Patrick Jenkin – 1978 Speech on the NHS

Below is the text of the speech made by Patrick Jenkin, the then Conservative MP for Wanstead and Woodford, in the House of Commons on 2 November 1978.

May I begin with a word of welcome to the right hon. Gentleman? This. I think, is the first occasion on which he has addressed the House since he was struck down and whipped off to hospital in July. We very much welcome his return to health and hope that this time it will be lasting.

I can agree with the right hon. Gentleman on two of the matters to which he ​ referred. First, he said at the outset of his speech that there is real concern in the country about the state of our Health Service. That is correct, and it is why we have chosen to devote the second day of the debate on the Queen’s Speech to the subject of health.

Secondly, I agree with the right hon. Gentleman’s expression of the thanks of the House, and indeed of the whole country, to those who work in the Health Service. He singled out the nurses. That was certainly justified, and one can add all the other professional, para-medical and non-professional people who work and strive to give of their best, often in extremely difficult circumstances.

The Prime Minister has intimated to me that he must depart very soon, so, if I may, I shall break the natural order of my speech and make one point now in his presence—and may I say how grateful I am to him that he has chosen to wait.
One of the things that we expected to hear about in the Queen’s Speech was a Bill to reorganise the Health Service. The right hon. Gentleman made a powerful statement at Blackpool—in fact, I think that he startled his right hon. Friend. He certainly startled the Health Service when he said that it was to be further reorganised.

Naturally enough, the press, caught a little unawares by this, tried to find out what was happening. There was an interesting article in The Times. After referring to the Prime Minister’s words, Mr. George Clark, whom we all know well and greatly respect, wrote:

“According to the ministers closely involved, the area health boards will disappear in the reorganisation and there will be greater democratic control of the hospital service.”

Mr. George Clark contacted me and asked me what were the implications of that statement—he was obviously making his inquiries. He is not a man who writes the words

“According to the ministers closely involved”

unless he has had some contact with Ministers closely involved. So there it was. Presumably, this was what the Prime Minister was referring to, and it is interesting because it is exactly what we have been advocating. We believe that there needs to be a slimming down of the ​ structure, the merging of a tier, and, in most of the country—although there must be flexibility about this—it is the area tier which must be merged into the others.

But, alas, it was all wrong. That was not what the Prime Minister meant—or certainly not what the Secretary of State meant—because apparently a letter was written on behalf of the Secretary of State to administrators of regional and area health authorities of which, Mr. Speaker, for greater accuracy, I have obtained a copy. This was a little difficult because, despite the great importance of the Prime Minister’s remarks as interpreted by Ministers, and the very wide interest they had aroused, no publicity at all was given to the letter. There was no press release, no press guidance, no private briefings, not even one of the Secretary of State’s many speeches.

But the letter is clear beyond peradventure. It is short, blunt and to the point. It reads:

“Dear Administrator,

In view of some of the misleading press comments on what the Prime Minister said at the Labour Party Conference on 3 October you may like to know that the Secretary of State has given an assurance that there is no commitment on the part of the Government to introduce legislation on the organisation of the National Health Service in advance of receiving and considering the Report of the Royal Commission.”

The Prime Minister (Mr. James Callaghan)

Hear, hear.

Mr. Jenkin

The Prime Minister said “Hear, hear.” What, then, are we to make of Mr. George Clark’s statement beginning:

“According to the Ministers closely involved”?

Mr. Ennals

The right hon. Gentleman should not allow himself to be fooled by everything that he reads in the press. I can assure him that no such statement was made by any Minister in the Department. Perhaps the right hon. Gentleman should have taken the trouble to read what the Prime Minister actually said, which was:

“Subject to the recommendations of the Royal Commission on the Health Service, we intend to undo much of the damage caused by the Tory reorganisation and make the management of the Health Service more responsive to the patients and to the dedicated people at all levels who work in the Service.”

I hope that the right hon. Gentleman will warmly congratulate my right hon. Friend on setting that lead.

