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Mr. Greenway: I know that we are running out of time, but before the hon. Gentleman provides a modern definition, and given that he seems to be suggesting that there is an argument purely between the Conservative party and the Government, may I remind him that the Select Committee on Culture, Media and Sport, chaired by the right hon. Member for Manchester, Gorton (Mr. Kaufman), expressly stated that there was no justification for breaking the five-year formula? Does the hon. Gentleman agree with the recommendation that the BBC should
- cut its coat according to the cloth?
Mr. Browne: However old an illogical argument is, it is an illogical argument. My response to the hon. Gentleman's intervention was in my introductory remarks. The BBC is living in a more rapidly changing environment than it has recognised. Yet there are certain forces that still argue for whatever reason--including Opposition spokesmen and the Select Committee--that we should stick to the funding formula that was agreed six years ago, despite the fact that the world is changing around them.
I return to my core theme: what is a modern role for the BBC at the turn of the century? A vigorous media are essential to hold government, institutions and individuals to account. Broadcasting is unique in doing that, unlike the print medium, because it gives access to what politicians say and do, and to what is said and done by professionals and other individuals.
Secondly, broadcasting has a role in promoting personal responsibility. That role is well known in combating crime and increasing awareness of health issues.
Thirdly, broadcasting--uniquely--can facilitate the acquisition of basic skills in literacy and numeracy all the way through to further education at the Open university.
Fourthly, broadcasting has the unique ability to allow many people to share information and to tackle social exclusion. Given the way the BBC is funded through the licence fee, and because of its charter, it can do that without the pressures that any other form of funding would bring.
Mr. John Grogan (Selby):
In the two or three minutes that are left for the debate, I shall deal with a couple of arguments advanced by the hon. Member for Ryedale (Mr. Greenway). He seemed to suggest that unless there is a precise definition of what public sector broadcasting will be, it is not possible to commit any more resources to the BBC. That is a misunderstanding of the changing broadcasting world. No one can say precisely what public sector broadcasting will be like in 10 years' time. No one can say whether there will be television channels in the conventional sense by then.
If, in the 1950s, a committee of Members or others had been formed to draw up the future for radio, it would not have identified Radio 1. In the 1980s, it would not have been possible to define Radio 5 Live by means of a committee. Public sector broadcasting is a creative and dynamic force, and as a nation we must commit ourselves to the principles that have served us well in the past.
In the 1990s, the private sector was increasing its revenues in broadcasting by 5 per cent. in real terms per annum. That was not envisaged at the time of the earlier review, and neither was the digital expansion.
It is suggested, particularly among those who now have cable or satellite television, that there is a disinclination to pay the licence fee. There is no evidence of a revolt against the licence fee. Collection rates are increasing. When the BBC took over collection of the licence fee in the early part of the last decade, the evasion rate was 10 ten cent; it is now down to about 5 per cent. Pannell Kerr Forster, the consultants to whom my hon. Friend the Minister referred, suggest that the overall cost of collection and evasion will be down to 9 per cent. by 2006-07, compared with 13.2 per cent. in 1995. The licence fee is a small sum compared with the £300 that the average digital or satellite subscriber pays for what are essentially sports and movies.
I want quickly to say--
It being one and a half hours after the commencement of proceedings on the motion, Mr. Deputy Speaker put the Question, pursuant to Standing Order No. 16(1).
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Dowd.]
Mr. John Healey (Wentworth):
I am grateful for this chance to raise the issue of discretionary pay points for practice nurses. The matter was raised with me by four local practice nurses, who skipped lunch to see me at my constituency office a month ago.
These are senior nurses at the top of their profession. They manage their own case load, run clinics and lead service delivery teams on family planning, women's health, asthma and chronic obstructive pulmonary disease, which is a legacy of the coal mines that is only too common in south Yorkshire. They are responsible for health promotion, Medical Research Council-sponsored research and the training and professional development of other primary care staff.
Practice nurses are developing new quality standards, audit work and clinical governance systems. They are, to all intents and purposes, making prescription decisions, although of course because they are not health visitors or district nurses, despite the fact that they have the same qualifications, those prescriptions are still countersigned by GPs. In other words, practice nurses see and manage patients who would previously have been seen and managed by GPs.
That part of the nursing profession is the backbone of the GP service at present and the base on which we will build a better, more multidisciplinary primary care service in the future. Ministers have therefore rightly given strong support to the expansion of practice nurse numbers and roles.
