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Mr. Hayes : My hon. Friend has only just come into the Chamber and he will have the opportunity to speak in a moment. However, as he is a dear friend and can buy me a drink in a moment, I shall give way.

Mr. Budgen : I know that my hon. Friend has taken a great deal of interest in the details of the dispute. Has he given any thought to who might chair the review body? Perhaps he has Professor Clegg in mind for the job.

Mr. Hayes : I regret that my hon. Friend, uncharacteristically, has not been listening. I said that a review body and linkage to the emergency services should be ruled out. I suspect that a pay mechanism could be a basis for discussion and negotiation, but not if it is across-the-board, or could be inflationary, as has been suggested in the Government's amendment- -and I shall support that amendment tonight. We need a mechanism that will help emergency workers in particular.

Some of my hon. Friends have mentioned the deplorable state of some of the emergency services, and the number of paramedics. I was horrified to learn that there are only eight paramedics in the London ambulance service, whereas Essex, which is a good deal smaller, has 30. The number depends on the dedication of chief officers in the service. I hope that once the dispute is settled there will be an initiative to encourage the training of paramedics. When one looks at the situation in other parts of the country, for example Yorkshire and Essex, one sees that it can be done if there is the will.

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

Mr. Hayes : I am sorry, but I am running short of time. There has been a lot of criticism of my right hon. and learned Friend the Secretary of State, and I regret that. During the dispute, he has been in an impossible position, because there has been so much media hype. We all know that he cares deeply and passionately about the Health Service. He is like a man on a tightrope : we see him walking across ; we wish him well ; we hope that he does not fall ; but none of us wants to be there with him. The best way to move towards an honourable settlement is not to crush one side to the ground. There should be no victory for either side. I support the amendment tonight, but I wish to encourage the Government to be flexible, as I have suggested in my speech.

8.5 pm

Mr. Jeremy Corbyn (Islington, North) : At present, we are in an unbelievable situation in Britain, if one cares to step back and look at it. Trained, skilled ambulance crews are waiting in their stations, ready to work and prepared to deal with any emergency. They turned out the other night on the M25, and over Christmas for every emergency.

The police are trying to operate an ambulance service in police vehicles that are not equipped or safe for the job. They are no more than freight vehicles but they are carrying people around in them. The police do not know what they are doing, and they would be the first to admit that they are frightened by that.

When ordinary people ask a police station, or the 999 service, if they can have the telephone number of the local ambulance station to get an ambulance to come to the scene of an accident, they are denied that information. The police have been instructed not to give it out.

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Army vehicles, with all-terrain and all- weather tyres, are skidding around the greasy roads in London, and that is very dangerous. They have ill-experienced crews and no equipment, and they are completely incapable of doing the job. They would also be the first to admit that. Young soldiers, policemen and women are scared out of their wits every night when they are sent out on 999 calls. However, skilled crews are waiting in every ambulance station who are ready, able and willing, and they are prepared to do the job.

Who is putting people's safety at risk? Is it the ambulance crews, who are in their stations ready to go out and deal with any emergency? I think not. I think that the person responsible is the Secretary of State and there is no point his hiding behind Duncan Nichol and everybody else.

If I were a psychiatrist, I should say that the last 20 minutes of the Secretary of State's speech showed some counselling angst. He was saying that nobody understood him. He was saying that there is a conspiracy among newspaper journalists and television reporters to misrepresent what the Government are saying. It comes ill from the Tory party to say that, when it has the support of 95 per cent. of the newspapers in Britain.

Mr. Phillip Oppenheim ( Amber Valley) : The Guardian and The Sun ?

Mr. Corbyn : Readership of The Guardian is about 400,000. Tragically, sales of The Sun reach 4 million every day. That is a big difference, but perhaps the hon. Gentleman is not very good at arithmetic and cannot work it out.

The Government are on a hook of their own making. They thought that the ambulance workers were not serious about their claim. They were serious about their initial pay claim, and they are serious about it now, because they care about the service. Many highly skilled and trained ambulance workers can no longer afford to stay in the service.

