From one argumentative Scot to another I beg to move,
That this House believes that district health authorities and Scottish health boards should not be expected to find the extra resources in the current financial year that are now necessary to implement the Government's decisions arising out of the recommendations of the pay review bodies; and further believes that if no extra money is provided from the Contingency Reserve there will be a damaging in and unacceptable reduction in real terms in standards of health care.
In moving the motion, our task and objective is to highlight the disgraceful state of affairs into which the Government are plunging the National Health Service and important branches of it by rather inadequate and third-rate stealth, and to offer a constructive solution to the present financial paralysis facing many health authorities and the nation.
My hon. Friend the Member for Woolwich (Mr. Cartwright), in a question to the Prime Minister, asked whether
any pay settlement for the nurses which is above 3 per cent. must be paid for by savings inside the National Health Service? … Is that not an appallingly unfair way to treat a dedicated profession?"—[Official Report, 4 June 1985; Vol. 80,c. 153.]
If the Minister for Health speaks this afternoon, he may have to behave more in his capacity as a Queen's Counsel than a Privy Councillor. The more one studies the Government's financing of the NHS, the more one realises that the description applied to the former Chancellor of the Exchequer in the previous Tory Government could well be applied to the Minister for Health, who displays all the attributes of a barrister trying his best to defend his client without realising that his client has seen the light and changed his plea to guilty.
The unfairness which my hon. Friend tried to highlight was that the lack of extra cash to fund the rewards would lead to job reductions. The complete lack of extra cash in the aftermath of the pay review body recommendations will, as an inevitable and direct consequence of ministerial decisions, lead to a lowering of health provision and a decline in the quality of patient care. That is why the alliance describes the Government's NHS policy as cuts by stealth at the expense of patients. Today we seek to highlight the plight of the NHS, and to persuade the Government to make extra cash available from the contingency reserve.
It is worth putting into context the role and position of nurses within both the NHS and the community as a whole. Who better to quote than the Minister? In a debate on the NHS, referring to the nursing profession's pay increase, the Minister said:
The Government have made it available to them, because we recognise their abstention from industrial action and the fact that the country, the Government, and the patients in particular, owe them a great obligation. It is irrefutable that it is good news for nurses to have major pay increases, in the second instalment, particularly for the staff nurses and ward sisters. It is irrefutable
that it is a major advance for the nursing profession to have a lasting system."—[Official Report, 2 July 1985; Vol. 82, c. 216.]
Those are noble and honourable sentiments, which will command support from both sides of the House. It is sad that, characteristically, the Minister is not living up to his rhetoric at the Dispatch Box in his funding of the NHS.
The Minister and the Secretary of State for Social Services have confirmed that the cost of the pay review body awards would be about £240 million in England in 1985–86. The Under-Secretary of State for Scotland, the hon. Member for Argyll and Bute (Mr. MacKay) who is responsible for health in Scotland, is present, and I shall deal with the Scottish position later. DHSS Ministers make great play of the fact that this year they are cash allocating an additional £500 million, which is equivalent to 5·5 per cent., to branches of the NHS. They refer in particular to the hospital and community health services, and rightly so. However, we must consider what the figure means when it is analysed carefully and beyond the rhetoric of Ministers.
The January 1985 public expenditure White Paper notes that the hospital and community health services will account for more than 70 per cent. of the NHS budget. In 1985–86, current expenditure will increase by 5·8 per cent. over last year's total. The inflation rate, which the Government estimate at 3·5 per cent. and which will produce a notional real terms increase of 2·3 per cent., reflects the Government's general illustrative assumption of a 3 per cent. pay rise in the public sector and a 5 per cent. general price rise in the NHS sector. Those figures are taken directly from the Government's White Paper.
However, there is an important qualification and, for the purposes of the debate, a fundamental point to be made. The assumptions about wage and price increases are fundamental to the forecasts, because the 2·2 per cent. real growth figure has disappeared as a result of the 6 June doctors and nurses pay review body reports. The additional pay costs in 1985–86 for cash-limited NHS services will be 5·4 per cent. for doctors and 5·6 per cent. for nurses. The inflation rate or relative price effect estimate has been pushed up to nearly 6 per cent.—I shall return to that figure and quote the Minister shortly—according to the Social Services Select Committee's sixth report, which was published on 22 June. That would mean a real terms decrease of about 0·3 per cent., which is 0·2 per cent. higher than what the DHSS now concedes was one tenth of a 1 per cent. decrease in 1984–85.
Those detailed figures are based on a careful and serious analysis of the projections and on hard accurate statistics, which the Government have made available in their forecasting and White Paper. The figures are extremely damaging because they point the way to further reductions in patient care and health service facilities to fund the costs of legitimate and well-deserved pay increases for the professions allied to medicine—nursing, health visiting and midwifery.
That is not a nice way to describe my hon. Friend and me.
The hon. Gentleman talks about further cuts. Why does he expect further cuts when, since May 1979, the NHS budget has increased by 20 per cent., there are 55,000 more nurses, 6,000 more doctors and dentists, more outpatients and inpatients have been treated, and there are more day patients and home visits? Why does he speak of further cuts when that is manifestly not the case? Does the hon. Gentleman concede that the Government's record on the NHS is the finest since the war?
I have been a Member of the House for only two years, but I must tell the hon. Gentleman, who entered at the same time as me, that the gullibility of Tory Back-Bench Members never ceases to amaze me. Let us consider the real world and leave the Thatcherite monetarist universe which the hon. Gentleman seems to occupy. Let us consider what those in the front line of the service say about the figures. The hon. Gentleman did not listen—[Interruption.] The public school boys on the Treasury Bench should keep quiet, because we are quoting their figures.
The hon. Member for Glanford and Scunthorpe (Mr. Hickmet) did not listen to what I said. When he talks about last year's figures, he should remember what I said about a 0·1 per cent. cut in real terms, which, on current predictions, will be trebled this year. That will be extremely damaging.
I hope that the hon. Gentleman will agree that the National Association of Health Authorities is aware of the difficulties and realities of providing health care. The Minister for Health visited Cardiff last month, and much good that did the Tory party when the voters were asked for their opinion—[HON. MEMBERS: "Cheap."] It was not cheap. I was an expensive mistake for the Tory party to send the Minister to address the annual conference of the National Association of Health Authorities. To be fair to the Minister, we should argue on his terms this afternoon and use his words as the parameters within which the debate should be conducted. When the general manager of West Lancashire health authority asked him what the funding consequences would be for next year's allocation, the Minister said:
I do not accept that the award poses any threat to standards of care.
Within the NHS, the Minister's is a lone voice compared with what is being said in the authorities of England and Wales and in the Scottish boards. He continued:
I just hope we are not looking too far ahead"—
it is good to know that the Health Service is being governed by ad hoc expediency
with the implications of this"—
—[Interruption.] Those are the Minister's words. Hon. Members should heckle him, not me. The Minister continued:
After all, we have until next February to fund the full award and I hope we will not hear about cutbacks, which I frankly regard as the routine small talk of NHS politics and not necessary in a well-managed and well-run health service.
That demonstration of arrogance and insensitivity to those who must make the painful choices that will be made necessary by having to fund the nurses' pay award is extremely disturbing.
We should examine what some of those who live in the real world said in response to the Minister's comment. The
national association passed a motion calling on the Government fully to meet the costs of the award. The member of Salford health authority who moved the motion said that her authority had already used its efficiency savings—no doubt the Minister will try to tell us about those—and faced a burden of £1 million for wage claims during next year. The person who seconded the motion, who came from North Tees authority, said that patient care would suffer if authorities had to find the cash for awards. Simply to balance the budget, his authority would have to make a 2 per cent. cut, and he referred to this as "crisis management" leading to inefficiency. I ask the House to compare that statement with the Minister's statement that the routine small talk of NHS politics is
not necessary in a well-managed and well-run health service.
We now know who realises the damage that will be caused by the Government's decision in relation to the nurses' pay award.
However, the matter goes deeper and further than that. During a debate on nurses' pay on 25 March this year, the Minister talked about the expected outcome of the pay review structure. Hon. Members should not let him off of that hook this afternoon. He said:
The result is that all we are doing is facing everybody—Government, health authorities, staff and review body—with the reality that there is a relationship between pay and service provision."—[Official Report, 25 March 1985; Vol. 76, c. 195.]
I am glad that we have established that reality, because the thrust of the argument by alliance Members today will be that, given that the Minister has signalled clearly that we cannot divorce the two elements of Health Service management and delivery of patient care, it is wrong for the Government to argue that, even if they do not provide additional funds to meet the pay increases, there will be no detrimental impact on patient care.
Perhaps the hon. Gentleman will give serious instead of frivolous consideration to my point. He talked about service provision. Has he heard about cost effectiveness in service provision? Will he say anything about putting ancillary services out to tender? Has he said a word to the officers of his local health authority about putting services out to tender? He must realise that many costs can be saved in that way.
Like the hon. Member for Glanford and Scunthorpe, the hon. Gentleman did not listen to what I said at the outset. I quoted from a representative of one authority at the NAHA conference, which the Minister addressed, who recognised immediately that the efficiency savings that the authority had achieved, and which I hope the Minister will confirm have been achieved in many cases, have already been swallowed up as a result of the Government's decision. I was extremely interested to note that the Institute of Health Services Management said that it makes nonsense of Health Service management to try to encourage efficiency savings and then to tell managers that those savings cannot be ploughed back into providing better patient care.
The hon. Gentleman has been remarkably dismissive, as he is entitled to be, of what I said. He used my words when describing an increase which, this year, will be more than 5 per cent. on part of the pay bill of all health authorities when it comes to meeting the review body awards. Given that authorities have had a cash increase this year of 5·5 per cent. and that they are making cost improvements on top of that, has the hon. Gentleman bothered to check the assertions of one stray delegate from Teesside, or is that his only evidence for sweeping aside the care fully considered financing of the nurses' pay award?
The Minister is being extremely helpful, because he is falling back—I shall quote his words from the debate of 2 July—on the argument that he used against the hon. Member for Aberdeen, North (Mr. Hughes), who gave an example from his constituency. The Minister said:
I prefer that intervention"—from a supporter of his——"to anecdotes about a man in Aberdeen.
When it comes to savings, the Minister should take seriously the views of any Aberdonian. He continued:
It is obvious, apart from anecdotal evidence"—
this from a Minister who talks about me being dismissive—
that the Opposition have produced from a few places, that pay for nurses and improving the services can go hand in hand if one continues to improve the way that the service is delivered, as the Government have."—[Official Report, 2 July 1985; Vol. 82, c. 215–16.]
It is interesting that the Minister is sticking to that trenchant defence today.
Let me give a little more anecdotal evidence, and consider the difficulties of Bloomsbury health authority. I know that the hon. Member for Holborn and St. Pancras (Mr. Dobson) is extremely worried about this matter. The authority faces a shortfall this year of about £1·4 million, and the figure could rise to double that.
In Northampton, the district health authority chairman has already said that he is envisaging a £500,000 cut in terms not only of expanding—we are talking not just about pushing the frontiers further—but of maintaining the service of health care.
In Canterbury, the health authority has lobbied furiously, and the nurses in particularly have met their constituency representative to express their grave concern and the fact that they feel that they are being held open to moral blackmail. That is their phrase.
With regard to the Under-Secretary of State for Health and Social Security, the hon. Member for Oxford, West and Abingdon (Mr. Patten), his district health authority has expressed its grave concern, as no doubt he is aware, about the effects in the area.
As one piles up case after case, it is not enough to be dismissive. The Minister has been dismissive about the anecdotal evidence, but this is the real front line health care, and these are the people who are having to make the unpalatable choices.
On the question of anecdotal evidence, would it not be an innovation in such a debate to hear from Conservative Members anecdotal evidence that the standard of health care in their communities is increasing? Is not one of the problems that, despite the figures which the Government publish, when we go to our constituencies, constituents report cuts rather than increases in services?
The hon. Gentleman keeps referring to me. He began his search for further evidence by citing the example of Bloomsbury district health authority. He knows perfectly well that what is happening in Bloomsbury has nothing whatever to do with the nurses' pay settlement. It has a great deal to do with the implementation of the redistribution of resources between Bloomsbury and other parts of that district and of the country. As the RAWP policy now being implemented by Bloomsbury was introduced by his right hon. Friend the Member for Plymouth, Devonport (Dr. Owen) and has been supported by his party throughout, would he please withdraw Bloomsbury and its £1·5 million as an example of anything to do with the debate?
I do not know how recently the Minister for Health spoke to Bloomsbury, but we spoke to Bloomsbury last week. He is quite right to say that my right hon. Friend the Member for Plymouth, Devonport (Dr. Owen) introduced the RAWP formula and policy. He is also right to say, as I pointed out in the debate on the National Health Service cuts less than two weeks ago, that we continue to support the thrust of that policy. But he is quite wrong to try to attribute all the difficulties and ills affecting Bloomsbury to the pure product of the RAWP formula. He knows as well as I do that much of the difficulty which Bloomsbury is facing in terms of the £1·5 million, and indeed almost twice that amount, which it is having to find from the figures which it has presented, comes largely from the lack of additional revenue resources which are being made available to implement the pay review body recommendations. It is typical of the Minister to try to deflect the argument on to other ground and to argue some other formula, which is not the core of the debate, to provide the shield for his own inadequate resource support for the National Health Service.
Does the hon. Gentleman recall that Golden Square hospital, to which every deaf person in the country has been grateful, and which is attached to the Royal National throat, nose and ear hospital, is a victim also? It is a constituency case in which we know that everything is good, yet the hospital is closed.
It is interesting to hear in the House and in the National Health Service generally the contrast between the ivory tower which the Minister seems to occupy in regard to NHS funding and the reality in the streets and communities where patients are worried and nurses are disillusioned and depressed about being given a phased pay increase. It is being made clear locally that this can be borne only on the backs of cuts in provisions elsewhere.
I shall not give way. I have given way quite a few times. I look forward to the hon. Gentleman's contribution.
I turn briefly—the House will appreciate that it is only fair that I should—to north of the border, Scotland. Thinking about the other land, Wales, I am delighted to note that the cuts in the Health Service and the failure of communication and of content of policy exemplified and personified by the Minister were an important item on the agenda in the Brecon and Radnor by-election. I hope that my hon. Friend the Member for Brecon and Radnor (Mr. Livesey) will catch your eye later, Mr. Deputy Speaker, and put the case for the people of Brecon and Radnor who forcefully identified the paucity of the Government's policy.
The Minister will have heard my views on several other occasions, so I shall not dwell on the difficulties which the Highland health board is encountering. In some respects it is akin to the problems which Livingston is encountering with the new West Lothian district general hospital. It is like something out of "Yes, Minister". It has been told that it can open up new and important technological facilities, which we all welcome, but is being given not a penny extra to run them. Highland health board, for example, has two new hospitals, one in Inverness, which will be opened in August, and one in Wick, which we very much welcome. However, in response, Highland health board had to issue a consultative document which envisaged the effect of the closure of two hospitals in my constituency and in the island of Skye—the reduction of maternity facilities to two beds on Broadford at the south end of the island. Those are the kind of hard-line cuts which are having to be envisaged to meet the revenue implications which arise from lack of Government support. The situation will worsen as a result of the pay award.
It is interesting that the position is no better in Ayrshire or in the health board in Argyll.
