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Orders Of The Day

Volume 656: debated on Tuesday 27 March 1962

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Consolidated Fund (No 2) Bill

Considered in Committee; reported, without Amendment.

Motion made, and Question proposed, That the Bill be now read the Third time.

National Health Service (Nursing, Medical And Other Professional Staffs)

6.35 p.m.

In the National Health Service today staff morale is at its lowest ebb. Staff shortages seem to be endemic at almost every level. Health Service Whitleyism is virtually dead, killed by the Minister, and resentment in the Service at the Minister's conduct is intense. It is for these reasons that my hon. and right hon. Friends have chosen to debate first on this Motion for the Third Reading of the Bill the problems of Health Service staff.

I want at the outset to say a word—and it will be a very brief word—about the shortage of doctors. I have a great deal of ground to cover and I hope that the House will appreciate that the importance of this subject merits a great deal more time than I can give to it this afternoon. I shall have to compress my remarks in this part of my speech.

All the evidence points to the fact that there is already a serious shortage of doctors throughout the Health Service, in the hospital service and in general practice, that this shortage is growing, and that it will soon become critical. It is not a shortage, like the others we shall be discussing, due to pay. The doctors are perhaps one of the few categories of staff in the National Health Service who are adequately remunerated. It is a shortage which arises primarily out of a failure of planning not perhaps so much by the Minister of Health as by his predecessors. It was a failure of planning which arose out of statistical misinformation as particularly exemplified in the Report of the Willink Committee and acceptance of the Willink Committee's recommendations by the Government.

The House will recall that that Committee advised a reduction of 10 per cent. in the intake of medical students. One distinguished member of that Committee, in a speech not long ago in another place, admitted that the Committee had based its conclusions on no fewer than four false assumptions. He also admitted that the Committee was wrong in the advice which it gave to the Minister. To do the Minister justice, he has now reversed the decision that his predecessor took and has agreed that the cut of 10 per cent. should be restored.

I think that the best estimate is that we need at the moment not fewer than 250 more doctors a year coming into the Service than we are now getting. It is quite clear that an accretion like this cannot be squeezed into the existing medical schools. I submit that the one essential step that the Government must take—and take now—is to ensure the immediate establishment of two, probably three, new medical schools. Even if they take that decision now, it will be eight or ten years before those new schools can make any real contribution to the medical staffing of the Health Service.

If there appears to be any difficulty—although I do not think that there will be—in getting enough medical students, I suggest that medical students might in future be drawn from a somewhat wider social class than has been the practice in the past. Much propaganda has been made in recent months about the emigration of doctors, and suggestions have been made that this has been the prime cause of the shortage of medical staff in our Health Service. It has been suggested that about one-third of the doctors who qualify in each year find themselves, within a very short time, emigrating either to Commonwealth countries or to the United States of America.

Papers have been published—and very much attention has been given to them by the medical Press—by persons who might be described as amateur statisticians, making this case with some cogency. It is not a case that I accept. I do not believe that the emigration figures are anything like those suggested. But the fact is that credence has been given to these papers, and this allegation has been used not ineffectively by the enemies of the Service to try to persuade people that doctors in the Service are very "fed up", and that they can obtain decent conditions of work only in other countries.

Credence is given to these papers because the right hon. Gentleman cannot or will not produce any official figures to refute them. All I want to say now is that it is the Minister's plain duty to discover the facts about medical emigration. It is not an impossibility. If he cannot do it within his own Department there are university departments which would undertake a survey. I suggest that he should forthwith institute a survey to find out how many doctors are emigrating every year, and if it is a substantial number—although I do not think that it is anything like one third—there should be a searching inquiry into the causes.

In the meantime, there is one other way in which we can mitigate the effect upon the patient of this doctor shortage in the Service. That way is to build up the strength of the other members of the therapeutic team, and, in particular, the professions supplementary to medicine. There is little doubt that the effective use of medical auxiliaries—people like psychotherapists, and psychiatric social workers—can enable a doctor to concentrate better upon that part of the therapeutic job which only he can do. It would make possible the more efficient use of our scarce and highly skilled medical manpower.

But we find that, in terms of numbers, there are shortages perhaps even more serious among the professions supplementary to medicine than there are among the doctors. Among physiotherapists, occupational therapists, radiographers and other similar professions, the shortage is acute. I have no time to go into detail on the matter, but, taking the country as a whole, these professions are 25 per cent. under establishment. In other words, out of every four posts which are considered by the authorities to be necessary to give an adequate service to the patient, one is vacant and is likely to remain vacant.

It is no answer for the right hon. Gentleman to tell the House that things were worse in 1948. We know that, and we expect them to be very much better today, after fourteen years' development and expansion of the Service. But is it surprising that we cannot get these professional workers? The starting salary for a physiotherapist is just over £10 a week, and for a radiographer it is substantially under £10 a week. Both scales rise to about £12 a week, but this is the limit, unless members of these professions become heads of departments. These are the salaries that we are paying to professional workers who have good educational qualifications and up to three years' specialised training. I could quote similar examples for comparable professions in the Service.

This is pitiful remuneration, which has been inherited largely from the days before the Health Service came into being. Experience has shown that the Whitley Council system has been quite impotent to bring about any basic revaluation of the services of these skilled, devoted and hard-working people.

I should like the Minister to tell us why the whole professional salary structure, aside from that of the doctors and dentists, cannot be examined with a fresh eye by an independent committee. I made this suggestion from this Dispatch Box last November, and it was turned down by the Minister from that Dispatch Box. It is, broadly, the proposal contained in an early-day Motion on the Order Paper, signed by about 220 hon. Members of all parties.

This is not a job to be done by the Whitley Councils. I do not think that it would be even if they were relatively unfettered in their operations. Still less is it a job to be done by bodies which have been so subjected to Ministerial direction as the Health Service Whitley Councils have been in recent months. Let these services be evaluated objectively, say, in relation to the remuneration of doctors and dentists. They had their Royal Commission. They have now been given their review body. As far as I can see, they seem to have opted out of the Whitley Council system altogether. I do not suggest that this need happen in the case of these other professions, but what is the difference in principle between the kind of independent committee the House is asking for and the Royal Commission which was granted for the doctors?

The right hon. Gentleman has produced two reasons, which apparently satisfy him, for turning down this proposal. The first is that such an inquiry could not be confined to those professions which are seeking it. Perhaps the Minister was thinking of the nurses. Why not include them? Their trade union has already asked for a Royal Commission on nursing, and I imagine that after their bitter experiences of the last few months nurses as a whole would welcome being included in such an inquiry.

The Minister's second objection is almost ironical. He has said that it would be wrong to by-pass, and thus to weaken, the existing Whitley Council machinery. I have only two questions to ask about that. First, why were these considerations not valid in the case of the doctors? There was a medical Whitley Council, but that did not prevent the right hon. Gentleman's predecessor from agreeing to a Royal Commission. Was it not merely that the pressure exercised by the doctors was far greater than can be exercised by these smaller and weaker professions? My second question arising out of this objection of the Minister's is: could such an independent committee possibly weaken the Whitley Council system to anything like the same extent that his own actions have debilitated it during the past six months or so?

Confidence in the Whitley Council system was dying before all this started. Ever since the system began claims for more pay have almost invariably been settled not by the Whitley Council themselves but by arbitration. I have one or two rather interesting figures about this aspect of the matter. Since the Councils started, in about 1948, 58 arbitrations have been completed and five arbitrations are pending in respect of non-manual workers in the Health Service—that is, 63 arbitrations in all. Over the same period there have been three arbitrations in respect of local government workers, one arbitration in the electricity industry, and none at all in the gas industry. Does not the right hon. Gentleman think that this at least suggests that the system has not been working as happily as he would wish?

Even before the pay pause, delays in dealing with claims were excessive and, in many cases, quite inexcusable. It has long been clear to all those who take part in the system that there is no proper negotiation, in the accepted sense of the word, between the management and the staff side. When a case goes to arbitration—and most cases do—the farcical nature of the structure becomes apparent for all to see, because the management side plays no part whatever in the arbitration.

I am informed that it does not even see the case that is presented to the arbitration court in its own name. These are all handled, I am told, by the Minister's own representatives, who have been the "bear leaders" for many years on the management side of the Whitley Council. This is the tottering edifice that the right hon. Gentleman has been still further undermining in recent weeks.

I should like to look in some detail at a couple of recent pay claims before the Whitley Council. The first concerns almoners and psychiatric social workers. This claim was submitted on 31st May, nearly two months before the Chancellor's first pay pause statement. Matters proceeded at the normal snail's pace. Finally, a full Whitley Council was summoned for 16th January, seven and a half months after the claim was submitted, for proposals to be made to the staff side.

It is generally believed—if I am wrong, perhaps the Minister will correct me—that the agreed figure was an increase of 8 per cent. and that this had been actually approved by the Treasury. What happened? A few moments before the opening of this meeting, the chairman of the Whitley Council received an urgent telephone message from the Permanent Secretary of the Ministry of Health telling her that no offer could be made. So she had no option but to tell the members, who had come from far and wide to attend the Whitley Council meeting, that they had better just go home again, which they did.

It has never been satisfactorily explained, so far as I know, how it came about that a pay offer, which had received the approval both of the Ministry of Health and of the Treasury, was withdrawn at the eleventh hour and fifty-ninth minute. Perhaps the right hon. Gentleman will explain to us today what happened. Needless to say, in the end, a 2½ per cent. offer was made, was rejected by the staff side, and is now the subject of arbitration.

I want to devote most of the rest of my remarks to the case of the nurses and midwives. The House will not expect me to dwell for long on the critical situation in the nursing service. There are about 25,000 vacancies for nurses in the Health Service. Nearly 10,000 beds have been closed for lack of nursing staff, according to the Ministry's Annual Report. The shortage of midwives is even more acute, both in local government service and in the hospital service. Of course, the Minister will again produce figures to show that nurses are more numerous than they were in 1949. That, too, is only to be expected. The fact is that there are not nearly enough of them, as everyone in the hospital service knows. It is becoming increasingly difficult to recruit student nurses.

