Nurses: Clinical Grading Appeals (Hansard, 5 June 1991)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)
My Lords, information on the total number of appeals is not collected centrally. However, as at the end of last month, and since 1988 when the new system came into force, 17,087 appeals were lodged at regional level and 897 at national level.

§ The Countess of Mar
My Lords, I thank the Minister for that Answer. However, is she aware that the Royal College of Nursing estimates that there are something like 40,000 cases still waiting for appeal? Is she also aware that, despite the Secretary of State's statement to the House of Commons in 1988 that all the appeals would be heard by the spring of 1989, at the present rate of progress it is likely to be the year 2000 before all the appeals are heard?

§ Baroness Hooper
My Lords, I am well aware that the procedure under which these appeals are heard is a very time-consuming one. However, it was established by the General Whitley Council and in fact it gives appellants three chances to overturn the original grading decision. Of course, delays can arise in that process. Nevertheless, I am happy to say that the management and staff sides of the Nursing and Midwifery Staffs Negotiating Council have now agreed to discuss ways of streamlining the system.

§ Lord Molloy
My Lords, after listening to the incredible figures quoted a moment ago by my noble friend, does the Minister not think that those figures are, to put it mildly, somewhat alarming? Does she also agree that there is a need, on behalf of the Royal College of Nursing, the Confederation of Health Service Employees and indeed all nurses, for the department to take a very serious look at the situation?

§ Baroness Hooper
My Lords, in the Department of Health, and also as Ministers, we have always emphasised that we wish to see clinical grading appeals at all levels heard quickly and fairly. It has to be said that the obstacle to that has been the insistence of the unions on very complex procedures which I have outlined. However, I think the fact that the two sides are getting together to discuss a better procedure is a hopeful sign.

§ Lord Ennals
My Lords, can the Minister explain why these figures are not known nationally? After all, the decision was taken nationally. Is this just a sequence in which Ministers are failing to accept responsibility for decisions which were taken? Does not the noble Baroness think that such figures ought to be taken nationally? Further, does she recognise the fact that this is a most unsatisfactory situation? The morale of 40,000 nurses is gravely affected by the fact that they have now been kept waiting for three years. Does the situation not worry the Minister?

§ Baroness Hooper
My Lords, we certainly want to see an efficient system in place and we certainly wish to see happy staff. However, it is necessary that everyone's interests are taken into account. The Government have pursued a course of encouraging the sides to get together in order to improve the system.

§ Baroness Robson of Kiddington
My Lords, many of the outstanding 40,000 cases will go up to the region. Therefore, in view of the fact that the region now has so few members, is not the Minister slightly worried that the length of time will double before such appeals can be heard; that is, compared with the system which we had before 1st April when there were quite a number of people able to hear such complaints?

§ Baroness Hooper
My Lords, we are very concerned about the problem. That is why our activities have been directed towards getting improvements and changes in the system. Nevertheless, I beg to differ with the noble Baroness as regards the size of the health authorities having anything to do with it. For the purpose of appeals, it is possible for health authorities to co-opt members.

§ Lord Skelmersdale
My Lords, the noble Baroness, Lady Robson, is absolutely correct in that one of the major difficulties in the appeals system is that it appears that in most areas of the country the authorities have insisted on a member being on the appeals panel. If we could do away with having members on such panels, would this very unfortunate situation be resolved much faster?

§ Baroness Hooper
My Lords, as I said, authorities are empowered to co-opt members to appeals panels. That has been provided for by recent amendments to the Health Authority Membership and Procedures Regulations set out in the guidance issued to health authorities.

§ Lady Kinloss
My Lords, is the Minister aware that the Royal College of Nursing estimates that the appeals so far have cost in excess of £9 million? Can she say what the likely cost may be when the final appeals have been heard?

§ Baroness Hooper
No, my Lords; we do not have that information at present. However, it is certainly true that the Government announced that they were fully funding the introduction of the clinical grading structure, which was, incidentally, originally recommended by the Nurses' Pay Review Body. We provided an additional allocation in April 1988 in 643 order to do this and a further one was provided in October 1988. The total cost involved for the new structure in 1988–89 was £928 million.

§ Lord Stoddart of Swindon
My Lords, is the Minister aware that we are very pleased to hear that she wants to improve the system and that she wants the delays to be eliminated? However, how can she possibly do that, and how can the Government possibly know that they can do so, unless they have the figures centrally? If they do not have the figures, they do not know what they have to do or how much they have to do.

§ Baroness Hooper
My Lords, as I said, we do not collect the figures centrally. I quoted earlier the number of appeals which have been lodged—the figures I quoted concerned the number of appeals lodged at regional and national levels. Of those, 1,831 appeals have been heard at regional level and 56 at national level, of which, incidentally, 27 per cent. and 35 per cent. respectively have been successful. The delay is caused by the three-tier system. Noble Lords are quoting figures which apply to the first stage in the procedure. The accurate figures which I have on the second two stages of the procedure are also ones which give considerable cause for concern.

§ Lord Ennals
My Lords, my first question, and it was the question also put by my noble friend Lord Stoddart, was: why does the department not know the figures? The Minister has not answered that question. Is there some reason why it does not have the information which has been collected and is readily available from the RCN and other bodies?

§ Baroness Hooper
My Lords, there is no system in place to provide that detailed information centrally. However, we are well aware of the figures being quoted by the RCN and others.

§ Lord Campbell of Alloway
My Lords, will my noble friend say what has been done to hurry up these appeals?

§ Baroness Hooper
My Lords, a working group of the NMNC is currently considering options designed to streamline the process as it applies to clinical grading appeals for nurses. The forum for agreeing any permanent change, which would apply nationally, is the General Whitley Council. That, too, is currently examining all aspects of existing appeals procedures. The Government are encouraging progress on both fronts.

§ Lord Monkswell
My Lords, bearing in mind the large number of appeals at regional and national level, and assuming that none of them is because nursing staff have been graded too highly, will the Government instruct the NHS management to ensure that the grading of nurses and midwives recognises the value of the clinical job that they do?

§ Baroness Hooper
My Lords, one of the problems with the implementation of the new structure is the difference between the new structure and its predecessor as grading is now based upon the duties 644 and responsibilities of a particular post and not on the postholder's qualifications. That obviously allows for differences of opinion. Nevertheless, we believe that there is justification for a clinical grading structure because it provides a means of recognising and rewarding increasing skill levels. It is important to get the guidance right. Currently part of the problem is that there are two rival sets of guidance—one produced by the staff side and one produced by the management side. That is all part and parcel of the exercise being conducted to streamline the procedures.