Does the hon. Gentleman not realise that the SHARE formula, which is the equivalent of RAWP in Scotland, was designed by the last Labour Government, supported by most of his hon. Friends, in such a way that central Government did not keep back money in order to help with new hospital opening? It was agreed then that all the money should be disbursed and that health boards should plan for the future opening of hospitals. That is what Highland health board has done with Raigmore which is being opened, has patients in it and is in no way like the hospital in "Yes, Minister".
It is amazing to hear the Minister sound like an Opposition Front Bench spokesman. He blames the previous Government when his own party was elected to government in 1979. If he thinks that the policy is damaging and if he finds the reductions in patient care offensive, why does he not change the policy? He is the Minister with responsibility and authority to implement such changes. We know why only too well. As he proved in such matters as the limited list, he is willing to lie down at the feet of the Treasury rather than fight his corner for Scottish health provision.
We argue today that cash must and should be found. We specifically earmark the contingency reserve as one possible area where cash can be made available. It has been deliberately set high this year and increased by £2 billion which, on the other side of the swings and roundabouts, will mean a further deflationary measure elsewhere in the economy. The contingency reserve has been increased by £2 billion. That is probably due to the Chancellor learning from his experience of a £3 billion to £4 billion overshoot last year. The public sector borrowing requirement currently is set at about £7 billion—approximately one third higher than last year. It would appear that the Chancellor is going to allow for a further £3 billion to £4 billion overshoot this year. We do not know exactly how the Government view public expenditure and whether they are proud or ashamed of it.
The truth about NHS expenditure is that a lot of the overshoot—the item which we are debating today being a notable exception—often comes about by default rather than by design. It comes about through demographic pressures and the pace and pressure imposed by medical technology. It comes about through increasing equipment costs in a financial year. That is why at the time of the Budget, alliance Members argued that PSBR should be increased, and we were quite unashamed about that. The proposed increase to £9 billion was relatively modest by international standards. We said that it would be expansionary, that it would require more borrowing and that we should have to find money to increase real expenditure on the Health Service by 1·5 per cent. per year. Such an increase only begins to make some inroads not so much in keeping pace with expenditure but pushing forward the frontiers of health care. That must be a better resource to fund welcome awards for nurses, widwives, health visitors and other allied professions. We should not forget that there will be more cost increases, which will increase the pressure. Anything less than that approach amounts to a serious cut by stealth.
It will be interesting to see how the Centre Forward Conservatives decide to vote at 7 pm. If they support the Government amendment, which is thoroughly fraudulent and bears no resemblance to the funding problem, they will be supporting later this year, and even more savagely next year, further demoralising, debilitating cuts which alliance Members firmly oppose, based on our carefully costed economic programmes which were published at the time of the Budget. We will try to reverse that trend after the next general election when we assume government.
I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:
`congratulates the Government on implementing the recommendation of the Health Service Pay Review Bodies and awarding a fair pay increase to all the staff concerned, with particularly high awards for staff nurses and ward sisters; notes that nurses' pay has risen by 23 per cent. in real terms between April 1979 and March 1985 and will rise significantly this year as a result of the Review Body award; welcomes the 5·5 per cent. increase in health authority and health board funding which, together with the extra resources gained from cost improvement programmes, will enable service developments to take place in addition to the funding of the pay award; and notes with approval the continuing increases in the number of patients treated by the Health Service.'
If I was attempting the briefest possible opening speech, it would go like this. Thanks to my right hon. Friend the Secretary of State for Social Services and my right hon. and learned Friend the Minister for Health, we now have a record number of nurses paid record salaries helping a record number of patients in a National Health Service which is funded at a record high. However, after what the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) said, it looks as though a bit more is needed.
The motion shows a surprising lack of realism. Rather surprisingly, alliance Members seem today to want to indulge in the luxury of ignoring the substantial improvements that have been made in the Health Service during the past few years. The hon. Member for Ross, Cromarty and Skye is generally a reasonable sort of bloke. We listen to him with care and interest and sometimes with respect for him as a bit of a prodigy—a Boris Becker of the Highlands and Islands, even down to the correct patination.
On 2 July, the hon. Gentleman made some criticisms of Government policy and mentioned the funding of the nurses' pay award. Unlike the Labour Front Bench that day, the hon. Gentleman was realistic about some of our achievements and, unlike today, he was prepared to give credit where credit was due. He talked of our "sensible ideas" and recognised
that cuts in the number of beds do not always mean that there are cuts in health care."—[Official Report, 2 July 1985; Vol. 82, c. 229.]
I welcomed that speech and was looking forward to today's. Alas, today, leading for the Social Democratic party, he seems, in view of his talk of cuts by stealth, accusations about public schoolboys on the Front Bench and savage personal attacks on my right hon. and learned Friend the Minister for Health who, as we all know, is not a robust spirit, to have caught more than a touch of Meacheritis during the weekend. I hope that he will recover soon and return back to his old, balanced, self.
We went over much of the ground that the hon. Gentleman covered today in response to a similarly ill-conceived motion moved by the hon. Member for Oldham, West (Mr. Meacher), who we are pleased to see on the Opposition Front Bench. The scene set by my right hon. and learned Friend in that debate hardly lends itself to the prospect of overblown damaging long-term reductions such as the hon. Member for Ross, Cromarty and Skye would have us believe. I shall not repeat what my right hon. and learned Friend said in that debate as we have only until 7 pm and many of my hon. Friends hope to speak.
Nobody would dispute the importance of paying dedicated staff a fair wage for their vital work. I believe that we are achieving the right balance in the NHS. Our concern for the Health Service is amply demonstrated by what we have done for nurses since 1979. There are four main points, all of which, uncharacteristically, the hon. Member for Ross, Cromarty and Skye skated over. First, between April 1979 and February 1986, nurses' basic pay rates will have risen by an average of 111 per cent.—more than 30 per cent. ahead of the forecast rise in prices during the same period.
I apologise unreservedly if I have offended the hon. Gentleman, but I shall not give way to him.
Thirdly, we are now employing more nurses than ever before. The House has heard some criticisms of our conduct of the NHS, but I can announce that the manpower figures for March 1985, which we have just received, reveal that the NHS in England has 401,200 nurses—the most in its history.
An extra 42,500 whole-time equivalents have been employed in England since we came to office. The equivalent figure for Scotland is 6,358. Even if we take account of the reduction in the nurses' working week, 18,900 more nurses are on the wards in England. Within those increases, the proportion of fully trained nurses is also rising. More and better care is being given on the wards.
My hon. Friend will recall the challenge made by the hon. Member for Birkenhead (Mr. Field), stating that the Government cite the blanket figures of 42,000 in England and 6,000 in Scotland. Is my hon. Friend aware of the position in Scunthorpe general hospital, where the number of staff has increased by 55 in the past year, seven of whom are paramedical staff and five of whom are doctors, where there is a new £30 million building programme and where a new psychiatric wing opened last year?
I am aware of the improvements to which my hon. Friend the Member for Glanford and Scunthorpe (Mr. Hickmet) referred. I was in the Humberside area two Fridays ago and I heard about how pleased people are with the developments in hospitals such as that in my hon. Friend's constituency and in the nearby hospital in Grimsby.
Fourth and last in the list of improvements for nurses, is the establishment of the new review body to make recommendations about appropriate pay levels. This is a most important step foward. There can be no question but that this represents a major advance for the nursing profession. Nurses have never had their pay determined through a standing system of this type and the two major inquiries that produced for a while substantial pay increases for nurses—Halsbury in 1974 and Clegg at a later stage—were one-off exercises. Consequently, pay levels, for example those established by Halsbury, were quickly eroded as a result of the high inflation under the last Labour Government. By 1979, the pay awards had been written off by inflation. Is the Labour party proud of that? It cannot be. I do not believe that the Labour party did anything other than let nurses and the nursing profession down badly.
While the Government have every reason to congratulate themselves on this magnificent achievement, does my hon. Friend accept that, under Governments of both parties, there is a special problem of underfunded districts and overfunded regions? Will he be prepared to look into this problem urgently, particularly as Southend is one such area?
My hon. Friend knows that I am concerned about the problems of funding in the Health Service in Southend. He has already been to visit me and talk about these matters. He knows that discussions are going on between his health district, the North-East Thames regional health authority and my Department. We are continuing to look at the problem of the Southend health district and I take this opportunity to congratulate its excellent chairman and all those who work in it on what they are doing.
I am sure that the setting up of the pay body has been welcomed, not only by nurses but by everybody in this country who feels an enormous debt of gratitude for the magnificent work that nurses do. Against this background, which was ignored by the hon. Member for Ross, Cromarty and Skye, I move on to the arguments about the 1985–86 pay awards and their funding. I thought that the SDP was keen on fair and even-handed treatment, but the hon. Member looked at the one without having set the scene of the other.
We would have preferred to be able to implement the latest set of review body recommendations all at once instead of in two stages. However, we had to strike a careful balance between the speed of implementation of the awards and the capacity of the NHS to absorb these major pay increases without damaging patient services. Our evidence to the review bodies for both nurses and doctors clearly spelled out that no additional funding would be forthcoming on top of the large increase in cash that had already been made available in the general allocations. It is no good pretending that pay can somehow be divorced from the realities of spending generally in the NHS. We have faced up to this, as any Government must, and have made our position abundantly clear. Pay accounts for between 73 and 75 per cent. of the NHS annual revenue budget.
Nor should it be overlooked that the full rates recommended by the review body for nurses and midwives, like those for doctors, will be in payment well before the end of the financial year. I take just two examples. First, this means that ward sisters and staff nurses, the main clinical grades, will be on pay rates between 9 and 14·3 per cent. higher than they were in 1984. In layman's terms, forgetting percentages, this means that from next February we estimate that the average earnings of a staff nurse will have risen by £11·50 per week and by £21·40 per week for a ward sister. These are very considerable increases.
Secondly, the position of student nurses has improved. They get an increase of £3 to £5 a week. Before Opposition Members start talking about the erosion of pay awards by increases in lodging charges for those in residential accommodation, in which a number, but far from the majority, of student nurses are housed, I point out that residential accommodation charges have gone up by 44p.
The hon. Gentleman has in front of him, or he would have if he went to the Library or looked at Hansard, the pay agreement arranged between the nurses, the Royal College of Nursing and the Government. The nurses have settled on the figure announced for this year, which includes all their duties. If the hon. Gentleman is telling me that he is unable to recognise genuine improvements in the position of a staff nurse getting £11·50 a week more or a ward sister getting £21·40 a week more, he is blind to the facts. I am afraid that we have to use facts in place of absurd arguments.
I am sure that right hon. and hon. Members on both sides of the House will be pleased to learn that the new pay rates for both nurses and the allied professions have now gone out to health authorities and should be reflected in the August pay packets.
I have given way a great deal already and I trust that the House will forgive me for not giving way any more in the interests of other hon. Gentlemen on both sides of the House who wish to make speeches. If there is one hon. Gentleman who would have to wait a very long time before I gave way to him, it would have to be the hon. Gentleman for Islington, North (Mr. Corbyn), with his interest in the IRA. Anyone who, like me, has served in the Northern Ireland Office would, like me, treat the hon. Gentleman's attitude with contempt.
"Windy" describes all too well the hon. Member for wherever it is that the tube stations are located—Holborn and St. Pancras (Mr. Dobson).
The hon. Member for Ross, Cromarty and Skye made great play of the impact that funding these awards will have on health authorities.
We need to pause and get the funding of the pay awards into perspective. For example, health authorities in England will receive some £9·5 billion in revenue funding from the Government this year. This includes a cash increase of over £500 million for 1985–86. Scottish health boards received £1·35 billion, a cash increase of some £70 million. Health authorities have also told us that they plan to realise about £150 million extra this year through their growing programme of cost improvements—something largely ignored by the hon. Member for Ross, Cromarty and Skye. In Scotland, health boards are doing the same, including the health board that is chaired by the hon. Gentleman's former headmaster.
One has to look at figures that demonstrate the economic cost of the services being provided.
In the face of the formidable additional sums which have gone into the National Health Service, linked to the equally formidable sums of cost improvement, both south and north of the Border, it is completely misleading to suggest that the pay rises of nurses and doctors can only be met at the expense of patient services. It is obvious that decisions like this, taken during the course of the year, sometimes require the revision of short-term plans, but flexibility like this always has and always will be a characteristic of NHS planning. The vast majority of authorities recognise this and will cope more than adequately with the pay bill costs that they face this year.
I was surprised that the hon. Member for Ross, Cromarty and Skye indulged in speculation about the prospects for 1986–87 and future expenditure years. It does the NHS no good if, far from talking about the current or the past position, people indulge in highly speculative and morale-damaging allegations about the future, and I do not propose to join the hon. Gentleman. The effect of the staged awards on next year's pay costs will be taken into account in the public expenditure review. I hope that those who are making alarmist statements about problems that they imagine will arise next year will take note.
I reject the hon. Gentleman's strictures. My right hon. and learned Friend the Minister for Health and I stand by the Government's record. I am convinced that the Government's treatment of this year's award represents a highly satisfactory outcome, which is fair to nurses, taxpayers, the NHS and NHS patients. I believe that, together, the review body that we set up in 1983, our increased spending on the NHS and its better management is enabling us to begin to solve sensibly the difficult and complex problem of settling the pay of nurses. This is essential to the united aim of the Government and the NHS to improve the service that we provide for patients. Nurses and doctors have a critical role to play in achieving that aim.
I am slightly confused about the health policy of the Social Democratic party and about how it hopes to help more patients. Is the SDP's health policy the same as the Liberal party's health policy? If not, how does it differ from the Liberal party's policy? We may be told by the hon. Member for Leeds, West (Mr. Meadowcroft) when he winds up the debate. I understand that a little later tonight those hon. Members who want to do so can hear him play the clarinet in the Liberal jazz band. It will be interesting to see whether he and his SDP friends play the same tune about health care.
Every time we look at the policies of the Social Democratic party and the Liberal party we see very wide gaps between them. Is the gap on health as wide between the Liberal party and the Social Democratic party as it is between the unilaterialism of the Liberal party defence policy and the nuclear deterrence defence policy of the SDP?
Does my hon. Friend agree that it will be interesting to see whether the spokesman for the Liberal party mentions patients in his speech, and in particular whether he is able to bring himself to appreciate the substantial increase in the number of outpatients, inpatients and day case patients who are now being treated by the NHS? It will be interesting to see whether he welcomes that increase or whether he denies its existence, which was the theme of the spokesman for the Social Democratic party.
My hon. Friend is characteristically right, so I am pleased that I acceded to the temptation to give way to him. Either the hon. Member for Leeds, West must agree that more patients are being treated nationally and locally, or he must disagree with his hon. Friend the Member for Ross, Cromarty and Skye. He cannot have it both ways. The Liberal and Social Democratic parties cannot try to have it both ways in public relations but then go in two separate directions over policy, one party being in favour of unilateral disarmament, the other party being in favour of nuclear deterrence. Shall we find that the same differences exist over NHS policy as exist over economic policies, with one party liking free market economics and the other party wanting to manage everything in sight? The Liberal party opposes the use of nuclear power for providing energy, while the SDP supports it.
I apologise profoundly, Mr. Deputy Speaker, for having gone down that road. I thought it was important that the general public should know about the substantial policy differences between the Social Democratic party and the Liberal party and that it should be exposed in a way that the press is all too disinclined to expose. We shall have to wait and see how big is the gap between them on health matters. However, the hon. Menber for Ross, Cromarty and Skye has made no case this afternoon which allows us to understand any more clearly his party's health policy. He made no case at all for his motion and I must invite my right hon. and hon. Friends to reject it in the Lobby.
