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NHS Scientists

12.1 pm

On resuming--

Dr. Vincent Cable (Twickenham): I am delighted to have an opportunity to discuss scientists in the national health service. This is the first opportunity that I have had to speak in Westminster Hall.

The Minister is aleady well aware of the issue. There has been a succession of parliamentary questions from other hon. Members and me throughout the year and earlier in the year the Manufacturing, Science and Finance Union, which represents many of the members of staff involved, organised a big lobby. He is currently dealing directly with pay and conditions through negotiations, and is discussing his paper "Agenda for Change", which addresses many of the issues.

I am not here as a spokesman for the union although, in this case, the issues that it raises are valid. I have two reasons for bringing the matter to debate. First, as often happens, I was approached by a constituent--a laboratory scientist in the NHS who works at Guy's and St. Thomas' hospital. He wanted to alert me to problems. I was taken on a guided tour of the laboratories, as was my hon. Friend the Member for Richmond Park (Dr. Tonge), who has a personal and professional interest in the matter. I was struck by the combination of the dedication of the staff and their unhappiness, sometimes amounting to bitterness, about the extent to which they had been overlooked in successive pay negotiation rounds. Frankly, they were in a parlous economic position.

Secondly, I represent a constituency with an exceptionally high number of professional scientists. It has two major physics and chemistry laboratories and many related scientific commercial enterprises. I therefore have an interest in promoting in Parliament science and the people who work in it. If one group of professional scientists is seriously undervalued, it sends the signal to all scientists that their qualifications and training are not valued.

The specific issue that I wish to raise is the problem--many would call it the scandal--of low pay among what are now called biomedical scientists. They are scientists at BSc (Hons.) level who enter the NHS and can train for up to five years to achieve a qualification that, as the Minister explained to me in a written answer yesterday, is not enshrined in law and is not fully portable. They serve a long apprenticeship on low pay to work within that cadre of professions.

For some years, the headline story has been of people at the bottom of the scale--trainees, laboratory technicians and trainee scientific officers--being hired on wages of approximately £7,500 a year. That is only a little more than the minimum wage, and those of them with dependants would certainly qualify for family credit. The Minister will, no doubt, say that his offer to professionals, which he confirmed in a written answer yesterday, will take care of their problem. None the less, assuming that the pay offer is accepted, many young scientific officers will join the profession on about £9,500 or £10,000 a year. That is the status of the profession into which many of those people are moving.

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Why is that a problem? First, many young professionals are emerging from university in near poverty. Unlike other workers, many have substantial debts--they have obtained student loans and have borrowed in lieu of student grants. They then have to enter a long and difficult apprenticeship on exceptionally low pay. Secondly, large differentials have opened up within the NHS. I welcome the advances in nurses' pay as much as anyone else--they are well deserved, long overdue and almost certainly inadequate. A grade D nurse, who is roughly comparable to those professionals in terms of educational qualifications and age, is probably joining the NHS on approximately £14,500. I do not begrudge the nurses anything that has been given to them, but they attract emotional and political support that backroom laboratory workers do not enjoy. That has contributed to the big disparity.

Invidious contrasts can be made with pay outside the NHS. People concerned with that group of workers and I have done some checking. The going rate for menial jobs in supermarkets, certainly in south-west suburban London, is probably between £9,500 and £10,000--roughly the same as that for scientists with degrees and student debts. The contrast is painful.

The other contrast is with people in the private sector. Again, I rely on anecdote, but I gather that laboratory technicians are paid about £16,000 or £16,500 by Glaxo Wellcome--one of the leading groups employing staff on roughly comparable grades to the NHS--whereas in the NHS they would be paid £10,000.

The problem is not just that that is invidious but that hospitals are increasingly contracting out scientific work. My local district general hospital, West Middlesex University hospital, now has a contract with Glaxo Wellcome for much of that work. I am troubled not only by the unfairness but by the economics. Why is the NHS having to contract out work of such quality and importance to the private sector, in which pay is much higher? One assumes that the NHS is not making savings and that it is having to do so because it cannot attract enough staff of the right quality. The same is true of agency nursing. The position of nurses is being undermined within the NHS, and the practice is extremely uneconomic: I suspect that the same is happening with scientists.

