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Mr. Kenneth Clarke : My hon. Friend and I are broadly in accord. It is not necessary in any ambulance service for everyone to have that high level of training, but it is desirable that a much higher proportion should. I agree that the way to that should be paved, probably by local flexibility and productivity agreements, to release the resources to pay for it, as has happened in Northumbria

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and Wiltshire--as my hon. Friends the Members for Bolton, North-East (Mr. Thurnham) and for Stockton, South (Mr. Devlin) have already said.

Mr. Greenway : I am grateful to my right hon. and learned Friend for that clarification, which brings me to the second part of my remarks, which concern the non-emergency ambulance service. That is also important. It arranges for the collection of patients to take them for treatment and for their collection from hospital or place of treatment after they have been treated. It has been very unsatisfactory in London for a long time. Now is the time to tackle it. It must be a problem for management rather than for ambulance drivers.

Day after day, I receive letters and representations from constituents saying that, in advanced age, they have sat at home and waited for an ambulance to come at the appointed hour of 9 am. By 4 o'clock it has not arrived, and by 5 o'clock they give up. That is unsatisfactory. Sometimes, the ambulance picks them up on time and gets them to hospital, but they must wait for up to eight hours for the ambulance to take them home. That is damaging for patients' morale. There must be many occasions when the treatment for which they have been taken to hospital is undone by the long, damaging and hungry wait. They get no food, and there is no one to talk to. They must sit and wait. I look to my right hon. and learned Friend the Secretary of State to improve the non-emergency service across London and the rest of the country.

The present dispute touches the hearts and families of everyone. No one can say with certainty that he or she will never require the aid of an ambulance driver or worker. Therefore, there is natural sympathy for that fine body of people. I know them well in my constituency, and I regard them highly. There is a discipline upon everyone--hon. Members, the ambulance men and those who employ them--to see that their conditions of employment are always fair. They must give, management must give, but a solution must be found, and found soon.

9 pm

Mrs. Rosie Barnes (Greenwich) : There is general agreement among hon. Members that we must look for a long-term settlement and not just a short-term ceasefire in the dispute. The problem is not just to solve the current pay element but to make sure that we never face this problem again. It is clear that both management and unions are increasingly desperate for a face-saving formula, but a marginal pay increase and a vague commitment to a future review body are just not enough. We do not want any more accidents.

There are many underlying causes of the dispute. It goes much deeper and further back than current pay levels. There is a deep-seated morale crisis in the ambulance service, and it is based on several factors. The lack of recognition of their status and the language used throughout the dispute have not helped. There is a clear lack of training opportunities. Again, that has been fundamental to ambulance personnels' response to the offer of increased pay for paramedics. There is an absence of any meaningful reward for being trained. Although a remedy has been offered, it is limited by the lack of training. There is resentment at the lack of overtime pay. Many people would be surprised to know that ambulance

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workers' overtime is paid not at time-and-a -quarter,

time-and-a-half or double-time rates, but at ordinary rates. There is no acknowledgement of the experience and expertise that are acquired after several years' service. An ambulance worker who has been employed for 10, 20 or 30 years gets only three extra days' holiday in recognition of that experience. Many hon. Members know that if one needs an emergency ambulance and one is attended to by someone with 10 or 20 years' experience, one's chances of survival are much higher than if one is attended to by a new but enthusiastic recruit who has not yet learnt to use all the tools of the trade. The debate has revolved around whether the ambulance service is an emergency service. Most members of the public know that, in an emergency, one dials 999 if one needs a fire engine, police car or an ambulance. Enormous relief, gratitude and respect are accorded to ambulance personnel when they answer such calls.

Yesterday, on the 5 o'clock programme on Radio 4, a letter was read out from the mother of a girl who had been critically injured in a road accident. When her daughter was on the way to a good recovery, the mother sought out the hospital consultant under whose care her daughter had been to thank him for his dedication and expertise. He said that she should thank the ambulance people who delivered her daughter alive to the hospital. Without that expertise a life would not have been saved.

Whether we are talking about 999 calls or people visiting hospital for chemotherapy, radiotheraphy or dialysis, they are all seen as life or death matters. It was stated in a recent radio programme about London that on a typical Saturday night the fire brigade received 140 999 calls, whereas there were 2,000 calls for ambulances. Those figures must be seen in the context of what the fire brigade and the police do. For example, much of their work is routine, and all fire brigade calls are 999 calls.

