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Category: Health

  • Lindsay Hoyle – 2020 Statement on the Department of Health and Social Care

    Lindsay Hoyle – 2020 Statement on the Department of Health and Social Care

    Below is the text of the Speaker’s statement made in the House of Commons on 11 May 2020.

    Before calling the Prime Minister to make a statement, I would like to make a statement of my own accord. I am aware of widespread concerns across the House about delays in Government Departments, and the Department of Health and Social Care in particular, responding to written questions and correspondence. I have received representations on this matter from the Procedure Committee and from Back Benchers across the House from Opposition parties.

    Last Wednesday, the Leader of the House argued that a degree of latitude is allowable for the Department. However, the Secretary of State himself has referred repeatedly to the value of parliamentary scrutiny. Written questions and letters to Ministers are integral to such scrutiny. I accept that the Department of Health and Social Care faces many challenges, but I am sure that resources across Whitehall can be mobilised to support it in maintaining proper standards of accountability.

    While I think it is right for me to call for improvements within the Government, I also make a plea to all hon. Members to be targeted and considered in the written questions that they table at this time, and to avoid swamping Departments with questions on a fast-moving situation that will be superseded before they can be answered.

    I now call the Prime Minister, who should speak for no more than 10 minutes.

  • Michael Howard – 2004 Speech on the Voluntary Sector and Public Services

    Michael Howard – 2004 Speech on the Voluntary Sector and Public Services

    Below is the text of the speech made by Michael Howard, the then Leader of the Opposition, at Toynbee Hall on 30 November 2004.

    Since becoming Leader of the Opposition, I’ve spent a lot of time travelling round Britain. And wherever I go, I meet remarkable people who give up their time to help those who are less fortunate.

    I meet people that have pulled together to tackle the problems they face. I visit communities who have been emancipated by the realisation that they can help themselves. And I see society working to meet the needs of its most vulnerable people, often more successfully than the State.

    As Beveridge wrote in 1948:

    “The making of a good society depends not on the State but on the citizens, acting individually or in free association with one another, acting on motives of various kinds, some selfish, some unselfish, some narrow and material, others inspired by love of man and love of God. The happiness or unhappiness of the society in which we live depends upon ourselves as citizens, not on the instrument of political power which we call the State.”

    Central to my approach is a belief that voluntary organisations are often better at delivering services than government.

    Just because the State pays for services, it doesn’t always have to provide them. Involving the voluntary or private sectors helps to drive up standards – benefiting everyone.

    Voluntary organisations are often more flexible and more responsive than the State. They tailor their services to the communities they work in. They do not simply hand out money – they know how it’s going to be used. They rarely suffer widespread fraud – because they know their clients personally. Some of the most successful organisations in the country – the schools, care homes and child care centres catering to the poorest people in society – are independent charities.

    Institutions like Toynbee Hall do not simply offer a contract with their customers. They offer a covenant: a relationship, an understanding of the emotional aspects of life, a recognition that we are not economic units or faceless statistics, but human beings.

    That’s why I would like to involve the voluntary sector much more in the delivery of public services. In education, we want charitable schools to be able to compete for the money which the taxpayer spends on each child – so that parents have a greater choice of school. In health care, we want charitable hospitals and clinics to qualify for NHS funding, if they can deliver care at NHS standards and NHS prices.

    But voluntary activity is more than about providing services to people in need. It’s part of a mindset, it’s a set of values, it’s a sense of humanity by which people can show responsibility for others. It’s practical. But it can also be wonderfully inspirational.

    A thriving voluntary sector, by virtue of the fact that it is voluntary, is a sign of a society in which people recognise that freedom brings responsibility – responsibility not just to our communities but to those less fortunate than ourselves. It offers the decisive and positive answer to that age-old biblical question: am I my brother’s keeper?

    What drives me forward is my trust in people.

    I believe that if people are given a choice they will make the right decisions for themselves and their families.

    I believe that if professionals – doctors, nurses and teachers – are trusted to exercise their judgment, they will take the right decisions: decisions that are in the best interests of patients and pupils.

    And I believe that if the voluntary sector is trusted to help run our schools and hospitals, we can improve the services on offer.

    My ambition is simple – to give everyone the choice in health and education that today only people with money can buy.

    As Winston Churchill said in 1940:

    “When this war is won, as it surely will be, it must be one of our aims to establish a state of society where the advantages and privileges which have hitherto been enjoyed by the few shall be far more widely shared by the many”.

    It’s a dream worth turning into reality.

  • Vaughan Gething – 2020 Statement on Scientific Advice in Wales

    Vaughan Gething – 2020 Statement on Scientific Advice in Wales

    Below is the text of the statement made by Vaughan Gething, the Minister for Health and Social Services in Wales, on 4 May 2020.

    The Welsh Government’s Chief Scientific Advisor for Health Dr Rob Orford joined the UK Government’s Scientific Advisory Group for Emergencies (SAGE) COVID-19 meetings on 11 February 2020.

    SAGE is responsible for ensuring timely and co-ordinated scientific advice is available to decision makers to support UK cross-government decisions in the Cabinet Office Briefing Room (COBR).

    Wales’ Chief Medical Officer Dr Frank Atherton and Dr Orford agreed a formal technical and scientific advisory structure within Welsh Government was also needed to provide official sensitive advice to Ministers. The terms of reference for a Technical Advisory Cell (TAC) were agreed on 3 March, in accordance with SAGE guidance. TAC meets three times a week.

    The TAC is designed to:

    Interpret SAGE outputs into a Welsh context

    Relay relevant information and questions from Welsh Government to SAGE

    Ensure indirect harm is not caused by the proposed interventions

    Help inform NHS and social care planning guidance

    Ensure Welsh Government and Public Health Wales have timely access to the most up-to-date scientific and technical information

    Brief Local Resilience Forum and Strategic Coordinating Group chairs about scientific and technical outputs, via the

    Strategic Health Coordinating Support Group, which is chaired by Public Health Wales.

    TAC does not replace statutory functions of Public Health Wales or use the technical or scientific information, which has not been agreed or discussed by SAGE, unless this has a specific Welsh context.

    The priorities of TAC are aligned to SAGE and include:

    The detection and monitoring of coronavirus

    Understanding effective actions to help contain a cluster

    Understand, measure and alter the shape of the UK epidemic

    Ensure indirect harm is not caused by the proposed interventions

    Model the UK epidemic and identify key numbers for NHS planning

    Understand risk factors around demographics, geographies and vulnerable groups

    Generate behavioural science insights for policy makers

    Ensure NHS tests and trials key interventions

    Consider emerging therapeutic, diagnostic and other opportunities.

    TAC is co-chaired by Dr Orford and the Deputy Director for Technology and Digital. Membership is drawn from Welsh Government, Public Health Wales, Cardiff University and Swansea University. A range of experts from different disciplines are included covering public health, health protection, medicine, epidemiology, modelling, technology, data science, statistics, microbiology, molecular biology, immunology, genomics, physical sciences and research.

    Membership of TAC is kept under constant review.

  • Vaughan Gething – 2020 Statement on the NHS and Covid-19 in Wales

    Vaughan Gething – 2020 Statement on the NHS and Covid-19 in Wales

    Below is the text of the statement made by Vaughan Gething, the Minister for Health and Social Services in Wales, on 6 May 2020.

    We are moving out of a period of COVID-19 critical planning and response and into a longer period where our health and care system must remain both prepared for any future peaks and effectively providing essential services and other high quality care and treatment for the people of Wales.

    In March I made a number of decisions to ensure early and decisive action to continue to provide care and support to the most vulnerable people in our communities, whilst also making sure organisations and professionals were supported to prepare local responses to the public health emergency. The NHS in Wales has already delivered a remarkable response to the COVID-19 health emergency since receiving the first coronavirus patients and now we must take the next steps.

    To maintain momentum and to ensure the system continues to focus its attention on the provision of a wider range of services, I have issued an NHS Wales COVID-19 operating framework for quarter 1 (2020/21).

    The document highlights four types of harm that could emanate from Covid-19 which we must remain focused on and guard against. These are;

    Harm from COVID-19 itself

    Harm from an overwhelmed NHS and social care system

    Harm from a reduction in non COVID-19 activity

    Harm from a wider societal actions / lockdown

    This framework will drive, even further, our systems focus on the two components of ensuring both a continued effective response to COVID-19 whilst providing other essential services in a careful and balanced manner.

