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Mr. Clarke : Let us address ourselves to what the shadow Secretary of State for Health said should be done as it gives us an idea of what a Labour Government would do faced with the present situation. Mr. Frank Haynes (Ashfield) rose --

Mr. Clarke : I am sorry, but I will not give way, even to the hon. Gentleman, or there will be no time for debate.

The hon. Member for Livingston has suggested that I should push the management out of the way and intervene as Secretary of State. He thinks that I should get in the trade unions, ask them what they want and make some arrangements to ensure that they get it. I did not appoint one of the best general managers in the National Health Service, Mr. Duncan Nichol, to treat him in that way. I do not believe that that is a sensible way in which to run the service. The suggestions of the hon. Member for Livingston show the type of approach that the Labour party adopts to the management of great public services such as the NHS. The Opposition's idea is that if the unions demand something one should overrule and undermine the management, get the trade unions in and do a political deal which is acceptable to their trade union masters. That is exactly what they did in the late 1970s. All this is familiar to every hon. Member who was a Member during the Callaghan Government. The then Minister for Health--the post now held by my hon. Friend the Member for Surrey, South-West (Mrs. Bottomley)--was NUPE- sponsored. The Opposition gave so many concessions to everyone who took srike action that, by the winter of 1979, they had everyone in the services on strike. The only ones who suffered when Labour was in power were those, especially NHS employees, who would not take industrial action.

Mr. Campbell-Savours rose--

Mr. Clarke : I shall not give way to the same hon. Gentleman. Mr. Campbell-Savours rose--

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Mr. Speaker : Order. The hon. Gentleman must sit down.

Mr. Clarke : In the six years of the previous Labour Government the real-terms pay of nurses sank every year for six years. During that time, doctors' pay was below inflation--

Mr. Campbell-Savours rose--

Mr. Speaker : Order. The hon. Gentleman must not continually rise.

Mr. Campbell-Savours : Let us get back to parity.

Mr. Clarke : The BMA does not take the kind of industrial action that brings Opposition Members flocking to the Floor of the House to say that Ministers should intervene to give them the money to get the service back working.

This debate is not the way in which to resolve this dispute. The dispute will be resolved by common sense and by the responsible action of those outside. Meanwhile, everyone should discharge their duty to the NHS.

Mr. Dennis Turner (Wolverhampton, South-East) rose

Mr. Clarke : I shall not give way.

It is the duty of the London ambulance service management to make its best judgment about whether it can guarantee an effective service to the public and to seek to get its trade unions to honour the agreement that the unions made with it on 24 October. It is the duty of Duncan Nichol and his colleagues on the NHS management executive to continue to make valiant efforts--

Mr. Campbell-Savours rose--

Mr. Turner rose--

Mr. Speaker : Order.

Mr. Clarke : It is Duncan Nichol's duty to continue with his efforts to get the unions back to the negotiating table.

It is the Government's responsibility to look after the interests of innocent people whose welfare, when injured or seriously ill, is put at risk by the irresponsible action taken by the unions in parts of the ambulance service, in particular, in the capital.

Mr. Campbell-Savours rose--

Mr. Clarke : What we are hearing from the Labour party is a din. What we should be hearing from it is an appeal for common sense and an appeal for negotiations to be resumed.

I believe that the trade unions should show some compassion and concern for the people of London. They should honour their commitment to maintain the accident and emergency service. The Labour party and NUPE should tell the trade unions to get back to the negotiating table and to follow the procedures of the NHS. In that way, the dispute could be settled for those staff as it was for 95 per cent. of NHS staff.

Hon. Members : Resign!

Mr. Speaker : Order.

Mr. Tony Baldry (Banbury) : On a point of order, Mr. Speaker. It must be the right of every hon. Member to be

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able to listen to debates. I was sitting near my right hon. and learned Friend the Secretary of State, but, because of the barracking from the Labour Benches, it was almost impossible to hear what he said. Will you please remind

Mr. Speaker : Order. The hon. Gentleman was here and he saw me rise on numerous occasions.

