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Mr. Hayes : Will the hon. Gentleman give way?

Mr. Cook : No, I will not.

The irony of the present dispute is that, in the confrontation between Ministers and unions, Ministers are trying to beat down staff who are clear that they want a formula that will take their pay out of the realm of annual disputes, so that the ambulance service will never again need to be disrupted.

We now come to the central mystery of the dispute. Every attempt that the Secretary of State makes to explain the mystery leaves it more baffling than before. When he responds to the debate, he must say why, if he is so

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confident in his case and if he is so convinced that 6.5 per cent. is the just, fair and final offer to ambulance staff, he is so frightened of putting it to arbitration.

Mr. Hayes rose --

Mr. Cook : The whole country knows that the dispute would stop tonight if the Secretary of State only had the courage to go to arbitration. He does not demonstrate strength by sending in the Army ; he demonstrates weakness by running away from arbitration.

Mr. Hayes : Will the hon. Gentleman give way?

Mr. Cook : I cannot resist the hon. Gentleman tonight.

Mr. Hayes : I am grateful to the hon. Gentleman. He has a unique opportunity today to behave in a statesmanlike manner. He has the opportunity because people who are frail, elderly and vulnerable, who may die tonight as a result of this dispute, would like to hear those who have influence with the trade union movement say that no wage dispute is worth the death of an old lady or a child. He has the opportunity to say, "Go back to the negotiating table and talk about structure." The hon. Gentleman is a decent, honourable and caring man. Why does he not go to the National Union of Public Employees and say, "You have peered over the abyss ; don't let the inevitable happen."

Mr. Cook : The hon. Gentleman began with the perfectly fair point that lives are at risk and that this is an extremely grave situation. That is why we pressed for a debate today. If the hon. Gentleman believes that the situation is so grave and important that the House should consider it in a statesmanlike manner, I find it a pity that neither he nor any other Conservative Member supported our application for an emergency debate yesterday. The reason is simple : they know that their case cannot readily be defended.

Every time the Secretary of State is asked why he does not go to arbitration, he replies that he cannot because he decides how much money goes into the National Health Service and he is responsible for how that mony is carved up, so he cannot hand over decisions on that to an outside, independent body.

There is one obvious problem with that logic. Half the staff in the NHS already have access to an independent pay review body. Why should ambulance staff be so different that it is a point of principle that they cannot have access to an independent review? The real problem for the Secretary of State is that, every time he gives that answer to the question about arbitration into the microphone, every listener to the radio set knows that what he means is that he dare not go to arbitration because he knows that any form of arbitration will give the ambulance staff more money. The Secretary of State does not believe that he can convince any independent adjudicator that he is right. If he believes that his case cannot convince anyone else, he cannot really believe it himself.

Over the past three weeks, the Secretary of State has talked himself into a corner from which he cannot escape into arbitration. The House has the opportunity tonight to help him to make that escape. The House can decide tonight whether to prolong the dispute by calling in the Army, or whether to resolve it by calling in the arbitrators. I do not ask only my hon. Friends to join me in the Lobby

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for arbitration. I ask every hon. Member who wants to see full ambulance cover restored to his constituency to join us in the Lobby tonight.

5.26 pm

The Secretary of State for Health (Mr. Kenneth Clarke) : With the industrial action that we are facing now, especially in London, and with the seriousness of the issues involved, I should have thought that the whole House should be united by bonds of common humanity and concern for the plight of innocent members of the public who are being put at risk by industrial action in a key service. I shall begin by assuming that we are united in that. We should also be united by an overriding concern for the well-being of the National Health Service and all its staff, including those taking industrial action at present, and also for its patients, who look to us especially to guarantee the vital emergency parts of the service. We all profess to agree on those points, but the massed ranks of Opposition Members are here for a debate about industrial action, which they always find especially attractive. Their attitude to the dispute, judged from what various hon. Members have said from a sedentary position and, by implication, from what the hon. Member for Livingston (Mr. Cook) said, is that if we and the people of London want the ambulance service back fully, we should give the ambulance men the money or whatever they want. That is an unattractive position.