The intake last year was 1,259 down on the previous year. In one hospital region last year, every conceivable effort was made to stimulate the recruitment of student nurses, by innumerable school visits to about 40 secondary schools, by lectures, by open days, by inviting the schools to the hospitals, by mobile exhibitions, films, leaflets, and, of course, Press advertising. Everything possible was done. What was the result?

The number of student nurses recruited in the region as a result of this special effort was 4,387, which was 11 fewer than the previous year and one more than in 1959. All that really happened was that this effort staved off a very substantial reduction that would otherwise have taken place. The wastage rate among student nurses is running at about 30 per cent. and I am told that in psychiatric nursing the figure is nearly 50 per cent. These are girls who start their training and who fail to complete it for one reason or another.

Why has this situation arisen? It has arisen, I think, largely because the nursing service is failing to compete today, especially in terms of pay and working conditions, with other comparable occupations open to young women and, indeed, to young men. Nursing, as the House well knows, is a hard, responsible and skilled job. The hours are still long. There is night duty and weekend duty without any extra pay. A qualified staff nurse, after three years' training, and aged at least 21, starts at about £10 per week. No doubt other of my hon. Friends will be able to give further examples of salary levels in the nursing service. It is largely for these reasons that the nurses' representatives decided to put forward a claim which embodied a complete overhaul of the salary structure. The claim was for an increase generally of about 10 per cent., but in some cases, particularly where there was a dangerously acute shortage, an increase rising to about 30 per cent.

I want to deal in some detail with the history of this claim. The claim was submitted on 11th August last. The day before, on 10th August, a letter had been sent on behalf of the Minister to all chairmen of Whitley Councils. That was following the Chancellor's statement about the pay pause in this House. The letter to the chairmen included the following sentence:
"Claims will be considered on their merits, but during the period of the pause any offer of increased pay which it may be thought reasonable to make will generally be for future implementation when circumstances permit."
The letter went on to say that the actual timing of awards, if made through arbitration, would be withdrawn from the scope of arbitration.

In November, the staff side was told by the management side of the nurses and midwives Whitley Council that it was not ready. So another meeting was called for December, but again it was not ready. In January it was not ready. On 13th February, six months after the original submission of the claim, the first response from the management side was forthcoming. A meeting was held and a prepared statement was read by the secretary to the management side. This is what he told the Council:
"We have received advice of the Ministers concerned and have considered the Staff Side claim. We have taken cognizance of the statement made by the Chancellor of the Exchequer in the House of Commons in December, 1961. You are aware of the letter sent to the Management Side Chairman on 6th February. 1962, and of the White Paper on Personal Incomes. The Management Side have considered the claim in the context and are prepared to offer 2½ per cent. increase as from 1st April, 1962."
When it was asked why the claim had not been considered on its merits, in accordance with the previous instructions from the Minister, the management side had to reply that circumstances had changed. They went on to say that
"current consideration had been given to the claim in the light of the White Paper".
But that is a White Paper published on 2nd February, and the claim had been submitted six months earlier and deliberately stalled by the Ministry representatives on the Whitley Council.

In a Question I asked the right hon. Gentleman what was the advice which he had given to the management side, and he replied that he had asked them to have regard to the White Paper, to which he had drawn their attention at the beginning of February. Would the Minister like to tell the House what happened on 9th January, three weeks before the White Paper was published? Did he not then do something rather extraordinary—something which, I believe, no other Minister of Health had ever done before him? Did he not go in person to a meeting of the management side of the Nurses and Midwives Whitley Council and tell them on 9th January that the nurses must not be offered more than 2½ per cent.?

Action like this finally destroys the myth of the Whitley Council as an independent negotiating body. The only thing that surprises me is that the management did not resign en bloc. To add insult to injury, the right hon. Gentleman said in the House that his advice—perhaps he would have done better to use the word "instructions"—did not preclude the consideration of the claim on its merits.

The nurses were offered 2½ per cent. from 1st April. The almoners were offered 2½ per cent., the psychiatric social workers were offered 2½ per cent., the physiotherapists were offered 2½ per cent. and the biochemists and physicists, who had asked that their salaries should be equated to those of their opposite numbers in the Government scientific service, have been offered 2½ per cent. Must we take it that the merits of all these claims happen to be identical? This is humbug.

Today, nurses are furious and utterly disgusted with the treatment which they have had at the Minister's hands. Through their representatives they rejected this offer unanimously and with contempt. They resubmitted the claim, only to be met with a blank refusal on the part of the management side to discuss the matter further. That is where the matter rests for the present.

I wish to register, on behalf of my right hon. and hon. Friends, the strongest protest at the Minister's breach of faith and double dealing with a section of the community which cannot hit back without injuring the patients in their care. Is it surprising, after all this, that demands are being made for an independent inquiry into the Health Service Whitley system? Is it surprising that the Minister had a letter only last week from the chairman of the staff side of the National Whitley Council protesting at his frustration of the whole working of the Council, and at what the writer of the letter called the scandalous inefficiency of the Minister's Department?

This letter appeared in the Press, and I want to quote one sentence from it:
"For both sides of the council Health Service Whitleyism has become a complete farce and I cannot express too strongly the anger and resentment felt by the staff side and by the professional staffs its represents."
The letter was in harsh terms, but I suggest that very word was justified by experience.

Something odd has been happening to the right hon. Gentleman lately. It seems that he has been at some pains to change his public image. Perhaps the Conservative Central Office and the public relations "boys" have had something to do with what may well have been a policy decision. One can see them reflecting on the right hon. Gentleman, pondering his Treasury past, his resignation from the Government over their refusal to cut expenditure by £50 million, his savage cuts as Minister of Health a year ago, and perhaps his general air of colourless austerity.

One can see them asking themselves whether this is not rather bad for the Tory image in general and perhaps particularly bad for the right hon. Gentleman if, as may be the case, he is being groomed for promotion. They probably decided that something had to be done, that somehow it must be shown that underneath this arid exterior a human heart was beating after all. No other satisfactory explanation has occurred to me for the somewhat uncharacteristic cavortings of the Minister in public recently. Why else should he happen to have been bouncing round Eaton Square on a pogo stick just as the Daily Express cameraman was passing by? Why should he choose this time to appear in a Channel 9 "Face to Face" programme, or what I suppose we could call "Mug to Mug with Muggeridge"?

Why, above all, as a Minister of Cabinet rank, did he decide to take part, somewhat disastrously I might add, in a television guessing panel shortly after that, especially when what the panel was trying to guess was the result of the Orpington by-election half-an-hour before it was announced? I can assure the right hon. Gentleman and the Conservative Central Office that it will take a good deal more than this to erase the right hon. Gentleman's Ministerial past.

In a speech which he made last week to a gathering of manufacturers, the Minister asked his audience whether they thought that he had found it easy to limit nurses to a 2½ per cent. increase, or to refuse an independent inquiry into the salaries of physiotherapists. The answer to what was clearly intended as a rhetorical question is that the right Gentleman probably did not find it so very difficult. If he wants to alter his brand image, let him, for a change, begin fighting within the Government for, and not against, the devoted men and women who are carrying the burden of the Health Service and who have to look to him for support.

At present these people are bitterly aware that, because of the relative weakness of their bargaining position, and their reluctance to lake strike action, they have been singled out as the guinea pigs of the pay pause. They are angry, resentful and utterly sick of the Government and their policies.

7.7 p.m.

It is a very good thing that the House should have an opportunity to consider in a broad context recruitment to the National Health Service, because, as the hon. Member for St. Pancras, North (Mr. K. Robinson) said, there has been a good deal of misrepresentation about the trends of recruitment in the Health Service, and the per- petuation of this misrepresentation cannot do other than harm the future of the Service. I want, therefore, to take this opportunity to put the facts of recruitment to the Health Service clearly before the House of Commons and the public.

There are broadly three groups of professions involved, which I will deal with in the same order as did the hon. Gentleman—the doctors, the professions supplementary to medicine and the nurses and midwives. In each of these three great fields the experience of the Health Service right up to the present time has been of a steady improvement in staffing and a continuous increase in the staff at work in the Health Service. I shall proceed to demonstrate this by taking each of those three groups in succession.

First, I will take the doctors. Roughly speaking, one may think of approximately half the doctors in the Health Service as being in general practice and half in service in the hospitals. In fact, it is slightly more than half in general practice and slightly less than half in the hospitals. The hospital doctors, in turn, fall roughly half-and-half between the senior and the junior grades. In all those three groups within the profession, there has been a steady increase year by year right up to the present time. For example, in general practice there has been an annual increase over the last seven years, averaging just under 200 per annum. Every year there has been an increase, and particularly in principals, i.e. in the number of doctors giving unrestricted service in the General Medical Service.

In the hospitals there has equally been a steady manning up both of the senior and of the junior grades. There was, of course, a good deal of reclassification in the early years of the Service, but that has nothing to do with the continued increase in the number of consultants and senior hospital medical officers year by year up to the present time, averaging over the last four years about 100 additional senior doctors in the hospital service every year. The increase has been equally steady in the junior ranks, running between 200 and 300 on average per annum over the last four or five years. Here, as in every branch of the medical service in the National Health Service, is a steady manning up of the service. This is a picture which is absolutely inconsistent with that which some—not the hon. Gentleman, but some—have sought to paint of a Service—particularly of general practice—which, because it offered little to attract and to satisfy the doctors, they were leaving in large numbers. This is a Service in which the doctors are serving in increasing numbers, and in every part of it.

There has been one argument to the contrary still advanced. It is said that this manning up of the Service, at any rate in the hospitals, is largely or entirely due to an increase in the number of overseas doctors who are serving in our hospitals. I think I should say, in using this phrase "overseas doctors", it includes several hundred doctors who studied and qualified in this country. It means quite literally doctors, wherever qualified, who were born outside the British Isles. But this increase—and an increase there has been—is far from accounting for the total strengthening of the medical staff of the hospitals.