I must tell the House that a great many hon. Members want to participate--

Mr. George Galloway (Glasgow, Hillhead) rose--

Mr. Speaker : Order. So that as many hon. Members as possible can be called I ask for brief speeches--speeches of five minutes even, if that can be achieved.

5.59 pm

Mrs. Gwyneth Dunwoody (Crewe and Nantwich) : I have listened carefully to the Secretary of State, and find it difficult to express my anger and contempt in adequate terms. I have sat in this House for 22 years. Today, I speak freely as someone who has been closely involved with the work of the London ambulance service for the past 14 years. I hold the view which I shall express today because a member of my family who has been closely involved in the issue has been driven out of the ambulance service to which he gave total commitment by the appalling pay and conditions.

When I listen to the Secretary of State, I find it impossible to believe that any serious politician can come to the House and make such scurrilous and totally unacceptable attacks on the London ambulance service or any other service. We are talking about a pay dispute which has been forced upon men and women who, day after day, give a commitment to the people of London of whom the Secretary of State spoke. Day after day, shift after shift, those men and women face increasing personal violence and great risk from increasingly hazardous diseases. They are constantly prepared to do so for wages which the Secretary of State would not accept for someone who devilled for him.

In this dispute, the Government have deliberately sought to provoke the ambulance men and women. Since cash limiting has taken over in the Health Service, the Government have deliberately sought to split those who work in what the Secretary of State constantly refers to as the emergency services from other men and women. His suggestion, somehow or other--

Mr. Dykes rose--

Hon. Members : Sit down!

Mrs. Dunwoody : The Secretary of State's suggestion is that this is a service in which less than 10 per cent. of the calls involve emergency work and for the rest of the time the staff do no more than taxi drivers. That was the implication of everything that the Secretary of State said.

The service is so stretched and ambulance workers are so tired because they are constantly working--some of them seven days a week. They include people who one day drive old ladies to hospital on coaches and the next day kneel into a battered car to give mouth-to-mouth resuscitation to save someone's life. The Secretary of State's constant assertion that these people are not ordinary ambulance men and women is not only despicable but unworthy of comment.

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Mr. Dykes rose--

Hon. Members : Sit down!

Mrs. Dunwoody : I have watched the deterioration of the service, the inability of managers to manage and the imposition of management services which do not operate.

The Secretary of State talked about the open-call system. Why is it so essential? It is essential because, when all the other systems do not work, the ambulance workers can hear one another and respond. I have known children with steel bolts in their heads saved because the open-call system was used to relay urgent messages from one ambulance to another. Time and again I have seen men and women take risks that the Secretary of State would never take. He talks about bandages and blankets. He would not care to see his family wrapped in dirty blankets, yet he dares to suggest that the ambulance men and women are wrong to refuse to co-operate without properly equipped and cleaned ambulances. What he is doing is beneath contempt. The Secretary of State is removing the dignity and the right to a decent standard of living from the men and women who provide a vital service which saves lives every day and night--not just when it suits him. I cannot tell him how much I despise that action from someone who is paid a reasonable wage and, supposedly, comes to this House as a responsible Secretary of State. He is becoming the Erich Honecker of the Government, riding his Wartburg round and round the M25, looking for a way out. Let him do the decent thing and resign with grace.

6.5 pm

Dame Jill Knight (Birmingham, Edgbaston) : The speech of the hon. Member for Livingston (Mr. Cook) was rather odd in some particulars. He finished with a throb in his throat and begged the House to vote for his motion to bring back full cover for the people of this country. The odd thing was that he had spent a considerable amount of time earlier in his speech telling us that people were receiving full ambulance cover and all the 999 calls were being answered. I was listening extremely carefully, and the fact is that we were told that 999 calls were being answered and then told to vote for the motion so that all 999 calls would be answered.

I am getting a little sick of the parrot cry for arbitration, arbitration, arbitration. I wonder why Opposition Members do not bother to find out the facts and recall history. The NHS pay and conditions have never ever been settled by arbitration. Pay and terms of service for ambulance staff and others in the NHS have always--this was so when the Labour party was in government--been settled by the Whitley council. Therefore, to suppose that this is a magic formula which the Labour party never used when it was in office is quite extraordinary.

