Health Service Staff Commission

Orders of the Day — Health Services Bill – in the House of Commons at 12:00 am on 9th June 1980.

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' (1) It shall be the duty of the Secretary of State to appoint, within one month beginning with the date of the passing of this Act, two Commissions to be called the National Health Service Staff Commission and the Welsh National Health Service Staff Commission ; and the Commissions—

  1. (a) shall consist respectively of such persons as the Secretary of State may from time to time appoint as members of the Commission after consulting the bodies appearing to him to represent persons employed in England, or, as the case may be, employed in Wales who are liable to transfer in pursuance of section 1 of this Act and any other bodies appearing to him to be concerned with transfers of such persons in pursuance of that section ; and
  2. (b) shall in the case of the National Health Service Staff Commission exercise its functions in relation to England and in the case of the other Commission exercise its functions in relation to Wales.
(2) It shall be the duty of each Commission—
  1. (a) to keep under review the arrangements made by relevant bodies in recruiting and engaging employees and the arrangements made in transfers in pursuance of section 1 and this Act and to give advice to the Secretary of State and the relevant bodies with respect to the arrangements ;
  2. (b) to consider and advise the Secretary of State on any matter which he refers to the Commission as being a matter which in his opinion arises in connection with persons liable to transfer in pursuance of section 1 of this Act ;
  3. (c) to consider and advise the Secretary of State on the steps required to safeguard the interests of persons liable as aforesaid ; and
  4. (d) to arrange for the consideration of representations made to the Commission by an employee transferred from the employment of one health authority to that of another objecting to such a transfer and for the giving of advice to such employees by the appropriate Commission ;
  5. (e) shall so advise health authorities that no officer employed by a health authority at the date when the Commissions are appointed shall be deprived of employment within the National Health Service on consequence of this Act save with his express consent freely given to his employing health authority and the appropriate Commission in writing ;
and each Commission shall have power to take any steps which it considers are appropriate for the purpose of selecting and recommending to Regional or Area District Health Authorities and special health authorities persons whom it considers are suitable for employment by any of those authorities.(3) The Secretary of State may—
  1. (a) give directions to each Commission with respect to its procedure ;
  2. (b) give directions to relevant bodies with respect to the furnishing by them of information requested by the appropriate Commission and with respect to the action to be taken by them in consequence of advice given by that Commission ;
  3. (c) pay to any member of either Commission such remuneration as the Secretary of State may determine with the approval of the Minister for the Civil Service ;
  4. (d) defray any expenses incurred with his approval by either Commission in the performance of its functions ; and
  5. (e) wind up either Commission in such manner and at such time as he thinks fit ;
and it shall be the duty of a body to which directions are given in pursuance of this subsection to comply with the directions.
(4) In this section "relevant bodies" means bodies from and to whose employment persons are liable to be transferred by virtue of section 1 of this Act.'.—[Mr. Moyle.]

Brought up, and read the First time.

Photo of Mr Roland Moyle Mr Roland Moyle , Lewisham East

I beg to move, That the clause be read a Second time.

In passing, Mr. Speaker, I thank you for your indulgence in selecting amendment No. 3 in place of admendment No. 2.

In moving this clause we give the Government an opportunity to enlighten the House and employees of the Health Service about their broad approach to personnel problems and the human factor in the reorganisation. I stress the phrase "broad approach", because on the Labour Benches we accept that protection of staff and redundancy arrangements are essentially for negotiation through the Whitley machinery. Nevertheless, when the Health Service was last reorganised the House legislated to provide a staff commission to protect the staff. That staff commission clause was contained in the National Health Services Reorganisation Act 1973. We are not breaking new ground. That is why we have to raise the matter on the Floor of the House.

The Minister will remember that we raised the matter in Committee, and were not satisfied with reactions to the clause. We did not vote in Committee, because we wanted to leave maximum freedom for negotiation on the Whitley machinery. However, we gave notice that we should return to the matter on Report. That is why we have retabled new clause 9 in exactly the same terms as in Committee. The new clause almost exactly mirrors the 1973 clause. There can therefore be no major objection in principle to its acceptance by the Government.

One of the main reasons why this reorganisation in the Health Service is being carried out is to improve the morale of employees, which was badly shattered as the result of the reorganisation carried out by a Conservative Government in 1973. The human factor is therefore very important. Once the reorganisation has been carried through, we must ensure that we do not return to the situation that prevailed between 1973 and 1980.

The signs are that the Government are mishandling the industrial relations side of the reorganisation even at this early stage. They told us in Committee that they did not want to disclose the details of their approach to these problems in Committee because they wanted to be precise and make precise proposals to the staff. To some extent we accepted that. We appreciated that the Government could indicate only a broad approach, and that certain problems exist Having consulted the staff side of the Whitley council, we find that its criticism of the Minister is that he is being vague with it. The hon. Gentleman was vague with us in Committee and is being vague with the staff through the Whitley machinery. Do the Government know what they are about in carrying out the reorganisation? If so, this is an opportunity for them to tell us.

It is clear beyond peradventure that the staff side wants a staff commission to look after the interests of its members. I do not suppose that it is particularly concerned that it should be a legal staff commission, as opposed to an administrative one, but it feels that it needs a staff commission to look after the interests of its members in the coming reorganisation. The staff side has had much experience of such machinery.

The unions worked with staff commissions when the GLC was set up in the early 1960s ; when the local government reorganisation was carried out by the right hon. Member for Worcester (Mr. Walker), who is now Minister of Agriculture, Fisheries and Food ; and on the new towns reorganisation and the Health Service reorganisation in 1973, as I have already said. It feels that the management and staff members of the Whitley council, committed to the guidelines issued by the council—which would have caused the trouble in the first place and upon which a staff commission would have to adjudicate—would not be the ideal body to carry out and supervise the reorganisation. A staff commission would have a chance for a second look at the situation, uncluttered by any preconceptions arising from the negotiation.

In addition, the staff representatives are not keen on one of the hon. Gentleman's bright ideas—local, regional, area and even lower-level negotiations on staff redundancy.

In Committee the Government rejected a staff commission. I hope that they have reconsidered the matter and will now accept the idea. The opportunity for legislation in this House is disappearing. If the Government want to give the staff side legal guarantees of security during the reorganisation, they have an opportunity this afternoon, which will not arise again. The idea of a staff commission cannot be rejected in principle or drafting detail. As I said, the Conservative Party accepted a commission in 1973, and we have put forward that same clause for adoption today. It is not time for Government undertakings. If a staff commission clause is introduced by the Government in another place, we shall want to debate it when the Bill returns to this House.