Mr. Jenkin

Yes, if I knew what the Government’s intentions were. What we have in this episide is that on Tuesday 3rd October the Prime Minister goes to Blackpool and cheers up the Labour troops by telling them that it is all going to be changed. On Friday 6th October, quietly and surreptitiously and without any publicity at all, the Secretary of State reassures the managers principally concerned that, of course, it is all nonsense and that nothing whatever will happen. All I can say is that it is one hell of a way to run a health service.

I am grateful to the Prime Minister for staying in the Chamber, but he must realise that he caused great dismay by his talk of a major reorganisation at this stage. This most emphatically is not our policy.

The Prime Minister

I am not sure that it was worth staying. I have the very highest opinion of Mr. George Clark, as of every other journalist, as we all have; we all know how splendid they all are. But I think that the misapprehension could have been avoided if the initial words of my statement had been quoted, but, alas, they were left out of a number of the press documents.

They were

“subject to the recommendations of the Royal Commission”,

which, I understand, we shall not have until several months from now. Anybody who really studied these matters would therefore know very well indeed that we could not possibly legislate in the current Session, so there was no need for the apprehensions.

I would just say this in conclusion. Every morning I say to myself “Shall I really correct this error that is in the newspapers?”, and then I decide “No. If I spend my day correcting all the things that are wrong which are written about me I shall never do anything else”.

Mr. Jenkin

Perhaps we can leave it at that. I accept the Prime Minister’s bona fides on this. Apparently, he did not mean what was attributed. But it seems to me that with a matter of this importance—and the Secretary of State had a very strong letter from John Bettinson, the chairman of the National Association of Health Authorities—a little more publicity might have been given to the denial, as a good deal of publicity had ​ been given to the original misapprehensions.

I said that we selected the subject of health for debate today because of the real concern of the people over the state of the National Health Service—not just because of the appalling damage done by the recent dispute, or even on account of the evidence that we have recently had from the Royal College of Nursing about falling standards and collapsing morale, but because as I go round and talk to people in the hospitals and in the constituencies I detect a growing fear that the NHS is rapidly sliding out of control while the Secretary of State stands, as it were, feebly expostulating on the sidelines and quite powerless to halt the slide.

We read in the Queen’s Speech about “fresh support”. I come straight away to the points that the Secretary of State has made about the financial support. I thought that today he might be announcing additional spending for the Health Service. Certainly that is what I read into his remarks in his reply to the nurses’ deputation. He has said that this will come. May I put this to him? We would welcome this. It would be a step to get back to the rates of growth which the Health Service enjoyed under the last Conservative Government. Let me repeat the figures to get it clear. On capital expenditure alone, in real terms, for every £2 that is being spent now on Health Service capital spending, £3 was being spent when we left office—I am talking about real terms, taking account of inflation. After a prolonged period of more than 3 per cent. growth per year, the growth rate has been cut back to 2 per cent. over the last four years, and the figures in the public expenditure White Paper, even taking account of the £50 million, made it 1·8 per cent. over the next four years. There was a suggestion in one of the medical magazines that the Government were aiming to get back to the long run rate of growth of spending. That would involve very substantial sums indeed. We shall wait and see what comes.

A more general point is that in the Health Service local health authorities are large and complex organisations. If they are asked to change speed and direction at short notice and suddenly, as, for ​ instance, with the extra £50 million in the Budget coming only three months after the public expenditure White Paper, this makes rational planning of health services for the future almost impossible. It is bound to lead to a waste of resources. Of course people welcome the extra money. But one does not get the best value for money if one is constantly chopping and changing; sensible planning is made almost impossible.

Mr. William Molloy (Ealing, North)

The right hon. Gentleman should have told the right hon. Member for Leeds, North-East (Sir K. Joseph) that.

Mr. Jenkin

On the contrary. When we were publishing White Papers on public expenditure and health expenditures over a prolonged period, we tended to stick to the projections. If more money is to be spent on the Health Service, the sooner that people know when it will be available so that they can incorporate it into their plans the better value we shall get for the money.

Mr. Ennals

I gave an assurance without giving the figures. However, the right hon. Gentleman is clearly dedicated to George Clark and what he writes in the columns of The Times. I read on 16th May:

“Mr. Jenkin explained the scheme when he was asked whether the Conservatives, if returned to office, would provide extra resources for the National Health Service. He said the Conservatives would adopt the projections for spending contained in the present White Paper on public expenditure.

