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5.15 pm
Mr. Peter Luff (Worcester): It will not have escaped hon. Members' attention that the hon. Member for Peckham (Ms Harman) could not put any figure on the amount of money that a future Labour Government might spend on the health service. I had had hopes that the hon. Member for The Wrekin (Mr. Grocott) who, I believe, is parliamentary private secretary to the Leader of the Opposition, might have been able to shed a bit more light on that subject, but those hopes were quickly dashed.
Perhaps I should not be too harsh on the Labour party. It makes a pleasant change for an Opposition-initiated debate about health matters not to be dominated by talk about money, as the health service is about much more than just that. It is indeed about a high level of morale. Before the hon. Member for Peckham leaves, I thank her for what she has done to boost morale among Conservative Members recently. The right decision that she took for her son was not the right decision for morale on the Labour Benches.
Most of the motion that we are being invited to endorse is simply fatuous nonsense, but we can agree on one thing: the high importance that we all attach to nursing staff in the national health service. We all agree that it is important that the House should affirm that
That unites all hon. Members.
We also agree--if I understood my right hon. Friend the Secretary of State for Health correctly, he agrees, too--that the views of staff in the NHS should be heard clearly. As a constituency Member of Parliament, I sometimes find that a tricky exercise. Different branches of NHS staff do not always agree about the priorities for health delivery locally. Hospitals, doctors, general practitioners, nurses and ancillary workers often disagree about the priorities that should be attached to various issues in the local health service. They all make an invaluable contribution, but that does not necessarily mean that they should be expected to speak with one voice. Naturally, they have their own priorities.
The question that the motion begs is what makes for high morale in the NHS. Obviously pay is a factor--it would be wrong to deny that--but a host of other intangible and tangible issues affect morale. They include job satisfaction, good working conditions--by which I mean a hospital's physical environment--a sense of direction and purpose in the health service as a whole and in the trust for which staff work, and patients' manifest gratitude to staff for their help in making them fit and well again and able to go about their daily lives.
If there is one thing that destroys morale in the health service, it is the Labour party's constant denigration of what is being achieved. If there is one thing that I find especially shabby about the way in which the Opposition
behave on this issue, it is their malicious attempt to weaken morale in the health service for narrow party advantage.
It is important to state clearly that the health service's achievements in recent years under this Government have been built firmly on extra money and on ensuring that that money is spent well. It must be repeated time and again that spending on the NHS in England is up sharply: by70 per cent. in real terms since 1979. Moreover, health service spending represents a larger share of national income. When we took office in 1979, the Labour party was spending just 4.7 per cent. of gross domestic product on health; now, we are spending some 6 per cent. That is a sharply increased share of an increased national income.
It is obviously important to discuss pay, as it has a significant impact on morale. No active constituency Member of Parliament could fail to be aware of the public concern about nurses' pay; probably no group in society is more admired than nurses, and rightly so. That is precisely why their pay has risen by so much--by some 70 per cent. over and above inflation under the present Government. I am told that an experienced ward sister now earns about £22,000 per year.
I do not take kindly to lectures from the Labour party about nurses' pay. It was Labour that cut their pay, in real terms, when it last had any responsibility for health. It was the Conservatives' respect for nurses that led us to establish the Nurses and Midwives Pay Review Body in, I believe, 1983. It is essential for that body's findings always to be respected. Sometimes they will please the nurses and alarm the Treasury; on other occasions, they may please the Treasury and upset the nurses. That is the nature of independent bodies.
I issue not a warning but a judgment when I say that I do not think that nurses can seriously expect to retain an independent body to review their pay if they are prepared to accept the outcome only when it suits them. I hope that the Government will continue to accept the pay review body's recommendations in full, as they have in the past. We should also remember that--as my right hon. Friend the Secretary of State pointed out--no nurse has yet received a pay award. Personally, I hope that the awards will be well above the 2 per cent. minimum established by the pay review body: I want nurses' pay to continue to grow in real terms. We should also remember that many individual nurses will in any event receive considerably more than 2 per cent., plus the locally agreed settlement, because many receive annual salary increments.
I should say, in fairness--I try to be a fair man--that there are signs of a few recruitment difficulties in certain specialties in my constituency, but I suspect that pay is not the root cause. I suspect that the problems are also caused by something of which my right hon. Friend has considerable personal experience--continuing concern about delay in the building of our new district general hospital.
The independence of the pay review body shines through every page of its report. It is important for people outside to understand that: the Government have accepted independent advice. The report states:
the hospital and community health services--
The body is at pains to point out some of the problems as well:
I hope that trusts will consider that recommendation carefully.