The Opposition support the motion. It is broadly in line with our own response to the Government's handling of the pay review body's awards that were announced on 6 June. I agree with many of the points made by the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy). It is even more significant that in the reply of the Parliamentary Under-Secretary—or PUSS as I believe he is known in the trade—he played the usual gramophone record about the Government's performance but in a characteristically ungenerous speech flailed about at everything in sight and said embarrassingly little about the subject under debate, and very little indeed about the funding of the pay award for nurses.
There are three aspects to the awards about which we made strong objections at the time and about which we still object. First, there is a marked difference in the time scale for implementing the awards, which severely discriminates against nurses. The award for the armed forces was met in full and was backdated to 1 April. The award to the doctors was met in full and paid from 1 June. The award to nurses, midwives, health visitors and professions allied to medicine is, however, to be held back for 10 months.
On the nurses' pay review body the Minister, with a wonderful elasticity of language, said:
We are accepting the review body's recommended levels and we will bring them into payment in full as soon as we can.
When translated, I think that he meant: "The Government have rejected the review body's proposals for nurses and
midwives and will pay the recommended increase only for the final two months." For almost the entire year, nurses will receive, at most, 5 per cent. This will leave them below the rate of inflation and will do nothing to eliminate low pay among unqualified nurses who are living on the poverty line.
The Opposition's second objection is that, compared with last year, the funding arrangements represent, by any standard, a major tightening of the screw on the National Health Service. In the year before last, the Government covered 100 per cent. of the pay award to nurses out of central funds. They were quite right to do so, and we would do the same. Last year, the Government covered £180 million only out of the £216 million award to nurses and related groups, which is 83 per cent. This year they are covering only 33 per cent. That is a measure of the sharpening pressure on NHS budgets during the last two years.
Our third objection is that the whole exercise has involved the declaration of a pay norm that the Government know to be completely unrealistic as a way of camouflaging the imposition of further cuts. To that extent I agree with the hon. Member for Ross, Cromarty and Skye, who referred to making cuts by stealth.
The Minister has denied that he set a 3 per cent. pay ceiling at any time. But it is clear from reading the document that both the permanent secretary, Sir Kenneth Stowe, and the chairman of the NHS management supervisory board, Mr. Victor Paige, told the Select Committee on Social Services that the pay assumption was 3 per cent. If the Minister doubts that, I suggest he reads the record. The Government know perfectly well that a 3 per cent. limit can never be met while inflation is running at 7 per cent. and pay settlements generally at something between 7 per cent. and 8 per cent. It was simply a device to offload most of the onus for meeting the pay claim on to the health authorities, and the Government knew it must lead either to cuts in nurses' jobs or to cuts in services to patients. Either way, that is moral blackmail.
The Minister chose to disregard these criticisms in the bland statement he issued at the National Association of Health Authorities conference in Cardiff last month. That cannot have been one of his most enjoyable visits. At that conference he said he was
'singularly unimpressed' by any English health authority which said the nurses' settlement would have any impact on its budgeting plans.
He went so far as to say:
I must greet with disbelief any authority saying it cannot afford the full cost of the nurses' pay award.
I have news for the Minister. The disbelief is all on the side of the health authorities, who view such a dismissive statement from the Minister as either supremely arrogant or astonishingly naive. A great many health authorities believe that the nurses' pay award cannot be met without substantial cuts. It is not difficult to see why.
No, not until I finish this section. I will say why we believe that that crucial point is the case. In a year when the total cash increase for hospital and community health services in England was £521 million—that is the Government figure—this pay award alone will cost health authorities £240 million. Even those health authorities which receive additional cash to help them cope with demographic pressures will find that this money is needed to fund pay awards, and savings obtained from cost improvement programmes will have to be diverted from new developments, for which they are intended, to compensate for this.
That is because this year's pay award to nurses and doctors can be accommodated—this is the crucial point Ministers have to answer—within health authority budgets only if prices rise by only 5 per cent.—as everyone knows, they are currently running at 7 per cent.—and only if pay to other Health Service groups does not exceed 3 per cent. Ministers and possibly other hon. Members know that a pay increase to other Health Service workers of 4·7 per cent. has been rejected. The Government's only refuge is to talk, as the Minister has done many times and as his hon. Friend did today, about efficiency savings. But in this world, one does not get owt for nowt, as they say in Lancashire.
So-called efficiency savings, which is a euphemism if ever there was one, are bought at a price, and are often achieved only at the expense of reduced maintenance and repair work or through land sales or the postponement of new projects. That is not a saving at all. It is simply an uneconomic deferment of today's problems until tomorrow when they will be solved often at higher cost. The cost of the Government's foolish policy, not the savings, was pinpointed recently by the Audit Commission. Its report drew attention to the fact that completing the backlog of repairs to hospitals would cost £1,700 million. That is some efficiency saving, if it is at the price of postponing those repairs even further.
I am very grateful to the hon. Member. Does he not recognise that one of the reasons that the backlog, both in the capital programme and in building maintenance in the National Health Service, grew so much in the late 1970s was the savage 30 per cent. cuts in the NHS capital account that the last Labour Government set in train?
The hon. Gentleman's attempt to defend the Government would be much more plausible if the Government's current spending on investment in the Health Service was up to the level achieved by the last Labour Government. When the Government can achieve that performance, they might have some case.
The Government's excuse about efficiency savings needs to be met once and for all. It resolves itself into two options: either maintenance or repair work or new projects needed now are postponed, in which case the eventual cost to the NHS will be substantially higher and efficiency savings can be seen as merely storing up bigger trouble for tomorrow; or this needed work is carried out now, as it should be, in which case there will have to be other cuts in the Health Service to meet these pay awards. Either way, it must surely be clear to everyone in the House that a sizeable funding gap cannot be filled by glibly trotting out phrases like "efficiency savings".
Exactly the same conclusion was reached by the Select Committee on Social Services in its sixth report. published on 12 June. In a carefully argued passage in paragraph 13 the Committee says:
the additional pay costs in 1985–86 for cash-limited NHS services would be 5·4 per cent for doctors and 5·6 per cent. for nurses. The Department is unable to give a sensible estimate at this stage for an HCHS pay and prices factor, because of the outstanding pay settlement for other NHS staff.
I understand that. The report continues:
It is highly unlikely that inflation in the HCHS will be under 5 per cent. If it were to be 6 per cent, that would leave an input volume figure of—0·2 per cent, similar to 1984–85.
Leaving aside the jargon, that means a cut, and on the most careful analysis, the Select Committee on Social Services, on which Conservative Members have a majority, arrived at the conclusion that, based on the likely level of this year's inflation, there will be cuts in services. That is the report to the House of the Select Committee on Social Services and its analysis of the evidence. The report makes it clear that, far from there being any growth in the NHS services this year, following these pay awards there will almost certainly be cuts.
I always regret, almost as soon as I get up, arguing against the hon. Gentleman's tortuous use of figures. He will admit that the passage he has read is about measuring spending in the Health Service in relation to pay and price movements. It says that "if" the pay and prices factor inside the NHS were to reach 6 per cent. then there would be a reduction.
The hon. Gentleman is either not listening or not understanding. We are talking about 1985–86. The nurses' award is 5·6 per cent., but we do not have a settlement for the other staff. An amazing settlement for the other staff would be required to take it up to 6 per cent. on that basis alone. The hon. Gentleman is being alarmist by taking an inflated view of the likely level of inflation for the whole year, which he thinks is going to come to 7 per cent. That is the highest estimate that I have ever heard. That has been driven up anyway by mortgage interest, which is not, to my knowledge, paid by health authorities. Even the month-to-month figures have been driven up by factors which health authorities do not meet. The hon. Gentleman has also overlooked the effect of the reduction of national insurance contributions in this year's Budget. Those are paid by health authorities on the great bulk of their staff.
For all those reasons, will the hon. Gentleman admit that once again he is going through the evidence of a Select Committee desperately trying to put together unlikely figures to turn £500 million of increased cash limits into an alleged and fictitious cut?
The Minister is getting very worried at my simply repeating what the Social Services Committee said. If he disagrees with the Committee, perhaps he will give us his estimate of the likely pay and prices factor for this year. If he disagrees with 5 or 6 per cent., I will give way so that he can give us his estimate of what he thinks it will be.
The hon. Gentleman forgets that a moment ago he said that it was fair for us to say that we could not give an estimate because we had not yet settled. Therefore, will the hon. Gentleman stop basing fatuous cases on hypothetical assumptions?
The other way of putting it is that the Minister cannot deny that there may be a pay and prices factor this year which will lead to cuts in the NHS.
What worries health authorities most is the fact that the situation could become much more serious next year. They are having to meet two thirds of the 9 per cent. nurses' pay award from February next year, and if a similarly large proportion of next year's pay award were left unfunded by the Government—given the trend of the past two years, that is extremely likely—health authorities could find themselves forced to make far bigger cuts than anything yet contemplated.
I shall give the Minister several examples, which he will be pleased to hear are not anecdotes. I have been in touch with several health authorities about how they propose to fund next year's pay award. In West Lambeth—[HON. MEMBERS: "Ah!"] West Lambeth is a significant health authority. The Minister wishes to sack the members because of their unwillingness to carry through cuts which will amount to £80 million by 1993. The West Lambeth treasurer tells me that, as a result of the authority having to fund most of the pay award, there will be a shortfall of £450,000 this year and of £1 million next year.
The health authority already has to cut—1 million from next year's budget—the Minister wishes it to do that—in addition to suffering a cut of a further £1 million in RAWP money, making a loss of £3 million by 1986–87. The authority told me:
Inevitably, there will be cuts in services to patients
either in acute beds or in putting a stop to community development.
Salford said that the fact that it is being required to fund most of the nurses' pay award will produce a shortfall in finance for health services of £360,000 this year and £ 1 million next year. It does not have a development fund and gets money from the region only for specific programmes.
The Salford authority says that it has cut everything possible over the past few years, and all that is left to be cut are services to patients.
The hon. Gentleman knows nothing about Salford. His intervention demonstrates either arrogance or absurd pretentiousness.
As a result of having to fund most of the pay award, the Brighton health authority will have to make cuts of £500,000 this year and £1·3 million to £1·5 million next year. I have with me Brighton's document "Impact of Pay Review Body Awards and Increased Rate of Price Inflation on the Finances of the Authority", which makes it clear that the authority is planning cuts from among 60 items. They include taking all or most services from Hove and Lewes hospitals, not replacing consultants when they retire, employing trainee nurses rather than trained staff in GP surgeries, abolishing the ambulance bus service for the sick and frail, reducing nursing cover on night duties, reducing cleaning standards in staff accommodation, charging low-paid NHS staff more for meals, cutting staffing levels on long-stay wards, reducing training spending, reducing fire precaution levels, reducing the quality of services in the control sterile supplies department and reducing family planning and dentistry services. [Interruption.] Here is the report; if the Minister does not believe me, he can read it for himself.
Having listened to that list, all I can say is that they must be paying their nurses a fortune in Brighton.
Does the hon. Gentleman accept that the two authorities that he has quoted—West Lambeth and Salford—are both overspending authorities and that the changes that they are having to make are to get back within planned budgets? The previous Labour Government insisted on that policy. Whatever arguments we may have about the overspending that has happened in Salford and is planned in Lambeth, all Governments have insisted that health authorities live within cash limits, and neither case has much to do with the nurses' pay claim.
How can all those cuts be necessary in Brighton when the pay award to nurses is costing only 5·6 per cent. this year? Does not the hon. Gentleman accept that all this is based on a hypothetical assumption about next year's PESC settlement and next year's cash limits? None of the health authorities, any more than the Government and the Opposition, can have firm figures. We have not even started speaking to the Chief Secretary yet. I do not know the figures, never mind Brighton knowing them.
The Minister must get out of the doublespeak in which he indulges so readily when he talks about overspending. Underfunding is causing all the difficulties. It is not a case of authorities overspending and having to be brought back within budgets. The Minister is imposing intolerable strains on health authorities that are trying to provide a decent standard of service for patients.
My final quotation comes from the Lewisham and North Southwark health authority. In a letter to the Secretary of State dated 26 June, the authority said:
This Health Authority … views with disdain this Government's repeated abdication from its responsibilities to fund fully pay awards to which it is a willing party. In not funding fully such pay awards, this Government is displaying a cavalier and uncaring attitude towards our staff and those people with whose health-care we are entrusted. Should this Government claim that those monies voted by Parliament are sufficient to cover any underfunding of pay awards, then we can only conclude that this Government has no understanding, by design or otherwise, of the parlous and precarious state of NHS provision in this inner London Health District attributable directly to this Government's attitude to Public Spending.
That comes from a Tory-dominated health authority.
No. I know that the health authority is in the hon. Gentleman's constituency, but I must get on.
Like so many health authorities, Lewisham and North Southwark has a majority of known Tory supporters. Its letter shows how exasperated health authorities, even Tory authorities, are becoming at the Government's high-handedness in forcing major cuts, especially next year, which cannot be absorbed, whatever productivity improvements are made and however much the Minister juggles the figures, without significant cuts in patient care.
If the Minister cannot or will not see that fact, it is high time that he took the telescope from his blind eye and started looking directly at the facts and at what health authorities are telling him.
The heart of the debate is the central question of NHS funding. I cannot repeat too often or too strongly that there is no way that an adequate health service can be provided on a budget that is unchanged as a proportion of GDP or, even worse, on a budget that represents a declining share of GDP over the next few years, as the Government's public expenditure White Paper suggests is proposed.
Under this Government, Britain is the lowest spender on health services in the western world. We spend only 5·7 per cent. of our GNP on health, compared with 8 per cent. in France and Germany, 9·5 per cent. in the United States and 10 per cent. in Sweden. Those are enormous differences between countries. We are not just marginally lower than our competitors; we are substantially lower.
The Government seek to force health authorities to fund most of the pay award to doctors and nurses and to force them, without extra Government funds, to cope with major new and pressing requirements, which are not the Government's fault, but have arisen in recent times—such as community care provision, countering AIDS, cervical screening, containing the spread of hard drugs and countering further outbreaks of Legionnaire's disease. That is impossible within an NHS budget that is declining as a share of overall national resources.
That is why the Government stand condemned and why no amount of special pleading about cost improvement programmes or so-called efficiency savings can insulate the Government from the stark reality that they are trying to force on to health authorities the onus which falls squarely on the Government for failing to fund the National Health Service properly.
It is not that health authorities are guilty of overspending. It is that the Government are guilty of underfunding. Until the Government reconsider that position and the increasingly intolerable consequences on the ground in terms of patient care, the Opposition will be supporting the motion.
I hope that the House will excuse my by-election voice, which is compounded by a heavy cold.
First, I pay tribute to the late hon. Member for Brecon and Radnor, Mr. Tom Hooson. He was an excellent constituency Member and has been taken from us at an early age. He was dedicated to the people of Brecon and Radnor and served them well. I am sure that the House will wish to join me in remembering his good work and in extending great sympathy to his family. [HON. MEMBERS: "Hear, hear."]
The people of Brecon and Radnor have entrusted to me the great privilege of representing them here in Parliament. This I shall do to the best of my ability. You, Mr. Deputy Speaker, will know that I was brought up amongst them and therefore feel well qualified to communicate with them and they with me, so that our voice can be heard here at Westminster.
