|Previous Section||Home Page|
Mr. Roger King (Birmingham, Northfield) : On a point of order, Mr. Deputy Speaker. Many of us on the Conservative Benches are having great difficulty hearing what the Secretary of State is saying, thanks to the hooligan babbling on the Opposition Benches.
Mr. Deputy Speaker : I take the hon. Gentleman's point, and I wish that the House would give as fair a hearing to the Secretary of State as it gave to the hon. Member for Livingston (Mr. Cook). Constant heckling does little to enhance our reputation.
Mr. Clarke rose--
Mr. Cooke : I advise the Secretary of State that of the 325 defibrillators in service in the ambulance service in Scotland, not a single one has been provided from Health Service funds. Every single one has been provided by charity arrangements. Every single defibrillator that I have met on my way round the ambulance stations has been obtained by the staff of that station either through donations or by seeking sponsorship. If the Secretary of State is serious, I entirely agree that we should seize upon the common ground--expanding the number of paramedics in the Health Service. Will he tackle the scandal of the
Column 1122lack of funds provided for training? In London that has caused a six-year waiting list for people who want that training.
Mr. Clarke : The hon. Gentleman says that he wishes to increase investment in the ambulance service, and the amount of training, which he knows is costly. He would set those back if he allows excessive pay claims to take the resources required for such improvements.
Several Hon. Members rose--
Mr. Clarke : I must be allowed to move on. We have described, and I hope agreed, the basis on which we are considering the service. Surprisingly, there seems to be almost universal agreement on the desire to upgrade the status and career prospects of those in the service, and to improve its quality.
Mr. Clarke : The hon. Gentleman obviously reads the newspapers in the morning before he comes to the Chamber, and shouts about them in the afternoon. This morning, there was a description of a two-tier service of the kind that I, and the management, can see us moving towards. The description said that I have not been to Wiltshire--
Mr. Clarke : I visited the Northumbria service about 12 months ago, when I opened a new ambulance station in the constituency of my hon. Friend the Member for Hexham (Mr. Amos). I talked to Laurie Caple, the chief ambulance officer there, about all that he has done to improve the Northumbria service which, I am sorry to say, is being disrupted at the moment by industrial action being taken by some, if not all, of the staff.
If the Opposition will stop shouting about it, I think that we have agreed to get a better ambulance service within the National Health Service.
Returning to the subject of pay, I think that everyone agrees with the point of my letter to my constituent--that part of an ambulance man's work requires paramedical training, that that ought to be increased, and that the paramedics' work is extraordinary compared with other workers within the Health Service. It was a feature of the management offer at the time that there should be a higher pay rise for paramedics compared to the rest of the staff. As my letter in the Nottingham Evening Post makes clear, the unions resisted the offer at the time, saying that it was divisive and elitist. At the Whitley council they demanded that the money that the management wanted to give for paramedical training should be distributed among all the men. If the House wishes to hear good news, as far as I can tell from public statements, that is the first point on which the trade unions have moved for many months. We appear to have accepted that special attention will be paid to the paramedics in the service.
Column 1123incapable of dealing with the points raised. Will the Secretary of State explain why only one ambulance person in the county of Staffordshire has received special paramedical training, and he had to undertake the training in his own time, not in work time?
Mr. Clarke : That should be changed, and that is what we are seeking to change. I agree with the hon. Lady that the future of the ambulance service lies in tackling those deficiences. It does not lie in the support of industrial action and excessive pay claims, which is what the hon. Member for Livingston has concentrated on. The future of the ambulance service is one thing that is worth fighting for during this industrial dispute. The House must want to understand the underlying policy of the management of the Health Service and of the Government during such a damaging dispute. I did not want this controversy. We should be devoting time to more important issues concerning the Health Service.
The judgments that I exercise are managerial and political. All right hon. and hon. Members must watch this damaging dispute and ask, what is its underlying cause? Why do the management not move to the extent that the hon. Member for Livingston advises them to do? During the recess I wrote a much longer letter, in my own fair hand, and distributed it to the chairmen and managers of the Health Service. They are under great strain during this dispute. I sent copies of the letter to every hon. Member. It sets out the underlying problems in the dispute, and the underlying policy problems that would face management if we took the no doubt well-intentioned advice of some of my hon. Friends and of Opposition Members, who have commented in the media that we should move substantially from our position and buy off the industrial action.