The review body says a great deal about its own independence. It says, for example:
That is what drives the review body, and I think that it is absolutely right. What the body says gives the lie to the line peddled by the hon. Member for Peckham, that a national health service is all about national pay scales. It manifestly is not: a national health service is not a national employment service. Addressing local issues means achieving equality of care. That is the real need of the health service. The pay review body's report makes it clear that achieving that equality can be assisted by an element of local pay bargaining. For me, that is what a national health service is all about.
I said that morale in the health service was not just a question of pay. Working in a successful organisation matters to everyone, whatever field they are in. It is certainly true that the NHS has been a spectacular success: the Labour party tries to conceal that, but, I hope, consistently fails to do so.
Mr. Campbell-Savours:
Will the hon. Gentleman give way?
Mr. Luff:
No, I do not think I will. I observed the way in which the hon. Gentleman treated my right hon. Friend the Secretary of State, and I have no particular desire to give him any currency.
This year, hospitals will carry out 3 million more treatments than in 1979 and 1 million more than in 1991, when reforms were introduced. That is reflected in shorter waiting times. Over the past five years--my righthon. Friend made this point, but it bears repetition--the number of patients waiting for more than a year has fallen from more than 200,000 to about 31,600, the lowest figure since 1948. Over the past six years, the average wait for treatment has halved.
In Worcester, the success has been particularly spectacular, as my right hon. Friend saw for himself on Christmas eve when we toured Worcester Royal infirmary
together. I hope that he agrees that what we saw suggested that nurse-patient relations at the infirmary were of the highest order, as they have always been. I also hope that he agrees that, during our walk around the wards, there was an atmosphere of professional dedication and high-quality patient care. That suggests to me that morale in my hospital trust is reasonably high. Perhaps in areas that we did not see it is not quite so high, but certainly it is generally good, as it has every reason to be.
Worcester Royal infirmary treated 2,851 more patients in 1994-95, and is on course to treat a surprisingly precise 3,444 in the current financial year. That represents increases in activity of 7.9 per cent. and 7 per cent. in two successive years. Further increases are planned for the coming year. Maximum waiting times have fallen sharply in my constituency. In 1993-94, the trust reduced them from two years to one; in 1994-95, they were reduced from 12 months to nine; this year, the trust is on target for a reduction from nine months to six. That is a phenomenal achievement by any standards, but it does not stop there. Worcester Royal infirmary is one of the12 significantly improved hospitals in the national league tables. It was awarded a charter mark for its out-patient work, and it was the first hospital in England to win World Health Organisation status as a health-promoting hospital.
I know from what I see in my surgery, read in my post bag and hear from friends who have received treatment at the hospital, how grateful patients are for the quality of care that they are given there. I know that almost every patient receives an extremely favourable impression. There is a "but", however. My right hon. Friend probably knows what is coming.
Morale is also about good facilities. I am glad to say that facilities have been provided at a spectacular rate throughout the country: I believe that there has been a multi-million-pound project every week throughout the lifetime of the present Government. That is a real shot in the arm for the morale of those working with the new facilities. The massive increase in funds that the Government have made available to the NHS has made that possible.
Worcester's new hospital, however, is overdue. I am delighted to be able to tell my right hon. Friend that approval for the outline business case has now been won from the region, and the trust's ambition is to get contracts signed this year. Three private finance initiative syndicates have already pre-qualified, and the invitation to tender will go out early in the spring, with bids due in the summer. I look to my right hon. Friend to ensure that no obstacles or elephant traps are placed in the way of the new hospital by, for example, his friends in the Treasury.
I know what keeping to the predicted schedules for building that new hospital will do for the morale of the Worcester Royal infirmary trust staff. The new hospital, which will have a fine range of core services, will be one of which to be proud. I know that other hospitals in the region are facing severe difficulties because plans for them are inappropriate, but I am confident that the trust, the health authority, the region and the Department will not make those mistakes again.
I am delighted that the hospital is likely to be built using money from the private finance initiative. I am sure that that will produce some innovative solutions to the health needs of Worcester. Freeing up the supply of
capital should enable more such hospitals to be built in other parts of the country sooner than might otherwise have been possible.
