§ Mr. Mark Oaten (Winchester)I am pleased to have a chance to revisit the issue of the quality of the working conditions for staff in pathology departments throughout the country. I acknowledge that the Minister has already responded to this issue. I am pleased that my hon. Friend the Member for Twickenham (Dr. Cable) last year raised concerns about work in this field. My aim is not to repeat those points, but to raise issues that have come up since then, and to urge the Minister to act swiftly and decisively.
§ Mr. Deputy Speaker (Mr. John McWilliam)Order. I am sorry, but I think that the Minister has an adviser sitting beside him.
§ The Minister of State, Department of Health (Mr. John Denham)No, he is my parliamentary private secretary.
§ Mr. Deputy SpeakerI beg your pardon.
§ Mr. OatenI am delighted that there are more than two people in the Chamber. It is welcome to see the Minister's parliamentary private secretary in his place.
I am seeking from the Minister an update on conditions for pathology staff, and some decisive remarks about the timing and the process for improving their working conditions. It is encouraging that there has been cross-party support on this issue. I was pleased yesterday to sign the early-day motion proposed by the hon. Member for Erith and Thamesmead (Mr. Austin), which notes that NHS scientific staff have received pay increases less than those awarded to comparable staff covered by the pay review body.
My personal involvement in this issue followed my visit a couple of weeks ago to the pathology department at the Royal Hampshire County hospital in my constituency. I confess that I went there with some trepidation. I usually pass out at the sight of blood, so the prospect of being shown lots of test tubes filled me with some dread. It was a squeamish experience, but I got over it by listening to staff and watching them perform their high-quality work.
During my visit, I met many of the pathology staff at all levels. My local Echo newspaper was right to describe them as
the hidden army of the NHS.Laboratory scientists work behind the scenes, and are regarded as backroom men and women whose work in pathology saves lives.A common public perception of pathology is that it is about post mortems and cutting up bodies. Endless television programmes reinforce that view. But pathology provides many vital services for the living—it is not just about examining why people have died. It is the branch of medicine concerned with the cause, origin and nature of disease. We need only cast our minds back to the recent flu outbreak to realise the pressure that those departments can be under and the importance of their work. The pressure is enormous.
224WH In the Royal Hampshire hospital, 22,000 tests are carried out each week. I understand that that is typical of hospitals of a similar size throughout the country. Through such tests, biochemical scientists are able to diagnose hundreds of conditions, including life-threatening illnesses such as cancer, meningitis and, sadly, HIV. Figures suggest that demand for their services is on the increase. In the Royal Hampshire, the work load has increased by 60 per cent. in the past 10 years. Other hospitals have experienced similar increases.
Against that backdrop of an enormous throughput of tests and the massive rise in demand for pathology services, the NHS owes a tremendous debt to staff who work under these conditions and whose pay has not increased to reflect their increased work load.
During my visit to the Royal Hampshire hospital I spoke to science graduate Alex Walster, aged 22. He is one of three scientific officers who are training in the pathology department. His salary falls short of £9,000, which is £2,000 less than the salary that he was earning a few weeks before he took up that job, when he was working in a chicken factory testing chicken for salmonella. I think that that is a tragic story. A graduate who wants to use his skills to benefit sick people and to cure illnesses earned more when he was diagnosing salmonella in chicken.
I heard from another trainee, Sarah Lowdon, aged 23, who is suffering similar hardship. Sarah showed me a petri dish and told me that she was called out at 3 am to diagnose meningitis in the blood. That same evening, she went to work in a bar, which she must do to supplement her income. She received a call-out fee of £13 to do that test, which helped to save a child's life by monitoring the meningitis. She works four hours in the pub in the evening and earns the same money. She looked exhausted. I assumed that that was because of the pressure of work, but it was because she has to work in a bar most evenings to supplement her income.
I represent a constituency where accommodation is unaffordable for people on such low salaries. Even with the extra income that Sarah earns from her bar work, she cannot afford to live in Winchester near her place of work. She must commute daily from Portsmouth, which adds to the length of her working day. That problem was also experienced by the third trainee to whom I spoke, who could not keep up the costs of shared accommodation in Winchester. Not long after he started work at the hospital, he was forced to move back home with his parents, and now faces a 40-mile daily journey to work.
