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5.34 pm
Mr. Simon Hughes (Southwark and Bermondsey): I welcome the debate, although, like last week's, it has not added greatly so far to the sum of human knowledge. Although the hon. Member for Peckham (Ms Harman) was right to identify the lack of morale, I join others who have identified her huge flaw in not mentioning what the Labour party would do about the biggest issue connected with morale: pay. [Interruption.] The hon. Member for Fife, Central (Mr. McLeish) says that he will answer that in his winding-up speech, so I shall look--
Mr. McLeish indicated dissent.
Mr. Hughes: He said that from a sedentary position a few moments ago. He will either deal with the issue and we will have an answer, or he will not do so and we will go without an answer. I was not expecting an answer--I do not think that the Labour party has one. I hope that all those who are interested will read the account of the debate and realise that, although it is very easy to say what is wrong with the health service, it is much more difficult to come up with the recipe to put it right.
The hon. Member for Peckham described five points. First, she said that health professionals should be given a say, with which the Minister and every hon. Member
agrees. Secondly, she said that there should be an end to employees being gagged. I did not hear the Secretary of State agree with that, but my hon. Friends and I certainly do. Thirdly, she said that there should be improved safety at work, which is a general proposition that others and I would support. Fourthly, she said that there should be fair pay, which is easy to enunciate without any elaboration. The fifth point got lost in the general exchange on what fair pay might be. We clearly have to wait for another day to find out what the Labour party will do in practical terms about the pay of NHS staff.
I expressly join the Secretary of State in congratulating and thanking the people who work for the health service--the largest employer in the country--for all they do and for their dedication. That is where we ought to start. I am all too willing to support many phrases in the Government amendment. There has been considerable improvement in many parts of the health service, such as nurse training, and many of the developments have produced better qualified people.
There is, however, some difficulty. I confirm that there is low morale in many parts of the health service, which the Secretary of State has not yet addressed. I hope that the Minister will address it. It is no secret to aficionados of health service debates that across the country Liberal Democrats are surveying morale, among many other issues. [Interruption.] I shall add factual evidence that confirms that morale is low. [Interruption.] Sincehon. Members are always rightly sceptical of the veracity of such evidence, I shall even cite the number of forms sent out and the number of responses returned.
The leader of the Liberal Democrat party in the west midlands, John Hemming, and the deputy leader, Paul Keech, who are respectively our prospective candidates in Birmingham and in Hereford, carried out a survey among the majority of practices--that is a real test--in Birmingham and Hereford, in which 354 forms were returned. In answer to the question, "Are you seriously considering leaving medicine by early retirement?",41 per cent. of GPs said that they were.
That survey was conducted at the end of last year. When Chris Fox, a colleague who is our prospective candidate in Windsor--the seat of the deputy chairman of the Conservative party--asked GPs in that constituency the same question, more than 50 per cent. said that they were considering early retirement. To ensure that the statistics are on the record, I should like to point out that30 per cent. of GPs in that constituency replied, representing 70 per cent. of the practices. I shall give the House two further statistics, only to demonstrate that my proposition has many resources to back it up.
Steve Jarvis, our prospective parliamentary candidate for Hertfordshire, North-East, had a reply rate of42 per cent. to his survey, and more than half the GPs in that constituency are seriously considering giving up medicine. The results of those surveys will be compiled in future--so that people do not have to wait for their exciting conclusion.
My colleague, Mark Oaten, who is our prospective candidate in Winchester--
Mr. Simon Hughes:
It is not outrageous at all; it is fact.
Mark Oaten received replies from more than 80 per cent. of the practices in that constituency, and 47 per cent. of the GPs there were seriously considering leaving the profession by taking early retirement.
Mr. Luff:
Will the hon. Gentleman give way?
Mr. Hughes:
Of course I shall give way to the hon. Gentleman, with whom I discover I share one thing in common--I, too, was once a hospital porter.
Mr. Luff:
I wonder whether any of those surveys will be about anyone other than prospective Liberal parliamentary candidates. I ask just for my own amusement and information.
Mr. Hughes:
If the hon. Gentleman and his colleagues want to join my colleagues in conducting the surveys, I should be entirely happy for that to happen and would equally attribute the results to them.
The Minister for Health (Mr. Gerald Malone):
I should like to clarify a point, because the hon. Gentleman has mentioned my constituency. Is this the same survey that came from the Liberal Democrats' style book of campaigning tactics, which asked, in a general sense, what Nora Batty's view was of the local health service? I must know what we are talking about. That survey predicated its approach with the view that, of course, a vast majority of people would be demoralised. If it is the same one, I should certainly like to know.
Mr. Hughes:
I do not know whether Nora Batty features in it. However, as it is the Minister's constituency, I shall happily send him a copy of the surveys. We could then debate the health service in Winchester, as my colleague in Winchester would be happy to do.
It seems me that there is abundant evidence for my proposition. The surveys were obviously a partisan collection, but they had responses from independent professionals. The surveys are borne out by all the other evidence. It ill behoves the Secretary of State--I hope that the Minister will not make the same mistake--to fail to acknowledge that there is a common dissatisfaction among professionals. One has only to ask the representative professional bodies to confirm that; whether one asks the BMA or the Royal College of Nursing, the evidence is the same. All the briefings that Members of Parliament receive from those bodies confirm those facts.