‘We have to live within that, and there is no possibility of extra money’.”

Did George Clark get that wrong, too?

Mr. Jenkin

I was asked on that occasion whether we were proposing to cut the money for the Health Service. I gave an absolute commitment then, and have repeated it since on a number of occasions. We have no plans for cutting the Health Service below what we shall inherit. That is the phrase I am using. I made that statement soon after the publication of the White Paper on public expenditure. The phrase I have used, which I stand by and repeat today, is that we shall not cut spending on the Health Service below the figures that we shall inherit. How far and how fast we shall be able to increase spending will depend, as is common ground between the two parties, ​ on how successful we are at managing the economy and restarting economic growth. It will be our aim, when we can, to get back to the rate of growth and spending on health that we had under the last Conservative Government.

Dr. M. S. Miller (East Kilbride)

It is not the same thing for the Conservative Party to say that, if elected, it will not cut expenditure. Other allegations have been made about increasing the money going into the Health Service by charges which are to be levied.

Mr. Jenkin

I have nothing to add to what I said in the earlier debate. The Secretary of State played the same old tune and perhaps I may be allowed to: we must wait for the advice of the Royal Commission. Listening to the Secretary of State fiddling his old tune, one might have thought that everything had stood still in the meantime. The fact is that we are expecting the report of the Royal Commission in a few months and it would be foolish now to make pledges in advance of that.

I turn briefly to the subject of the nurses, because they have made a long and detailed critique of the Health Service.

They talk of the falling standards in the Health Service, of the collapse in morale, and use very serious language about “continuing deterioration” and

“the serious threat to the maintenance of standards of care.”

In describing clinical areas, they talk of the resulting

“positively dangerous standards of care.”

We need to take those criticisms very seriously indeed. I do not know whether the nurses’ complaints are to be included in the right hon. Gentleman’s description of “carping criticism” which he made in his speech, but I take the memorandum, which I have carefully studied, extremely seriously.

I take no part more seriously than the figures given of the rapidly declining number of learner nurses in the Health Service. Initial entrants from March 1977 to March 1978 are down 17 per cent. and learners down 13 per cent. That is very bad news for the country and for the Health Service. We did not hear anything from the Secretary of State on what is to be done about that.

In many parts of the country—and this is true in my own area—it is not possible to fill those posts for which funds exist and they are below the regional norms. What the future position will be like fills one with great despondency. We are in the grip of a vicious circle, with falling numbers that result in overwork, leading to lower standards and increasing job dissatisfaction for the nurses. Consequently, many leave early, many do not complete their period of training, and the situation deteriorates further.

Job satisfaction for nurses is the absolute key. They want to feel that their work is up to the highest standards that they were taught in their nursing schools. There is nothing more demoralising for people in that kind of work to know that they are giving only second or third-rate service.

Mr. Molloy

I agree with much of what the right hon. Gentleman is saying. Indeed, I think that the whole House agrees with it. However, we should like to know whether he will also agree that there must be a massive resurgence of resources to put right the matters about which the nurses have been complaining.

Mr. Jenkin

I made the point that we could afford a substantial increase in money spent on health only when the economy is once again producing the resources to enable that to be done. That is common ground between the parties. I do not think that there is any point in calling for a huge influx of funds at this stage, because we know that that cannot be done.

I turn to the Briggs report, which was referred to in the Gracious Speech. We shall debate that, I believe, on Monday week, so I need say little now about it. It has been a long time coming, and we welcome it. I know of the lengthy consultations that have taken place, because of the understandable desire on the part of professional groups who wish to preserve their separate identities within the profession, bearing in mind their long and honourable records of service to the community. At the same time, we must avoid—and this is a question of balance—creating an over-rigid, over-cumbersome structure. We support the general aims of the Bill, but we shall ​ certainly wish to study the details very carefully.

The Gracious Speech referred to vaccine compensation. We also welcome that. May we ask the Under-Secretary to state whether that will be taken into account in the calculation of supplementary benefits for affected families? When the Government were last asked that question, they reserved their position, but we now need to know. I do not know whether the Under-Secretary intends to say something on the future of the Pearson report and where the Government stand on that. These subjects are clearly interrelated.