I should like to remind the Minister that in his response to the debate that took place in December, he touched on the question of salaries for trainee biomedical scientists. He said that they had been offered a 26 per cent. pay rise. It was welcome that the Government had recognised that they needed to support trainees at the lower end of the salary scale. Will he comment on the claim by the Institute of Biomedical Science that the 26 per cent. increase affects no more than 100 trainees out of a total work force of some 22,000? Even with that 26 per cent. increase, trainees still earn less than £9,500. Although welcome, the increase has not gone far enough and has not been broad enough to have made the difference that I am sure the Government intended.
225WH We are all aware of the debate about the quality of pay for NHS staff. It is easy for Opposition Members to argue that more money should be thrown at the problem. In this case, however, biochemical scientists have, for the past 20 years, received lower rises than other NHS staff. Like my constituents, many of them rely on overtime payments and have to work 50 hours a week to supplement their salaries.
I am sure that the Minister will remind me that through the "working together" programme, the Government are rightly reviewing the pay system in consultation with the Manufacturing, Science and Finance trade union. That process is expected to produce an agreed package later this year. I hope that the Minister will give more details on the timing of that, and tell us how those negotiations are going.
Although that review is welcome, it is odd that other professional staff in the NHS have already had their pay reviews completed in advance of the "working together" programme. Why is it proving so difficult for this particular group of individuals? It is making morale in the profession much worse.
Ultimately, if these issues are not tackled patients will suffer. If hospitals cannot recruit and retain suitable trained staff, there will be a knock-on effect on the throughput of work, which will not be delivered effectively. Indeed, alarming new evidence clearly shows that NHS trust laboratories are already experiencing recruitment and retention problems.
Research published in January by the Institute of Biomedical Science found that 88 per cent. of all trust laboratories were understaffed, and 66 per cent. had unfilled vacancies. There was a large shortfall in staff throughout the country, and 97 per cent. of respondents to the survey said that pay levels were the key to recruitment difficulties. When interviewed, 61 per cent. of individuals who had left jobs in pathology in the health service said that low pay was their reason for leaving.
My hospital is lucky that it has suitable trainees who are prepared to suffer financial hardship to pursue what they regard as a worthwhile career. Other hospitals are not so lucky. There are similar recruitment problems at higher levels of pathology. A recent national advertisement issued by my hospital for the position of area manager received just three applications. A potential applicant from Swindon was put off applying by local house prices. The successful candidate from Worksop turned the job down because she could not afford the price of accommodation. I know that the Government have recognised that problem through London weighting allowances, but could the Minister comment on some of the difficulties that regions outside London have with high prices?
Seven years ago, a study of pathology services by the Audit Commission concluded that improved communication was needed between those working in pathology and health managers, and recent research suggests that the problem still exists. About half the trusts that responded to the survey believed that biomedical scientist recruitment and retention problems were not being recognised by human resources directors. Even fewer thought that their problems were 226WH being recognised by trust chief executives, and only 10 per cent. of those working in pathology believed that their local authorities understood their difficulties.
Perhaps the most worrying conclusion of the research was that 76 per cent. of NHS trusts were using inappropriate staff groups to cover biomedical scientist duties. I have heard alarming suggestions that in some hospitals pathology departments are close to being run by agency staff. I fear that, as work load pressures increase in laboratories, the number of mistakes will also increase as staff members are continually chopped and changed and, owing to recruitment difficulties, agency staff are brought in.
It is time that pathology staff were fully recognised and rewarded for their major contribution to patient care. It is wrong to pass off well-qualified, dedicated young people as trainees, on salaries of less than £10,000 a year. It is wrong for people who are responsible for diagnosing life-threatening illnesses, and who work exhausting hours, to be forced to take second jobs.
The issue of the welfare of biomedical scientists in the NHS has been ducked for far too long. I hope that the Minister will refer specifically to the pay and conditions of biomedical scientists, rather than just to broader NHS salaries, and will give a clear indication that the Government value the contribution of those working in what I fear is increasingly becoming a Cinderella service.
§ The Minister of State, Department of Health (Mr. John Denham)I congratulate the hon. Member for Winchester (Mr. Oaten) on securing the debate, which gives me an opportunity to stress the importance of NHS pathology, to speak of the improvements that we are making in staff pay and conditions, and to draw attention to the excellent services provided by pathologists and laboratories.
Pathology services play an integral part in effective NHS treatment, the diagnosis of illness and the early detection of disease, the provision of evidence-based care and the protection of public health. The quality of the service is paramount, and we are taking wide-ranging action to ensure that the performance of laboratories meets national standards. Since December 1997, quality assurance measures have been strengthened and most laboratories have succeeded in obtaining accreditation. That is a testament to the hard work and commitment of the staff involved.