Why is there a wider problem? I have discussed the matter with people in the profession. Recruitment and retention are beginning to be seriously affected. The Government's figures, published in September, are helpful. They show that about 50 per cent of trusts have recruitment difficulties and 25 per cent have retention difficulties with scientific workers. The situation is not as extreme as it is with nurses, but it is much worse than with other groups of NHS workers and is becoming a big problem. The problem is especially acute in cytology--cancer detection. About a third of those scientists in the NHS are due to retire soon because of the age structure of their group. There is no sign that the NHS will be able to recruit on the scale required. That will affect the safety and security of cancer screenings and delay women waiting to receive test results. There is a particularly serious recruitment problem in that area. I realise that the Minister's offer acknowledged the problem, as there is a differentially favourable offer to cytology scientists. None the less, there is a major problem.

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The issue of recruitment and retention reveals a wider problem: the integrity of the NHS as a whole. Any NHS hospital must operate as a team, with people in the front line and in the back room. Anything that weakens a key part weakens the whole system and I emphasise the importance of that group of professionals, the NHS scientists, in that context. The key area is cancer screening, as I said a few moments ago. We know from publicity about the failures in cancer screening that disasters can result, but that is not all. In the laboratory that I and my hon. Friend the Member for Richmond Park visited, some of the key testing related to tuberculosis, which is now on a rapid growth curve, as the Minister explained to the press a few days ago. Early and accurate detection is critical in getting on top of a potential epidemic.

The laboratory also carried out tests for MRSA--methicillin-resistant streptococcus aureus--the effects of which are not fully understood in the United Kingdom, but which is reaching epidemic proportions, with enormous consequences for patients and for the functioning of hospitals because patients suffering from MRSA need to be isolated.

The problems arose from a political decision taken by the right hon. and learned Member for Rushcliffe (Mr. Clarke), when he was the Secretary of State for Health, to drop that group of workers from the pay review body. Why that decision was taken is shrouded in the mists of history, but it has had cumulatively disastrous consequences. As a result of successive rounds of settlements outside the pay review body structure, that group of workers has fallen roughly 30 per cent. behind. I know that the Minister is trying to tackle it now, but there is an enormous catch-up problem as a result of that decision.

I return to what I think the Government are trying to do to tackle the problem and the extent to which they appear to be succeeding or failing. The Minister told me yesterday in a written answer that they are making a serious attempt to get to grips with the shocking headline figures at the bottom of the scale by effectively removing the two bottom rungs. However, the laboratory staff told me that only one of the 40 employees there would benefit. It may be an isolated extreme, but the unhappiness in the laboratory, which I am sure is replicated elsewhere, is happening because the more experienced scientists and those in the middle of the scale will get an increase, if the offer is accepted, of about 3 per cent. That is lower than this year's increase for the public sector as a whole and lower than for those on average earnings. One anomaly has, rightly, been tackled, but the consequences are that, for most people in the profession, the underlying inequity has not been dealt with.

The Minister has addressed the issue of London weighting, which is welcome, because the problems of retention and recruitment are exceptionally severe in London. There will be a 13 per cent. increase in London weighting; applying the arithmetic to the current figures means that that is worth about £260 a year. That is welcome, but given the magnitude of the problem, it has not been tackled in a substantial way.

The key issue for the future--the real meat of the problem--is that the Minister has agreed that in future those categories should be brought within the pay review body structure, which is a welcome and positive

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step forward. The sting in the tail, however--perhaps the Minister will confirm it--is that he is suggesting that that should not happen until April 2001. People in the profession fear that by the time a review has taken place a year will have elapsed and by the time that negotiations have taken place on the basis of that review, another year will have passed. Therefore, it may be three or four years before the anomalies have been rectified; meanwhile, they are growing because the groups are not within the proper structure. Although I welcome the Minister's proposal, I ask him why it is not possible to bring these workers within the pay review body structure now, to start the process of examining their predicament. There is no overwhelming reason why that should not be done.

I recognise, as an Opposition Member must, that all this has to be paid for. I am not being flippant about that; I know that the priority is to improve services and it is right that that should be done. However, there is a link between improved services and the pay and conditions of NHS staff. If pay and conditions are not right there is inadequate and poor-quality recruitment, with mistakes and delays. Thus, ultimately, the cost to the public purse will be greater than if the upfront payment were made. The economics are not totally unambiguous.

As I said earlier, science is an important industry in my constituency and it is important, whether or not we are talking about the NHS, that scientists are recognised and rewarded appropriately and that the right signal is sent to people who are now aged 13, 14 and 15 and making choices about A-levels and careers. The present position is that there is a massive disincentive to go into science and a temptation to go for easier options. I hope that the bigger picture is not lost sight of within the minutiae of negotiation.