Hon. Members should ask London ambulance workers about their position. They cannot afford to buy housing in London because their salaries are so low, and they cannot obtain council accommodation because there is none to be had and none on offer to them. They would like to look forward to a lifetime in a service that they love, doing a job that they enjoy, but they cannot afford to stay in it. The ambulance men have presented a reasonable claim : they want parity with the fire and police services. Is the ambulance worker who arrives at the scene of an accident really worth £60 a week less than a fireman--and an even larger amount less than a police person who is directing traffic, among other things? No : all those workers are equally valuable and equally necessary in their own way. Why are the ambulance workers being treated so badly?

Conservative Members are always paying tribute to the ambulance service-- and I readily join them in that, for I have witnessed and experienced their work--but have Conservative Members considered the trauma involved in pulling children out of car crashes? Has any of them imagined what it was like to pull people out of the Clapham disaster, and all the other disasters that we have seen, and then, a few hours later, to be back on the job not knowing what the next task would be? Have Conservative Members considered the abuse that ambulance men receive--for instance, on a Saturday night, when they pick

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up drunks who may take a swing at them? And, after all that, they are told by the Secretary of State that they are no better than qualified drivers.

I do not wish to be disrespectful to qualified drivers ; they too do a valuable job. An ambulance worker, however, does a much more valuable job than merely driving a vehicle. This is not a taxi service or a freight service, but an emergency service that is the envy of many other countries.

The Government thought that they could face out the ambulance workers and win the dispute. They thought that they could make it go away by means of their usual tactic of smearing the union leaders and workers concerned-- saying that they do not care, and that they are hasty, greedy, brutal and brutish. Then they discovered that the majority of people simply did not believe any of that, because they have some experience of the ambulance service.

It is no accident that a petition expressing support for the ambulance workers contained nearly 5 million signatures. It was the biggest petition ever presented to the House, certainly in the past 150 years. Every day there are queues of people in the Holloway road in my constituency, waiting to sign petitions and to put money into the collecting buckets. They want the ambulance men to win and to be paid decently, because they want the security of knowing that there is a proper ambulance service.

The Government's con trick has failed. They are now pleading that that is because Roger Poole is so good on television. Compared to the Secretary of State, Roger Poole is very good on television, but I know that he would not mind my saying that the public support for the ambulance men is not just because of him : it is due to the public's perception of the service, and of the justice of the men's claim. The Secretary of State ought to realise what is going to happen. He is a long way into the dispute. He keeps saying that it is nothing to do with him, that he cannot afford it, that Duncan Nichol is doing the negotiation and that conceding the men's claim would unleash a spate of further NHS pay claims. There are several points there. First, Duncan Nichol is now earning some £70,000 a year, following an increase in his performance-related pay, while heaping abuse on the ambulance workers. The Secretary of State, like most hon. Members, has a guaranteed annual pay rise because of the linkage arrangements, although I understand that he has not managed to obtain quite the same pay increase in his role as a Cabinet Minister ; we shall pass the hat around for him if he is hard up. Is he really in a position to lecture the ambulance workers about their perfectly reasonable pay claim? Of course he is not.

The Secretary of State keeps saying that accepting the claim might lead to other demands in the Health Service. What he fears is that it would lead to a public examination of the low pay received by many Health Service workers. We treat our health workers scandalously. They are threatened with privatisation if they ask for a pay rise, and, if they ask for one, they are told first it would have a knock-on effect on another sector, and then that it would affect patient care. What is affecting patient care is the obsession of central Government with creating a market economy within the NHS. The reason why 140 hospital beds have been taken out of use in the Islington health authority area is not the greed of health workers, but the meanness of the Government who have underfunded the authority.

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The Government's long-term objective-- which, I think, is behind the dispute--is the breaking up of national negotiations and the privatisation of the ambulance service. They know perfectly well that, if they succeed in privatising any service, the power of workers to negotiate pay rises is reduced, because they are subjected to the competition of the unemployment queue.

Tonight's debate is very timely. Millions of people will have heard what the Secretary of State really said, and will have observed the meanness of his attitude. Those people will again demonstrate their support by signing petitions, collecting money and taking part in the stoppage on 30 January, and at some point in the not too distant future we shall see that same Secretary of State, at that same Dispatch Box, announce a settlement--and a big rise in the ambulance workers' pay.