When firemen are not on active service, they are not doing other more routine work. Generally speaking, they are training to ensure that they keep fit. They do that in their various fire stations, and to many people that is thought of as leisure activity. I am not knocking that, but compare it with ambulance workers who undertake their emergency work in addition to their other duties.

The Secretary of State may not have seen the justice of the ambulance men and women's cause, but the overwhelming majority of the public have. They recognise the emergency nature of their work. The 6.5 per cent. offer is frequently compared with the 6.5 per cent. accepted by the nurses, but the nurses accepted that settlement before inflation was as high as it is today. Further, the nurses' settlement followed a substantial, exceptional and wholly deserved increase in 1988, when the Government were forced to respond to a public outcry over the level of nurses' wages. There is now a similar public outcry on behalf of ambulance workers.

There must be an independent review body. The dispute must be settled by a binding pendular arbitration process, and it would be fair to expect a no- strike agreement in return for a commitment on the part of management to submit offers and claims to binding arbitration in the event of disagreement.

It has been said time and again in the debate that there are inadequate facilities for training paramedics. It is clear that the ambulance personnel will set themselves adamantly against allowing the Government to take the

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paramedic route, as it were, out of the dispute without giving a clear commitment about access to that type of training. If paramedic and general skills training for ambulance personnel is to be made more widely available, so that ambulance workers will have the opportunity to upgrade their skills and salaries and embark on more of a career structure, that course may be reconsidered. At present, so few ambulance workers have access to such training that they feel that, in fairness to their colleagues, they cannot accept it. We need a long-term formula to solve the dispute. Nothing short term will do. It must involve an independent pay review body, binding pendular arbitration and probably a no-strike agreement. It must include more and better paramedic training and an acknowledgement of the status of ambulance personnel and their emergency role. Above all, Britain's ambulance personnal must be acknowledged as fulfilling that vital emergency service on which all of us may at some stage depend.

9.8 pm

Mr. Anthony Coombs (Wyre Forest) : I agree with the Secretary of State and others who have said that there can be few more inappropriate places to try to make progress in resolving the dispute than a debate in the House of Commons. But at least it gives us the oportunity rationally, if not calmly, to consider some of the longer-term problems--which the hon. Member for Greenwich (Mrs. Barnes) outlined--of the ambulance service, its public perceptions and its principal characteristics.

It is not surprising that, although the public may be ignorant of the details of the dispute--particularly the fact that the ambulance workers have received an offer of 6.5 per cent., which has been accepted by 94 per cent. of other National Health Service workers--they have a great deal of sympathy for the ambulance workers' case.

One of the first things that I did when I heard that the dispute was in train was to talk to the local ambulance workers in my constituency of Kidderminster. I pay tribute to those people. They are loyal, hard-working and sensible people who obviously have a great commitment to their service. Their rate of staff turnover, if that exhibits loyalty, is extremely low. On the other hand, they did not have a clear definition of what was required of them. Their job was not particularly well-structured and there was no real incentive to improve their professional qualifications.

In short, they are imprisoned inside a salary structure that is inappropriate to their different abilities and qualifications to the extent that a leading ambulance man with 15 years' experience and with paramedic qualifications, who has spent no fewer than five months on off-the-job training to gain those qualifications, is paid only £3,000 more than a new recruit who has possibly only two weeks' training in first aid and has good driving skills. That lack of differentiation across the ambulance service is wrong and is possibly perpetuated by the way in which the service is organised. People's perception is that old people or out- patients are transported in ambulances that to all intents and purposes are appropriate to the highest kind of ambulance care, and they perceive that use as not necessarily appropriate. Again, it is not appreciated by the public that, although 15,000 of our 22,000 ambulance staff have qualified training and between 12 and 18 months relevant

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experience, in most cases--except for the paramedics--those qualifications amount to nowhere near the skills levels of senior nurses who are paid £12,000, which is only £500 more than the wage offer that has recently been made to leading ambulance men in the current pay negotiations.

Under those circumstances, irrespective of comparability and the effect of any wage increases on public sector pay, irrespective of the possibility that a large pay increase will undermine management and the Whitley structure, and irrespective of the fact that a large pay increase would lead to a fall in patient services or even to a decline in morale among other NHS staff who have not decided to take industrial action in prosecuting their pay claims, surely, on a true skill basis alone, across- the-board increases irrespective of the degree of skill, the local geography and the local labour markets would be totally unjustified in terms of the long-term good of the ambulance service. The Government are therefore right to resist them.

