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Column 401coach and horses through the long- established principle of even-handedness, as British industry has never received relaxations for its discharges on the scale now being sought by some parts of the water industry and granted by the Government to facilitate privatisation.
The Government's arguments pull the Bill in opposite directions. One argument is to provide firm assurances that the Bill contains genuine additional environmental safeguards, and the second argument is to convince the City that there are no destabilising uncertainties about costs attached to environmental controls. That is the Government's dilemma.
On the first of those counts, the Government are heavily burdened by recent history. Broadly speaking, this is an enabling Bill. Many environmental clauses have to be fleshed out in regulations before they can have any practical effect. Many of the clauses characterised as new by the Secretary of State have been carried forward with some simplification or amendment from the Control of Pollution Act 1974. Developments since 1974 do not inspire confidence that the Government, with a successful flotation uppermost in their mind, will look rapidly to give effect to these provisions. The powers in that Act to introduce protection zones and to impose controls on the storage of dangerous substances have never been invoked. The Government are continuing to display little haste about introducing statutory controls on nitrogen fertiliser applications to agricultural land, using the water protection zone powers that they already have in the Control of Pollution Act. They are backsliding all over the place. Last year, the Department of the Environment said that the Bill would give backing for the first time to river quality objectives and provide for deadlines to be set for their achievement. But the Department also said that these would be in place when the Bill was enacted. Now the intention is not to introduce them until 1992. The conflicts are inevitable and the Government's record on the environment is clear.
One of the Government's main arguments for privatisation is that it will release the water authorities from public sector borrowing requirement controls, but the Government are nationalising many functions of the water industry and giving them to the National Rivers Authority. That does not release water resource planning and licensing, abstracting and monitoring of licences, environmental quality and pollution control, land drainage and flood protection, the maintenance, improvement and development of fisheries and inland waters, conservation and recreation, navigational responsibilities and functions of three water authorities, the functions of Her Majesty's inspectorate of pollution, research, and flood and sea defences.
None of those will be released from PSBR restrictions. They will be the functions of a National Rivers Authority, and that will not solve any problems. The revenue consequences of all those functions will be paid for by additional, higher charges--it says so in the Government's document--and by taxation. That is not releasing the evironmental functions of the water industry from PSBR constraints. At a stroke, and without privatisation, the Government could release the water industry from the stupid and ridiculous PSBR control.
Column 402We were asked whether a Labour Government would take the water industry back into public ownership. The answer is yes. We will not nationalise it. It is this Government who are doing the nationalising by setting up the NRA.
This is absolute nonsense. Let us look at the logic of it. The same organisation, whether in public or private ownership, will borrow the same money on the market from the same people to spend on the same projects. One is bad for the nation's economy because the public sector is doing it, and the other is good for the nation's economy because the private sector is doing it. We are talking about the same money from the same sources for the same purposes. What economic nonsense. If that is the only justification for privatisation, no wonder the public have seen it for what it is--asset stripping. Conservative Members laughed when my hon. Friend the Member for Wakefield (Mr. Hinchliffe) spoke about poverty. They think that compulsory water metering and charging people per second per gallon per squirt is good. They do not think that an old-age pensioner will worry about the bill and will continue to flush the toilet as often as now. They do not believe that large families in the poverty trap will stop bathing their children as often as now because they will be worried about how much water they are using and their water bills. I would not mind if water metering saved significant sums. The lowest estimate for putting water meters into people's houses is £2 billion--others have been about £3 billion or £4 billion. Having put the meter into a house, it does not matter whether that household uses twice as much or four times less water than it was using before it had the meter, it will still cost the water authority the same to deliver it. Conservative Members do not understand that water is not the same as electricity. Electricity is expensive to produce, but cheap to distribute. Water is cheap to produce--it droppeth, as the quality of mercy, from the heavens--but expensive to distribute. Once the pipe has been laid from the reservoir to the house, the cost has been paid. It does not matter how much water is used or is not used, the cost will be the same. If people economise with water--unless there is a drought and people economise on a voluntary basis--the water authorities save nothing, because any water that is saved flows out of the reservoir, back into the rivers and into the oceans. Water--that God--given asset--is freely available, but must be paid for by the gallon and by the pint once the reservoirs have been built and the pipes have been laid to the households.
