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Mr. Andrew George (St. Ives): I declare an interest, as my wife is a nurse. One issue that is often overlooked in seeking to retain, recruit and encourage the re-entry of nurses into the profession is the cost to nurses of training and retraining. They are treated as if they were highly paid professionals. Will my hon. Friend comment on the fact that nurses often have to undertake training in their own time and at their own expense? In effect, they are being asked to pay for the right to be poorly paid, which adds insult to injury.

Mr. Hughes: I am grateful to my hon. Friend, who knows more about that issue than most. I, too, declare a slight interest, because people in my office have spoken to my hon. Friend's wife over the past couple of days to check what is going on in nursing in rural areas, to ensure that we are not just picking up information from inner-city constituencies. The situation that my hon. Friend describes is a scandal. I know of no other profession in which one is expected to retrain in one's own time or, effectively, at one's own expense. We are short of 12,000 nurses and desperate for people such as my hon. Friend's wife to work for the health service, yet we tell them that we will not pay them to get back up to speed if they want to return. That is not acceptable, and would not be in any other profession.

My hon. Friends and I have put on the table two procedural but important propositions about the way in which this place should deal with public sector pay reviews. First, in the past--I understand why--pay review body recommendations have gone to the Prime Minister, then the Chancellor and have been finally decided by the Cabinet. The House has never had an opportunity to decide such matters. We vote willingly on our own pay, but are never given the chance to vote on key public sector pay--whether it be of the armed forces, teachers, senior officials such as judges, or people who work in the health service.

Liberal Democrat Members are clear that, whatever the pay review body's recommendations, they should never be turned down unless Parliament agrees. If we are all asked to go through the Lobby in favour of or against the recommendation of a pay review body, the views of the country will be far more clearly reflected than if the Government take a possibly partisan decision which often favours the short-term economic interest as opposed to the long-term interest of the nation.

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From the spring, there will be a Parliament in Edinburgh and assemblies in Cardiff and Belfast. We shall have four health services, accountable to local representatives. We have always believed that the health service should be more accountable. Therefore, logically, the pay review body should report to the Parliament in Edinburgh and the assemblies in Cardiff and Belfast, as well as to this place, so that what is right for Scotland, Wales, Northern Ireland and England can be decided by the people in those places on the basis of the particular facts. Different recruitment and retention problems and different mixes of professions need different solutions.

Although there are expert groups on nurses, midwives and health visitors, no one has ever compared their pay with that of cleaners or trust chairs. People who chair trust boards, who receive £120,000 a year, have had large pay increases. Yet, at the bottom of the scale, people have ended up on £12,000 a year following pay increases of 2.5 per cent. We take the very strong view that the health service will work together and feel like a team only when everybody's pay is considered collectively and seen to be fair.

We all know--it is almost trite to say--that the United Kingdom spends 5.8 per cent. of its gross domestic product on the public health service and about 6.9 per cent. on health care in total. We are halfway up the league table of European Union countries in public spending on health care, and 13th out of the 15 in total spending. The public are saying to us very loudly, "We want to spend more on the health service." We cannot divorce the pressure for better pay from the fact that the public are willing the health service to receive more. A huge majority of people believe that we need to spend more of our national wealth on our national health.

Health professionals have a good case when they say that, as they are frontline workers who do life-or-death jobs, it is reasonable that their pay should be compared with that of people who do similarly important public service jobs, and with the average wage of the work force as a whole. Last year, while a grade D clinical nurse was paid £12,635, a fire fighter's starting salary was £14,500, and a police officer's and a qualified ambulance worker's £15,500. A teacher's starting salary, at more than £13,000, was also higher than that of a nurse, midwife or health visitor. The average wage was more than £20,000, and the average graduate starting salary--now, all nurses are graduates--was about £16,500.

Since the beginning of the 1980s, the pay of a nurse or midwife has slipped from about three quarters of average pay to much nearer half. I do not think the country thinks that that is acceptable. We must restore the status that is recognised by pay. It is no good saying, as the Government are saying to teachers, that people are very important, while not giving them the money in order that they may do their important job properly.

I do not want to go into the details of the practices to which my hon. Friend the Member for St. Ives alluded, but it nonsensical that nurses should be better off leaving the health service and then returning for regular part-time agency work. That is undermining the health service. However good such agency nurses or midwives may be, they are not part of the team, do not know the patients in the same way and are not present all the time. Everyone in the health service agrees that the doubling of reliance on agency nurses, which was corroborated in figures in a

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written answer to me just before Christmas, is an unacceptable trend which ought to be ended--let alone the practices of training in one's own time and the like.

