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Rumbold, Rt Hon Dame Angela

Ryder, Rt Hon Richard

Sackville, Tom

Shaw, Sir Giles (Pudsey)

Shephard, Rt Hon Gillian

Shersby, Michael

Sims, Roger

Smith, Tim (Beaconsfield)

Soames, Nicholas

Spicer, Michael (S Worcs)

Spink, Dr Robert

Spring, Richard

Sproat, Iain

Squire, Robin (Hornchurch)

Streeter, Gary

Taylor, Ian (Esher)

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Taylor, John M (Solihull)

Thurnham, Peter

Trend, Michael

Twinn, Dr Ian

Waldegrave, Rt Hon William

Ward, John

Watts, John

Wells, Bowen

Wheeler, Rt Hon Sir John

Whittingdale, John

Widdecombe, Ann

Wood, Timothy

Young, Rt Hon Sir George

Tellers for the Ayes: Mr. Sydney Chapman and Mr. David Willetts.

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NOES

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Barnes, Harry

Benn, Rt Hon Tony

Campbell-Savours, D N

Carlile, Alexander (Montgomery)

Clwyd, Mrs Ann

Corbyn, Jeremy

Eagle, Ms Angela

Enright, Derek

Etherington, Bill

Ewing, Mrs Margaret

Gerrard, Neil

Godman, Dr Norman A

Grant, Bernie (Tottenham)

Hanson, David

Hardy, Peter

Hill, Keith (Streatham)

Hinchliffe, David

Hughes, Simon (Southwark)

Jones, Lynne (B'ham S O)

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Livingstone, Ken

Mackinlay, Andrew

MacShane, Denis

Madden, Max

Michie, Bill (Sheffield Heeley)

Pickthall, Colin

Pike, Peter L

Rendel, David

Sedgemore, Brian

Skinner, Dennis

Vaz, Keith

Wallace, James

Welsh, Andrew

Wicks, Malcolm

Winnick, David

Wray, Jimmy

Tellers for the Noes: Mr. Terry Lewis and Mr. Piara S. Khabra.

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Question accordingly agreed to.

Ordered,

That if any select committee, or sub-committee thereof, considers that the presence at a meeting, or part of a meeting, of that committee to which the public are not admitted of any specified Member of the House not nominated to that committee would obstruct the business of the committee, it shall have power to direct such Member to withdraw forthwith; and the Serjeant at Arms shall act on such instructions as he may receive from the chairman of the committee in pursuance of this Order.

That this Order be a Standing Order of the House.

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Health Board Funding (Scotland)

Motion made, and Question proposed, That this House do now adjourn.-- [Mr. Bates.]

7.50 pm

Mrs. Margaret Ewing (Moray): As you, Madam Speaker, will be aware, after several attempts I have managed to raise on the Adjournment the subject of funding for health boards in Scotland and its implications for the pay of those who work in the national health service. I am pleased to see that, although there is a fairly small number in the Chamber this evening, there are more hon. Members present than is normal for Adjournment debates, which are often attended by only the hon. Member who has the Adjournment and the Minister. I hope that that reflects the genuine interest of everyone present in the implications for pay of those who work in the national health service.

I must declare an interest: I serve on the parliamentary panel of the Royal College of Nursing. I am also in regular contact with the Royal College of Midwives, the British Medical Association and other groups involved in health. But that having been said, I think that I speak as an individual and someone who reflects the views of all our constituents.

All of us, irrespective of our standing in society, our income or where we come from, need the national health service. We must recognise the dedication and commitment of those who work in that organisation. We are all indebted to them for the work that they do. I speak as someone who went through a long illness and appreciated the work done by the nurses and others in the hospital. I am also a daughter with an aged mother who suffers from Alzheimer's disease and I recognise the contribution of the staff to people such as my mother.