    I have taken advice from professional colleagues, including NHS Chief Executives and Medical Directors. This advice demonstrates consensus across the health and care system that we must ensure delivery of essential services for our population and where possible recommence more routine care. The advice I have received also says that this must be done progressively, with caution and in a flexible and agile manner to ensure confidence for the public and staff.

    This framework is set under a number of themes;

    New ways of working and workforce wellbeing – Staff have created and quickly embraced new ways of working to respond to the COVID19 challenge- offering benefits in terms of safety and quality to both staff and patients whilst also contributing to reduced congestion in primary care and hospital settings. We must continue to build on this work and harness the opportunities it has provided.

    Examples of the scale of transformation include the rollout of video consultations safely to primary care. Locally and nationally these new ways of working must be sustainably embedded.

    This framework recognises the importance of the wellbeing of our workforce, and in particular those staff who have been under significant pressure in responding to COVID 19 and they must be at the forefront of our minds. Pressures may increase again in the next few months. I am clear that appropriate testing systems must be in place and be informed by the impending Testing Strategy being developed to support and help sustain staff.

    Managing COVID 19 – It will always be difficult to guarantee that health and social settings will be COVID free, however patients using the NHS must be confident that hospital environments are as safe as possible. The key criterion I will looking to organisations to be assured on include:

    Ongoing and consistent application of Infection Prevention and Control guidance.

    Identification of COVID “zones” and dedicated isolation facilities. I will be anticipating that regional solutions are explored along with the targeted use of independent sector hospitals and field hospitals to support the separation of covid and non-covid activity in the immediate term.

    New service or specialty based triage and streaming processes in both unscheduled and planned care to support the separation of patient services.

    Continued implementation of Acute Pathways for COVID 19 and the related rehabilitation
    Assurance on the availability of sufficient physical and workforce capacity that reflect the need to maintain social distancing and infection prevention and control measures.

    The framework reflects my determination that we retain our ability to quickly activate additional critical care capacity, if we enter into another peak.

    “Essential” services – I am clear that Essential Services should be maintained at all times throughout the pandemic. An Essential Services technical document has been developed in line with The World Health Organization (WHO) guidance. If, in any areas of essential services, the response to COVID 19 has led to backlogs they must be urgently addressed. Ultimately I recognise that some decisions on treatment will rest between patients and their clinicians, taking account of their specific risks during the COVID outbreak.

    “Routine” services – We know that capacity exists in some parts of our system to support the re-introduction of routine services. The reintroduction of these services is a local operational decision for Health Boards and Trusts in conjunction with relevant partners. These decisions must be taken with care, and organisations need to assure themselves that it is safe and appropriate to do so. I outline how they need to assure themselves in the framework.

    Primary care – For General Medical Services we have seen a shift to telephone first triage; this must remain in place during Quarter 1 and I encourage it longer term. Equally our community pharmacy services have been under significant pressure and have introduced new ways of working to manage patient care safely and efficiently, these too must continue where the benefits are clear.

    All routine primary care dental treatments and check-ups continue to be cancelled. Dental practices with NHS contracts remain ‘open’ for remote triage, the provision of advice and the issuing of prescription. Further guidance will be issued separately to this framework about the future status and restoration of dental services. In optometry services, a number of practices remain open for emergency and essential eye care services. Health boards must continue to ensure urgent patients are seen.

    Social Care Interface – Finally the framework makes clear that NHS organisations must continue to work with partners to ensure an effective interface with social care. This is in line with the approach set out in “A Healthier Wales” and the framework makes clear how this must happen.

    There has been clear and consistent messages for the public that the NHS is still available at times of need despite COVID-19. We must continue to ensure that key services are available and patients can access them, now and in the future.

    To help patients access these services over the last eight to ten weeks there has been a seismic level of transformation across our system. We must reflect on these changes but not dwell on them. They must be adopted, adapted and applied. This framework supports the health and care system in moving to the next phase of providing services.

  • Liz Kendall – 2020 Statement on Exercise Cygnus

    Liz Kendall – 2020 Statement on Exercise Cygnus

    Below is the text of the statement made by Liz Kendall, the Shadow Social Care Minister, on 7 May 2020.

    The report on Exercise Cygnus provided clear warnings that we were not properly prepared for a pandemic.

    In particular it highlights that local plans for social care were inadequate and that social care services wouldn’t be able to cope with the number of people discharged from hospitals to ensure the NHS had enough beds to meet demand.

    These warnings have now proved all too sadly true as the unfolding tragedy in our care homes shows. Care providers confirm they were not involved in subsequent discussions on how to put these problems right.

    Ministers must be clear about why they failed to act on the report’s recommendations and what they will now do to fully protect and resource these vital services in future.

  • Matt Hancock – 2020 Statement on the NHS Covid-19 App

    Matt Hancock – 2020 Statement on the NHS Covid-19 App

    Below is the text of the speech made by Matt Hancock, the Secretary of State for Health and Social Care, in the House of Commons on 5 May 2020.

    Yesterday we launched the NHS covid-19 app (“the app”) for initial roll-out on the Isle of Wight over the next two weeks.

    This is the first phase in the development and roll-out of a national “test and trace” programme which will bring together the app, expanded web and phone-based contact tracing, and swab testing for those with potential covid-19 symptoms. This is a vital part of our plans as we move towards the second phase in our battle against covid-19.

    The app has been built by a team including world-leading doctors, scientists and tech experts. If someone installs the app, it will start logging the distance between their phone and other phones nearby that also have the app installed. If a person becomes unwell with symptoms of covid-19, they can report this through the app, which will then anonymously alert other app users that they have come into significant contact with over the previous few days and provide appropriate advice. The app, which takes full consideration of privacy and security, has already been tested in closed conditions at an RAF base.

    This initial roll-out will provide valuable insights into how the public respond to and use the app and how we can improve it further. There will be no changes to social distancing measures during this initial roll-out phase.

    Using the app is voluntary but the more residents who download the app, the more informed our national response will be. The Isle of Wight is leading the way for the UK, for which we thank them.​

    The more rapidly we can identify people at risk of infection and provide them with advice on what action they should take, the more effectively we can reduce the spread of the virus. The test and trace programme will play an increasingly important part in our wider strategy to save lives and protect the health and care system.

    Further details of the national roll-out will be available soon.

  • Eric Deakins – 1978 Speech on Redditch Casualty Service

    Eric Deakins – 1978 Speech on Redditch Casualty Service

    Below is the text of the speech made by Eric Deakins, the then Under-Secretary of State for Health and Social Security, in the House of Commons on 3 November 1978.

    I begin by congratulating the hon. Member for Bromsgrove and Redditch (Mr. Miller) on getting an Adjournment debate so quickly in the new Session and for giving me the opportunity to speak about the problem generally—it is a difficult one— and to assure the people of Redditch that the difficulties over their casualty service have not gone unnoticed here in London.

    As the hon. Gentleman well knows, through our correspondence, and in his meetings with my right hon. Friend the Minister of State, we have been involved in this issue for some time now. As he ​ said, it is a most difficult one, and I hope in the course of my remarks to clarify some of the problems.

    Our concern has been to ensure that the residents of Redditch are provided with an accident and emergency service appropriate to their needs and—of almost equal importance—that they are fully informed about the different services available. I hope, if there is time, to return to this latter point.

    Hospital treatment for the great majority of casualties from Redditch is provided in one of three ways. The most serious cases are usually treated at Selly Oak hospital in Birmingham—a journey of about 15 to 18 minutes by ambulance.

    Other, less serious, cases are dealt with either at one of the hospitals in Bromsgrove, about seven miles away, or, if the casualty arises between 9 a.m. and 5 p.m. on a Monday to Friday, at the Smallwood hospital in Redditch.
    Smallwood hospital is a general practitioner hospital of some 42 beds, with a casualty department staffed by 24 local general practitioners. They provide medical cover according to a rota which they themselves have drawn up. The general practitioners are not necessarily in attendance at the hospital throughout their period of duty, but they obviously have to be immediately available if required. During the last period of 12 months for which figures are available there were, on average, 170 new patients treated at Smallwood hospital each week. It does appear, however, that the numbers have recently been increasing. Until the end of March 1977 the general practitioners in Redditch provided 24-hour seven days a week cover and were, at that time, treating about 260 new patients a week.