If the Government embark on a reorganisation of the Health Service with- out a staff commission, they will not carry the staff with them, and will prejudice the final outcome of the reoganisation. The idea that there should be a sub-committee of the Whitley council to negotiate the reorganisation is entirely different. That would be a different piece of machinery for an entirely different purpose, and does not meet the desires of the staff side.

Two other points arise. There are groups of functionally organised disciplines whose members stand to be decimated as a result of reorganisation, such as some nurse managers, works officers, catering officers, laundry officers and many others. These people have had a system of functional report up to area level, and that is threatened with extinction, together with a number of professional jobs.

I know that the functional organisation is a matter of controversy within the Health Service. However, the individuals concerned have been sent there by the Government to do jobs in those places. They have done those jobs conscientiously, in accordance with their best lights. In some cases they have made considerable improvements. It will be through no fault of theirs if those jobs are done away with. We have had no indication from the Government so far that they even recognise that there is a problem for such groups. I hope that the Government will say something about their future this afternoon.

Finally, there is a major change in the mood of the staff in terms of the reoganisation and its timing, of which the Government should be aware. I believe that the permanent secretary to the Ministry has mentioned reorganisation taking place over four years. I have said that it might take two years. The National and Local Government Officers Association would like the reorganisation carried out as rapidly as possible, and based on an appointed day.

That is a mood that we must take into account in approaching the reorganisation. The view is simple. It is based on the fact that if reorganisation is piecemeal across the country and spread over a long period, those who are reorganised first will not be aware of all the jobs that are coming up in the NHS for which they might apply when they lose their jobs and are forced to decide about their future employment.

The staff would like the reorganisation to be confined to as short a time as possible, so that if they are then declared redundant they will be aware of the wide range of employment available throughout the NHS when they have to take a decision about moving elsewhere.

A staff commission will be necessary to ensure that the staff know that there is a powerful independent body to look after their interests. The Government will be wrong if they continue to resist the plea of the staff side of the Whitley machinery for a staff commission. We shall be pleased to hear what they have to say about it.

Photo of Mr Paul Dean Mr Paul Dean , Somerset North

I agree with much of what the right hon. Member for Lewisham, East (Mr. Moyle) said about the need to deal as expeditiously and fairly as possible with the feelings of the staff about reorganisation, but I part company with him on his preferred method of doing that.

There is no doubt that another reorganisation, following quite speedily on the previous one, will inevitably create another area of uncertainty for the staff concerned, some of whom are being reorganised for the second or third time in their professional lives. It is necessary that the Government should take seriously the uncertainty that is bound to be created by such a situation.

I also agree with the right hon. Member for Lewisham, East that the sooner that the reorganisation is completed the better, so that those who may have to change jobs may know as quickly as possible where their new responsibilities will lie. I am sure that there is no argument on either side of the House about those general principles.

However, I doubt whether setting up a new body is the right way to go about it. Safeguarding the interests of the staff on reorganisation is primarily a matter for the established bodies. It can be argued that the Whitley councils have not been entirely satisfactory to some in their method of operation, but they represent an established, well-known procedure which has existed for many years. It would be much more satisfactory to use that established machinery rather than to set up a new body which would inevitably lack experience of the problems involved and would lead to delay rather than to speedy decisions for the staff concerned.

If one considers the propositions in the new clause and the detailed duties of the commission one sees that it would be a well-meaning, busybody advisory committee, which would be much more likely to hold up the process of reorganisation and getting people into new jobs. I hope that my hon. Friend the Minister for Health will be able to assure the House that decisions will be taken as speedily as possible, in the interests of the staff concerned, but that he will resist the invitation to set up a new body which would not be in the interests of the security of employment of the staff.

Photo of Mr David Ennals Mr David Ennals , Norwich North

The Government would be well advised to accept the new clause. There are strong feelings among the staff on a variety of issues, one of which is the proposed reorganisation. It was a traumatic experience for them in 1974 when they were put through a reorganisation imposed by the previous Conservative Government, which led to many difficulties and much sorting out. Those of us in the succeeding Labour Government had to spend much time getting the position settled again.

4.15 pm

To embark on reorganisation again, as both sides of the House recognise that we need to do, will impose further strains on the different sections of the staff. We know the difficulties in industrial relations and the need for staff to be able to meet round the table in order to avoid some of the difficulties that have beset the NHS over the years.

There is a great deal of ill feeling, concern, and even anger about nurses' remuneration. I am not suggesting that a staff commission should replace the Whitley council negotiations, but the Secretary of State has done a great disservice to the nurses, including the Royal College of Nursing and the trade unions, by seeking to suggest that the 14 per cent. cash limit imposed by the Prime Minister and the Secretary of State on nurses puts them into a comparable position with the medical profession.

The Secretary of State grossed up some figures and said that pay awards since April 1978 to both doctors and nurses totalled about 65 per cent. Anyone who makes inquiries into the matter will discover that that is not so and that the comparisons are grossly misleading. I have done my own arithmetic, taking April 1978 as the base line for both doctors and nurses. Nurses received a 9 per cent. increase in that April, followed by a Clegg award of 20 per cent., the adjustment of hours, worth roughly 6·7 per cent., followed by the 14 per cent., on offer now. That takes us to 58·5 per cent. The grossed-up figure for doctors is 65 per cent. There is a sharp difference.

I know that when the differences were put to the DHSS it was claimed that like was not being compared with like because the total salary bill for nurses and doctors was involved. There are more nurses employed now than there were two years ago and it may be that the total payment for nurses has gone up by 65 per cent. However, I know that there has also been a substantial increase in the number of doctors and dentists. Therefore, the Government are not comparing like with like.

In the Secretary of State's attempts to deal with the problems that have been raised by the Royal College of Nursing and will be raised by the nurses' unions, he does not help his cause—I say this with some experience—to try to fool or mislead the organisations on such matters.

