I understand that some appeals against individual gradings have been registered in most, if not all districts. That is hardly surprising in the regrading of some half a million nursing and midwifery staff.
That reply does not reflect the grave dissatisfaction and sense of injustice that nurses throughout the country feel over their grading in the recent pay award. Does the Secretary of State accept that if dedicated people, such as midwives and nurses working in intensive care units, take such action, that is a real expression of their sense of injustice? Does he accept that, if the matter is to be resolved, nurses must be heard and must not be subject to the abuse and attacks that he and other Ministers in his Department have heaped on them in recent weeks? When will the Secretary of State listen to what the nurses are saying and act on that?
It must come as a considerable disappointment to the hon. Gentleman that comparatively few nurses have taken industrial action anywhere, and that action is undoubtedly on the wane. That is not surprising when one considers that the pay increase for the profession as a whole is 17·9 per cent. and in London, the hon. Gentleman's own part of the world, there have been supplements of 5 per cent. to 9 per cent. on top of that. The nursing profession has received its biggest pay award in the history of the National Health Service.
Does my right hon. and learned Friend agree that one of the lessons of the regrading exercise is that matters could be much better managed if the districts had all the necessary powers to recruit, retain and motivate staff and were not second-guessed by the regions?
We have a system of national pay bargaining, from which the regrading exercise emanated in the first place. The exercise started with a national agreement between six trade unions—including the two now organising strikes—and management. I am very much in favour of having much more discretion at district level. However, in a large organisation such as the Health Service, there has to be a national structure in which sensible local discretion can be set. I shall be very glad if we make progress in that direction this year, but we shall have to wait for the response of the review body to our modest suggestions.
Does the Secretary of State acknowledge that we are not only talking about the problem of applying the decisions at national level, and that at district level, too, there seem to be anomalies in the grading structure? Does he realise that, although there may not be much industrial action, there is deep unrest throughout the nursing services, which is spreading in particular to health visitors and school nurses?
I do not accept that there are anomalies. I accept that difficulties arise when people who have all previously been paid the same rate find themselves paid at three different rates according to the grade of the post that they originally held. For midwifery sisters, that can mean the difference between an increase of £500 and an increase of £4,500 a year, and people naturally feel strongly about the grading of their posts. The regrading exercise has been conducted in line with a UK—wide agreement and we have a perfectly satisfactory appeals process to ensure that individual cases are sorted out and that nurses and midwives are put where they belong in the new structure.
Is my right hon. and learned Friend aware that during my hospitalisation last month at the eye, ear and throat hospital in Shrewsbury, a number of members of staff commented about the grading system—one of them starting to do so as early as ten past six in the morning? Although they had genuine grievances, which, after a few days, I could understand in some detail, they continued to give the benefit of their expertise and compassion to the patients, and that is the significant factor. They were not led astray by union agitators or persuaded to demonstrate. My right hon. and learned Friend is absolutely right not to be drawn down the path proposed by COHSE and NUPE, which would be a betrayal of the nurses, sisters and midwives who have stuck by their patients rather than deserted to the picket lines.
I agree with my hon. Friend. For the reasons that I have just given, many nurses were inevitably disappointed by the outcome of this year's grading review, although they have all received substantial pay increases. Even so, most of the nurses who were disappointed would treat with contempt attempts to persuade them to take strike action against their patients to get themselves put on to a higher grade. That is why the action taken by COHSE and NUPE has been so unsuccessful throughout the country.
Is not the Secretary of State worried by the fact that, by 28 December, 40 of the 50 midwives at north Middlesex hospital will have resigned? Does he really believe that he can provide a maternity service with those who remain? Does he not realise that the departure of those midwives and of many disillusioned nurses and midwives could be averted if he accepted the unions' offer to go to binding arbitration? If he is so confident of his case, why is he so afraid of arbitration?
I am pleased to hear that talks with the midwives at north Middlesex hospital have resumed. They are plainly dedicated people, and I hope that they will reconsider their present declared intention and continue to work at the hospital. Meanwhile, they are arguing that they should all be put on the higher grade, which would mean an increase of almost £2,000 a year over arid above the £2,000 a year increase that they have already received. That would simply not be consistent with the agreement reached with all the unions, including the Royal College of Midwives earlier this year. We followed the review body's recommendations and I see no reason at this stage to go to arbitration. The regrading deal was carried out in line with the agreement that we had with the unions and has been accepted by the review body. It has been finished and implemented. We should be looking to next year rather than trying to arbitrate on a settled matter.