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Mr. Amess : The House will know that I was referring specifically to the part of the Gracious Speech that states :

"Other measures will be laid before you."

I was perhaps anticipating that, if my speech was persuasive, further measures might be announced.

The reference in the Gracious Speech to the National Health Service is another reason for me to be pleased that my hon. Friend the Under-Secretary of State for Health is on the Front Bench. She will know what an excellent job Basildon hospital is doing, and what superb health care it is providing throughout the district. The Health and Medicines Bill--I had the privilege of serving on the Standing Committee--has been taken up willingly by Basildon and Thurrock district health authority, and my hon. Friend will be glad to know that the authority has already won a number of contracts to provide occupational health care for Essex police, GEC Avionics and any number of others.

Car parking is being charged for, which so far has brought in revenue of

Mr. Speaker : Order. I think that local issues are a little wide of the Queen's Speech.

Mr. Amess : I welcome the Government's commitment to continued improvement in health care provision, on which they embarked last year.

I am delighted that the Government are to introduce legislation to stop local authorities being extravagant and getting people into debt. There is no worse example of debt

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burden than can be seen in Basildon. Year after year, the council has spent money that it does not have. It is the only local authority to have built a brand new theatre costing £11 million. Of course, we have not the money to pay for it, and through creative accounting, the authority has presented the books in such a way that Basildon's ratepayers will be in debt for a considerable time.

I am also very concerned about the handover of Commission for the New Towns property, as the Local Government Bill will enable local authorities to compete on an equal financial footing with housing associations. The House will understand why my constituents and I were outraged to learn from a press release that the local authority clearly will not co-operate with the legislation :

"Basildon Council will not co-operate with housing associations, trusts or private landlords trying to take over Commission for New Towns homes. That was the message from last week's full Council as members voted to reaffirm the district authority's opposition to any transfer of Basildon's 15,000 CNT properties against the wishes of tenants."

Basildon is supposed to be a hung council, but it is not a hung council at all. It is an amalgamation of Socialists who are not prepared to come out--

Mr. McCartney : On a point of order. Mr. Speaker. I do not intend to cause any further problems, but the matters raised by the hon. Gentleman were dealt with over the past 12 months in the debates on the Housing Bill, soon to become an Act. Everything that the hon. Gentleman has said in the last five minutes is covered by that legislation, so what he is saying is not relevant to this debate.

Mr. Speaker : I heard the hon. Member for Basildon (Mr. Amess) say that he was drawing attention to those elements of the Queen's Speech concerned with local government.

Mr. Amess : My constituents know that we must legislate this year to enable them to compete on an equal financial footing.

The local authority has wasted further money in staging a firework display. Only about 20 local residents turned up to discuss the authority's proposals, but coachloads of outsiders were brought in to see the taxpayers' money go up in smoke.

In conclusion, the American public has recently "won one for the Gipper". We are proud in this country that we have the greatest Prime Minister since the war and the greatest world statesman. We can be proud of the proposals in the Queen's Speech.

It being Ten o'clock, the debate stood adjourned.

Debate to be resumed tomorrow.

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Physiological Measurement Technicians

Motion made, and Question proposed, That this House do now adjourn.-- [Mr. Maclean.]

10 pm

Mr. Michael Shersby (Uxbridge) : The matter that I wish to raise this evening is important to many people who work in the National Health Service--the pay and conditions of physiological measurement technicians. There are several kinds of these technicians--for example, those who work in audiology, those who work in neurology and those who work in cardiology. Although what I have to say tonight applies to all those specialties, I shall concentrate on those who are engaged in cardiology. Therefore, I shall refer to them as cardiac technicians for the sake of clarity.

For the most part, cardiac technicians are part of the resuscitation teams in many hospitals. They play a crucial role in establishing a good quality ECG rhythm and constantly update doctors on many ECG changes. There have been many advances in technology in recent years that have greatly enhanced cardiology investigations. Consequently, the technicians must be trained and skilled professionals.