However, that is not to say that the ambulance service does not have a case for restructuring or for higher pay. Indeed it does, but that should be achieved within the framework of changes to the 1986 agreement and in the pay and conditions of ambulance staff. I shall outline four elements that such an agreement should contain. First, subject to national guidelines on standards of service, the ambulance service should be as decentralised as possible, because then decisions could be more responsive to the needs of the local labour market and to what the local community needs. As long as the national negotiations confirm a pay package that protects the real value of ambulance workers' pay, questions of relative pay, merit pay and skill differentials should be decided as locally as possible.

Secondly, the organisation of the service should be as local as possible. We have already heard that, in Northumberland and Avon, 43 per cent. of the cases for which the ambulance service is used to provide transport for the elderly are covered by a separate service--albeit one that is county council funded. The out-patient services are farmed out to local taxi firms and 10 per cent. of accident and emergency resources are concentrated on that service, which is increasingly a paramedical service.

That sort of organisation would have a number of advantages. Staff would be deployed more appropriately according to their skill, and vehicles and capital equipment would be used more effectively. Also, savings would be available to be ploughed into a better quality service, and, possibly most importantly, the professionalism that the ambulance workers possess could be better rewarded through a clearer idea of the tasks demanded of them.

Thirdly, there should be greater incentives for paramedical qualifications in the ambulance service. A £500 increase to gain qualifications that take between five and eight months off-the-job training is not significant. That should be considered without delay to improve the professional qualifications and the drive of the ambulance men.

Fourthly, if the ambulance service were divided so that 10 per cent. was primarily orientated towards accident and emergency and staffed with people with better qualifications, we could ensure that capital spending was primarily orientated towards that service. Defibrillators and other

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capital equipment that are supplied to ambulance services in my area and other areas only through voluntary subscription could be provided through Government or local authorities. Obviously, that would improve the quality of the newly specialised accident and emergency service.

Those should be some of the goals in the long term. In the meantime, the Government are right to hold the line on the dispute, while offering to consider the structure, pay and conditions of the ambulance service in the medium term.

9.16 pm

Mr. Geoffrey Robinson (Coventry, North-West) : Every hon. Member who has attended the debate will be left with three overriding impressions. The first will be the clear, overwhelming public support for the ambulance service in its dispute with the Government, and its dispute is with the Government alone. The second will be the genuine desire among almost all hon. Members for a settlement to the dispute.

Sadly, the third impression is a new one from tonight's debate. It is absurd for Conservative Members to suggest that it is inappropriate for the House to discuss a dispute that is now in its 18th week. We cannot settle the dispute across this Table, but it has to be settled across a table in the end. We should discuss the issues and consider which way forward is appropriate.

The sad and new impression that comes from tonight's debate is the total intransigence of the Government's position. Many Conservative Members have told the Government that they cannot take an intransigent and entrenched position and expect to negotiate from it. It has been conceded by many Conservative Members that the union position is flexible on the amount of the settlement and on the mechanism by which it might be reached. That is clear and undeniable. If the Secretary of State--as he has indicated by shaking his head on several occasions, whenever those issues have been raised--does not believe it, he should put it to the test. He cannot put it to the test if he says in advance of entering into negotiations--which is his present position--that there can be no movement on the terms of the wage settlement or the indexing arrangement. One cannot negotiate on that basis.

The debate is an accident that he has created because he was initially complacent about it. Subsequently he has moved from insensitivity to condescension. If I may offer the Secretary of State some advice in a friendly spirit across the Floor, he should get himself off the screen and confine himself to the negotiating room. That is where the dispute must be settled, and quickly. It cannot be settled on a take it or leave it, total surrender offer of 6.5 per cent. The dispute started in 1989 and if it had been settled some time ago it may have been possible to settle near that figure. I have no intention of advising any of the parties to this dispute about where to settle. Further, it is clear that, in present circumstances, that offer is no longer viable. It is no way forward for the Secretary of State now to say, "Take it or leave it".