    I think it might be helpful if at this point I briefly describe the general picture with regard to the remuneration of general practitioners who work in general practitioner hospitals. At present, the only approved methods of remuneration are the staff fund—also known as the bed fund—system as provided for by the terms and conditions of service of hospital medical and dental staff, or, where appropriate, sessional payments at the part-time hospital medical officer rate. These practitioners are commonly referred to as clinical assistants. Where the number of patients attending the ​ general practitioner hospital as casualties or the nature of the services being provided—that is, services other than those the general practitioner might have provided in his own surgery—are such that the staff fund alone is not considered to provide adequate remuneration for the work, health authorities may make sessional appointments at the clinical assistant rate to remunerate the work falling outside the scope of the staff fund.

    The clinical assistant rate is, at present, £720 per year for one session per week. Each session is equivalent to three and a half hours’ work at the hospital. There are no nationally agreed rates for “on-call” work for this group and health authorities are expected to agree locally on appropriate assessment of sessions for any on-call work, taking into account the amount of clinical work arising from the on-call commitment, not merely the length of time on-call. The rate of payment into the staff fund and the sessional fees payable to clinical assistants are those recommended by the Doctors’ and Dentists’ Review Body, the independent body set up to advise the Prime Minister of the day on matters of medical and dental remuneration within the NHS.

    Discussions between the general practioners and the Hereford and Worcester area health authority about its future level of remuneration for services at Smallwood hospital began in 1976 when the general practitioners were still providing full casualty cover. I understand that at one stage it was thought that the general practitioners might be eligible for the new hospital practitioner grade. As they were not working as part of a specialist consultant team, however, such a regrading was not possible. At another stage in the negotiations the general practitioners were made an offer that was subsequently withdrawn. I can well understand the general practitioners’ frustration at these events which must clearly have adversely affected their relationship with the area health authority.

    In the end the only agreement that could be reached was for the restricted casualty service now in operation for which the general practitioners as a group are paid 17 clinical assistant sessions a week. This total number is made up of three sessions per day plus an additional ​ two per week to cover bank holidays, sick absences and so on.

    The concern over the introduction of a restricted service and the need for the AHA to establish what kind of service was being provided and what kind was necessary, led the authority to set up a survey of general practitioner casualty provision. As the chairman of the AHA explained in his letter of 27th February 1978 to the hon. Gentleman, the aim of the survey was to establish three things. First, the degree to which the nature and quantity of work carried out by general practitioners at the Smallwood hospital compared with a consultant manned accident and emergency department. One case for paying additional remuneration would be if the general practitioners were dealing with more serious cases than was normal in such a casualty department.

    Secondly, the survey was to find out the degree to which the work undertaken in the department might be considered part of the general practitioners’ normal workload. There is little doubt that a proportion of the patients treated in the casualty department would, elsewhere, be treated in their general practitioners’ surgeries.

    Thirdly, the survey was to provide information to help the AHA to decide whether or not the restricted service provided an acceptable level of casualty cover for the town.

    Unfortunately, both because of the illness of the officer conducting the survey, and because of the complexity and number of patient records being analysed, this review took longer than expected and, indeed, is still incomplete. Apparently the analysis of patients’ records retrospectively has not provided as much information as was expected. It has therefore become necessary to consider embarking on a prospective survey in which, it is hoped specific information will be obtained from patients during the course of their treatment. An interim report from the survey was put before the authority’s meeting on 16th June 1978. On the first of the three questions the report concluded that although the contention that the work was more akin to that of a consultant department could not be conclusively refuted, the evidence thus far available was strongly suggestive to the contrary. The report also dealt at some length with the pattern of treatment ​ for Redditch patients with particular reference to the location of the treatment whilst the Smallwood hospital casualty department was closed.

    I understand that the AHA discussed the report and the whole situation in considerable detail but felt unable to depart from the general principle adopted for its area; namely, that one session per week should be paid for each 600 new attendances annually. The Redditch general practitioners’ current level of remuneration, which had been separately negotiated at 17 sessions a week, exceeds that which would be payable under the general formula; and their request for an ultimate payment of 42 sessions a week for 24-hour cover is well in excess of the level likely to be reached were they to provide such a service.

    The AHA asked the district management team to pursue with the general practitioners the possibility of rearranging the sessions currently worked so as to provide fuller cover at the hospital. This might have involved, for instance, transferring one of the three sessions from the morning period. As the hon. Gentleman is aware, the general practitioners have rejected this approach. The AHA also resolved to delay any final decision on the general level of remuneration payable to general practitioners in cottage hospitals pending the outcome of discussions on the consultants’ contracts.

    The hon. Member may like to know that a joint working group made up of representatives from the health Departments—DHSS, Scottish Home and Health Department and Welsh Office—representatives from NHS management and representatives from the British Medical Association has recently been set up to discuss the work of general practitioners in hospitals with particular reference to the implications for the remuneration general practitioners receive for this work which obviously is directly relevant to this problem. The payment of general practitioners for casualty work in general practitioner hospitals and units is one of the subjects being considered by the working group. The health Departments have made certain proposals on this to the BMA; these include the setting up of a special casualty fund, on the lines of the existing staff fund, to remunerate these casualty services. I cannot say more at ​ this point on progress in the working group or of the shape of any future agreement, but I can assure the hon. Member that we hope that an agreement may be possible in the reasonably near future.

    We must hope that these national discussions lead to a generally accepted basis for this type of remuneration. In the meantime, however, it is for the health authority and the general practitioners locally to agree on an acceptable level of service and of remuneration to the general practitioners for providing it, taking account, obviously, of the needs of the residents of Redditch and of the requirements of the pay policy that extra pay can be justified only by identifiably additional work.

    I ought perhaps also to draw attention to the long-term solution to the problem. As the hon. Gentleman knows, the West Midlands regional health authority is firmly committed to the provision of a major new district general hospital in Redditch. Its first phase is expected to include some 330 beds, together with a full consultant-staffed accident and emergency department. The question of the site for the new hospital has now been finally resolved and it is expected that construction will start in early 1983 with a view to completion of the first phase by 1986.

    A number of points were raised by the deputation which the hon. Gentleman brought to see my right hon. Friend the Minister of State on 20th July. I should like now to deal with these points. I hope that the hon. Member will treat my remarks as a further reply to his recent letter and parliamentary Question.

    Perhaps the most serious point raised was that unless the general practitioner’s remuneration was improved there was a danger that insufficient doctors would be prepared to participate in the scheme and the service might collapse altogether. I hope that the remarks I have made this afternoon about the comparison between the amount paid to Redditch general practitioners and that payable in other hospitals in the area will go some way to avert that danger. I should like to take this opportunity to say that there is no doubt that the local general practitioners are providing an extremely valuable service for their town.

    It was also suggested that the AHA might make its own arrangements for providing an extended casualty service, perhaps by advertising for additional staff. It must be said, however, that this is no more than a theoretical possibility. There would be very great difficulty in attracting suitable applicants for such a post and it is by no means certain that proper consultant supervision could be arranged.

    The deputation raised the possibility of a reduction in the number of new attendances on which the payment was based. I have already said that the AHA felt unable to depart from its general basis of one session for each 600 new attendances.

    Finally, the deputation spoke of the refusal of the Hereford and Worcester family practitioner committee to pay night visit fees for the work formerly undertaken after 11 p.m. by the general practitioners at Smallwood hospital. The statement of fees and allowances payable to general medical practitioners provides that a night’s visit fee will be payable subject to the relevant conditions being met where in the patient’s interest the general practitioner provides specific treatment at a general practitioner hospital, provided that the doctor is not on duty at or on call for the hospital at the time, and that the request for the patient to be seen did not come from the hospital. I think it is clear that those conditions were not satisfied and that the decision of the family practitioner committee not to pay a night visit fee was, therefore, correct.

