I am sorry that the clock has just turned one o'clock as we begin to debate the important nurses’ pay issue. I have no doubt that the Official Report will be well read.
The whole question of nurses’ pay has been sadly neglected over many years under successive Governments. The good will and decency of the nurses and the professions allied to medicine, such as physiotherapists and radiographers, has been abused for too long. We are debating the livelihood of a group of the most respected, dedicated and skilled staff who do not take strike action. Years ago, people were pleased to describe nursing as a "calling" for special pople who put the dedication of patient care in front of financial reward.
Let me be quite blunt and record that that is a most accurate description of the nursing profession even today. However, this is a profession which is admired and respected and we have a duty to ensure that its members can afford their rent, clothing and a few luxuries. Can there be a more deserving group within society entitled to be able to afford a holiday each year?
Periodic inquiries into nurses’ pay have proved a failure. An example is that by Lord Halsbury in 1974 which led to large pay increases for nurses, only to be followed by a period of several years when the value of that increase was eroded.
I accept that. I did not intend to score a political point, but that point was well worth making.
We desperately required a sound system, and I am delighted to applaud my own Government for their initiative. Full marks go to this Government for establishing a pay review body in 1983 for nursing staff, midwives, health visitors and professions allied to medicine. This system will create better arrangements for settling the pay of these staff within the NHS. Being independent, the pay review body is free to recommend levels of pay that it believes to be appropriate in all the circumstances.
My research tells me that NHS funding has risen by over 20 per cent. since we took office, enabling nurses’ pay rates to rise faster than prices, working hours to be cut from 40 to 37½ per week without loss of pay, and an extra 57,000 whole-time nursing equivalents to be employed in Great Britain.
Returning to the review body, the Government are on record as stating that they will stand by their commitments to implement the review body's recommendations—this is where I part company from the Government—unless there are clear and compelling reasons for not doing so. That is the Government's safety valve.
But since the Government themselves always submit evidence to review bodies, on economic and financial considerations as well as such matters as the recruitment and retention of staff groups concerned, it is rather like one group of witnesses at a trial stating that there may be clear and compelling reasons for not accepting the costs that the judge awards.
The review body will have taken evidence from all other interested parties, including the staff organisations. We are now waiting, with bated breath, for the review body recommendations and also to know whether the Government, having given their own evidence, now propose to act as judge—I really hope not. I have great confidence in the Prime Minister, as well as the Ministers and civil servants in the Department of Health and Social Security, and believe that that will not be the case.
Of course, it is fully appreciated that there is no such thing as Treasury money, only money raised from taxpayers—including nurses themselves. In the current financial year, a cash increase of 5·5 per cent. representing £500 million, has been made available in England, and there is a similar proportion for Scotland and Wales. Regional health authorities will also have available the extra resources produced by local cost improvement programmes. From that vast pool of money — and, I hope, a bit of central money—the NHS must strike the correct balance between all competing demands on those resources. That will need to include the pay of its staff and the development of patient services. In any public body or private company, there is always a direct relationship between pay, capital equipment, expenditure and the number of people employed.
However, as the pay settlement to cover the period from 23 August 1982 to 1 April 1984 of 12·3 per cent. was agreed between parties on the understanding of the proposed setting up of the pay review body, it is most important, in my view, to ensure that we have a contented, sensibly paid nursing staff who will feel motivated to continue their great patient care tradition.
I do hope that, in replying to the debate, the Minister will further enhance his own very high standing in the country in general, and within the NHS in particular, by clearly demonstrating once more to the nurses, the professions allied to medicine, and indeed to the population of the United Kingdom, that patient care is his no. 1 objective.
My hon. Friend the Member for Littleborough and Saddleworth (Mr. Dickens) is noted for his robust patriotism and firm common sense. That was admirably displayed during our last debate on the coal industry, when I listened to what he said. We have all been fortunate to hear him speak again on this important issue.
My hon. Friend is also noted for his interest in social issues. We know of his concern for the welfare of children, and tonight he has shown his deep concern for the welfare of those who work in the NHS as nurses and midwives. I thank him for raising the important subject of nurses’ pay and for giving me the opportunity to set out the Government's record. However, I am in some difficulty. as I am sure he will appreciate, in that I must at the outset make it clear that I cannot comment in detail on this year's pay claim on behalf on nurses and midwives.
As my hon. Friend knows, we have received the report of the independent review body, and we are still considering its recommendations. I cannot tonight anticipate what our conclusions on that report, or those of the other review bodies will be. However, I hope that my hon. Friend and others will not have to wait long for the reports to be published.
Having said that, it is important to put the nurses’ pay claim, and the evidence submitted by all parties to the review body, into context. As my hon. Friend said in his concise and characteristically clear speech, since April 1979, the basic pay rates of nurses have on average risen by 94 per cent. That is 23 per cent. more than the increase in prices over the same period. It is important to put that on the record. In addition, the Government found the necessary money — a substantial sum of around £116 million — to reduce nurses' working hours in 1980–81 from 40 to 37½ a week without any loss of pay, thereby enhancing their working conditions and, I hope, their quality of life. That was equivalent to a further increase of 6·5 per cent. on basic pay.
This Government have a lot to be proud of. We have paid the nurses substantially more than the rate of inflation, and we have substantially reduced their hours. But the number of nursing and midwifery staff has also risen steadily, not just to make up for the reduction in hours. We have actually increased the number of nurses and midwives employed overall, thus ensuring a steady and substantial increase in nursing care.