The Secretary of State must remove the other obstacle to settlement : the Prime Minister. In recent months, the dispute and pay claim have been turned by the Prime Minister into a test about wages policy for the whole of the public sector and the country. That is the ultimate logjam which the Secretary of State must have the courage to face

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up to. He must also have the courage to lose face--if that is how he sees it. I assure him, as other hon. Members have already, that he will gain much respect if he is prepared to reconsider his position, return to the Cabinet, persuade his colleagues to accept his views, bring the proposals back, sit round a table and hammer out a settlement in the short time available. In his heart, he knows that such a settlement can be reached.

The ambulance workers are a dedicated, hard-working and skilled group of people. They are committed to improving the service and hate the dispute as much as hon. Members do--in fact, they want a settlement even more than we do. There are two blockages to a settlement and I urge the Secretary of State to find the courage, dignity and statesmanship to remove them, sit down at the table and find a settlement.

9.22 pm

Mr. John Bowis (Battersea) : If I were to pick out one word from the speech of the hon. Member for Coventry, North-West (Mr. Robinson), it would be "settlement", which we all seek. The Government, ambulance men and the National Health Service all seek that elusive settlement. If I were to sing a duet with the hon. Member for Greenwich (Mrs. Barnes), who has levitated up the stairs a little, it would be to reflect on one of her last words--to call for an element of pendulum bargaining as a way forward for the dispute and the service. My right hon. and learned Friend the Secretary of State might reflect on that for the future.

I start, as many hon. Members have done, with a salute to the ambulance service and its personnel. I have always had a high regard for those who work in the ambulance service. If I needed reminding, I was given a reminder one morning just over a year ago when there was a train crash at Clapham junction in my constituency. I saw the ambulance workers at first hand and was there alongside them as they battled to save lives and did so, and then battled to remove the dead. Theirs was a fairly gruesome and awesome task that morning and underlined the sort of work that many ambulance men face day by day. That is why we have a great feeling for the ambulance men and it is right for that feeling to be reflected in speeches from both sides of the House.

During this sad dispute I have talked to ambulance men and women from my area. It is clear that they do not like being in dispute and want to find a way out. The paradox is that it was started by union action. The right hon. Member for Birmingham, Small Heath (Mr. Howell) referred to entering a dispute and finding a way out ; I hope that that was in union members' minds when they entered the dispute. It is important to find a way out that is fair and affordable. Sadly, when in dispute, it is not always possible to find a way out that contains both factors. Therefore, we must look for that element of compromise to end this problem.

My message to the Health Service management is to keep looking for solutions and keep explaining in simple and clear terms what they are offering. It is clear from talking to my ambulance men that they do not always understand precisely what is on offer. When the offer was increased from 6.5 per cent. to between 9 and 16 per cent. over 18 months, they immediately took the figure on an annual basis and came up with a figure of 6 per cent. They thought that they were being offered an overall reduction.

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They did not understand that it was backdated to April and that pay in the pocket now is not a straight sum. The management of the NHS must get that message across.

The ambulance men and their union leaders must bear it in mind that perhaps the country and the Health Service cannot afford the solution that they seek. It is a fact that excessive--or perhaps I should say high--pay settlements can trigger inflationary spirals in the economy and could trigger a spiral in the Health Service. It is unrealistic to think that, while the ambulance service is within the Health Service, there will be no knock-on effect if the ambulance men receive a high pay reward. That may be sad, but it is a fact. The effect of a high wage settlement in the Health Service now can be only a reduced service. A letter of 10 January from the chairman of the South West Thames regional health authority to London Members of Parliament said that 75 per cent. of NHS costs are pay-related. That means that high pay awards above the budget that has been prepared can result only in closures of beds and wards, postponed operations and delays in improving the Health Service. I beg the ambulance men and women to reflect on that when they seek a way out of the dispute. I hope that both sides will come together soon to find a solution. I hope that my right hon. and learned Friend the Secretary of State will play his part in looking ahead to the future. If the British people express one view, it is that they want such a dispute never to occur again.

We must consider the structure of the negotiation procedures. Discussions with my ambulance men and women lead me to believe that they would be willing to consider a no-strike agreement for the future in return for some sort of assured settlement. If they do not achieve parity with other emergency services, they will seek some structure linked to a no-strike agreement or possibly alternative ambulance services. I believe that that is the way forward. The people working in the ambulance service do not want the strike to continue. I hope that they and the management will come together to ensure that patients do not suffer from the dispute and that the ambulance men return to work to provide the service which we know that they provide so well.