If we take, for instance, the last 10 years, we find that in the hospital service there has been an increase of no fewer than 4,000 doctors, while at the end of the 10-year period, running from 1950 to 1960, there were approximately 3,000 overseas doctors in all in the junior ranks—and they nearly all are in the junior ranks—in the hospital service. In other words, the increase in the total medical staff of the hospitals was much greater than not only the increase in the number of overseas doctors but the total number of overseas doctors. Therefore, even on the ludicrously extreme assumption—which, of course, is not true—that there had been no overseas doctors at all at the beginning of the 10 years, there would still have been a substantial and steady increase in the number of British doctors in the hospital service.

These are figures which completely refute the notion that service in the National Health Service is somehow not attractive to the graduates of our British medical schools. It is attractive to them, and they are coming into it. Their numbers in every branch of this Service are increasing, and it is right that these facts should be placed upon the record and should be widely known.

What of the immediate future? We know that the number of medical students who graduated last autumn and who correspond, broadly speaking, to the 1956 entry. The following few years will be years of graduation which correspond to the entry in the year of the Willink Report and the years immediately following it. It is important to note that in the estimates made by the deans of the medical schools they expect to see over the next three years at least an increase in the number of students graduating. Here I am talking about British graduates of British birth, not students from overseas who may serve a year or two and then go home. They expect an increase year by year over at least three years in the number of British medical students who are graduating. Therefore, even without the addition to the intake of the medical schools which, as the hon. Gentleman mentioned, is in contemplation, we can look forward to the movement which I have described being sustained by an increasing number of British graduates leaving our medical schools. The House will, I know, appreciate that the number of graduates in any one year or in any brief series of years is only a small factor and one of many factors which determine the size of the profession at work in the National Health Service.

I pass from this favourable and expanding position in the medical service inside and outside the hospitals to consider the professions supplementary to medicine. For many of these professions virtually a new field of work has come into existence since the Health Service. I quite agree with the hon. Gentleman that the comparison with the year 1948 is practically meaningless since the possibilities and scope of so many of these professions have been part of the development of medicine during these past twelve to fourteen years. So rapidly has the appreciation of the scope for these disciplines expanded that it would have been impracticable, consistently with the maintenance of the necessary quality and training, for the numbers to expand at that rate and in that proportion; but the important fact is that, with one exception which I will come to instantly, in each of these professions there has been a steady annual growth. Naturally, we should have liked to have seen a faster growth, but it is the trend which matters, and the trend throughout all but one of these professions—I shall mention the exception in a moment—has been a steady upward trend continuing right into the present time.

The exception which I have in mind is the position in the profession of physiotherapy. It is individually the largest of these professions supplementary to medicine. There the figures of the staff in post, after rising quite sharply in the early years of the Service, have remained more or less stationary for some six or seven years past.

There is, however, another feature of the situation which is very important, and that is that in the last three or four years the number of students has shown a very marked increase, so that it is running on average around 300 higher than it was three or four years ago. The effect of this quite marked increase in the numbers of students of physiotherapy in our hospitals could not yet for chronological reasons, be reflected even in the latest staffing figures, but it provides a basis for the firm expectation that we shall very shortly see physiotherapy joining the other professions supplementary to medicine in this common upward trend.

Does the right hon. Gentleman expect to get recruits among physiotherapists unless he increases the appalling rate of pay which they now receive?

Well, the fact is that there is an increase in the numbers who are coming forward as students, and indeed we could train more—and this was the point I was coming to—

They will stop for a number of years and do service there, otherwise they would not be coming forward in these increasing numbers. Indeed, we could train more if we had more teaching staff, and this in fact is the limiting factor at the present time in the expansion of our physiotherapy service. The figures I have mentioned of the increased numbers of students are themselves evidence of expansion of training facili- ties, and I think the House knows that there have been emergency measures and shortened courses instituted for the training of additional teachers; but I must say that I feel the situation would be further helped if, on reconsideration, the Chartered Society came to the conclusion that it would be possible to train at any rate physiotherapists as teachers in a shorter than the normal two-year course.

As long as we are limited in numbers in the professions supplementary to medicine, and above all in physiotherapy, we must be absolutely sure that we do not waste their services.

My right hon. Friend referred to the Chartered Society. I have to declare an interest, because I sit on the Council of the Chartered Society. Has it ever occurred to my right hon. Friend that when he asks something from the Chartered Society it would be a good thing to give something which the Chartered Society wants? There should be reciprocity, not a dogmatic assertion that what is wanted in the Health Service by the Minister is so-and-so. It should be a co-operative effort. If he would give, perhaps they would give.

The suggestion I was making was not for my benefit. It was for the benefit of the profession and the service. I am sure that knowing and seeing it to be so the Society wild give it its best consideration.

I come back to the question of the effective use of these trained people in the Health Service. There is evidence that we could be more effectively using them, and that there could be reduction in waste or under-use of physiotherapy services in the hospital service. I am today sending to hospital authorities advice, based upon a report of my Standing Medical Advisory Committee, for a much more careful conservation of our physiotherapy services. In particular, there should be a regular review of patients who are under physiotherapy treatment so that we may be absolutely sure that we are not wasting a speciality which is in such demand.

I come now to the third group of professional staff in the Health Service, namely, the nurses. Here again, there is precisely the same picture of a steady increase in staff which has continued right up to the present time, so that the numbers of nurses are today at the highest level at which they have ever stood.

Is the Minister also prepared to say that the number of qualified nurses in the service is at the highest level it has ever been?

Yes, it is. I will not trouble the House with the almost infinite variety of figures which one can take to illustrate this. I will take merely two series. Over the last five years there has been an increase of 10 per cent. in whole-time and of 70 per cent. in part-time nurses in general hospitals. Over the same period there has been an increase of 10 per cent. in full-time and of 33 per cent. in part-time midwives.

The House will note that this increase is most marked in the case of part-time staff. This is a very important and, indeed, a very welcome feature, because we shall, as the years go on—this is a part of a very general social change—find that we need to bring into the Health Service—perhaps this applies not only to the Health Service—a great many who have served in it in early life, have left and are able to return.

I am glad to say that the hospital service is learning ever better so to arrange its work that there is an increasing scope for the part-time nurse and, I add, for the part-time midwife. That is why it is so misleading when the expression "wastage" is used in relation to trained nurses Who leave the hospitals—for example, upon getting married. It would be much truer to see these trained people as a reservoir and as a reserve from which we shall be able to draw increasingily in future years. After all, the student nurse and the pupil nurse, while they are receiving their training, are also serving and working in our hospitals. I do not begrudge it for an instant that many of them, after their training or after a comparatively brief period of service, should pass out of the hospitals.

Would not the Minister agree that wastage during training, which was the only wastage to which I referred, is a very serious and disturbing matter?

Yes. I was not criticising the hon. Gentleman's use of the word "wastage" in that context, but people often speak as though the departure from the service of trained nurses was somehow a permanent dead loss. We must learn to recognise that it can be very much the reverse.

Is the Minister satisfied that the total number of nurses is fairly and equitably distributed throughout the country? Some areas have a sufficient number of nurses, but other areas are steadily depleted.

I am dealing with the total national position, as I did with the other categories. I am showing—this is my theme—an increase which is bound to redound to the benefit of all parts of the country. I am saying that there is a continued upward trend here and in the other professional services in the National Health Service.

Are the Minister's figures in relation to the establishment in each hospital? Hospitals have had to supply an establishment—the number of nurses they want. I agree that there has been an increase in the number of nurses, but is it in relation to the full national establishment, if the Minister says that we are not short of nurses?

I have not said that we are not short of nurses. I am inviting the House to take note that the nursing service is constantly expanding and increasing. This is virtually common to all parts of the nursing service.

I want to mention two minor exceptions. In the last year or two there has been a slight drop in the number of student nurses from the peak of 1958 and 1959. There are a number of causes at work here, one of which—this has relevance to wastage in the sense in which the hon. Member for St. Pancras, North referred to it—is the undoubted fact that in many hospitals higher educational standards have now been voluntarily adopted, which will bring their advantage probably in a lower rate of true wastage during the student years.

Another point is that the number of pupil nurses has continued to increase very rapidly, and I am sure that the relative importance of the roll is destined, and rightly destined, to increase in the nursing staff of the hospitals.

Finally I am glad to say that the latest figures from the schools of nursing indicate that there has been just recently a resumption of the previous upward trend, but I remind the House that the figure which we are about 2 per cent. below—namely the 1958–59 figure—was itself a very high peak and the highest number of students who had ever been under training.

There is one other branch, and it is the only other branch, in which we are otherwise than absolutely at the top at the moment. In the staffing of psychiatric hospitals we are also a little below the peak figures reached in 1959. I want to come back to that point later, but meanwhile I should like to sum up the whole picture of staffing and recruitment in the Service as I have put it to the House. The picture is that in every one of the branches of the Service—in medical staffs, in professions supplementary to medicine, and in nursing—there has been a steady expansion which has been going on up to the present day. These are facts which entirely refute any suggestion—it is a suggestion which can only harm the service—that service in the National Health Service is unattractive to the young men and women who are equipped for it.

I believe that the publication at the beginning of this year of the hospital plan will itself be a great asset to further recruitment in the service. It can do nothing but good. It can exercise nothing but a strong attraction if the public and all who are thinking about service in hospitals can see before them the prospect of the development over the next ten or fifteen years of a service where the buildings and the pattern will be fundamentally modernised.

Here I would like to say a few words particularly about the prospects that modernisation and the new pattern open up for psychiatric nursing. I think that there has been an impression, and I would like to do all I can to correct it, that the prospective reduction in the number of beds for mental illness carries with it the implication that there will be less need for trained mental nurses. I believe that it carries with it the quite opposite implication—that there will be a need for them in a calling which will be much more attractive and rewarding than that which previous generations in our mental hospitals have ever enjoyed. Therefore I believe that, when this is seen, the brief halt in the recruitment for psychiatric nursing will quickly be overcome and we shall go forward there as on other fronts.

Among the factors which influence and which are at the root of this steady and continuing expansion, pay is one, but it is only one, and in many cases it may not in itself be the most influential or important. But this brings me to speak of pay, particularly in the nursing service and of the current controversy.