We should consider the claim made by the Whitley council trade unions which are conducting the present dispute. They do not include the Association of Professional Ambulance Personnel, to which the hon. Member for Livingston referred. That is a moderate trade union which disapproves of industrial action. It represents about 20 per cent. of ambulance men, but because of its moderate stance the staff side has never admitted it to the Whitley council. Although some of the trade unions organising sanctions have fewer members, they monopolise the seats of the Whitley council and its negotiations. The Whitley council trade unions have a claim for a pay increase of 11.1 per cent., with the establishment of a formula for determining future increases as well. The London men are seeking some London weighting above the over 11 per cent. claim that they are presently pursuing and I assume that they are looking for about 12 per cent. or 13 per cent. They have other claims, such as the reintroduction of premium rates for overtime--which they agreed to forgo in 1986--an increase in the standby allowances to bring them into line with those paid to ambulance officers, which management is minded to concede, an increase in annual leave and long service holidays, a reduction in the working week and the introduction of long service pay after five, 10 and 15 years of service. Those claims have not been withdrawn and they add up to more than 20 per cent. although it is the cash claim of more than 11 per cent. that is being pursued at the moment. The unions are determined to get that claim or something like it by pursuing industrial action. Anyone who believes that in such a difficult situation it is easy for the management of the Health Service to get the service back by giving them a little bit more must reflect on the fact that I am quite confident, as is the management from its contacts with the trade union side, that they are not

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taking the action against the people of London to get a little bit more--they are looking for rather a lot more money.

Mr. Nigel Griffiths (Edinburgh, South) : Will the Secretary of State give way?

Mr. Clarke : No, I will not give way. This is a short debate. The hon. Member for Livingston (Mr. Cook) gave way only a couple of times. When I get on to the radiotelephones, people will want me to give way and there will be no Back-Bench debate if I give way too soon.

The fact that the ambulance men are pursuing their claim through industrial action of such an extreme nature is surprising when we recall that the trade unions were recommending the management's offer some months ago, and that offer was arrived at as a result of negotiation in the Whitley council. A few months ago the union leaders who now say that the offer of 6.5 per cent. is disgraceful, recommended their members to accept such an offer. No Labour Members referred to the inadequacy of a 6.5 per cent. offer then. No Labour Member said then that those vital men should be paid more. Mr. Dennis Skinner (Bolsover) rose--

Mr. Dave Nellist (Coventry, South-East) rose--

Mr. Clarke : The reason for this noisy demonstration of support from Opposition Members now is that the ambulance men have taken industrial action having rejected the offer on a ballot. However, the trade union leaders who are now organising this action had recommended the 6.5 per cent.

Mr. Skinner : Will the Secretary of State give way?

Mr. Clarke : No.

Since the trade union leaders recommended 6.5 per cent., the offer has been improved. The men are being offered more money than their leaders recommended them to accept. The recommendation was not too surprising, nor was the fact that it emerged from the Whitely council. We are talking about a settlement which dates back to April this year.

The 6.5 per cent. offer must be set beside the 6.8 per cent. awards to the nurses and the Army. Most of the soldiers taking over ambulance men's duties today are less well paid than the ambulance men. Hon. Members accepted 6.7 per cent. and 160,000 National Health Service staff, including the ancillary workers represented by the same trade unions, also settled for 6.5 per cent. as a result of sensible negotiations.

After the 6.5 per cent. was rejected, the offer was improved--in particular, in London. The offer now, which has been rejected by the unions, is at least 9.3 per cent. for qualified personnel in London. At the moment the whole service in London is closed down because the ambulance men want more than 9.3 per cent. and they are taking industrial action to achieve that.

Mr. Skinner : Give way on that point.

Mr. Clarke : No.

The offer as it stands is worth about £13 a week for qualified staff outside London and about £20 a week for London staff. Back pay is accruing because the offer dates back to April 1989. Therefore, the ambulance men in London have at least £600 back pay waiting for them and the men outside have at least £400.

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Labour Members say that that is not enough and that we should give them the money. However, they have not specified how much. They have not commented on the size of the claim-- [Interruption.] We know why all these Opposition Members are in the Chamber now. Even the Leader of the Opposition is here. They are lured by the scent of a good strike-- [Interruption.]