9.27 pm

Mr. Jeff Rooker (Birmingham, Perry Barr) : I shall take only a short time to support what my right hon. Friend the Member for Birmingham, Small Heath (Mr. Howell) said about the conduct of the dispute in the west midlands. I sincerely believe that the action of Sir James Ackers was reckless in the extreme. He put people's lives at risk by locking up ambulances and removing insurance cover and the road fund licence. He did so of his own accord without the authority of the regional health authority. He did that purely as an executive action. It was an example of Ramboesque management, simply to prove his credentials to the Secretary of State as a member of the executive health board. It is not on for public officials to conduct themselves in that way and then refuse to meet Members of Parliament to discuss what has happened. Our constituents' lives were at risk and we are as much entitled to put our case here as we are to put it to the Minister's officials in the west midlands. That is what a devolved health authority is all about. Sir James Ackers refused access until he knew about the debate today.

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In the meantime, local authorities have taken action in the west midlands. The hon. Member for Wyre Forest (Mr. Coombs) talked about making the ambulance service local. It was perfectly OK when it was run by the local authorities. People got a decent 999 service from the local authorities before and that is the way forward, not a privatised local service.

Everybody knows that there has to be a solution, and the sooner it is found, the better for all concerned. There will have to be give and take and above all the solution will have to include a negotiating mechanism that will guarantee that this vital group of workers will never again have to take such action. The Government cannot escape their responsibility in achieving that.

9.30 pm

Ms. Harriet Harman (Peckham) : We are in the 18th week of a dispute of great seriousness, yet today the Secretary of State has told us nothing new, nothing positive, nothing to suggest that he has any clear idea of the way forward from here.

The Secretary of State's speech will fill the public with deep dismay. People are concerned that a vital emergency service has been suspended and that ambulance crews have been subjected by the Government to a campaign aimed at belittling and undermining them, and people are concerned about the huge sums of public money that the Government have squandered in their conduct of the dispute. It is costing £23,000 every day for the police to provide cover in the west midlands ; £26,000 every day for police cover in south Yorkshire ; £10,000 every day for police cover in west Yorkshire ; and £60,000 every day for police cover in London. The bill for that and for other police and Army work will be sent to hard-pressed district health authorities that are already closing beds and wards in an attempt to meet their budget deadline by the end of the year without going into deficit.

The money spent on continuing the dispute would easily have met the ambulance men's pay claim in full. The Secretary of State uses public money to prolong the dispute, but says that he cannot use public money to do what the public really want, and that is to settle the dispute.

The reason why there is a dispute at all is that the Government offered ambulance crews a wage increase below the level of inflation--in effect, a wage cut. That would have been unwelcome to any group of workers, but it is particularly unwelcome to ambulance workers, who have seen a comparative decline in their pay over recent years.

In 1986 ambulance crews' earnings were 6 per cent. below average male earnings. That gap has now widened, so that their earnings are 16 per cent. below. In 1986 ambulance crews had parity of earnings with fire fighters. Now they have fallen behind by £60 a week. Ambulance workers' pay is now so low that many have to claim housing benefit and family credit to make ends meet. Yet it is that group of public employees who have been asked to see their standard of living cut.

It is not that a decent pay award to the ambulance crews would set some sort of dangerous precedent, as the Secretary of State would have us believe. Other groups of

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public workers have won increases above the rate of inflation. For example, the police have won more than 9 per cent., fire fighters 8.8 per cent. and, as has been mentioned, senior civil servants and Members of Parliament nearly 11 per cent. Now the newspapers are full of stories that the Secretary of State's front man in this sorry affair, the NHS chief executive, Duncan Nichol, is about to receive a pay rise that is worth more than 50 per cent. of what an ambulance worker earns in an entire year.

Mrs. Maria Fyfe (Glasgow, Maryhill) : Has my hon. Friend noticed the newspaper coverage of the fact that Conservative councillors in some areas have supported the ambulance workers? Has she heard today of the strange events in Stirling, where Mr. Alan Hogarth, personal assistant to the Parliamentary Under-Secretary of State for Scotland, the hon. Member for Stirling (Mr. Forsyth), and Mr. Peter Finnie, the Conservative party agent in that area, were caught red-handed secretly tape recording the district council's discussions on the dispute?