    At the start of my speech I said that, if there were time, I would return to the question of the information available to the people of Redditch about the health services provided for them. The difficulties over the Smallwood hospital casualty service were discussed at a recent meeting of the West Midlands regional health authority. The authority concluded that the resolution of the dispute did not lie in its hands but felt that the local residents should be kept in touch with the facilities in the area. I understand that the authority’s public relations department is currently having information compiled about the whole range of these services and that, after discussions with the district management team, the family practitioner committee and the ​ local community health council, it is hoped to issue a comprehensive health information sheet within the next few weeks. It is expected that this will be issued by a professional distribution service on a door-to-door basis to every household in Redditch. Such an information sheet would thus have a wider distribution than the existing leaflet on the family practitioner services which is issued by the housing department of the new town development corporation to all its new tenants.

    One of the items which I should imagine will be included is a description of the hospital services available in Bromsgrove. I understand that there is some confusion about the location of the casualty department in that town. The department is, in fact, at the cottage hospital and not at the larger general hospital. I know that the community health council has suggested that a full accident and emergency department should be provided at Bromsgrove general hospital. The AHA has, however, pointed out that when, as would be inevitable, the unit transferred to the new district general hospital planned for Redditch there might be difficulties in reintroducing a general practitioner service in Bromsgrove.

    I should like to conclude by reiterating what I said at the outset. Our concern is to ensure that the residents of Redditch have the type of accident and emergency service they need as quickly as possible. In that connection I am sure that the chairman of the Hereford and Worcester area health authority will not mind my making public a comment in his letter of 27th February 1978 to the hon. Gentleman. In that letter he said that anyone who had direct information concerning patients who had suffered as a result of the restricted service should let either him or the area medical officer know as soon as possible. I understand that no such cases have yet been brought to their attention but the request for information still stands.

  • Hal Miller – 1978 Speech on Redditch Casualty Service

    Hal Miller – 1978 Speech on Redditch Casualty Service

    Below is the text of the speech made by Hal Miller, the then Conservative MP for Bromsgrove and Redditch, in the House of Commons on 3 November 1978.

    On Thursday, 30th May 1895, as reported in the Redditch Indicator, one Thomas Woodward, agricultural labourer, of Red Lion Street, Redditch was admitted as the first patient to the recently opened Smallwood Hospital, Redditch. I assure the Under-Secretary of State for Health and Social Security, for whose presence I am grateful, that I do not intend to set out the whole history of the difficulties besetting the provision of a casualty service in Redditch since that date. But it is significant that the first patient admitted was a casualty patient, there having previously been some argument as to whether a hospital was needed there for that purpose.

    The Minister may be familiar with the argument about whether a new district general hospital was required in my constituency at all, an argument happily concluded. But the hon. Gentleman will not be surprised to learn that even with the construction of the Smallwood hospital there was an argument for about three years over the choice of the site, and there was some delay in the construction. All that my constituents are hoping is that ​ the new hospital will be open well before the centenary of the Smallwood hospital.

    My intention in raising the matter this afternoon is by no means to conduct a witch-hunt of any kind. I pay tribute to the courtesy and attention with which I have been received by the Minister of State on several occasions—regrettably several occasions—on this most difficult matter.

    The truth is that we are confronted with a log jam. My purpose in raising the matter this afternoon is to seek the Minister’s assistance in attempting to break it. I hope that he will understand me when I say that it is also my intention to try to head off the possibility of a witch-hunt being conducted locally, in the press and by other means, against those who are imagined to be responsible for the difficulties affecting the provision of the casualty service. Such a public witch-hunt could only do serious damage to the morale of those who are continuing to provide the greatly reduced service and could well result in the complete withdrawal of the service.

    I hope that the Minister understands that that is a real possibility. I am a member of an action committee which I have been trying to head off from that very course, but I regret that it is one that it may determine to pursue.

    I spoke of a log jam and referred to several visits to the Department. I think that I should proceed to discuss the need for the casualty service before going on to list the various elements in the situation as I see them.

    The new town of Redditch now has a population of about 60,000. According to the statistics handed to me last week by the local employment office, there is a workforce of 33,000, practically all in manufacturing industry. The casualty service does not just provide for the growing new town of Redditch. It also provides for the surrounding areas. That has been recognised in the calculation of the population of the catchment area for the new district general hospital.

    The population of the area currently served by the Redditch casualty service, restricted as it unfortunately is, is about 90,000 and is increasing as the new town moves towards fulfilment in 1981. During the discussions we have had on several ​ occasions with the Department, mention has been made of the need for this service. The Under-Secretary referred to this in his letter to me of 19th August 1977. The area health authority was asked to undertake a survey at that time. A year later an interim survey was produced. We still do not have the results of any final survey, despite the lapse of time since the Under-Secretary was good enough to write to me.

    It can be said that the figure for the number of casualties from Redditch attending the Selly Oak hospital out of normal working hours, which are the only hours during which the Redditch service is provided—this can therefore be taken as a fair indicator of the increase in demand and consequently of the need— have risen from 13 per month in 1976 to 145 per month last year. More up-to-date figures are not available. A further illustration can be obtained by the fact that on a recent Saturday afternoon at the Bromsgrove cottage hospital there were 37 patients from Redditch in attendance.

    There is also a query about the extent of the treatment accorded to these casualties from Redditch at Selly Oak hospital. The question that arises is whether they are given full treatment or some first aid attention and then referred to the Redditch hospital during working hours on Monday for a full and proper examination. I am not qualified to speculate on that but I would point out that it is not unknown for there to be 110 cases awaiting the magic hour of 9 o’clock on Monday morning in Redditch. To the bulk of the 90,000 population the need for this service is totally apparent. People cannot understand why the service cannot be provided on a more satisfactory, that is continuous, basis.

    We must bear in mind that there is in Redditch a history of 24-hour provision of casualty service. Smallwood hospital is equipped not only with radiography but with an operating theatre. The staff at that hospital took a great and justifiable pride in the service they provided for their fellow citizens. It will readily be understood what a serious effect there was upon morale when the hours of operation of the casualty service were reduced to the normal working hours of 9 am to 5 pm, Monday to Friday.

    This reduction in service took place in April 1977. Previous warning had been given—very nearly a year’s warning—that the service would be reduced unless something could be done. Indeed, resignations from the general practitioners providing the service were finally handed in in October 1976, although they continued to provide the full service until April 1977.

    During that period of warning notice, there had been attempts to try to resolve the situation. The suggestion was made that the practitioners providing the service might qualify for the newly-constituted grade the previous year—1975— of hospital practitioner. This was found to be out of order on what appears to the layman to be the technicality that a consultant was not in overall charge. I say that it appears to be a technicality to the layman because consultants do provide a specialist consultant service on a sessional basis at the hospital. It may be that there is some professional objection at the bottom of this situation.

    It is not as if there has been adequate primary care available in the new town of Redditch. We need only to look at the new estate of Church Hill, with a population of 8,000 out of the 16,000 to be achieved in two years time, where there is at the moment a doctor operating from a semi-detached house. It is hoped to provide some portakabins next spring, but heavens knows what happens to people who get ill this winter.

    Adequate primary care is not available in this new town. I have raised this matter before in the House. I did so with the present Foreign Secretary when he was at the Department of Health and Social Security. There has been no provision in new towns for expenditure on health concomitant with the growth of new towns in the same way as has been provided for roads and education. This is a very serious matter.

    I turn now to the possible elements in the log jam. I have hinted that there may be some professional difficulties over the qualifications of these doctors. There may, indeed, be further professional difficulties or disagreements as to the provision of the casualty service and the priority it should be accorded in the expenditure of public funds.

    Whereas, for example, the medical staff committee in Redditch is quite convinced of the need for 24-hour coverage, and has accepted that, as a stage towards that, extension of the hours of the provisions of the casualty service might be a logical next move, expressing its willingness to do so if the necessary arrangements could be made, the district medical team, advising, apparently, the area health authority, did not share that opinion.

    There are administrative elements in the log jam. I will spare the Minister’s blushes about the effects on pay policy on the situation. That was one of the stumbling blocks to an earlier proposal during the period of notice in 1976. But it appears that there may well still be administrative difficulties. The Minister of State at one stage told me that a working party was to be set up with the Department of the Environment to examine new towns and the provision of medical facilities. That would appear to have made no progress. There has been, apparently, some administrative difficulty in the AHA concluding its survey, which has now taken well over a year.