Mr. Roberts : What has the water rate to do with water metering? I predict that compulsory water metering will be an inevitable consequence of water privatisation. Many members of the public have not realised that, in the interim, while the meters are being fitted--they will be fitted in all commercial and industrial premises in the north-west almost immediately, and automatically into any new dwellings--we shall get rid of water rates and have a water poll tax, which will not be related to the ability to pay, the size of the household or its consumption. That will be on top of the poll tax, and they will be
Column 403introduced, as they say in the music hall, at one and the same time. The water poll tax, along with the poll tax, will be the end of the Government. The Bill will put another nail in their coffin because water metering--as is the privatisation of water and making a profit from it--is opposed by the public.
The Government are keen to sell off water, and they do not care who buys it. They do not care if the French buy it. They tell us that the French system is excellent. Some 99.2 per cent. of British households are connected to mains water supplies. In the United States it is 75 per cent. ; in West Germany it is 86 per cent. ; and in France--where the system is so good--under French privatisation it is only 56 per cent. When I visit France, Spain and many other countries, I must buy my water in bottles, because the tap water is not drinkable. That is becoming the state of affairs in many parts of this country because of the Government's neglect and their ignoring of EEC directives. The Australians want to buy into British water. The Australians are interested, and they do not give a triple X for our environment. They certainly do not give a triple X for providing cheap wholesome water for the British people.
It is said that costs will not rise, but there will not only be the extra costs--as the Minister admits--of any pollution control that may be imposed on the water industry by the National Rivers Authority, but there will be the costs arising directly from privatisation. There will be higher directors' fees and top managers' salaries. So far, there have been 85 per cent. increases in managers' pay in the first two years of any privatisation.
In addition to the National Rivers Authority, there will be the cost of shareholders' registrations and servicing, dividends for shareholders, and corporation tax, which the consumer will have to pay because that will not come out of the profits. An expert on water authority finance has calculated that there will be an increase of 29 per cent. on existing costs. That will inevitably lead to higher charges. After announcing a 39 per cent. increase in profits, British Telecom put rentals up by 8.6 per cent. Many other costs will also be involved.
What should be done? All the Government's stated aims for privatisation could be achieved without privatisation. The Government could free the authorities from their tight borrowing limits and the stupid restrictions of the public sector borrowing requirement. We will, and the Government could, democratise the water industry and put some accountability back into the way in which it is run regionally. At present the Government contribute no money to water authorities' operating costs, but they take out an increasing amount. That should stop. The present problems that the Government rightly highlight could be dealt with adequately.
The Labour party and most of the British people are totally opposed to the privatisation of water. We recognise that water is even more essential than food. It should not be subject to the free market or to the profit motive. It
Column 404should be free and readily available, in public ownership, providing a plentiful supply to all who need it, and it should not be related to people's ability to pay.
The Parliamentary Under-Secretary of State for the Environment (Mr. Colin Moynihan) : I have never heard such a fundamental misunderstanding of an industry from a Front Bench spokesman as I have this evening from the hon. Member for Bootle (Mr. Roberts). To say that water just trickles down from the sky and appears, without cost, in the pipes and through the taps is a nonsense. It is a highly expensive industry, requiring highly expensive inputs for treatment and preparation. It is also subject to many European directives and many quality objectives. When the hon. Gentleman is on the Committee I only hope that he will pay as much attention to the importance of producing first-rate quality water as he has to the pipes and the supply works that provide water to homes.
Mr. Allan Roberts : If water is so expensive to produce, why do the Government not take action to stop 30 per cent. of it leaking out of our aging system? From leaving the reservoir to reaching the tap, 30 per cent. of water is lost. How will water metering solve that problem? Will the Minister admit that the major cost to the water industry is distribution and not production?
Tonight has also revealed another interesting point that emerged from an earlier and excellent speech from my hon. Friend the Member for Cambridgeshire, South-West (Sir A. Grant). Through his lucid description of the importance of his statutory water company, he identified that we have an interesting framework for the water industry--private companies under public regulation. My hon. Friend challenged the Opposition to inform the House whether it was their intention to nationalise the statutory water companies and to remove, as the hon. Member for Copeland (Dr. Cunningham) had stated, their present private monopoly status.