Mr. Speaker : Order. The hon. Member for Livingston (Mr. Cook) was heard in comparative silence. Throughout this debate there has been a background of commentary from a sedentary position. Hon. Members should listen to the Minister's speech.

Mr. Neil Kinnock (Islwyn) : The Secretary of State for Health mentioned me specifically. If the case that he is making convinces him so absolutely, why is he not willing to let the issue go to arbitration? The Labour party and the ambulance men and women have asked for nothing more.

Mr. Clarke : In the Health Service it is necessary to settle the pay of more than 1 million staff at a level which allows management to strike the right balance between staff pay and the growth of patient services. It is necessary to be fair to all staff in every grade because most of them do vital work in a dedicated way. It is also necessary to have an overall view of how much money will be allowed for pay because some money must be left for the expansion of patient services. It would be an abdication of management's responsibility for it to say that if a group of staff strikes or takes industrial action, it will hand over its responsibility, because of that action, to an outside body to decide how much more staff should get and how far patient services should expand.

Mr. Hugh Dykes (Harrow, East) : Will my right hon. and learned Friend give way?

Mr. Clarke : If any Government tried to run the National Health Service on the basis that a group which took industrial action against the patients would receive arbitration, they would reproduce the chaos that was produced in 1979 in the Health Service by giving way to every member of staff-- [Interruption.] This is a noisy display by Labour Members because they have been drawn here by a strike. I have not seen the Labour Benches so crowded for a health debate for years-- [Interruption.] Labour Members have not been drawn here by the National Health Service; they have been drawn here to back the National Union of Public Employees in its industrial action.

Mr. Dykes : Does my right hon. and learned Friend agree that the cumbersome suggestion of arbitration is very much the second option in comparison with the direct offer of immediate negotiations to be resumed right away?

Mr. Clarke : Exactly.

So far I have described the claim with which the Leader of the Opposition did not quite have the nerve to associate himself.

Mr. Harry Ewing (Falkirk, East) : On a point of order, Mr. Speaker. Is it in order for the Secretary of State for Health to use the fact that, as always, the Labour Benches are crowded to divert attention from the fact that, as always, the Tory Benches are empty?

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Mr. Speaker : That is not a matter for me and it is taking up time.

Mr. David Clelland (Tyne Bridge) : Further to that point of order, Mr. Speaker. Is it in order for the Secretary of State, who has now twice mentioned the word strike, to mislead the House when no strike is taking place?

Mr. Speaker : The hon. Gentleman knows what this debate is about.

Mr. Clarke : In London absolutely no ambulance men are working at the moment, which by my definition is a strike.

I have covered the claim and the offer. My hon. Friend the Member for Harrow, East (Mr. Dykes) has just referred to the efforts of the management to move on given that the original offer was rejected by the men in a ballot. As we can all see, the improved offer in London has not brought an end to the action in London.

Duncan Nichol, the chief executive of the National Health Service, has been making repeated efforts for several weeks to resume proper talks between his Whitley council negotiators and the trade unions. He has publicly offered to contemplate a two-year deal including bringing some money forward from the second year into the first year. He has offered a review of the overtime arrangements because the unions are not satisfied with the way in which their 1986 agreement is working on overtime. He has referred to the possibility of local flexibility to meet particular recruitment and retention shortages and the possibility of looking in particular at the paramedical staff and the emergency side of the service.

Mr. Skinner : How much does he earn?

Mr. Clarke : That was a public statement in advance of a resumption in negotiations. I see no way in which the chief executive of the NHS can possibly go any further in trying to get people back to work and sort the problem out where it should sensibly be sorted out--in the NHS negotiating machinery. He, I and the House have a duty to all the other staff in the service. Ninety-five per cent. of National Health Service staff have settled within the ordinary agreed procedures. They are all dedicated people as well. They have claims, some of which have been met in negotiations. The management has given over 10 per cent. to some of the low -paid staff whose jobs in the past have not been appreciated.

Any group of those staff could take industrial action and do great damage to the service if they thought that that was the way to get more than the others. I cannot help thinking that there are some in the trade union movement who have every intention that some of the others should do that if the ambulance men can establish that this sort of industrial action--if one is prepared to take it--gets more money.

