Orders of the Day — National Health Service

Part of the debate – in the House of Commons at 12:00 am on 8th May 1963.

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Photo of Mr Kenneth Robinson Mr Kenneth Robinson , St Pancras North 12:00 am, 8th May 1963

The British nation is fitter and longer-lived today than ever before. Britain's health record and her medical services are the envy of many nations and may well become their model. Our Health Service has been described by an American social historian, Professor Almont Lindsey, as 'magnificent in scope and almost breath-taking in its implications'. Those sentences which remain broadly true even today, are not mine. They are taken from the first and the last pages of a pamphlet "Design for the Nation's Health", just published by the Conservative Central Office. It is a little odd how Conservative love for the National Health Service grows with the approach of a General Election, and just in case anyone may be mislead by any attempted takeover bid for the Service perhaps I had better start by reminding the Committee and the country, once again, that this great Service would never have been born if the party opposite, which voted against the Second and Third Readings of the National Health Service Bill, had had its way.

I should like to add a quotation of my own from the same American professor and the same admirable book which was quoted by the Conservative Central Office pamphlet, which is, incidentally, called, "Socialised Medicine". On page 100, Professor Lindsey writes: Until the Conservatives came into power in the fall of 1951, the cost of the Health Service was an issue that that party did not fail to exploit in its attack upon the Labour Government. The main structure of the Service was so soundly designed and built by Aneurin Bevan that it has stood up remarkably well to the strains and stresses of twelve years of government by the party opposite, but the Service has certainly not expanded and developed in the way that we all looked forward to at the start of what was then a great experiment. Indeed, far from advancing, in some respects we have been going steadily backwards and in the place of expansion we have had contraction. I want to come back to this in a moment.

I am sure that hon. Members on both sides of the Committee must have been entertained by an article which appeared last Sunday in the Sunday Times, entitled "Enoch's Week-end". It purported to be a kind of fly-on-the-wall report of that now famous Chequers meeting of 10 days ago, and if one is to believe this article, in the course of a generally dazzling display of intellectual virtuosity by Her Majesty's Ministers, one star shone out far brighter than the rest, and that was the right hon. Gentleman the Minister of Health.

I was reminded of the famous description of the boat race by the Victorian novelist Ouida, who wrote that All rowed fast, but none rowed so fast as stroke". I am sure that the right hon. Gentleman handled his stroke oar with great dexterity on that occasion. I am equally sure that some of his colleagues found great difficulty in keeping up with him in his break-neck excursion into the Britain 'seventies, but I beg the right hon. Gentleman to take his eyes off the far political horizon for a few moments and to take a closer look at what is happening today in the early 'sixties, to the hospital services, for which he has a rather more direct responsibility. The right hon. Gentleman has subjected the hospitals to a painful and quite deliberate financial squeeze which has had the effect of weakening the service and forcing it in many respects to contract.

This may all sound very paradoxical, at any rate to those hon. Gentlemen who have been dazzled by the ten-year Hospital Plan and the large sums of capital moneys which are scheduled to be spent an hospital building over the next fifteen years. Though we have criticised that plan in detail, I think the right hon. Gentleman will agree that we welcomed it in principle, even if we noticed that there was no firm commitment to anything anywhere. Nevertheless, we all recognised that at long last money was more freely available for capital development of the hospitals, and that this came after a long period of capital starvation when the hospital service could do little more than make do and mend.

During the last six to nine months we have become aware of the price, of at any rate part of the price, that we have to pay for these major developments in hospital building, because capital starvation has now been replaced by a maintenance squeeze. This all goes back to the right hon. Gentleman's Lloyd Roberts lecture in the autumn of 1961, when he expressed the view that a figure of 2½ per cent. in real terms was about the right figure for the annual growth of the National Health Service.

In Question and Answer in the House later, he made it clear that this was not so much his own figure as that of the right hon. and learned Member for Wirral (Mr. Selwyn Lloyd), who was then Chancellor of the Exchequer and who quoted this figure in his economic crisis statement of July, 1961. But the Minister of Health added his own refinement to this 21 per cent. and said that he thought 2 per cent. was enough for the hospital service.

I freely admit that at the time the right hon. Gentleman's remarks created no very great stir. They were not so much a bombshell as a time bomb, and this weapon went on ticking away merrily. Few people in the hospital service paid very much attention to it until it exploded in their faces about a year ago, because when the regional hospital boards came to examine their 1962–63 allocations, most of them found to their dismay that they had not got even 2 per cent. I think that out of 15 regional hospital boards 10 received markedly less than 2 per cent. The range was from just over ½ per cent. to just over 2½ per cent.