I turn next to the Bill to pay attendance allowance to kidney patients. The conduct of Ministers here has been a good deal less admirable. The sad thing is that those payments could now be being made if the Government had had the sense to adopt the Private Member’s Bill presented by my hon. Friend the Member for Ealing, Acton (Sir G. Young) in the last Session. I have been singularly unimpressed by the excuses why that did not happen. The Government said that the Bill was not properly worded and did not cover the subject adequately. My hon. Friend—indeed, the whole House—would have been ready to accept any amendments that could have been made to the Bill, either here or in another place, to enable those payments to be made to kidney dialysis patients as rapidly as possible.

I have a horrid suspicion that the reason we have not had that Bill is that the right hon. Gentleman has an almost obsessive compulsion to take the credit for everything that happens. Why cannot he have a little grace and give credit where credit is due? Why could he not have allowed my hon. Friend’s Bill to reach the statute book? The right hon. Gentleman has not enhanced his reputation in this affair.

Important though all this is, it is overshadowed by recent events in the Health Service—the maintenance supervisors’ strike. I should like to examine in some detail the arguments which the right hon. Gentleman has put to the House and those which were advanced during the strike. By common consent, this has been the most damaging strike—although it should not be described as a strike but a ​ dispute; the supervisors were being paid all the time—in the history of the NHS. That point has been raised by my hon. Friend the Member for Aylesbury (Mr. Raison) on a number of occasions.

We cannot know whether deaths actually resulted from it, but we certainly may assume that deaths may have been hastened and that some who could have been cured will not now be cured. A total of 9,000 beds were closed, 300 hospitals were on emergencies only and waiting lists are now up by 60,000—a 10 per cent. increase—with untold misery and despair for patients. The dispute certainly dealt a further blow to morale in the NHS.

The Secretary of State’s explanation has left a whole raft of questions unanswered. It needs to be made clear why the dispute was left outstanding for so long. That point was made by the hon. Member for Nelson and Colne (Mr. Hoyle).

The dispute dates back to 1974. For all the criticisms of this party, the Government have been in office for four and a half years; they have been in charge of matters. They really cannot put the responsibility back on the last Conservative Government.

The pay structure was settled for senior work staff in grades 1, 2 and 3 but not for grades 4 and 5. Yet it was only two months ago that management got round to putting forward pay scales for grades 4 and 5. Why was the grievance allowed to fester for over four years?

By his inaction on this matter alone, the Secretary of State deserves severe censure. However, a much more serious question that he must answer—he has not yet done so to my satisfaction—is why this dispute was not settled within the first few days. His case, as he presented it to the public throughout and as he presented it again today, was that the Government were standing firm in defence of their pay policy. In his letter of 9th October to Allan Black, the chief staff side negotiator, he wrote

“The Government would not be prepared to authorise any offers which would involve further increase in cost … we must ensure that any agreement is consistent with pay policy.”

He has maintained that attitude throughout, including his phrase, repeated this afternoon, that what the staff side was demanding was “just not on”.

The Daily Mirror quoted him as saying on 26th October, that

“…we mustn’t create a situation which makes such a hole in the pay policy that there is nothing left.”

Yet there has now been substantial evidence, from authoritative sources, that pay policy had nothing whatever to do with it. The Sunday Times quoted one of the staff side negotiators, Mr. Ray Harris—[Interruption.] I am quoting what the paper reported him as saying, and I believe it to be true that he said it. He said:

“he … first realised that pay policy was an issue when they met Ennals two days after their action began. We were amazed at his attitude.… until then, and from our meeting with the Secretary’s junior colleagues at the ministry,”—
that will be the Under-Secretaries—

“we had been led to believe that pay policy had nothing whatsoever to do with our dispute.”

Mr. Len Murray, whom the Secretary of State praised—and to whom we pay tribute for his part in settling the dispute—said:

“‘Whatever the merits of the pay policy this dispute was concerned with the relationship between supervisors and related grades on the one hand, and electricians on the other. In no sense did the works staff concerned, or their unions, regard this as an attempt to break the pay policy.'”.