I hope that the establishment of a new staff commission would lead to better relations between one section of the staff and others so that we should not have the present sort of conflict. I hope that the Secretary of State or the Minister for Health will come clean about the comparison that the Government have sought to make between the doctors—I accept that an 11·7 per cent. rise was a commitment undertaken by both sides of the House and that the rate of inflation took it up to over 30 per cent.—and the nurses, whom, we are told, have to live within a 14 per cent. increase. There is no more important group than the nurses in the National Health Service. It is important that there should be co-operation between nurses and doctors and others who work within the Health Service. I hope that Ministers will come clean so that the public and the nurses are not mislead—

Photo of Mr Stan Orme Mr Stan Orme , Salford West

My right hon. Friend will perhaps recollect what the Minister for Health and the Secretary of State had to say about the previous Government's treatment of the nurses. He will recall the criticisms that were made and the stand that they took at the time. That can be contrasted with what is happening at present.

Photo of Mr David Ennals Mr David Ennals , Norwich North

It is true, looking back over the last 12 years, that the biggest improvements in nurses' pay have occurred under Labour Governments and not under Conservative Governments. I did not wish to make a point of that, although I agree with my right hon. Friend. If the Secretary of State and his ministerial colleagues think that they will be able to force the nurses into a totally different position from that of the medical and dental profession, they have another think coming.

I have seen anger among the nurses. Nurses have been angry with previous Governments, including the Government in which I was Secretary of State, but I do not think that there has been a time when they have felt more angry than they are at present. Their anger is increased when they see the Secretary of State deliberately distorting the figures and making comparisons that the nurses know do not stand up to examination.

Photo of Mr Laurie Pavitt Mr Laurie Pavitt , Brent South

I wish to commend strongly the new clause moved by my right hon. Friend the Member for Lewisham, East (Mr. Moyle). It was interesting to hear the contribution of the hon. Member for Somerset, North (Mr. Dean). It is a typical instance of how hon. Members on both sides of the House who are knowledgeable about these matters can have the same objective but differ about the means of achieving it.

I hope that the Minister will be more forthcoming than he proved to be during a similar debate in Standing Committee. The concern is already apparent. One has only to go back to 1973, to the period before the 1974 Act and its appointed day, to recall how morale in the Health Service was shattered from top to bottom because no one knew what was happening or when it would happen. It was perhaps no coincidence that the 1974 Act came into effect on 1 April, All Fools' Day. The Act has certainly proved an all fools' Act. The Opposition have supported the Government in trying to rectify some of its worst provisions.

The problem of morale in the National Health Service extends back for an even longer period. One of the contributory factors has been uncertainty about the future. I remind the Minister of answers that he has given me about what is to happen in my own health authority. The area medical officer has resigned. It is not known when or where changes will take place. Throughout the country, 90 area health authorities are to be replaced by between 150 and 190 district authorities. How that is supposed to save money baffles me.

The uncertainty about the number of people in posts between now and the time when the reorganisation comes into effect will mean a further lowering of morale in the National Health Service. It has been suggested that the problems can be solved through some medium of the Whitley council. Lord McArthy's report on revision of the Whitley councils was far-reaching. With due respect to Administrations of both parties, little has happened. My view is that the Whitley council machinery is not the best for the Health Service. Only 10 years after the Act was passed in 1948, doctors had contracted out entirely from the Whitley council machinery and had their own review body.

When the future of jobs, the transfer of jobs and the protection of employees are involved, the new clause could solve the problems that lie ahead in the next two years. The comments made by my right hon. Friend are relevant to the situation in which the nurses find themselves. I recall the fight in which area nursing officers and the nurses in the district management teams were involved. There seemed to be one scale of salaries for finance officers and other administrators and another scale for medical officers. In the reorganisation that took place in 1973 and 1974, the nursing officer was always bottom of the list That is what lies behind the new clause put forward by the Opposition. It is an attempt to get some sense into the change-over.

The big problem faced by nurses in the past two or three decades is that they catch up only temporarily and, two or three years later, find their conditions of service eroded in comparison with professions supplementary to medicine and especially the medical profession. Nurses are not especially political. They are not particularly attached to party labels. In my experience, nurses have not been especially anxious to see a Labour Government. It was with some delight that I noted that the journal of the Royal College of Nursing paid tribute to the fact that the only time nurses have received anything was while a Labour Government were in power. The Halsbury award, made at the time that Mrs Barbara Castle was Secretary of State, was a breakthrough. By 1978, however, that award had been eroded. The nurses are to have a ballot—

Photo of Mr Bernard Weatherill Mr Bernard Weatherill , Croydon North East

Order. I am sorry to interrupt the hon. Gentleman. His right hon. Friend referred to nurses' pay, but this is not a debate on nurses' pay. The hon. Gentleman should stick to the new clause. He can allude to that matter, but not debate it.

Photo of Mr Laurie Pavitt Mr Laurie Pavitt , Brent South

I am endeavouring to relate my remarks to the new clause. This provision might be relevant if there were to be negotiating machinery for the transfer, and the safeguarding of conditions, of employees, especially nurses. I accept your ruling, Mr. Deputy Speaker. The matter is very much on the periphery of the new clause and I shall not pursue it much further. The ballot taking place in the nursing profession over its conditions of service and whether for the first time it should take industrial action is a further argument that I would put to the Government. If the nurses could see a little daylight, at least on the issue of the transfer of engagements, this might help the Department and Ministers in defusing the future situation.

We face a situation of blight. Hon. Members know the situation that exists when it is discovered that a new trunk road is to go through one's constituency. The whole area immediately becomes subject to blight. I submit to the Government that the new clause seeks to prevent a serious blight over a whole range of posts that are now at risk.

Apparently the accepted proposal, although the Bill only provides permission to do it, without taking it any further, is to transfer responsibility from 90 area health authorities to between 150 and 190 district authorities, with all the officers concerned—administration, paramedicals, medicals, the nursing service and even the architects and surveyors of the present regional health authorities. All the 1 million people employed by the Health Service are likely to be affected.

My right hon. Friend's attempt to rescue the Government from their dilemma, therefore, should be commended and accepted.

Photo of Mr Reg Race Mr Reg Race , Haringey Wood Green 4:30 pm, 9th June 1980

This debate is very important to the staff of the National Health Service, and I hope that the Minister will make a clear statement about how he intends to deal with the staff in the proposed reorganisation. His statements so far have been confusing and contradictory. On many occasions the staff have not understood precisely what the Minister has been saying to them, not through any fault of their own but because the statements have been to say the least unclear.