One key underlying problem that is political as well as managerial, because it dominates the interests of patients, is that the money about which we are talking, and with which people make so free during debates, comes from the NHS budget. The arrangement whereby those budgets are cash-limited was introduced by the previous Labour Government, and I do not believe that anybody would seriously argue that we should return to completely open- ended financing. In the past two years we have allocated--
Mr. Clarke : I shall give way when I have finished this point. In the past two years we have allocated huge resources to the NHS. Those resources were increased last year and this year. An underlying dilemma of the Government's health care policy is to get the correct balance between fair rewards for staff, which is in the interests of all the staff concerned, and the expansion and improvement of services for patients. When one is in opposition one can exercise the privilege of running away from that dilemma, but one can never do that when in government. If we spend more on pay than is fair and justified we shall be able to spend less on patient services ; that underlying truth should be apparent to all.
I do not think that the scale and the sensitivity of the Health Service budgets to pay rises is understood by many people. The Health Service is labour-intensive, and 70 per
Column 1124cent. of its costs are made up of pay. When other industries, or other organisations, have difficulties with pay claims --
At Question Time today we heard that industry and other organisations are in trouble on the pay front. However, the difficulties in other organisations are dwarfed by the problems that excessive pay claims pose to a service that employs more than 1 million people. The total pay bill of the National Health Service is £13,000 million each year. When people talk about a little bit of movement on a pay claim, they must realise that 1 per cent. means £130 million. For groups in the Whitley council1 per cent. would mean £40 million, and that is the entire budget of a major teaching hospital. The entire budget of a large district health authority is £140 million.
As right hon. and hon. Members know from health authority members and managers in their own constituencies, any movement in costs makes all the difference between growth and a stagnation or reduction in services.
We have exercises in the Department of Health, and we make various assumptions about possible Whitley pay movements next year, what other movements in costs there may be and their effect on our plans to develop services. I cannot tell hon. Members exactly what assumptions we made about Whitley council pay, as the managers will obviously not make that public before starting negotiations, but I can tell them that a very small shift in the reality during the year can make all the difference between growth in services nationally and stagnation.
Several Hon. Members rose --
Mr. Clarke : Hon. Members will know when I have finished this passage when I give way to the hon. Member for Leeds, West. I can tell all hon. Members what is my political judgment in the dispute, and what is my political--with a small "p"--priority. Next year, in April 1991, we propose to reform the NHS : the coming winter will end the last year of an entirely unreformed service. The winter of next year will not be dominated by cancelled operations, closed wards and cuts in services, which would be caused if the current industrial action were successful. I will not contemplate the cancellation of operations and the turning away of patients. My hon. Friend the Member for Langbaurgh (Mr. Holt) has always been open with me : as he has frequently told me, he has supported the ambulance men's claim from the word go, and he continues to speak out evermore vigorously on their behalf. Although I respect his views, let me tell my hon. Friend that if we conceded the claim he would come to me next winter and tell me that his district general manager was complaining about underfunded pay rises, while cutting services and cancelling operations in my hon. Friend's constituency. I know from my hon. Friend's record that he will be equally vigorous and outspoken about that.
Mr. Richard Holt (Langbaurgh) : I am grateful to the Secretary of State. May I make it absolutely clear that I feel that he could have strengthened the Government's position in regard to fighting inflation if he had conceded
Column 1125a modest increase to the ambulance men several months ago, at the same time making it abundantly clear that, whatever industrial action was taken by other public employees, there would be no backing down by the Government? I should have thought that that would have commanded public support throughout the country, and I stand by what I have said.
Mr. Clarke : Let me say with the greatest respect to my hon. Friend that I have been--obviously--very closely involved in the dispute for the past four months. I can tell him categorically that there has never been a moment when a comparatively small movement on the employers' side would have produced the response from the unions that he believes it would have produced. The reason for our activity last weekend, and for the exchange of letters to which I have been trying to draw everyone's attention--because they are the basis on which Duncan Nichol is offering talks--is that we are seeking to move on, while trade unions that have not changed their position since last October are behaving as though small changes did not interest them at all.