This is a powerful case, which the right hon. Gentleman must answer. Yet he later went on the radio simply repeating that it was a matter of pay policy. As I understand it—and I have made my own inquiries—the issue, at the end, was relatively simple. It was whether all supervisors should share in the productivity bonuses, or only where a productivity scheme was in operation. The unions were insisting “all”. The management side was insisting “No. A productivity scheme must be financially viable”. That is common form when anyone introduces a productivity scheme. It must pay its way. There were also arguments about the lead-in time.

But does not this mean that all we had here was not a dispute that put at stake the whole Government pay policy but a haggle over the small print of a productivity deal? That was the view of The Times, which said:

“… the immediate issues are small beer to both sides.”

​The Guardian, in one of the strongest worded leaders that I have seen on the issue, said that it was

“a snivelling pay anomaly of the most petty nature … It was foolish to try to construe the present dispute as a challenge to pay policy. We may be in Stage Four, but the supervisors’ grievance, hoary with age, predates even this Government’s long-running incomes policy.”

The House needs to know which was right. Was it the view of management? The management told me that at no stage in the negotiations was pay policy even mentioned. Was that right? Were the unions right—Mr. Harris and Mr. Murray? Were the junior Ministers right, when they gave their indications earlier that pay policy was not involved? Or are we now to believe the Secretary of State that it was all a matter of pay policy?

I am bound to tell the right hon. Gentleman that he has not emerged from this episode with any credit at all.

Throughout he has given the impression of thrashing about in frenzied futility, blaming everyone and everything except his own dilatoriness in settling the matter years ago, and one of the reasons for his ineffectiveness has been his total confusion about whether pay policy was or was not at the back of it.

Mr. Ennals

Of course I can well understand the right hon. Gentleman, who represents a party which does not believe in pay policy—well, part of it dots and part of it does not; the Front Bench does not. I can well understand that The Times or The Sunday Times, or all sorts of other spokesmen, would wish to say that it was not a pay policy issue. The people who have to decide whether it is a pay policy issue are those who have responsibility for pay policy. That is Her Majesty’s Government. I say straight away that my hon. Friends did not give that impression. That was incorrect. When I spoke, I spoke not just for myself. I spoke for my Government—our Government—who have responsibility for pay policy. I have spelt out in detail the two clear roles in which this was a breach of pay policy. I can understand that people would say “No, we are not trying to break the pay policy”. The Government have to decide whether the pay policy is being challenged.

Mr. Jenkin

I wish that I had not given way to the right hon. Gentleman because ​ I am coming to these points. I think there was throughout a confusion as to whether it was pay policy or not. But I should like to take the argument a little wider and look at it in the context of the discussion that took place here yesterday between the Prime Minister and my right hon. Friend.

Let us suppose, in the first instance, that the negotiators were right and the Secretary of State was wrong—that the junior Ministers were right and that pay policy was not the issue. Where does the case stand then? Surely, it is that this episode demonstrated, as starkly as could be imagined, that if one has a rigid pay limit it can foul up negotiations even where it is not relevant at all.

Alternatively, let us take the other way. Let us assume that the Secretary State was right—and there may be some grounds for saying that at the later stage, when the 25 per cent. claim across the board for productivity bonus was made—and pay policy did by then become an issue. Does not this, too, demonstrate the folly of brandishing about a fixed limit at this stage in a pay cycle in that one sets up an Aunt Sally for the trade unions? We know that there are unions which are prepared to have it as their objective to smash the limit, irrespective of the merits of the particular case. None of the unions which are used to negotiating in this Whitley Council can have believed for one moment that a 25 per cent. across the board productivity payment irrespective of financial viability was a starter at all; but it was as good a way as any of trying to smash the Government’s pay limit.

Mr. Ennals

That is right.

Mr. Jenkin

Yes, but let us see where it takes the right hon. Gentleman. This was the view of a person who perhaps should know, the chairman of the area works officers’ association, West Midlands region, who has written an extremely interesting letter in this week’s Health and Social Service Journal. I quote:

“It is only within the past week that both the media and our colleagues within the Service have considered that this is a direct confrontation with the Government pay policy. There appears to be evidence that this dispute is being used as an attack on the Government pay policy by unions and preventing a reasonable settlement.”

