell whether it was a Miss or a Mr. who was writing to me. It was accompanied—and here my experience differs from Lord Reigate's —by 26 pages of background information. This I tore up, but did not put in the wastepaper basket, because I sent it back to the Secretary of the Staff Advisory Committee. I sent him the reference. I said that I had given hundreds of references in my life and I expected to have some personal letter and not a form to fill up: and I did not expect to do the homework. When a registrar of a university writes to me for a reference, if he wants to tell me something about the post which I may not know it is condensed to a proper single sheet. Was it not Churchill who said: Give me the facts on one side of a single piece of paper. I never turn over."? I received a most extraordinary letter in reply—quite polite—rather regretting that a personal letter was not sent, and saying (and this is what your Lordships should know): During the past two weeks it has been necessary to send out almost 2,000 requests for references for nearly 1,000 applicants for top posts in the new Health Service. That is the kind of thing that they are up against. Then, with regard to the background information, it said: This Committee was asked to circulate information, and it was not part of their duty to reduce it to a précis. Well, my Lords, is it part of my duty? I acknowledged the letter, very politely of course, and I received another letter saying: Of course this Committee feel an obligation to see that the amount of literature sent out is reduced to a reasonable size"— 26 pages!—and then it ended up: As I said in my earlier letter, the background information was provided by the Department of Health and Social Security. If they had seen fit to condense it without, of course, reducing its usefulness, they would have done so. I replied that I was sorry that I had not realised that a person in his situation was unable to make any decisions for himself, and I was sorry that I had troubled him.

My Lords, personal experiences can be boring and irrelevant unless there is some lesson to be learned from them. What I learned from this was that any organisation which attempts to deal with 2,000 requests for references in two weeks —and these were apparently concerned only with the top posts—is bound to be impersonal. It is unlikely to achieve its objects and will lead to discourtesy and muddle, which industries such as the Health Service can ill afford.

8.51 p.m.

LORD FISKE

My Lords, I am sure we are very grateful to the noble Lord, Lord Reigate, for bringing this matter before us this evening and for dealing with it in the sympathetic way he did and with such a wealth of detail, because by that means he has eased the task of those who follow him. As he spoke, I was able to confirm mentally all his various points as he went through them, and there is no doubt that there is great uneasiness among the people concerned. As one secretary of a Regional Hospital Board expressed it to me: "We should all have felt much happier and more justified if they had put all the names in a hat." This is simple, and one can laugh at it—but, my goodness! it is a criticism, is it not? So far as I can see, the general reason which is put forward as an excuse by the staff concerned is the shortness of time which is involved. Perhaps here I might add a word from this side of the Chamber that the noble Lord, Lord Reigate, might not wish to say from his side: that the timing, and the responsibility for the timing, is the Government's and the Government's alone. There is no question of world prices, of the E.E.C. or intransigent trade union leaders, or anything else, that can possibly be blamed. It is the business of the Government themselves to arrange their legislation and its timing.

My own experience in this field concerned the reform of London government, and as we have been finding out what has happened in regard to the Health Service, it is interesting to note that the present Secretary of State for Health and Social Security is the man who was Minister of Housing and Local Government at the time of the reform of London government. Quite honestly, we did not have these troubles when we reformed London government, which involved an enormous shifting and amalgamation of senior posts and a great deal of redundancy—which is a much greater problem to deal with, but it was dealt with in a humane way. It was dealt with efficiently because it was given time. I repeat what I said a moment or two ago, that timing is the sole responsibility of the Government, so that if there is a muddle here, they must take the blame for it.

On the introduction of all this National Health Service reorganisation we were told that one of the aims was to bring brisk modern business methods and approaches into the Health Service. This was a laudable ambition, but if it begins by alienating all the top executives who are to take part in the undertaking, then it is a very poor start for brisk business methods. Give me, every time, the good old bumbling Civil Service! I think their approach would be preferable to the kind of approach that we have seen here. So I think we must ask the Minister, when he replies, to answer the challenge about timing, and to tell us how long those people who might want to be displaced in view of the troubles that have occurred must wait for the compensation code, and whether it is possible for the Staff Commission, even at this very late stage, to devise some better method of dealing with those posts which have not already been filled.