Nevertheless, laboratory performance is kept under close review. Pathology services are not perfect, and there will always be particular elements that need attention. In the very few cases in which concern has been expressed about a laboratory's performance, swift action has been and will continue to be taken.
Quality in pathology services is maintained at three levels: by laboratory accreditation, by state registration of staff, and by the underpinning of education and training programmes. The accreditation procedure is part of an overall quality assurance programme, and shows that a laboratory is operating according to defined standards of practice that have been independently confirmed. The application process itself entails exacting work on the part of the laboratory, and requires it to examine a number of aspects of its operation ranging from health and safety to staffing. As 227WH a result of engaging in the process, laboratories gain detailed knowledge of their strengths and weaknesses, and can begin to address the weaknesses. The hon. Gentleman will be pleased to know that the pathology service at Royal Hampshire County hospital is fully accredited in all six areas of pathology: microbiology, histology, haematology, biology, immunology and public health.
We are not complacent, however. We are determined to modernise the NHS as a whole, and pathology is no exception. Successive reviews of pathology services conducted over the past 10 years by the Audit Commission and the NHS executive have identified a long-standing need for us to reconfigure and invest in pathology provision in England. We are acting on those reviews; we want to reconfigure the service, improve quality and efficiency and meet the changing demands of a modern NHS.
Last year, we embarked on a long-term pathology modernisation programme, overseen by an independent steering group representing a broad range of professional expertise, in order to ensure that developments are in tune with the many diverse facets of the NHS pathology service. To launch the programme and to put in train exemplar initiatives, we allocated £5 million of capital in the current financial year for pathology modernisation projects. We have identified five areas requiring modernisation: the needs of inner cities, the needs of isolated rural areas, the need for innovation in pathology provision, the role of information management technology and the need for modest modernisation initiatives. We intend to allocate a further £15 million in the next financial year to enable larger rationalisation to take place.
I hope that the hon. Gentleman finds that information useful as a context, reinforcing our central commitment to quality and our measures to bring about accreditation and investment. Recent media concern about staffing levels will have undoubtedly led to public concern about the quality of services. We should also bear in mind what is currently available, so that public confidence is not damaged.
One report was alleged—not, of course, by its authors, but by its interpreters—to show that unqualified staff were conducting laboratory tests. That allegation is entirely untrue, and we considered it serious enough to issue a statement jointly with the Institute of Biomedical Science refuting it. A corresponding statement was made by Clinical Pathology Accreditation UK Ltd, refuting allegations that clerical staff were playing a role in reading and interpreting test results. It confirmed that NHS laboratories provide a high-quality service—indeed, I think that it said "second to none".
It is true that, at present, laboratories contain a number of support staff who are trained in-house to carry out a number of tasks under the supervision of qualified staff, but quality services can be provided only by quality staff, and work must be "signed or by them. There is a range of skilled staff: clinical and biomedical scientists—also called medical laboratory scientific officers, or MLSOs—and medical laboratory technical and support staff.
For the first time since the foundation of the NHS, our national service frameworks to deal with, for instance, coronary heart disease—in the case of one 228WH launched this week—and mental illness provide standards against which we can marry service, resource and staff planning. Pathology will play a crucial part in the work of the frameworks. We are determined to ensure that those three elements come together, so that we can make certain that the right pathology staff and services are in place to support the frameworks.
I agree with the hon. Gentleman that the issue of pay is important. Current pay for clinical scientists ranges from £13,000 to £54,000, and for biomedical scientists from £7,400 to £32,000. Our pay offer for the current financial year—now included in the offer of a three-year deal—seeks to address the problem of low pay at the bottom end of the biomedical scientists' scale by raising the salary to £9,400. That is an increase of 26 per cent.
All scientists have been offered at least 3 per cent., which is considerably higher than the rate of inflation. About half of all biomedical scientists—some 6,000, in the lowest grades—have been offered 7 per cent. to deal with special recruitment problems. Trainee biomedical scientists have been offered an enhanced deal as well. There are about 1,000, and, as the hon. Gentleman said, some 100 have been offered 26 per cent. The rest have been offered increases ranging from nearly 7 per cent. to 22 per cent. through a restructuring of their pay scale. That is a fair offer in current circumstances. We set out to target funds where the need was demonstrably greatest—in recruitment and retention. That is a bigger problem with some staff groups than others.
