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Lord Winston: My Lords, can the Minister say whether that miserable and inadequate increase in payment will be provided for in new funds from the Government, or will it come from the existing funds of already hard-pressed health authorities? Can the Minister give us an assurance that patient services will not suffer in consequence?

Baroness Cumberlege: My Lords, the Government have been very honourable to nurses. There has been a 52.2 per cent. increase in nurses' pay since 1979--that is more than for any other group of health worker, so I think that we have an honourable record in that regard. As to where the funding is coming from, your Lordships will be aware that there is an increase of £1.3 billion in growth moneys for the coming year. We would expect the National Health Service to use some of that, as well as savings through efficiencies and other economies.

The Earl of Halsbury: My Lords, when nurses' pay was my responsibility as chairman of what was going to be the review body, then a departmental committee of inquiry, the pay of ward sisters was equated to that of station sergeants in the police force. Can the noble Baroness tell me how that equation corresponds today?

Baroness Cumberlege: My Lords, I am afraid that I cannot give an exact equation. All that I can say is that nurses' pay has increased considerably. A senior nurse can earn up to £46,000 a year and an experienced ward sister can expect to earn around £22,000 a year.

Lady Kinloss: My Lords, will the Minister ask the Government to look again at nurses' pay in view of the fact that they receive roughly less than 21 per cent. of teachers' pay and roughly less than 31 per cent. of a social worker's pay?

Baroness Cumberlege: My Lords, nurses fought hard for a pay review body to be established. The Conservative

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Government gave them that review body. Every year nurses make representations and give evidence to the body. The review body considers their evidence and that of the Government and others involved, and comes up with a decision. The Government have always honoured that decision. However, it is different now in that the review body is increasingly giving local autonomy to local employers to pay local pay. That makes sense because if 70 per cent. of the costs of running a hospital are wages and if the majority are nurses' wages, it is right that the employers should have some control, especially as they may want to increase some of the remuneration packages or to tackle shortages. They need that flexibility and they need to tailor it to patient care.

Lord Rea: My Lords, perhaps I may quote from the review body's statement something that the Minister did not quote. The review body said that it believed:

    "there are some signs that more general shortages of nurses may emerge in the future".
Does the Minister believe that giving nurses the task of negotiating their pay locally, thus distracting their attention from their patient-care role, is the right way to go about this? Surely the Government would have enormously increased morale in the nursing profession if they had given a generous central increase in pay.

Baroness Cumberlege: My Lords, I do not believe that it is right that trade unions should decide nationally the exact pay of individuals on the wards and in the community. It is much more appropriate that those who know the local situation should be involved in those negotiations. We are firm believers that local pay is the way forward. It is interesting that when we look at those who want to go into nursing, the number of suitable applicants has increased. For this coming year, there have been 21,000 applicants--an increase of 2,000--for 12,000 places. We are seeing more people wanting to come into nursing.

Baroness Jay of Paddington: My Lords, if the Government are relying upon locally determined pay to raise the levels above the 2 per cent. recommended, is the Minister aware that there are still several thousand nurses whose pay agreements at the local level have not been agreed since last year? Is the round in which nurses receive their national pay at low levels, and find it difficult to establish local pay agreements, to continue? That surely is unsatisfactory.

Baroness Cumberlege: My Lords, last year was the first time that we entered into local pay negotiations, and 90 per cent. of nurses received local pay settlements in addition to the national award. I am sure that nurses will become increasingly more skilled at this, so will employers. Any noble Lord who has run an organisation, and who has been involved in a company, will know that one has to tailor reward packages for staff to meet local circumstances. It is a nonsense to pay the same in a big city as in a rural

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area; it is a nonsense not to take into account local market forces; and it is a nonsense not to take into account the skills of those whom one employs.

Gulf War Health Studies

2.52 p.m.

The Countess of Mar: My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In so doing, I declare an interest as patron of the Gulf Veterans Association.

The Question was as follows:

To ask Her Majesty's Government:

    Whether the epidemiological studies into Gulf health issues will be put out to tender in a similar manner to the study into the health effects of exposure to sheep dips.

Earl Howe: My Lords, invitations to submit research proposals will be issued in due course. It is possible that these will be issued by the Medical Research Council on our behalf, but no decision has yet been taken.

The Countess of Mar: My Lords, I thank the Minister for that reply. Perhaps I may say how pleased I am that this study is at long last going forward. In which journals will the tenders be asked for, what health aspects will be studied, and how long is the study expected to take?

Earl Howe: My Lords, at present we are discussing with the MRC the establishment of an epidemiological programme. I do not believe that any firm decisions have been taken as to which publications will be used to advertise the invitations, but they will clearly be in appropriate medical and scientific publications. The aim of the studies will be to establish whether Gulf veterans are experiencing a greater prevalence of symptoms and illnesses in comparison with an appropriately matched control population in terms of age, sex, and previous medical history. The studies will seek also to establish whether the prevalence of birth defects is greater among children born to Gulf veterans than in the general population. These studies are expected to take between two and three years.

Lord Williams of Elvel: My Lords, is it the case that the studies, whose remit the noble Earl read out, will include studies into what is known as Gulf War syndrome? Will the Minister enlighten the House as to what is the Government's present view on the Gulf War syndrome, and whether or not they believe it exists?

Earl Howe: My Lords, we recognise that some individuals who served in the Gulf are ill. We keep an open mind as to any possible link with their service in the Gulf. Extensive investigations in this country and in other coalition countries have to date found no compelling medical or scientific evidence to suggest the existence of a Gulf War syndrome. But we are anxious that all those who believe that they are suffering

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unexplained symptoms should come forward for medical assessment so that they can be diagnosed and the appropriate treatment can be recommended.

Prison Service: Finance

2.55 p.m.

The Earl of Longford asked Her Majesty's Government:

    What effect the cuts in the money allocated to the Prison Service will have on the numbers of prison staff over the next three years.

The Minister of State, Home Office (Baroness Blatch): My Lords, it is too early to say what the effect will be. The picture for 1996-97 will start to emerge by Easter when establishments' and headquarters' business plans are agreed. Further planning will be needed for future years.

The Earl of Longford: My Lords, perhaps I may, as usual, congratulate the Minister on evading the Question. Is she aware that in the past three years the prison population has increased by about 10,000; that, on present calculations, it will rise by another 5,000 in the next few years; that if the Home Secretary has his way the prison population will increase by about another 20,000 in the years ahead; and that the Latin quotation which the noble Viscount would not wish me to give in Latin, because he would not like my pronunciation, is:

    "Whom God would destroy He first sends mad".
Is she aware of that quotation?

Baroness Blatch: My Lords, the noble Earl asked me what would be the effect. I told him that it is too early to say. He must desist from impugning my integrity when I come to the Dispatch Box to give honest Answers to his Questions. Having said that, the Prison Service is asked to find 2.2 per cent. worth of efficiency savings this year. The intention is that they should be efficiency savings and not affect frontline staff so as to put at risk either security or control. Staffing increases have gone along with all the increases to which the noble Earl referred. Even given this year's budget, over the next three years there is still funding for an extra 3,500 places. There is also funding for a drugs testing programme and for the Woodcock recommendations.

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