I have no doubt that the Under-Secretary was right when he saw the staff side some time ago and said that to settle this dispute need not involve pay policy at all.

Mr. Ennals

Absolute nonsense.

Mr. Jenkin

What has happened by having the Prime Minister’s 5 per cent. pay policy is that it provoked the unions into putting forward a totally unreasonable claim which the Secretary of State then had to say was in breach of pay policy.

Mr. Ennals rose—

Mr. Jenkin

Let me just finish my case. Whichever way one looks at it, whether pay policy was involved or whether it was not, the fact of the matter is that this dispute has taken us right to the heart of the argument which we had yesterday. At this stage of a pay policy, does it help to have a rigid 5 per cent. figure, which either gets fouled up with negotiations which are not relevant or else is used as a target by the unions to try to smash?

Mr. Ennals

I did not wish to intervene again, but the right hon. Gentleman has made an accusation against my hon. Friends which I have already denied. I made it absolutely clear that my hon. Friends in their discussions said no such thing. The right hon. Gentleman really cannot do this in the House. It is quite wrong. I have given him an assurance that no such statement was made by Ministers, and if he wishes to turn this into an economic debate, let him do so.

Mr. Jenkin

I accept what the right hon. Gentleman says. If he gives me an assurance, of course I accept it. The fact of the matter is that we are in the heart of an economic debate, and as a result of the way in which the situation has been handled we have had now the worst dispute in the history of the National Health Service. It is well known that the 5 per cent. figure was plucked from the air by the Prime Minister in the course of a television interview, much to the dismay of many of his colleagues. They knew what the consequences would be. In 1974, a rigid limit plunged the country into the three-day week and brought down the Government. Now, in 1978, another rigid figure has hit the National Health ​ Service with the worst dispute in its history and may well have led to loss of life.

In his speech yesterday the Prime Minister asked:

“Are we to have a winter of strikes?”

It means, he continued:

“that life could seize up in a closely-knit industrial society such as our own.”[Official Report, 1st November 1978; Vol. 957, c. 53.]

In the National Health Service it is not just that life seizes up, it is that lives are snuffed out. That is the price that we are now paying for an over-rigid pay policy.

Of course, this would not be so if it were not for the activities of those in the National Health Service who use patients as weapons in their disputes, by taking industrial action. We debated this subject last July, but it has now become one of even more intense public concern.

People have been horrified by what they have seen and read in recent weeks. In a straightforward battle for more money, the unions involved have not hesitated to use the torment of patients as a weapon in their struggle—and “torment” is the right word. There was the lady sent home with a fractured knee joint, in agony and untreated; the 85-year-old man with a broken shoulder joint, sent home in agony and untreated; cancer patients, where surgeons reported that cases which were operable were now becoming inoperable. The list is very long.

My hon. Friend the Member for Aylesbury received a letter last week from an elderly lady of 77 with polio in one leg who needs an operation on an arthritic knee in the other. She has already been waiting over 10 months. She wrote:

“Mr. Taylor the consultant has told me that owing to the industrial dispute the waiting list will now be much longer and as I live alone and am not able to get out life is becoming very depressing. When working before retirement I worked 10 years in the hospital service including the Royal Bucks.”

What does she think of what has been going on during the past few weeks? All over the country there were similar stories, and 60,000 cases were added to the waiting list.

I have to ask this—have we all gone mad? How can one justify using the sick and injured in this callous and inhuman ​ way? Have we reached such a level of moral bankruptcy that we accept with a resigned shrug that one man’s pay claim may be another man’s coffin? [Interruption.] I have said many times that I condemn all those who strike in the Health Service. We were very firm about that when we were faced with strikes in the medical profession.

Look at the defences we have heard. First, there was the flat denial that anything at all was going wrong. COHSE’s spokesman, Nick Grant, said:

“It is extremely doubtful whether there’s a cause-and-effect relationship between the patients being turned away and the supervisors’ action.”

Further on he said:

“The difficulty we always have in disputes is that certain consultants tend to exaggerate and make some sort of capital out of them.”

We can treat that statement with the contempt it deserves.