Mr. Speaker : Order. I am sorry to interrupt the hon. Lady, but I emphasise that her remarks must be relevant to the debate.

Mrs. Fyfe : Can my hon. Friend imagine what was the intention of the Stirling Securitate behind that bizarre behaviour?

Ms. Harman : Whatever may have been the intention, the public will not be browbeaten into withdrawing their support. The Secretary of State has also tried to browbeat ambulance crews into accepting an inadequate pay offer by delivering a series of smears and insults, while refusing to meet ambulance staff representatives face to face for discussions or negotiations.

Despite the Secretary of State's intransigence, ambulance staff took the softest possible industrial action available to them. They withdrew from performing routine duties, but they continued to provide accident, emergency and other vital services. Clearly, that was not the outcome that the Secretary of State wanted, so he quickly escalated the dispute by suspending crews and then calling in the police and Army. Although those services gave of their best, it soon became apparent that they were inadequate for the task. The Secretary of State chooses to ignore that aspect and the views shared by those whose opinions ought to carry some weight with him.

Dr. David Williams, president of the Casualty Surgeons Association, told ITN that the emergency system is confused, which leads to delays, and that police and Army personnel have neither the training nor the equipment to deal with all casualties. That sentiment was echoed by Dr. Pamela Nash, head of accident and emergency services at Hillingdon hospital, who commented that the dispute was having a serious effect on patients. For all those reasons, the public continue to call on ambulance crews to provide emergency services, even though they have been suspended without pay.

Despite being provoked, accident crews are responding with dignity, restraint and an overriding sense of responsibility. The Government's response, by contrast, has been disgraceful. In Coventry, 'phone lines to the voluntary ambulance stations were cut, and those to the crews' social club were also disconnected, so that, no matter what the emergency, members of the public were

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unable to call on the speedy and expert assistance of trained ambulance men and women rather than contact the police or Army. In London, police officers refused to divulge the telephone number of volunteer ambulance crews to people seeking urgent assistance for a man who had fallen from a ladder and broken his spine, arm, leg, rib and pelvis. The police officer said that instructions had been received on the highest authority not to disclose that telephone number. As a consequence, the injured man lay on the ground without receiving assistance for more than two hours.

In Birmingham, a private company, Racal, provided Motorola 'phones and other equipment to allow volunteer emergency crews to provide the city with adequate coverage. Almost immediately, letters were sent to Birmingham ambulance crews informing them that their vehicles were no longer taxed or insured and that crews and their passengers--that is patients--risked committing the criminal offence of using a vehicle without its owner's consent.

This week, within hours of ambulance crews working without pay to provide essential services after the M25 crash, ambulances in London were immobilised by management to ensure that crews would be unable to provide vital services again. I do not say that those and similar actions by management were undertaken on the direct orders of the Government, but no one can fail to detect that a guiding hand is at work.

Mr. Dennis Skinner (Bolsover) : Does my hon. Friend recall that when miners who took part in industrial action during the 1984-85 strike were alleged to have engaged in actions of the type that she has just described they were put in gaol?

Ms. Harman : The Government have systematically sought to escalate the dispute in the cynical hope that if and when disaster strikes ambulance workers will finally forfeit public support and be forced to give up. As we know, the public have not been deceived. The petition in support of the ambulance workers is the largest ever presented and, as a result, the Government's handling of the dispute will find its way into "The Guinness Book of Records". The signatures and the money given so freely in collections all over the country are more than mere tokens of support. They are the public expression of the shame that is felt by the British people at the shoddy treatment meted out to the heroes of Lockerbie and King's Cross.

Mr. Gerald Howarth (Cannock and Burntwood) : The hon. Lady is trying to mislead the House into believing that the dispute is entirely the responsibility of the Government. [ Hon. Members :-- "It is."] In fact, the ambulance crews are responsible in very large measure for the denial of facilities to patients in need. They are just as much to blame, if not more so. In Staffordshire, crews were offering to work only 50 per cent. of the time. Is the hon. Lady suggesting that management should rely on a 50 per cent. service?

Ms. Harman : The question for the House tonight is not who caused the dispute but whether the Government have the political will to solve it. People have been genuinely distressed to hear Ministers declare and imply that the ambulance service is not really an emergency service. It appears to be the only non-emergency service equipped

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with blue flashing lights and sirens. People were sickened and embarrassed to hear the Secretary of State describe ambulance crews in the following terms :

"They are professional drivers, a worthwhile job--but not an exceptional one."