8.15 pm

Mr. Peter Thurnham (Bolton, North-East) : I was surprised to hear my hon. Friend the Member for Harlow (Mr. Hayes)--who has just left his seat-- say that he regretted that we were having this debate tonight, because he seemed to have been having a continuous debate on the subject for many weeks. My hon. Friend felt that tonight's debate would not add to our understanding of the position. I, too, feel sorry that we are having the debate in such circumstances, but I believe that it has enabled us to gain a deeper understanding of the dispute. I agree with my hon. Friend the Member for Fylde (Mr. Jack), who said that it had opened a Pandora's box, and that the management of the ambulance service will be different in the future because of the greater knowledge and understanding that has emerged. I dislike all disputes, but surely this dispute is the best possible example of the need for reforms in the National Health Service. I dislike disputes in the Health Service most of all because the service is far too important to be fought over in this way. I am, however, surprised at the extent to which those who are committed to its success have been able to maintain it. I have not received a single letter concerning a specific failure to provide patient care, nor have any of my colleagues to whom I have spoken. That is a remarkable tribute to National Health Service workers' determination to maintain standards, and to look after the vulnerable members of society--especially the elderly and the mentally ill- -who rely so much on the non-accident and non-emergency aspects of the service. Any attempt to resolve the dispute through a return to the old days of beer and sandwiches at Downing street would be entirely the wrong approach, and I must differ with Opposition Members who feel that that is the way in which to treat the Health Service. The hon. Member for Islington, North (Mr. Corbyn) said that we treat our health workers scandalously, and that it is wrong for the Government to look to market- economy measures. I say that it is scandalous to treat health workers as Opposition Members would like to treat them, with collective bargaining systems that are entirely unresponsive to the need for extra skills. Ambulance workers need more training, and the way to provide for that is to allow them local negotiation. I was appalled by the remarks of the hon. Member for Durham, North-West (Ms. Armstrong), who attacked the

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general manager of the ambulance service in Northumbria. Let me quote some of what I have read in the Sunday press. The Sunday Telegraph tells us :

"The Northumbria Ambulance Service has drawn up plans to become self- managing under the Government's Health Service reforms." If ever there was an example of the need for those reforms, it is the current dispute. The report continues :

"If it does opt out in 1991, it will become a model for the future. Already health officials in Newcastle upon Tyne are planning for a future in which ambulance drivers will receive £3,000 a year more than today--with no strikes."

That is what we should aim for. I understand that the service also intends that every driver of every ambulance should be fully skilled as a paramedic.

The article continues :

"Northumbria is an outstandingly efficient service. Skilled management has brought big savings and the service has started selling its expertise to the private sector. Northumbria's free enterprise includes a radio-paging service, ambulances, vehicle maintenance and first-aid training. This is the thin end of the wedge for the Health Service and local government, where an end to national bargaining would appear to have great awards."

The Sunday Correspondent also carried an article on Northumberland's example to the rest of the Health Service. It says :

"There the service was re-organised in the mid-1980s : five ambulance stations, 73 vehicles and 79 staff were cut. The transporting of elderly people to day hospitals was hived off to a separate service, still run by the health authority. But the rest of the work (43 per cent. of the total journeys) carrying out-patients, is now contracted out to private companies which run taxis and minibuses.

The result, according to Laurie Caple, the director, has been improved emergency response times (from 83 per cent. answered within 14 minutes to 98 per cent.) and shorter waiting times for out-patients."

Amazingly, with this better service,

"he is also saving £2.6 million a year on a total budget of £10 million. Mr. Caple would like the freedom of local pay bargaining : and he would increase the pay of the paramedics. That ambition has until now been anathema to the ambulance staff and their unions. It explains the duration of the dispute--and the increasing frustration of those responsible for prosecuting it."

I received in my post today a letter from Mr. Bob Abberley, the parliamentary officer for the five ambulance unions. He gives me his mobile, his home and his office telephone numbers. Enclosed with the letter is the briefing material on the ambulance dispute, as the unions see it. It contains a most extraordinary statement. The briefing paper says that the NHS chief executive

"has refused to hold further talks unless the unions reveal their position before a meeting is called. The unions cannot do this because they believe that would undermine the whole bargaining process."