Last year, we carried out a survey of NHS staff vacancies in all staff groups. About 98 per cent. of people responded. It found that, across the board, pathology staff were in a relatively healthy position compared with other disciplines, and showed that hardto-fill vacancies—those lasting more than three months—accounted for only 0.9 per cent. of vacancies across the discipline as a whole. However, there is a problem in recruiting staff at the bottom end of the biomedical scientist scale. We recognised that and have offered larger increases to staff at that end of the profession. That means that some pathology staff will receive more than review body staff: biomedical scientists will receive up to 7 per cent., and trainees up to 26 per cent., which compares favourably with the 4.7 per cent. that was awarded to many, although not all, nurses.
Local employers already have some flexibility within the existing national Whitley system to offer pay rates that are attractive enough to get staff with the skills that are needed. There is, for example, the provision within Whitley to restructure on-call and call-out payments to suit local service organisations. That action has been taken by NHS employers, including those at Winchester and Eastleigh Healthcare NHS trust, to pay staff more attractively to ensure key services are provided when they are needed.
At Winchester, that means that staff working in biochemistry and haematology may have their annual pay increased by £3,744 for providing on-call services twice a month. I am informed that the extra increase is paid to 13 out of the 15 biomedical scientists at Winchester who work in biochemistry and haematology. Having said that, as the hon. Gentleman rightly said, the current pay system is out of date and in need of review. That is why, last year, we published "Agenda for Change", which gives detailed proposals 229WH for modernising the way in which the NHS rewards its staff. We want a new system based on efficiency, fairness, flexibility and partnership.
To free the time to design that new system properly, among other reasons, we have made a pay offer well ahead of inflation for 1999 to 2002. Our intention is to give staff security about their pay over that period while we continue to negotiate a new pay system that will give all staff better career progression, will give them fairer rewards for taking on extended roles, and will widen their skills and encourage people to work in teams. We want the new pay system to deliver modern conditions of service and to provide a fair basis for pay rises in the security of a national pay system.
Modernising the pay system is one of our key priorities. It will be fair for staff, but, critically, also help to deliver new patient-centred services that both the Government and staff want. Our discussions have been constructive and positive. We recognise that, for various reasons, some smaller groups of highly qualified health professionals are outside the remit of the Nurses and Midwives Pay Review Body. Talks are under way with staff and employer representatives around "Agenda for Change." Those will include discussion on whether any new groups should come under the pay review body. It is not intended to change in any way the fundamentally professional coverage of the body.
I understand why the hon. Gentleman wants further information about where and when decisions and announcements will be made. As I have said to the hon. Member for Twickenham (Dr. Cable), it is too early to comment on proposals for specific staff groups. The negotiations are being dealt with as a package—as a whole. However, I am confident that pay modernisation will bring benefits to all NHS staff, whether or not they are covered by a review body.
Consultations and discussions are going ahead. They are constructive and useful. The MSF union—I declare an interest as I am a member—is, I am pleased to say, playing an important and major part in the talks and ensuring that scientists' views are well represented. The hon. Gentleman asked about time scales. I like to feel 230WH that, if our negotiations are successful, we could have a fully agreed package by the summer, with implementation starting next spring, but clearly that depends on the progress of the negotiations.
To get the work force we need in pathology, as elsewhere, we need to attract the right calibre of staff to employment. When we do, we need to ensure that we can keep them. Our wider human resources "working together" programme concentrates on providing a better human resources framework for the whole work force. That includes scientists and technicians. They are not one of the largest staff groups, but they are vital, as the hon. Gentleman said, to a first-class health care system. That means looking at issues such as flexible working patterns, flexible working life and staff participation.
We will target recruitment and retention at wider groups of staff. For understandable reasons, to date the more visible focus of recruitment and retention work has been on larger staff groups such as nurses, but the new recruitment and retention unit has met leading members of the scientist professional organisations and is working with them and NHS employers to draw together a new strategy to raise the profile of the work of scientists and technicians in the NHS. That will publicise the work and career prospects available. It will help to underpin effective national recruitment activity, to promote return to practice and to ensure that there is modern, up-to-date careers advice. We have established an annual recruitment and retention survey, so that we always know that we have the right information on which to act.
Pathology services are too important for us to be complacent about the issues that have been raised by the hon. Gentleman. The basic pay of some biomedical scientists, including trainees, is low. Employers can and do supplement that in a variety of ways to attract quality staff. There is an offer on the table that would make a significant difference to some key groups of staff. What is key is to recognise that accreditation of NHS pathology laboratories is high both in quality and coverage. That provides safeguards for patient services.
§ Question put and agreed to.
§ Adjourned accordingly at three minutes to Two o'clock.