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Miss Widdecombe: So why sack them?

Mr. Dobson: I cannot sack any NHS staff. That comment just displays the ignorance of Opposition Members.

This Government are also taking action to end the institutionalised racism to be found in some parts of the NHS. We have changed the arrangements for allocating distinction and merit awards so that the proportion of black and Asian doctors getting awards has increased by 50 per cent. in the first year. We have almost doubled the percentage of black and Asian members of the boards of health authorities and trusts and we have been taking other measures to improve the situation for black and Asian staff.

I do not pretend that the changes that we have set in train will put everything right as quickly as we would like, but we have made a start, both with immediate measures to deal with the staffing crisis that we inherited and with long-term changes designed to provide more and better qualified staff in five, seven, 10 or 12 years' time. Both are being carried out by this Government. Both should have been done by the Tory Government. But they were not and that is why any Tory criticism of what we are trying to do amounts, as I said at the beginning of my speech, to bare-faced cheek.

8.17 pm

Mr. Simon Hughes (Southwark, North and Bermondsey): We welcome the debate and the fact that the Conservative party has chosen this subject. It is our perception that there is extremely wide concern, distress and lack of morale in the health service. The last debate on these issues was the one that I initiated on 13 January, which was on the pay and conditions of nurses, midwives and health visitors--the first debate on that subject for 10 years. Although we might find technical reasons to differ with the motion tabled by the Conservatives, because the nature of the complaints seems valid to us, unusually, we did not table our own amendment. We thought that it was more important on this occasion to register that, in spite of the good things that the Government have done and their best intentions, so far they have not cured the fundamental problem of a health

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service in which huge number of workers do not believe that the Government are saving it or coming to their rescue.

At the very beginning of the year, on several occasions, not least the winter flu outbreak, the Secretary of State or one of his Ministers came to the House and made a statement of support for the workers in the health service. On 11 January, the Secretary of State said:

We all agree with that. He continued:

    "Over the past few weeks, nurses doctors, midwives, health visitors, cleaners, kitchen staff, managers, porters, ambulance staff, laboratory scientists, therapists, pharmacists, telephonists, clerical, administrative and maintenance staff and social services staff have all performed wonders on our behalf . . . I thank them all. They have done us proud."--[Official Report, 11 January 1999; Vol. 323, c. 35-39.]

I shall now read a letter dated 26 April from one of my constituents, who is a nurse. It reads:

    "Dear Simon Hughes,

    I am writing to tell you of my deep distress and anger at the way the nurses' pay rise has been treated by the NHS. I work for the Guy's and St. Thomas health trust and when I rang salaries to find out why the nurses had not been given their rise in April, I was first asked why I expected a pay-rise and secondly told we might get it in July if we were lucky. I then spoke to the personnel department at the . . . trust, who blamed the N.H.S. Executive for not sending out a letter of instruction to the trusts in time. They had managed to do this for the medical staff, who got their pay-rise when promised. This is typical. Nurses are the disregarded underclass of the N.H.S. Nobody gives a damn about us in real terms. All we get are well-meaning cliches and no action. The Labour Government promised that this pay award would not be staged or deferred, but that has obviously not happened. Labour boasts that 50,000 calls have been made to the back-to-nursing 'phone line. Nurses vote with their feet and leave the health service. No amount of cosmetic tinkering will reverse this unless pay and conditions improve. I know that you take a close interest in this health trust and feel sure you do not approve of this high-handed and arrogant approach to nurses' pay. I hope that you will be able to help us to get what was promised to us by the present Labour Government."

I do not know the nurse who wrote that letter. To my knowledge, I have never met this nurse, although the nurse in question lives only a few hundred yards from my house. I have read out the nurse's words; they are not my words. They are from a nurse who feels that the Government have let down nurses. We say that, if that is what they feel, that is what we must believe. That is a view that is widely felt in the national health service.

Mr. Dobson: The instructions to the national health service about doctors' pay were issued sooner than those about nurses' pay because there has to be agreement with the representatives of the staff and the doctors agreed considerably sooner than the Royal College of Nursing. One of the other reasons for the delay in producing the letters, so I am told, is that the text has to be agreed by all the unions with which we are in negotiations. As far as I know, everybody should be paid in May if payment has not been made in April.

Mr. Hughes: I am grateful to the Secretary of State. I know him well enough to know that, when he thinks that something has been done wrongly, he lets people know his views. If the NHS and the Government, who are

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accountable to the nation, thought that increased pay for nurses was important, he should have exclaimed to civil servants and managers of the NHS, as I have heard him exclaim to other people on other occasions, that that delayed payment was not acceptable. Indeed, it is not acceptable. Whatever the processes, it was not acceptable for the Government not to have given the instruction until after the beginning of the financial year. I hope that this never, ever, happens again.

I first picked up this concern at Morriston hospital in Swansea during the last week in April, when nurses came to me. I did not ask them to raise the matter with me. They told me that they had just received their pay slips and that the pay increase did not feature in them. I made inquiries and I asked my assistant to phone every NHS region in England, one trust per region. I was told that no trust had paid the increase in April. My assistant phoned Bromley in London, Kettering in the south-east, Gloucestershire Royal NHS trust in the south and west, Allington in the eastern region, Wolverhampton health care in the west midlands, Barnsley in Trent, Blackpool Victoria in the north-west and Harrogate Healthcare. Not one had paid. [Interruption.] I do not know what the hon. Member for Crawley (Laura Moffatt) said. Most of those asked said that they hoped to pay this month.

What does this do for morale? Nurses were told, "You are hugely valued. We think that you are important and you will get a big pay rise." Then there was nothing. That is not good enough. I let the case rest there. I look to the Secretary of State to ensure that that does not happen again. It is no good saying that we love nurses when we kick them in the teeth when it comes to their pay packet.

Secondly, there is common ground in the House that we need to have a package of measures to make people want to come in to, stay in, or return to, the NHS in all the professions, but particularly nursing, which is the largest. I ask the Secretary of State to consider with his colleagues whether it is not time--this applies to other professions in the NHS and beyond--to examine ways in which we can assist better those who might consider coming into nursing and the other professions. For example, we used to offer bursary schemes to those in the armed services.

There are ways in which we could give people extra funding in return for a commitment to stay. We could offer loyalty payments for those who do not disappear. There could also be packages that make it worth while to cover the cost of retraining--a matter that the Secretary of State and I have debated before--those who have left the health service but need to come back. Such packages would mean that people would not be out of pocket. There are some people who have to travel to courses to train before they are allowed back into the health service. Packages to pay for all this would give an incentive to return. In other words, there would be a premium to come back and make a commitment of three or five years to the NHS.

If we have about 12,000 or 14,000 nursing shortages and if about 70,000 of the 140,000 qualified nurses are not in the NHS, we have enough people potentially, if they are willing to come back. Some have responded. The Government have taken initiatives to try to persuade them to respond, but there has been no financial incentive for them to do so. It would cost so little to provide one in

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terms of the total budget of the health service. The cost would be worth it for their sake and for the patients' sake. The return of those people would speed up treatment times. At the same time, the morale of the health service would improve because people would not be trying to cover jobs that are left vacant.

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