I wish to draw attention to some developments today to which the right hon. Gentleman should have some regard when he replies to this debate. I refer to the decision of the NALGO conference today when discussing the reorganisation of the National Health Service. It has decided to give its executive authority to take industrial action about the reorganisation of the NHS and specifically to black work on the reorganisation envisaged in the Bill because of the way in which the Government are dealing with the pay dispute with the administrative and clerical staff in the Health Service. There is a direct link therefore, between the way in which the Government deal with the pay negotiations of the administrative and clerical staff and the way in which they respond to this new clause. I hope that the Government will have serious regard to that when deciding whether to establish a staff commission.

A staff commission, amongst other things, is really a question of confidence. Government supporters often talk at great length in economic debates about the importance of confidence for the good of the economy. They tell us of the need for the City of London to have confidence in the future. The staff of the National Health Service need to have confidence in the future as well, and I should have thought that the establishment of a staff commission would give the staff in the NHS that confidence. The absence of such a commission may result in their believing that the Government have it in for them or intend to act in a way which is against the interests of the more than 1 million people who work in the Service.

I draw attention to the fantastic disparity between the policy which the DHSS is following and that being followed by the Department of the Environment. The Department of the Environment is establishing a staff commission to deal with the 5,000 people who are being transferred from the GLC to the London boroughs as a consequence of the sale of council estates by the GLC to the London boroughs. A staff commission is to be appointed to deal with them. An order has been laid before this House and approved to deal with that question for 5,000 people. Yet here we have the Secretary of State saying that it is good enough for 5,000 people but that it is not good enough for 1 million people. That is convoluted logic which I do not understand. Many people in the National Health Service will be deeply dismayed by the Government's failure so far to give clear assurances about this matter.

My right hon. Friend the Member for Lewisham, East (Mr. Moyle) said that the Whitley council staff side wanted a staff commission. It was my hope that the Minister would be in a position to respond positively to that statement and to establish a commission along the lines agreed with the staff side of the Whitley council or those set out in new clause 9. If that does not take place, we may be in for a period of serious mistrust and distrust on the part of NHS staff about the Government's intentions.

I know about discussions going on at the moment in a number of trade unions which have members working in the National Health Service about the way that they propose to deal with some of the present industrial disputes with the Government in the Health Service. I refer especially to the administrative and clerical staff dispute, the nurses' pay dispute and the trouble with those in the professions supplementary to medicine. There are those in those unions arguing that one of the ways of persuading the Government to change their minds about their decision to freeze the nurses' pay offer at 14 per cent. is to say that, if the Government want this reorganisation so badly, one of the actions that might be taken by the unions to pursue their claims is to black the reorganisation work which will be carried out at area and regional level and also to black work in the NHS dealing with the area and strategic plans, the closures of hospitals and—another clause in this Bill—the compulsory cash limit.

The Minister ought to have regard to those views, which are being discussed at the moment, because one way of dealing with these problems would be to establish a staff commission in this area. At the very least, that would give the administrative and clerical staff especially the feeling that the Minister was not trying to bludgeon through a proposal which was against their interests.

I come back to an argument which I put forward to the Minister in Committee. If we do not have a staff commission or something very like it to deal with reorganisation and the change in engagements which will flow automatically from the establishment of a staff commission, the Secretary of State will have a great deal more work to do.

One of the interesting features of new clause 9 is its fine print. I remind the House, for example, of subsection (3)(a) : 'The Secretary of State may … give directions to each Commission with respect to its procedure" ; and there is a string of proposals set out in the clause designed to do one thing and one thing only—to establish machinery whereby people can take disputes about jobs, gradings and other matters and resolve them in a way which does not involve their political masters either at the level of the health authority or at that of the Secretary of State.

I am sure that my right hon. Friends the Members for Norwich, North (Mr. Ennals) and Lewisham, East will accept the honesty and logic of doing that. There is nothing worse than political intervention in what are essentially individual cases. I should have expected the Minister to respond to that kind of approach, because it is eminently sensible from his own point of view.

Reference has been made to the importance of industrial relations in the National Health Service. In my view, if the Government do not accept something very like new clause 9, they will be accused, correctly, of deliberately worsening industrial relations in the NHS. I am sure that that is a brickbat that they will wish to avoid. Therefore, in their own interest it would be advisable if they were to accept something on the lines of new clause 9 before we move any further since we shall have an extremely argumentative debate later this evening about the impact of certain measures that the Government are about to take in the NHS.

No doubt reference will be made later—at greater length than in this debate—to nurses' pay and the pay of administrative and clerical staffs. The Government will have to tell us what they propose to do about that in relation to the Bill, and if they do not introduce something like a staff commission to deal with the problems of the NHS they will be in for a much rougher ride than is necessary.

Photo of Mr Roger Thomas Mr Roger Thomas , Carmarthen

I emphatically support new clause 9 and the setting up of a staff commission. May I say what a pleasure it is to see a Welsh Minister on the Government Front Bench? We did not have the pleasure of the presence of a Welsh Minister in Committee when we were discussing the reorganisation of the NHS in England and Wales. I am glad that something has been done to rectify that.

There is a general acceptance of the need for a change aimed at the simplification of structure and management arrangements in the NHS. The general principle involves the removal of a tier of management and the need to strengthen local management. Our main concern is how this change is to be managed and whether the likely extent of disruption entailed in such change is fully understood. It is beginning to be fully understood by the staff who will be affected by the changes.

Effective measures must be planned in order to minimise any harmful effects on the services, the patients and the morale of staff. Much Government thinking appears to be centred on the elimination of waste and general inefficiency in management. Such aims are admirable, but they are undoubtedly limited in scope and distribution and they must not be achieved at the staff's expense.

In planning the integration of services, much has been achieved over the past five years. However, I immediately stress my doubts about the Government's current proposals and thinking because I fear that they may put into reverse what should be a continuing process. It has to be emphasised that the turbulence that followed the reorganisation of 1974 contributed to the demands for more change. Those demands led directly to the present proposals.

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I believe that the Government wish to avoid wholesale upheaval, but disruption will be inevitable since so much that is proposed is deep and radical. The proposals apply not only to individual career prospects but, more seriously, to the service as a whole. For a considerable period management effort will be diverted by the dismantling of existing structures and the designing of new ones. Permeating all this will be uncertainty about the future which could undermine the resolve of those who have to tackle the more difficult problems.