That is a most extraordinary statement. The unions are undermining the whole bargaining process. They have the Whitley council, although it is not much better than the old Burnham council. The unions are undermining that process by trying to reach an agreement here. The hon. Member for Livingston (Mr. Cook) said that he thought that the unions would settle for 50 per cent. less than their claim. What grounds does he have for making that statement? Is he trying to reach a settlement across the Floor of the House? What an absurd way to try to manage the National Health Service. It has to work within the cash limits that were introduced by a Labour Government. The NHS has to live within the cash limits discipline.

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My message to the unions is that they should work within that discipline. That is what Mr. Nichol is trying to do, that is what he is paid to do, and that is what everybody else has to do. We have to seek a flexible method of local pay bargaining that will reward skills and provide us with a much more highly skilled ambulance service than we have now and a far more satisfied and much better motivated work force. Ambulance personnel will then be rewarded for their additional skills and their dedication. I commend Northumberland for setting an example that I hope the rest of the country will follow. We should provide the flexible pay bargaining structure that the ambulance men so obviously need.

8.23 pm

Mr. Martin Redmond (Don Valley) : The Secretary of State's arrogance and conceit are matched only by the Government's arrogance and conceit and that of the vast majority of Conservative Members. A few Conservative Members have referred to the need for a settlement. The two sides must be brought together. The debate will not have helped to bring them together. Those Conservative Members have obviously been looking at their parliamentary majorities and the opinion polls, which show strong support for the ambulance men. I pay tribute to the marvellous work that ambulance men do. I am a former HGV 1 driver, right at the top of the list of professional drivers. If I were to be involved in an accident, I should prefer ambulance men to come to my aid rather than an HGV 1 driver, because their skills are completely different. The ambulance man does not deserve to be called a professional driver ; he is far more than that. The Secretary of State should spend a little time with ambulance men during the night and on emergencies if he wants fully to appreciate the duties that they perform on behalf of the public. The Secretary of State is not speaking on behalf of the Health Service. If he were, we should not be here this evening. He said that a 1 per cent. increase in pay would cost about £340 million. It was the most significant statement that he made. It was a clear message that the Government are deliberately seeking to keep down Health Service costs. The Secretary of State referred to the fact that 70 per cent. of costs are due to wages. He should have said that in no circumstances will the Government link Health Service workers to the wages structure of any other workers.

People work in the National Health Service because they want to serve the public. They are the Cinderellas ; they put patients before wages. They have not been prepared to take industrial action and put people's lives at risk, so their wages have gradually been eroded. We should all be ashamed. The vast majority of people of this country are prepared to pay, either through their taxes or through their national insurance stamp, for an adequate Health Service. All this tinkering round the edges is designed to bring about privatisation. The Government want to split up the NHS, but privatisation does not lead to El Dorado and all kinds of wonderful benefits. It gives an increase to the few, but after privatisation the vast majority have to suffer wage cuts. The Secretary of State for Transport should be here. He is not afraid to give wage increases above 6, 8 or 10 per cent. He gave a huge wage increase to the head of British Rail, Bob Reid.

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The Prime Minister talks about Victorian values. In Victorian times the worker had to doff his cap to the management. The Prime Minister wants us to return to such Victorian values. I do not. Management and employees should be part of the team and should provide a service. The Secretary of State has put himself into a trap of his own making, and he does not have the gumption or the courage to admit that he is wrong.

The work of ambulance men cannot be compared with other jobs. Of course ambulance men perform a job different from that of nurses. The Secretary of State really should get off his backside and resolve the nurses' outstanding wage claims. Many cases have been waiting for two years to be resolved. Ambulance men are different from the police and the fire brigade, but they perform a similar function.

Job evaluation is also important. The unions are prepared to talk, but it would appear that management is not. I used to be on the Whitley council. Nichol can only work within the terms set down by you and the Government. If you want to resolve the dispute, you should not keep sending letters through the post and sending Nichol back to the negotiating table, because he has no power. Get off your backside, get back to the table and get negotiating. You are setting the terms ; it is not Nichol. You say that industrial action is putting patients at risk, but it is not the ambulance men ; it is the fact that you are refusing to budge.