The right hon. Gentleman is leaving that section of his speech in which he has been discussing the staff situation in the various sectors of the Service. May I draw his attention to the fact that he has spoken for over twenty minutes and has not made a single reference to there being any shortage anywhere in the Service, or to there being any difficulties anywhere in it? Does the right hon. Gentleman intend to leave that passage of his speech and to leave everybody, outside and in the Service, who know it to be untrue, to believe that he thinks that there is no desperate shortage anywhere in the Service?

I hope that I have given the House the impression that I want and expect the trend which I have proved to exist to continue, but what I am not going to do is to attempt to quantify for years ahead the number of staff who, under rapidly changing and developing conditions and medical methods, will be needed in the different branches.

The overwhelmingly important fact is that in every sector we see expansion. In every direction we are pushing ahead, and there is certainly no direction in which I am saying to the hospital authorities that they have reached the limit of their endeavour and that the requirements are fully met. But the important thing is the trend. The important thing is the spirit. The important thing is the direction in which we are moving.

I was about to refer to what was the major subject of the speech of the hon. Member for St. Pancras, North, the current pay negotiations and the Government's incomes policy. It is from the incomes policy of the Government, stemming from the Chancellor's announcement in July last, that this must set out. For this is not a partial policy. The incomes policy is not a policy for one section of the community. It is a policy for the nation as a whole, and it is a policy which could not be carried through and could not succeed if the Government, where the Government themselves have the responsibility, authority or influence, did not act and were not seen to be acting in accordance with their own policy.

Therefore, when I exercised what is my duty of advising the management side of the Nurses' and Midwives' Whitley Council, I drew their attention, as in duty bound, to the incomes policy set out by the Government. The nurses and all the other sections in the National Health Service are not being called upon to take part in a policy which does not apply to the nation at large. They are only being asked to accept the same common sense of the incomes policy as the whole of the nation is being asked to accept. [HON. MEMBERS: "Surtax payers."] They are not in any sense being singled out.

The day after tomorrow I am to see a deputation from the professions concerned. I very much welcome this, for it will give me the opportunity of setting the issue of nurses' pay where it belongs—in the nationwide context of incomes policy. I do not, therefore, in advance of that meeting, want to argue the details, but it is only right that I should point out to the House and should place on record the fact that the salaries and the grading structure of the nursing profession were thoroughly reviewed three years ago, with increases in pay ranging up to 25 per cent., and that there was an increase of 5 per cent. only just over a year ago.

There is one other very germane consideration, and that is that no one has more to gain from the success of this national incomes policy than the professions themselves, for in the race against inflation it is always the profess- sions who will be left behind. They therefore have the greatest interest in the success of a policy which will prevent it.

Almost the whole of my speech has been occupied with figures. I make no apology for that, because the figures which I have put on the record decisively disprove some misconceptions which were contrary to the interests of the Health Service. But I do not want to end upon the note of statistics, for, whatever the shortages of today, it would be wrong and narrow-minded to envisage the future of the Service and its future improvement exclusively or even mainly in terms of a continual increase in mere numbers. The staff, their quality, and particularly the effectiveness with which the Service uses them, is by far the greatest source to which we have to look for the improvement of the Service.

The professions, and above all the nurses, have in recent months made the most striking response to the movement—indeed they have been the leaders of the movement—towards improving all the human aspects of the Health Service. I believe that they will continue to be in the van of that movement, but we must see that in the Health Service, whatever numbers we are able to recruit and however this expanding trend continues, we make more and more effective use of those who give their skill and devotion to the Service.

This will come about by improvement in organisation. It will come about by relieving nurses and trained staff of tasks which those less trained or untrained can perform. It will come about by setting the staff in the context of all the technical improvements which the advance of medical science is bringing about, and by giving them a modern hospital service, modern in buildings and modern in pattern in which to serve. It is by these means, much more than by the continuation, important though that may be, of the rising trend of recruitment, that they will be able to perform an ever greater service to their patients.

7.40 p.m.

I understand, Mr. Deputy-Speaker, that there are two conventions which are generally followed by hon. Members in making their maiden speeches. The first of these is that they should make some general references to their constituency. In view of the fact that a great many things have been written in the national Press about my constituency which hon. Members may have had an opportunity of reading, I think that I need not deal with that subject. Indeed, several hon. Members have paid visits to my constituency within the last few weeks. Some of them came away with some curious ideas.

The right hon. Gentleman the Leader of the House, from his researches, concludes that there are—and I think that I have the figure correct—22,846 people out of an adult population of 55,000 who do not possess features. I happen to be an example of them, but I have, as you can see, Mr. Deputy-Speaker, a perfectly good nose and ears and I have, not only in the literal sense but also in the metaphorical sense, teeth—as the right hon. Gentleman may discover.

The second convention which is generally followed by maiden speakers is that they should say nothing controversial. But we are speaking about nurses' pay, which is a subject on which I feel very strongly—as, indeed, do many of my constituents—and, therefore, if it is necessary to transgress this rule slightly I am sure that hon. Members will understand.

There is another factor, which is that I have already been attacked from the Treasury Bench before I had an opportunity of speaking and when I did not have an opportunity to reply. But this is a thing which I welcome. I hope that it will happen on many future occasions, because it proves conclusively to me that I have been saying the right things.

In speaking about nurses' pay, I would like to refer to a reply given on 12th March by the Parliamentary Secretary to the Ministry of Health to the hon. Member for Stoke-on-Trent, Central (Dr. Stross). The hon. Lady told him that it was mistaken to compare the salaries and conditions of nurses with those of ancillaries. It may be mistaken, but that is what I intend to begin by doing today.

A male ward orderly in the London area receives £10 0s. 8d. basic pay for a 42-hour week, which was the figure the hon. Lady gave. He also gets 100 per cent. extra for Sundays; 25 per cent. extra for nights; 50 per cent. extra for Saturday afternoons; 100 per cent. extra for Bank Holidays, and, of course, if he works on a Bank Holiday, he has another day off in lieu as well. He also gets overtime for all hours over 42.

A State enrolled nurse at the top of the scale receives £11 13s. 3d. for a basic week which is two hours longer, and does not receive one penny extra, no matter if he or she works round the clock.

Two pay slips have been shown to me by a constituent, and they have been sent to the Parliamentary Secretary. I hope that she will have seen them by now. They were sent to her by a nurse in Orpington Hospital. One of them was the pay slip of the nurse. He received the maximum figure of £11 13s. 3d.—and he is a man with twenty-five years' service in the profession. Also sent to the hon. Lady was the pay slip of a ward orderly who had been in the hospital five weeks, who worked for two hours less and who received £13.

The hon. Lady also said that we should not compare these two because the nurses receive better conditions of service—among other things, better holidays. I can prove that that statement is false, because they work a greater number of hours in the course of the year than do the ancillaries. The nurse, indeed, has five weeks holiday. But if my arithmetic is correct, he or she is working 47 weeks at 44 hours a week. Multiply these, and the total is 2,068 hours. The ward orderly works 50 weeks of 42 hours, but he gets five Bank Holidays, each of eight hours, so that his total comes to 2,060 hours. In fact, there is hardly any difference, in spite of the fact that, on the face of it, nurses get longer holidays.

In one respect, indeed, there should be no comparison between trained nurses and ward orderlies. The ward orderly has no responsibility whatever, whereas the trained nurse has the greatest responsibility which any person can possibly undertake—that of protecting human life.

The consequences of this situation are much more grave than the Minister would lead us to suppose. I must talk about my own constituency in this because, obviously, I know more about it than I do about other parts of the country. But I think that the situation which we have in Orpington is a microcosm of the whole country, and many of the aspects of our situation are repeated in other places, as the hon. Member for Abertillery (Mr. L1. Williams) has already said.

We have trained nurses who are leaving the service in Orpington and are going to industry—to Morphy Richards, or to Tip Top Bakeries, or whatever we have in Orpington—and there are nearly as many trained nurses in Orpington's factories as there are in Orpington Hospital. This is because we have presumed on the spirit and devotion of the nurses for far too long. But if we want to look at this not from the point of view of equity, but from the point of view of how public money is spent, then the present policy is entirely wrong because public money is being spent on training these people. They take several years to acquire their skills and then leave to work at a factory bench.

The hon. Member for St. Pancras, North (Mr. K. Robinson) said that 30 per cent. of those who enrol in the nursing profession fail to complete the course, but the Guardian of 12th October last gave the figure of 40 per cent., and in the same article said that 50 per cent. of the nurses who had completed their training had left for other work.

The students are already doing a shorter week, and they spend less time in the wards nowadays than they used to because there are more lectures in the course. Therefore, it becomes all the more important that those who enrol remain in the profession, because the ward sisters have less time to give attention to the students in the wards, because there is a more rapid turnover of patients, and because there is a shortage of ward sisters. It is extremely important for those who enrol in the profession to complete the course and stay with it.

What inducements are there? I have already quoted the figure of the maximum which a State enrolled nurse can attain. Also of interest is that a staff nurse's maximum is £656 and a ward sister's £840. This maximum of a State enrolled nurse of £578 per annum is after two years' training and six years of qualified service.

When one considers that this is £1 a week less, roughly, than a shorthand typist gets right at the beginning of her professional career, one can see how ridiculous these salary scales are. The Minister has been unwarrantably complacent about the staffing situation in hospitals. He sees the situation as being adequately covered in the nation as a whole. I can tell him that, in Orpington Hospital, there are 58 vacancies in its establishment of 168 trained people. In the country as a whole, there are 25,000 such vacancies.

This is borne out by looking through the pages of journals such as the Nursing Mirror. I was looking through its issue for 23rd March, and I counted 56 pages of situations vacant. Someone asked the Parliamentary Secretary the other day how much money was being spent on advertising vacancies in the National Health Service. I therefore did a little sum and I found that the Nursing Mirror was receiving £150,000 a year in advertising revenue for nursing situations vacant—and this is not the only journal in which these vacancies are advertised.

I have spoken of shortages of staff and the danger particularly as it refers to Orpington Hospital, which has three night sisters on duty for 23 wards, in which there are between 500 and 530 patients. As a result of this situation, first-year students are in charge of the wards after only nine months' training and in other cases, nursing auxiliaries are in charge of the wards.