Having set out the claim, the offer originally recommended by the trade unions and what has been done to try to get negotiations going again, let me consider the nature of the action now being taken and organised by the trade unions against an offer that they were once minded to accept and recommend.

Mr. Skinner : Will the right hon. and learned Gentleman give way?

Mr. Clarke : No, I will not give way.

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First, we should look at the non-emergency work of the National Health Service. About nine out of 10 patients driven by ambulances are for non-emergency work such as taking patients to clinics. That is extremely important to patients especially when, as has already been described, it involves taking cancer patients to their radiotherapy sessions. That is not being provided, and in London it has stopped completely.

The Trades Union Congress has drawn up guidelines on non-emergency patients and said which categories, in the opinion of the trade unions, need to travel as non-emergency patients. In London they were offering to do about 2 per cent. of the ordinary patient journeys described as non-emergency work. The management has said that it will not pay ambulance men in full for doing about 2 per cent. of the work when many vehicles are travelling with no patients at all during the day. The reaction of the trade unions was to withdraw all that non-emergency work. They will not accept docking of pay while they are offering to do about 2 per cent. of the work. That is what brought things to a head earlier this week. The men doing little or no work were told that they would not be paid unless they did about half the work and that their pay would be docked unless they did full work. The response to that approach to non-emergency work was that the unions immediately moved to shut down the accident and emergency service in London again. They reverted to the 14 points.

We have heard much about the 14 points and the most extraordinary quotations are being made. Yesterday, when applying for this debate, the hon. Member for Livingston quoted something to do with the radio- telephones, but I still cannot find the document from which he took it. I did not recognise it as any part of the 14 points or discussions upon them. However, he may help us later.

I have a copy of the "London Ambulance Convenors News" upon which the badges of the trade unions are proudly displayed. It sets out the 14 points with which staff were to comply from Monday 23 October. That is the day on which the accident and emergency service first vanished from the streets of London. I readily accept that some of those points are far more important than others and some have nothing to do with the accident and emergency service. We are all getting bogged down with radio-telephones. Point three of the 14 points under the heading

"A ban on the use of the radio telephone"

states :

"Day crews to report at nearest hospital or ambulance station. A and E crews to assist with open-call system and to comply with blue calls, urgent assists and queries on calls."

That was a deliberate decision to stop using the new semi-automatic call and recall system which was introduced because of the inadequacy, about which Labour Members have long complained, of the old system in London. We were not complying in London with the

Several Hon. Members rose --

Mr. Clarke : I promise that I will give way on the radiotelephone, but then we must move on.

That was the point put into practice when the accident and emergency service first vanished about two weeks ago. The management has expertise, and it does not wish to use the police and the Army in London. However, it rapidly came to the conclusion that it could not guarantee an

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accident and emergency service on those terms. The open-call system had long been inadequate in London. All that it requires--as could happen--is for one microphone to be left open accidentally, or accidentally on purpose, and the whole system is aborted. It also means that one loses control of the vehicle because the crew does not report back when it has finished work. It works in the rest of the country because it has not yet been computerised, but it was known not to work in London and it was abandoned because of its inadequacy. It was reintroduced by the trade unions because of that inadequacy and because they knew the management would lose control of the whereabouts of the vehicles.

The House must ask itself, what was the motive in introducing a rule which states :

"A ban on the use of the radio telephone"?

The motive for setting out the 14 points was to ensure that the service did not work properly. That is what was achieved.

Mr. Robin Cook : The Secretary of State will acknowledge that the point explicitly said :

"A and E crews to assist with open-call system' ".

That means that they will respond to every 999 call over the open-call system. If that system is considered so appalling and unreliable that it was necessary to suspend the service and bring in the police and the Army, why was it that for 20 years until eight months ago that was the service covering London?

Mr. Clarke : It was becoming increasingly inadequate, and Labour Members were in the forefront of those complaining about its inadequacy. It cannot cope with the volume of traffic in London and certainly not when there is an industrial dispute, when microphones are being left open, nobody knows where vehicles are and they are not reporting back--

Mr. Nigel Spearing (Newham, South) rose --

Mr. Clarke : Let me move on.