Mr. Tom Clarke (Monklands, West) : He is not "you" ; he is the Minister.

Mr. Redmond : I apologise. I was referring to the Government, the Secretary of State and the Minister. I could think of something else to call him.

We really want to resolve the dispute. For Christ's sake let us get the two sides round the table negotiating because they cannot negotiate through the media or by letter. They have to get round the table and discuss it. There is a whole range of possible options, but I know the biggest stumbling block. I have been involved with management before and only a stupid management creates disputes. The reason why there is no early result is that no one wants to lose face. People are dying and a little loss of face would not go amiss in saving lives.

8.31 pm

Mr. Tim Devlin (Stockton, South) : I begin by paying tribute to the ambulance men. Many years ago I trained as a Royal Life Saving Society instructor and examiner. I spent some time in my teens teaching first aid and I was involved with the emergency services. I have also been a member of the Thames rescue service, so I know what a fully-trained ambulance man can do in an emergency. We all owe them a great debt of honour for the fine service that they provide throughout the country.

The dispute turns on one issue--whether there should be a formula for the settlement of future pay disputes in the ambulance service. That is not a new question. I was interested to hear my hon. Friend the Member for Derbyshire, South (Mrs. Currie) draw attention to the ambulance dispute of 1979. On that occasion the former Minister of Health, now Lord Ennals, was refused access to a hospital because a shop steward, I think representing NUPE, said that he was not genuinely ill. That was rather distressing for all involved.

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I also read the debate in the House on 21 February 1979 about the ambulance service industrial dispute. It was a goldmine of remarks from the Labour party. I was trying to discover what the Opposition propose and their attitude to these matters. Perhaps I can draw attention to column 427 where a Mr. Pavitt--I do not know who he was-- [Interruption.] I am sorry, I understand that he died last week. I am a new Member, and I did not know that. Mr. Pavitt said : "In the longer term, is not a revision of the whole of the Whitley Council machinery within the National Health Service overdue?" He asked that question referring specifically to the ambulance service. Lord Ennals, the then Labour Minister, replied : "On the second question, the important report that was produced by Lord McCarthy was carefully studied. It led to considerable changes. It may very well be that other changes may be proposed. Certainly the Government are ready to look at them. We have already had a careful look at the way in which the Whitley Council system works. Basically it works well."

That was the attitude of the Labour party then and it does not appear that there is any good reason for it to have changed since. In the next column, Mr. Arthur Lewis asked :

"Is the Minister aware that ambulance workers, rightly I think, claim that as they have always been allied to the life-saving services, such as the police and the firemen, they should be treated like them?"

The Labour Minister of Health replied :

"However, it must be recognised that only 10 per cent. of the time and duties of ambulance men is spent dealing with emergencies. The rest is spent dealing with non-emergencies. Therefore, that emergency 10 per cent. is an important part of their task."--[ Official Report, 21 February 1979 ; Vol. 963, c. 427-28.]

The Labour Government then asked Professor Clegg for his proposals.

On 14 September 1989 The Times reported that the ambulance men "should be seen as part of the emergency arm of the health service rather than the health arm of the emergency service. They cannot realistically be considered in isolation from other staff in the health service, some of whom are no less essential in meeting the immediate needs of accident victims and other urgent cases". This year, 94 per cent. of NHS staff settled their pay without recourse to industrial action. The vast majority of them have settled at around 6.5 per cent. Almost 500,000 nurses, for example, received a 6.8 per cent. increase. It would be manifestly unfair to those workers to give additional rises to ambulance staff simply because they have taken industrial action. Moreover, it would be disastrous if every year the NHS pay round opened with a benchmark award to ambulance staff based on some generous formula similar to that of the police. For the reasons that I have just given, the two services are not strictly comparable, although 10 per cent. of them might be. I pay tribute to those 10 per cent. who have paramedical skills. However, 90 per cent. of the work is routine. The Independent reported on 1 November that 12 per cent. of the work undertaken in the average county involves those skills.