Many misapprehensions are going round this House tonight. One is that hon. Members from one side of the House have bleeding hearts and the others have stony ones. That is completely untrue. No hon. Member has anything but admiration for the way that the ambulance personnel normally respond to emergency and more run-of-the-mill calls. Between 80 per cent. and 90 per cent. of the duties which ambulance personnel carry out are not actually emergency calls, but important calls to take people to treatment.

Mrs. Dunwoody : The same people carry them out.

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Dame Jill Knight : The hon. Lady must not pretend to have the only bleeding heart in the House, because she is totally inaccurate. We all want the ambulance staff to get a fairer wage.

Mr. Nellist : Will the hon. Lady give way?

Dame Jill Knight : No, I am trying to be quick.

The second misapprehension is that what is on offer is so unreasonable that it calls for an industrial dispute. Virtually all other staff in the NHS have settled pay claims--some of which have not produced a settlement as favourable as the one on offer. As we know, the London ambulance men are being offered 9.3 per cent. Many settlements have been made that are far below that figure. An increase of 20 per cent. in overtime pay has been offered, which does not seem unreasonable.

I believe that, during the past three years, ambulance men have been given a 28 per cent. increase. My right hon. and learned Friend the Secretary of State will correct me if I am wrong but I believe that during those three years the retail price index has risen by considerably less--I think that the figure is 9.4 per cent. Therefore, it is hardly the case that the offer is so unreasonable and--with all the discussions that can take place in the Whitley council--it seems incredible that the ambulance staff feel that they must continue with this dispute.

The fourth misapprehension is that ambulance staff should be linked with firefighters--fifth-year firefighters at that. What about first, second or third-year firefighters?

The Minister for Health (Mrs. Virginia Bottomley) : They are not paid so much.

Dame Jill Knight : My hon. Friend is correct. I sometimes think that Opposition Members will never be satisfied with any decision of a court or other body outside this House unless the decision goes their way.

Professor Clegg looked at this very point of comparability between ambulance men and firefighters. I refer hon. Members to Command Paper 7641- -the standing commission on pay comparability--a most thorough document. Hon. Members may be interested to know the yardsticks examined by the professor and his commission. He looked at the degree to which the job is made disagreeable and/or difficult by dust, fumes, wet, noise, extremes of temperature, lack of freedom of movement, lighting or unpleasant movement-- and at the degree of physical endurance involved. He also considered work performed under unfavourable environmental conditions such as those that I have already mentioned

Mrs. Dunwoody : When was that study done?

Dame Jill Knight : In 1978. The hon. Lady would do well to have a look at what Professor Clegg had to say. He considered the danger of falling from height and of incurring cuts and burns. Things have not changed-- [Interruption.] Why does not the hon. Member for Bradford, South (Mr. Cryer), who makes a fetish of involving himself in every debate from a sedentary position, not have the guts to stand up and make his own speech instead of trying to spoil someone else's? Mr. Cryer (Bradford, South) rose--

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Madam Deputy Speaker (Miss Betty Boothroyd) : Order. I think that the hon. Lady is indicating that she is not giving way. Mr. Cryer rose--

Madam Deputy Speaker : Order. The hon. Gentleman has not been called and he is wasting valuable time.

Dame Jill Knight : I should like to draw attention to a statement made by the right hon. Member for Morley and Leeds, South (Mr. Rees) when he was Home Secretary :

"People talk about special cases. But the point is that a number of people in industry in general can also put forward a special case. I must make it clear that we cannot move outside our guidelines". If that was a fair comment to make when the Opposition were in power, it is fair comment to make today.