What does this figure mean to a hospital authority trying to run a group of hospitals or a region? It may not sound disastrous, but that is precisely what it is, because even a figure of 2 per cent., let alone one of 1½ or 1 per cent., for expansion, means one thing only, and that is a contraction of hospital services. I should like to explain this to the House, because it is not altogether a simple matter.

One must first ask oneself what this increase, which amounts to 3d., 4d. or 5d. in the £, has to do. First, it has to cover any increase in staff, though not of course, any increase in wages or salaries. I recognise that this is met by Supplementary Estimates as a separate operation, but any numerical increase in staff must be covered by this increase. It must cover any price increases in the course of the year, and last year there were many such price increases, particularly in food. I think that the Committee will recall that the price of potatoes, which are consumed in large quantities in our hospitals, rose to an all-time high. The increase also has to finance the maintenance costs of any new development in the hospital service, but above all this there is another and still more important factor.

The techniques of medicine are inevitably becoming more complex and more expensive all the time. This is an irresistible process, and is not unique to the hospital service. It is common to every scientific or technological field. In the hospitals, this increase in complexity and costs results, and I think is wholly justified, in more intensive and effective medical care of the patients. This is not easy to measure in monetary terms, but the amount of this increase, going on remorselessly year after year, is a good deal more than 2 per cent. One medical journal suggests a figure of 5 per cent. per annum for this aspect alone. All this can only mean that a hospital which is squeezed down to a 2 per cent. figure of increase must contract, and that to some extent the service it can give to its patients must deteriorate.

But this is not the whole story, because 1962 showed a sudden and marked improvement in the nurse recruitment situation. One cannot be sure what this was due to. It may have been due, to some extent, to rising unemployment, to fewer opportunities in fields in competition with the Health Service—light industry and that kind of thing—and possibly to some extent to the much publicised and ultimately successful fight of the nurses for more pay and a better standard of living. Anyway the situation improved.

Up to that time nearly every non-teaching hospital in the country had been suffering from a shortage of trained nurses and of suitable student nurses. The shortage was acute, and, indeed, endemic, but where hospitals had been able to recruit additional nurses the money had in the past been found somehow. Regional boards usually had some small reserve tucked away which they would make available to any hospital authority which managed to increase its establishment of nurses. Suddenly, about a year ago, the recruiting situation changed. More girls, and young men, too, became available. Some hospitals recruited more nurses, and immediately found themselves, often less than half way through the financial year, with a financial crisis because, owing to the squeeze, there were no reserves to meet this additional expenditure. Worse than that, other hospitals—the right hon. Gentleman might think that they were the more prudent ones—had no option but to turn away potential nurses. In fact, they were turned away in their hundreds and thousands and were lost to the nursing profession for ever. It is no less than a tragedy, and it is one for which we shall probably be paying many years hence.

What did the hospitals do, faced with this situation? Any hospital authority is reluctant in the extreme to cut down in any way the service which it gives the patient, but many of them had to close down wards for lack of nurses. In many more—indeed, in most—recruitment of nurses stopped absolutely. More than one regional hospital board actually instructed its hospital management com- mittees not to recruit any more nurses. Some hospitals were even unable to replace the nursing staff which had left for one reason or another. In one hospital that I know of the preliminary nurses training school had to cut down its intake of student nurses by 50 per cent. All this had an appalling effect on the morale in the hospital service.

Here again, this is not the end of the story. What else did the hospitals have to do to tighten their belts? Some made economies in food. We heard stories of butter being replaced by margarine. Some stopped overtime, and some dismissed staff. But most were forced to do the one thing that does not immediately affect the patient, namely, to defer building maintenance work and to postpone repairs, redecorations, and renewals of equipment of all kinds, including medical equipment.

The net effect of the right hon. Gentleman's economy drive on the hospitals was to force them into an utterly false economy, because maintenance and repairs must be done in the end. The equipment must be renewed, and it is bound to cost more when it is done. I have been talking about 1961–62, but exactly the same situation was repeated this year. No more money was allowed for maintenance; the same proportionate increase was granted by the Ministry, and the same work must be deferred for another twelve months, and will still be more costly to carry out when it can be deferred no longer.