Without doubt, Brecon and Radnor is the finest constituency in Britain. Its beauty is unsurpassed in all of Wales, and the great quality of its people was recognised by the huge numbers of people of all political persuasions who visited us during the recent by-election. In fact I see many familiar faces on the Government Benches, and I am told that no fewer than 150 members of the official Opposition visited us. I also saw them in the highways and byways of my great constituency, some in Brecon, some in Llandrindod Wells, others in Knighton and Ystradgynlais, and some, too, were even lost.
Brecon and Radnor is a series of communities, many of which are very small. The result is that the people are great individualists and rightly expect a lot from their Member of Parliament—hence my voice at the moment—and from their Government.
The people of Rhayader will not tolerate being ignored or their efficient Vickers factory being under threat as a result of the privatisation of British Shipbuilders. Builth Wells was up in arms about the Audit Commission's thoughts on denying it a new school. Brecon would not suffer the closure of St. David's hospital, nor would Crickhowell tolerate the closure of Cwrt y Gollen camp. Ystradgynlais and its people have seen levels of unemployment in excess of 18 per cent. for far too long.
The by-election was fought and won largely on the issue of cuts in public expenditure. These are policies being implemented by the Government and they have been found wanting by the people of Brecon and Radnor. Opposition to these cuts was focused on education and other local government expenditure, farming and especially the National Health Service.
I was brought up in Talgarth, a town which is almost entirely dependent on National Health Service employment. The NHS employs 2,100 people in the constituency. There were many problems identified during the by-election campaign, but the future for the NHS in Brecon and Radnor is grim.
Government cash limits throughout Powys area health authority allow a 3 per cent. increase in 1985–86, yet the nurses are to receive a 9 per cent. award, well deserved but not exceptional taking into account that it covers a two-year period.
According to the chief executive of Powys area health authority, the net effect is a deficit of 5·4 per cent. on the area health authority budget for 1985–86 not catered for by the 3 per cent. increase in cash limits. The knock-on effect for the authority is to have to find £700,000 in the current year to finance pay awards from within its own resources—this in a budget of £21·496 million. The latest presumption is that a further £1·3 million will have to be found in 1986–87.
I draw attention to the fact that 78 per cent. of the area health authority's expenditure in Powys goes on salaries. If this is related to the 1986–87 figures it will, taking account of Powys area health authority's average employer's cost of £8,000 per employee, result in a possible loss of 126 jobs within the authority.
If losses in Government revenue from redundancy payments, national insurance and tax losses, and VAT are taken into account, the so-called saving of £1·3 million will cost the Government £1·89 million in lost revenue and at the same time inflict great hardship on the people of Brecon and Radnor.
These figures imply that a £1 restriction in cash limits has a consequent loss of revenue of £1·45 in the first year—in other words, a net loss of 45p. This is surely the economics of despair.
These matters also cast suspicion on the Government's claim nationally of a 20 per cent. real growth in National Health Service funding since 1979. There was a 30 per cent. increase in nursing staff salaries in May 1979, and there has been a reduction of two and a half hours per week worked by nurses since 1980. If this is coupled with a 2·5 million increase in out-patients since 1980, a 650,000 increase in in-patients and 300,000 more day patients in the same period, Health Service output has increased significantly.
These factors must surely be taken into account in future policy decisions about the National Health Service. The service requires adequate funding and a built-in allowance for an increasing aging population. This is a particular problem in my constituency and featured very strongly in the by-election campaign.
Brecon and Radnor is a fine constituency traversed by the valleys of the rivers Usk and Wye. It is farmed supremely well, whether in the uplands of Radnorshire or in the Brecon Beacons, and in the great traditions of its livestock farming. The rewards of honest endeavour at present are declining farm incomes. These good people of Brecon and Radnor, whether in the hamlets, villages or towns such as those of Sennybridge, Llanwrtyd, Presteigne and even "independent" Hay-on-Wye, all need a better future.
Our small businesses and communities must be allowed to thrive. Nor should we forget the immense job that needs doing for the area of Ystradgynlais and its fine people. The Government must provide us with the means to get aid from the European social fund. The need is quite clear. All that is required is the will power to provide it.
I dedicated myself to Wales, my constituency and its people—to work constructively for them all. Will the Government of the day take their cue from the verdict of the people of Brecon and Radnor and work for them, too?
It is my pleasure to be called immediately after the new and hon. Member for Brecon and Radnor (Mr. Livsey) and to welcome him to the House.
I speak for all right hon. and hon. Members when I say that the House will appreciate his generous tribute to his predecessor, who was a brave and much-respected Member and who sat on the Government Benches. He practised what many Liberals preach by way of community politics, and I hope that the hon. Gentleman will serve his constituency as well as his predecessor did.
The hon. Gentleman has started well. His speech was responsible and constructive. I hope that his tenure of Brecon and Radnor will be glorious, even though it will necessarily be brief.
A general feature of health services everywhere is that there is no natural level of expenditure and no level of expenditure that satisfies the requirements put on it. Expenditure can increase practically without limit. That is partly because demand is increasing. For example, we have an aging population, and the number of old and very old people will increase dramatically by the end of the century.
I pay tribute to the private sector for looking after large numbers of elderly people in nursing and residential homes. About 30,000 people are looked after in nursing homes. That is often done more economically than would be possible in the public sector or in geriatric hospitals. I urge Labour Members to think long and hard before they dismiss the private sector in that respect. Where would those people go if the Labour party carried out its threat and shut down or restricted the entire private sector?
Demand for health care is increasing for other reasons. We are now better at diagnosing diseases and there is an almost inexhaustible supply of new technology in the health sphere. The effect of the new technology is perverse. In industry, the introduction of new technology usually leads to savings in manpower—at any rate in the short term—to a reduction in unit costs and to lower revenue expenditure. A new piece of equipment in a hospital can have the opposite effect. It tends to increase demand. Expenditure rises and often new staff are required to service and look after it.
The advance of medical science is almost without limit. That is welcome because it means that previously incurable illnesses can be treated. It also means, however, that treatments costing a few hundred pounds last year can he replaced by new treatments costing a few thousand pounds this year. It will always be difficult to accommodate such increases in expenditure in a budget which, in overall terms, can increase by only a few percentage points annually.
If medical need is to be the sole criteria, there will be no limit to the scale of expenditure, because, if any human being anywhere is receiving a more advanced type of treatment, it will be open to people to demand that treatment, and patients and doctors will say that they need it, that the NHS should supply it and that the Government should pay for it.
There is no escaping the fact that there is no level of expenditure or increase which will ever meet medical demand in its entirely. That is why, in the real world, choices must be made and priorities set. There will always be allegations that some treatment is being denied one or other group of patients. That fact must be faced by any party in office, and that is why I have been disappointed by the speeches made so far by Opposition Members. They have not addressed themselves to the central facts of expenditure in relation to health care.
Labour Members should think carefully about their policy of ending private medicine. I have spoken of that in relation to the care of the elderly. How could the NHS cope with the additional patients if the private sector were shut down? How could it manage without that revenue and still have resources over to increase expenditure in the ways in which Opposition spokesmen promise?
I urge my hon. Friend to pay tribute also to the way in which the private sector makes available pieces of equipment which the NHS would find it difficult to buy.
I am grateful to my hon. Friend for making that important point. It is a partnership between the private and public sectors. That, under the present Administration, is enabling many patients to receive advanced medical care which would otherwise not be available to them.
Nor should Opposition Members be so dismissive of the internal economies and efficiency savings that have been achieved and the scope for funding at least part of the nurses' and doctors' wage award out of further economies. The hon. Member for Oldham, West (Mr. Meacher) seemed almost to say that economies were impossible. 1 put that down to his lack of business or any other practical experience. He can take it from me that it is possible in any undertaking to increase output while holding costs.
Will the hon. Gentleman accept that the amount of expenditure that is not represented by staff costs in the NHS amounts to about 25 per cent.? Thus, the savings that can be made in percentage terms bear more heavily on that component than on staff costs. If, however, savings are made at the expense of staff, what happens to those who are made unemployed? Presumably the net cost would not be great enough to warrant the redundancies that might be thought worth while if the policies that he is advocating were taken to their logical conclusion because the low-paid, being almost invariably those who are made redundant. cost almost as much to keep unemployed.
I shall come to the question of the balance of staff and other costs later in my speech. The answer to the rest of that intervention is that the hon. Gentleman's argument is a case for making no economic change at any time. If his argument is generalised, everyone must stay in his or her existing job from now until the end of time.
I hope that Opposition Members are not so naive in relation to efficiency savings to imagine that only recorded and published savings give the full picture. It is of benefit to have in-house services and the knowledge that performance can be assessed against some external yardstick. Those concerned then know that their ultimate job security depends on their performance and the performance of the units in which they work. That feeling is familiar to anyone working in industry, but it has not been sufficiently prominent up to now in the NHS.
Naturally, people prefer a quiet life. Few organisations ever reform themselves. That is why the Government must keep the pressure on. It is no criticism of existing NHS managements to say that there must be areas of waste, overlap and duplication still to be found and corrected. With almost 1 million people employed in the NHS, it is fantastic to allege that no further economies can be made. Of course they can, and it is no disrespect to the administrators at present in the health service to say that. Above all, let us end the obsession with how much money we are putting into the NHS and concentrate instead on how that money can be turned into patient care for the maximum number of people.
I am interested in my hon. Friend's remarks about the level of NHS expenditure. Does he agree that we should not compare carelessly or easily the amount of the gross domestic product spent in this country on health care with that of other countries? We should relate that expenditure to the quality of health care that is given. Does he agree, for example, that it is extraordinary for the NHS to be spending at the present level of GDP and to be achieving lower perinatal mortality and higher life expectancy rates than are being achieved in the United States?
It is an achievement of the Government that they have not only provided more resources for the Health Service, but have made them go further.
I was disappointed with the speech of the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy). which was all about cash and resources. He said almost nothing about patients and patient care and the performance of the NHS.
I do not wish to get into the statistical quagmire with the hon. Member for Oldham, West. He was obviously confused by the figures and failed to present a convincing case using them. The overall expenditure increase of 17 per cent. in real terms during the past six years gives the lie to the allegation that the Government are relentlessly cutting or dismantling the NHS. My hon. Friend the Minister gave a detailed breakdown of the figures, and they will no doubt be referred to again.
The hon. Member for Birkenhead (Mr. Field), who is not currently in the Chamber but who intervened earlier, said that figures were one aspect, but that there was no anecdotal evidence from Conservative Members that health care was increasing and improving on the ground. I can help the hon. Gentleman with that. The people at the western end of my constituency will soon have the benefit of a new, large, modern hospital at Weston-Super-Mare. During the past six years capital expenditure has increased substantially more than it did during the previous six years. The treatment of the mentally ill and mentally handicapped in Somerset is undergoing a process of structural change and reform. That will not save money, but it will improve care. The change will involve the closure of a number of large hospitals, including the Mendip hospital in Wells, and the transfer of patients to smaller satellite units, community residential units and day care units.
That change is controversial in many respects and some people think that the trend towards community care for the mentally ill has gone too far—and I am inclined to agree with them. The new structure will not save money; indeed, the budgeted costs will be somewhat higher than at present. The emphasis is on improvements in care. The increased costs—which will be modest, but nevertheless will occur—have been agreed with this so-called uncaring Government.
I suspect that the hon. Gentleman did not deliberately misrepresent what I said. He is describing what is happening in his local area, and I am listening to him with care. Can he tell us how much direct benefit will accrue to his area as a result of the health authorities having to meet the cost of the nurses' pay award?
My regional and district health authorities are perfectly confident that they can proceed with budgeted plans on capital and revenue expenditure and meet the nurses' pay award.
Reference has been made to inflation in the NHS being faster than the general index of prices. It has been alleged that, therefore, spending increases have not really taken place. The reason for a faster rate of inflation in the NHS is precisely because wage costs and wage awards have risen faster than the retail prices index. Nurses' pay rates have risen by 23 per cent. during the past six years, but, even after taking account of that price deflator, it is still true to say that there has been a substantial volume increase in NHS expenditure during the past six years. Nothing that Opposition Members may say, either inside or outside the House, can alter that fact.
Opposition Members appear to be saying—and it is reflected in the motion before us—that we should have two NHS budgets: one for pay and one for general expenditure, and both of them elastic. I do not think that that is a sensible way to run the NHS. No commercial organisation can regard its wages bill as separate, to be topped up by an outside body from time to time. Indeed, it would be quite wrong and damaging for future negotiations if the Government stepped in in that way this year. If that happened, the review body and the Health Service negotiators would know that they were not working within a strict financial framework, but that their recommendations, negotiations and settlements could always be funded by some additional levy on the taxpayer. That is an old, familiar story of nationalised industry. We have been trying to move away from that way of settling our affairs. Let us not re-import it into this year's—or any year's—negotiations.
If anything, I believe that this year's award highlights the problem of having an independent review body. I appreciate that it is convenient for Ministers to have such a body, and I pay tribute to its work in juggling some of the gradings within the NHS. But, by and large, it is better if those who pay the piper also negotiate with the piper.
It would have been better if the alliance had faced that issue rather than, as usual, following the path of least resistance and calling for more public expenditure. The alliance has a long way to go, based on today's debate, before it can pose as a credible party of government.
The hon. Member for Wells (Mr. Heathcoat-Amory) said that the debate was about priorities, and to that extent I agree with him. Every Government must decide how much they allocate to health, defence, education and so on. Everyone who listens to or reads the debate must know that the NHS is in a shambles. It is being ruined day by day. That is why we are supporting the motion tonight.
I congratulate the hon. Member for Brecon and Radnor (Mr. Livsey) on his speech, especially for its brevity, clarity and the unequivocal statement that he won his seat because of the Government's neglect of the NHS in that area. Other hon. Members throughout the country know that to be true.
The Government themselves, when they prepared their paper for the National Economic Development Office, provided figures showing that £1,700 million would be required to renovate and maintain our existing hospitals. The Government even said that that figure might be wrong because it included estimates for repairs to hospitals that should be demolished. That is the state of our National Health Service today.
The Government's amendment congratulates them on
implementing the recommendations of the Health Service Pay Review Bodies".
Quite frankly, that is a lie. If I am called to order. I shall say that it is a deliberate distortion of the truth. They are not implementing the proposals of the review body, which said that the award should be paid in full and backdated to April. The Government are making an award of 5·6 per cent. now, but the nurses will have to wait until next February for the rest. In other words, it is jam tomorrow. Meanwhile, some of the nurses have to make do with less than 5 per cent. while prices are increasing by 7 per cent.
The Government are saying to the nurses, "You are wonderful people and because you are so dedicated we shall cut your standard of living." That is what the figures mean. A 5 per cent. increase in salary and a 7 per cent. increase in prices results in a 2 per cent. reduction in a nurse's standard of living. However the figures are dressed up, they mean a cut in the standard of living for tens of thousands of nurses.
Pupil nurses and first and second-year student nurses will have an increase of 4·7 per cent. or 4·8 per cent. up to next February. Hon. Members may argue that student nurses are training for qualifications, but we are talking about cheap, exploited labour. Even with the increase, those kids will receive only £80 a week gross.
The Nursing Mirror carried an article the other day about student nurses. It warned:
Staff shortages are putting patients' lives in danger by leaving student nurses alone in charge of wards.