In addition to registering my concern about their pay and conditions, I should like to ask my hon. Friend the Under-Secretary of State for Health, the hon. Member for Derbyshire, South (Mrs. Currie), to explain the Government's policy on recruitment and retention. I refer, first, to the pay and conditions of cardiac technicians. Their pay is determined by the appropriate Whitley council. For largely historical reasons, the technicians do not have their pay considered by an independent review body, as do, for example, radiographers. Therefore, cardiac technicians are locked into a situation where their annual pay increase is determined by the Whitley council and they have little, if any, prospect of material improvement. I hope to demonstrate that that is an unjust state of affairs and that it should be remedied. Cardiac technicians should be transferred to the professions allied to medicine so that their pay and conditions can in future be considered by an independent review body.

Apart from the historical reasons, it has been argued that cardiac technicians are different from, for example, radiographers and nurses, because they do not have the so-called "hands-on" responsibility for dealing with patients. As a result, cardiac technicians earn between £5,977 and £7,650 after two years' training. A senior cardiac technician earns between £7,383 and £9,250 after five years' experience. A chief technician earns between £9,479 and £11,824 after seven years. A comparatively small number of senior chief cardiac technicians earn between £11,425 and £13,345.

Those modest rates of pay compare poorly with people such as radiographers, physiotherapists and dieticians, whose pay and conditions are determined by the pay review body. A radiographer, for example, with three years' experience, earns between £8,000 and £9, 150 compared with a cardiac technician earning between £5,977 and £7, 650. A senior radiographer with five years' experience earns between £9,500 and £11,390, compared with only £7,383 to £9,250 for a cardiac technician. Moreover, a radiographer, physiotherapist or dietician

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can rise to a salary of between £15,605 and £17,225 for a super grade I, whereas that level is not open to cardiac technicians. Then there are nurses, who, following the recent upgrading exercise, had a considerable pay increase. I shall only compare nurses with five years' experience--that is to say, a nurse who would be an SRN staff nurse on grade E, who would earn between £9,200 and £10,650, compared with a senior cardiac technician earning only between £7,383 and £9,250.

I particularly wish to direct my hon. Friend's attention to the comparison between cardiac technicians and radiographers. I stress that cardiac technicians have as much hands-on experience as radiographers. A cardiac technician working in, say, the intensive care unit of a large hospital, such as Harefield hospital in my constituency, has the responsible job of setting up cardiac pacing equipment for patients and operating the balloon pump. Technicians are directly involved in permanent pacemaker implants. They are engaged in invasive theatre work. For example, they provide ECGs, and they undertake pressure monitoring and pace-maker backup. Although radiographers get points that are considered by their review body when determining their pay awards and conditions, cardiac technicians do not, nor are they subject to the pay review procedure. A cardiac technician works with patients and wears a lead apron. However, a radiographer sits behind a screen, where he or she is protected from radiography. In operating theatres, technicians are directly involved with the post-heart transplant patients having cardiac catheterisation and angiography. Once again, technicians are inside the theatre and wear lead aprons, whereas radiographers work outside behind a protective screen. Cardiac technicians are responsible for operating such sophisticated equipment as the scanner, for example, which uses the echo cardiograph and doppler techniques, both vital pieces of equipment in the diagnosis of heart abnormalities.

My hon. Friend the Minister may be interested to know that I recently visited Harefield hospital and, for half a day, watched technicians doing their work and testing pacemakers. I was impressed by the fact that they are responsible for doing that work. There is no doctor standing beside them, overseeing what they do. They are trained to find faults in pacemakers, and they alone are responsible for dealing with transplant patients in a truly hands-on way. I emphasise that only technicians see electrocardiograms to detect the problem of heart rejection. They also interpret results and report directly to consultants. Technicians actually control the follow-up in both procedures and decide how frequently to do an ECG. What could be more responsible? What could be more hands-on? How then can cardiac technicians be regarded as anything but members of a profession that is allied to medicine?

As my hon. Friend knows, a patient with a pacemaker receives a programme of exercise. It involves the checking and adjusting of parameters to obtain the most favourable amount of exercise that can be tolerated. The majority of patients who undergo that treatment are tested for angina. The exercise in which the patient is involved is potentially hazardous. However, only cardiac technicians are in attendance. Again, that demonstrates the high regard in which they are held. They are not accompanied by a doctor. In fact, a doctor plays no active role unless, for

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example, a cardiac arrest occurs. However, the technicians have direct responsibility for ensuring the welfare of the patient until the doctor takes over.

Does my hon. Friend know whether the Whitley council has ever visited a hospital, such as Hillingdon or Harefield, to see what the cardiac technicians actually do? I suspect that it has not visited such hospitals.