Morale also relates to working in a well-managed organisation. Working in a badly managed organisation is incredibly poor for morale. Although I hope that nothing that the hon. Member for Peckham said suggested that management is intrinsically bad, that was the impression that I formed from her remarks. It is generally accepted that the NHS has been appallingly under-managed. Bureaucracy must be resisted and I welcome the8 per cent. real-terms cut in administration costs across the health service that my right hon. Friend the Secretary of State repeatedly reminds us has been made this year.
I welcome the reduction in the number of executive directors in my trust. My right hon. Friend the Secretary of State's plans to fight bureaucracy are impressive. The abolition of a whole tier of the health service, opposed by the Labour party, is welcome. The merging of three health authorities into one in my county is also welcome. What does that do for bureaucracy? It does a great deal; it helpfully releases resources for patient care.
Reducing bureaucracy locally is not always as uncontroversial as it might appear. The merger of two community health trusts in my county has been opposed--sadly--by one vote on my local community health council. Interestingly, the debate and the voting was swung by the intervention of my former Labour opponent at the last election. He persuaded the community health council to oppose a further reduction in local health service bureaucracy--so much for Labour's opposition to bureaucracy at a local level. Give Labour a chance and it supports unnecessary management costs and less money for patient care. It is yet another case of do as we say, not as we do.
I think that I am right in saying that the righthon. Member for Derby, South (Mrs. Beckett) said a year ago:
Perhaps the hon. Member for Peckham, who now speaks on such matters from the Opposition Front Bench, needs to be reminded of that. The £34 billion or so that we spend each year on the health service must be properly managed--the House has a right to expect my righthon. Friend the Secretary of State to ensure accountability and effectiveness in delivering a high level of patient care.
I do not think that many hon. Members know that I worked in the NHS for a few months in 1973, as a hospital porter. The huge scope to manage resources more effectively rapidly became clear to me. The Socialist Health Association gave some very wise advice to the Labour party last January, when it was quoted inThe Guardian as saying:
the Labour party--
I had hoped to hear something in this debate about the Labour party's plans for the health service. As far as I could tell, my right hon. Friend the Secretary of State agreed with much of Labour's five-point plan and is already putting it in place himself.
The Labour party needs to bear in mind three things. First, it is still not promising any new money, yet constantly suggests that we are not spending enough. The silence when my right hon. Friend confronted the hon. Member for Peckham with that point spoke volumes. In fact, I noticed that she even avoided catching his eye while he put the point to her because she was so embarrassed by it.
Secondly, Labour's plans for the NHS, if it were ever to form a Government, involve substantial extra costs with no increased patient care. A national minimum wage would directly and indirectly increase costs through reclaimed differentials, and its plans to end competitive tendering would build costs back into the system and reduce funds for patient care.
Thirdly, even though the Labour party cannot quite work out what it does not like about our health service reforms, it plans more upheaval--even of reforms that are working well and that the medical profession has said it likes, such as GP fundholding. Those are three direct routes to lower morale. The system has experienced major change and the Labour party seems to want to impose more on it. That change is delivering the goods and should be allowed to settle down.
"the NHS staff are its most precious resource".
"Pay increases for nursing staff in 1995-96 have compared favourably with awards in the public sector and been broadly in line with those in the private sector, despite problems associated with the introduction of a measure of local pay determination . . . We further recommend that individual Trusts should engage in
13 Feb 1996 : Column 839negotiation with their staff representatives for local pay increases in 1996-97. We note that the Government is providing 3.9 per cent. additional resources to the HCHS"--
"in England in 1996-97. We have no reason to think that Scotland and Wales will be worse off. We believe that these resources should enable all Trusts to offer reasonable local pay increases to their staff, in addition to our recommended increase in national salary scales."
"The Review Body is not a negotiating partner and we have not sought to determine conditions of employment. However we would be remiss if we did not point out that in our view local pay arrangements can only contribute to increasing efficiency and job satisfaction if all aspects of work organisation are considered."
"The Review Body has in our view always to work within the broad framework for the NHS established by Government policies: this would apply to any Government and any policy framework. This does not affect the Review Body's independence, which means that we come to our own judgement on the issues we are required to consider. We accepted in our last report that local pay determination was an inherent part of the Government's NHS reforms. In particular we felt that Trusts and staff representatives should be able to use local pay bargaining to achieve greater flexibility and efficiency in delivering health services, for example, by responding to the local labour market, or by improving the quality and quantity of patient care."
"I do not think it's really in question any more that the NHS has been under-managed in the past."
"the NHS was traditionally under-managed and the Party"--
"should avoid 'bureaucrat-bashing' . . . It is clear that in an organisation such as the NHS, good management is a prerequisite for good patient care".
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