Does the Secretary of State wish us to believe that skills such as emergency resuscitation, assisting emergency childbirth, dealing with haemorrhages and immobilising fractures are learnt from the highway code? Does he think that he will be able to persuade his colleague, Sir Leon Brittan, who congratulated and thanked the ambulance crews after the Brighton bombing, or his right hon. Friend the Member for Southend, West (Mr. Channon), the former Secretary of State for Transport, who congratulated ambulance workers after the British Midland air crash? The right hon. and learned Gentleman's handling of the dispute has failed to persuade a number of his own Back-Bench colleagues from whom we have heard tonight.

Mr. Kenneth Clarke : What is the hon. Lady's motive for inventing insults that no one ever made? Is it to inflame reluctant ambulance men into joining industrial action that they do not wish to take?

Ms. Harman : Our overwhelming concern tonight is that the Secretary of State should show that he will take the initiative to solve the dispute. He has failed to persuade many of his own Back Benchers. The hon. Member for Battersea (Mr. Bowis) expressed concern. The hon. Member for Eastleigh (Sir D. Price) expressed concern. The hon. Members for Staffordshire, South (Mr. Cormack), for Langbaurgh (Mr. Holt), for Harlow (Mr. Hayes) and even for Fylde (Mr. Jack) have all expressed concern tonight.

The Secretary of State has not even been able to get support for his handling of the dispute from the sections of the press that the Tory party has usually been able to count on. The Sun says : "Settle 999 row. How much longer, says the Sun, are the Government going to let the whole sorry business drag on?"

The Daily Mail says :

"It is time for Mr. Clarke to pay Santa not Scrooge and to do what most men and women down every high street in the land are cheerfully doing--put his percentage into the ambulancemen's bucket." The Daily Express says :

"It should not be beyond the wit of Ministers to make concessions that would end the dispute without triggering claims elsewhere." The Secretary of State cannot even claim that the unions have forced him into the stance that he has taken. The unions have said that they are willing to negotiate on local pay flexibility and on their 11.4 per cent. claim. They have said that they are willing to negotiate on a formula. They are not insisting on the fire service formula. But what they rightly insist is that there should be a pay mechanism for the future, so that a dispute such as this can never happen again.

The Government's plan to browbeat the ambulance crews back to work has backfired, and has served only to increase public support for the ambulance men. It seems that the Government have no strategy and they have descended into a shambles. Last Friday, the Secretary of State briefed the Sunday papers that more money might be available. By Sunday he was denying it. Last Tuesday, the Prime Minister said that no more money was available, and at the No. 10 briefing on Wednesday they said that there might be.

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The public's rejection of the Government's approach has left the Government bewildered. It is clear from listening to the Secretary of State in the debate that he has not decided whether to tough it out, or whether, as he no doubt sees it, he should cut his losses. When the Government lose their way, it becomes the responsibility of the House to point them in the right direction. Tonight's vote offers that opportunity to hon. Members on both sides of the House. It offers the opportunity to bring this unfortunate dispute to a speedy and satisfactory conclusion.

9.45 pm

The Minister for Health (Mrs. Virginia Bottomley) : Beginning with the Secretary of State, all hon. Members have paid fulsome tribute to the important work undertaken by ambulance men and women in Britain. We share a pride in their work, and we want them to return to normal working at the earliest opportunity.

I shall not respond in kind to the remarks of the hon. Member for Peckham (Ms. Harman). Perhaps it is hard for her to recall that, when the Opposition were in power, the pay of most National Health Service workers dropped in value. Since the Government have been in power there are more workers in the Health Service than ever before, their pay has risen and they are treating more patients. The Secretary of State spoke of his passionate commitment to the National Health Service. All of us, when we see the record sums being spent, and the record number of patients being treated, know that his commitment is working out in practice--they are not just idle words.

I stress our appreciation for ambulance men and women, for the police, for the Army and for the voluntary services who are maintaining the emergency services, often in difficult circumstances.