That is being said not by the Labour party but by the Royal College of Nursing. The article continues:
A survey of 1,000 nurses showed that 31 per cent. of student nurses were often left in charge of wards, usually at night. Another 61 per cent. had occasionally been left alone. Staff shortages are blamed. Nearly 90 per cent. of qualified nurses in the survey said that they had warned hospital authorities that staff levels were dangerously low. Young students were being left to cope with acutely ill and dying patients.
That is said by the Royal College of Nursing Students Association head, Miss Sandra Mills. That is what is happening in the real Health Service.
The Minister behaved like a juvenile delinquent when he adopted his sneering manner today. He treated everyone who dared to criticise as either ignorant or malicious. We know from our surgeries throughout the country that we are talking about the real Health Service.
In their amendment the Government preen themselves on the
particularly high awards for staff nurses and ward sisters".
Of course the £6,000 starting point for newly qualified staff nurses is good, but only because the salary has been so inadequate. The staff nurse is the key nurse in any hospital. The maximum pay for a staff nurse in 1982–83 was £7,008. In 1983–84 it was £7,569. I obtained the figures in answer to a written question on 10 July last year.
The hon. Member for Wells (Mr. Heathcoat-Amory) talked about priorities and how we pay different rates for different services. In 1982–83 an untrained, unqualified police constable was paid a maximum of £9,798. By 1 September 1984 his maximum pay had risen to £11,193—about £3,600 more than the maximum for a fully qualified and fully trained staff nurse in our hospitals. Does anybody in the country or in the Government dare to say that a fully qualified staff nurse is not worth as much as a police constable?
Government Members say that throwing money at the problem is no good, but that is exactly what they have done with the police. There is no talk of cash limits for them.
No. The hon. Gentleman has only just arrived. I want to make my case and then sit down.
I say good luck to the police. In 1980 the police had an increase of 21·3 per cent. In 1981 they received another 13·2 per cent., in 1982 a further 10·3 per cent., in 1983 another 8·4 per cent. and in 1984–85 a further 5·1 per cent. Let us compare those figures with the figures that apply to nurses, who this year receive a miserable 5 per cent. it is not worth tuppence. The Government are throwing money like confetti at the police and armed forces when the nurses have to wait.
The hon. Member for Lanarkshire, West (Mr. Hind) has only just come into the Chamber. He wants to intervene only to prove to his constituents that he has taken part in the debate.
The Minister did not mention waiting lists. Since the Government came to office there has been an increase of 15 per cent. in the number of people on waiting lists.—[Interruption] I see that the Minister is impatient to intervene. He has given me figures about waiting lists for Scotland. In March 1980, a total of 69,904 people were on the waiting lists in Scotland. In March 1984, 85,364 people were on the waiting lists. The provisional figure for March 1984 was 83,061—an increase of over 18 per cent. That is the measure of how the Health Service is failing the people.
I thought that the Minister would say that. The figures up to that date were not down. I challenge the Minister to say whether he is claiming that over the next two years the waiting lists in Scotland and in the United Kingdom as a whole will be reduced. If he is not prepared to say that, it is a measure of how the Government are failing the people of Scotland and the United Kingdom.
The Government talk about shortage of money. If there is a shortage of resources in the Health Service they should explain why they are spending £2,000 million over the next three years on 1,200 folk in the Falkland Islands. They can find money for that. Members of the Labour party should go on repeating that because it is indefensible and a waste of public money. That £2,000 million would be far better spent on the Health Service, for the good of the 56 million people in Britain, rather than being poured down the drain for 1,200 people 8,000 miles away
There is always a whiff of unreality and almost a whiff of hypocrisy when the House discusses an Opposition motion on the Health Service. There could be nothing more unreal and hypocritical than the speech that we have just heard from the hon. Member for Fife, Central (Mr. Hamilton). The hon. Gentleman comes to this House with his heart on his sleeve, telling us what this wicked Thatcher junta is doing to the Health Service and forgetting what his own Government did.
We had the privilege of listening to the hon. Member for Oldham, West (Mr. Meacher) giving his swansong as the Opposition spokesman on the Health Service. The right name for him would be "Mr. 30 per cent.", because he was a Minister at a time when the Labour Party cut capital expenditure on hospital building by about 30 per cent.
Under the Conservative Government, 35 hospital schemes in excess of £5 million each were completed between 1980 and 1984. In addition, 11,000 new beds have been provided, together with 169 new operating theatres, 105 X-ray rooms, 25 accident and emergency departments, and 22 out-patient departments.
Admittedly, the hon. Member's speech was not quite so over the top as his previous speech, and I am delighted to see that he is sweetening his words. That is understandable. With the gaffes that he is making, he can only sweeten his words, because he never knows how often he will have to eat them.
Will my hon. Friend bear in mind that the hon. Member for Fife, Central (Mr. Hamilton) ignored the fact that when the Conservative Government took office in May 1979, the NHS waiting list was 749,000? It is interesting to note that the hon. Gentleman is leaving the Chamber. Before the dispute that he supported, the waiting list had been reduced to 619,000. Even after that dispute, the waiting list is still much lower than it was when the Labour Members Government left office in 1979.
My hon. Friend is 100 per cent. correct.
If Labour really cared about patients, the hon. Member for Oldham, West would be the first to get up and say that he wholeheartedly condemned the decision made the NUPE annual conference to abandon the TUC code of conduct about giving industrial cover for emergency services. It is important to note that Labour Members will not condemn action that they know will jeopardise the old, casualty wards, and young people.
Although there is a whiff of hypocrisy and unreality about the debate, and although I am the first to congratulate the Minister for Health and his able deputy on their success in increasing finance for the Health Service, I must draw attention to two problems that affect my district health authority.
I find it a peculiar paradox that the British Medical Association tells us that there are 700 junior doctors unemployed, and that 20 per cent. of junior doctors have experienced six months' unemployment over a two-year period, when in my authority in the past month a casualty ward has been closed in three hospitals, not through lack of resources or lack of finance. [Interruption.] Opposition Members may laugh and joke but I have spoken to the administrators of those hospitals, and they have assured me in writing and orally that it is not due to lack of finance. The difficulty that the NHS faces is a shortage of casualty locums. Surely it is not beyond the wit——
I will give way in a moment if the hon. Gentleman will be patient and let me finish the point I am making.
It is a paradox that casualty wards are being closed not through lack of finance or resources or because of the alleged cuts that Opposition Members talk about but because people on programmed leave cannot find the locums to replace them. I ask my right hon. and learned Friend to look at that paradox. Surely it is not beyond the wit of the DHSS to put right those imbalances.
I shall not debate with the hon. Gentleman the point that he is making. Having introduced the debate, I simply want to ask him whether he believes that health authorities should be given additional support by the Government to meet the pay increases of nurses, midwives and other sectors of the Health Service which have been recommended by the pay review bodies.
As the hon. Gentleman knows, this is a wide-ranging debate. I notice that the hon. Member for Crewe and Nantwich (Mrs. Dunwoody) has joined us. Sadly, I note that she is not wearing a fur coat.
I assure the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) that I am particularly worried that there will be difficulties in financing and funding the pay awards, which are especially generous. My right hon. and learned Friend and his able deputy, the Under-Secretary of State, have said that the Health Service should be cost-effective. That statement is greeted by the Opposition with howls of derision, but why should the Health Service be cost-effective? Why should not doctors understand the true cost of the treatment that is given to patients? Why should not the Health Service be run on a more commercial footing, so that the benefits may go directly into patient care?
We have had the Rayner reports and the efficiency reviews, and my own health authority has been particularly good in cutting back and allocating directly to patient care the resources that have been saved. In the next few years my health authority will be gaining about £20 million extra resources for the centralisation of acute casualties. There will be benefits all over my constituency and in neighbouring constituencies as a result. However, there are problems to which I must draw the Minister's attention.
The Government rightly say, "Make your health authority cost-effective. Run it like a commercial enterprise." Last year we had 4·2 per cent. allocated to us for pay awards. Rightly and properly, we shall have to find, on average, 8·6 per cent. for the nurses and about 12·1 per cent. for the additional workers. We have not settled on the figure for the ancillary workers, and we still have to find 6·3 per cent. for the doctors and nurses. On a half-yearly basis there will be a shortfall of £450,000. In a full financial year there will be a shortfall of £1 million.
The shortfall will cause us several problems which, sad to say, will be reflected in patient care. It would be wrong and irresponsible to deny it. I am grateful for the considerable efforts made by my right hon. and learned Friend and his deputy in giving an extra £500 million—an additional 5·5 per cent.—to health authorities this year.
My health authority is not a RAWP gainer but a RAWP loser. It does not gain from the efficiencies. I know from where this funding will come. It might mean the closure of an acute ward in Princess Alexandra hospital in Harlow, costing £200,000, an acute ward at St. Margaret's hospital, costing £200,000, a children's ward at Herts and Essex hospital, costing £105,000, the accident and emergency department at Herts and Essex hospital at Bishop's Stortford, costing £105,000 and the associated casualty ward at the same hospital, costing £200,000, a reduction in community nursing at Waltham Abbey, costing £100,000 and the closure of the minor injuries ward at Saffron Walden hospital costing £30,000.
I support the Government's policy and the amount of money that they have put into the Health Service—20 per cent. in real terms since 1978. Since then there have been 12 per cent. more in-patients, 45 per cent. more day care attendances, 52 per cent. more patients accepted for kidney failure treatment and 112 per cent. more heart bypass operations. It would be foolish and churlish to ignore that.
I ask my right hon. and learned Friend the Minister to consider generously in the next financial settlement the plight of authorities, such as mine of West Essex, which have shown that they are prepared to make themselves cost-effective and put themselves on a commercial footing and which are not RAWP gainers but RAWP losers.
I wish to pick up some of the points of the hon. Member for Harlow (Mr. Hayes) in my own time and in my own way. The nurses have been conned and the con trick has been compounded by hypocrisy. The Government have made great play of the fact that they are accepting the pay award. I pay great tribute to the review body, which has done a first-class job, but the Government have not accepted its recommendations. As my hon. Friend the Member for Fife, Central (Mr. Hamilton) said, once again for the nurses it is jam tomorrow, never today.
Nurses suffer from the effects of two public attitudes—the Florence Nightingale attitude, whereby nurses are expected to live on pay that is not incomparable with the pay during the Crimean war, and from the attitude of "the nurses are so good; it will be all right tomorrow". In this case, "tomorrow" does not come until next February.
I am sorry that the Under-Secretary of State did not have a good day today. He was forced to flail around a number of other subjects. The hon. Gentleman is not usually short of matters to bring up. Nurses' pay in 1985–86—I do not need to labour the figures—means that they have been short-changed. The 10-month delay is exceptional—doctors faced a two-month delay. Why have one rule for doctors and another for nurses?
The next pay award for the nurses will be made on 1 April 1986, and the review body will have to report back after that date. If the Government persist in their policy of phasing, in three years the nurses will have lost at least one year's worth of pay increases.
The Under-Secretary of State referred to the board and lodging charges for the people who will get the least out of this pay packet. Whereas nurses will not receive their pay increases until the end of August, board and lodging and other service charges for nurses who work in hospitals have increased. For four months these nurses paid extra money out of a pay packet which has not yet shown their pay increases.
The Government made great play of the fact that the nurses could have a review body on condition that they did not strike. For that reason the nurses were to have what the doctors have had since the 1960 Pilkington award. The Government know that the nurses never strike. Nurses have been disadvantaged compared with doctors. The doctors went on strike twice in 1974—first the junior doctors went on strike and then the consultants worked to rule. At that time my colleague Barbara Castle was Secretary of State. Because of the doctors' struggle in 1975 and 1976, the waiting lists increased tremendously and it took six or seven years to start to reduce the numbers. Yet there is no thought of stressing a condition of no industrial action in relation to the doctors.
When discussing the way in which nurses' pay has been funded we always come back to what has happened before. The Prime Minister makes this point regularly. Conservative Members say that between 1974 and 1979 there was a tremendous cut in capital expenditure. I can claim some credit for that. When Barbara Castle was made Secretary of State I was privileged to attend the planning conference at Sunningdale with the chief medical officers and the various boffins who surrounded the Secretary of State. About 75 per cent. of the huge resources of the NHS go towards pay. After the right hon. Member for Old Bexley and Sidcup (Mr. Heath) had had his four years in office, the Labour Government were faced with a choice. Once again, the Labour party came into office after a balance of payments deficit when the country was bankrupt. The choice was whether to give the money to people or to give it to buildings. Should the money be given to nurses or towards more equipment? I believe that the Labour Government were right to cut capital expenditure. The nurses' only good pay award was the 1974 Halsbury award. They could not have been given that award had the Labour Government not been prepared to cut capital expenditure so that nurses could have a fair deal.
The North-West Thames regional health authority is the authority for my area. I received an emergency notice stating that this year the authority has to find another £2 million. This is disastrous for economic planning, because budget estimates are made at the beginning of the year. What happens if, half-way through the year, the authority is told that it has £2 million less? It is nonsense for the Under-Secretary of State to say that these measures will not interfere with patient care. They can do nothing else but interfere. The Government cannot suddenly say in the middle of the year that the authority has to take £2 million out of the amount budgeted for, and claim that this will not interfere with patient care.
For three years every regional health authority was given a certain increase in its budget—about 0·5 per cent. for the North-West Thames regional health authority—through the RAWP formula. The North-West Thames regional health authority has had a tough time. During the past three years a percentage of the increase has been for efficiency savings. It is money that is not given but has to be found within the budget. For three years there have been cuts in each of the regions, under the various budget headings, to make efficiency savings.
The wretched computer is a further con for the nurses because it cannot make payments before the end of August. Therefore, although the announcement was made in June, nurses do not see the money until four months after it is due. I know of no other employees who receive such treatment, yet we pay lip service to nurses and say how marvellous they are.
The Minister keeps saying that the Department does not yet know what it will receive from the Exchequer next year, and that it is still making estimates. The North-West Thames regional health authority now has a chairman, Mr. Doughty, and a general manager, Mr. Kenny, who has the same job that he held previously, but has been given more money and a fresh title. They say that next year £6 million more will be needed for nurses' pay on this award alone. Taken over the whole country, next year there will be another increase in nurses' pay. Therefore, unless the Government do a U-turn in their public expenditure policies, the money will not be available.
The second cheat relates to the £240 million which should have been paid on 1 April but which will start to be paid at only 5 per cent. at the end of August. Therefore, the Government will borrow money from the nurses for four months. Every year out of the kindness of its heart the Department of Social Security gives pensioners a £10 bonus. Considering the present rates of interest, if the Government have any sense of justice, they could give nurses in their Christmas pay packets the amount of accrued interest which the nurses will have lost during four months.
We bandy figures about, and I know no better jugglers of figures than the Minister for Health and the Secretary of State for Social Services. One minute money is there, the next it is not. I do not accept that the productivity argument for industry and commerce applies to the NHS.
In my introductory remarks I said that, net of the reduction in the nurses' working week, 18,900 more nurses were on the wards than in 1979. Does that or does that not represent an improvement in health care in England?
That does not. The reduction in the working week from 40 to 37·5 hours accounts for a great deal of that. The latest figure I have from the Department of Employment shows that 9,500 nurses are on the dole. As I said earlier, the Minister chooses the figures to make selected points.
If the Department of Employment could announce to the House that 650,000 more people were in full-time employment and that 2·5 million more people were in part-time employment, that would be a success. However, when one learns that 650,000 more people are chronically ill and need hospitalisation, and that 2·5 million more people are so ill that they must be referred by their general practitioner to an out-patients department, that is a failure. It is a reflection of sick people in a sick society. There cannot be 4 million people unemployed without all the stress and problems that the NHS must counteract accumulating.