I shall not cite the evidence which we received in anticipation of today's debate, although I shall cite two other recent pieces of evidence. The first is a report, from last June, of the Department of Health's medical work force standing advisory committee. It contained clear evidence that there is a shortage of doctors in the hospital sector, as set out on page 18, and in general practice.A significant number of posts remained unfilled and without applicants. In response to the pay review body's recommendations and the Government's response to them, Michael Lowe, the BMA deputy secretary, said in a letter:
That is the most telling point; doctors have complained that the award, once recommended, will be phased in.
Nurses are entirely unhappy. The general secretary of the Royal College of Nursing has said on the radio and, during the weekend, in the newspapers that nurses find a fundamental award of 2 per cent., with a prospective local top-up, entirely unsatisfactory, and that they will campaign for a 6 per cent. basic award everywhere. Of course pay is not the only influence on morale. Other things impinge on morale, such as stress and work load; the number of people working in the ward, practice or hospital; how staff are treated by management; and how often they must go for locums or to an agency. Our job is to seek to alleviate those factors; that is our collective responsibility.
I should say one other thing to elaborate the point that I made in my intervention on the Secretary of State's speech. There are acute crises in various parts of the health service. The Secretary of State was right in saying that the review body did not say that the crises were occurring everywhere. However, that does not mean that the crises are not acute where they exist. One directorate at my local hospital, in the Guy's and St. Thomas's NHS trust, lost 13 staff nurses between November last year and January this year. That loss of people from one department cannot be sustained without a huge impact.
Whenever I have gone around to my local hospital, I have been able to testify to the truth of most patients' view--to which the hon. Member for Worcester(Mr. Luff) alluded--that the staff there do an excellent job. However, the patients often also recognise how much stress and overwork the staff experience, and how that makes it difficult for staff to do the job that they would like to do.
I should like to give a few propositions on how we might proceed. My right hon. and hon. Friends and I stated our position on pay in an amendment on the Order Paper, which was in contradistinction to the Labour party's position. We believe that there should be a pay review. We ask the Government to re-think the pay increase that has been awarded to nurses and for the national pay increase to keep pace, at least, with inflation. It is extremely unfair that nurses--uniquely, out of all the people to have had a pay increase recommended--have had recommended a below-inflation pay increase. Of course I appreciate that the increase may be topped up by local awards, but the fundamental 2 per cent. award is clearly below inflation.
What shall we do? It is right to say that the elimination of short-term contracts would help considerably, because they undermine morale. One of the problems of the NHS structure, in which trusts themselves have short-term contracts, is that trusts employ people only on short-term contracts. That is a fundamental flaw in the system. There must also be increased flexibility in the types of contract that are offered. I am not saying that they should not be long-term, but people need to have sabbaticals, to share jobs and to have part-time contracts, particularly to encourage returners--the people who have left a profession, especially nursing, and want to return to it.
There must be--sadly, we heard not a word about it from the Secretary of State--effective forward planning. One of the dangers of a divided NHS, as it is under
the current structure, is that there is no clear planning to meet the staff demand. When professional colleagues who advised our party in 1992 examined what would be the likely result of current policy, it was found that there would be a shortage of nurses, doctors, consultants and senior registrars in many places. Indeed, we are short of those people. We are not adequately planning ahead. We cannot leave such matters to the market. We have a national health service, and it must have people to meet patients' demands. I am grateful that the Minister agrees with that, and I hope that he will tell us how the Government propose to deal with that problem, so that we can plan for adequate staff and prevent shortages.
A small point--it does not apply everywhere in the country--is that there should be adequate staff accommodation, which is a factor in recruiting younger new staff in particular. There is now less staff accommodation, and trusts should sometimes subsidise it to enable staff to work in hospitals.
We believe that there should be one NHS pay review body, to deal with the disparity between management and other pay grades. The pay of everyone, from chief executives to cleaners, would be reviewed by the same body. That would prevent the situation in which the pay levels of some grades and professions are decided without taking into account the pay levels of others. The current position absolutely gets the goat of people who work in the mainstream of the health service.
I shall take the example of my local health service. If a nurse there is on £10,000, £15,000 or £20,000 and the chief executive is on £115,000 or thereabouts, nothing will persuade that nurse that the pay levels are equitable, however big a responsibility the chief executive has.
We believe that the pay review body's recommendations should be altered or varied only with the assent of the House of Commons. If the Government decide not to follow the recommendations, as they have done this year by delaying implementation, that should require parliamentary approval. That would give parliamentary protection against the actions of any Government who wanted to change what the independent body recommended.
We believe that there should be national criteria for local flexibility. There is a need for local flexibility, but there should be national criteria to govern how that is applied. For example, there should be flexibility to reorganise the staff structure in a trust, to deal with a local recruitment problem or to reward exemplary performances. However, local flexibility should be used within a pattern established for the country as a whole.
I shall mention two more issues. First, compulsory competitive tendering should be optional, and not compulsory. Secondly, the medical hierarchy should be reformed. I could elaborate on that, but I will not. However, the present structure is not compatible in many ways with the best use of resources. If we took less time to train our specialists, if we had specialists accredited earlier by the professional colleges and if we increased the number of consultant posts by bringing people into consultant grades earlier, we would start to fill the gaps in the system.
"The underlying failure of the Review Body to acknowledge an act upon the excessive and unsustainable workload facing doctors is further exacerbated by the Government's gratuitous insult of phasing the award."
13 Feb 1996 : Column 845
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