I draw attention to a newspaper which I know has the sympathy of many Opposition Members. On 18 September 1989 The Guardian reported that one

"option which would be opposed by the Unions would be to separate emergency from non-emergency work. Much non-emergency work is no more difficult than mini-cab driving."

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My right hon. and learned Friend the Secretary of State was accused of being callous because of his alleged remarks--if I could I would underscore the word "alleged" in Hansard, as that is not strictly what he said.

My hon. Friends the Members for Leeds, North-East (Mr. Kirkhope) and for Bolton, North-East (Mr. Thurnham) referred to the service adopted by Northumbria where such a two-tier system works extremely well. Private contractors deal with 40 per cent. of non-urgent cases and the two-tier system that has been working for some years has generated savings of £2.6 million on a budget of £10 million. That money has been invested in improved services such as defibrillator machines and greater training for emergency crews. Overall, the response times in Northumbria, which is one of the largest ambulance regions in the country, have improved. One third of the 370 dedicated accident crews have full paramedic training and basic training is given to the drivers of private line buses.

Wiltshire is another county that uses trained crews only for emergencies or where specialist crews are needed. Its system is backed up by a plethora of different initiatives, some of which are voluntary and some private taxi arrangements, for people who need to attend outpatient departments or hospital for other reasons. One of the chief complaints that hon. Members occasionally hear is when people have had to wait for an ambulance. Usually they are not serious cases, such as people who have been run down by a car or involved in an accident, but they have been told that an ambulance will pick them up from their sheltered accommodation at, say, 11 am but have had to wait two or three hours. I am aware of someone who had to wait eight hours. The reason for the delay, which they all understand and accept, is usually that the ambulance had been called away to an emergency, had returned to the station and as it was about to collect them had been called out to another emergency. Northumbria and Wiltshire set out to improve the system for patients who merely needed transport. As a result of reorganisation, Wiltshire was able to increase its number of paramedics because it diverted the money that it saved into further training. Fifty per cent. of all ambulance crews in Wiltshire have full paramedical training, which is a major improvement for patients. We heard earlier in the debate that there are only eight paramedically trained people in London, and my hon. Friend the Member for Harlow (Mr. Hayes) said that there are 30 in Essex. The national average is 12 per cent.

Mr. Holt : There are six in Cleveland.

Mr. Devlin : My hon. Friend informs me that there are six in Cleveland. Last year, the county of Wiltshire responded to 13,500 emergency calls, 61 per cent. of which were attended within eight minutes--the Department of Health target is 50 per cent--and 98 per cent. within 20 minutes, for which the Department's target is 95 per cent. The savings made have gone into extra cover, new vehicles and equipment.

Perhaps we should take the opportunity of this debate not to discuss the dispute--many hon. Members agree that the debate will not advance the resolution of the dispute

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--but to say what sort of service we want in the future : a faster-responding, higher-qualified and better-paid service. 8.42 pm

Mr. Denis Howell (Birmingham, Small Heath) : I am delighted to put on record the views of the people of the west midlands about the provocative way in which the dispute is being conducted by Sir James Ackers, who is chairman of the West Midlands regional health authority.

I should also like to deplore some of the comments that the Secretary of State has made during the dispute, such as his sneers about taxi drivers.

Mr. Kenneth Clarke indicated dissent.

Mr. Howell : It is no good the Secretary of State shaking his head, because we all know that those comments are on record.

I have taken the trouble to find out about the earnings of taxi drivers. The London taxi drivers association tells me that the average wage in London is £15,000, and in Birmingham it is £14,000. Mr. Clarke rose--

Mr. Howell : I cannot give way, because I have only 10 minutes. Mr. Clarke indicated dissent.

Mr. Howell : I did not say that the Secretary of State had called them taxi drivers ; I said that they had been called taxi drivers. The right hon. and learned Gentleman referred to them as drivers, but taxi drivers were referred to.