The Opposition did not go as far as saying that they want to nationalise the statutory water companies. They accepted that there should be private companies and they welcomed the fact that, if one had private companies, they should be subject to proper and effective regulation. That is what we understood to be their argument. If the Opposition are unhappy about that summary of their argument, I shall give way.
Mr. Allan Roberts : My hon. Friend the shadow Secretary of State made our position clear. We will take the water industry back into social ownership. That does not mean that a nationalised body will run all the water industry. If nothing has changed and the private statutory companies, which are regulated, still exist, they will not necessarily be taken back. But we predict that they will not, because powerful conglomerates will be running the water industry, and then they will be taken into social ownership.
We have come before the House with a Bill to create private companies within a strong regulatory regime to protect the customer against general abuses such as excessive charges, reduced service levels and the neglect of assets. Under that regulation individual customers should be entitled to rights and protection. We recognise that on the one hand the water industry can be given tremendous opportunities through the private sector and on the other hand that we need an important regulatory framework to protect customers. That is precisely the position being espoused by the Opposition on statutory water companies and that is exactly what we have produced in the Bill.
We are now halfway through the debate and many important points have been made about the National Rivers Authority. First, let me pay tribute to the work of the Select Committee on the Environment under the Chairmanship of my hon. Friend the Member for Hornsey and Wood Green (Sir H. Rossi). It was its report on the pollution of rivers and estuaries in May 1987 that drew attention to the anomaly that the present arangements for the control of water pollution involve water authorities having the dual role of poacher and gamekeeper. That anomaly has been central to our decision to create the National Rivers Authority.
Let me try to allay the worries that many hon. Members have raised about the structure and organisation of the National Rivers Authority. We are confident that the proposals for the National Rivers Authority combine the best features of the existing system of unified control of the river basin while providing the essential separation of the regulatory functions in the new national body. The National Rivers Authority will retain control over river catchments because it will have all the functions associated with the management of natural waters--abstractions, discharges, pollution control, land drainage, flood protection and conservation.
Hon. Members have raised an important issue relating to the staff and resources of the National Rivers Authority, a point rightly raised by the Select Committee in its third report. I can assure hon. Members that the Government are fully committed to ensuring that the authority has adequate staff and resources.
But hon. Members will want me to go further than that. I hope that in the first stage hon. Members will have already drawn comfort from the fact that in the summary schemes of organisation that are now available in the Library it is clear that our commitments at the Dispatch Box are backed up by actions. The National Rivers Authority will have the vast majority of its 6,500 staff in the regions. The schemes show that pollution control and other functions will be carried out by same people who are currently carrying out those functions in the water authorities.
The National Rivers Authority will inherit from the water authorities the staff needed to carry out all the functions, but--this is an important but- -instead of being
Column 406a small part of a water authority whose primary function is water supply, it will represent the main function of an important national environment body. The creation of that new body is a major component of the Bill which recognises the great importance that we attach to pollution control and the environment.
Important issues have also been raised on conservation and recreation. The first important point is to promote the good practice that exists already. Over recent years, numerous and varied practices and strategies have been adopted by water authorities in respect of conservation and recreation, some successful, others less so. The time has now come to identify and promote best practice to ensure that the industry learns from experience and to give more meaning and substance to the general duties placed upon it --hence, a code of practice for the first time, to which I shall return.
The second is to seize the opportunities for conservation and recreation created by the restructuring of the industry. The creation of the NRA is an important milestone. It can take on tasks and functions which could not so readily have fallen to the water authorities, and some of its functions will be new. I shall return to that subject, too.
Our brief should be twofold : to promote good practice and to seize the opportunities for positive steps forward in conservation and recreation. I shall follow through three aspects of the legislation, the first of which are statutory duties. The Bill imposes on the NRA and the plcs the duties to further conservation, having regard to landscape, natural beauty and public access, and to put their rights and properties to good use for recreation. These are broad and positive duties, which will set the tone for the privatised industry. I know that many people did not believe that we would preserve in a privatised regime the present duty to further conservation--but we have. So the Government are not going back on what has been achieved.
