House of Commons
Wednesday 13 January 1999
The House met at half-past Nine o'clock
PRAYERS
[Madam Speaker in the Chair]
Nurses, Midwives and Health Visitors
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Mike Hall.]
9.33 am
Mr. Simon Hughes (Southwark, North and Bermondsey): I am grateful that you, Madam Speaker, have chosen for our first Wednesday morning debate of the new year the extremely topical subject of pay and conditions for nurses, midwives and health visitors. Out there in the country, a lot of people will be pleased that we have been given this opportunity for such a debate.
First, may I perform the usual courtesy of welcoming the Minister, who has a great opportunity? In one speech, he could guarantee a successful career and make himself popular with the whole country, hugely popular with the health service and entirely popular with hon. Members on both sides of the House. I look to him to rise to an unparalleled occasion. I shall give him a few prompts and hope that he will respond appropriately.
As hon. Members know, in a couple of weeks, the pay review body will recommend what should be paid to nursing staff, midwives and health visitors for the coming year. The Secretary of State for Health said the other day that the country faces a crisis in the health service. The Royal College of Nursing, also in the past few days, has said that the crisis in terms of shortage of nurses in the health service is the worst for a quarter of a century. Midwives say that the number of registered midwives has fallen by 2,500 over the past five years, and that the number of registered and practising midwives is lower than at any time this decade.
I am conscious that the debate is about only some of the people who work in the health service. We could have had a debate a wide-ranging debate about all NHS employees. May I allay their concerns and possible jealousy? We pay tribute to all those who work directly for the health service or are contracted to it. Although I shall concentrate on the largest group in the health service, I hope that--if you are generous, Madam Speaker--we will soon be able to debate the other two large groups, which also have pay review bodies and have their futures determined in the sameway: the professions allied to medicine--chiropodists, dieticians, occupational therapists, orthoptists, physiotherapists and radiographers--and related grades and, of course, doctors and dentists. I am conscious that they, equally, play a part in the team, as do those who are not yet covered by the review body procedure, such as psychologists and psychiatrists.
We are grateful to all those people, but it seemed appropriate to debate nurses, midwives and health visitors, not only because they are the largest group, but because
they are the group which manifests the most severe problems of recruitment and retention. It is vital to the future of the health service that we find solutions to those problems.
The national health service employs slightly fewer than 1 million people, which makes it by far the largest employer in the country. The review body considers workers in Scotland, England and Wales and recommends for the three countries together. We are discussing the futures of about 750,000 people in these professions. Interestingly, and perhaps relevantly, about 80 per cent. of them are women. As a man, I must say that, had the gender balance in the health service been different during the 50 years of its existence, wages for nurses, midwives and other health workers would not be relatively as low. Everybody in the health service should be paid appropriately, especially those who often have the larger caring and outside-work responsibilities.
The latest available figures show that there are about 600,000 practitioners on the United Kingdom Central Council for Nursing, Midwifery and Health Visiting register, but they also show a lot of alarming trends. I shall spend a couple of moments discussing the background statistics before coming to the argument and where we go from here.
The statistics show that the number of people available, on the list and qualified to work has gone down by about 2 per cent. in the past year, which is the biggest annual decline ever reported. People in the professions are also aging rapidly. We all age rapidly, but the profile of people in these groups is changing significantly. Fewer than one in seven is under 30, and more than one in eight is 55 or over and eligible for retirement. The trend looks unhelpful, because, within about 10 years, a fifth of all nurses will be over 50 and retirements are likely to increase from about 5,000 a year to about 10,000.
That means that we must replace those at one end of the health service who are leaving because of age, but, unhelpfully, we do not appear to have the numbers coming in at the other end. The number of people coming on to the register has fallen by more than a third--from about 19,000 a year to about 12,000--and we have lost a third of that number in the past 12 months. Thus, recruitment has declined over the past 10 years but the last big decline has been in the past year.
Not surprisingly, we have had to look abroad for people to help the health service. Although that issue has been well publicised, we are talking about small numbers--of more than 500,000 employees, only some 4,500 people from overseas work in our health service. We cannot, therefore, hope to rescue the NHS by bringing people from overseas.
Mr. David Chidgey (Eastleigh):
Is my hon. Friend aware of a recent survey that shows that at least a third of nurses work two weeks' unpaid overtime a year just to keep the national health service going? Is that not an appalling indictment of the Government's record as an employer, especially given that they continually promote policies on fairness at work?
Mr. Hughes:
There are many anomalies, of which that is one. Another is that many nurses and midwives are paid a lower hourly rate for overtime. That goes against normal practice.