The Parliamentary Under-Secretary of State for Health (Mrs. Edwina Currie) indicated assent.

Mr. Shersby : My hon. Friend is nodding. If the council has, it has kept a pretty low profile. If it had visited such a hospital and made the kind of investigation that I have made, I cannot believe that it would have recommended the miserable salaries that those extremely skilled and valuable people are being paid.

Another of the technicians' responsibilities is to train other cardiac technicians, including nurses, radiographers and other groups. That is all part of the learning process. It is also time-consuming and requires additional skills.

I want to make the point, too, that the technicians respond to demands in the night and at weekends when they frequently work on their own in the hospital dealing with patients who have undergone major surgery.

I hope that I have convinced my hon. Friend that a serious injustice exists because those technicians are excluded from the review body which considers the pay and conditions of professions allied to medicine. I hope that my hon. Friend will make it her business to ensure that that situation is remedied. I know that the cardiac technicians are not alone. There are others, such as audio technicians, whose position also should be carefully considered to see whether they should come under the auspices of the professions allied to medicine pay review body rather than the Whitley council. I have raised the question of training in correspondence both with my right hon. Friend the Member for Braintree (Mr. Newton), when he was Minister for Health, and more recently with my hon. Friend the Under- Secretary of State. In a letter to me dated 16 August, my hon. Friend, commenting on the recruitment and retention of physiological measurement technicians, made the point that, in answer to a parliamentary question in which I had referred to the difficulty of recruiting and retaining student technicians, the then Minister had said that he was not aware of difficulties.

I must tell my hon. Friend that, following an overview of the present situation, carried out in August by the acting director of personnel of the North West Thames regional health authority, it was concluded that, while the recruitment and retention problem is not at present universal, the situation is worsening. In North West Thames the vacancy rate at basic grade has risen by 50 per cent. since 1985. The overall vacancy rate across the region is currently 21 per cent. Therefore, my hon. Friend may conclude from those figures that the situation is not quite as cosy as our right hon. Friend the Member for Braintree thought it was, and as she thought it was when she replied to me in August.

In his report, the acting director of personnel came to the conclusion that several key points must be considered. First, although there is a widespread increase in the work load and development of cardiology services at district level, there is little increase in the number of technicians employed. Secondly, responsible departments do not take

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on students, as time is not available for effective training. A qualified work force, therefore, is not being developed within the region. I suspect that this situation applies throughout the country.

It is unlikely in North West Thames--considering present salary scales and accommodation costs in the south east--that basic grade technicians can be recruited from outside. Consequently, in order to provide a service, departments must employ local agency technicians. This, of course, is an expensive exercise, about which my hon. Friend must be concerned. For example, for a 37.5-hour week, a basic grade technician working in the National Health Service is paid £166.88, whereas a locum agency technician is paid £202.13.

I have mentioned these matters in the hope that, when my hon. Friend replies, she will say what her policy is towards the training and recruitment of such valuable people. I have spent a great deal of time with them and seen them working in the hospitals. I cannot honestly see any difference between the kind of work that they do and that of radiographers who have their pay determined by a review body.

This is an important matter and it is right to raise it in the House tonight. I hope that my hon. Friend will be able to give me some words of encouragement and some hope of a change in the future. 10.15 pm

The Parliamentary Under-Secretary of State for Health (Mrs. Edwina Currie) : I congratulate my hon. Friend the Member for Uxbridge (Mr.Shersby) on again winning the ballot. It is always a pleasure to debate with him as he is always well informed, courteous and persistent. He always checks his facts before he quotes them. I followed his speech carefully tonight, and he has all his facts just about right.

We have shared an Adjournment debate before on an aspect of work at Hillingdon. If I remember rightly, it was about the cost of agency staff who were causing some budget difficulties. My hon. Friend may recall that in 1982-83, when the Hillingdon health authority was created, the gross revenue expenditure was £46 million. This year, the cash allocation to that health authority is nearly £66 million, which represents a 10.5 per cent. increase in cash terms over the past year. In addition, we expect that it will spend £9 million on capital schemes and we hope that some of the money will be raised through land sales. Therefore, those sharp increases will show how seriously we take the points that have been made by my hon. Friend in his Adjournment debates. I hope that his constituents have found that the health service offered at Hillingdon is now responding better to their needs.