12.16 pm

The Minister of State, Department of Health (Mr. John Denham): I congratulate the hon. Member for Twickenham (Dr. Cable) on securing this debate. He has chosen to discuss the pay and conditions of NHS scientists. They are a small group of about 14,000 people within the health service, but they are, none the less, an important group of staff, who make a crucial contribution to patient care through their work in diagnostic techniques and treatment.

I am grateful to the hon. Gentleman for the way in which he made his case and for acknowledging some of the measures that the Government have already taken on the matter. I shall develop my remarks in the context of the wider changes in the pay system in the NHS to which he referred.

It is important to acknowledge that both clinical and biomedial scientists work in the NHS on a range of activities that use scientific principles to determine the extent, cause and treatment of a wide variety of patient conditions. They have a crucial part to play in the treatment of people with life-threatening conditions, such as cancer and coronary heart disease--two areas that we have established as top priorities for the Government. We are introducing a national service framework for a 10-year modernisation programme for heart disease, mental health and diabetes, all of which require a skilled input from a well-trained scientific work force if diagnosis and treatment are to be effective.

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For the first time since the NHS was founded, the approach to national service frameworks will give us the opportunity to marry up service, resource and staff planning. We want to ensure that those three processes come together. We will use the national service frameworks and our new work force review as the means of doing so. The work force review is wide-ranging; it will cover scientists and technical support staff and other groups.

As the hon. Gentleman said, many scientists are involved in clinical-based research on new diagnostic techniques and treatments. All have a first degree in science, and often further training, some to masters or doctorate level. There are many distinct specialties such as medical physics, clinical chemistry, microbiology, histopathology and haematology. Those scientists are an important part of the health care team; they carry out tests on samples such as tissues and body fluids from patients to help doctors to diagnose disease and to monitor patients' progress, so that nursing care and drug and other therapies can be tailored to match.

As the hon. Gentleman said, current pay for clinical scientists ranges from £13,000 to £54,000 and for biomedical scientists from £7,400 to £32,000. As he acknowledges, this year's pay offer addresses low pay at the bottom end of the biomedical scientists' pay scale by increasing it to £9,400, a rise of 26 per cent. All scientists have been offered at least 3 per cent., significantly more than inflation, with some offered up to 7 per cent. To tackle special recruitment problems. Some trainees have been offered up to 26 per cent. by restructuring their pay scale.

In addition, London weighting has been increased by 13.5 per cent. to restore it to 1995 values. Given the current circumstances, that is a fair offer. We were right, this year, to target the funds at areas with a demonstrably greater need to address recruitment and retention problems that would have damaged patient care. That is a bigger problem with some staff groups than others.

Across the board, scientists are in a relatively healthy position in comparison with other disciplines--hard-to-fill vacancies lasting over three months account for a vacancy rate of only 1.1 per cent. across the discipline as a whole. However, there is a difficulty in recruiting staff at the bottom end of the biomedical scientist scale. Having recognised that, we have offered larger increases to staff at the end of the profession.

I accept that those figures mask some local variations. London finds recruitment and retention more difficult than other parts of the country. However, local employers already have some flexibility within the national Whitley system to offer pay rates that are attractive enough to get staff with the skills that they need. For example, Whitley contains a provision to offer local pay supplements of up to 30 per cent. in the London area, specifically to address recruitment and retention issues where management consider that proven problems could be redressed by pay enhancement. That and similar action is being taken by London NHS employees, including those at Kingston hospital, in which the hon. Member for Twickenham will have an interest.

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The hon. Gentleman acknowledged the wider changes that we are trying to bring about. We know that the current pay system is out of date and in need of review. That is why, on 15 February, we published "Agenda for Change", which sets out detailed proposals for modernising the way in which the NHS rewards its staff. We want to develop a new pay system based on efficiency, fairness, flexibility and partnership. That system must be able to offer all staff better career progression and fairer rewards for taking on extended roles, widening their skills and working in teams; modern conditions of service; and a fair basis for pay increases in the security of a national pay system.

We intend to do that in tandem with considering work force issues from the point of view of the skills that are needed to deliver modern, fast and convenient services to patients. That is long overdue. On the ground, practice is changing. The traditional hard-and-fast demarcations between clinical professions are giving way to more fluid and flexible team working. Now is the right time to be considering the skills that the NHS of the future will need. It is time to examine the issues in a new way--across professions, sectors and services. All clinical groups in the NHS believe that to be necessary in order to ensure that patients get the timely and appropriate care that they need.