That was accepted by the trade unions. The House will recall that the police, St. John Ambulance and the Red Cross were used for only about 36 hours before normal service was resumed. The management said that it could not maintain an accident and emergency service in London without the police, Red Cross and St. John Ambulance. That was worrying and the trade unions sat down with the management and discussed what to do. On 24 October the 14 points were revised and an agreement was reached.

The media and half the House are suddenly becoming experts on radiotelephones, although that is not the only issue. Point five of the 24 October agreement states :

"All operational staff, including the frontline crews, will use the radiotelephone, in accordance with London Ambulance Service radio-telephone procedures".

That is working normally and, as we all recall, the result was that the police left the streets of London and returned to their policing duties, the Red Cross and St. John Ambulance were stood down and we had a safe and reliable accident and emergency service again. That was the agreement between the trade unions and the management. The events of 48 hours ago occurred because of the rows over the non-emergency staff and because the management would not pay the men in full for offering to do 2 per cent. of the work. The trade unions broke their agreement and told their men to go back to the 14 points knowing perfectly well that they were bringing back on to

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the streets the police, the Red Cross, St. John Ambulance and--as I told the House in my statement a fortnight ago-- the Army to provide a service that they were refusing to maintain.

Mr. D. N. Campbell-Savours (Workington) : Is the Secretary of State aware of the letter sent by the five unions this morning to the London ambulance service, which says in its final sentence : "Finally, the representatives of the trade unions in London will meet you to discuss any matters the moment you restore an accident and emergency service in London?"

Will he confirm that the accident and emergency service in London to which they are referring is the system that worked in London up to eight months ago? Is that not the truth? If it is, why will not the right hon. and learned Gentleman arrange for someone to meet them?

Mr. Clarke : On 24 October the trade unions agreed to restore accident and emergency services--

Mr. Campbell-Savours : Is it true?

Mr. Clarke : It is not true.

Mr. Campbell-Savours : Is this the truth? The trade unions are offering to meet if the right hon. and learned Gentleman arranges for the restoration of the service in London to what it was eight months ago.

Mr. Clarke : It was an inadequate service. It proved inadequate on 23 October and the unions-- [Interruption.] On 24 October the trade unions accepted that they had gone too far with their 14 points. They agreed with the management that they would use the radiotelephones in accordance with London ambulance procedures. They broke that agreement to make an industrial point.

The management side offered to meet the trade unions again. My hon. Friend the Member for Bristol, East (Mr. Sayeed) was right to remind the House of my meeting with Roger Poole on television when he continued to assert that the men were prepared to operate normally. The London ambulance service management, which is desperate to get an ordinary service back, immediately contacted Chris Humphreys, the trade union leader in London, to see whether Roger Poole was confirming that the trade unions would comply with their agreement to use the radiotelephones in the ordinary way. Those London trade union leaders were pulled out of a meeting by their national leaders to avoid going back and confirming what Roger Poole had said. They are still refusing to honour the agreement that they reached on 24 October. That is the background to the dispute.

From my point of view--I believe that it should also be the view of the House--we require an effective accident and emergency service in London that can be guaranteed. People must decide who they believe can make the judgment on that service-- [Interruption.]

Mr. Speaker : Order.

Mr. Clarke : The management of the London ambulance service has expertise, judgment and is not directly party to the dispute-- [Interruption.]

Mr. Speaker : Order.

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Mr. Clarke : In the past, the management has discovered, through experience forced upon it, that one cannot guarantee an effective service with the 14 points.

The Labour party prefers the judgment of the National Union of Public Employees on how to operate the accident and emergency service in London. The Opposition have asked me to overrule the local management because NUPE has gone back on its word by breaking the agreement of 24 October. NUPE wants to operate a system that it knows will not work.

Mr. Sydney Bidwell (Ealing, Southall) rose --

Mr. Clarke : No.

My hon. Friend the Member for Harlow (Mr. Hayes) invited the hon. Member for Livingston to take a statesmanlike view. The speech of the shadow Secretary of State for Health was worthy of a shop steward in the middle of an industrial dispute-- [Interruption.] He went over the point about the radiotelephones with all the accuracy of a barrack room lawyer trying to defend the difficult position created for him by a trade union-- [Interruption.]

Mr. Speaker : Order.

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