Secondly, I turn to the code of practice. I hope that hon. Members on both sides who are concerned about the important issue of sport and recreation and conservation will carefully examine the implications of the code and benefit from the discussions about its detailed context that will take place. Early on in our privatisation proposals we suggested that the general statutory duties should be supplemented by a code of conservation and recreation practice. As is clear from much correspondence that I have received, that has received a wide welcome in the sporting world, and clause 9 provides for it.
We shall shortly publish a first discussion draft of the code so that it can be taken into account at the relevant stages of the Committee proceedings. It will provide guidance on how the general duties, which are enforceable by the Secretary of State, are to be interpreted and applied. The Secretary of State will have to take account of the code and of any failure to observe it when exercising his enforcement powers. We hope that it will provide effective practical guidance to the companies on how the conservation and recreation duties are to be discharged. It will certainly provide them with a clear warning about the essential standards to be observed in this area--on matters concerning recreational duties, ramblers and anglers, canoeists and oarsmen. I have found in discussions with the bodies that represent anglers that they believe the NRA will enhance and protect their interests.
Column 407Another point mentioned by several of my hon. Friends concerned the importance of not segregating pollution control from recreation duties in the NRA. The two are intermingled in their effects. Anglers and, to a lesser extent, canoeists and oarsmen need pure water, so it is important for the recreation and conservation committees to ensure that all these interests are represented so that we can see the water course in the round and ensure that we enhance the conservation and recreation interest and improve the quality of the waters, thereby reducing the pollution risk.
The hon. Member for Wakefield (Mr. Hinchliffe) raised one of the most important issues of the debate--disconnections--and I want to allay concerns about them. We shall discuss with the industry how the existing code of practice applying to customers who have difficulty in paying their bills could be strengthened to include additional safeguards. The existing arrangements, whereby debts may be paid off by instalments and people in receipt of income support may have serious debts deducted from benefit by the DSS and paid direct to the water undertaker, will continue. The new companies will be required to prepare or adopt a code of practice on disconnections at least as extensive as the present one.
Column 408[Interruption.] Opposition Members may laugh, but disconnections are a serious issue and I regret that the Opposition do not regard them as important. We do.
My hon. Friend the Member for Norfolk, North-West (Mr. Bellingham) asked why there are so few prosecutions for pollution. I agree that there are too few prosecutions of those who pollute our water courses. We shall look to the National Rivers Authority to develop more rigorous and consistent national enforcement policies. Other measures are also needed and that is why we propose new regulations governing the construction of silage and slurry stores and oil storage installations in order to reduce the pollution risks about which my hon. Friend spoke.
The hon. Member for Copeland spoke about drinking water standards not being in the Bill.
It being Ten o'clock, the debate stood adjourned.
Debate to be resumed tomorrow.
That this House agrees with the Select Committee on House of Commons (Services) in its First Report of the last Session of Parliament on New Parliamentary Building (Phase 2) : The Next Steps (House of Commons Paper No. 561 (1987-88)).-- [Mr. David Hunt.]
Column 409Midwives (Grading Review)
Motion made, and Question proposed, That this House do now adjourn.-- [Mr. John M. Taylor.]
Mr. David Alton (Liverpool, Mossley Hill) : I am indebted to you, Mr. Speaker, for this opportunity to raise the manner in which the regrading of midwives has been undertaken. I intend to examine the particular problems that this has caused in the Merseyside area. I am pleased to see that the Minister of State, Department of Health, is in his place to reply to the debate. I am sure that he will not be offended if I say that it might have been more appropriate if his hon. Friend the Parliamentary Under-Secretary of State were present. I understand that she was born in the Oxford street maternity unit which serves much of Liverpool. I am also pleased to see in the House the official Opposition spokesman. Anyone reading the debate will realise that in an Adjournment debate it is not possible for all hon. Members who are present to take part. However, I am glad to see so much interest.
It is no bad thing to remind the House that 76 per cent. of us were brought safely into the world by midwives acting alone and assuming total responsibility for life and death decisions. Ministers are no exception, and while stridently asserting their claim that the National Health Service is safe in their hands they should pause to reflect that from the moment of birth many of us are safe in the hands of any one of the 32,000 members of the Royal College of Midwives.