In England, an estimated 39,500 whole-time equivalents were employed between September 1979 and September 1984. Around 24,000 were additional staff to compensate purely for the much-welcomed reduction in hours. But the remainder—on average about an extra 3,000 staff per year—are providing additional services for patients. My hon. Friend was right to end his speech on that note. Consequently, more better paid nurses, employed during a shorter working week, are providing more care for more patients.
Current estimated average earnings — I stress that these are average earnings — of a staff nurse on the maximum of her scale are £147 a week, and those of a ward sister on the maximum £192 a week. I am not suggesting that the Government have provided everything that nurses want, but I am setting down our not inconsiderable record as a background against which this year's pay claim and review body recommendations, when published, must be judged.
The establishment of the review body is a major step forward in making better arrangements for determining nurses’ pay. We established it because we recognised the special position of nursing and midwifery staff in not resorting to industrial action. People of all political parties and none, throughout the country welcome our recognition of that.
I am happy to repeat our commitment to implement the review body's recommendations, unless there are clear and compelling reasons for not doing so. That was the arrangement made when we set up the review body, and I am glad that my hon. Friend gives us full marks for creating it. I know from my constituency that there has been a uniform welcome for the establishment of the pay review body and for the reduction in the working week.
The new arrangements that we have set up in this financial year for funding the NHS mean that there is a direct relationship between pay and service provision. It was important for my hon. Friend to stress the realities of life in this debate, as he did in the previous debate on the coal industry. Pay and service provision simply cannot be divorced. The NHS has no right to expect to be different from other employers in that respect, whether public or private sector employers. The public purse is not bottomless. There must always be a trade off between pay and services. High pay increases will eat into money for patient care, just as in any industry, and public or private body, they eat into its capacity to do what it sets out to do. That is simple common sense.
The more resources that are devoted to pay, the less will be available for services. That has been a fact for successive Governments of all political colours. Only a fool would seek to deny that truth. It cannot be wished away.
It is particularly important to remember that a 1 per cent. increase in the nurses’ pay bill costs approximately £33 million. To meet a 20 per cent. pay claim would cost £650 million a year extra. We must put that message across to the review bodies. In doing so, we are not for one second saying that we do not want to see nurses and midwives paid properly. Surely our record since 1979, with a substantial increase ahead of inflation and the decrease in the working week demonstrates the Government's determination to those ends.
I should make a further point connected to the Halsbury report to which my hon. Friend referred in his wholly non-party political speech. He may have been right to point to my perhaps unnecessarily partisan references to what happened to the Halsbury pay award after 1974. In evidence to the review body, the staff side referred to increases allegedly required to restore pay to the Halsbury levels of 1974. Such an approach to setting pay is obsolete. We cannot return to it for two reasons.
First, huge pay awards such as the Halsbury award, which was 30 per cent. must be a thing of the past, if we are to maintain the low inflation which is necessary to continue the restoration of our economy. Without that restoration, we cannot increase provision in the NHS, as we are doing at this time of economic difficulty and hope to do at a greater level in a time of economic prosperity.
Secondly, any professional group chooses its favourite year for the purposes of comparison. To allow a group in pay bargaining to pick the year most favourable to its case will produce the leapfrogging in pay rises, which in the past contributed to high inflation, ridiculous rises in pay, and the feeding of inflation, characteristic of the 1970s. That led to the economic problems, especially of 1976, 1977 and 1978, and also to the substantial cuts in provision in the NHS which had to be made in real terms. There have never been cuts in provision in the NHS in real terms since this Government came into office in 1979. Year on year, by any measure, there has been an increase in provision in real terms.
My hon. Friend was right in saying that there is no such thing as Treasury money. Of course there is not. There is only money that is raised from taxpayers. Among those taxpayers are nurses, and with them there are midwives.
The crucial determinants of pay must be the need to deal fairly with staff and also to recruit and retain staff of the right quality. I must ask my hon. Friend to await our decisions on the review body's recommendations, which will, I am confident, satisfy him on that score. Recruitment and retention are not a great problem in nursing, although there are improvements which could be made. That is why we pointed, in our evidence to the review body, to the need to reward experience in the clinical grades, and to increase the attraction of remaining in those grades rather than opting for management or teaching—a road down which, sometimes unfortunately, a number of nurses have gone.
In addition, although this is not strictly a pay issue, we are following with great interest the proposals for revised education and training for nurses which are emerging from the statutory bodies and from the Royal College of Nursing. An improved approach to the training of nurses, midwives and health visitors which meets the aspirations of the profession and the needs of the NHS, and is affordable, should further attract qualified entrants to nursing.
I am sure that my hon. Friend will accept that we are as committed to the position of nurses in the NHS as we are to the service as a whole. Our record is one that we can be proud of. The extra cash that we have made available and the increased efficiency that we have sought to achieve have enabled record numbers of patients to be treated. That is a triumph not of the Government since 1979 but of the NHS, and of all who work in it — doctors, ancillary workers, ambulance men, nurses and midwives. It is their labours — supported by the Government's policies and the hard-won taxpayers’ money which has gone into the NHS — which have enabled record numbers of patients to be treated year after year in the life of this Government. My hon. Friend referred to that in the closing moments of his speech, as I do in mine.
In 1983, hospitals in England alone treated nearly 1 million more in-patient and day cases than they did five years earlier. We are planning to build on that achievement with the help of all those who work in the NHS — including, of course, nurses and midwives.
Question put and agreed to.
Adjourned accordingly at twenty-two minutes past One o'clock.