The nurses who came to see me are highly experienced and have been at the top of their pay scale for many years. Their annual salary is between £18,000 and £19,000 for a full 34-hour week, although, as many surveys confirm, practice nurses, like other nurses, often work extra hours unpaid. They are also very committed to their work. Care of their patients is their first, second and third priority. They are the last people to make complaints on their own behalf, but they have been driven to do so, first, by the mishandling of their position by Rotherham health authority and, secondly, by the muddle over their position generally as nurses employed by GPs, who are independent small business people.
In 1998, the Nurses and Midwives Pay Review Body recognised a serious problem of career progression for such senior nurses. Three quarters of nursing staff in G, H, and I grades were at their grade maximum, and the pay review body stated that there was
The 1998 pay review body report, therefore, introduced the concept of a discretionary points system to allow the most senior nurses with the greatest responsibilities to apply for up to three additional increments, each worth between £375 and £400. As the pay review body made clear, those were introduced as an interim solution, and not a long-term answer to the problems.
National agreement was reached between the parties in September 1998 on implementing the discretionary points. The NHS executive issued an advance notice on 11 September 1998, and the Nursing and Midwifery Staffs Negotiating Council was charged with agreeing criteria for the operation of the system, which it published in November of that year.
The review body expressed the firm expectation that, to quote the NMNC guidance,
Our Priority Health Services NHS trust employs two practice nurses, although other nurses and health visitors have used the scheme set up by that trust in November 1998. Under that scheme, 64 discretionary points have been awarded.
By the early summer of 1999, Rotherham health authority had set up arrangements to deal with applications from practice nurses employed by GPs. During the summer, a number of nurses went through lengthy efforts to prepare applications, which were assessed by the health authority's panel.
Eleven nurses were awarded discretionary points. In August or September, they received confirmation of their awards in writing from the health authority's professional nurse adviser, who, quite reasonably, had been co-ordinating the assessment system. In the letter, the nurses were informed that a report would
I shall deal with Mr. Hinchcliffe's points one by one. First, practice nurses had to raise the question of their application with their GP employer before it was submitted. Certainly in the cases that I have examined, the GP either endorsed the application, or at least confirmed the accuracy of the description of the practice nurse's role contained in--
It being Ten o'clock, the motion for the Adjournment of the House lapsed, without Question put.
Motion made, and Question proposed, That this House do now adjourn.--[Mrs. McGuire.]
9.50 pm
little, if any, scope to reward the taking on of extra responsibilities or the acquisition of new skills. We were also aware of the deleterious effect that limitations on career progression could have on recruitment and retention.
Nurses, including practice nurses, at the top of their grade were getting extra responsibility without extra reward or recognition.
initial awards of discretionary points locally will have been achieved by the end of December 1998, backdated to 11 September 1998.
In Rotherham, our General Hospitals NHS trust set up and operated such a scheme, as required, from September 1998. To date, 126 midwives and nurses--none of them practice nurses, of course--have applied and been assessed for discretionary points, and 111 such points have been awarded.
now go to the Executive Team who will need to approve the awards. Any money approved will be backdated to September 1998.
In November, out of the blue, the nurses received a letter from the health authority chief executive, Mr. John Hinchcliffe, which stated that since the time that the practice nurses received the letter about discretionary points from the health authority,
we have been considering how to proceed and seeking advice from the Department of Health. We have come to the view that the process that was used to award the points did not follow nationally-agreed guidelines and we have therefore decided that we need to rectify this situation. To do this, we will, in fact, need to run through the process again. I do apologise for this but it is important that this system operates properly and that it is seen to be fair and equitable for all involved.
The letter continued:
We will put in place the appropriate procedure as soon as we can and any awards made under the new procedure will be backdated to the date of your original application.
Understandably, the practice nurses were extremely disappointed, demoralised and demotivated, but they are determined professionals, and they pressed Mr. Hinchcliffe for the reasons why he thought that the process introduced by the health authority had been flawed. Mr. Hinchcliffe explained that
GPs need to be involved in the process not least because they will be required to part-fund any awards.
28 Mar 2000 : Column 317
According to Mr. Hinchcliffe, the authority's arrangements had not followed national guidelines in four areas. He stated that
GPs have not ratified applications; staff representatives have not been involved in developing the local procedure; the executive team--
of the health authority--
was not clear what decision-making process had been used; there is no clear indication of how any appeal should be handled.
I met Mr. Hinchcliffe 10 days ago to discuss the problem, and I made it clear to him that I did not accept his arguments that the process was unsound, or that it needed to be redesigned and rerun from scratch.
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