I want to use my time today to do three things. First, I shall set out the background to the present crisis, then I shall rehearse the grievances and finally I shall explore some of the ways forward. For just over 30 years between 1870 and 1902 midwives waged a national campaign to see themselves established as a separate profession and to create better maternity facilities for women. Thirteen Bills were required to be laid before Parliament before their much-prized autonomy was finally conferred. It is that hard-fought-for professional standing that is at the heart of the present dispute, not an avaricious love of money.
The present Prime Minister established the pay review body for nurses, midwives, health visitors and the professions allied to medicine. In its third report, the review body conceded that the RCM had put forward a well argued case for a separate pay and grading structure for midwives. Unfortunately, both management and staff sides opposed any such development and midwives were simply lumped into the general regrading exercise. Only one of the eight seats for negotiators on the staff side is held by an RCM representative, so the unique and distinctive arguments of the midwives have been pushed to the margins and given a Cinderella status.
As recently as 30 November, in reply to a letter from me, the Under- Secretary of State was still hiding behind the fig leaf of an agreement. Although midwives were a party to that agreement, it was never directly discussed with their professional body on a bipartisan basis. Two days ago, in answer to a parliamentary question which I tabled, the Secretary of State said :
"I suspect that much of the sense of grievance felt by some midwives in Merseyside is caused by misunderstanding of the basis of the grading exercise which the Royal College of Midwives and other trades unions agreed to."--[ Official Report, 5 December 1988 ; Vol. 143, c. 86 .]
Column 410I repeat that midwives were never entirely happy about the basis on which the regrading exercise was begun, and as the row simmered over the summer period their unhappiness turned to anger and dismay. The other organisations which made up the staff side understandably concentrated on important issues such as the definition of supervision and continuing responsibility. The midwives were treated as an obscure minority interest.
What are the midwives' grievances? Guidance on prime care providers was given by the Department to general managers in May and July 1988. The original agreement made between staff and management stated that one of the criteria for being placed on scale E was a requirement "to take responsibility as the prime care provider for one or a defined group of patients/mothers, in the hospital setting. He/she works with minimal supervision in the assessment of all relevant care needs, the development, implementation and evaluation of programmes of care. The post holder is able to supervise and teach junior staff including basic and/or post-basic students."
Subsequently, in evidence to the pay review body on 5 January 1988, the staff stated in paragraph 4.3 that
"the definition of the prime care provider at Scale E(2) was intended to cover those nurses and midwives carrying high levels of responsibility in relation to patients, clients or mothers, but whose work is so organised that they do not normally take charge of a ward or supervise other staff. There is no dispute that such jobs should be graded on scale E rather than D because of the level of their direct care responsibilities."
When the Department's guidance to general managers was published, it sought first to limit and then to prevent the use of those criteria for midwives. It inserted double-talk in the form of an interpretative note, which was never agreed with staff, stating that "this is a 24 hour responsibility even though delivery of care is assigned to another nurse or midwife when the prime care provider is off duty."
Clearly, in the context of midwives dealing with women whose labour may be less than eight hours, let alone 24 hours, and who may be discharged within hours of being admitted to the hospital, this is a deliberate exclusion clause. Yet the mother will have been cared for by one midwife throughout, who will have to make critical life-or-death decisions and a series of crucial judgments. The midwife is unarguably a prime care provider.
The Department proceeded to compound its felony in supplementary management guidance which advised health authorities that the prime care provider criteria applied to a few authorities where primary nursing had been introduced. By implication, it did not include midwives. I hope that the Minister will confirm that health authorities may apply those criteria for midwives, and that he will arrange for written guidance to general managers clarifying this apparent misunderstanding and the 24-hour rule.
Another grievance concerns the lack of fairness and consistency applied to the regrading exercise. Why has one staff midwife in 10 in England and Wales been placed on scale D, but only one in 500 in Scotland? Why have half the staff midwives in Wales been placed on scale F, but only one in eight in England? Why have 25 per cent. of midwifery sisters in Scotland and England been placed on scale F, but only 8 per cent. in Wales? There are many examples of hospitals where all or virtually all the hospital- based midwifery sisters have been placed on scale F, while in some areas every midwifery sister has been placed on scale G.