8.56 p.m.

LADY RUTHVEN OF FREELAND

My Lords, I should like to say just a few words in support of the Question put by my noble friend Lord Reigate to my noble friend the Minister of State. I think there is a great deal in what has been said by all noble Lords who have spoken. I know there is much distress and worry throughout the Hospital Service concerning the reorganisation, and particularly, as my noble friend said, in the administrative section, very few of whom seem to know where their future lies—only the very top ones who have had that matter decided for them.

In my capacity as Chairman of the League of Hospital Friends, I visit quite a number of hospitals throughout the country so I hear from people on the spot. I am always taken round by the administrator, the chief nursing officer and probably members of the hospital management committee, and I know there is this very real distress over not knowing where those concerned are going and what is going to happen. They have no news of their future. I can speak from personal experience of this, since I have visited three different hospitals in the last 10 days. It has been difficult during the last 25 years to build up a good staff, because at the beginning of the Health Service we inherited some very bad administrators from the local authority hospitals. They were not as efficient as they should have been. This has all been changed, and we now have some very good, young and efficient administrators. What will happen to all of them if they are not being told, even at this late moment, where their future lies? I am frightened that they will get so disheartened that they will apply for some other job and leave the Hospital Service. They have been working extremely hard, and it really would be a terrible tragedy if the Secretary of State does not make certain that their future still lies with the Health Service.

8.58 p.m.

LORD AUCKLAND

My Lords, I should like to add a few words to what my noble friend Lord Reigate has said in initiating this very important debate, at a late hour and, alas! to a very thin House. There remain about five months between now and when the new administration is due to begin, and I should like to raise one or two questions. Section 149 of the White Paper on the National Health Service reorganisation concerns management training. I wonder whether the Minister can enlarge on what is said there. I have not given him notice of this question, so I do not necessarily expect an answer to-night. Is the Minister satisfied that this management training will improve the quality of those who are going to take over work, or indeed continue to work, in the new authorities? Who is to carry out this management training? Is there enough time—and this is the important point—between now and the establishent of these new authorities for such training to be given? I have yet to find anyone in the Hospital Service who is not worried about the way in which all this reorganisation is being rushed through. It is not necessarily a wrong move. I think most people will accept that the National Health Service has been in need of reorganisation for some time. I question whether enough thought has been given to this matter.

Secondly, and finally, I should like to refer to the position of the voluntary organisations. My noble friend Lady Ruthven mentioned the League of Friends. The hospital in Surrey on whose house committee I sit has a very strong League of Friends movement. The League of Friends, together with the house committees, do an enormous amount for these hospitals. There is considerable worry among administrators as to how under this new set-up there will be liaison between these two bodies. During the passage of the recent Bill (now an Act) it seems to me that all too little emphasis was given to what is going to be the future of the voluntary bodies. Whatever form reorganisation takes, the role of the voluntary bodies is vital. I hope the Minister will bear in mind the necessity of this, because between now and the appointed day time is perilously short.

9.2 p.m.

THE MINISTER or STATE, DEPARTMENT OF HEALTH AND SOCIAL SECURITY (LORD ABERDARE)

My Lords, this is the first occasion since the Bill became an Act that we have had an opportunity of discussing the progress of the reorganisation of the National Health Service. I should like to say at the start how much we miss the noble Baroness, Lady Serota, because she did such a lot in a very constructive way in the course of the passing of the Bill, and I hope that she will find time to read Hansard. I am sure it is the wish of your Lordships that she will return very soon and give us the benefit of her always helpful advice.

BARONESS LLEWELYN-DAVIES OF HASTOE

My Lords, we on this side of the House deeply appreciate what the noble Lord has said. I should like to reassure him that my noble friend is following with passionate interest everything we do. She is making a recovery which is astonishing simply because of her own willpower. I know that it will delight her to read what the noble Lord has said.