The Government have deceived the nurses by the funding of the pay award. I hope that the nurses will remember that when the Minister, or, if all the prophets are right and he climbs up the ladder before we return from the summer recess, his successor next deals with the subject. I hope that in the Queen's Speech he will guarantee that next year the nurses will not have a con trick played on them, as they had this year.
I welcome and congratulate the new hon. Member for Brecon and Radnor (Mr. Livsey). I am sorry to see that, having burst into the debate, he rushed out quickly; I hope that he does not find the House so fearsome that he has returned to the Brecon Beacons so soon. Today he has witnessed mark 2 of a Lib-Lab pact, with an appendix written by the Social Democratic party. When the debate is reported the public will know that the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) did an Armageddon job on the state of affairs in the National Health Service, and that the hon. Member for Oldham, West (Mr. Meacher) who is almost Armageddon itself, completely agreed with the speeches from the SDP Bench. We saw a similar great unity at the end of the 1970s, which led us into the disastrous position that then produced a large Conservative majority to run the country and the NHS properly.
I welcome what my right hon. and learned Friend the Minister for Health said in his interventions, and what my hon. Friend the Under-Secretary of State for Health and Social Security said about the Government's record on the NHS. The hon. member for Birkenhead (Mr. Field), who also burst into the debate and rushed off, asked whether we had received compliments from our constituents. My constituents who have been treated at Kingston hospital—the main hospital in the Kingston and Esher district health authority—are full of compliments for the doctors' and nurses' services, the food, the cleanliness, and every other aspect. If the hospital's record is ever attacked in the press, anybody who has been treated there jumps to its defence.
My hon. Friend will undoubtedly have seen the recent Marplan poll which showed that 90 per cent. of those asked were satisfied and felt that they were well cared for by the NHS.
I have seen that Marplan poll, and I noted that the Audit Commission found a similar high standard in the NHS when its officers reported.
Throughout the Health Service there are undoubtedly more doctors, more nurses, more out-patients being treated, more highly technical operations carried out, such as heart bypasses and kidney transplants, more dental treatment and a large hospital building programme. I welcome the Government's decision on the nurses' pay award.
The hon. Member for Ross, Cromarty and Skye has asked when we shall spell out how we shall pay for the extra award to the nurses, if we do not take money from the contingency fund. I refer him to the words of the amendment in the name of my right hon. Friend the Prime Minister. It states that the Government
welcomes the 5·5 per cent. increase in health authority and health board funding which, together with the extra resources
gained from cost improvement programmes, will enable service developments to take place in addition to the funding of the pay award.
That is the key factor, and answers his question in plain language.
Will the hon. Gentleman answer the question which the Under-Secretary of State, who spoke about many issues which had nothing to do with nurses' pay or the funding of health authorities, was not keen to answer? Will he answer the economic argument based on the Government's figures, which I spelled out in my speech? Is it not the case that, when the percentage figure in the Government's motion is analysed under the constraints against which the Government measure health spending, in the present year there will be a 3 per cent. cut?
The hon. Gentleman made that point earlier, and I am sure that my right hon. and learned Friend the Minister for Health will answer it with complete authority.
My main reason for speaking in the debate is to stress that substantial savings can be made through the cost-effectiveness programmes. In May this year, my hon. Friend the Under-Secretary of State, answering a question in the House, said that £13·1 million savings had been made from cost-effectiveness programmes, £10·7 million as a result of contracts going out to tender and £2·7 million as a result of in-house savings after putting services out to tender. Those savings have been made in only a few district health authorities—the ones that have grasped the nettle, carried through the process faithfully and contracted out their services.
It is possible to achieve anything up to the remarkable savings—58 per cent.—made by Merton and Sutton district health authority on the cleaning of St. Helier hospital at Carshalton. The in-house service cost 1·4 million, and the new service costs £583,000.
Why will not Opposition Members, whether from the Labour party or from the other half of the new Lib-Lab pact, encourage trade unions to pursue those policies in better faith? Why do they always wish to destroy the efforts of district health authorities to put services out to tender? Why must the TUC produce propaganda documents——
Trade unions oppose the privatisation of cleaning and other services because the job is done less efficiently by private enterprise, and workers have worse conditions, lower wages, shorter holidays and fewer work prospects.
My hon. Friend mentioned the considerable savings made at St. Helier hospital. Alas, I must report to the House that one criticism of the district health authority was that the standard of work done by NHS employees was lower than the standard of work carried out by private contractors. It should not have been the case, but unfortunately it was.
My hon. Friend is absolutely right. I wish to illustrate how far from the truth was the intervention of the hon. Member for Islington, North (Mr. Corbyn). There is no doubt that the TUC and the Health Service unions have pursued a campaign of destruction and cynicism when attempts are made by district health authorities to put services out to tender. A classic example was Addenbrooke's hospital in Cambridge, whose problems have been reported in the House and outside by my hon. Friend the Member for Cambridgeshire, South-West (Sir A. Grant).
I end with the specific example of Barking hospital. Following a strike by cleaners in March 1984, the TUC reported a lack of regular and effective cleaning, resulting in the presence of grease, dirt and cockroaches. At the request of trade union representatives, an inspector from the Health and Safety Executive made three visits to the hospital. He reported:
As you know, I have recently made a series of visits to Barking Hospital to look at the standard of cleaning. I have visited in my opinion a reasonable cross-section of wards, public areas and service areas. On each occasion the hospital has been very clean and I have no cause to criticise. Accordingly I have no recommendation to make.
That report was made during the first year of the contract. It has been renewed by Redbridge district health authority for a further four years, which represents a saving of £150,000 a year and a total saving of £750,000. Such savings could he made in many district health authorities, and they would more than adequately fund part of the nurses' pay award.
The hon. Member for Surbiton (Mr. Tracey) has just demonstrated everything that the Tory party hates about the Health Service. Conservative Members hate Health Service workers, especially the lowest-paid ancillary workers. That is why they are trying to destroy their jobs through privatisation, and their living standards through the inevitable cuts in wages and working conditions that follow privatisation. The brave people at Barking and Addenbrooke's hospitals, who fought for the principle of high standards of cleanliness in hospitals, deserve more praise than the hon. Gentleman gave to them.
I am sponsored by the National Union of Public Employees, which, with other unions, has many members among nurses and midwives in the NHS. The speeches of Conservative Members have not adequately demonstrated to the House the attitude of nurses and midwives to the Government and to the pay increase that has been offered. It is one of disgust and anger, and of shame at being stuck between a Government who will not adequately fund the Health Service and increasing demands for better health care. They are told that the real problem in the Health Service is high pay. That is why they are so angry about what the Government say about them.
NUPE has produced a substantial document entitled "End Poverty Pay—A Strategy for the 1980s", which tries to describe the erosion of the wages of local government and Health Service workers. It states:
Each year we are climbing up an escalator that is moving down, as the rising cost of living cuts away at our living standards. In some years we can beat inflation and our members are better off. But the Government is making it more and more difficult to climb the escalator, blocking our way with cash limits, the threat of job cuts and the threat of privatisation. So in some years the pay rises we are offered do not even match the cost of living.
That is true of the pay increases that have been offered to some nurses and midwives.
I should tell the House how appallingly low NHS pay is. Under existing pay arrangements for ancillary staff, who are the lowest paid in the NHS, 58·7 per cent. earn less than £100 a week, 92 per cent. earn less than £150 a week and 10 per cent. earn less than £68·70 a week. By any standards, those wages are disgraceful. Before the Government's announcement, 33·1 per cent. of nurses and midwives earned less than £100 a week, 74·1 per cent. earned less than £150 a week and 10 per cent. earned less than £80·60 a week.
Everyone recognises that those who work in the Health Service, in whatever grade, have valuable and responsible jobs. Nurses and midwives are doing extremely valuable and skilled work. How many Conservative Members would be prepared to live on those wages? How many of them go round the country saying what a splendid job the nurses do, but are not prepared to pay them for the work that they must do? That is the issue facing us.
Under the Government, the way in which the poverty trap and the funding of the Health Service and local government work means that the people who have lost out most are already the worst off, and their prospects, particularly those of the nurses after this settlement, are not very good. There are 550,000 people employed as nurses, which is 484,000 whole-time equivalent jobs.
To give a couple of examples of the sort of pay levels I speak of, a nursing auxiliary will get an increase of £3·30 per week as a result of the settlement. Even under the retail price index figures·and people do not live on the retail price index but on what they can afford to buy and to eat—nursing auxiliaries should have an increase of £5 per week. A sister will get an increase of £36·42 per month. All these figures are verifiable, and in my view they are disgraceful.
Conservative Members have made great play of the way in which they believe hospital waiting lists are being reduced and, indeed, of the way in which they believe Health Service expenditure has gone up. I wish to quote from a letter written by Mr. D. J. Holdstock, MD, FRCP, of Ashford hospital, Middlesex, which appeared in The Guardian of 13 July:
Mr. Clarke claims that the NHS is treating more people. Like most statistics emanating from the Elephant and Castle, this is a myth. Many patients, particularly the mentally ill and elderly, are readmitted many times, having been discharged not because they are well enough to remain in the community, but to make room for others who are worse. Mr. Clarke's figures refer to numbers of admissions, not individuals. Community care, when it is available, is labour-intensive and therefore expensive; often it is a euphemism for care by hard-pressed and unsupported neighbours or relatives.
Many people in the country would support that statement and agree with it wholeheartedly.
The Government stand condemned for their attitude towards the Health Service and Health Service workers, whom they expect to bear the brunt of Government cuts in the Health Service and of hospital closures, of which more than 200 have occurred since the Government came into office. The Government expect these people to care for those who have been so badly treated by a Government who claim that they support the National Health Service when in reality they are reducing Health Service standards in the country. If hon. Members cared to talk to people who work in hospitals and to people who are or who expect to be patients in hospitals, they will observe a dangerously low level of morale and a deep feeling of anger towards the Government. People look forward to the day when the Government are swept out of office and those who genuinely care about the health of the people of the country are put into office.
I am glad that so many hon. Members have taken part in this important debate even though some were rather wide of the mark in their comments. I had hoped that we would have more of substance from the Under-Secretary. I had hoped that we might have had a rather more formidable attack on the form of words of the motion and a more passionate defence of the amendment.
At one point, the hon. Gentleman used some figures to match nurses' pay to inflation. It is important that we study the figures carefully. Their validity depends on what base year one uses. If one takes the base year of 1979, there has been some increase in the comparison between nurses' pay and inflation since that time. As was mentioned by the hon. Member for Brent, South (Mr. Pavitt) the fact remains that, if one considers the year following the 1975 Halsbury report and awards, nurses' pay has not yet got back to that same level.
The hon. Member for Gillingham (Mr. Couchman) assists me in his reference to a pact. I would be as critical if not more critical of members of the Labour Government who allowed nurses' pay to slip back more than the Conservatives.
The figure dropped between 1975 and 1978, it picked up a little in 1979—and we might speculate on the reasons for that—and it picked up still further in 1980, but it has dropped back since and has never returned to the 1979 level.
The Under-Secretary also challenged us on patient numbers. He said that we ought to come clean on whether we were prepared to accept that more patients were treated. Of course I accept that. There is some element of double counting of people. He referred to the number of treatments. If people are discharged early and have to go back into hospital, they count as two patients in the figures. This should be recognised.
One cannot always measure the adequacy of care by the number of patients treated. I have referred on other occasions to renal work. The local health authority in Leeds is delighted to have less dialysis done because this means that more transplants are carried out. It wishes to see a reduction in the number of patients because this means better health care. As large mental health institutions are closed, there will be fewer patients in NHS care, but more people out in the community, and again, the figures will go down. Therefore, I do not see that the number of patients being treated is an adequate measure of improvement in the Health Service. I would argue with the hon. Gentleman, as I have done on other occasions, that the Government might better claim that the health of a country has improved because fewer people are being treated than claim that this is so because more people are being treated.
The Minister then tried to drive a wedge between the two parties in the alliance. I will give him the official alliance policy position. It has to be recognised that, in the great mass parties in the Chamber, there are differences between all sorts of people. The hon. Member for Harlow (Mr. Hayes) veered a bit here and a bit there, but he expressed his opinion. He was not entirely without criticism. That will happen with all mass parties.
Ultimately, one has to come down to some agreed statement, and I will give it to the Minister. The joint programme for the last election, in 1983, stated:
the continuing commitment of all NHS staff is vital if the health service is to deliver the best care it can. This means that NHS staff must be properly and fairly treated. We gave our commitment … to determine pay in the public services by a new system based on fair comparison with other groups and a fair arbitration procedure which will also apply to NHS staff.
I think that that is straightforward. The Minister asked for it, and he has it.
After that, we went all round the block—defence, nuclear power and even jazz. I am not averse to a plug for the band—heaven knows we need it—but with no admission fees. I am also worried about the reference to the band because I have maintained my reputation as a musician by never playing in public, and I was hoping to continue in that.
What is rather alarming—it may be a new trend in the speeches of the Minister—is that, just when I thought that he was going to return to the motion and to the peroration, he sat down. I could not understand this. Not only was there no peroration, but there was no finger wagging. Where is the Minister without some finger wagging?
It was a pleasure to hear the contribution of my new hon. Friend the Member for Brecon and Radnor (Mr. Livsey). Indeed, I anticipate that the increased frequency of the alliance Opposition days will coincide with the increased frequency of being able to welcome new Members representing the Liberal party.
The hon. Member for Harlow baffled me. He started off as a straightforward pure monetarist. I thought that he was going to go straightforwad down the line. He then veered in a centre forward direction but, before he could get right into that camp, he drew back from the brink. At the end, I thought that there was a slight warning. The right hon. Member for Cambridgeshire, South-East (Mr. Pym) should beware if the hon. Member for Harlow sends him a post-dated cheque because the cheque will certainly be cancelled long before the right hon. Gentleman gets round to cashing it.
We then heard the hon. Member for Surbiton (Mr. Tracey), who, I thought, was unnecessarily snide and looked for ulterior motives. I do not believe that there is a monopoly of compassion in any political party. I have never been one who wishes to look into people's hearts and minds to find some ulterior motive. One accepts the debate on the terms in which it is framed and put forward. Thus, if things are right, they should be supported and, if they are wrong, one should oppose them rather than look for some ulterior motive. If things are as good as the hon. Gentleman set out, why has there been virtually no increase in male life expectancy in the 40 years since the inception of the National Health Service? It is not enough to say that things are wonderful, that the Government are doing a great job and that we ought to be able to support everything that they do.
The hon. Gentleman went on about privatisation. The Select Committee report published a week ago says that, although we have had pressure for privatisation for four years, that process has not yet "brought home the bacon". It is difficult for people in the Health Service to count and treble-count the same efficiency savings that the Government are demanding.
I said in an intervention that about 25 per cent. of spending does not go on staff, so the spending available from which cuts can be made is smaller than many people imagine. It has not been proved that it is wise from an economic or from a service point of view to cut staff numbers and their pay.
The logic of a pay review is that, if there is to be independent inspection of pay, the Government must fund it. The psychological effect on nurses of having to fight for pay increases at the expense of the service to which they are committed is immoral and insupportable.