    There may be differences of opinion between the hospital, the district and the area as to how these problems should be tackled, but the public simply cannot understand how it has proved impossible for this log jam to be resolved. With the withdrawal of the service, the increase of population and the advent of the new hospital, I should have thought it would have been perfectly possible to meet their quite legitimate aspirations and to treat this question as the special case which I believe it to be.

  • David Ennals – 1978 Statement on the NHS

    David Ennals – 1978 Statement on the NHS

    Below is the text of the statement made by David Ennals, the then Secretary of State for Social Services, in the House of Commons on 2 November 1978.

    I welcome the opportunity of today’s debate on the Gracious Speech to review the state of the National Health Service and to discuss its problems. No public service is held in higher regard than the National Health Service. It has within it men and women of high skill and dedication. None is held in higher esteem than the nurses—and I speak from experience, having had five weeks as a patient in an NHS hospital this summer.

    I believe that much of this respect is due to the basic principles on which the National Health Service is based—namely, a service for everyone, paid for by everyone, free at the point of delivery.

    Today’s debate provides an opportunity for the Government to set out their policies and aims. There is today concern about the state of the NHS. I hope that the Opposition, having chosen this subject, will give the House and the country some straight answers to some straight questions.

    There are three main areas of concern that worry patients, staff and the public generally. First, there is the problem of resources and the priorities for using them. Secondly, there is the bureaucracy in the NHS and the reorganisation carried out by the Conservatives. Thirdly, there are the difficulties over industrial relations ​ and pay, and the alarming effects that industrial action can have in our Health Service.

    I propose to deal with these three areas in turn, starting with resources and priorities. The needs for more cash and more staff in the NHS are plain for all to see. There are increasing demands on the service from growing numbers of elderly people.

    There are new methods of treatment for conditions that would have gone untreated only a few years ago. We have long waiting lists—now sadly longer still. There is a backlog of old, inadequate hospitals and the inheritance of an unfair share-out of health funds and facilities across the country. There are not enough staff, cash or facilities for our geriatric wards or our mental illness hospitals or our hospitals for the mentally handicapped. There is the need to cut still further the number of babies who die at or shortly after birth, and to reduce to a minimum those born handicapped.

    There is also the need for a further improvement in community care, and better primary care, particularly in inner cities. The list could go on. I said at the Labour Party Conference that I had the longest shopping list in the business. I have recognised—I think that we all do—the pressures on the Service, the strain on staff of all kinds, and the suffering of patients who have to wait too long for treatment or face unsatisfactory conditions—let us face it—in some of our hospitals.

    That is why we are planning to spend this year £120 million more in real terms on the NHS than we did last year. The £50 million Budget boost is only now beginning to show results. We have seen the opening of modern new hospitals in, for example, Newcastle, Northampton, Oxford and elsewhere. There has been the recruitment of more staff—especially nurses—and the provision of more resources for the Cinderella services. There is more home dialysis for kidney patients. This is beginning to happen.

    In addition, we have made provision in the Gracious Speech for a scheme of payments for those seriously damaged by vaccination—a problem which has caused great concern in this House over many years. I am proud that it was this Government who responded to that ​ concern. Legislation to cover the scheme of payments will shortly be introduced and will, I hope, have the support of the whole House.

    We are now spending about £8 billion a year on our health and personal social services, an increase from 4·7 per cent. of GNP in 1973 to 5·7 per cent. on the latest available figures. What is more, we are spending this money in accordance with a clear set of priorities, worked out after careful discussion. We are pressing ahead with a steady programme to achieve a fairer share of health funds across the country. That means that while programmes are held back in some regions, particularly in the Thames regions, areas of greatest need in the North, North-West and the East Midlands are seeing very rapid growth. I am sure that that principle is right and should be supported by the House.

    We are giving the Cinderella services for the elderly, the mentally handicapped and the mentally ill a higher priority.

    The House will know that during the recess there have been two important developments in these areas. First, the Government published a White Paper on our review of the Mental Health Act in which we propose new safeguards in the treatment and detention of mental patients and other reforms. Secondly, the National Development Group reported to me on “Helping Mentally Handicapped People in Hospital”, and I have made a statement setting out the Government’s proposals for further improving the quality of care for the mentally handicapped.

    The Cinderella services and geographical redistribution of funds are two of our key priorities. A third is a shift towards prevention. My hon. Friend will have more to say on this subject, especially in relation to perinatal mortality. I hope soon to announce some further initiatives, building on the much improved figures for perinatal mortality of the past few years.

    The Gracious Speech stated:

    “Fresh support will be given to enable the National Health Service to fulfil and extend its services to the public.”

    The Government have a firm commitment to strengthen and develop our National Health Service. We have made it plain that, as the economy improves, it will be possible to devote more resources ​ to the services. We have given practical effect to that commitment twice in the past year, in the November and April measures.

    The House will, of course, have to await announcements at the appropriate time on the Government’s plans for public spending in the period ahead, but there will be an increase in resources available for 1979–80, compared with figures in the last White Paper. It will give us some more room for manoeuvre and will, I am sure, be warmly welcomed in the country, especially by those working in the Service.

    We shall stick to our agreed priorities, and I hope to announce additional resources to help meet the needs of the elderly, to assist mentally-handicapped children, to assist disadvantaged groups, particularly in areas of high mortality, and to make some contribution to the assault on the long waiting lists.

    I have set out the Government’s priorities on resources and the way in which they will spend them. The House and the country will also wish to know where the Conservative Opposition stand. Let us start with the issue of spending on the Health Service. A few months ago, the right hon. Member for Wanstead and Woodford (Mr. Jenkin) was quite clear. He said that a Conservative Government would adopt the projections in last February’s White Paper on public expenditure. His actual words were

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

    What could be plainer than that? And that was after the Budget injection of £50 million. He was saying that under a Tory Government there would not have been that £50 million boost and there would not be any further increases beyond the figures in the White Paper.

    I hope that the right hon. Gentleman will confirm that that is the dismal prospect facing the NHS if the Tories, by misadventure, were to be returned to power. [Interruption.] If the hon. Member for Reading, South (Dr. Vaughan) doubts that, his right hon. Friend will have an opportunity of dissociating himself from his own quoted statement.

    The subject of resources raises, I believe, two further issues—charges and the Tory plan to shift to an insurance ​ basis of finance. When we last debated the National Health Service in this House, I put a number of questions to the right hon. Member for Wanstead and Woodford. He refused absolutely to answer them. So, having got no way at all with the monkey, I went to the organ-grinder. In order not to confuse the public and the House about who really is the Leader of the Opposition, I should explain that when I use the term “organ-grinder”, I do not mean the organist. I am referring to the right hon. Member for Finchley (Mrs. Thatcher) and not to the right hon. Member for Sidcup (Mr. Heath). In any event, I got no reply. So I shall put the questions again, and give the right hon. Member for Wanstead and Woodford the chance to answer them.

    How much would a Tory Government put on the prescription charge? Will the Tories introduce a new charge for seeing a GP? If so, how much? Will they bring in so-called hotel charges for staying in hospital? If so, how much? Will they bring in a new insurance-based system of finance? If so, will there be different levels of service for different levels of premium, and will there be separate premiums for each member of the family, with extra to pay for the children? When will the Tories publish the Vaughan report on charges? We have had a lot of open government. It is about time we had a little open opposition.

    These are fair questions. I warn the right hon. Member for Wanstead and Woodford that he cannot get away—as he did once before—with saying “We are waiting for the views of the Royal Commission.” He is quite happy to tell us in detail what he wants to do about the organisational structure of the NHS without waiting for the Royal Commission—and that is purely technical matter. This is a matter of deep principle. He does not need the Royal Commission to tell him where his principles lie—or I hope he does not. Let us see what he has to say.

    While he is about it, I hope the right hon. Gentleman will spell out where the Conservative Party stands on the issue of queue-jumping. Where does it stand on common waiting lists for private and NHS patients in NHS hospitals? The Government’s position is plain. While pay beds are being phased out, we believe ​ that those who pay should not be able to jump the queue for treatment. That is why I made proposals in the summer for the implementation of common waiting lists. The hon. Member for Reading, South leapt up and sharply criticised this policy. The issue is all the more important since, as we understand, the Tories want to bring back more pay beds. So I ask the question today: do the Tories support common waiting lists, or are they now openly in favour of queue-jumping? I hope we shall hear an answer to that question from the right hon. Member for Wanstead and Woodford.