It is clear that in the west midlands we are engaged in trench warfare. A most disgraceful letter, the like of which I have never seen in all my public life, was sent by the regional general manager of the West Midlands regional health authority to ambulance workers, who have been locked out. The facilities to provide the same service as throughout the rest of the country have been withdrawn. Telephone lines have been cut. Yesterday, I saw people waiting to work but not being allowed to receive telephone calls. That is being done at the behest of the Secretary of State and the regional chairman, who sits on the National Health Service Policy Board and is in part responsible for this dispute. He has returned to the west midlands to conduct trench warfare, which no other regional chairman has done. When the chairman wrote that provocative letter, I promptly took action on behalf of six Birmingham Members of Parliament, including two Privy Councillors, and asked for a meeting, which was refused. I got in touch with the Secretary of State's office, but he took no action. It is only because this debate is being held that we have been offered a meeting tomorrow, which we shall attend. I shall tell the chairman, in terms that I cannot use here, what I think of him for telling six Members of Parliament that they have no right of audience. He is paid to run a public service, and the Secretary of State should remind him of that. If membership of Parliament, parliamentary accountability and the right of our constituents to be heard mean anything, the Secretary of State should get rid of that chairman at once for refusing that basic right.

On 18 December, the regional general manager, Mr. K. F. Bales, wrote a letter to each ambulance man. He told

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them that if they use their ambulance they will be liable to prosecution for driving an uninsured vehicle, for driving a vehicle without road tax and--this is the most important--that any passenger whom they carry may be prosecuted under section 12 of the Theft Act 1968.

Mr. Jeff Rooker (Birmingham, Perry Barr) : Passengers?

Mr. Howell : Passengers--what a ludicrous proposition! If we had a disaster on the M6 near Birmingham such as that which recently occurred on the M25, ambulance men could not turn out because of that written notice.

Mr. Kenneth Clarke indicated dissent.

Mr. Howell : It is no good the Secretary of State shaking his head. If people are told that they may be prosecuted under the Theft Act, they would be foolish to turn out unless they had a letter telling them that the notice had been rescinded. One could imagine the havoc on the motorway while all that is going on. Ambulance men would say, "Although we should like to attend, we cannot do so until the notice has been withdrawn."

Can hon. Members imagine what would happen if they turned out to tend to people who were seriously ill? A policeman may get into an ambulance and say, "Before you drive your ambulance, I must warn you that under the Theft Act 1968 you are liable to be prosecuted and that anything you say may be taken down and used in a subsequent criminal investigation." The Secretary of State is laughing.

Mr. Clarke : I am laughing at the right hon. Gentleman's ludicrous description.

Mr. Howell : Will the Secretary of State have that notice withdrawn?

Mr. Clarke : I should like to respond to the right hon. Gentleman's suggestion, which might be taken seriously in the west midlands. If ambulance crews turned out in response to a control room, as they did on the M25, what the right hon. Gentleman has said would not apply. It is not true, and when he has time I shall explain to him why.

Mr. Howell : It is true. I visited the control room at the ambulance station in Henrietta street in my constituency, which is the largest ambulance station in Europe. The controller was not present because he had had to go somewhere else. As the Secretary of State has had all the telephones cut off, how will controllers convey messages? That is the state that the Secretary of State has got the service into in the west midlands. I beg him to look into it. Like everyone else, I want the dispute to be resolved, but we do not want it conducted in the west midlands on the basis of trench warfare, with elected representatives being refused meetings and ambulance men's telephones being cut off. That is a disgraceful way to handle any industrial dispute.

I was president of a trade union for 12 years, and I am a consensus man. I say with respect to the Secretary of State that one should never go into an industrial dispute unless one knows the way out of it. That is what the Secretary of State does not know. He has not asked himself how we get out of this dispute--which is what we want. We shall get out of it by asking a simple question, which he has not asked himself : what is the worth of an ambulance driver? We have been told that, if we give some

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ambulance drivers more, others in the ambulance service will have less. The reason why the Secretary of State will not go to arbitration or to ACAS is that arbitration would address the question that he will not address : what is the worth of an ambulance driver compared to anyone else, not only in the Health Service? That question must be answered at some time in this dispute, and it is the question that every trade unionist and every employer has to ask himself at some point.

