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Mr. Ken Purchase (Wolverhampton, North-East): I agree with what my hon. Friend is saying, but is it not also true that simply saying that there is more money on the table to attract nurses to the profession is not enough? We must recognise that, owing to the 18 years of neglect, training places have not been filled. They have been artificially repressed when the demand has been there. The present Government's task has been impeded by the actions of the last Government, to the point at which we cannot possibly obtain the number of nurses we need in

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the time available. Training places must be opened up as a matter of urgency--although, at the same time, we must do as my hon. Friend suggests, and cajole the Government into paying our nurses more.

Mr. Skinner: There is no doubt about that. Just before the recess, I went to St. Thomas's hospital with a colleague who was ill, and I had the shock of my life. I have not spent a great deal of time in hospitals. It was late on a Thursday night, and about 30 people were queueing. Some had been involved in scuffles and the like. It should be noted that it was a Thursday, not a Friday, a Saturday or a Sunday. A nurse was trying to deal with all the people who were trying to get on to the casualty ward. My colleague, who turned out to have had a minor stroke, was taken in. During the two or three hours that I spent in the hospital, people with blood on their ties were shouting and bawling at the lone nurse who was trying to deal with the problems. I heard it said that there would be a three-hour wait for a doctor. This was at about 10 pm on a Thursday, in one of our largest hospitals, just over the river. I realised that the nurse was having some difficulty in handling the problem, so I went outside and had to cajole some of those people into realising that she was not responsible for the mess that night.

It is important that we do not finish up with one nurse at St. Thomas's hospital between 10 o'clock and 1 o'clock trying to deal with 30 people in the casualty department. I suppose that that situation could be mirrored throughout Britain. That is why training and all the rest have to go along with the other policies.

When he talked about England, Scotland, Wales and all the rest of it, the Liberal Democrat spokesman gave the impression that there might be different pay rates for different regions. I happen to be first and foremost a trade unionist and I do not want national pay negotiations to be broken up. It is conceivable that the existing method of pay bargaining will result in more and more break-up, with the result that pay can be negotiated locally. People will then get more pay in some parts of the country and, where unemployment rates are high, they will get considerably less. I can imagine some of the Liberal Democrat Members from Cornwall and the south-west, where pay is traditionally lower, playing merry hell if they found that pay negotiations had been broken up in that fashion. National pay rates are important across the board.

Mr. Simon Hughes: I understand the hon. Gentleman's argument and I have always said that there should be national pay negotiations and national pay rates--I took on the Tories about that when they were in power--but, as he is aware, from later this year, the health service in Scotland will be accountable to the Scottish Parliament. We are not talking about different regions in England, but the four countries of the United Kingdom--different nations. It will be illogical and completely against the wishes of the people if they cannot negotiate their own pay for their own health service. However, that does not mean that, throughout England, we break up the national pay strategy. I support him on that, but Scotland, Northern Ireland and Wales are different countries.

Mr. Skinner: Frankly, I do not go along with that fancy idea. People can call it devolution or whatever they like, but I used to be a coal miner before I came here and

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I cannot conceive of a situation where, if we had a lot of pits in Scotland--we do not because the Tories closed most of them--we should have miners being paid one rate in Derbyshire and Yorkshire, another in Scotland and another in Wales. I am not in favour of that.

As a trade unionist, I believe that it is important that we have national pay negotiations. The moment that we have inroads into that proposal, the lowest common denominator in pay sets the pace. The result will be lower wages for all at the end, not the highest common factor.

When my hon. Friend the Minister winds up, and in his representations at other levels, will he bear it in mind that we have to strive to get rid of the internal market, to ensure that we get more nurses, to improve training, to have a pay increase of at least 10 per cent. for those at the bottom of the pay scale, and to ensure that the national pay scale system remains, irrespective of devolution and all the rest that is on stream?

Mr. Purchase: It is refreshing to hear analysis when there was a lack of it from the hon. Member for Southwark, North and Bermondsey (Mr. Hughes)--in fact, the hon. Gentleman was determined not to engage in any analysis or to blame anyone.

Does my hon. Friend accept that the greater problem in the NHS is the lack of acute beds, which were systematically closed year on year in every health district in the British Isles? Throughout the period of Conservative rule, those acute beds were wasted away. During the current crisis, the problem is not just at the front of the house--my hon. Friend referred to accident and emergency--but at the back of the house, where the beds have not been available, with the result that people have been stuck on trolleys in corridors. Does he not accept that that is a critical part of the problem?

Mr. Skinner: Everyone knows that that is one of the problems that we have to resolve. That is one reason why the £21 billion was important. The decision by the Labour Government in the past few months to find £21 billion can help us to resolve that issue. It is one that can be resolved only if the Government take on the system within the NHS that was left to us by the Tory Government, which meant that all those decisions could be taken, that all the trusts could be set up and that the power that used to exist in the NHS was disseminated through the trusts. We have to deal with that as well.

I welcome the fact that we have that additional money to spend. I hope that it will be spent wisely and that we will ensure that, at the core at what we do in the NHS, those people who provide the services will get a much better pay deal as a result of the efforts of the Government to find sufficient money, as they have during the past few months.

10.16 am

Mr. David Amess (Southend, West): I congratulate the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) on his success in the ballot. The debate is important. I also welcome the Minister of State to his first opportunity to show his ability at the Dispatch Box.

It is interesting to note the Labour Members who are present; I put aside the Minister and I do not really know the hon. Member for Wythenshawe and Sale, East (Mr. Goggins), but I assume that he is his Parliamentary

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Private Secretary. At least I know where I stand with the other four Members who are present--that will damage their careers. We certainly know where we stand with the hon. Members for Bolsover (Mr. Skinner) and for Wolverhampton, North-East (Mr. Purchase); I forgot the Whip, the hon. Member for Weaver Vale (Mr. Hall).

I do not know whether the father of the hon. Member for Chorley (Mr. Hoyle) would have been pleased with what he said to the Minister for Local Government and Housing yesterday about rate capping. I did not agree with a word that the hon. Gentleman said, but at least he had the guts to take on his own Minister. The hon. Member for Leyton and Wanstead (Mr. Cohen) was first elected at the same time as me, although we share nothing in common politically, except perhaps on animal welfare. He was entirely right before Christmas in wanting a debate on the bombing of Iraq. Those four hon. Members are certainly not part of the rubbish that was sold to the British people on 1 May.

I am delighted that the Liberal party has initiated the debate. I am somewhat confused about the position of the Liberal party these days. This morning is a perfect opportunity to find out where it stands. One of its Members, the right hon. and learned Member for North-East Fife (Mr. Campbell), was made a privy councillor in the new year's honours list. I congratulate him on that. Over the weekend, he was interviewed on television. He dismissed completely all the difficulties of the Government over the Christmas period and said that he would continue to support the Labour party as long as it continued with its policies on health and education. What we have heard this morning does not seem to bear out that out--and that privy councillor was sitting here earlier. As ever, the Liberal party wants to have its cake and eat it.

Dr. Evan Harris (Oxford, West and Abingdon): Liberal Democrats.

Mr. Amess: Like all politicians, we want to be loved, but what on earth does the Liberal party stand for?

Dr. Harris: Liberal Democrats.

Mr. Amess: The Liberal Democrat party. The hon. Member for Oxford, East or whatever it is--


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