That is not a situation about which the hospital authorities can do anything. They would like to be able to get the extra trained staff to which their establishment entitles them, but there are 74 part-time and 30 full-time auxiliaries working in the hospital and it would be impossible to function without them. They are not trained, however, to recognise an acute condition when it occurs. Moreover, even if they recognise it, they have to summon help in a crisis, because, obviously, they are not themselves allowed to give treatment. This constitutes a danger to human life.

The danger is increased by the expansion of the geriatric side of the general hospitals. To ease overcrowding in the mental hospitals—this is an arrangement which dates back some years—a great many senile dementia cases were diverted to the general hospitals which took geriatrics and were rechristened cerebral arteriosclerosis cases. In Orpington Hospital, there are 350 geriatric patients in a total of 510, many of whom are totally incapable and require constant skilled attention. It may well be imagined that in these circumstances superhuman efforts are necessary to cope with any emergency.

During the summer, accident cases are brought in nearly every weekend and this happens frequently even in the winter and spring. Nurses have to be recalled to duty in their time off and from their beds. I should like to quote an instance of this which happened on Sunday, 11th March. A particularly serious motor accident occurred at Badger's Mount and the casualties were brought into Orpington Hospital. The theatre sister had already done two spells of duty that Sunday, from 7.45 a.m. to 1.15 p.m. and from 4.30 to 8.15 p.m. She was summoned back to the hospital, where she attended from 10 p.m. until 7 a.m. next day, having assisted at two major operations.

That is not the end of the story. Monday is a busy day in Orpington Hospital and it was not possible to allow that sister to go home. She then had to do another spell of duty from 9 a.m. until 1.15 p.m., at the end of which time she had been on duty on and off for 22½ hours without sleep. How many professions or occupations are there in which people would not only stand for this kind of treatment, but would do so without asking for a penny extra?

The 2½ per cent. which has been offered to those in nursing is an outrageous insult and is presuming on the noble ideals of service of the profession. The Minister knows of the reluctance of these people to take positive action by striking in defence of their legitimate rights. Perhaps he thinks, like the Minister of Aviation, that striking terror into the hearts of a potential enemy is a mission which should be fulfilled at the expense of those sections of the community who are least able to protest.

7.54 p.m.

It is a great pleasure and privilege to be able to congratulate one of one's neighbours on making his maiden speech. Not only do I have the good fortune to have the hon. Member for Orpington (Mr. Lubbock) as my fairly near neighbour, but we have all enjoyed the fund of information on this subject which he has brought to the House and the charm and humour with which he introduced his speech. I therefore congratulate him most warmly.

The hon. Member for St. Pancras, North (Mr. K. Robinson) said towards the end of his speech that it was a pity that my right hon. Friend the Minister was not fighting for, but fighting against, the excellent people who work in the Health Service. The hon. Member was completely wrong, because to my mind my right hon. Friend, with his hospital building and modernisation programmes, is fighting many battles on behalf of the people who will work in the Health Service. We welcome all that he does for them.

On the matter of salaries and the salary structure, however, I hope that we may have some rethinking. The national income policy which allows an average of 2½ per cent. to workers of one sort and another should, in my view, be breached in respect of nurses and other workers in the professions supplementary to medicine, for the reason that it is essential to improve the social status of the people in these professions. They are, as has been said, a devoted band who do great service to the nation.

The fact is, however, that certain sections of the community must get greater status and others lose status if a society is to be flexible. We do not wish to see society stay exactly put. We want a flexible society. I suggest to my right hon. Friend that at some future date, which, I hope, will not be too far off, there should be scope for giving a greater share of the national income to the nursing, midwifery and other professions supplementary to medicine.

Last year, I had the privilege of visiting Finland on an Inter-Parliamentary Union delegation and I asked about the conditions of the nursing services. It was clear that nurses were contented, plentiful and enjoying their work. I made specific inquiries about the rates of pay and was told that they were by no means excessive. The rates of pay of nurses in that country were quite moderate. The fact remained, however, that throughout society in Finland, nursing was regarded as an excellent job from the community's point of view. In that country, nurses are held in high esteem.

There is no disputing that in this country of ours, nurses are held in high regard, but I should like to see the day when they are held in higher regard still, not only for the goodness of heart, their good looks and all the other many virtues that one associates with the nursing profession, but because they should have plenty of money in their pockets to spend. They should be a highly-educated section of the community, spending their money wisely and well. For this reason, I should like to see them enjoying a better standard of living than they do today.

All of us who have visited hospitals and nurses' homes must have noticed the great efforts that management committees have made in recent years to make nurses' homes more attractive. My right hon. Friend is partly responsible for this. The fact remains, however, that for a young woman, living in a nurses' home is not like living in her own home. There should be compensation in pay for the absence from her own home. I therefore ask that something specifically should be done for nurses.

The hon. Member for Orpington drew attention to the relative difference in pay between a ward orderly and a fully-qualified nurse. The fact remains that a male ward orderly is drawing only 6s. 6d. a week less, before overtime, than a fully qualified nurse. The fact also remains that my right hon. Friend, in an Answer to me yesterday, disclosed that he had no knowledge of the net earnings in the nursing, ward orderly and similar sections of this profession. Therefore, if he has no knowledge of the net earnings, the fact clearly emerges by implication that, as the hon. Member for Orpington said, ward orderlies are in many cases earning considerably more than nurses. I have no objection to ward orderlies earning high money. I think that we all appreciate the terrific amount of work they do. They earn big money through overtime, working at weekends and—

Is the bon. Gentleman, in his enthusiasm, describing £10 per week as big money?

I do not think that the hon. Gentleman could have been listening to what I said. I said, together with overtime and the other money they pick up. We do not know what the net earnings are, and that was part of my complaint, was it not? Indeed, they are higher than those of nurses, and that is the burden of my complaint.

It has been represented from time to time that my right hon. Friend is too conditioned in his thinking by the activities of the great London hospitals.

Before the hon. Gentleman leaves the point about comparative earnings, can he say precisely what he wants to see being done? He made the comparison between orderlies and nurses, but he did not say whether he wanted to see nurses get a substantial increase in wages. Will he deal with that point?

I feel that the hon. Member must have been "miles away" when I said, at least twice, that I hope that the nursing profession will have a substantial increase. I have also said that I hope that they will have a substantial increase relative to other sections of the community. Surely it is that which is important.

If I may be allowed to go on to the conditioning of the mind of my right hon. Friend, it has been brought to my notice by various opinions that he thinks too much of what goes on in the great London hospitals. To find out precisely the degree of knowledge that he and my hon. Friend the Parliamentary Secretary have of provincial hospitals, I asked them yesterday how many visits they have paid recently. I was extremely impressed, as I am sure all hon. Members who read the OFFICIAL REPORT yesterday will have been impressed, by the assiduous attendance of both my right hon. Friend and the Parliamentary Secretary in visiting provincial hospitals. We therefore see and understand that they have visited these hospitals.

Where, I should like to ask, when they have been visiting provincial hospitals, have they seen this great increase in nurses? That is the problem to me. My right hon. Friend says that there are these big increases in nursing staff, and I believe his figure. I am sure that it is a national statistic, and that it is true, but in my own constituency, which, after all, is the only place from which I can draw conclusions, just as the hon. Member for Orpington drew conclusions from his constituency, I say that the major hospitals are facing considerable staff shortages.

In the West Kent General Hospital, Which is the principal general hospital in my constituency, we are at present enjoying a very substantial rebuilding programme, which we all welcome. As a result of this rebuilding programme, 85 beds are vacant, but, at the same time, 13 beds are vacant now because of lack of staff.

Again, next door to the general hospital, there is a much smaller, highly-specialised ophthalmic hospital—the leading E.N.T. hospital for our part of south-eastern England—Greater London, Kent and other areas in our part of the country. This hospital is permanently working on about 60 per cent. occupancy because of shortage of staff. The right hon. Gentleman has given his figures, saying that there are plenty of staff in the nation as a whole, but they do not appear to be readily available in my constituency. The shortage of as few as seven members of the staff can cause a very big upset on the availability of the programme and the work of a small specialist hospital.

Again, in a large geriatric hospital, the Linton Hospital, in my constituency, Which, I am sorry to say, is an old-fashioned hospital, but one on which considerable sums of money are being spent, we have quite a different picture of staff shortages. This brings me straight back to the point about ward orderlies. The establishment of ward orderlies in this hospital is 17½. I never quite know where to find these half-persons, but that is the proper establishment in that hospital. Last month, the figure for ward orderlies there was 42. There are far more ward orderlies than the establishment allows. Why? It is because they are doing the work of other people, and it is this fact which is extremely worrying.

Also in my constituency there is a large mental hospital. Here, there is a somewhat different pattern. A far greater emphasis is placed on the requirements of male nurses. The male nurses are a most devoted body of men, but to a man with a wife and family and all the rest of it to support, the salaries they receive are totally inadequate.

The fact that we have been able to maintain so large a staff as we have in Oakwood Hospital is a great tribute to the ability of the senior staff there to keep their junior staff. It is on this point that I would ask the Minister to bear in mind, when there is a review of salaries, that the senior staff, the people carrying the weight of responsibility, should have some "weight of responsibility allowance" in their salaries.

A young nurse who has finished her training is looking to nursing as a career, and not just as a "dead-end" job. Those setting out on a career must surely look for substantial rewards later. They may fully realise that in the early years they are still, as it were, undergoing training, although they may just have qualified. They are still learning and adding to their own volume of experience, but they want to see that there are substantial rewards available to them if they stay in or go back to the service.

My right hon. Friend has quite rightly dealt with the valuable work of part-time service in mental hospitals such as Oakwood. Female staff part-time service is invaluable. If we cannot offer these ladies real rewards if they stay in the service, if we cannot offer incentives to them to stay on for the higher posts, I think that the wastage will be much more real than it has been in the past. With male nurses, this matter of money seems of importance, but with female staff, the ability of the seniors, the quality of the building, and so on, may have a considerable bearing on the retention of the staff in the hospital. No matter how good the matron is, or how good the senior staff, unless there are good buildings and a lively hospital atmosphere we shall invariably get wastage.