In tonight's debate we are talking about the values and principles of the society that we want to see. It is often said that nursing is a vocation, which has somehow become almost a derogatory term. We give those with a vocation a pat on the head and a lump of sugar, but do not, as a society, recognise the commitment that they give to individuals. They are people who carry out tasks that are important to the well-being of those we love and those we want to see cared for. We should look at ourselves, as the House of Commons and as representatives of the public, and ask whether people who take a vocational job should be dismissed as unimportant and not worthy of national recognition.

I have raised the subject in tonight's debate because I have seen what has happened over the past several weeks in the context of the discussion on the pay of nurses, midwives, health visitors and others in the health service. It is essentially a Scottish debate because I have made specific reference to the health boards in Scotland in recognition of the different administrative system in Scotland. But the principles about which I want to speak, and which underpin the debate, are UK-wide. I trust that the Under- Secretary of State for Scotland, the hon. Member for Edinburgh, West (Lord James Douglas-Hamilton) will accept that rationale of the comments that I shall make.

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A review body report was published on 9 February. It recommended a two-tier approach to salaries. It was the review body's 11th report and it was the first time that the Royal College of Nursing or any other organisation had rejected a review body's report. The reason that the college rejected it was the recommendation of a two-tier approach.

What was being offered was that 1 per cent. of a pay increase would be guaranteed as a national increase. The assumption was that it would be directly funded by the Government. But the reality was that the 1 per cent. was not being directly funded by Government, but had to be met by the trust boards--so many of our organisations are now represented by trust boards. The figure was going to be part of the payments that were to be made by the trust boards.

It is important to remind ourselves of that, because many people thought that the Government were directly funding the 1 per cent. and the trust boards had to find another 2 per cent. or whatever. But the figure was part of the final negotiations on the national health service funding system. Any additional funding had to come from the trusts, along with that 1 per cent.

Many people regard that aspect of the Government's policy as the beginning of an attitude that will lead to local pay negotiations in many professions and many trades where we would expect to have national recognition of the contribution made by those who work in them. If we add to that the fact that the trusts will, in future, theoretically be able to ensure that negotiations relating to conditions of service--such as sick leave, sick pay, annual leave and hours of work--could be included, we realise that national standards are being demeaned. If all aspects of negotiations and discussions of the conditions in which our health service workers operate are put alongside pay levels, we see that, even if they are diluted in one trust, the idea of equality of standards and equality of service delivery has been destroyed once and for all within what we call a national health service.

An editorial in the Nursing Times and Nursing Mirror of 8 to 14 March 1995 states:

"We also predict that within one or two years, the national element will have withered away altogether."

Were I to be suddenly afflicted by appendicitis in London or Lossiemouth, I would expect the same standards of treatment to be allocated to me as a member of the national health service. Wherever our nurses, doctors, health visitors and midwives happen to work, we should ensure that they are given equal recognition for the service that they offer us.

In answer to a parliamentary question that I put to the Minister of State on 29 March 1995, he told me that funding to health boards in Scotland had risen in real terms over the past year by 3.9 per cent. and, apparently, the projection for 1995-96 is that it is to rise by 3.6 per cent.

I do not dispute the figures, but they do not represent a standard pattern throughout the health boards in Scotland. In my area, the Grampian health board will receive a funding increase of only 2.66 per cent. How will areas which are receiving an increase of less than 3 per cent. pay their staff the salaries that they seek?

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It would cost the Moray health trust £600,000 to pay the 3 per cent. pay increase which the nurses have requested and which I endorse.

The Minister will probably respond by saying that efficiency savings are required within the health service. The efficiency savings target in Scotland this year is 2.75 per cent. or £75 million. A 3 per cent. pay increase across the board for the staff to whom I have referred tonight would cost £23.2 million. When we compare that sum with the efficiency savings target of £75 million, we can see how little it would cost to ensure that our health service workers are paid the salaries that they so obviously deserve. What does it mean when we talk about efficiency savings within the health service? In reality, it means a reduction in all kinds of services. Services within the NHS have already been pared to the bone. Are we now expected to drain the marrow from those services? What efficiency savings does the Minister envisage making in Scotland while maintaining the current standard of service delivery? What would happen if health service staff asked to be paid for the overtime they work--overtime that is not recognised at present? Those committed and dedicated staff work that overtime because no nurse, midwife or health visitor will be dictated to by the clock. None of them would walk away from a case because they had already worked an eight-hour day. We must recognise their commitment and their dedication.