Mr. Battle : I am sure that the Secretary of State will confirm that each year he has to go to the Chancellor of the Exchequer with his departmental bid. Is he now telling us that the bid put in by his Department last year for the ambulance workers was lower than the rate of inflation? If so--as he seems to be confirming--why can he not go back to the Chancellor, who has a £14 billion surplus, and obtain the money that the ambulance workers need?
Mr. Clarke : The public spending settlement for the current financial year--the year that we are discussing--which was the first that I negotiated, was based on a Whitley council staff assumption that I can now disclose : it was very close to the 6.5 per cent. at which the bulk of the service has settled. A total of 84 per cent. have settled for 6.5 or 6.8 per cent. Some have received more, because the management is not inflexible, and some of those groups--particularly medical secretaries, operating department assistants and junior clerical staff--had an extremely good claim. Had we not given them such awards, we should have found it difficult to recruit and retain staff whom we wanted.
The public expenditure assumptions that we made last year--the basis on which I settled with my right hon. Friend the present Chancellor of the Exchequer in deciding the amount that we are now spending--would have dealt with the amubulance men's case. The whole dispute is an accident-- [Laughter.] It is an accident as far as the trade unions are concerned : they settled for 6.5 per cent. last summer. No one on either side of the Whitley council thought that the ambulance men would be difficult this year, and Roger Poole and his negotiating team actually settled for 6.5 per cent. last summer and recommended it to their members. They solemnly believed that the ambulance men would go along with the remainder of the staff, who had accepted the 6.5 per cent.
There are two reasons why that did not happen. First, the ambulance men were surprised with a ballot ; secondly, when they went back for a second ballot, it coincided--an unhappy coincidence--with the railway dispute. Just as the ballot papers were in the men's hands, the railway management conceded an increase of 8.8 per cent.
Column 1126The money that we are spending in the Health Service this year is entirely adequate to finance a fair and reasonable offer for the ambulance men, and £6 million more will be spent on their pay this year if the management's current fair and reasonable offer is accepted.
Mr right hon. and learned Friend has the overwhelming support of all who believe that the NHS deserves the kind of priority that he has described ; nevertheless, if a no-strike, no-industrial action agreement could be reached with the ambulance men, would it not be worth settling at around 8.6 per cent., which would cost about an extra £5 million or £6 million?
Mr. Clarke : With the greatest respect, I must return to the point that I made earlier, when I tried to touch briefly on the handling of the dispute. I do not say this only to my hon. Friend the Member for Staffordshire, South (Mr. Cormack) ; I could have said it to many people over the past three or four months.
It is absurd to suggest that industrial action can be discussed and negotiated on television, radio and the Floor of the House of Commons. We are all agreed that such matters should be pursued through talks. Let me answer my hon. Friend by saying candidly, first, that I do not believe that the trade unions involved would contemplate a no-strike agreement : their constitution certainly does not include no-strike clauses, as does the constitution of the Royal College of Nursing--which is the basis of its review body status. I also do not believe that we can link the pay of any group in the NHS with automatic formulae or with people outside the service. That would undermine the ability of managers to obtain the crucial balance between patient services and pay : that must be within their control, not led by outside influences.
Is it not the case that, if a link with either inflation or another group of workers is yielded to all ambulance men, it will lead to a total breakdown of the Whitley machinery? However imperfect and cumbersome that machinery may be, such a breakdown would surely lead to chaos in this year's pay round.
Mr. Clarke : My hon. Friend was the chairman of a district health authority. He is quite correct. We should destroy good industrial relations in the National Health Service if we allowed one Whitley council group to be automatically linked to another group outside the National Health Service.
Mr. Campbell-Savours rose --
Column 1127Mr. Clarke : I read in the newspapers that I am under pressure from my Back Benchers. I am under very strong pressure from my Back Benchers not to give way to the hon. Gentleman.