Young nurses do not like the small specialist hospital. They prefer the hubbub of a general and larger hospital. Would it not be possible for my right hon. Friend to see whether a method of exchange could be arranged to enable nurses for a period to go to the smaller specialist hospitals before returning to their main hospitals? This is a matter of some importance if the smaller hospitals are to continue to be staffed as we would like.

Reference has been made to overseas personnel, and especially to doctors. In my own constituency applications have been received for nursing appointments from overseas personnel, but the hospital authorities now always insist on the prospective nurses applying in their own handwriting, because there seems to be a total lack of screening of prospective nurses in their own country. It might not be beyond the bounds of possibility for the United Kingdom representatives in various Commonwealth countries which send us prospective nurses to organise some form of screening for literacy and personal health. It is clearly foolish to bring into our great hospitals people who can scarcely read and write and who may not measure up to the requisite standards of personal health.

In the country areas we are all very much aware of the great burden which is being placed on rural mid wives. The rural midwife works long hours and has to drive her own car. Her work comes in spates. It always seems that there is a great number of babies when there is snow on the ground. Life for these ladies can be very trying at times, but they are most devoted. In view of the present trend for more and more young married women to seek to have their babies in hospital rather than at home, there is great difficulty especially for rural midwives who work at too great a pressure, because the mothers-to-be are told that they have to have their babies at home because of the shortage of beds. They then have a somewhat belligerent outlook and feel that they are getting second-best.

That is by no means the case and I would be grateful if my right hon. Friend would go out of his way not only to see that the rural midwife gets an increase in pay when the general increases come along, but is also commended for her work. I would also like him to see that the supply of maternity beds in hospitals is increased so that there are no more unwilling confinements at home. Hon. Members will have seen the various items which appeared in The Times last week and, in particular, the article, published on 22nd March, about the acute shortage of maternity beds.

My right hon. Friend has already said that there is a great increase in the number of physiotherapists, but the demand still outstrips the supply. That is surely because of the new skills and the new use made of physiotherapists and similar practitioners. The fact remains that they are on a salary scale belonging to a previous generation. If it is possible, they should be put on a salary scale which has a more realistic appreciation of their service to the community. They, too, work long hours.

There is no point in going on about the long hours which everybody in the hospital service appears to work. Hon. Members and my right hon. Friend are all clearly aware of the effort and good will in the Health Service. My right hon. Friend said that the national income policy would benefit the professions most. I appreciate his point, but when the Government are formulating that national income policy I hope that they will bear in mind that the various professions centred around medicine have not had a fair deal in the past. Before they are subjected to any 2½ per cent. rule, they should be given a fair and square 1962 basis from which any further 2½ per cent. may be taken.

I ask for a fair deal for these people at the earliest opportunity—I am not being unrealistic and asking for it tomorrow—so that they can enjoy the same standard of living as their neighbours in other trades and professions.

8.15 p.m.

I am very glad to have the opportunity of following the hon. Member for Maidstone (Mr. J. Wells). As a member of the delegation to Finland, to which he referred, I should like to endorse his tribute to the Finnish people for their nursing standards. As he said, the nursing profession throughout that country is held in very high regard.

The Minister of Health has given little pleasure to our nurses. The Government's policy towards nurses has been shocking. Even the community generally has always been prepared to allow the nursing profession to be exploited. My mind goes back to the time when we used to have collection boxes and flag days to maintain our hospitals. We are proud to feel that it was the first majority Labour Party, in that historic period of 1945 to 1950, which put an end to that nonsense and provided this country with a National Health Service which is the envy of the world. There can be no greater monument to the memory of Aneurin Bevan than our National Health Service.

When one reads of the difficulties of the people in the United States of America, that great capitalist nation, when they are ill and when they have to pay hospital and doctors' fees, we can be proud that, in a period when the nation had lost so much of its financial resources during the war, the Labour Government introduced the Health Service. If by some misfortune a Tory Government had been returned, all kinds of excuses would have been used to show why it was not then possible to introduce the Service.

But having destroyed the voluntary hospital system, it is our duty to make our hospitals the finest in the world and to see that those who are employed in them, medical, nursing and other staff, receive financial rewards which are reasonable and just.

I was moved by a letter I read in the Bradford Telegraph and Argus on Friday, 23rd March. It was written by a student nurse and was in clear terms—far clearer than I could express. She spoke of the problems confronting student nurses, and I am grateful to this evening newspaper for having given the letter this publicity so that the public can know precisely what this problem means. This young lady, who signs herself "Just a Nurse", writes
"I am a student nurse at one of our local teaching hospitals and am at present doing a spell of night duty. I work 10i hours each night, and although only 18 I have been left in sole charge of a whole ward of sick people all night. The work is exacting, both mentally and physically, yet despite all this and the responsibility of having other people's lives in one's hands, I receive at the end of the month the magnificent sum of £10. Out of this I had to pay nearly £3 this month for entrance examination fees, and before long shall need to spend several pounds on books for my training."
Her letter continues:
"I like nursing and don't want to have to give it up, but if something isn't done soon in the way of increased remuneration I shall be reluctantly compelled to join the rest of the girls who went into training when I did but have left for jobs with better hours, far less responsibility as well as twice the amount of money."
Do I see the Minister smiling? It may amuse him, but these are the words of a sincere young student nurse which, I am submitting, should receive not the laughter and sneers of the right hon. Gentleman but—

The hon. Gentleman should have been in this House long enough not to play that silly game.

I was not playing a silly game. I was referring to the Minister having grinned when I was reading that letter.

If the hon. Gentleman thinks that I was laughing or smiling about what he was saying he is mistaken, and he knows it.

If so, I apologise for suggesting that the right hon. Gentleman was laughing. I took it from the Minister's attitude that he was amused by my remarks. I thought it was necessary to bring the facts contained in this letter to the right hon. Gentleman's attention.

We are discussing a service which is invaluable and which will undoubtedly increase in its scope in the years to come. It is evident from what the Minister has said that, although recruitment is increasing in various sectors of the service, there is a considerable shortage of nurses in certain parts of the country. The warning which is so clearly stated in the letter from which I have quoted—that people cannot be retained in the service if they do not receive a reasonable remuneration—should receive the Government's immediate attention.

The nursing profession has been exploited for far too long by the community at large. Nurses are dedicated and responsible people who are inspired by a desire to serve rather than to exploit their fellow citizens, and they should be given every possible encouragement. It is a "shocker" when we are told that a student nurse is expected to pay £3 for examination fees out of her paltry wage of £10 a month. The Minister should look at the whole matter to ensure that student nurses, when going through their examinations, are not called upon to pay examination fees out of their meagre salaries. Surely the books which are essential to enable them to qualify can be made readily available in the hospital libraries? Our whole attitude towards the nursing profession must be changed.

I can understand the Minister being bound by Cabinet decisions regarding the wage freeze. It was a deplorable decision, but I appeal to the Government to go into the whole question again at the earliest possible moment and to re-examine the wages and conditions structure for nurses. Let us ensure that their conditions of employment and salaries bear a relationship to other responsible jobs. All I am asking is for the Minister to re-examine the position and to make a comparison between the salaries paid to nurses and those paid to other responsible people.

Whatever the results of an investigation made by an impartial committee on this matter, I am sure that all hon. Members would be willing to accept those results on which, we would hope, the Minister would act. Unless we provide a proper salary for the job and encourage these dedicated young women to continue in the service—and enrol in greater numbers—our aims will be defeated. We must let them feel that we are not putting obstructions in their way or placing undue hurdles before them in order that they may enter the profession. The training facilities must be better than they are today and the awards for qualifying and continued service must be commensurate with those existing elsewhere. We have a great responsibility to see that justice is done.

The Government have failed lamentably in this matter. I ask the Minister to go into it once again and to see whether we cannot provide for the musing profession a standard and conditions of employment which will ensure that they are treated at least as reason- ably as other professional people with similar responsibilities.

8.30 p.m.

Before I launch my broadsides, which will be quite numerous, I wish to say of my right hon. Friend that I think the Minisitry of Health is very lucky indeed to get a Minister who is dedicated to making it effective and efficient and to helping it to develop the Service which is so essential to the nation as a whole.

Although I often find myself in conflict with my right hon. Friend and expect that by the time I have finished my speech he will feel I am very much more in conflict with him, I feel that when one argues a case with him he is full of interest and determined to make the best possible Health Service we can have. We should be very wrong if we did not recognise that that is his objective, as well as the objective of my hon. Friend the Parliamentary Secretary. I follow that by saying that I agreed very much indeed with the speech of the hon. Member for St. Pancras, North (Mr. K. Robinson). He expressed very well indeed many of the thoughts and experiences of those who are in the Health Service. He put forward a case which, I regret to say, my right hon. Friend made no attempt whatever to answer.

It would not serve any useful purpose to go over all the ground which has been covered. On the point about recruitment figures, however, my right hon. Friend dealt with the whole national picture. I have not at my finger-tips all the information he has in his Department. Therefore I am bound to accept the figures he has given. That does not relieve individual Members of Parliament of the anxieties and difficulties they feel in individual regions and hospital management committee areas. My right hon. Friend could give the necessary information which would be satisfactory to all of us only if he were to publish details of the hospitals with their establishments and their situations. If necessary, I should be delighted to put a Question on the Order Paper so that this information may be obtained. I do not want to get out of the train of my theme, but I give one example to emphasise the point I am trying to make.

Not long ago I asked my right hon. Friend a Question about physiotherapists in the Newcastle region, particularly in the physiotherapists' school in the Royal Victoria Infirmary, which is our teaching hospital. A considerable sum of money was expended a short time ago in extending the school. My notice had been drawn to the fact that it would have to close one of the courses. The course which was in operation when I asked the Question was carried on only through the good services and good offices of experienced personnel in the Royal Victoria Infirmary who were not actually part of the staff of the physiotherapists' school. My right hon. Friend gave me an Answer, which on the face of it seemed completely satisfactory, that a shortened course would enable people in training to complete their course and there would be some additional teachers to be used for training personnel in other physiotherapists' schools.

