Nurses' Pay Award: Implementation (Hansard, 12 October 1988)

§ Lord Hesketh
My Lords, regional health authorities have been issued with a range of guidance covering the implementation of this year's pay award for nurses. Our objective throughout has been to ensure that the new grading structure on which the award is based is implemented properly and in accordance with the spirit and letter of the agreement reached by both sides of the Nursing and Midwifery Staffs Negotiating Council.

§ Lord Dean of Beswick
My Lords, I am grateful to the noble Lord for that reply, but can he confirm that some weeks ago Mr. Clarke gave regional health authorities the right to offer increased inducements in some areas in order to remedy staff shortages? From past experience is he not aware that such a practice is very dangerous indeed and could tempt one regional authority to poach staff from another? Is he further aware that some years ago, benefiting from earlier 875 experience, local authorities set up their own national body to prevent this sort of thing happening in local government and that it has worked well? May I suggest to the noble Lord that he puts my Question to the Minister, Mr. Clarke, because in my opinion he is setting a very dangerous precedent indeed?

§ Lord Hesketh
My Lords, I fear that the noble Lord is ignoring a very important fact; namely, that there are a large number of trained nurses and midwives who for one reason or another are not practising their skills in the National Health Service. One reason for that is that in some parts of the country nurses' pay compares favourably with that available in alternative employment; in other areas the comparison is not quite so favourable.

§ Lord Ennals
My Lords, can the noble Lord say why the Secretary of State for Social Services last night refused to see the leaders of the RCN and other unions that represent the nurses? Why has the Minister said this morning that the time for talking is past? Is it not totally intolerable and irresponsible at this time to treat nurses in such a cavalier manner when feelings are running so high? Is he aware that feelings are running high not only among the nurses but also among the health authorities, many of whom are now obliged to cut back on services to their patients because the Government are not fully funding the award?

§ Lord Hesketh
My Lords, to answer the noble Lord's last point that is a supposition and not a fact. If I may say so, the simple fact of the matter is that the Minister for Health, to whom the responsibility is directly attributable rather than to the Secretary of State, offered to meet the representatives of the staff negotiating side and that that offer was declined last night.

§ Lord Ennals
My Lords, the Secretary of State himself is responsible. Simply to say that he has delegated to his Minister an issue that affects nurses right across the country is surely another sign of irresponsibility, is it not? Does the noble Lord agree that it is comparable with the irresponsibility that he showed when for a whole month in the summer he failed to tackle the problem?

§ Lord Hesketh
My Lords, my right honourable friend the Minister for Health is directly responsible for these negotiations. I should have thought that, as in any branch of management, he would not be considered an unreasonable first base at which to stop before going to the Secretary of State.

§ Lord Stoddart of Swindon
My Lords, the country wants the nurses to have their pay. Why will Mr. Clarke not allow the issue to go to arbitration as the unions have offered, the results of which they have offered to make binding on themselves?

§ Lord Hesketh
My Lords, all the negotiations to date have been based on the original position which the Government adopted, which was based on a 876 figure of £803 million for this year. As noble Lords on both sides of the House are aware, we are examining the returns from the regions and will make an announcement as soon as possible. But I am sure that your Lordships' House would not expect me to put forward any suggestion that is based on a hypothetical question.

§ Lord Grimond
My Lords, I understood from the papers this morning that the Minister responsible whoever he is, has refused to meet the nurses' representatives for further talks. Do I understand from what the noble Lord has said that this is not the case and that the Government are willing to have further talks, with all suggestions open?

§ Lord Hesketh
My Lords, I am very grateful to the noble Lord, because that is exactly the case. My right honourable friend the Minister for Health has said exactly that, but his offer was declined last night.

The Earl of Halsbury
My Lords, can the noble Lord confirm this simple managerial thesis: one can delegate authority but not responsibility? However much the Secretary of State may have told the Minister of State to get on with the detail, he himself remains answerable in the other place.

§ Lord Hesketh
My Lords, I am most grateful to the noble Earl for his point. However, if one is to have any form of management and management structure and one has a Minister of State who is responsible for health, it is only fair that one should go through the structure rather than deny its existence.

§ The Countess of Mar
My Lords, is the noble Lord aware that this problem exists not only in the hospital sector but also in the primary care sector? GPs have agreed a scale with their practice nurses and family practitioners are not agreeing to it. Can he say what instructions have been given to family practitioners about practice nurses?

§ Lord Hesketh
My Lords, to the best of my knowledge with regard to the position of clinical nurses and hospital sisters within hospitals, two out of three will be on the higher grade; outside primary care the figure will be three out of four.

§ Lord Ennals
My Lords, is the noble Lord prepared to clarify the confusion that seems to exist? Did he hear the statement, as I did, by the Minister for Health on the radio this morning? Does he have the text before him? Did he or did he not say that the time is past for talking? Did he or did he not mean that?

§ Lord Hesketh
My Lords, yes, he did, but he was still willing to see the unions. We agreed with them that we would introduce this new range of pay for different responsibilities. One of the great issues of contention is this. Everyone wishes to see implementation of this pay award in the nurses' pay packet before Christmas and we must deliver what we agreed.

§ Lord Dean of Beswick
My Lords, perhaps I may ask a question regarding the answer to my supplementary question. While I accept what the Minister has said about attracting people into the health service by giving regional authorities the right to offer enhanced salaries in certain areas, is he aware that that is a very dangerous practice in a National Health Service? It may well result in different standards in two health services which are almost next to each other. Those are the dangers that I am highlighting. Will the Government note that these are the same objections that have been raised by the nursing profession?

§ Lord Hesketh
My Lords, I fully appreciate the point that the noble Lord is making. We must accept that differentials already exist for inner and outer London and the London fringe zone. It is a fact of life in this country today that there are substantial differences in the cost of living in the North, South, East and West, and indeed throughout parts of England. These differences have to be accommodated and understood in all walks of life and in all jobs.