The key question is what is to happen now. That is what the whole House wants to know. All disputes have to be resolved, and we need to know how this one is to be resolved.
Mr. Ray Powell (Ogmore) : On a point of order, Mr. Deputy Speaker. Is it in order for a Minister to say that he does not intend to allow an hon. Member to intervene as a result of pressure from his Back Benchers?
Mr. Clarke : What happens will depend on Roger Poole and his team. Those hon. Members who wish to know exactly where we stand should do what I have recommended those outside the House to do : to study the exchange of letters between Roger Poole, Duncan Nichol and myself about the basis on which talks could be resumed. There was confusion at the weekend in the reporting, but there has been no confusion about the position and there has been no change in it whatsoever. We have had repeated talks, in public and in private. The trade unions are not putting anything, either publicly or privately, to the Health Service management that has not been heard before, either at ACAS in October or at the last Whitley council meeting in December. A proposition has been put to Roger Poole which he must consider. He has one public line, which we all know. It is, "Come on, Ken, let's sit down, have talks and settle it." The talks with Duncan Nichol, which is where they should take place, cannot go on for ever if the same things are said every time a meeting is held, and then suddenly feelings are aroused because the talks have broken down once more. The Health Service management has made it clear that the 9 per cent. claim that Roger Poole is pursuing is unacceptable and cannot be afforded by the NHS. The formula is not acceptable, either, for the same reasons as were advanced by Governments and managements throughout the entire time that I have been a Member of Parliament. That view is held strongly by the management, the district health authority chairmen and the chairman of the relevant Whitley council, David Rennie, whose letter appears in this morning's press. When Mr. Poole says that he is prepared to come to the management and say something new, we all hope that talks will again resume. I am delighted that no hon. Member has tried to intervene on that point. Ms. Ruddock rose--
Duncan Nichol wrote a letter in which he said that he would be prepared to have talks on the position that I have clearly set out. Understandably, journalists and Members of Parliament then asked me what he would say if the talks were resumed. I am accused of having occasionally lost my cool in the dispute, but I have not yet turned round and said to anybody, "That was a silly question to ask." In a recent early-morning radio programme I was persistently asked that question, after an invitation to talks had been issued. I could not say, "I shall now tell you publicly what Duncan Nichol wants to say if the talks are held." We have
Column 1128reaffirmed emphatically several times, as I did publicly at the weekend, that there is no question of the NHS making more money available. There is no question of any formula.
People try to give helpful advice on industrial relations. They ask, "Does that not mean that you are rather boxed in?" Of course it does not. Many of those who have commented throughout on the dispute have not followed any of the details. They have followed the froth--[ Hon. Members :-- "Oh !"] Oh, yes. The management made a final offer last year to the Association of Professional Ambulance Personnel and the TUC unions. Since then the management has said, and I support it, that there is no more money and that there is no formula. The final offer has been publicly available for weeks. The exchanges between Duncan Nichol and Roger Poole have also been available for weeks. I am sure that no hon. Member who takes part in the debate and criticises our offer will have read the final offer. So far, I have not been interviewed by anybody who has read it. I have never been faced by an opponent, such as the hon. Member for Livingston, who has betrayed any sign of having the first idea of exactly what we have offered, or of knowing where we are in the discussions.
Let me read paragraph 4 of the offer. It proposes that the management and staff sides should undertake
"a joint review of the 1986 salaried structure in the light of 3 years' experience, designed to take the ambulance service into the 1990s. There will be no preconditions as to scope or timing of the implementation of any agreements reached."
The paragraph goes on to refer to important matters, as I know from my discussions with the management, who are not ciphers. They have to determine the negotiations. They have strong views about the details of the negotiations, since they have to deliver the better ambulance service which I am requiring them to deliver as a matter of policy. The paragraph refers to flexible local arrangements and improved productivity, because productivity in the National Health Service, as in other services, can release the resources required for paramedical training and the additional pay that the staff require. All that is in the final offer and provides scope for further discussions.
Mr. Clarke : No, I will not-- [Hon. Members :-- "Give way!"] No. One can be a little more expansive in answers to questions to hon. Members than one can be outside. I have gone further into the substance of the discussions here than it has been possible to do outside.