Column 411Funding restrictions are given as the reason for not having graded in accordance with the agreed criteria. Perhaps when the Minister replies he will say what differences exist between the five districts in the Mersey region. Will he say what consideration has been given to the consequences for recruitment and retention of midwives in the Mersey region and when it will be possible for them to move to north Wales and have their clinical skills recognised by higher grades and salaries? The problem cannot be minimised in a profession that already has an 8 per cent. vacancy rate at the sister-midwife level and a 17 per cent. shortfall of sister midwives.
The Minister will no doubt state, as have his right hon. and hon. Friends, that the sheer size of the award should satisfy midwives. If he or representatives of the regional health authority had been present at a meeting that I addressed on 18 November at the Liverpool Institution, he would realise that the inconsistencies and confusion caused by the grading implementation have far outweighed any so-called benefits. The 130 midwives present at that meeting--even those who had benefited--signed a petition, which I subsequently presented to the House on 23 November, registering their unanimous dismay at the block grading, which they believe has been determined by cash constraints and not clinical considerations. In early day motion 79, my right hon. and hon. Friends and I emphasise our support for their case.
Midwives at that meeting gave an example of a midwife with 10 or 12 years' service who was still on E grade. She will remain there until she either votes with her feet to leave the area or decides to go back into general nursing or into health visiting. To get to G grade is a near impossibility. Some sisters of 30 years' standing are not on G grade. The midwives told us at that meeting about students cancelling places at training schools. Although in October the Department stated that nurses opting for midwifery training need not be worse off during their training, the ludicrous situation still applies that, once they complete their training, they will be forced to apply for posts at the lower grade D. What sort of incentive is that? No one with a mortgage will be able to afford to take that option, so expenditure on such training will be of no avail. Taxpayers' money will be used to train people who will not be able to afford to take up posts.
The Merseyside midwives gave an example of one woman who had trained another, yet the trainee had ended up on a higher grade than the trainer. One midwife said, "The Minister seemed to think that just because Lofty could deliver a baby on EastEnders anyone could do it," and that midwives' worth had effectively been downgraded. Experience in other countries shows that fewer midwives leads to more deliveries by doctors, more intervention and more caesarian deliveries--in other words, serious long-term shortages of midwives will be detrimental to care of mother and child and carry grave consequences for maternity services.
What needs to be done? It is no good the Minister simply telling us that midwives in Merseyside and elsewhere should appeal. For a start, in many authorities the watchdog is too closely identified with the burglar, with the appeals mechanism weighted in favour of the health authorities. It is also a gruesomely long drawn out process, the length of which will turn this issue into a running sore. Before they consider the appeals, the Minister needs to tell the House what instructions he will give health authorities over issues such as prime care
Column 412provider criteria and on what basis appeals are to be settled. Are they, for instance, to be heard against the agreed grading criteria, or will authorities be expected to apply management guidance which grossly distorts those agreed criteria? The Minister needs to say what funds will be available if authorities decide to set aside their earlier decisions.
The Government also need to change their attitude. They appear to believe that midwives do not understand the grading structure and that that is responsible for much of the unhappiness in the profession. As midwives see it, the problem is very much the other way around.
Mr. Nigel Spearing (Newham, South) : Does the hon. Gentleman agree that despite the 25 per cent. reduction in staff at Newham general hospital the midwives' diagnosis of the problem is virtually the same as the one that he is outlining, which, I dare say, is found throughout the country? It appears to the staff that the Department does not understand their job or profession.
Mr. Alton : I am grateful to the hon. Gentleman for that intervention. The Merseyside problem is a microcosm of the difficulties faced all over the country and experienced by hon. Members on both sides of the House.
It is important for us to recognise that midwives are not arguing that they should all be on the same grade. They believe that those midwives with identical responsibilities should be on the same grade. They cannot accept that it is right for an arbitrary distinction to be made between midwives doing precisely the same jobs. Many are on the sister scale, not because of supervisory duties but because of their clinical expertise and responsibilities. They will not accept being told that only a limited number of them can be paid on the scale appropriate to those skills and responsibilities because the regional health authority will allow them only a limited number of posts at that grade. They strongly resent that, whether the district authority has selected certain midwives for the higher grade or whether they are all asked to compete for the limited number of scale G posts.