At the individual level changes will be all the more disruptive for staff because they will come so soon after the 1974 reorganisation and will, in so many cases, affect those most affected by the changes of 1974. For some there will be demotion. That is sometimes called lateral promotion. The changes will mean blocked career progression and foreshortened career structures. Sadly, it will be inevitable that with such changes management effort will be both diverted and diluted. It may not always be a case of patients first.

An Act of Parliament does not achieve change in itself ; it merely formalises the beginning of a process that will take a number of years during which pressure for further change will build up, just as it built up in 1975 and 1976. I fear that that pressure will build up, if we are not careful, even before these changes are fully implemented.

Photo of Mr Wyn Roberts Mr Wyn Roberts , Conway

The hon. Member for Carmarthen (Dr. Thomas) will, of course, be aware that we do not anticipate a major upheaval in Wales. We have stressed that at paragraph 47 of "Patients First". We have also stressed the need for stability. The hon. Gentleman will also know that we have said that consultations will pay particular attention to staff interests.

Photo of Mr Roger Thomas Mr Roger Thomas , Carmarthen

I thank the Minister for his remarks, but, as he has reminded me in answers to parliamentary questions, he has received more than 500 representations from people at all levels in Wales about health services. That is a fair amount of representation. The people of Wales will not be content to see a reorganisation in England while being told that everything in the garden is lovely in Wales. It would be a good thing if we in Wales could discuss changes in the Health Service here in Parliament and not through extra-parliamentary means such as the leading columns of the Western Mail.

I fully support new clause 9, which advocates the setting up of a staff commission. There is much discontent and misgiving in Wales and it is sad to reflect that the Minister may not be aware of it.

Photo of Mr Willie Hamilton Mr Willie Hamilton , Central Fife

New clause 9 does not include provision for a staff commission for Scotland. That is not to say for a moment that we are not concerned about the implications of the provisions of the Bill for staff problems in that country. My hon. Friend the Member for Wood Green (Mr. Race) referred to the decisions that have been taken by NALGO at its conference in Eastbourne today.

As the House knows, I am sponsored by the Confederaton of Health Service Employees which will no doubt be taking decisions on these precise matters at its conference next week. There is a good deal of concern about the implications of the Bill for staff employment. We shall no doubt have the chance to discuss, in the early hours of tomorrow morning, the Secretary of State for Scotland's paper "Structure and Management of the NHS in Scotland". Page 11, when dealing with implications for staff says : The Secretary of State recognises that although his proposals do not involve any major reorganisation of the service "— though that is challenged— they have considerable and wide-ranging implications for many members of staff. The Government intend to be as fair as possible to all staff involved in the changes ; and at an appropriate time will be discussing with staff interests arrangements for the filling of posts and for the protection of the interests of those adversely affected. That is all and I presume that that means, by implication, that there will be the fullest consideration within the Whitley council procedure and with all the relevant trade unions. I guess that that will be the gist of the Minister's answer. But the Whitley council machinery is not adequate. The Minister and the Departments recognise that the Whitley council machinery leaves a lot to be desired. That is one of the reasons why we are putting forward the proposition in the new clause.

Though I have racked my brains, I find it difficult to see any merit in the Bill which is designed to do two things. It aims, first, to transfer resources from the public to the private sector in order to make people understand that their health depends on the depth of their pocket rather than on the willingness of the taxpayer to foot the bill for our health services. That is the main purpose of the Bill.

It is significant that the White Paper produced by the Scottish Office lacks any public relations element compared with the White Paper produced by the English Department. At least the English Ministers try to kid the people that patients come first. The Scottish Office is honest and more brutal. It never mentions patients once in its document. The English Department is disarmingly deceptive. It tries to convince the people that it is concerned about patients—but not about nurses. I shall say something brutal to the Minister about that later.

Whatever the merits of the Bill, there is no doubt that, since we are dealing with the second major upheaval in the National Health Service initiated by a Tory Government, whose record is appalling, there will be a deepening crisis of confidence among the staff and users of the Health Service. When the full implications of the Bill are realised there will be a serious deterioration in the morale of employees—and there are 1 million of them. The Health Service is one of our major industries.

The Bill, with the Government's overall policy to cut public expenditure on every other social service including education and housing, will lead to increasing bitterness among employees. In a relatively modest way we are seeking to remedy the situation. We are trying to decrease the bitterness and to give workers the knowledge that they will participate in any discussions that affect their jobs, their promotion prospects and the Service. The Government would be well advised not to reject the new clause out of hand. They should not argue that the Whitley machinery is adequate to deal with the problems.

If the Government cannot accept the new clause they should at least accept the principle behind it and emphasise the imperative need to negotiate with and consult the staff at all levels. If a worker in the Health Service, or anywhere else, loses his job he will find it almost impossible to get another. No alternative employment is available in many parts of the country, not least in Scotland. I hope that the Minister will not reject the new clause out of hand without outlining in detail how he sees the solution to the problems that will occur during the transitional period.

Photo of Mr Frank Haynes Mr Frank Haynes , Ashfield

I am not as worried today as I was in Committee ; because we appear to be getting one or two approving nods from the Government Front Bench. However, I am worried because in Committee the Minister threw the document by the Royal Commission on the National Health Service into the Thames and said that he was not prepared to accept its contents. He said that he and the Government would make up their own minds about what was to happen to the National Health Service. I have seen nods of approval. I hope that that is an encouraging sign.

I sincerely believe that my right hon. and hon. Friends who have contributed to the debate are correct. The Conservative Government made a hell of a mess of the last reorganisation of the Health Service. Some of us were involved in that in one way or another. The lowering of the state of morale which occurred at that time is being repeated. Each individual fears what will happen within the Health Service. The message is loud and clear in my area. People are frightened to death about what will happen this time.

A commission such as that suggested in the new clause would give each individual in the Health Service the opportunity and right to know about and to contribute to the shape of the Service. There is a feeling of bitterness. People remember what happened last time. They are all jockeying for positions in preparation for what is to happen. Certain individuals will be hit, as they were on the last occasion. Jobs will be given to people whose faces fit. I believe that the suggestion in the amendment is correct. I hope that, in the interests of everybody who works in the National Health Service, the Government will consider seriously what has been said.