My right hon. and learned Friend has two clear overriding duties to this country. First, he cannot allow the message to go out that failing to care for emergency patients or for those who have met with accidents or heart attacks will put extra money into people's pockets. It would be monstrous if one had only to threaten to withhold medical care to obtain an increase in salary. That is what my right hon. and learned Friend would be saying if he allowed himself to be blackmailed into meeting the Opposition's demands. The second duty--

Mr. Geoffrey Lofthouse (Pontefract and Castleford) rose --

Dame Jill Knight : I am anxious to be quick.

Mr. Lofthouse rose --

Madam Deputy Speaker : Order. The hon. Lady has made it clear that she will not give way.

Mr. Cryer : I should be quite happy to make my own speech--

Madam Deputy Speaker : Order. The hon. Lady has made it very clear that she is not giving way.

Dame Jill Knight : I have never known the hon. Member for Bradford, South to need the pity of the rest of the House.

The second duty on my right hon. and learned Friend's shoulders-- Mr. Lofthouse rose --

Madam Deputy Speaker : Order. The hon. Gentleman should not persist once the hon. Lady has said that she will not give way.

Dame Jill Knight : Many hon. Members want to speak, as I know you are aware, Madam Deputy Speaker.

The second duty that lies heavy on the shoulders of my right hon. and learned Friend is that of ensuring that all emergency calls are met. If the only way to do that is to call in the Army and the police, so be it. I do not believe that ambulance staff generally are militant people. Most of them must detest putting sick people in jeopardy. I hope that in future we can arrive at a no-strike agreement so that never again will our people have to face the trauma, worry and fear that are now in their hearts.

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6.17 pm

Mr. Charles Kennedy (Ross, Cromarty and Skye) : The placing of troops on the streets of the capital by the Health Department is a reflection of the gravity of the situation, but some of the Secretary of State's characteristic comments on it did not measure up to that gravity. There have been reports during the afternoon of some staff being suspended without pay in Manchester, Surrey and Essex, so the problem is unequivocally a national one. The dispute should never have been allowed to reach this stage. The Secretary of State could have used his office long ago to prevent that.

I want to offer one reflection on the post-Griffiths NHS management which has become visible through this sad dispute. At the time of the Griffiths report and the debates in the House on the new management structure that was envisaged--I believe that the Secretary of State was then a Minister of State at the Department of Health--we were offered an assurance of the Minister's continuing political accountability to Parliament for the NHS. Yet in this dispute the Secretary of State appears to be willing to regard the NHS from his office as a spectator sport.

This contrasts dramatically with the position that the right hon. and learned Gentleman adopted in the House only two weeks ago on GPs' contracts. He did not spectate on that occasion : he dictated. As a result of the belligerence that he has shown in this dispute and in other matters he has inflamed an already vexed problem.

The Secretary of State defended Mr. Duncan Nichol. In what The Guardian yesterday described as a frank interview, Mr. Nichol "acknowledged that he and his colleagues were failing to convince NHS staff, let alone the wider public, of the merits of the Government's health shake-up. There was, he said, a long way to go." I suspect that the Secretary of State's comments this afternoon have not got him much further down the road towards displaying concern or sensitivity about the attitudes expressed in the dispute. Elsewhere we are told that advisers advise and Ministers decide. In the Department of Health it appears that managers decide and Ministers do little more than provoke. The Secretary of State should face up to his responsibility for that.

What of the remuneration of the ambulance men and their comparability with other emergency services? The Secretary of State has made it clear on several occasions, and confirmed this afternoon, that he sets the parameters within which pay bargaining is conducted at Whitley council level, but he and the Prime Minister earlier today were disingenuous to suggest that progress can be achieved at Whitley council level, given that he has made it categorically clear that more resources will not be available. That knocks on the head any room for meaningful manoeuvre or further negotiations to try to resolve the dispute.