Hospital management committees appreciate the sheer stupidity of this policy, even if the right hon. Gentleman does not. I do not know whether he is aware of the fact, but he is breaking the hearts of the members and officers of hospital authorities who are dedicated to improving the Service in any way they can. The situation was summed up in an editorial in the Lancet on 6th April this year, which said: hospitals can introduce improvements … only at the price of deliberate economies in existing services; and hospital authorities insist that, having saved as much as they can—for instance, on the hotel side, or by postponing redecoration, or even by abstaining from buying necessary medical equipment—they can save no more. In the drive to improve the service they have been brought to a halt: without extra aid the next move will be downhill. There is no sign that extra aid is coming from this Government, and in my view the move downhill has already begun.

I want to know why the right hon. Gentleman imposed these cuts—because they are cuts. Certainly, one can see nothing in the current economic situation to justify this. When, last July, the right hon. Gentleman was elevated to the Cabinet, nearly everybody in the National Health Service was delighted. Everybody felt, somehow, that this raised the status of the service, and that the Minister would he able to fight all the harder for the service and get more money for it. All I can say is that, in the event, they have been bitterly disappointed at the result.

Before I turn to my other main topic, I want to say a few words about the doctors' pay award. I thank the right hon. Gentleman for his courtesy in letting me have some statistics—making a special effort to do so—which might be useful in this afternoon's debate. There are some extraordinary features about this pay award. It stems from the original appointment of the Royal Commission on Medical and Dental Remuneration—which recommended the award of a 22 per cent. increase in medical salaries in February, 1960, although the House will recall that part of that 22 per cent. had already been paid in the form of interim awards before 1960.

The Royal Commission recommended the setting up of a review body, which was to be independent of the Minister of Health, of the Government and of the professions—a body which would be charged with the duty periodically of reviewing the level of medical and dental incomes, and a body to which the professions could from time to time make their submissions. There was some delay, but the review body was in due course set up—not by the Minister of Health but by the Prime Minister, presumably because the Royal Commission had been set up by the Prime Minister, and the review body derived from that Royal Commission. A prominent banker was chosen as chairman of the review body.

But, with that unerring instinct that characterises all the Prime Minister's appointments, and presumably to emphasise the impartiality of the review body, the Prima Minister selected as chairman the one bunker in Britain who just happened to be an honorary Fellow of the Royal College of Surgeons. At least, I hope that I am right in assuming that Lord Kindersley was not made an honorary F.R.C.S. subsequently, as a reward for his services to the medical profession. The form in which these recommendations are made is an extremely odd one. It comprises a long, chatty letter from the chairman to the Prime Minister, which begins, "Dear Prime Minister", and ends, "Yours sincerely, Kindersley". It is the Prime Minister who accepts or rejects the review body's recommendations.

When the body reported, I asked the Prime Minister, at Question Time, whether he knew of any other wage-negotiating body which reported its recommendations directly to him. The Prime Minister did not know of any—and, indeed, he did not seem to know why this one did. Does not the Minister of Health find this position slightly humiliating? Is it not time that this body was told that in future it should report to him? He is clearly responsible for the level of medical remuneration. I hope that ha will put this matter right.

In the event, the doctors were awarded another 14 per cent. This means that they have had very nearly a 40 per cent. increase in about six years, which is more than most groups of workers in the community have had—certainly more than most groups within the National Health Service. The latest award, affecting over 50,000 doctors, will cost the taxpayers about £16 million more per year. The review body explained, however, that it was really an award for the next three years. If that is so, it is equivalent to very nearly 7 per cent. cumulative for each of the next three years. When I put this point to the Prime Minister he said that he did not accept my arithmetic. If the Minister of Health challenges my arithmetic, I hope that he will correct me when he replies. I think that he will find that it is just about 7 per cent. per annum for She next three years.

Without in any way wishing to criticise the award, I have two things to say about it. First, the review body's terms of reference are, broadly, to keep medical remuneration in line with other professional incomes and, presumably, with the cost of living. In practice, how can the review body foretell what will be the level of other professional incomes in 1966, or what will be the cost of living then? Does it add clairvoyance to the other distinguished qualities which it brings to its work? Secondly, the figure of 7 per cent. goes a good way beyond any guiding light that has so far illumined the Government's incomes policy, if we may dignify it with that name. The 14 per cent. is still further removed.

I should like to ask one question of the right hon. Gentleman, and I hope that he will answer it. Why was this salary award not referred to N.I.C.? Is not that precisely the kind of thing that the National Incomes Commission was set up to consider? Is there any class distinction here? Are professional earnings exempt from N.I.C.'s baleful glare?