Photo of Dr Gerard Vaughan Dr Gerard Vaughan , Reading South

I have listened with great care to what the Opposition have said because this is an important matter. The right hon. Member for Lewisham, East (Mr. Moyle) put the case for a staff commission reasonably and clearly. Naturally, we are as concerned as any Opposition Member that we should get the matter right this time. Large numbers of people are involved. We are seeking a procedure which will be sufficiently flexible to enable individuals to be considered and properly fitted in because their careers are at stake.

The hon. Member for Fife, Central (Mr. Hamilton) said that there was need for consultation at all levels. I took that point strongly. We shall not be able to carry the restructuring through without the good will of the staff. I believe that we have that good will and that the majority are as fed up as we are with the present structure and want to see a change. At the same time, they are anxious and insecure about how the restructuring will affect their careers.

The Opposition are on the wrong track in going for a national staff commission. I believe that the staff side of the Whitley council was wrong when it at first took this line.

5 pm

I was interested in the remarks of the right hon. Member for Lewisham, East to the effect that the staff side was still in favour of a staff commission, because I had hoped that it was coming to the same conclusion that we had reached—that this time something slightly different would be more to its advantage. There was a national staff commission in 1974 and it was very widely criticised, largely because of the lack of flexibility in regard to individual appointments. As I have already indicated, we are very concerned that that sort of problem should not arise again.

There is a problem over timing. We should all recognise that. I was very sorry when the hon. Member for Wood Green (Mr. Race) started to convey what sounded suspiciously like threatening remarks from some of the unions that, if necessary, they would slow down the whole process if they could not get then-way. That would be a most unkind and inhuman action to take.

There is a problem over timing. If we go very fast, it will be difficult for individual members to be looked after properly. If we go very slowly—allowing time for more individual variation—we shall leave large numbers of people in a state of uncertainty for a long time. So we have to strike a balance, if we can, that is fair between those alternatives.

We hope that our timetable is a reasonable one. In July, we shall publish our paper, the regions will report back to us by the end of February next year, and then we shall be able to start implementing the changes.

Photo of Mr Roland Moyle Mr Roland Moyle , Lewisham East

What the Minister has said on timetables is helpful, but the crucial issue with regard to the staff is how long the reorganisation will take, beginning with next February. Will it be a year or two years, three years, or even four years, as some people in the Department have said?

Photo of Dr Gerard Vaughan Dr Gerard Vaughan , Reading South

I do not think that we can answer that question clearly until we have seen the advice that comes back from the various regions and until we have seen the exact procedure that the staff side wants to follow.

Photo of Dr Brian Mawhinney Dr Brian Mawhinney , Peterborough

My hon. Friend has said that he expects to hear from the regions in February and then to implement the changes. For how long does he expect the matter to be in his Department between the time of referring back and the beginning of implementing? Will it be a matter of weeks or of months?

Photo of Dr Gerard Vaughan Dr Gerard Vaughan , Reading South

I should like to satisfy my hon. Friend on this, but I think that we have to wait until we see the response from the Health Service to our paper in July. We shall then have a much clearer idea how much change is involved.

Photo of Mr Laurie Pavitt Mr Laurie Pavitt , Brent South

Will the hon. Gentleman be giving advice about the advertising of posts, or must all this wait until after the Department has considered the February replies? Where posts are now vacant or are about to become vacant, will he be giving advice to the authorities concerned?

Photo of Dr Gerard Vaughan Dr Gerard Vaughan , Reading South

I should like to go a little further in my remarks as to what we have in mind. We have come to the conclusion that it would be to the greatest advantage of the staff if guidelines were laid down centrally, and if these were then applied locally as flexibly as possible. It is felt that the central arrangement for this should be through a special independent small body, derived in conjunction with the Whitley Council but nevertheless an independent body.

The staff side was not at all happy about this and put to us that it wished the procedures to be agreed between management and staff sides within the Whitley Council machinery. We have accepted this. The important thing now is that we get down quickly to discussions of our proposals between the joint management and staff sides. There should be discussions on how posts are to be filled, on protection of pay, on the terms for premature retirement, and, in the last resort only, redundancy.

A joint mechanism for these discussions has now been agreed within the staff side, and that is the special sub-committee of the general Whitley council. We have made offers to the staff side on this and we are awaiting its response. That is why I was particularly concerned when the right hon. Member for Lewisham, East said that he thought that the staff side was still dissatisfied, because my information is that it is not. I hope very much that my information is correct.

Photo of Dr Gerard Vaughan Dr Gerard Vaughan , Reading South

So that the staff in the National Health Service might be kept fully in the picture, my Department wrote to the administrators of health authorities on 4 June, giving as much detail as we could of the offers that we have made, and asking that this information should be circulated as quickly and as widely as possible.

We have in mind what I believe are clear safeguards. First, we wish to safeguard salaries. We are suggesting that for older staff—people over 50—salaries should be safeguarded indefinitely. For people under 50, we believe that salaries should be safeguarded for at least five years.

Photo of Mr Roland Moyle Mr Roland Moyle , Lewisham East

This again is very helpful, but will the Minister say whether the safeguarding includes upward adjustments for inflation, as well as the preservation of the figures of the salaries at the time when the reorganisation takes place?

Photo of Dr Gerard Vaughan Dr Gerard Vaughan , Reading South

I shall come back to that, in a moment, if I may. [Interruption.] It is all right for some hon. Gentlemens to laugh, but the right hon. Member for Lewisham, East has said over and over again how important it is to have the matter absolutely clear and correct for the staff.

As many hon. Members know, we also have in mind a safeguard concerning early retirement. We believe that our scheme will go a very long way to reducing any need for compulsory redundancies. Here again we are offering, where the management agree, premature retirement for people over 50, with an immediate payment of pension and a lump sum calculated on an enhancement basis related to length of service.

Then there will have to be a procedure for local appeals. If someone feels that he has been wrongly treated, it is essential that there should be somewhere to turn in order to appeal against it. We have said all along that there must be a proper and effective appeals mechanism, and we shall be happy to discuss this in detail with the staff side.

Finally, we believe that there should be some local flexibility in regard to the details of shortlisting appointments to posts.

We see that as a package that will safeguard the staff, showing them that we have their interests at heart.

At the moment, we are opposed to a single national day of change, but we have asked the Whitley council—and through it the sub-committee—to consider the possibility of regional days of change, so that there would be in one part of the country a day of change rather than having it piecemeal throughout a region.