    I also hope that, instead of carping criticism, we shall get from the Opposition some recognition of what has been achieved by this Government and those who work in the Health Service. The fact is that, in spite of all the difficulties and the financial restraints, we have more and more staff treating more and more patients. The facts speak for themselves. I am comparing the position in 1977 with that in 1973, the last full year of the Tory Administration. The number of inpatients treated is up by 213,000 to 5,345,000—an all-time record. The number of day-patients is up by 123,000 to 532,000—again a record. The number of medical staff is up by 14 per cent. The number of nurses and midwives is up by 12 per cent.

    In spite of these achievements, waiting lists remain very long, with all the pain and the suffering that means for patients. This is one of the many problems we face in the National Health Service. We have a great deal still to do. But let us take a balanced view and recognise not only the tasks ahead but the real achievements of the many dedicated people who work in the Service.

    I have dealt with the first area of public concern: resources and priorities. I turn now more briefly to the second: the organisation and structure of the National Health Service.

    There is no disguising the very widespread concern over the reorganisation that the Conservatives foisted on the Service four years ago. The public believe—no one doubts it—that there is too much bureaucracy, that the machine is insensitive to the needs of patients and staff and, perhaps especially, that decisions are sometimes taken too far away from the patients themselves.

    I know that the right hon. Gentleman likes to wax eloquent on this last point—he makes speech after speech—but it is a little difficult to take seriously what he and the right hon. Member for Leeds, North-East (Sir K. Joseph) have to say on this matter. Somehow or other they talk as if they had no responsibility for it at all, as if somehow the situation that they are graphically describing is the responsibility of the Labour Government. But they are responsible for it—they and they alone. It was their pet scheme and it was vigorously opposed by Labour when we were in opposition. We knew that they had it wrong. But now they are coming forward with yet another Tory blueprint. The right hon. Gentleman’s party is coming forward with a new blueprint for the reorganisation of the NHS. I ask whether you, Mr. Speaker, would buy a second-hand reorganisation from the men who planted the first one upon us.

    My right hon. Friend the Prime Minister, in his speech to the Labour Party conference, made clear that this Government intend to make decision-making more democratic in a number of spheres of life. In the light of the views of the Royal Commission on the NHS, we are determined to make the Health Service more responsive both to those who use it and to those who work in it. As the Prime Minister made clear, we shall not take major steps on this before we have had a chance to consider the views of the Royal Commission that will be reporting to us early next year.

    This is in stark contrast to right hon. Members on the Opposition side. They are so embarrassed by what they have done that they are falling over themselves to suggest new remedies. I believe that in their haste they seem to be seeking to impose yet another rigid, ill-thought-out pattern upon the Service. Frankenstein may be dissatisfied with his first monster so he is helpfully making another. Let the public be warned.

    Mr. Stanley Newens (Harlow)

    Is it not a fact that one result of the dreadful structure which has been imposed by the present Opposition on the Health Service is not only bureaucracy and administrative waste but the diversion of too many resources from patient care to administration? Ought we not to be seeking some reorganisation which will put more of ​ the money which goes into the Health Service into patient care?

    Mr. Ennals

    That is absolutely right. Until we can carry out the changes that we need—because the burden of bureaucracy must be reduced—we have to see what we can do right now. I advise right hon. Gentlemen that we are first cutting down on management costs which, as my hon. Friend said, result directly from the reorganisation for which they were responsible. In the past two and a half years we have cut out nearly 3,000 administrative posts and at the same time we have seen the number of doctors and nurses increasing. As a result, this year we have been able to release about £13 million for patient care. In a sense, this is a form of organic change. As for districts, we are also looking at the structure at local level to see how we can meet local needs. I have already given approval for four area reorganisations and there are several others in the pipeline. We are making savings on fuel, supplies, drug costs and the rest. My hon. Friend is absolutely right. These are the issues on which we are concentrating.

    That brings me to the third and final area of concern for the Health Service—the problems of industrial relations, pay disputes and industrial action. That is perhaps the most immediate area of concern for the public generally. In fact, the last time this House debated the National Health Service—it was at a time when I was in hospital and could not be here—it was about industrial relations in the Service.

    As patients see only too clearly, the real damage that can be caused by industrial action is the lengthening waiting lists, postponed operations, real problems for staff morale and all the rest. It is in times of internal conflict that the NHS sometimes gives the appearance of having too many warring factions rather than being a united team. The right hon. Member for Wanstead and Woodford will understand what I mean by that. The difficulties are enormous.

    There are no easy answers to problems of pay. Many other disputes can blow up, and they blow up locally. We have all been greatly alarmed by the recent works supervisors’ dispute and by ​ troubles in particular hospitals. There may be more difficulties ahead as we enter the pay bargaining season.

    What judgment can we pass on the use of industrial action in the National Health Service? In 1973 it was the ancillaries who used it, in 1975 it was the doctors, and in 1978 the works supervisors. Some people have attacked industrial action within the NHS as part of a general attack upon the trade unions. That is absolutely unfair.

    I pay tribute to the commitment of the leaders of the Health Service unions to the Service and the interests of patients.

    Can we—as some people suggest—impose a requirement that because they work in the Health Service they should forswear the normal rights of trade unionists? I believe that that would be unrealistic. Most organisations—and I suspect that they include the British Medical Association—would not agree to have their hands tied. Of the three areas of concern being discussed today, I think that this is the one in which Tory hypocrisy is at its worst.

    Mr. Eldon Griffiths (Bury St. Edmunds)

    Before the right hon. Gentleman continues his attacks, may I say that the vast majority of people who work in the Health Service at all levels hate the idea of strikes against patients? They do not like it any more than we do.

    Would the right hon. Gentleman consider at least what was done in the recent police pay settlement, when the police agreed to continue to give up the right to strike but were compensated by an inflation-indexed pay increase and machinery to maintain it? Large numbers of doctors and nurses and other members of the National Health Service have written to me saying that they would like such a deal to be tried out in the Service.

    Mr. Ennals

    I suppose that many people would say that they were prepared to make some sacrifices if they were given 25 per cent. extra pay. I can see that prospect winning a battle across the country.

    I want to come on to the inflationary consequences, because we cannot totally exclude the National Health Service from this Government’s battle against inflation, as the hon. Gentleman seems to think we can. I believe that those who ​ choose to work in the NHS have a very special responsibility to those they serve and to sick people. A hospital is not like a factory complex. Human health and lives are at stake. It cannot be right to put human lives at risk and to cause suffering as an indication of industrial muscle. We must find a better way. We must get our procedures right. We owe it to the Health Service workers and to the patients. Let us look at what we can do in a serious way.

    I believe that there are two distinct problems. First, there is the question of pay and conditions of service, matters dealt with in the Whitley Council machinery. Secondly, there are the disputes that blow up locally—rows about the duty roster, the level of staffing on a ward, where someone parks his bicycle, or a clash of personalities. If they are not tackled, these problems fester and eventually erupt into industrial action, with all that it involves for patients, and all the publicity and effect upon morale.

    That is why earlier this year I brought together round my table the general secretaries of the main Health Service unions, the chairman and secretary of the British Medical Association council, the chairman of the Conference of Medical Royal Colleges and the secretaries of the Royal Colleges of Nursing and of Midwives, together with a representative of the Trades Union Congress and a representative of management. It was the first time that such a meeting had ever taken place in the lifetime of the National Health Service. As a result, I was able to put forward concrete proposals only last week for a new disputes procedure in the National Health Service. This up-to-date procedure is designed to settle disputes quickly at the local level where they arise. The general Whitley Council is now considering these proposals, and I hope that it will embody the essential features in an agreement that can be put into effect as soon as possible throughout the NHS.

    This is a practical down-to-earth initiative that I hope will cut to a minimum the number of avoidable local disputes. I was impressed by the extent to which the leaders of the professions and the unions came together and hammered out something that they could all support.