I am grateful for the fact that, earlier in the week, my hon. Friend set out some of the points that he wished to make. I regard that as a considerable courtesy, and a great help, as it assists me in making a much more considered reply.

My hon. Friend has raised an important topic for debate tonight, and I wish first to express the Government's appreciation of the work of the physiological measurement technicians working for the Health Service in all the specialties in support of our physicians, surgeons and other staff. They include those working in audiology, neurophysiology and, respiratory physiology,

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the perfusionists who support the heart-lung operations, and those working in cardiology, which is the specific subject of tonight's debate.

Ministers have never said that physiological measurement technicians--PMTs, if I may call them that--do not have hands-on responsibility for dealing with patients. Ministers have not, would not and could not say that, because it is obvious that most PMTs have hands-on responsibility. By the very nature of their work, patient contact is an essential feature of their job.

My hon. Friend is right that cardiology technicians must explain to patients what it is that they are to test and how they will position the equipment. They also reassure the patients on what is about to happen. If anything untoward should occur, it is the technicians who summon medical assistance--normally, doctors would not be present--and perhaps become part of a resuscitation effort, if required. I do not know how the rumour that Ministers said that PMTs do not have hands-on responsibility came about, but I am glad of the opportunity to refute it.

My hon. Friend has referred to the shortage of cardiology technicians in the North West Thames region. We are aware of reports of shortages in some areas, including North West Thames region, but presently it is not a nationwide problem. That was the point that I was trying to make in the correspondence that we had earlier in the year. Between 1979 and 1987 in England the number of PMTs has increased by more than 500--an increase of more than 30 per cent. For cardiology technicians, the increase is more than 7 per cent. It is obvious that some of the other groups have grown somewhat faster, perhaps because some of the specialties are newer or because developments have occurred in other specialties. However, that does not help my hon. Friend and his constituents.

I accept that there are shortages of a variety of NHS staff, particularly in London and the south-east. We have had numerous Adjournment debates on this topic, often far later in the night, as you well know, Mr. Speaker. The most recent Adjournment debate was about the Mid-Downs district health authority, which was raised by my hon. Friend the Member for Horsham (Sir P. Hordern).

In London and the south-east, the employment pressures are greatest and these affect wages, housing and the cost of living. It is even more difficult when there is sharp competition from employers in other hi-tech industries for the same sort of manpower that we need to recruit to become cardiology and other technicians. Therefore, we are very much in an area of active competition. By and large, we do reasonably well in those circumstances, but there are gaps, as my hon. Friend described.

The problem is faced by the Health Service and, indeed, by all the other employers in my hon. Friend's constituency, who are now bidding against each other for a finite work force. It will not get better as demography causes the number of school leavers to drop quickly, both now and in the next few years.

The solution that my hon. Friend suggested to the problems is to increase pay, and his specific remedy is to include the technicians in the pay review body system. I have corresponded with my hon. Friend about the criteria

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which were used when the review body arrangements for nurses and midwives and the professions allied to medicine were established. Indeed, I have had several opportunities to correspond with many colleagues on both sides of the House about those criteria. The criteria were that first, each staff group, have an established tradition of not taking industrial action, often keeping services going in the face of such action by others ; secondly, each group should essentially be involved in direct patient care ; and thirdly, each group should, over a significant period, have been linked together for pay purposes. The important proviso then was that all the factors had to be satisfied--not just one or two, but all of them. It is clear that the PMTs did not and do not satisfy all of them, but they satisfy the point about direct patient care, which I dealt with. In saying that, I do not imply that PMTs or any other groups are not involved in patient care or have taken industrial action. We also readily accept that the pay gap between review body groups and non-review body groups has widened in recent years. My hon. Friend mentioned certain groups, but he did not mention nurses. He might compare in equally favourable terms nurses' pay, particularly including the recent pay rise, with what some of the other groups are getting. What we cannot accept is that this is an argument for extending the coverage of review bodies to other groups.

Mr. Shersby : With respect to my hon. Friend, I made a comparison between cardiac technicians and nurses on grade E.

Mrs. Currie : I apologise to my hon. Friend, he did. My attention was distracted by one of the Labour Members who was leaving. As my hon. Friend will agree, as none of them is left, none will be able to hear the answer to the points that he raised.