Hon. Members may be interested to have some information about the constitution of the sub-committee. I can at the moment give them information only concerning the management side of the sub-committee, because clearly the membership of the staff side is entirely a matter for the staff side. But, broadly speaking, we have in mind, first, that there should be five members of the general Whitley council. We believe that this will reflect a clear Whitley interest in the negotiations.

Secondly, we believe that there should be five members comprising a representative regional team of officers—that is, one from each of five regions—to reflect the role that the regions are playing in the reorganisation.

Thirdly, we believe that there should be representatives of NHS management in Scotland and Wales, reflecting the special characteristics of the proposed reorganisation outside England.

Finally, it is proposed that there should be representatives of the Department of Health.

I hope that hon. Members will agree that that represents an all-embracing, wide-ranging group of people and that if we cannot get justice for individuals out of that there is something very wrong. On that basis, I ask the House to reject the new clause.

Photo of Mr Reg Race Mr Reg Race , Haringey Wood Green

Before the Minister sits down, may I ask whether I understand him correctly? Will the management side of the sub-committee be composed entirely of officers of authorities rather than members of authorities? That is a very important point indeed, because—

Photo of Dr Gerard Vaughan Dr Gerard Vaughan , Reading South

On a point of order, Mr. Deputy Speaker. I do not know whether the hon. Gentleman is making a second speech, but I had sat down.

Photo of Mr Bernard Weatherill Mr Bernard Weatherill , Croydon North East

I had not appreciated that the Minister had sat down. I thought that he was giving way to the hon. Gentleman. As the hon. Gentleman has started, will the Minister be prepared to answer his question?

Photo of Dr Gerard Vaughan Dr Gerard Vaughan , Reading South

Dr. Vaughan indicated assent.

Photo of Mr Reg Race Mr Reg Race , Haringey Wood Green

Thank you for your assistance, Mr. Deputy Speaker.

My point relates to the composition of the management side. Will it be entirely composed of officers, or will there be representatives of the members of regional health authorities? As I understood joint negotiating machinery procedure, the employers' side—if one likes, the bosses' side—consists of representatives of the employing authorities, which in the case of the NHS means the area health authorities where individual contracts are kept. Therefore, one would have thought that on the joint sub-committee there would be representatives of the employers in the NHS, namely, the area health authorities as at present constituted.

I hope that the Minister can enlighten us on that point. It would be a break from tradition, and I believe a retrograde step, if the sub-committee did not contain people who had been appointed to positions on the area or regional health authorities as well as people who simply represented the interests of officers or senior management.

Photo of Dr Gerard Vaughan Dr Gerard Vaughan , Reading South

There will be both members and officers.

I was asked about salaries and any uplifts. The over-50s will be protected fully—that is, they will be indexed. The under-50s will be protected fully for five years, and thereafter on a mark-time basis. For example, if one is then on a £6,000 a year salary, one's salary will stay at £6,000 a year until the salary of the grade to which the officer has been downgraded overtakes it. I hope that that answers the question.

Photo of Dr Alan Glyn Dr Alan Glyn , Windsor and Maidenhead

The question of the change-over and whether it should be national or regional is important. Has my hon. Friend had any indication from the staff side as to which it would prefer?

Photo of Dr Gerard Vaughan Dr Gerard Vaughan , Reading South

As I have just said, we are against a national appointed day. We have put it to the regions that they should perhaps consider local—that is, regional—appointed days.

Photo of Mr Roland Moyle Mr Roland Moyle , Lewisham East

We have had an interesting debate and have had a much more informative reply from the Minister than we did when we discussed this matter in Committee. He has given us some interesting and useful information. However, some of the comments which have been made during the debate demand a reply.

First, I was surprised that the hon. Member for Somerset, North (Mr. Dean) called new clause 9 a busybodying clause, because it was one for which he, along with all the other members of his Department, voted in 1973. I ask the House also to bear in mind the views of my hon. Friend the Member for Brent, South (Mr. Pavitt), who brings the voice of experience to our debates in connection with this reorganisation. Looking around the Chamber, I notice that very few of us who took part in the debate then are here now, but my hon. Friend took part in it. Everything that he said in 1973 about uncertainty is a problem which, unless we are very careful, could be faced in 1981 and 1982.

5.15 pm

My hon. Friend the Member for Wood Green (Mr. Race) indicated that the room for manoeuvre is rapidly contracting. I had not seen the report that the NALGO conference had decided to black work on reorganisation. If that is true, it lends emphasis to everything that we have said about the need to handle the morale of the staff and relations with the staff with consummate care and to do our utmost to satisfy it. My hon. Friend raised an interesting point—that there is to be a staff commission to supervise the reorganisation within the GLC housing department affecting 5,000 jobs overall. My calculation is that in the Health Service reorganisation 4,500 jobs will go—not that there will be 4,500 sackings of necessity, but that 4,500 jobs will not exist when reorganisation has ended. On top of that, I believe that many thousands of other jobs will be shunted around the countryside. Therefore, if a staff commission is required for 5,000 people, a staff commission is certainly required for 4,500 jobs which will go as well as many thousands more which will be altered.

Photo of Dr Brian Mawhinney Dr Brian Mawhinney , Peterborough

The Minister made his view clear—that such an attitude on the part of NALGO would be extremely unfortunate. Would the right hon. Gentleman care to associate himself with my hon. Friend's remarks?

Photo of Mr Roland Moyle Mr Roland Moyle , Lewisham East

If I may say so, industrial relations upsets are always unfortunate. What I am now trying to do is to give the best advice that I can to the Government as to how they might avoid the unfortunate circumstances to which the attention of the House has been drawn.

The Under-Secretary of State for Wales intervened in the speech of my hon. Friend the Member for Carmarthen (Dr. Thomas). Interventions by Welsh Ministers in our debates have been beasts of such rare quality that I hope I shall not be accused of giving undue prominence to the hon. Gentleman's. He said that he would be prepared to receive representations from staff in Wales about the NHS situation there. Last time, Wales had a staff commission to do that sort of thing. Therefore, his offer to receive representations does not seem to be totally adequate on this occasion.

The hon. Gentleman also made a positive statement about not intending to do anything with regard to the Health Service in Wales. The Government are going through a process of consultation, and I do not think it is entirely sound for Ministers to make positive statements at this stage. However, there is a growing feeling of opinion in Wales that there should be a regional health authority for Wales, on the ground that health problems in Wales are discussed and resolved in private within the Welsh Office whereas in England all these matters are thrashed out in open debate in the regional health authorities. Therefore, the hon. Gentleman ought to take those points into consideration.