    ​The Opposition are always quick to criticise whenever they see the chance, but let us remember that when they had responsibility for these matters, they did absolutely nothing. Now they draw on their great reservoir of imagination and come up with fanciful ideas of a patients’ charter. I hope that the right hon. Member for Wanstead and Woodford will tell us about it. It sounds good. What does it mean? How will it work? I hope that it is more sensible than the right hon. Gentleman’s best known proposal that we should brush our teeth in the dark. At least I can understand that, and perhaps he will enable me to understand his ideas for improving industrial relations in the National Health Service. We are talking about industrial disputes. The Opposition’s attitude to disputes about pay is equally unconstructive. They did nothing to be proud of when they were in office, but they are quick to make capital out of any difficulties that we have.

    Mr. David Crouch (Canterbury) rose—

    Mr. Ennals

    I would have preferred to give way later to the hon. Gentleman. However, as I know he takes a great interest in this matter, I shall give way now.

    Mr. Crouch

    I wish to intervene only on the matter of pay policy. The Secretary of State told us that he had a meeting recently when he called together the representatives of the responsible trade unions operating in the Health Service. Do they appreciate that not only do they operate under the Cabinet’s pay policy so strongly advocated by the Prime Minister, but they also operate under the cash limits that fall on his Department? If they take more than the pay policy limits allow, it will be a matter of robbing Peter to pay Paul. Did he make that clear to them?

    Mr. Ennals

    The conference that produced this initiative on local disputes was dealing specifically with non-Whitley-Council-type disputes. I believe that there may be merit in inviting the same group of people to meet to see whether we can improve methods of dealing with the types of disputes that affect Whitley Council ​ issues. I shall cone to the main issue—the question of the supervisors—in a moment.

    In the case that we have been discussing, the machinery is not the real issue. The real issue is what sort of pay rises various groups of NHS staff are seeking and what they can be given. Here, not only the question of cash limits but the question of pay policy is crucial.

    I must comment briefly on two recent matters of concern—the supervisors’ dispute and the worries expressed about the pay and morale of nurses. I deal first with the dispute.

    I have no doubt that the House will have shared my great anxiety about the effect of the recent dispute on waiting lists and the very real risk to patients. Happily, a settlement has been reached with the help of the good offices of the general secretary of the TUC—and the House will, I know, be grateful to Mr. Len Murray for his most helpful initiative.

    I have no wish to rake over the coals. But there have been suggestions that this dispute could have been settled weeks earlier if Ministers had wished, suggestions that the issue had nothing to do with pay policy, and suggestions that the Government finally accepted a deal that I had said earlier was not on. All these suggestions are false.

    Ministers intervened on a number of occasions in efforts to settle the dispute. It was at my request that ACAS made an attempt to conciliate after talks had broken down. What was really being suggested by some critics of the Government was that we should simply have given the staff concerned all that they were demanding—regardless of pay policy and regardless of cash limits and the consequences for other groups of staff. It was a sure recipe for further disputes and further industrial action in the NHS. Pay up and hang the consequences seemed at one stage to have been the attitude of the hon. Member for Reading, South in a statement that he made. No doubt he or his right hon. Friend the Member for Wanstead and Woodford will tell us the purpose of his intervention at that time, if that was not it. I suppose that is what he wanted.

    Mr. Doug Hoyle (Nelson and Colne)

    Does not my right hon. Friend agree that this dispute was not connected with pay policy but was a hangover from the reorganisation that should have been settled much earlier?

    Mr. Ennals

    No. Let me spell it out. It is most important that the House should understand. Of course it was not a straight issue of whether the pay claim was above 5 per cent. This dispute was not about annual pay settlements. It was about a genuine regrading of staff.

    There were two very important issues of pay policy. First, the Government had to be satisfied that the new salaries offered for the new posts were commensurate with the job descriptions. On this basis, we approved the salary scales that had been offered by the management side several weeks before. The rejection of that management offer was the start of the supervisors’ action. Happily, six weeks later, after the disruption in the Service, they accepted precisely the same salary scales that they had rejected.

    Secondly, we had to be satisfied that any improvements to the supervisors’ productivity allowances were genuinely self-financing. That condition is met in the agreement reached last wek. Bonus payments are clearly subject to the financial viability of the scheme.

    During the negotiations, the staff side was demanding a minimum—I repeat minimum, because it was from 15 per cent. up to 30 per cent.—of 15 per cent. allowances for all supervisors regardless of whether they were involved in productivity schemes and regardless of whether the schemes were saving enough money to cover the costs. I said that that was not on. Productivity deals must be genuinely self-financing. I have stuck to that position. The agreement reached last week is entirely consistent with it. The 15 per cent. allowances provided for will not be an unconditional minimum available to all, regardless of membership of schemes and their viability. All supervisors will now have the opportunity to participate in schemes, but the allowances paid, which we hope may reach 15 per cent. six months after schemes are initiated locally, will depend upon the financial viability of the schemes. That is the crucial point. I am glad that the unions were able to ​ accept it. Until they did, no settlement was possible.

    The other subject that I have to mention is the morale and pay of nurses. I recognise the great pressure that nursing staffs are under, particularly during industrial action by other groups when, in a sense, nurses have to pick up the tabs and carry on seeing that patients are cared for. I think that the House will join me today in expressing the country’s deep feeling of thanks to the nurses and to other staff who did so much to maintain the services during that very difficult and, I believe, tragic period.

    Nurses are under stress for many other reasons. There has been a steady increase in the number of nurses working in the National Health Service. It has doubled in 30 years. There has been an increase in the proportion of trained nurses. But they are under very great pressure. I know that from my own experience in hospital. The number of patients increases, the period that an in-patient stays declines, and inevitably the amount of attention that each patient needs increases. As more patients are elderly, they make heavier demands upon the nurses. The nurses need to master new skills.

    I am very glad that we have managed to include in the legislative programme a Bill to establish a new, unified structure for the regulation, discipline, education and training of nurses, midwives and health visitors. This structure will comprise a United Kingdom central council and four national boards, one for each country of the United Kingdom, with supporting specialist committees which will replace the existing statutory and non-statutory bodies. For heaven’s sake, the nurses have been waiting for a long time for this.

    Mr. Laurie Pavitt (Brent, South)

    Since 1972.

    Mr. Ennals

    We can go back to 1974 at least, when my right hon. Friend the Member for Blackburn (Mrs. Castle) announced the Government’s acceptance of the main recommendations of the Briggs report.

    I am pleased to say that we can now start moving forward. I know that many nurses will welcome this, but that they ​ will also say that their pay has fallen behind. They have asked me to look at their position in the light of the “special case” provisions in the White Paper. The question of nurses’ pay is one that will have to be looked at by the Government in the light of our declared policy on pay as set out in the White Paper.

    I hope that Conservative Members will not seek to make capital out of this matter. With their record on nurses’ pay, they have nothing to be proud of. What did they ever do about it when they had the chance? It was a Labour Government who raised nurses’ pay by 20 per cent. in 1970—I know because I was a Minister in the Department at that time—and it was a Labour Government who gave nurses a further boost of 30 per cent. in 1974 following the Halsbury report. And what happened between 1970 and 1974? Nothing—because we had a Tory Government.

    In the months ahead we face many difficult problems over pay in the National Health Service. I hope that they can be resolved without industrial action. As I have said. I deplore any industrial action in the NHS that puts patients at risk. I hope to explore, with leaders of the profession and the unions, what scope there is for avoiding such action in relation to pay disputes. But to those who say that industrial action in the Health Service must be avoided simply by giving in to whatever demands are made, I give this reply. Of course we must see, within the scope of what is economically possible, that justice is done to the staff. But merely to give in to all demands is the road to anarchy, in the Health Service itself and in the wider pay context.

    I repeat what my right hon. Friend the Prime Minister said yesterday. This Government are not prepared to take that road. Here we see one of the great divides that is opening up in British politics today. The Conservative Party is taking up a series of extreme positions, on the NHS and on the economy. After 30 years of bipartisan approach to the principles behind the NHS, the Tories seem to be showing their true colours. They seem ready to tax the sick with new and heavier charges.

    Dr. Gerard Vaughan (Reading, South)

    Rubbish.