LORD ABERDARE

My Lords, I know that her recovery has been due very much to her own willpower. But I hope that when she reads the debate she will not pay too much attention to the six noble Jeremiahs who have already spoken here, and that she may be, if not encouraged, at least convinced, as I hope your Lordships will be, that not only is the answer to my noble friend's question, "Yes: we do really understand and appreciate that there is concern among the staff", but also that we are trying to do all we can to reassure them. When we first announced proposals for the reorganisation we knew that this would be a trying time for many of the staff in the Service, especially those whose futures were being affected through their having to change jobs.

The noble Lord, Lord Garnsworthy, will remember very well—in fact he has referred to it—how deeply and how hard we tried, in the course of the passing of the Bill here, to meet his points on consultation with staff interests. We wrote several Amendments into the Bill to ensure that this consultation did happen. We have continued since then and we have consistently urged the importance of consultation at the local level by the existing authorities and by the joint liaison committees which were set up to co-ordinate local planning. In agreement with the staff side we advised local managements how to make effective arrangements, and we have asked the new authorities to continue and develop these consultations. I would emphasise that we are determined to continue with these consultations at every level. I was appreciative of the constructive suggestion which the noble Lord made, off his own bat, as he said, that it would be helpful if we were to meet the unions who represent the Staff Side. My right honourable friend is always the first to do what he can in the way of these meetings if they are useful; I can tell the noble Lord that he will in fact be meeting NALGO on November 29.

The noble Lord, Lord Fiske, compared this reorganisation with the reorganisation of local government, of which he has such a first-hand knowledge. I would not wish to deny that the timing must be the responsibility of the Government. On the other hand, there are all sorts of pressures on the Government which have made it extremely difficult. Perhaps the major one is the fact that there was a deadline date of April 1, 1974, owing to the fact that that was the date on which local government reorganisation had to take place. I know the noble Lord will tell me that we had responsibility for fixing that date; and that is true, too. But it has been a great difficulty, looking at it from the National Health Service itself, that we have to meet a deadline date which, so far as we were concerned, is absolutely immutable, and we have not had all the time we should have liked.

My noble friend Lord Reigate spoke on two major issues with which I shall try to deal. One of the points he mentioned concerned the temporary allowances to staff. The Administrative and Clerical Whitley Council reached agreement on temporary allowances for National Health Service reorganisation work in April, and a similar agreement was reached by the Nurses and Midwives Whitley Council. These agreements were referred to the Pay Board which, notwithstanding the fact that the Councils made supplementary submissions, ruled that these payments could not be made outside the Stage 2 pay limit. As my noble friend has said, the Board took the view that the work was appropriate to present Health Service employment and that, in the absence of provision for extra payments in their terms of service, any new payment would represent a benefit that could not be allowed outside the pay limit. My noble friend quoted one sentence from their letter. He is well aware of the full letter, and so, I am sure, is the noble Lord, Lord Garnsworthy.

LORD GARNSWORTHY

My Lords, I realise this is an Unstarred Question, and I do not want to interrupt very much. But did I understand the noble Lord correctly? Would the Department accept from anybody that it could possibly be in the conditions of service that people would have to do this extra work when nobody could have foreseen at the time of the appointment of many of them that this was going to take place?

LORD ABERDARE

My Lords, I can only tell the noble Lord what the Pay Board said. I do not want to waste a lot of time in quoting from this letter; I am sure the noble Lord has a copy of it—if he has not I will certainly make sure that he gets one. It is quite a long letter and goes into great detail as to why they found that they could not agree that this payment came within the Stage 2 terms. The sentence after the one which my noble friend read out, reads: The duties involved in the preparatory work may be new in the sense that they differ from the other listed duties of the posts concerned, but a variation in the nature of the work performed is not sufficient to qualify as the introduction of new work for the purposes of paragraph 133 of the Pay Code.

LORD REIGATE

My Lords, would my noble friend allow me to intervene? I think he has missed the point that I was trying to make. The Pay Board have the right to their own views, but I was really asking what on earth was the difference between these people and the local government staff. If the Health Service staff are not doing any extra work, why did the local government staff get a bonus at all?