Photo of Mr Wyn Roberts Mr Wyn Roberts , Conway

I did not say that there would be no change. I said that we did not want an upheaval and that there was a need for stability. I was, of course, quoting from "Patients First". The same applied when I said that there would be consultations with staff. I am saying not that there will be no change but that there will not be an upheaval of the sort which the hon. Member for Carmarthen (Dr. Thomas) seemed to be encouraging in calling for a staff commission. I was not quite sure which side the hon. Gentleman was on, or whether he was for change or against it.

Photo of Mr Roland Moyle Mr Roland Moyle , Lewisham East

We are glad to have the hon. Gentleman's clarification. I have now reciprocated by telling him that before long he will receive representations to the effect that there should be a regional health authority for Wales. I take it from his remarks that he is prepared to consider that suggestion with an open mind.

The Minister made some important contributions to the discussion, but he overstated the importance of the special sub-committee. The staff side is in favour of the special sub-committee as machinery for negotiating the settlement of the terms and conditions of service that will be applied to staff who are involved in redundancies. That is a step forward, and the staff welcome it. However, the Minister is making a mistake in believing that the staff side will consider that that special sub-committee by itself will be enough to keep the staff happy. I reiterate that, in addition to the special sub-committee, they will want a staff commission, and they will continue to press the Government for such a commission. Staff throughout the country will feel unsupported and insecure if they do not have the umbrella of a staff commission.

The special sub-committee will be formed substantially of active members of the Whitley council. The Minister said that there would be at least five members of the Whitley council on the management side, and presumably a similar number on the trade union side. They will be regarded as influential people in the Whitley council. The sub-committee will reach agreement not only on pensions, preservation of salaries and so on, but also on job filling. The Whitley council and the sub-committee will, in the view of the staff, become enamoured of their work. If a dispute arises subsequently on the reorganisation, it will be referred to the Whitley council, which will settle the problem entirely in terms of the agreement reached.

An independent staff commission is required to be able to look a second time at those matters, because if there is a dispute the guidelines of the agreement of the Whitley council will be the cause of the dispute. Therefore, the staff will want a second look at their individual fates through a staff commission. It is therefore, a matter of considerable regret among Labour Members that the Government are refusing to accept the idea of a staff commission.

The staff commission that was set up in 1973 was criticised in the initial stages of the reorganisation, but as the reorganisation continued it improved its work and standing, and it was eventually accepted. As a result of the experience of 1973, the trade unions on the negotiating side of the Whitley machinery now want a staff commission again. It would be a small concession by the Government, but it would be a great concession for the employees of the National Health Service if they felt they had the protection of a staff commission.

Photo of Dr Gerard Vaughan Dr Gerard Vaughan , Reading South

Does not the right hon. Gentleman agree that the likely membership of the management side—five Whitley council members, five representatives of regional teams and representatives of Scotland, Wales and the Health Department—is wide ranging? The membership of the staff side is for the staff side to decide. It will be able to bring in an equally wide-ranging membership if it wishes.

Photo of Mr Roland Moyle Mr Roland Moyle , Lewisham East

That is standard industrial relations procedure, and, in a sense, the wide-ranging composition of the special sub-committee will be a difficulty if there is discontent with its decisions during the course of the reorganisation. It will be more difficult to change the mind of the Whitley council through that special sub-committee procedure. Therefore, the Government would be well advised to look again at the idea of a staff commission.

The Minister set out some parts of his timetable. Will he tell the House in February, after he has received the reports from the regional health authorities, the period during which he expects the reorganisation to take place?

Photo of Mr Willie Hamilton Mr Willie Hamilton , Central Fife

This is a United Kingdom Bill, and I gathered only in the last intervention of the Minister that he was speaking for Scotland as well as for England and Wales. He did not make that clear in his opening remarks. Do the Government presume that the timetable to which the Minister referred applies equally to Scotland, because the timetable that the Scottish Office envisages is different from that enunciated by the Minister?

Photo of Mr Roland Moyle Mr Roland Moyle , Lewisham East

If the Under-Secretary of State for Scotland were to try to intervene in my speech on those pertinent matters, I should have no hesitation in giving way briefly to enable him to clarify the position.

The hon. Member for Windsor and Maidenhead (Dr. Glyn) asked whether the Government had heard from the staff side about whether it wanted a regional or national appointed day. The main staff association involved would like a national appointed day. The Government should bear that in mind.

Having waited in vain for an intervention by the Under-Secretary of State for Scotland—he shakes his head, so I shall continue to wait in vain—we shall ask permission of the House to withdraw the new clause, because we feel that these matters are basically best negotiated between management and staff in the Whitley machinery before the consequences of any decisions are inserted into the Bill. We shall not seek to force the issue by calling for a vote on the new clause, but the Government must not believe that because of that we do not feel strongly about it. We cannot reiterate too strongly that we believe that the Government will be making a substantial mistake if they do not concede a staff commission to the staff side of the National Health Service.

Photo of Mr Willie Hamilton Mr Willie Hamilton , Central Fife

May I press my right hon. Friend to press the Under-Secretary of State for Scotland to intervene and to make clear that he is thinking along lines parallel with those mentioned by the Minister representing England and Wales? It is not good enough for the Minister to set out a timetable which obviously applies to the United Kingdom. The sub-committee is clearly United Kingdom machinery, and presumably the timetable is a United Kingdom timetable. It is the responsibility, duty and obligation of the Under-Secretary of State for Scotland to stand up now and say that he goes along with that. Otherwise, what other part of the Bill will give him an opportunity to do so? Or will he give an undertaking that at some time during the course of our proceedings he will state in detail the timetable for the reorganisation of the Health Service in Scotland?

Photo of Mr Roland Moyle Mr Roland Moyle , Lewisham East

My hon. Friend is a magnanimous man. He has given the Under-Secretary of State for Scotland at least one hour's notice that he will raise that matter on new clauses 17 and 18.

Photo of Dr Gerard Vaughan Dr Gerard Vaughan , Reading South

There will be an opportunity shortly for a debate on Scottish matters and my hon. Friend the Under-Secretary of State will speak to that point then.

Photo of Mr Roland Moyle Mr Roland Moyle , Lewisham East

We are grateful, and we look forward eagerly to hearing the Under-Secretary's comments on behalf of Scotland. I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.