Then there was the counter-attack. The right hon. Gentleman felt its blast when he finally, from Norwich, made his appeal to the men to go back and pointed out what the consultants there had told him. Of what was he accused? He was accused of “blackmailing the union” which, when one considers what was going on really makes one puke.

Perhaps almost more offensive than the other defences was the mealy-mouthed excuse “Yes, we know. We are very sorry, but it is not our fault.” I have said that I thought the men had a case that should have been dealt with years ago, but it seems to me absolutely outrageous that the sums of money involved should have given rise to the hardship which we have been facing.

Geoffrey Drain, in his letter to The Times, which aroused a pretty fierce riposte from a number of people, said:

“NALGO joins … in feeling sympathy for patients caught up in the effects of the industrial action currently being undertaken by hospital engineers and building supervisors. Mr. Rodger “—

who had written earlier—

“however, is misinformed. These NALGO members are not on strike. They are refusing to undertake tasks for which they are not being paid; additionally they are not carrying out certain maintenance work.”

In law a man is presumed to intend the natural and probable consequences of his act. If a union orders men not to service ​ essential equipment and as a result patients have to be sent home in pain and untreated, it does not lie in the mouths of the union leaders to claim that that consequence is unintended. However we look at it, the object, the purpose, is to put the screws on management, but the result is to punish the patient.

None of the men concerned would, individually, set out to cause suffering to a sick or injured person to secure a private gain. I must again ask the question that I asked on 3rd July, to which I have never had an answer: why does it apparently become quite acceptable to do so collectively in order to secure a collective gain? What is it about trade union morality which seems to blunt individual consciences?

When I asked that question in July Albert Spanswick, the general secretary of COHSE, in reply to the debate, wrote a very intemperate article in the COHSE journal, accusing me of “an extraordinary display of Tory prejudice.” On some matters I admit to prejudice. I am prejudiced against depriving patients of urgent medical care as a weapon in a dispute over more money. That is one of the matters on which I shall maintain my prejudice, because I believe that that is totally wrong.

Therefore, I ask—and I was half encouraged by what the Secretary of State said—that we now work towards what I have called a patients’ charter. Of course, that must mean improved negotiating procedures. The Secretary of State said that the Whitley machinery existed to avoid such disruption when difficulties arose. It is clearly not working. Four and a half years have passed without this grievance being dealt with.

The action announced last week was a small step in the right direction, but, as the Secretary of State conceded, it does not deal with major issues. It may deal with the kind of case that occurred in the constituency of my hon. Friend the Member for Kingston upon Thames (Mr. Lamont), where, because of a keen and efficient security manager, thefts totalling £100,000 a year were traced and stopped, but the unions have walked out on strike because they think they are being victimised. I hope that the right hon. ​ Gentleman’s new procedure will stop that sort of scandal. It makes me very angry. That security manager has now been suspended because of union pressure pending the inquiry. It is absolutely outrageous.

Mr. David Price

Will my right hon. Friend answer the question that I wished to put to the Secretary of State? Surely, at the non-pay level we must have a more effective consultative industrial relations machine in the Health Service. I do not wish to be pompous, but I have had much experience in industry. Although one may have national agreements, a great deal of detail is filled in at work level. That is what participation is about. I do not wish to mention particular cases from my part of the country—I am speaking as one who was once a governor of a London teaching hospital—but surely we must have better machinery whereby more matters can be settled in the hospitals and not have to go higher.

Mr. Jenkin

I agree. We want more than just the short-term brush-fire operation which the Secretary of State announced last week. My hon. Friend is saying that there must be a greater capacity to deal with industrial relations problems at the working level. I am sure of that. The right hon. Gentleman has had the McCarthy report; practically nothing has happened—

Mr. Ennals

Oh.

Mr. Jenkin

No doubt, the Under-Secretary will tell us what has happened. Consideration of the McCarthy report, which dealt with the structure of the staff side, seems to be grinding exceedingly slowly. Meanwhile, the nation is having to suffer as we suffered over the past few weeks. It is already clear that we are to suffer again in the future. Other unions are threatening to follow the supervisors down the same road. The National Union of Public Employees has tabled a 40 per cent. pay claim for hospital ancillary workers, as reported in the Financial Times, warning that it has

“completed detailed contingency plans for industrial action against the Government’s 5 per cent. pay policy.”