LORD ABERDARE

My Lords, I think my noble friend knows that the local authority agreement was agreed before Stage 2 came into operation.

LORD GARNSWORTHY

It is really a matter of time.

LORD ABERDARE

It really is a matter of time. This has affected a great many people in a great many different occupations, and that is the worst of a statutory policy. People get caught, as the noble Lord knows very well. There are many cases where people feel hard done by. My Lords, we have made provision in the Stage 3 code for payment of allowances in respect of work for statutory reorganisation from November 7, and this date is in line with the other new provisions of Stage 3. The Staff Side of the Administrative and Clerical Whitley Council saw my right honourable friend on October 23. They expressed disappointment and frustration on behalf of their members and asked him to secure the implementation of the Whitley agreement from its original date, notwithstanding the Pay Board's advice. My right honourable friend promised that the Government would consider the points which were made to him. This we have done, and sympathetically, but we have concluded that payment from a date before November 6 could not be allowed without giving grounds for many other groups to claim that other additional provisions in the Stage 3 code, such as, for example, those correcting anomalies, should also be applied retrospectively. My right honourable friend has written to the Staff Side explaining this decision. The Government have taken the view that the provisions of the Pay Code should apply equally to employees in the public and private sectors and that the Government in respect of Crown servants should be bound in the same way as other employers. My Lords, we hope that arrangements can now be agreed with the Staff Side for payments to be made from November 7.

The other matter to which my noble friend and the noble Lord, Lord Garnsworthy, directed much of their remarks was the question of the Staff Commission and the short-listing procedures. The Staff Advisory Committee, which is now the Staff Commission, was set up to safeguard staff interests in the reorganisation. It was agreed after discussions with representatives of the appropriate staff organisations that the Commission should carry out respectively the advertising, assessing and short-listing for certain key posts, and I am well aware that concern has been expressed and indeed representations have been made on the subject of the short-listing for the Area Health Authorities' posts. I can only say that the Commission have considered these representations very carefully in conjunction with the assessors appointed in agreement with the staff organisations and that they issued a state- ment from which my noble friend quoted and which is available in the Library. He will not, I am sure, expect me to comment on the individual cases he mentioned—indeed he was saying he did not wish to make them specific—but I can tell him that during the past few weeks the 90 Area Health Authorities have been interviewing for the posts of area administrator, area treasurer and area nursing officer. In a relatively small number of cases an Area Health Authority has not felt able to make an appointment on the basis of the short list provided by the Commission.

In a somewhat larger number of cases the cross-matching of the preferences of the candidates and those of the authorities failed to produce a clear result. Because of those two factors, I understand that some 50 of the 270 Area Health Authority posts for which short-listing has been carried out by the Staff Commission will not be filled at this stage. But the Commission have now issued advice about the arrangements for filling the remaining posts. Briefly, all the eligible candidates who have not yet secured posts in their particular discipline will be informed of the vacancies remaining and invited to apply to the Area Health Authorities in question. These authorities, assisted by national assessors, will then short-list, interview and make appointments.

My Lords, I hope there can be no doubt that the task which the Staff Commission agreed to undertake in carrying out centrally the advertising, assessing and short-listing for key posts in the new Regional and Area Health Authorities was complex and therefore bound to be difficult. They agreed to undertake it only after wide discussions with staff organisations and with my Department. Indeed, it is difficult to imagine how such a task could have been carried out at all without their assistance; and I am sure that in discharging it they have acted not only properly but also with complete impartiality—I am sure my noble friend would agree with that.

He asked me again about the staffs of London postgraduate boards of governors being eligible to compete. We went into this on June 11 in answer to his Question, and he knows that the shadow Staff Commission gave its advice, that the staffs of the London postgraduate boards of governors, like others not affected by the reorganisation, should not be eligible for competition since their jobs were not at risk in the process of reorganisation. But I should like to make it clear that both the Staff Commission and my right honourable friend look forward to a resumption of normal recruitment policies once the immediate period of reorganisation is passed, and we expect to be receiving advice from the Staff Commission on this matter in the near future.