The Government keep on saying that if staff are given more money, there will be less for patient care.

Mr. Bob Russell (Colchester): What are staff for?

Mr. Hughes: Indeed. Patient care can be delivered only if staff are available: it is not a case of either/or. Wages are a significant part of the health service's budget because a large number of staff are needed to deliver high-quality care. There are two components to the staff issue: we need both enough staff and high-quality staff. If we have both, good patient care can be provided in pretty grim conditions. Buildings can be dire, but if equipment and staff are up to the job, people's lives can be saved and the quality of their lives significantly improved.

I hope that, in this Parliament, we do not experience the dishonesty that we experienced twice in the last Parliament. In the last Parliament, the Government said, "We will act on the pay recommendations, but the money will have to come out of existing budgets: we will not give you any more." The same has often been done in the case of teachers. Local authorities have been told that they can pay teachers more, but will have far less money for other purposes as a result.

I am afraid that the Government have already perpetrated a fiddle. In November, the then Minister of State, the right hon. Member for Darlington (Mr. Milburn)--now promoted to the Cabinet--announced the new criteria, or terms of reference, for the pay review body. He had changed those criteria, adding requirements for the body to take into account such factors as the Government's inflation targets, and also to take into account not just the need to recruit, retain and motivate staff, but spending limits.

In the past, the pay review body has always said that its job is to recommend fair pay and conditions for staff, and not to say that, although it would like to recommend a certain sum, it cannot do so, because the Government have said that only so much is available. I fear that, even if the Government implement in full and immediately all that the pay review body has recommended this year, the body will not be allowed to say what the health service requires as it did in the past, because its goalposts have been moved.

Pay for those in the health service should constitute what is needed to recruit and retain the staff who are required to do the job--in the real world, where people must meet real bills. I hope that today's debate will reflect the pressure from the country as a whole, and the public's wish for us not just to say good things about our health service workers, but to pay them properly so that they come, and stay, and come back, to do one of the most vital jobs that the country has to offer.

10.2 am

Mr. Dennis Skinner (Bolsover): I think it would be fair to say that our magnificent victory on 1 May 1997 resulted not just from economic factors and the failure of the last Government, but from the fact that, for at least 10 years, many people had felt that it was high time we

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had a change in order to save the national health service from the Tory Government who had been diminishing its role for so long. It is incumbent on every Labour Member to bear in mind the fact that we were elected for that specific reason--to save the national health service. We established it way back in the 1940s, and now, after 18 years of Tory rule, we must rebuild it.

It should also be remembered that last year the Labour Government decided to recognise the problems in the NHS, and to find sufficient money to put it back on its feet. It would be wrong to give the impression that we expected £21 billion to be allocated in the last Budget. I know of no hon. Member--and I include Tories and Liberal Democrats--who made any reference to such a figure. In fact, it is on record that the Tories' top figure was about £12 billion.

I believe that the Government's decision enables usto feel a little confident about the pay review recommendations for nurses and other NHS workers. I do not think that my speech, or that of the hon. Member for Southwark, North and Bermondsey (Mr. Hughes), will decide their fate; I think that the key ingredient in ensuring better pay for nurses was provided at the moment when the Government decided to allocate that £21 billion.

The Government may feel that the money should be spent in a certain way--that more should be spent in one area, and less in another. Let me emphasise again, as I have for several months, that the decision on pay for nurses and others--including those who clean the wards, for instance--will be a defining factor for the next three years. We cannot afford to hear, day in, day out, arguments from those who are at the sharp end in the NHS.

Unlike the Liberals, who cannot put a real figure on their spending proposals because they spent their extra penny on tax many months ago, the Government must think in terms of an increase of no less than 10 per cent. for nurses and others at the bottom of the pay scale. I hope that it will be more. If it is true that we are 12,000 nurses short, and that the NHS is short of staff at all levels, we must institute a regime that will enable us to change the position.

I agree with those who talk about getting rid of agency nurses. I will go further, and say that I do not approve of the pay review body, which was introduced by the Tory Government to solve some of their problems. I would much prefer the NHS trade unions to be able to engage in proper free collective bargaining like every other trade union. My hon. Friend the Minister should recognise that we have a crisis in the health service, that we must try to overcome it, and that in the next three years--in the run-up to the next election--we ought to be able to say that we not only found the necessary money for the NHS, but found enough for nurses, midwives and the rest.

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