Staff turnover among nurses in Scotland continues to rise, and last year it increased from 12 per cent. to 19 per cent. There is also a shortage of student and trainee nurses. Between 1988 and 1992, the number of student nurses in Scotland fell by 35 per cent. Those figures were supplied by the Department of Employment, whose labour force survey also showed that unemployment in the nursing profession is just 1.7 per cent.

Against that background, variations in local pay deals will set nurse against nurse and trust against trust. I represent a rural area where vast distances must be travelled. A local Lobby correspondent recently asked me why nurses in Moray should receive the same pay as nurses in London, when the cost of living is so different. I argue that the dedication of nurses and the care that they provide is equal throughout the length and breadth of the United Kingdom. Low wages must not be introduced to the rural areas of Scotland.

The Royal College of Nursing, to which I referred earlier, does not accept that increases in nurses' pay should be self-financing or funded through productivity improvements. Will there be arguments in favour of performance -related pay for nurses? How does one measure the productivity of a nurse, midwife, health visitor or someone working in the area of community care? A broader range of factors must be considered--I return to the issue of principles and values in society--including recruitment and retention, fair pay comparisons, morale and projections for future demand.

The Minister will be aware that, of the 46 trusts in Scotland, only four have made offers so far in the context of pay negotiations. In Greenock--I am glad to see that the hon. Member for Greenock and Port Glasgow (Dr. Godman) is in the Chamber--there has

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been an offer of 2.5 per cent. Grampian Health Care in my area has made an offer of 2.83 per cent., but that is conditional upon the acceptance of a trust contract. The Southern general hospital in Glasgow has offered 3 per cent., 1 per cent. of which has unspecified conditions attached. North Ayrshire has offered 3 per cent. with no conditions attached. Only four out of the 46 Scottish trust boards have made offers, two of which are conditional. What conditions are people being asked to accept in fulfilling their duties to society? By 13 April this year, 127 out of almost 500 trusts had made local pay offers. Of those, 80 per cent. offered an increase of 3 per cent. or more. I think that we must accept that most trusts wish to recognise the level of demand and the merits of the case that has been advanced. Some 75 per cent. of the 3 per cent. minimum offers are seemingly without strings: they are not conditional upon the acceptance of trust contracts, employment or changes to conditions of service, leads or allowances.

The Scottish Office has not issued any guidance to trusts in Scotland about local pay, unless it has done so in the last few hours. It is allowing individual trusts to make their own arrangements at their own pace--which may explain why a relatively small number of offers have been made in Scotland so far. I think that it is unfair and unjust that health service workers do not know what the trusts are prepared to offer.

I contrast that situation with what has happened in England and Wales. Ken Jarrold, the national health service executive and director of human resources, wrote to all trust chief executives in England and Wales on 11 April. He said:

"Ministers have expressed concern that there have not been more pay offers".

He continued:

"It is very important that all employers give an early indication of their intentions . . . It would be helpful for staff . . . to be made aware of the local pay offers being made by employers." Why has no instruction or advice along those lines been offered to the chief executives and executive and non-executive directors of trusts in Scotland? In responding to the debate tonight, I hope that the Minister will assure me that he intends to offer similar advice to Scottish trusts and that he will clearly endorse the argument for a 3 per cent. pay increase. He must make it clear that the Government recognise the worth of health service staff.

I believe that health service workers would be more interested in the colour of the money that the trusts intend to offer than in the colour of the BMWs which are driven by the administrators and managers who are not involved in service delivery. It is critical in this debate that we argue the case on behalf of the committed and dedicated people to whom many of us owe our lives. We must have a proper sense of values.

8.8 pm

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