That is the offer in Duncan Nichol's latest letter concerning the discussions that should now take place, on a basis that is designed to take the ambulance service into the 1990s. It is no good stepping up industrial action in pursuit of 11.4 per cent., or 9 per cent., or any industrial formula.
Mr. Robinson : It is no use the Secretary of State talking about an ambulance service for the 1990s when we do not have one in 1990. So long as he stands behind Duncan Nichol and instructs him to say that no more money is available, there can be no settlement. There will therefore
Column 1129be further disruption in the months ahead. He is simply calling for unconditional surrender by one side. One cannot negotiate on that basis.
Mr. Clarke : I am sure that the hon. Gentleman was trying to be helpful. The Labour party could be helpful if it urged the resumption of talks on the basis that the management has set out for the unions. They should seriously consider the offer. All of us have other important work to do in the NHS. No one wants patient services to be disrupted for a moment longer.
I wish to concentrate on the NHS reforms. Duncan Nichol wishes to concentrate, with his management team, on providing better services for the NHS. The ambulance workers have better work to do. They should be doing what they do so well--caring for sick and injured people and providing a good, reliable service to the National Health Service. I urge them to resume those duties confident that sensible talks will take place between management and trade unions. 5.59 pm
Ms. Dawn Primarolo (Bristol, South) : It is an extreme distortion and perversion of reality for the Secretary of State to juxtapose the pay of ambulance men and women with the equipment that should be available in the National Health Service. It is even more perverse when we consider that we have a £14 billion surplus. Some of that money could be used to increase the wages of ambulance men and women and to provide the National Health Service with the equipment that it needs.
I found it strange that the Secretary of State made so many references to publicity. The Government are not normally shy about spending taxpayers' money to maximise their own political publicity. They did it with water, gas, Telecom and electricity and the Secretary of State did just that in a futile way during the ambulance dispute, when he attempted to appeal directly to union members over the heads of their union representatives, asking them to abandon their demands for a decent pay increase and a linked pay formula. Unfortunately, among many other things, the Secretary of State failed to understand that the ambulance men and women decided to do what the Government suggested--they took the union back into the control of its members and demanded action against the pitiful pay award that the Government had offered.
This afternoon, in a speech lasting nearly 55 minutes, the Secretary of State said that there were three key points to the dispute. First, he said that the claim was excessive. He obviously believes that the pay of ambulance men and women is excessive. I should like to see him survive on the pay that they receive for the hours that they work and then tell the Chamber in all honesty that their pay is excessive. Secondly, he said that the management's offer was fair and justified. The offer was 6.5 per cent. During Prime Minister's Question Time this afternoon the right hon. Lady told us that the rate of inflation was 7.6 per cent. Perhaps the Secretary of State would like to explain to the House, to the country and to the ambulance men and women how a pay award which is less than the rate of inflation, which represents a salary cut, is fair and generous. It certainly escapes me. His third point was that industrial action was against the patients. He is a fine one
Column 1130to talk, having called in the police and the Army, who are doing their best but are providing inadequate services to deal with our emergencies. Every time the inadequacy of training and equipment was pointed out to him, the Secretary of State said, "That is a very good point. There should be more." Saying that in the House of Commons does not pay ambulance men and women a decent wage and does not ensure that the National Health Service has the proper resources to do its job.
The Government's record in the ambulance dispute is dishonourable and arrogant. They have changed their attitude before and during the dispute. Much reference has been made to a letter that the Prime Minister wrote to an ambulance man in Somerset on 22 August 1978 when she was Leader of the Opposition. The Government make great play of what happened in the latter part of 1978 and the beginning of 1979. The Prime Minister said then that she accepted that ambulance services were part of the emergency services, as were the police and the fire brigade, but that they deserved a pay award that was linked in the same way as that of the police and fire services. I have a copy of the letter and I am happy to read it out if hon. Members do not believe that it exists, but I know that the Government are aware of the letter.