Similarly, those midwives working in hospitals in ante-natal and post-natal areas cannot understand why they should be graded on lower scales than their colleagues doing similar work but based in the community. Midwives working in the community have a minimum of scale G, yet the Health Department has been advising that, although scale G posts may be in such areas as delivery suites and special care baby units, lower scales are appropriate for those hospital-based midwives who have responsibilities similar to those of their community-based colleagues. That is clearly nonsense. Each and every midwife, wherever she works, is legally accountable as an individual for the decisions that she makes and the actions that she takes. Hospital-based midwives are making crucial decisions without reference to other midwives or doctors every working day. If those decisions turn out to be mistaken, the midwife is liable to be struck off the professional register and be unable to practise. Community midwives find those arbitrary distinctions just as difficult to understand or support as do hospital-based midwives.
What midwives such as Lorna Muirhead, a local RCM representative who organised the Liverpool meeting to which I referred, cannot understand is how a health department which supports integrated maternity services and therefore flexibility within maternity units and
Column 413flexibility between hospitals and the community can be seeking to enforce gradings which are having the effect of preventing that. All concerned agree that the operation and extension of that flexibility is desirable and in the interests of mothers and babies alike. I hope that I have said enough for the Minister to realise that, on Merseyside and in the country at large, midwives feel a deep sense of grievance and that we owe it to them and to mothers-to-be to come up with something better than the present grading hotchpotch. I hope that the Minister understands that they and their professional body, the Royal College of Midwives, which has today met the Secretary of State, will be awaiting his reply tonight with hopeful anticipation.
The Minister of State, Department of Health (Mr. David Mellor) : I am grateful for the opportunity to set the record straight about the grading of midwives both nationally and in the Mersey region because the hon. Member for Liverpool, Mossley Hill (Mr. Alton) is only the last in a long, but perhaps not altogether distinguished, line of people who have said some pretty extraordinary things about this exercise.
Claims that the midwives have done badly out of this exercise quite simply do not stand up. This is the best deal ever for midwives and the biggest ever pay award for their profession, worth well over 20 per cent. on average. This award gives the profession the highest ever level of real terms pay, higher than the previous high point set by the Halsbury report in 1974 and the Clegg award in 1979. This is a larger award than that enjoyed by any other major staff group in the public sector this year. Midwives have done even better than nurses in the regrading exercise, which reflects their qualifications. I should like to bring some figures into this debate that will demonstrate that. As I have said, the average pay award for midwives this year is over 20 per cent. and, for staff midwives, it is over 25 per cent. In each case, these figures are exclusive of the London supplements which will add another 5 per cent. to 9 per cent. for those individuals who work in midwifery in London. Staff midwives have done particularly well. Nine out of 10 have gone on to the higher grades with increases this year of around £2,000, a quite unprecedented sum. The bulk of staff midwives have gone on to scale E with basic pay now of £9,200 to £10,650 a year and almost £2,000 a year more than that in inner London. With additional payments for working unsocial hours and overtime, the average earnings on this scale are likely to rise to £12,500 in the country generally and to around £14,500 in inner London.
About one in eight staff midwives has been graded at F and received even larger increases of 40 to 45 per cent., an utterly unprecedented sum ; that is to say, £2,900 to £3,900 this year. The hon. Member for Newham, South (Mr. Spearing) finds that funny, but he was a supine Back Bencher in the days when Labour Governments were cutting the real pay increases of nurses and midwives by 20 per cent. The minority of staff midwives--about one in 10--who have gone on to the lowest grade of D have still received increases this year of 7 to 10 per cent. and have still seen
Column 414their pay go up in real terms by 30 per cent. since 1979, an arresting contrast with what happened in the preceding years. Three out of four midwifery sisters have gone on to the higher grades and will receive increases of £2,000 to £3,000 this year. Their new scales are from £12,025 a year to £13,925 a year with additional payments for unsocial hours and overtime. Earnings for this grade are likely to rise to an average of £16,000 or almost £18, 000 in inner London.
A minority of midwifery sisters who receive smaller increases this year will nevertheless have seen their pay go up by over one third in real terms since 1979. Midwives have gone into the higher grades in even larger numbers than nurses at both levels. This reflects the additional qualifications that midwives must have.