As the Secretary of State will not speak to them directly, it is worth letting the ambulance men speak for themselves. A constituent of my hon. Friend the Member for Berwick-upon-Tweed (Mr. Beith), a Mr. Black, who has almost 12 years of service with the Northumbria ambulance service, wrote to my hon. Friend as follows :

"Over recent years we have in this service put up with a great deal of changes, cutbacks, and streamlining, but nevertheless weathered the storm' and picked ourselves up again Mr. Duncan Nichol makes a statement that we do not compare with the Police and Fire services. It is totally

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demoralising and upsetting. As you well know we have the notorious A.1 road running through our area, and often get calls to accidents on it. On some occasions the fire service are in attendance with the police and ourselves, and sometimes there is only Police and ambulance. After Mr. Nichol's comments I feel that whenever in future I am involved with other emergency services I am going to feel inferior to them. It is ridiculous to think that we work for a service that is not classed as an emergency service."

I quote his letter in full as he gives a clear representation of how the ambulance men feel. He continued :

"Whenever we leave an incident, we leave behind us the traffic police trying to take statements, and speak with witnesses, the Fire service hosing the road, and sweeping up broken glass, and the main responsibility for the major part of the incident is left with us, which is the lives of the injured who are in our hands only, until we reach the hospital. I am not decrying another service because one service can not work without the other, but it certainly makes me think that I am part of the Cinderella Service' I have been proud to be an ambulance man and thoroughly enjoy my work, but since Mr. Nichol's remarks I have felt demoralised and sickened The opinion I am portraying is my own, but I feel that this will be the same throughout the ambulance service nationally."

When, as he must, the Secretary of State defends Mr. Nichol, will he bear in mind that that is the effect of Mr. Nichol's attitude in this dispute?

Mr. Kenneth Clarke : The Northumberland ambulance service is one of the best in the country. It has gone through considerable reorganisation and it almost solely performs accident and emergency work. It does hardly any non-emergency work. A high proportion of its staff are trained as paramedical staff. Duncan Nichol openly talked about looking particularly at paramedical staff, people with high qualifications and those who concentrate on accident and emergency services. Unfortunately, that view is rejected by the trade unions, the Labour party, and the hon. Member for Crewe and Nantwich (Mrs. Dunwoody). They do not believe in distinguishing between the tenth of the mileage for emergency work and the other nine tenths for the rest. Duncan Nichol has freely spoken about the need to consider high-quality paramedically trained staff of the kind now concentrated in Northumberland.

Mr. Kennedy : I can only state the hallowed phrase that is used when things go badly for the Government--the message somehow does not seem to be getting across to the ambulance men.

I now quote another ambulance man in my constituency, Mr. Moore. He lives in Wester Ross, a typical profoundly rural area. He writes with a sense of frustration about the conditions in which he and his colleagues find themselves. He says :

"In addition to the 40 hours which I am on duty I also do on call' duty which amounts to a further 40 hours each week. For this I receive in the region of 50p per hour. Due to economic factors many rural areas are run on a wing and a prayer. Some are still served by contractors where untrained staff are paid per mile for driving an ambulance. Fortunately, the prayer' seems to work, so far. The current dispute is a call for fair treatment-- not to get rich but to stop getting poorer."

As many hon. Members will know from their constituency work, many ambulance men are in receipt of housing benefit and family credit. That shows the inadequacy of their pay, particularly for those with young families. It cannot be good for much of their income to be derived from the state benefit system. Surely the Secretary of State can recognise the inadequacies. More skill training

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and more paramedics are needed, but resources and political will are at the heart of the dispute. The Secretary of State's speech lacked conviction.

I now refer to the longer-term implications. There should be an independent pay review board for this sector to avoid leap-frogging between the Whitley arrangement and the independent pay review bodies for certain sectors. It should take into account public and private sector comparisons, market factors and conditions in local labour markets. If we have an independent arbitration service, it, too, should consider no-strike agreements and pendulum arbitration as a way of resolving future disputes.

Clearly, the existing management structure has failed by letting the dispute reach this stage. The remuneration on offer is unfair and the denial of comparability is equally unjust. As Lord McCarthy, when he looked at the Whitley set-up, said, it consisted of

"employers who do not pay and paymasters who do not employ." The dispute is presided over by a Minister who does not seem sufficiently to care. The Army should be put back into barracks and ambulance crews should be put back on our streets.

6.25 pm

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