Earlier this week the Prime Minister claimed that her Government acted on sound convictions and principles. But they are the convictions and principles of distortion, fair weather ideas and changing their mind about their principles when it best suits them. What is so unreasonable about ambulance workers asking to be linked to a pay review body? We have one, civil servants have one, and so do many other workers and services. The Secretary of State says that the ambulance service is not an emergency service. He admitted in his speech today that not all emergency calls come through the 999 service. He talked about referrals by GPs and patient admission. But he did not mention referrals between hospitals. In the south -west patients can be transported from Cornwall to Bristol by emergency ambulance to the nearest hospital able to treat them. Nor did he mention the fact that the ambulance service is used to take terminally ill patients to hospices to spend the last painful hours or days of their lives.
The Secretary of State went on to talk about the structure of the service. He tried to divide up the ambulance service, saying that some staff are only drivers and others are crew. He should examine the career structure of ambulance men and women. When they enter the service, they have to learn how to drive the ambulances and qualify to drive them at speed. They also have to acquire the qualifications that he mentioned, which enable them to carry out emergency treatment. He should also remember the physical problems and the great stress that ambulance workers suffer because of their job. They have to scrape people off the motorways. They have to take care of dying children. They have to make an effort to resuscitate people and save their lives. Those workers pay an enormous price in terms of their own health, and at times it is necessary for qualified workers to be transferred from the emergency services to the services that are not on the front line for health reasons or because of stress. The Secretary of State mentioned his letter to health authority chairmen--it is a truly extraordinary letter--which I have read. He must make up his mind. Is he
Column 1131interfering and directing the dispute? During his 55-minute speech he changed his mind several times about his role in it.
It is necessary to remind hon. Members--particularly the Secretary of State --of the contents of the letter, which is dated 3 January and which was circulated to hon. Members on that day. He said : "No Secretary of State has ever settled the pay of any group of NHS workers".
In that case, why is he setting the absolute limit on the pot of money that is available to be negotiated? Is that not intervention? He continued :
"Moves of that kind would undermine the authority of NHS management".
The Government's action has shown that, unfortunately, the management of the National Health Service are Government puppets. They have done much to undermine the integrity of the management involved in the dispute.
Having said that he is not involved in decisions, the Secretary of State said :
"There are other very important policy reasons which make Duncan"-- he is referring to Duncan Nichol--
"and me, management and Government, quite determined to get the right result to the present dispute."
The Secretary of State told us this afternoon that he is not directly involved in the settlement of the claim, although he clearly has in mind the outcome to the dispute that he wishes to see. That is the hidden agenda.
What the Government are up to when they talk about the ambulance service of the 1990s is its privatisation. The Secretary of State announced two privatisations in November. My region in the south-west is undertaking a review of privatised services. It is linked to the concept of multicontract privatisation in the Health Service, which is how the process has had to evolve. It is necessary for the negotiation of multicontract privatisation that the ambulance service is split between what the Secretary of State euphemistically calls a taxi service, or professional drivers, and the emergency service.
Mr. Roland Boyes (Houghton and Washington) : Is my hon. Friend aware that there are two private hospitals in the north-east, one of which is in my constituency and the other in Newcastle? Mr. Laurie Caple, who is the head of the Northumbria ambulance service in my area, has set aside a number of ambulances for people attending private hospitals. We in the north-east believe that that is a small step that will become a big step in the future.
I am worried that we shall be faced with the grotesque scenes that are not uncommon in the United States, where private ambulance services rush to an accident and can be seen arguing about who got there first and who should therefore take the patient to hospital.
Mr. Bob Cryer (Bradford, South) : My hon. Friend has been talking about privatisation. Does she accept that the dispute could have been solved with a tiny fraction of the money that the Government have thrown away on publicity, dodges and fees for the City in the £2 billion cost of privatisation?
Column 1132million that the Government will spend on the National Health Service reforms, which will mean its destruction. Rather than spend that money on so-called organisation, they should have spent it on services, pay and equipment. In his letter, the Secretary of State hints strongly that that is the future of the Health Service and of the ambulance service in particular. He says :
"The organisation of the ambulance service is likely to make much greater distinction in future between the emergency work and the routine patient transport services."
That is because privatisation and multicontracts will require the division of the service.