This dispute is a tragedy partly because it is needless. All hon. Members agree that ambulance men and women preform an important function within the National Health Service but they are NHS workers, not local authority workers, like fire fighters, or Home Office workers, like the police. They work for the NHS, along with millions of other employees, and we have to consider their financial rewards alongside those of the other people who work in the service. We want ambulance crews to be well-qualified and well- trained and to provide the service that we all look to them to perform. This offer, which was originally 6.5 per cent., was recommended by trade union leaders, and 84 per cent. of NHS employees have accepted something in that region. I am pleased to say that 97 per cent. of NHS employees have accepted agreements without resorting to industrial action, which sacrifices and jeopardises patients, and is no friend of the Health Service.

Few hon. Members can look at the increasing threat, and the disruption and the difficulties caused to the provision of emergency services, with anything but profound concern. Hon. Members have mentioned the importance of emergency services. Ambulance men and women perform valuable work on the emergency side, but nine out of 10 miles travelled are for non-emergencies. That is equally valuable work, and it is important to the

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frail, vulnerable people throughout Britain who are unable currently to receive the care that they need because of the industrial action, which jeopardises them.

There has been a great deal of misinformation about the final offer, which is for salary increases of between 9 and 16 per cent. over the next 18 months, depending on the location and extent of paramedical training. Those higher salaries include an extra payment of £500 a year for staff with full paramedical training. The back pay involved by the end of December was between £680 and £1,450. In London the new rates would result in increases of between 10.9 and 16.3 per cent., and increases of up to 22 per cent. in overtime rates.

An undertaking has also been given to agree a national framework for staff with intermediate paramedical skills, with payments backdated to April last year. It is important to spell out precisely what the offer means, because of the problem of misrepresentation. Equally important, however, is the joint review of the 1986 salary structure, to which my right hon. and learned Friend referred. That improved the status and recognised the professional nature of the ambulance workers' job. There is a wide agenda, which should include flexible local arrangements to deal with problems of recruitment and retention, overtime and improved productivity.

We reject the concept of comparability. The Labour party rejected it when it was in power, Clegg rejected it and this Government certainly reject it- - [Interruption.]

Mr. Speaker : Order. I say this to the whole House. I am not taking one side or the other, but may we have a halt to these private conversations?

Mrs. Bottomley : Let me deal with some of the points that have been made. Many hon. Members talked about the importance of training, including my hon. Friend the Member for Fylde (Mr. Jack). The hon. Member for Rochdale (Sir C. Smith) also mentioned the importance of paramedical staff who are not nationally trained and are not covered by the management's offer.

The fourth paragraph of the management's final offer, to which my right hon. and learned Friend referred, makes an explicit commitment to set up a review so that staff trained either locally to standards other than those of the NHS training authority, or partially to those standards, can be considered. It suggests that the review should be completed by the end of February.

Mr. Rooker : The Minister has moved away from what is, in her words, the "final offer". Will she make it clear that the Government seek the total surrender of the ambulance workers, and that in no circumstances will they be prepared to shift one iota from their present position? Is that how the debate will be left?

Mrs. Bottomley : Let me make it clear that the Government have already offered substantially more than they did originally. Another £6 million must be found this year--the equivalent of cataract operations, coronary artery bypass operations and hip replacement operations. It is not, as Opposition Members imagine, a question of thinking of a figure and doubling it ; the money must be found from limited resources, and it is patient care that stands to suffer. When people who work for the National Health Service hear language such as that used by the hon.

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Gentleman--if I may call him that--they cannot feel confident about their welfare and wellbeing should his party ever return to government.

I pay tribute to the contributions of several of my hon. Friends. My hon. Friend the Member for Derbyshire, South (Mrs. Currie) spoke, as ever, eloquently and effectively about the importance of the service. My hon. Friends the Members for Leeds, North-East (Mr. Kirkhope) and for Bolton, North-East (Mr. Thurnham) both made particular mention of Northumbria, and I am pleased to have the opportunity of putting on record my appreciation of the efforts of Laurie Caple, who has made the Northumbria ambulance service more efficient and better able to provide an effective service for patients. We welcome the fact that they are preparing plans that will provide them with the freedom to determine their own pay rates. My hon. Friend the Member for Ealing, North (Mr. Greenway) referred to the need to improve non-emergency ambulance services. I endorse his appreciation of the work that ambulance staff do. I share his concern about the development of the non-emergency side of the work of ambulance staff.

My hon. Friend the Member for Wyre Forest (Mr. Coombs) referred to the need for local flexibility in pay determination-- [Interruption.] We fully endorse his remarks and the direction in which-- [Interruption.]

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