When one got down to an examination of what my right hon. Friend had said, however, one found that each of the personnel who would emerge from that course would take up an appointment in another part of the country and none would be available in future for training in that physiotherapists' school under the Newcastle Regional Hospital Board. The school would fail to provide any additional physiotherapists for the hospital management committees working under the Newcastle Regional Hospital Board.

I say frankly to my right hon. Friend, although I hardly like to say it was deliberate—I never know whether the facts presented to him are accurate or inaccurate—that it looked to me as if he had deliberately tried to put me off the trail. In the area of the Newcastle Regional Hospital Board his Answer was very badly received. I suggest to my right hon. Friend that when he is asked Questions by hon. Members who have a legitimate interest in these matters he should give the true picture and not a national picture which is of no use to those within a particular region. I very much resented that Answer.

That brings me to another point. I might as well deal first with this problem of the professions supplementary to medicine. I cannot understand the objection to having a general inquiry into the pay, the recruitment and con- ditions of service. My right hon. Friend is to receive a deputation. He said that there were difficulties about physiotherapy personnel and what can be provided, but I cannot see, when a great deal of trouble, hardship and anxiety has infiltrated to the whole of the Health Service because of the pay pause, why my right hon. Friend has to maintain this rigid—and I think quite untenable—refusal of such a general inquiry.

I feel as many other hon. Members do about doctors and dentists. I do not blame my right hon. Friend, because he has not been long at the Ministry.

I do not believe that he has been there too long. I am glad to have a Minister who will at any rate listen to me, even if he does not always take my advice. But it is most deplorable that he cannot have this inquiry and obtain the facts from these professions, which are very worried about their future development.

The Minister would go a long way towards establishing his own position as an individual if he would cease adopting this terribly rigid approach to those who are qualified to appeal to him on behalf of their profession. I hope that before the end of the debate he will be able to reconsider the position. No harm would result from having an inquiry. There is no doubt that the doctors and the dentists have exercised a great influence on my right hon. Friend's Department in the past. He would be well advised to redress the balance now by listening to the cases put forward by those who are devoted, through their own services, to the National Health Service. We might then be able to make some progress, at any rate within the professions supplementary to medicine.

I do not need to go into all the details of their difficulties, because many other hon. Members can speak with real knowledge of their problems. I have risen merely to say, in my own small way, how unwise my right hon. Friend is. I think nothing of his speech tonight. He gave no answer whatever to the points raised by the hon. Member for St. Pancras, North. My right hon. Friend talked in generalities, and I am sick of generalities. I want details. I want to know exactly where we are, where we are going, and what we are doing. However brilliantly expressed it was, and however forceful its terms were, my right hon. Friend's speech conveyed nothing at all to me, and I am certain that it would convey nothing to the nursing profession or to those professions supplementary to medicine.

Having heard my broadside, I hope that my right hon. Friend will think again. I have always understood that when trying to deal with problems which are causing acute anxiety—and these must be doing so in the National Health Service—if it is possible to investigate all the facts it is possible to make a wiser judgment and to lay better foundations for future policy. My right hon. Friend has failed lamentably on this score.

I am sorry, but I have not finished. It was extremely nice of my hon. Friend to try to intervene between my right hon. Friend and myself, but I cannot give him an opportunity to do so at the moment because I have a lot of other broadsides to deliver.

I want to say something about the nursing profession. I always feel privileged to speak as a friend of the Royal College of Nurses. The other day the Minister for Science was talking about language and what it meant. He said that Ministers should always be quite certain that when they spoke everybody understood what they were saying. I know that the Minister for Science would not approve of me, because my grammar is appalling and my sentences leave much to be desired. But I want my right hon. Friend to answer one question. On 12th March this year, in answer to a Question asked by the hon. Member for St. Pancras, North, the Minister said:
"Early in February I asked the management side to have regard to the terms of Command Paper 1626. I do not accept that this precludes consideration of the claim on merits."—[Official Report, 12th March, 1962; Vol. 655, c. 873.]
He was referring to the claim of the nurses. Will he explain to the House in language which is crystal clear how, if he has already decided that no pay award over 2½ per cent. can be offered by the management side—and has issued an instruction to this effect—the case can be considered on its merits? In my opinion, it was again a most ridiculous statement to make. Of course my right hon. Friend may use different language from mine. I never mind people disagreeing with me, because half the time people do disagree with me, but I like things to be stated quite definitely and to know what they mean. I cannot for the life of me see, when my right hon. Friend says that there was nothing to preclude the case being considered on its merits, how, if he had already taken the steps which the hon. Member for St. Pancras, North said he had, the case could be considered on its merits.

Another thing that I want to know is this. Of course it is possible for the nursing profession to go to arbitration. The White Paper "Incomes Policy: The Next Step" is the most namby-pamby paper I have ever read. I am afraid that my right hon. Friend has not measured up to the language in accordance with the instructions of the Minister for Science. How on earth can anybody in his senses know what he means in his statement on page 5 of the White Paper on negotiation and arbitration? I want to know whether if any of the bodies which we are discussing tonight take their grievances to arbitration, it will be real arbitration. It is all very well to keep saying that they can talk and that they should have regard for this and regard for that, but that is not the kind of language which I prefer. I want to be down to earth. I am not suggesting that if the nursing profession goes to arbitration and is given a substantial award it should immediately be implemented.

What my right hon. Friend does not seem to understand is that the nursing profession feels very bitterly that it is being restricted to a 2½ per cent. pay award which certainly in no sense meets the claim made for a 25 per cent. to 49 per cent. increase. The nursing profession, s very bitterly about that, and I feel very bitterly for the nursing profession. It also asked for a reconsideration of the structure of its service. If I remember rightly, my right hon. Friend in his speech said that there had been an examination of the structure of the nursing service not so very long ago. It still thinks—and I think that this has been admirably brought out tonight by my hon. Friend the Member for Maidstone (Mr. J. Wells) and the hon. Member for Orpington (Mr. Lubbock)—that whatever was looked at a few years, months or days ago was about as useless as the piece of paper on which this White Paper is written. In my opinion, it is of no use whatever.

My right hon. Friend is taking part in a circus. He is trying to ride two horses at the same time, and he is a very bad performer. I cannot find out from the White Paper what will happen if any of these bodies go to arbitration—and that is what I want to know. Will there be interference with the amount which the arbitrators may award? Has some secret instruction been sent round to the arbitrators? When we have another debate will such information be made available to the House by hon. Members opposite so that we find that on this side of the House we have been sold a pup? I do not like Ministers who sell me pups. I want a straight, down-to-earth statement of what the White Paper means on arbitration.

I was staggered by what the hon. Member for St. Pancras, North said about the Whitley Council. I always understood that he and all other hon. Members opposite were wedded to the Whitley Council procedure, but today he seemed to abandon any idea that it can be effective. I believe in negotiating machinery. But my right hon. Friend has broken the negotiating machinery. That is how I read what he said and what is written in the White Paper. The negotiating machinery is as dead as a dodo, and that is very regrettable. I see the difficulty about the management committee, but I should feel much happier if we were told how the arbitrators assessed this position.

I am delighted that the hospital almoners intend to go to arbitration. When their claim is considered on arbitration, no one can possibly say that hospital almoners are in plentiful supply; that flimsy excuse will not hold water for a moment. When that arbitration award is announced I shall be interested to know all the facts behind it.

Undoubtedly there is a great shortage of maternity beds, but the Minister did not tell us whether this is because the hospital services cannot provide the beds, because there is a shortage of midwives or because there is a shortage of nurses. The Royal College of Midwives feels as strongly as does the National Association of State Enrolled Assistant Nurses about the whole of the Minister's action. Having been in the House for a long time, I assess character quite differently, perhaps, from the way in which many of my colleagues do.

I know very well that there are some Ministers who do not like to go to argue with the Treasury. All my life I have been an arguer. I am not saying this about my right hon. Friend, because I believe that he is a man of very great integrity, but during the war—it cannot be attributed to any of the present From Bench—I was told by a Minister that it did a Minister no good to go to the Treasury. That is not my idea of a Minister. I like a Minister to go to the Treasury as Lord Woolton did, to bang on the table and to say, "This is what I intend to have"—and to get it.

The difficulty about the whole problem is that I do not know whether the Minister is acting on the instructions of the Cabinet. I do not think that any of the members of the Cabinet who instruct my right hon. Friend have ever been round a hospital or discussed the hospital situation. My right hon. Friend came to the north of England and looked at some of our hospitals there, and one or two very good results ensued from his visit. But when he goes to the Cabinet to talk about the Health Service, how many Ministers there know what they are talking about in the dicussion? I do not think that they know anything about it at all.

It is very obvious to the nurses and to the midwives and to the professions supplementary to medicine that when the railway men wanted something they went to the Prime Minister and managed to get something fixed up. Of course, nobody quite knows what they got fixed up because when that sort of thing happens it is private, so that nobody ever knows. One cannot have documents published for 50 years in case one quotes a member of the Cabinet—very awkward, indeed. What we do know is that the railway men got to the Prime Minister and came out of the interview quite happy, apparently. That is all right. I am devoted to the railway men.

What I want to know is, why cannot my right hon. Friend the Minister of Health take the members of the Royal College of Nursing and the Royal College of Midwives and of the National Association of State Enrolled Assistant Nurses and all the professions supplementary to medicine to the Prime Minister? The Prime Minister wrote to me when I made that sort of suggestion—

I am glad the hon. Lady has mentioned that. One of the organisations concerned, the Confederation of Health Service Employees, has sent a telegram to the Prime Minister on that point. I think I may read the the reply in full. It was:

"The management side of the Whitley Council have been acting in accordance with the Government's policy as set out in the recent White Paper. Yours sincerely ".

All I can say is that the hon. Gentleman does not know how to deal with the Prime Minister.

Although I would not necessarily get good results, what I can say is that sometimes one can have an effect. If we do not get something in relation to this matter, and if I can get a Question on the Order Paper, I shall start badgering the Prime Minister. When I go into a battle, I go into a battle. That is part of the trouble about my right hon. Friends. They are so namby-pamby in their language that no one understands what they are talking about. In my part of the world—I cannot speak for Orpington, but I can speak for my part of the world—in the north of England if you call a spade a spade they may disagree with you and fight you to the death, but at least they understand you and they respect you. Nobody can respect this ridiculous White Paper.