As we try to make joined-up decisions on work force requirements, we will have to tackle some of the underlying barriers to change in the current system of pay and conditions of service in the NHS. In too many areas, employment practices in the NHS bear the stamp of 1948 rather than 1999. The NHS needs to become a 21st-century employer. It also needs to become a better employer, not least by offering greater flexibility in the way in which staff are employed. The current pay structure groups staff in ways that are increasingly less relevant to the way in which a modern health service works. Staff are defined by a combination of their titles, their pay and how they are trained, rather than by what they do for patients. Existing conditions of service, which often include a range of arcane allowances built up over many years, too often distort working patterns and inhibit the development of the around-the-clock, flexible services that patients need. Modernising the pay system is therefore one of our key priorities. It will help to deliver the new patient-centred services that both the Government and NHS staff want to see.

The discussions that have taken place so far on our pay proposals have been positive and constructive. A national system of job evaluation will allow creative approaches to job design, to match exactly the redesigned care processes that are so vital to patients.

In talking about the membership of the pay review body, the hon. Gentleman anticipated decisions and conclusions that have not yet been reached. We recognise that there are groups of highly qualified health professional who, for various reasons, are outside the pay review body's remit. That forms part of the talks that are underway with staff and representatives on the basis of "Agenda for Change". Those talks will include discussions about whether any new groups should be covered by the pay review body, but it is not intended that there should be any change to the fundamentally professional character of its coverage. It would be wrong of me to comment at this stage on the proposals that are being made for specific staff groups. However,

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I believe that pay modernisation will benefit all NHS staff, whether or not they are covered by a review body. The talks are part of a linked package of discussions and negotiations in which we are working constructively, and with a great deal of common purpose, with all those on the staff side in the NHS.

This is an opportunity to change the pay system for the better, so that staff can be fairly awarded for the work that they do rather than the titles that they hold. It will give us the flexibility to design jobs within the security of a national pay system, giving all staff better career progression and modern terms and conditions and, crucially, allowing managers and staff to deliver the quality of services that everyone wants.

I confirm that, in the course of the constructive discussions that are taking place with the trade unions and the staff side, the MSF--which represents the groups of staff that we have been discussing--is playing a major part in ensuring that the views and aspirations of scientists in the NHS are being played into those discussions. We are working towards radical changes in the NHS, and the necessary changes cannot all take place overnight. If our negotiations are successful, I hope that we will have a fully agreed package by next summer, with implementation starting the following spring.

A modern NHS should mean fair but affordable pay for staff alongside improved modern work practices. That is why our proposals for reform are a key part of the modernisation agenda for the NHS. We want to improve recruitment and retention, through fair rewards and better career progression; improve productivity, through more flexible job design and patterns of working; and improve quality of care, through rewarding the acquisition of better skills rather than applying automatic increments.

I recognise that a substantial portion of what I have said has concerned NHS staff in general rather than scientists in the NHS in particular. However, I am convinced that the correct context in which we should

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discuss the future pattern of rewards and career progression in the NHS for that group of staff is within those wider changes. We must address the needs of the NHS work force as a whole and those of the NHS as a whole.

I also recognise that, although pay and conditions are important, they are not all that we need to offer to staff, particularly highly qualified staff, to work in the NHS. Alongside our work on the pay system, therefore, is a substantial programme of work to improve the working conditions and environment of NHS staff. The new human resources framework that we have launched requires employers to address other key issues--for example, equality, staff involvement, personal development and the development of personal development plans, good employment practices and healthy workplaces. These will all add to the quality and attractiveness of working life in the NHS.

Many staff are concerned about striking the right balance between work and private life; many have responsibilities to care for dependent relatives. Flexible working arrangements that enable them to discharge those responsibilities and continue with their careers must be developed and encouraged.

We must also ensure that staff have access to reasonable career progression. That is central to the hon. Gentleman's earlier comments. Career pathways must be developed and support must be given for staff to gain relevant skills. That is particularly true in the case of scientific disciplines, where advances in knowledge and technology continually open up new fields of specialisation and create demand for new services. We must grasp that opportunity in order to boost the work force that we want for the 21st century.

To get the work force that is required, we have to get the right calibre of staff into employment and then ensure that they can be retained. Our "Working Together" programme concentrates on better management and better human resources for the entire work force, and that includes scientists and technicians.

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