At staff midwife level, no fewer than 77 per cent. are on grade E, compared with 66 per cent. of staff nurses, and 12 per cent. have gone into grade F compared with 9 per cent. of staff nurses. As for midwifery sisters, 74 per cent. have gone into grade G compared with 58 per cent. of nursing sisters.
It is not true that midwives have been treated badly during the exercise. Indeed, the exercise will give the nursing profession the greatest shot in the arm that it has had since the National Health Service was founded.
Mr. Mellor : No, I shall not give way. If the Opposition want to debate the matter, they have their parliamentary time. I can assure them that my right hon. Friend the Secretary of State and I are only too willing to debate it at greater length, but this is not the occasion to do so. I want to get a few facts on the record in response to what the hon. Member for Mossley Hill said.
Mr. Mellor : I understand that there is some misunderstanding in certain quarters within the profession. That is inevitable when a major change is instigated by the unions concerned, which were pressing for regrading. They did not want an across-the-board pay increase. They wanted a regrading that gave nurses and midwives an incentive to stay in clinical medicine rather than go into administration to improve their lot. When half a million people are being regraded in six months--perhaps the most massive industrial relations exercise that has ever been undertaken in Britain--it is inevitable that there will be some misunderstanding. That is why I want to deal with some of the issues that have been misunderstood. A number of points arise from what the hon. Member for Mossley Hill has said.
We are talking about the greatest change in the way in which nurses and midwives are graded and paid in the history of the NHS. It is clear that some do not fully understand the thinking behind the change, and that is inevitable. We have a task before us to ensure that the reasons for the change are plainly understood. The old grading system was based on qualifications. Under the new structure, posts are graded on the basis of duties and responsibilities. In other words, the basis of grading has been overturned. It follows that some of the issues raised by the hon. Member for Mossley Hill, such as length of time in post and qualifications held, are not in themselves
Column 415factors that decide grading. That was commonly agreed after two and a half years of negotiations between unions and management.
Mr. Mellor : Midwives absolutely, yes. As usual, the hon. Gentleman is wrong on his facts. The Royal College of Midwives was a party to the agreement, along with the Royal College of Nursing. The colleges actively sought a regrading exercise and sought to persuade the Government that it was not sufficient to think in terms of pay increases. They argued that it was necessary to change the basis of grading, which was entirely archaic. A staff nurse was on one grade and a sister was on another. There was a low plateau of achievement in clinical medicine in terms of salaries and awards. It was time to do better, and I believe that history will show that that is what we have done.
Inevitably, there is dislocation. The unions and the royal colleges knew when they embarked on the exercise that the basis of the regrading structure made it certain that some who were similarly graded in the past would find themselves in different grades and receiving different pay increases. That was inherent in the scale of the change.
I appreciate that there are some concerns that are specific to midwives, and I am happy to address them. We know that midwives have long had the ambition that they should have a separate pay and grading structure. They have sought unsuccessfully to persuade the management side and the rest of the staff side of the nursing and midwifery staff negotiating council to accept that. They failed to impress the staff side and they took their case to the review body, which also rejected the idea that midwives, valued though they are--and they are valued enormously within the service--should have an entirely separate grading structure.
The review body is another innovation of this Administration. Needless to say, the Labour Government were always in far too much economic jeopardy ever to agree to allow anything so radical as nurses' and midwives' pay to be recommended by a wholly independent body, recommendations which the Government would accept unless there were exceptional reasons not to do so. It was an innovation of the Conservative Government in recognition of the services nurses and midwives give to the community, and in recognition also of the happier economic times that allow us to fund increases of a sort that could not have been contemplated previously.
In its fifth report, the review body said that the new structure, to which the Royal College of Midwives as part of the staff side agreed, would
"provide a satisfactory basis on which to determine the grading of midwives, taking account of their training, qualifications and the particular responsibilities they carry."
In determining that midwives should be on the same grading structure as nurses, we were acting on the clear endorsement of the independent review body, which has been established to consider those matters. I understand that the Royal College of Midwives remains attached to its opinions, notwithstanding the fact that it has, thus far, been unable to persuade anyone else, not least its colleagues on the union side, to join it on that point.
Of course, the vast majority of midwives have to undertake midwifery training after they have completed training as general nurses and some midwives say therefore that they should have a higher level of grading as soon as