I congratulate the hon. Member for Brecon and Radnor (Mr. Livsey) on his election and on his maiden speech. He spoke with admirable brevity and clarity and with patent sincerity. I am sure that we all wish him well and trust that he will represent his constituents as well as his distinguished predecessor, Mr. Tom Hooson, whom we all miss.
When the hon. Gentleman referred to his constituency and matters relevant to this debate, he slipped into one or two factual errors. He talked of a 3·5 per cent. cash increase to his health authority, which has received a 4·5 per cent. cash increase. He also heavily laboured the effect of this year's pay award on the finances of Powys health authority. It is costing that authority £22,000 more than it was planning—0·1 per cent. of its revenue allocation—and Powys is one of those authorities which is unaffected by this year's award. I trust that, away from the rhetoric of the by-election, we shall find that, as with everything else the hon. Gentleman said, he devotes himself to the problems of his health authority. I hope that he will consider the terms of the first alliance motion that he has been asked to support.
The hon. Member for Ross, Cromarthy and Skye (Mr. Kennedy) tried to construct a great deal of bad news out of the opening of a new hospital in the Highlands. He also tried to create a good deal of bad news out of this year's review body recommendations and the pay awards for nurses and midwives. That seemed to be the whole point of the argument advanced by the Liberal, Social Democratic and Labour Opposition. They cannot sweep away the underlying good news for nurses, and those who have their interests at heart, of this year's pay award. With the exception of one or two speeches, I detected no criticism of the review body system, or of the size of the award that we are giving.
The creation of the nurses and midwives review body is one of the Government's major achievements. As my hon. Friend the Under-Secretary of State said, it opens up the prospect of nurses' pay no longer being dealt with by those pre-general election one-off gestures. We now have a permanent system which will give the Government the advice of independent people about the right level of pay for nurses and which will put Governments under an obligation to honour its recommendations.
If the national interest determines it, we will not follow the body's recommendations, but normally, as this year, I am sure that the Government will implement the recommended pay awards. I do not meet many nurses who think that they would be better off going back to what preceded the review body system which the Government have set up.
I listened with care to see whether any of the Opposition parties would commit themselves to the review body. Before we announced the award, the Leader of the Opposition went to the Royal College of Nursing conference and threw out vague figures about the money that Labour might give nurses. I do not think that he expected the level of the full-year award that was about to be forthcoming and hope that what he said was not intended to imply that, under Labour, we should go back to some form of bargaining process. We ought to know whether the review body is safe under Labour.
The alliance is meant to believe in pay policy. The hon. Member for Leeds, West (Mr. Meadowcroft) described what I admit was a fairly generalised passage from the alliance's last election manifesto concerning the arbitration arrangements that might be set up for all public sector workers. If I were a nurse, I am not at all sure that I should be happy to exchange the review body system that we have given to them because of the regard in which we hold them and because they do not take strike action against their patients, unlike other key public sector workers and their clients, for some form of Liberal pay policy for all public sector workers. When, under the Lib-Lab pact, there was pay policy, nurses did especially badly compared with inflation and other workers.
After the Halsbury award, between June 1974 and April 1979, nurses' pay went up by 65 per cent., whereas the retail prices index went up by 97 per cent. That is the record of the Labour Government and the Lib-Lab pact and their pay policy. Before this year's award, we had begun to redress the balance. My hon. Friend the Under-Secretary of State explained the effect of this year's award. By March 1985—before that award—the pay bill had increased by 126 per cent. because it was already 23 per cent. ahead of prices and we had cut hours from 40 to 37·5 a week. We had also employed 57,000 more whole-time equivalents in England. This year's award gives an average of 9 per cent. in a full year across the profession, up to 14 per cent. for sisters and up to 11 per cent. for staff nurses. That is an extremely good settlement.
The Opposition have to challenge what I believe is undilutedly good news for the Health Service by means of this motion on how the award will be funded. It is being funded as we always said it would be and in a way which health authorities can perfectly well contend with while delivering the patient services that we require. We have said from the word go that the cash limits for the Health Service this year would be increased by 5·5 per cent. We had to say what the Government could afford for the whole NHS, and not divide it artificially.
My hon. Friend the Member for Wells (Mr. Heathcoat-Amory) described the process clearly. I parody what he said, but we do not collect from the Treasury—nor would any Government—one pile of pound notes labelled "services" and another pile labelled "pay." There is a cash limit, which Governments have always determined. We told the review body of that limit. I do not care what anybody said in the Select Committee. I was at the negotiations with the Treasury when we agreed that the cash limit covered everything. There was no 3 per cent. norm for anybody. Therefore, when the review body made its recommendations, it knew what it was working within.
The chairman of the review body made it clear in public statements that he left the timing and implementation of an award which he knew amounted to 9 per cent. in a full year to the Government. We had to make a judgment, and we made a judgment precisely to avoid the dangers of which the motion accuses us.
We knew that health authority limits in England were going up by £500 million and that health authorities had identified for us £150 million which could be provided through cost improvements—not efficiency savings as some people have called them, and certainly not cuts. Those cost improvements did not affect patient care. We therefore decided that we could pay nurses in two instalments, so the total cost fell as £240 million in one year.
Hon. Members have tried to find anecdotal evidence to the contrary. The hon. Member for Ross, Cromarty and Skye ought to go back to his stray delegate at Cardiff from Teesside and ask how on earth a 2 per cent. cut is being forced on that authority as a result of the figures that I have given. Hon. Members, including the hon. Member for Oldham, West (Mr. Meacher) and even my hon. Friend the Member for Harlow (Mr. Hayes), threw in examples of health authorities with all kinds of difficulties, but none of those difficulties was attributable to nurses' pay.
The fact is that at the new Arrowe Hall hospital in Birkenhead, at the new Oldham hospital being built at Oldham and in my health authority and others, services and increased pay are going hand in hand because we are giving more money. The alliance even tried to outdo us in money. The hon. Member for Ross, Cromarty and Skye said that the alliance would increase expenditure by 1·5 per cent. each year in economic cost terms. If we had followed that modest target, health authorities would have £500 million less to spend than they have. He is promising——
|Division No. 271]||[7 pm|
|Ashton, Joe||Craigen, J. M.|
|Atkinson, N. (Tottenham)||Crowther, Stan|
|Bagier, Gordon A. T.||Cunliffe, Lawrence|
|Banks, Tony (Newham NW)||Dalyell, Tam|
|Beith, A. J.||Davies, Ronald (Caerphilly)|
|Benn, Tony||Davis, Terry (B'ham, H'ge H'l)|
|Bermingham, Gerald||Deakins, Eric|
|Bidwell, Sydney||Dewar, Donald|
|Blair, Anthony||Dixon, Donald|
|Boothroyd, Miss Betty||Dobson, Frank|
|Boyes, Roland||Dormand, Jack|
|Brown, Hugh D. (Provan)||Dubs, Alfred|
|Brown, Ron (E'burgh, Leith)||Duffy, A. E. P.|
|Bruce, Malcolm||Dunwoody, Hon Mrs G.|
|Buchan, Norman||Eadie, Alex|
|Caborn, Richard||Eastham, Ken|
|Callaghan, Jim (Heyw'd & M)||Edwards, Bob (W'h'mpt'n SE)|
|Campbell-Savours, Dale||Evans, John (St. Helens N)|
|Carlile, Alexander (Montg'y)||Ewing, Harry|
|Carter-Jones, Lewis||Fatchett, Derek|
|Clark, Dr David (S Shields)||Field, Frank (Birkenhead)|
|Clarke, Thomas||Fields, T. (L'pool Broad Gn)|
|Clay, Robert||Fisher, Mark|
|Clwyd, Mrs Ann||Flannery, Martin|
|Cocks, Rt Hon M. (Bristol S.)||Foot, Rt Hon Michael|
|Cook, Robin F. (Livingston)||Foster, Derek|
|Corbett, Robin||Freeson, Rt Hon Reginald|
|Corbyn, Jeremy||Garrett, W. E.|
|Cowans, Harry||George, Bruce|
|Gilbert, Rt Hon Dr John||Mitchell, Austin (G't Grimsby)|
|Godman, Dr Norman||Nellist, David|
|Golding, John||Oakes, Rt Hon Gordon|
|Gould, Bryan||O'Neill, Martin|
|Gourlay, Harry||Orme, Rt Hon Stanley|
|Hamilton, James (M'well N)||Owen, Rt Hon Dr David|
|Hamilton, W. W. (Central Fife)||Park, George|
|Hancock, Mr. Michael||Parry, Robert|
|Hardy, Peter||Patchett, Terry|
|Harrison, Rt Hon Walter||Pavitt, Laurie|
|Hart, Rt Hon Dame Judith||Pendry, Tom|
|Haynes, Frank||Penhaligon, David|
|Heffer, Eric S.||Pike, Peter|
|Hogg, N. (C'nauld & Kilsyth)||Powell, Raymond (Ogmore)|
|Holland, Stuart (Vauxhall)||Prescott, John|
|Home Robertson, John||Radice, Giles|
|Howells, Geraint||Randall, Stuart|
|Hoyle, Douglas||Rees, Rt Hon M. (Leeds S)|
|Hughes, Robert (Aberdeen N)||Richardson, Ms Jo|
|Hughes, Roy (Newport East)||Roberts, Ernest (Hackney N)|
|Hughes, Sean (Knowsley S)||Robertson, George|
|Hughes, Simon (Southwark)||Rogers, Allan|
|Jenkin, Rt Hon Patrick||Rooker, J. W.|
|John, Brynmor||Ross, Stephen (Isle of Wight)|
|Jones, Barry (Alyn & Deeside)||Rowlands, Ted|
|Kirkwood, Archy||Sheldon, Rt Hon R.|
|Lambie, David||Shore, Rt Hon Peter|
|Lamond, James||Short, Ms Clare (Ladywood)|
|Leighton, Ronald||Short, Mrs R.(Whampt'n NE)|
|Lewis, Ron (Carlisle)||Skinner, Dennis|
|Lewis, Terence (Worsley)||Snape, Peter|
|Litherland, Robert||Soley, Clive|
|Livsey, Richard||Steel, Rt Hon David|
|McCartney, Hugh||Stewart, Rt Hon D. (W Isles)|
|McDonald, Dr Oonagh||Stott, Roger|
|McKay, Allen (Penistone)||Thomas, Dafydd (Merioneth)|
|McKelvey, William||Thomas, Dr R. (Carmarthen)|
|MacKenzie, Rt Hon Gregor||Thompson, J. (Wansbeck)|
|Maclennan, Robert||Thorne, Stan (Preston)|
|McNamara, Kevin||Tinn, James|
|McTaggart, Robert||Wainwright, R.|
|McWilliam, John||Warden, Gareth (Gower)|
|Madden, Max||Wareing, Robert|
|Mason, Rt Hon Roy||Wilson, Gordon|
|Maxton, John||Woodall, Alec|
|Maynard, Miss Joan||Wrigglesworth, Ian|
|Michie, William||Tellers for the Ayes:|
|Millan, Rt Hon Bruce||Mr. Michael Meadowcroft and Mr. Charles Kennedy.|
|Miller, Dr M. S. (E Kilbride)|
|Adley, Robert||Browne, John|
|Amess, David||Bruinvels, Peter|
|Ancram, Michael||Buchanan-Smith, Rt Hon A.|
|Arnold, Tom||Buck, Sir Antony|
|Aspinwall, Jack||Budgen, Nick|
|Atkins, Rt Hon Sir H.||Burt, Alistair|
|Baker, Rt Hon K. (Mole Vall'y)||Butcher, John|
|Baker, Nicholas (N Dorset)||Butterfill, John|
|Baldry, Tony||Carlisle, John (N Luton)|
|Beaumont-Dark, Anthony||Carlisle, Rt Hon M. (W'ton S)|
|Bendall, Vivian||Carttiss, Michael|
|Bennett, Rt Hon Sir Frederic||Cash, William|
|Bevan, David Gilroy||Chalker, Mrs Lynda|
|Biffen, Rt Hon John||Channon, Rt Hon Paul|
|Biggs-Davison, Sir John||Chapman, Sydney|
|Blackburn, John||Chope, Christopher|
|Blaker, Rt Hon Sir Peter||Clark, Hon A. (Plym'th S'n)|
|Bonsor, Sir Nicholas||Clarke, Rt Hon K. (Rushcliffe)|
|Boscawen, Hon Robert||Clegg, Sir Walter|
|Bottomley, Peter||Cockeram, Eric|
|Bottomley, Mrs Virginia||Colvin, Michael|
|Bowden, A. (Brighton K'to'n)||Coombs, Simon|
|Bowden, Gerald (Dulwich)||Cope, John|
|Braine, Rt Hon Sir Bernard||Corrie, John|
|Bright, Graham||Couchman, James|
|Brinton, Tim||Cranborne, Viscount|