Mr. Menzies Campbell (North-East Fife):
It would not do Rover much good.
Mr. Hughes:
I agree with my right hon. and learned Friend. If NHS employees have the option of staying with their current employer and being paid less than the normal hourly rate or going to an agency and being hired back to do the same work at time and a half, the incentive to stay with the NHS is extremely small.
My hon. Friend the Member for Eastleigh (Mr. Chidgey) is absolutely right: there is a huge amount of unpaid overtime. There is also a huge amount of inadequately paid overtime. Those people are expected to do overtime, as many wards cannot cope without it. If we are to keep the work force at its current size, we need 20,000 to 25,000 new nurses and midwives a year, so we must have more pre-registration people as well.
It would be easy for an Opposition spokesman simply to apportion blame, but that does little good. Whatever the history of trends in recruitment, we need to get out of the hole in which we find ourselves. I want to use this debate to encourage people, and unashamedly to put pressure on the Minister and the Government not just to recognise the crisis but to seize what may be the only great opportunity remaining in this Parliament. Health service workers have been let down badly twice in the past two years--first under the previous Government, then under this Government. For the past three years, the pay review body has been asked to do its work and has come up with proposals, and the Government have said that the proposals cannot be implemented--certainly not altogether.
Nothing undermines the morale of people who are not even on average earnings more than being told that those in the private sector and other jobs will move ahead while they must stay at the same level or move backwards. The relative reduction in earnings and take-home pay has been unacceptable, and it would be a tragic mistake if the Government were to stage the pay review body's recommendations again. I call on the Government to say today that they will implement the recommendations in full from 1 April.
Last year, the Secretary of State apologised later in the year that he had had to stage the pay increases. Apologies are fine as far as they go, but they do not make up for £250 less pay in the pocket. My colleagues who deal with Treasury matters have confirmed that the country can afford to make that commitment. It would be a false economy not to pay health service staff what they deserve. If we do not pay them now, we shall not have a health service up to the job in the future, and the long-term cost to the economy will be far higher.
Rev. Martin Smyth (Belfast, South):
Does the hon. Gentleman accept that the cut in nurses' pay is leading employer bodies to appoint nursing auxiliaries--people who would love to be in the nursing profession--and money is being saved by taking on people at another level?
Mr. Hughes:
That is also true. The hon. Gentleman is knowledgeable about these matters. Although the pay review body's recommendations do not apply to Northern Ireland, and the staffing crisis is less great in Northern Ireland than in the rest of the United Kingdom, it is
I want to show the effect in cash terms of staging. In the past two years, a grade 2 clinical nurse has lost £248 as a result of staging. Last year, an award of 3.8 per cent. was made, but only 2 per cent. was paid in April and the rest was not paid until December. The rise did not keep pace with the cost of living. The Government are trying to con people by saying that it is all right if the pay increase keeps pace with the target rate of inflation. That is not the real inflation rate. The minimum that the Government must do is pay the real inflation rate--let alone make up for the money that was not paid last year.
In case the Minister says that it is all very well for Liberal Democrats to say that, but it is a huge sum of money, I remind him that the difference would have been £111 million and that the NHS budget is some £45 billion. If that was not money worth spending, we do not know what is. The Government have a huge reserve and could have afforded to pay in full last April. The Liberal Democrats said before, during and after the review that they should have paid, and the country made it abundantly clear in every opinion poll that nurses, midwives and health visitors, and others in similar professions, should have been paid a decent wage. In one respect it is too late, but in another there is still an opportunity.
May I do something slightly unusual and pay tribute to the national, regional and local press, which, over the past year, has clearly understood this issue better than the Government? It is unusual for Liberal Democrats--or other parties, for that matter--to pay tribute to the tabloid press, but The Express, the Daily Mail and The Mirror have consistently argued the case for health service employees to be paid better. They do so because they realise that a large proportion of their readership and the population at large want the health service to succeed. The NHS has lost 140,000 nurses in the past three years and there are some 12,000 nursing and 1,000 midwifery vacancies, so the press's interest has not been out of keeping.
The Liberal Democrats have seven simple-to-express elements of policy on pay and conditions. The issue is complex in many senses because of the complexity of each profession, grading structures, promotion and career development, training, overtime and local discretion. It would be wrong to seek to second-guess the pay review body's recommendations or make detailed proposals for each grade and profession. We shall value the pay review body's work this year as we have for more than a decade. It does an extremely good job and we are grateful for it. However, it is not difficult to reduce what needs to be done to some core propositions. Five of the seven proposals relate to what the Government should do now in terms of payment, and two relate to procedure.
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