My noble friend suggested that criteria for posts should have been published. I think this would have been an artificial step, and I doubt whether it would be a useful one. The Commission had appointed experienced assessors. These assessors were given full details of the posts concerned, and they assessed the candidates against this background. In fact, the noble Lord, Lord Platt, seemed to think that some of the details that were given were rather too voluminous.

All noble Lords who have spoken have asked about the employment and career prospects for the future of the staff of the Service. These are becoming clearer as the new senior appointments are made. Our policy is to make orderly progress by way of uniform appointments procedures and planned timetables. The regional administrators, treasurers and medical and nursing officers have been appointed and area appointments are in progress. The regional works officer, personnel and ambulance officer posts, and the posts for administrators of family practitioner services, have now been advertised. Taking this process further, we have issued guidance on interim management arrangements, and the Staff Commission's Circular 3/73 has supplemented this by indicating those further posts which should be filled before April 1, 1974.

In the main, the arrangements for short-listing and filling these posts will be made by the new authorities, and they are now working on the necessary preparations. The field of competition for most of the posts will be regional rather than national, and the largest number of them are those at district level. I am glad to say that the important posts of district administrator, district finance officer and district nursing officer will be advertised on November 23. They will be followed shortly by the corresponding advertisement for the district community physician post and by others as all the necessary details become available. This is a most important stage in building up the staff of the new authorities, and we shall expect shortly to receive advice from the Staff Commission and, in respect of detailed procedures, from the national staff committees, leading to fair and orderly appointments systems for the posts to be filled after the appointed day.

I am aware that there is anxiety that employment prospects will be unduly constrained by the need to carry out the reorganisation with regard to available resources of manpower and finance—a point which the noble Lord, Lord Garnsworthy, made—but such anxiety is hardly justified in view of the developments that will be continuing in all the main branches of the health services and in the light of the overall expected staffing requirements of the new authorities. I appreciate, too, that there are questions about terms of service which are common to all the staff involved and not just those affected by the new top management structure. Proposals of transfer, compensation, protection and early retirement have all been widely circulated and many comments have been received. These have been the subject of continuing consultation with staff interests at national level, and of course the staff are anxious to see these provisions in final form.

The noble Lord, Lord Garnsworthy, spoke of a serious failure in consultation. So far as I know, there has been no failure in consultation. Where perhaps we have been subject to criticism is that in the process of consultation things have been rather slower than they might otherwise have been. But there is one matter on which I can please my noble friend, and that is that the scheme for early retirement, which has been substantially improved as a result of central consultation, is being published this week. The terms originally proposed for early retirement of senior officers have been improved, the list of eligible officers has been extended and the latest date for electing to retire has been amended to January 31, 1975, with retirements taking place in the period beginning on April 1, 1974, and ending on March 31, 1975. Besides allowing much greater flexibility, this has the advantage that the decision as to whether consent can be given will rest in all cases with the new authorities, and that will greatly simplify the procedure. We intend to issue the arrangements for compensation and for protection of family and conditions of service within the neat few weeks.

LORD REIGATE

My Lords, if my noble friend will permit me, when he says that consent will rest with the new authorities does he mean that the option to choose early retirement on the part of an officer is not his own to make?

LORD ABERDARE

My Lords, there are certain provisions in the agreement, which has been made with full consultation with the staff, and in exceptional circumstances a health authority can object to a man's early retirement if he is vital to the Service.

My Lords, I hope I have shown that there has been no lack of appreciation or concern for the interests of the staff. Our policy continues to be one of proceeding step by step in an orderly programme of reorganisation, securing that appointments are made in the appropriate order by the fairest possible means and providing as soon as possible, after full and thorough consultation with their representatives at the national level, information required by staff about posts to be filled, salaries and conditions of service. We shall certainly develop our training services, and we shall certainly need all the help we can get from voluntary organisations. If I may say so to my two noble friends behind me, I am grateful for what they had to say.

Finally, my Lords, my noble friend Lord Reigate wished the National Health Service well, and I am sure that all your Lordships, despite the criticisms heard this evening, also wish the Health Service well. We for our part, will do all we can to smooth out what I know are deep concerns.