|Brooke, Hon Peter||Critchley, Julian|
|Brown, M. (Brigg & Cl'thpes)||Crouch, David|
|Currie, Mrs Edwina||Neale, Gerrard|
|Dorrell, Stephen||Needham, Richard|
|Douglas-Hamilton, Lord J.||Nelson, Anthony|
|Dover, Den||Neubert, Michael|
|Dunn, Robert||Newton, Tony|
|Durant, Tony||Nicholls, Patrick|
|Dykes, Hugh||Normanton, Tom|
|Eggar, Tim||Onslow, Cranley|
|Emery, Sir Peter||Osborn, Sir John|
|Evennett, David||Ottaway, Richard|
|Eyre, Sir Reginald||Page, Sir John (Harrow W)|
|Fairbairn, Nicholas||Page, Richard (Herts SW)|
|Fallon, Michael||Parkinson, Rt Hon Cecil|
|Favell, Anthony||Patten, Christopher (Bath)|
|Fenner, Mrs Peggy||Patten, J. (Oxf W & Abdgn)|
|Fletcher, Alexander||Peacock, Mrs Elizabeth|
|Fookes, Miss Janet||Pollock, Alexander|
|Forman, Nigel||Porter, Barry|
|Forth, Eric||Portillo, Michael|
|Fowler, Rt Hon Norman||Powell, William (Corby)|
|Fox, Marcus||Powley, John|
|Garel-Jones, Tristan||Price, Sir David|
|Glyn, Dr Alan||Prior, Rt Hon James|
|Gower, Sir Raymond||Proctor, K. Harvey|
|Griffiths, Sir Eldon||Raffan, Keith|
|Gummer, John Selwyn||Renton, Tim|
|Hamilton, Hon A. (Epsom)||Rhodes James, Robert|
|Hargreaves, Kenneth||Rhys Williams, Sir Brandon|
|Hayes, J.||Ridley, Rt Hon Nicholas|
|Hayhoe, Rt Hon Barney||Ridsdale, Sir Julian|
|Hayward, Robert||Rippon, Rt Hon Geoffrey|
|Heathcoat-Amory, David||Robinson, Mark (N'port W)|
|Henderson, Barry||Roe, Mrs Marion|
|Hickmet, Richard||Rowe, Andrew|
|Hicks, Robert||Ryder, Richard|
|Hill, James||Sackville, Hon Thomas|
|Hind, Kenneth||Sainsbury, Hon Timothy|
|Holland, Sir Philip (Gedling)||Sayeed, Jonathan|
|Holt, Richard||Shaw, Sir Michael (Scarb')|
|Hordern, Sir Peter||Shelton, William (Streatham)|
|Howard, Michael||Shepherd, Colin (Hereford)|
|Howell, Rt Hon D. (G'ldford)||Shersby, Michael|
|Hunt, David (Wirral)||Silvester, Fred|
|Jenkin, Rt Hon Patrick||Sims, Roger|
|Jessel, Toby||Skeet, T. H. H.|
|Key, Robert||Smith, Sir Dudley (Warwick)|
|Knight, Dame Jill (Edgbaston)||Smith, Tim (Beaconsfield)|
|Knowles, Michael||Soames, Hon Nicholas|
|Knox, David||Speed, Keith|
|Lawler, Geoffrey||Speller, Tony|
|Lennox-Boyd, Hon Mark||Spencer, Derek|
|Lewis, Sir Kenneth (Stamf'd)||Spicer, Jim (W Dorset)|
|Lightbown, David||Squire, Robin|
|Lilley, Peter||Stanbrook, Ivor|
|Lord, Michael||Stanley, John|
|McCurley, Mrs Anna||Steen, Anthony|
|Macfarlane, Neil||Stern, Michael|
|MacKay, Andrew (Berkshire)||Stevens, Lewis (Nuneaton)|
|MacKay, John (Argyll & Bute)||Stewart, Allan (Eastwood)|
|Maclean, David John||Stewart, Andrew (Sherwood)|
|McQuarrie, Albert||Stradling Thomas, J.|
|Madel, David||Sumberg, David|
|Major, John||Taylor, Teddy (S'end E)|
|Malins, Humfrey||Tebbit, Rt Hon Norman|
|Marlow, Antony||Temple-Morris, Peter|
|Marshall, Michael (Arundel)||Terlezki, Stefan|
|Mates, Michael||Thompson, Donald (Calder V)|
|Mather, Carol||Thorne, Neil (Ilford S)|
|Maude, Hon Francis||Thornton, Malcolm|
|Mawhinney, Dr Brian||Thurnham, Peter|
|Maxwell-Hyslop, Robin||Townend, John (Bridlington)|
|Mills, Iain (Meriden)||Townsend, Cyril D. (B'heath)|
|Mills, Sir Peter (West Devon)||Tracey, Richard|
|Moate, Roger||Twinn, Dr Ian|
|Montgomery, Sir Fergus||van Straubenzee, Sir W.|
|Moore, John||Viggers, Peter|
|Morris, M. (N'hampton, S)||Waddington, David|
|Morrison, Hon C. (Devizes)||Waldegrave, Hon William|
|Morrison, Hon P. (Chester)||Walden, George|
|Murphy, Christopher||Wall, Sir Patrick|
|Waller, Gary||Wolfson, Mark|
|Ward, John||Wood, Timothy|
|Wardle, C. (Bexhill)||Woodcock, Michael|
|Warren, Kenneth||Yeo, Tim|
|Wells, Bowen (Hertford)||Young, Sir George (Acton)|
|Wells, Sir John (Maidstone)||Younger, Rt Hon George|
|Whitney, Raymond||Tellers for the Noes:|
|Wilkinson, John||Mr. Ian Lang and Peter Lloyd.|
|Winterton, Mrs Ann|
|Division No. 272]||[7.12 pm|
|Adley, Robert||Dunn, Robert|
|Amess, David||Durant, Tony|
|Ancram, Michael||Dykes, Hugh|
|Arnold, Tom||Eggar, Tim|
|Aspinwall, Jack||Emery, Sir Peter|
|Baker, Rt Hon K. (Mole Vall'y)||Evennett, David|
|Baker, Nicholas (N Dorset)||Eyre, Sir Reginald|
|Baldry, Tony||Fairbairn, Nicholas|
|Beaumont-Dark, Anthony||Fallon, Michael|
|Bendall, Vivian||Favell, Anthony|
|Bennett, Rt Hon Sir Frederic||Fenner, Mrs Peggy|
|Bevan, David Gilroy||Fletcher, Alexander|
|Biffen, Rt Hon John||Fookes, Miss Janet|
|Biggs-Davison, Sir John||Forman, Nigel|
|Blackburn, John||Forth, Eric|
|Bonsor, Sir Nicholas||Fowler, Rt Hon Norman|
|Boscawen, Hon Robert||Fox, Marcus|
|Bottomley, Peter||Garel-Jones, Tristan|
|Bottomley, Mrs Virginia||Glyn, Dr Alan|
|Bowden, A. (Brighton K'to'n)||Gower, Sir Raymond|
|Bowden, Gerald (Dulwich)||Gregory, Conal|
|Bright, Graham||Griffiths, Sir Eldon|
|Brinton, Tim||Hamilton, Hon A. (Epsom)|
|Brooke, Hon Peter||Hargreaves, Kenneth|
|Brown, M. (Brigg & Cl'thpes)||Hayhoe, Rt Hon Barney|
|Browne, John||Hayward, Robert|
|Bruinvels, Peter||Heathcoat-Amory, David|
|Bryan, Sir Paul||Henderson, Barry|
|Buchanan-Smith, Rt Hon A.||Hickmet, Richard|
|Buck, Sir Antony||Hicks, Robert|
|Budgen, Nick||Hill, James|
|Burt, Alistair||Hind, Kenneth|
|Butcher, John||Holland, Sir Philip (Gedling)|
|Butterfill, John||Holt, Richard|
|Carlisle, John (N Luton)||Hordern, Sir Peter Howell|
|Carlisle, Rt Hon M. (W'ton S)||Howell, Rt Hon D. (G'ldford)|
|Carttiss, Michael||Hunt, David (Wirral)|
|Cash, William||Jenkin, Rt Hon Patrick|
|Chalker, Mrs Lynda||Key, Robert|
|Channon, Rt Hon Paul||Knight, Dame Jill (Edgbaston)|
|Chapman, Sydney||Knowles, Michael|
|Chope, Christopher||Knox, David|
|Clark, Hon A. (Plym'th S'n)||Lang, Ian|
|Clarke, Rt Hon K. (Rushcliffe)||Lawler, Geoffrey|
|Clegg, Sir Walter||Lennox-Boyd, Hon Mark|
|Cockeram, Eric||Lewis, Sir Kenneth (Stamf'd)|
|Colvin, Michael||Lightbown, David|
|Coombs, Simon||Lilley, Peter|
|Cope, John||Lord, Michael|
|Corrie, John||McCurley, Mrs Anna|
|Couchman, James||Macfarlane, Neil|
|Cranborne, Viscount||MacKay, Andrew (Berkshire)|
|Critchley, Julian||MacKay, John (Argyll & Bute)|
|Crouch, David||Maclean, David John|
|Currie, Mrs Edwina||McQuarrie, Albert|
|Dorrell, Stephen||Madel, David|
|Douglas-Hamilton, Lord J.||Major, John|
|Dover, Den||Malins, Humfrey|
|Marlow, Antony||Sims, Roger|
|Marshall, Michael (Arundel)||Smith, Sir Dudley (Warwick)|
|Mates, Michael||Smith, Tim (Beaconsfield)|
|Mather, Carol||Soames, Hon Nicholas|
|Maude, Hon Francis||Speed, Keith|
|Mawhinney, Dr Brian||Speller, Tony|
|Maxwell-Hyslop, Robin||Spencer, Derek|
|Mills, Iain (Meriden)||Spicer, Jim (W Dorset)|
|Mills, Sir Peter (West Devon)||Squire, Robin|
|Moate, Roger||Stanbrook, Ivor|
|Montgomery, Sir Fergus||Stanley, John|
|Moore, John||Steen, Anthony|
|Morris, M. (N'hampton, S)||Stern, Michael|
|Morrison, Hon C. (Devizes)||Stevens, Lewis (Nuneaton)|
|Morrison, Hon P. (Chester)||Stewart, Allan (Eastwood)|
|Murphy, Christopher||Stewart, Andrew (Sherwood)|
|Neale, Gerrard||Stradling Thomas, J.|
|Needham, Richard||Sumberg, David|
|Nelson, Anthony||Taylor, Teddy (S'end E)|
|Newton, Tony||Temple-Morris, Peter|
|Nicholls, Patrick||Terlezki, Stefan|
|Normanton, Tom||Thompson, Donald (Calder V)|
|Onslow, Cranley||Thorne, Neil (Ilford S)|
|Ottaway, Richard||Thornton, Malcolm|
|Page, Sir John (Harrow W)||Thurnham, Peter|
|Page, Richard (Herts SW)||Townend, John (Bridlington)|
|Parkinson, Rt Hon Cecil||Townsend, Cyril D. (B'heath)|
|Patten, Christopher (Bath)||Tracey, Richard|
|Patten, J. (Oxf W & Abdgn)||Twinn, Dr Ian|
|Peacock, Mrs Elizabeth||Viggers, Peter|
|Pollock, Alexander||Waddington, David|
|Porter, Barry||Waldegrave, Hon William|
|Portillo, Michael||Walden, George|
|Powell, William (Corby)||Wall, Sir Patrick|
|Powley, John||Waller, Gary|
|Price, Sir David||Ward, John|
|Prior, Rt Hon James||Wardle, C. (Bexhill)|
|Proctor, K. Harvey||Warren, Kenneth|
|Raffan, Keith||Wells, Bowen (Hertford)|
|Renton, Tim||Wells, Sir John (Maidstone)|
|Rhodes James, Robert||Wheeler, John|
|Rhys Williams, Sir Brandon||Whitney, Raymond|
|Ridley, Rt Hon Nicholas||Wilkinson, John|
|Ridsdale, Sir Julian||Winterton, Mrs Ann|
|Robinson, Mark (N'port W)||Winterton, Nicholas|
|Roe, Mrs Marion||Wolfson, Mark|
|Rowe, Andrew||Wood, Timothy|
|Ryder, Richard||Woodcock, Michael|
|Sackville, Hon Thomas||Yeo, Tim|
|Sainsbury, Hon Timothy||Young, Sir George (Acton)|
|Sayeed, Jonathan||Younger, Rt Hon George|
|Shaw, Sir Michael (Scarb')|
|Shelton, William (Streatham)||Tellers for the Ayes:|
|Shepherd, Colin (Hereford)||Mr. Michael Neubert and Mr. Peter Lloyd.|
|Atkinson, N. (Tottenham)||Carlile, Alexander (Montg'y)|
|Bagier, Gordon A. T.||Carter-Jones, Lewis|
|Banks, Tony (Newham NW)||Clark, Dr David (S Shields)|
|Beith, A. J.||Clarke, Thomas|
|Benn, Tony||Clay, Robert|
|Bermingham, Gerald||Clwyd, Mrs Ann|
|Bidwell, Sydney||Cocks, Rt Hon M. (Bristol S.)|
|Blair, Anthony||Cook, Robin F. (Livingston)|
|Boothroyd, Miss Betty||Corbett, Robin|
|Boyes, Roland||Corbyn, Jeremy|
|Bray, Dr Jeremy||Cowans, Harry|
|Brown, Gordon (D'f'mline E)||Craigen, J. M.|
|Brown, Hugh D. (Provan)||Crowther, Stan|
|Brown, Ron (E'burgh, Leith)||Cunliffe, Lawrence|
|Bruce, Malcolm||Dalyell, Tam|
|Buchan, Norman||Davies, Ronald (Caerphilly)|
|Caborn, Richard||Davis, Terry (B'ham, H'ge H'l)|
|Callaghan, Jim (Heyw'd & M)||Deakins, Eric|
|Campbell-Savours, Dale||Dewar, Donald|
|Dixon, Donald||McWilliam, John|
|Dobson, Frank||Madden, Max|
|Dormand, Jack||Mason, Rt Hon Roy|
|Dubs, Alfred||Maxton, John|
|Duffy, A. E. P.||Maynard, Miss Joan|
|Dunwoody, Hon Mrs G.||Meacher, Michael|
|Eadie, Alex||Michie, William|
|Eastham, Ken||Millan, Rt Hon Bruce|
|Edwards, Bob (W'h'mpt'n SE)||Miller, Dr M. S. (E Kilbride)|
|Evans, John (St. Helens N)||Mitchell, Austin (G't Grimsby)|
|Ewing, Harry||Nellist, David|
|Fatchett, Derek||Oakes, Rt Hon Gordon|
|Field, Frank (Birkenhead)||O'Neill, Martin|
|Fields, T. (L'pool Broad Gn)||Orme, Rt Hon Stanley|
|Fisher, Mark||Parry, Robert|
|Flannery, Martin||Patchett, Terry|
|Foster, Derek||Pavitt, Laurie|
|Freeson, Rt Hon Reginald||Pendry, Tom|
|Garrett, W. E.||Penhaligon, David|
|George, Bruce||Pike, Peter|
|Gilbert, Rt Hon Dr John||Powell, Raymond (Ogmore)|
|Godman, Dr Norman||Prescott, John|
|Golding, John||Radice, Giles|
|Gould, Bryan||Randall, Stuart|
|Gourlay, Harry||Redmond, M.|
|Hamilton, James (M'well N)||Rees, Rt Hon M. (Leeds S)|
|Hamilton, W. W. (Central Fife)||Richardson, Ms Jo|
|Hancock, Mr. Michael||Roberts, Ernest (Hackney N)|
|Hardy, Peter||Robertson, George|
|Harrison, Rt Hon Walter||Rogers, Allan|
|Haynes, Frank||Rooker, J. W.|
|Heffer, Eric S.||Ross, Stephen (Isle of Wight)|
|Hogg, N. (C'nauld & Kilsyth)||Rowlands, Ted|
|Holland, Stuart (Vauxhall)||Sheldon, Rt Hon R.|
|Home Robertson, John||Short, Ms Clare (Ladywood)|
|Howells, Geraint||Short, Mrs H.(W'hampt'n NE)|
|Hoyle, Douglas||Skinner, Dennis|
|Hughes, Robert (Aberdeen N)||Snape, Peter|
|Hughes, Sean (Knowsley S)||Soley, Clive|
|Hughes, Simon (Southwark)||Steel, Rt Hon David|
|Jenkins, Rt Hon Roy (Hillh'd)||Stewart, Rt Hon D. (W Isles)|
|John, Brynmor||Stott, Roger|
|Jones, Barry (Alyn & Deeside)||Thomas, Dafydd (Merioneth)|
|Kennedy, Charles||Thomas, Dr R. (Carmarthen)|
|Lambie, David||Thompson, J. (Wansbeck)|
|Lamond, James||Thorne, Stan (Preston)|
|Leighton, Ronald||Tinn, James|
|Lewis, Ron (Carlisle)||Wainwright, R.|
|Lewis, Terence (Worsley)||Wardell, Gareth (Gower)|
|Livsey, Richard||Wareing, Robert|
|McDonald, Dr Oonagh||Wilson, Gordon|
|McKay, Allen (Penistone)||Woodall, Alec|
|McKelvey, William||Wrigglesworth, Ian|
|MacKenzie, Rt Hon Gregor|
|Maclennan, Robert||Tellers for the Noes:|
|McNamara, Kevin||Mr. Michael Meadowcroft and Mr. Archy Kirkwood.|
That this House congratulates the Government on implementing the recommendations of the Health Service Pay Review Bodies and awarding a fair pay increase to all the staff concerned, with particularly high awards for staff nurses and ward sisters; notes that nurses' pay has risen by 23 per cent. in real terms between April 1979 and March 1985 and will rise significantly this year as a result of the Review Body award; welcomes the 5·5 per cent. increase in health authority and health board funding which, together with the extra resources gained from cost improvement programmes, will enable service developments to take place in addition to the funding of the pay award; and notes with approval the continuing increases in the number of patients treated by the Health Service.