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they have qualified. The management side's view is that the minimum level for midwives should be D--the same as the minimum level for registered nurses although, of course, only a small minority--one in 10--of staff midwives actually start on D. Nothing in the analysis of midwifery posts that was carried out during the grading review indicated that newly qualified midwives were working in a significantly different way from newly qualified nurses. We have to accept that in the modern Health Service of today, with high technology medicine a commonplace, there are many sophisticated practitioners of the arts of nursing and midwifery. Midwives, although vital to the service, are only one of a range of groups that bring additional qualifications and specialisms to the Health Service and that are equally entitled to be graded under this new grading structure, with unprecedented levels of salary and prospects. A sister who was earning £96 a week maximum less than 10 years ago under the benevolent rule of the Labour Government now stands to earn at least £270 a week and, usually, on higher grades, much more than £300 a week. We would hardly have dared in 1979 to have said that that would be the improved condition of nurses and midwives, but that is what we have achieved.

I conclude by dealing with the specific problems in Mersey. The hon. Gentleman very properly ranged more widely and I am glad to have had a chance to say something about the national picture. Turning to the outcome of the exercise in Mersey, the grading outcomes are very much in line with the national figures. A large majority of staff midwives and midwifery sisters have gone into the higher grades. That is hardly surprising because, of course, the exercise in Mersey has been carried out in line with the national guidelines. There are 190 different health districts in England and each of them is an independent decision-taker. It is inevitable that there will be differences between one district and another and the only alternative to that is for the man in Whitehall to do the whole job himself, which would lead to an equal range of protest, not more. I can imagine the outcry from the Opposition if there were more attempts by Whitehall to say that each district should come into line with another. We are caught in a Morton's fork. On the one hand, if we intervene too much we are criticised, and if we allow some districts to go their own way, we are criticised for that. It is a no-win situation and we must take much of the criticism with a substantial grain of salt. My hon. Friend the Parliamentary Under-Secretary of State for Health assures me that salt in excess is bad for health. To the extent that the pattern of grading differs from that elsewhere, this is likely to be explained by the fact that, under the old grading system, there were 60 per cent. more midwifery sisters than staff midwives in Mersey. That compares with a national pattern where there were about 10 per cent. more midwifery sisters. That is good news for Mersey because it means that the number of experienced midwives in the region is somewhat higher than elsewhere. It also means that sisters in Mersey were doing some of the jobs that staff midwives were doing elsewhere and vice versa, and this will, very properly, be reflected in the grading outcome, which analyses existing jobs and not individuals.

The newly appointed regional nursing officer in Mersey is keen to develop the educational strategies for midwives in the Mersey region. Plans are in hand for a direct entry midwifery training programme which will deal with some of the problems and anomalies that the hon. Gentleman

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has identified. It will allow students to follow a three-year course without first having to undertake nurse training and we hope that it will commence in the autumn of next year and will be well supported in the Mersey region.

There are also plans to extend professional development programmes for qualified midwives and to develop links with universities for an advanced diploma in midwifery course. Work is also beginning in Mersey on an examination of work loads and activity, linked to skill mix, to ensure the best utilisation of valuable midwifery resources. All these developments are to be welcomed and should serve to boost the morale of midwives in Mersey and aid their recruitment and retention.

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We hope that we have demonstrated in the most practical way possible the high regard in which we hold the midwifery profession. Midwives' pay stands at its highest ever in real terms. The new grading structure is the biggest change in the grading and pay of midwives since 1948. The agreement was reached after very hard negotiations with the trade unions. It provides a structure capable of recognising and rewarding the exciting developments in the maternity services--

The motion having been made at Ten o'clock and the debate having continued for half an hour, Mr. Speaker-- adjourned the debate without Question put, pursuant to the Standing Order.

Adjourned at half-past Ten o'clock.

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