The Financial Times gave an account of what is envisaged:

“The plans are aimed at identifying areas of maximum disruption to the Health Service ​ and the effects could be similar to—and possibly worse than—the crippling action taken by hospital works supervisors over the last five weeks.”

That is a grim outlook, which is already casting dark shadows over the next few months in the life of our hospitals. Yet against that background all that we have had is the bland and reassuring words of the Queen’s Speech that more resources will be made available. Against that kind of background it is empty rhetoric.

The Government have presided over the Health Service for four and a half years and the result is now rock-bottom morale, falling standards and growing public disillusion with the whole concept of the NHS. It is time for a fresh start—the kind of start that only a General Election can bring.

Mr. Laurie Pavitt (Brent, South)

You must have heard hundreds of speeches, Mr. Speaker, in which an hon. Member has apologised to his predecessor, saying “I shall not be following you”. I want to reassure the right hon. Member for Wanstead and Woodford (Mr. Jenkin) that I shall be following him very closely because, somehow or other, without straying very far from my own notes, I seem to be moving step by step in the same framework.

I wish to pick up three points which arose earlier. First, may I dispose of the intervention about Mr. George Clark? Mr. George Clark came to see me on the Friday after the Labour Party conference, and we had a chat. I assure the right hon. Gentleman that, although my right hon. Friend the Secretary of State has affection and respect for me, I have never been close enough to be able to influence what he says or what the Department does. So I am afraid that, as the right hon. Gentleman knows, the idea that someone could have direct access to the DHSS by talking to a Back-Bench Member is not feasible.

The second point that I should like to take from the right hon. Gentleman’s comments is the challenge put to him by the Government Front Bench. He made the categorical statement that a Conservative Government will not in any way allow less expenditure than that which they inherit on the NHS budget. Secondly, he believes that public expenditure must ​ be contained. Thirdly, I accept that he sincerely believes that resources for the Health Service must be improved.

If we take those three propositions together, we reach the inescapable conclusion that the only way in which he can get fresh resources without increasing public expenditure—while maintaining the expenditure which he inherits—is by some form of charging. I hope that whoever winds up the debate from the Opposition Front Bench will tell us whether there will be increased prescription charges, board and lodgings charges, increased charges for spectacles or teeth, a fee for an interview with a general practitioner, or any of the other kites that have been flown.

The right hon. Gentleman concluded by expressing anger and concern. For every case that he has put to the House—and I know of these cases, too, in the past few weeks—I know from personal experience of cases where, in spite of difficulties, devoted Health Service workers—including some in the grades that we have been discussing—have managed to clear the lines, do a job of work and save people from going on the waiting list. I speak from personal knowledge.

Why do we always hear this jeremiad about all that is wrong and how the trade unions do not do the job, yet never hear the compensating points? I hear both sides. It would be helpful if the House sometimes heard both sides as well.

The right hon. Gentleman said nothing about the attitude of the Tory Party when industrial action by doctors raised the waiting list from 500,000 to 600,000. That was the time when he should have spoken out about industrial action being harmful to patients.

Mr. Patrick Jenkin

I have not checked back through Hansard, but the conduct of my hon. Friend the Member for Sutton Coldfield (Mr. Fowler), who was then our spokesman, was in marked contrast to the attitude of Labour Ministers when we were facing strikes not only in the Health Service but elsewhere. My hon. Friend made it abundantly clear that in no way could we support industrial action aimed at disrupting the Health Service or indeed at breaking the Government’s pay policy.

That has been our consistent and responsible view throughout. I held my ​ peace entirely during this last dispute because I did not think that an Opposition spokesman not privy to the negotiations could make a comment upon it.

Mr. Ennals

What about the hon. Member for Reading, South (Dr. Vaughan)?

Mr. Jenkin

The natural revulsion of my hon. Friend the Member for Reading, South (Dr. Vaughan) stems from the fact that he is a doctor and perhaps feels more passionately than most of us what doctors feel when they are unable to treat patients whom they are asked to see.