    ​Mr. Ennals

    I am glad. In that case the hon. Gentleman will be able to assure us that it is rubbish and that that part of the Tory programme has been set aside. That will be a great relief for the whole country. I shall see whether we can get some more cries of “Rubbish.” The Tories are committed to a two-tier Health Service. No “Rubbish”? We shall see. The right hon. Member for Leeds, North-East seems to know what it is, because he has been putting forward the idea himself, as have the right hon. Member for Wanstead and Woodford and the hon. Member for Reading, South. They do not know what it means. Perhaps they cannot spell it out; perhaps they do not understand their own proposals. But the moment will come in a minute for the right hon. Gentleman to explain.

    The Tories are committed to massive cuts in public spending which cannot fail to hit the health and personal social services. No doubt the right hon. Gentleman will speak of that. They are also in favour of a free-for-all approach to wages, which would send inflation through the roof. If they restrain pay at all, it will be in the public sector only, so that nurses and other Health Service workers will again have to bear the brunt of rising prices. That is the Tory prescription, not only for the economy of the country but for the National Health Service. The contrast between the positive achievements and the positive programme, of this Government and what the right hon. Gentleman and his hon. Friends have to offer is patently obvious.

  • Maurice Miller – 1978 Speech on the NHS

    Below is the text of the speech made by Maurice Miller, the then Labour MP for East Kilbride, in the House of Commons on 2 November 1978.

    I am sorry that the hon. Member for Canterbury (Mr. Crouch) has taken 25 minutes to tell the House that there is a crisis in the National Health Service, and has told us nothing else.

    I wish to add my welcome to the Government’s commitment to fresh support for the NHS. I was sorry that the right hon. Member for Wanstead and Woodford (Mr. Jenkin) devoted the major part of his speech to a post mortem examination of the recent industrial action which upset the Health Service. I am not saying that we should not discuss the problems in the NHS, but I wish that the right hon. Gentleman had stuck to the theme of today’s debate, namely, what is to be done in this Session of Parliament about the Health Service.

    Having listened to the right hon. Gentleman, and having heard press and television reports, one would imagine that the problems in the NHS were new, and that there was once a golden era in ​ medicine before the establishment of the NHS. Nothing could be further from the truth, as those of us who remember the days before 1948 can testify.

    The fact of the matter—and I say this with a good deal of regret—is that at present another battle is being fought in the long war against the NHS, a war which unfortunately has been going on for 30 years. It is all very well for the Opposition to pledge their support now for the Health Service. Their predecessors did not take that view in 1947 and 1948. There has been stubborn opposition to the development and continuation of the Health Service which has followed on from the stubborn opposition which occurred when the idea of the Health Service was first mooted in 1946 and 1947 during the long debates that then took place. That opposition has not disappeared.

    Yet if we face the situation honestly—and this was a matter on which the hon. Member for Canterbury was totally wrong—we must take the view that a Health Service is needed even more today than it was 30 years ago. It is all very well for the hon. Gentleman to say that people should make a contribution. Costs in the Health Service are growing in geometric progression. Not only do we have to pay much more for old-established, well-tried services, but in addition advances in science and in technology have yielded diagnostic and therapeutic procedures unheard of, indeed undreamed of, 25 or 30 years ago.

    All branches of medicine and surgery have made enormous strides enabling those with kidney failure, heart conditions and blood disorders, to mention only a few examples, which used to have rapidly fatal consequences, to lead useful and even completely normal lives. Orthopaedic procedures for hips and knees have literally transformed a generation of sufferers, who a short time ago would have been confined to wheel-chairs, into fully ambulant members of the community.

    Even in conditions which as yet are not amenable to cure, the Health Service is the great saviour. I have a constituent who suffers from a relatively rare disease of the nervous system known as Hunting-ton’s chorea. Recently I had a long discussion with the secretary of an organisation which is striving valiantly to combat ​ this genetic disease. Although the disease is incurable, the Health Service provides a great deal of support for the victims—support which has bankrupted families in the United States, for example, where there is no National Health Service. There the very rich can afford the enormous amount of money necessary to sustain the sufferer over many years, and the poor can obtain institutional care. But the vast majority of the population who are in the middle have to pay and pay and pay. This is also true of many other long-term illnesses.

    The point I am making is that this enormous expense must be met on a national and not on an individual basis. The Health Service must be free at the time of use. But I do not think that shortage of money alone lies at the root of present unrest in the Health Service. Part of the problem is of our own creation. I am referring to the greater and greater expectations which the nation now has in respect of the part which the Health Service can play in our lives. This applies to all the workers in the Health Service. It applies to doctors, nurses, medical laboratory scientists and all the staff, as well as to the patients.

    This is a good thing, but it imposes an enormous strain on our resources of skill. This is an important aspect of the matter. There is a limit to the total amount of skill upon which we can call. This is one of the great problems that face us in the Health Service. There is no panacea, no overall speedy cure for all the problems, no shibboleths to be mouthed as passwords to perfection.

    There is no lack of suggestions. Indeed, the suggestions are so numerous that it is obvious that we need a rethink of how to dispose of NHS income. But—and this is important—there can be no question of going back or of nibbling away at the Health Service until it is completely eroded. Perhaps the Royal Commission will come up with some answers.

    Is there, for example, a surfeit of organisation? If so, we know where the responsibility for that lies. It is interesting to note that Scotland has a different structure from that in England and Wales and, in addition, Scotland has a much higher proportion of consultants who are full time in the National Health Service. This is a mode of action which my right ​ hon. Friend the Secretary of State for Social Services would do well to examine carefully, and perhaps copy.

    Should we, for example, encourage even greater authority to the doctors in the Health Service? Would this help? One eminent medical journalist put the matter this way only a few days ago:

    “Doctors are the sine qua non of this or any other health service. We know that we are indispensable, or at any rate most of us believe it, and so do most of our patients.”

    He continues in the following vein:

    “The solution to the problems of the NHS, I suggest, is to restore doctors openly to the position of authority which they once held. There is no point in pretending that medicine is a democratic profession, for it is not. It is a profession where vital decisions often have to be made quickly and clearly and democracy is not a very good way of doing that, whatever advantages it may have in other fields.”

    He then concludes:

    “Doctors are despots, but they are on the whole benevolent and enlightened despots. Furthermore, they are elected despots, for the patient has—or at any rate should have—the right to tell his doctor to go to hell, and to seek another one.”

    I mention this at some length because there is no use denying that it is a widely held view in the medical profession, but I hasten to add that it is not my view. However, we must examine whether over-organisation has not given doctors the feeling that professional freedom has been seriously eroded. But doctors must realise that accountability must accompany the very real freedom which they enjoy.

    I make only one suggestion which, in my opinion, would go a long way towards accomplishing what the Government describe as:

    “Fresh support … to enable the National Health Service to fulfil and extend its services to the public.”

    I advocate a considerable switch of funds to the family doctor sector. It is not good enough that this sector should command only 8 per cent. of the total budget. General practitioner services are the vital element and the GP is the first, and for most people the only, contact with the NHS. An increase in resources in this area would pay handsomely in fewer referrals to hospital and consequently more time being available to surgeons to carry out operations and reduce waiting lists. It would also reduce the enormous drug bill and have other benefits on ​ which time does not permit me to elaborate. To accept the family doctor as the linchpin of the whole Service and to allocate funds accordingly would have a snowballing effect on the whole Service.

    I am not being complacent, because I know that there are problems, but I should like to move on to a serious omission from the Gracious Speech, namely, that we should have had a complete revision of the conditions that have to be satisfied before a pension is paid for industrial deafness. Unfortunately, deafness is regarded as something to poke fun at or, at least, as something not to be taken as seriously as blindness, and this is not so. The Secretary of State can be assured that those of us involved in this area will continue to press for legislation.

    Today’s debate concentrates on the NHS and, according to my calculations, should occupy about 5 per cent. of the total time allotted for the debate on the Gracious Speech. However, I know that you, Mr. Deputy Speaker, do not have a rigid 5 per cent. fixation and I should therefore like to mention briefly one other matter that is related to health, if not directly. I refer to housing. Proposed legislation for a new charter of rights for public sector tenants is included in the Queen’s Speech. Nothing could be more welcome, but I conclude with one question directed to my right hon. Friend the Secretary of State for Scotland and of which I have given him notice. Will the provisions envisaged in the Queen’s Speech apply to the development corporations of new towns in Scotland?