When Ford workers are being offered 10 per cent., when we read that people in the Health Service will be offered considerable sums and when the Secretary of State, I and other hon. Members have part of our salary fixed by reference to some Civil Service machinery to avoid future disputes, it is no good the Secretary of State saying that what is good for the Civil Service, the police, the armed services, Members of Parliament, doctors and nurses is not good for ambulance men. That is a fundamental contradiction in logic and in fairness.

The reason why the Secretary of State has the whole population against him is that they believe in fairness, whatever their political views, and they do not see the treatment of the ambulance service as fair and just.

Mr. Geoffrey Lofthouse (Pontefract and Castleford) : On the question of what the ambulance men are worth, my right hon. Friend will recall that in 1977, at the time of the Ford strike when the Ford company broke through the Callaghan pay lines and paid 18 per cent., the present Prime Minister said that people should be paid what they were worth.

Mr. Howell : The Secretary of State complains about this debate. I was a member of the Cabinet wages committee at that time. Not a week went by when the Opposition, who were led then by the present Prime Minister, did not have a debate in this Chamber, so let us not have these crocodile tears.

I want to congratulate Sandwell and other local authorities. If the Secretary of State will not provide an ambulance service for our people, the local authorities must do it themselves. Sandwell tells me that it has dealt with 93 emergency cases in the eight days since it set up its service, which it says is higher than average. Calls are overwhelmingly coming in from doctors. I am glad to know that that service has been provided, and if there is to be no movement in the dispute, there is an obligation on us all to provide a service for our constituents. I am not interested in the course of the dispute and this debate should not concern that, but it should be about the right of British citizens to a decent ambulance service, which it is the statutory responsibility of the Secretary of State to provide.

The Army is doing excellent work, but it cannot provide that service. I heard that only the other day three policemen impeding Army ambulances had been knocked down because the ambulances could not stop in time at the crossing. That is typical of what is happening. We must get this matter right. We must get people to sit round the table and to negotiate. My plea to the Secretary of State is for him to stop the provocative action and to start talking. Let us have a civilised solution to this problem.

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Mr. Harry Greenway (Ealing, North) : It is clear that the time has come for both sides to sit round the table, to be locked in a room, if necessary, to stay there until a solution is found and to accept that there must be give on both sides until a solution is found. That is what is required by my right hon. and learned Friend the Secretary of State, the whole House and the nation.

I speak as one who has been affected by the dispute. A member of my own family needed an ambulance a few days ago and was picked up by the Army, who did a notably good job in the circumstances. The whole dispute has been brought home to me in a big way. A few weeks ago, I was sitting on a London Underground train and saw a lady opposite me being taken very ill. I immediately found someone to support her and I walked up and down the compartment to find a doctor. I found a nurse who gave the lady artificial respiration and I stopped the train at the next station where the ambulance service was summoned. The ambulance men did a notably good job in getting the lady fit to leave the train. I heard that she died a little while afterwards, although it was not for want of anything that the ambulance men could have done. It was an impressive sight to see the ambulance men working with everything that they had to revive a lady who was obviously dying. They did a fine job and I remember that. My remarks will fall into two parts. First, I shall comment on the medical side of the ambulance drivers' work and, secondly, I shall comment on other aspects of their work. I shall base my remarks on discussions with ambulance drivers in my own constituency with whom I have kept in contact. I had a long talk with them not long ago, on the emergency services and what some call the non- emergency services. The emergency services staff said--and I do not know whether their figures are right--that there are 2,000 ambulance drivers in London, of whom 200 are medically well qualified. They went on to say that there are only eight paramedics in the whole of London, and that figure has already been quoted to the House. They also said that only 20 people a year could become medically qualified as ambulance drivers--not to paramedic level, but to an advanced level. I was glad when I heard my right hon. and learned Friend say this afternoon that he did not think that there were enough courses for ambulance drivers to improve their qualifications and knowledge. He obviously means that there will be more and, indeed, there must be more. It would be unsatisfactory and unfair if 2,000 ambulance drivers in London--less the 200 who are already well qualified medically-- wanted to become qualified and could do so only at the rate of 20 a year. I know by his immediate response in the debate that my right hon. and learned Friend does not intend that. However, I draw the matter to his attention because it is an important factor in the morale of the ambulance drivers and in their representations to him about future qualifications.

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