As I have explained in the past to my hon. Friend, there have been attempts by other staff groups to join in the review body arrangements from which they were excluded at the outset. Those attempts were unsuccessful, and I have no reason to believe that they would be successful now. However, if the staff side representing the PMTs were formally to request inclusion in a review body, that request would be considered. I can tell the House that there has been no sign that the staff side intends to do so, as it has always been its contention that it prefers to continue within the collective bargaining system. That is a matter for the staff side and should it formally request inclusion in a review body, that would be considered.

If pay review bodies are not the answer, what are the alternatives? On pay, the main requirement is a need for more flexibility in our systems and for us to move towards some form of regional pay. We feel that that is the only way in which the differing problems about pay that affect the recruitment and retention of essential staff in various parts of the country can be resolved. We are already working towards that end.

We should also remember that pay is not the whole answer to the problem, although we accept that it is usually foremost in the minds of most people. Employers generally are not very good at pushing a total employment package in which pay is only one important part. For example, health authority employers do not always emphasise enough the advantages that we also offer through employment in the Health Service of an

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inflation-proofed pension, a generous holiday entitlement, sickness benefits and a secure, worthwhile and very interesting job. Local variations, such as flexible hours, part-time working and creches, which are beginning to appear, particularly in London, should also be included.

Much more effort needs to be put into retaining the staff that the National Health Service already has. Managers must manage better the career breaks, particularly of our women. They must also make certain that the skill mix is right so that tasks relate to the level and expertise of the staff concerned. Opportunities should also be taken to enable those without basic educational achievements to have the chance to do jobs that are denied them by current insurmountable entry requirements. In that sense, the technicians' work is attractive as they do not have the rigid, restrictive entry gates that some of the other professions have.

If recruitment and retention is a problem now in some parts of the country, we are afraid of how much worse it will be in a few years' time when the number of young people available for recruitment declines. We feel strongly --I think that my hon. Friend agrees--that attitudes must change.

While progress towards a system of regional pay is likely to be slow, in the meantime other initiatives are being pursued. A flexible pay and grading system for speech therapists is already in place. Medical laboratory scientific officers have recently accepted a similar proposal, and this will be implemented over the next few months. Negotiations are taking place with hospital pharmacists to see if they, too, would benefit from a scheme such as these. All these schemes are designed to improve career prospects and reward responsibility and expertise. They will not only make the jobs more attractive to new recruits, but we hope will encourage those already in the Health Service to stay there.

The current position on pay for physiological measurement technicians is negotiated, along with that of other technical staff groups, in committee E of the Professional and Technical B Whitley council. The staff side representing those staff recently accepted the management side's offer of an increase of 5.5 per cent. backdated to 1 April this year. Arrangements are in hand for the new rates to be paid as soon as possible. We hope

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that the new rate will be in the November salary payment, and the arrears in December. However, that depends on ensuring that we have everything on computer.

The management side has taken note of the staff side's complaint about pay and the effect on recruitment and retention. We are concerned about that, and the management side has recently conducted a national survey of staffing levels for all the staff groups in committee E. This has led to the setting up of a special working group to examine problems relating to the grade structure of several technical staff groups, including physiological measurement technicians.

I understand that this working group has already visited Guy's hospital, no doubt fairly quietly, to look at the work of physiological measurement technicians and medical physics technicians. The visits are to enable the group to see what technicians actually do and to find out at first hand from the people concerned what are the problems as the staff perceive them. It was able to see the work of the cardiology technicians and to discuss with them their particular problems.

When it has completed its work, the group will report back to the full management side. The group will be consulting staff side representatives, and the management side will finalise the report in time for next year's pay negotiations.

I hope that my hon. Friend will agree that the Government are aware of the problems of cardiology and other technicians and are actively trying to solve them. Pay negotiations must, of course, remain a matter for the Whitley council. As I have explained, the management side is taking positive steps to look closely at the perceived problems facing physiological measurement and other technicians within its purview. It will be seeking ways of alleviating those problems which it can positively identify.

We need to be able to recruit the staff we need, of the right calibre and to motivate them so that they remain in the Health Service. We value their work and we need them. However, this has to be done within a cost that the Health Service and the nation can afford. My hon. Friend's remarks are timely and wise. I undertake to ensure that his comments, as in previous debates, are duly noted in the appropriate quarters.

Question put and agreed to.

Adjourned accordingly at twenty eight minutes past Ten o'clock.


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