The Royal College of Nursing feels that for many years the nursing profession was at the bottom of the salaries scales because all of us accepted far too much from the nursing profession without asking what were its conditions of service.

I want to ask my right hon. Friend another question. He says that they have had these salary increases. If he says that, let us have circulated in the OFFICIAL REPORT details of all the salaries and wages of all sections of the community so that we can see where these nurses stand. I thought that my right hon. Friend was a really good digger for information, but, my goodness, he is not nearly such a good digger as I could be. There are thousands of permutations—I think that is the right word—which I should like to see set out in the OFFICIAL REPORT. I think my right hon. Friend might let us know these things.

The Royal College does feel that for very many years nurses have been—and indeed they have—far too low in the salaries scales, and now they have just begun to climb up my right hon. Friend talks about their having got this and having got that. That may be, but that does not necessarily make that finally just. I saw a documentary film, "The Judgment of Nuremberg", and one of the lawyers said, "This is logical", and the other lawyer said, "Yes, but it does not necessarily make it right". I kept on thinking about that as I listened to my right hon. Friend today—it does not make it right. I stand for justice, but not a word has been said about justice. All those figures really did not mean a thing.

I want to make another suggestion. I fully agree with my right hon. Friend that we have to see that we get value for money, but I never think that the Treasury knows how to spend money to save. I am sure that it does not. I do not think that the men in the Treasury have a clue about how to spend money to save, and I am very surprised that my right hon. Friend has never given his assessment of the value, in human terms, of the Health Service.

A very well-loved, highly-respected and very competent general practitioner in my part of the world said to me that before the introduction of the Service the very rich were all right and the very poor were all right—because we always provided for the very poor in very many ways—but that the bulk of the people just above the poverty line, the great bulk of people who were earning their living—often when they should have been in hospital—had no service at all.

I agree with that view. I think that the National Health Service has been of great benefit to the nation. Why, therefore, when we are talking about spending money, and when we are talking about the Health Service, are we not told of what value that Service has been to the nation? Not a word did we get from my right hon. Friend on that subject, though some of the money spent has had a brilliant result on the health of the nation.

We want increased productivity; surely, we can see that a really efficient, well-paid and happy Health Service would help to increase productivity. But part of the weakness of the Government is that there is absolutely no co-ordination between one Department and another. We deal with the Health Service in isolation. We deal with transport in isolation. We deal with the Prime Minister in isolation—[HON. MEMBERS: "Good."] No, I do not want to isolate my right hon. Friend; I think he is one of the best Prime Ministers we have ever had. Let me say to hon. Members opposite—and I hope that the hon. Member for St. Pan-eras, North will not get a swollen head because a Tory said she liked his speech—that I would not have them running the Health Service because there would then be even less money and less justice available to those in it.

9.4 p.m.

I hope that the hon. Lady the Member for Tyne-mouth (Dame Irene Ward) will forgive me for not following her argument too far, but I cannot help but comment on the fact that she began by praising the Minister, telling us what a good fellow he is, but, by the end of her speech, was telling us how bad he is. I agreed with her when she said that he had made a terribly bad speech, and had not given any consolation to the great Health Service in which we all believe.

The hon. Lady praised the Service, but we on this side cannot help remembering that one of the greatest political crimes ever committed in 1948 was when the party opposite voted against it—

It is true.

I share the view of the hon. Lady that the Minister's speech was a miserable effort. It did not face the facts. The right hon. Gentleman referred to an ex- panding Health Service. We are wondering what part of the Service is expanding. It seems that everyone except the Minister knows that there is a shortage of doctors. If he realised that, he would have told us about plans for the building of new medical schools. He did not say anything about the present overcrowding in medical schools. In short, he did not give us any facts on things about which we are concerned. The Government should tell us what plans there are for building new medical schools. This is a vital and important matter for the future. The country needs more doctors, and, therefore, needs more schools in which to train them.

I wish to mention one aspect of the Health Service which, to my knowledge, has not been mentioned. I refer to orthoptists. The Minister did not mention a word about the fact that there is a great shortage of orthoptists I do not single these people out because they have been treated any worse than anyone else, but I think that the House will agree that they have been treated as badly as anyone else. There is an acute shortage of orthoptists in the North-East in particular, and there is grave misapprehension that the Minister is doing nothing to remedy the situation, and if the present trend continues, there will be a serious crisis.

I want to give three examples of what I mean. In the Sunderland Eye Infirmary there was a training school which had to close because of a lack of staff. A clinic in Middlesbrough suffered the same fate. In Dryburn Hospital, in Durham, an orthoptist is working single-handed in a clinic which is far from adequate to meet the large demands of patients over a widely scattered area. Patients are travelling many miles to this clinic. They are travelling for treatment from Birtley, about eight miles away, from Tow Law, about 12 miles away, from Woolsingham, about 16 to 18 miles away and even from Saltburn, which is as many as 20 or thirty miles away. The reason they have to travel such distances is that there are no clinics near to them because of a shortage of suitable staff. In fact, there is a shortage of staff all over the country Surely we cannot be complacent about this desperate state of affairs, for which the Minister of Health is responsible?

Reference has been made to the emoluments of orthoptists. The Health Service could not be run if these people did not work overtime, and even their pay for working overtime is not particularly good. There is something wrong if starvation wages have to be supplemented by working overtime. It is bad for the Service if we have to tire some people to death to keep others alive. This is no way to run the Health Service.

Orthoptists are shockingly underpaid. They regard themselves as forgotten people. Students are not being attracted to the profession. This is because those already in the profession are uncertain about their future and unhappy in their work because they are insufficiently paid, and this sense of insecurity has an effect on potential recruits. Students are not prepared to work and study hard to pass difficult examinations only to find, when they are fully qualified, that they receive little more than clerks who have little or no responsibility and who have done no training for the work they do. It is not possible to get the best from skilled people if they are not paid the money that they are worth.

I have every reason to believe that there is now more discontent in the Service than ever before. I am not talking only about orthoptists. I find disgruntled people in every part of the Service. These are the people who have a vocation in life and provide a good service to humanity. They are the people who normally are not discontented with their lot.

People in the Health Service consider that they could follow an occupation outside the Service and get more money for accepting less responsibility. I understand that an orthoptist is paid between £520 and £630 per annum. If this is true, it is no wonder that there is a shortage of them. They are doing a great service to mankind—as are all the other people in the Health Service, nurses, midwives, doctors, physiotherapists, and so on—and we should ensure that they are paid wages which are commensurate with the value of their work.

These people do not want to strike. They are not like workers in other industry who sometimes decide to go on strike. They detest the use of the strike weapon and do not want to be forced to use it. But, because they do not go on strike, they should not be denied fair play and justice. I believe that it is up to the Government and the Minister of Health to see that they get them.

9.15 p.m.

There were large parts of the speech made by the hon. Members for Durham (Mr. Grey) and for St. Pancras, North (Mr. K. Robinson) with which I found myself in complete agreement. Without attempting to be in any sense disparaging, the parts of the speech of the hon. Member for Durham with which I was in agreement were the emotional parts, because, like him and the hon. Member for St. Pancras, North, I am of the opinion that in parts of the nursing profession and in the midwifery service there are under-staffing, over-work and under-payment. The remuneration which the people in these professions receive is not commensurate with the service they render to the community.

I also agree with my hon. Friend the Member for Tynemouth (Dame Irene Ward), who described these services as under-valued—not under-valued in any way in the hearts of the community, but under-valued in the cash return which they obtain from the community. We as a Government and we in Parliament owe them a debt of gratitude, and, indeed, a debt of honour, to ensure that the remuneration they receive is commensurate with the service that they render to the community.

So far, I agree with the hon. Member for St. Pancras, North, but he seemed to me to leave out completely the heart of the problem which we are now facing. The heart of the problem is surely that there is no single factor which has been more damaging to the interests of the nursing and midwifery profession than inflation. No single section of the community stands to gain greater benefits than nurses, midwives and the other professional bodies if we can curb inflationary pressures.

The fault rests with both political parties. During all the post-war years we have seen the wage-price spiral go twisting upwards. The wage-earning community, as a result of the strong representation which they have behind them, has been able to contract out of the impact of inflation, but those living on fixed incomes and those working in the professions which we are discussing have undergone a relative decline in their position in the community.

We have seen professional salaries lag behind the wage-earning increases.

No Government in this inflationary period has been at one and the same time able, on the one hand, to meet the wage demands and, on the other, to honour the obligations which we as a community owe to the professions. Therefore, it seems to me that just as no single factor has been more damaging to the interests of these professions, so there is no single economic achievement which will be of greater benefit to nurses and to midwives than the curbing and ultimately the elimination of inflation from our economy.

On the question of salaries lagging behind, could the noble Lord explain why it is that industry has been able to take from the Civil Service and many other Government services many people at increased salaries? Are those the kind of salaries he is talking about in this respect?

The hon. Member is really reinforcing my argument that industry is able to pay higher wages whereas the salaries of professional people have not kept pace with the wage increases. It is to achieve this objective of eliminating inflation, which is directly beneficial to the nurses and mid-wives, that the Government have addressed to the nation as a whole a call for restraint. Surely by now, after all these post-war years, there must be some measure of agreement in the country about the steps which are necessary to eliminate inflation. Surely by now there is also universal agreement that if wages, salaries, and dividends outrun production we are moving along the road to inflation.

The noble Lord is arguing that there are unjust differentials between professionals and wage earners. How, then, can he defend a policy which is freezing the present position and maintaining the preferentials which he claims are unjust?

If the hon. Member will allow me to continue my speech, I am trying to point out that we at this stage are trying to eliminate inflation. Elimination at this stage is, surely without any question—and I doubt whether he would question this—the greatest benefit that we can render to such professional persons as nurses and midwives. There is, of course, a later stage beyond the elimination of inflation to which I hope to be able to turn.

There is also, so far, fairly universal acceptance of the fact that the gross national product in recent years has increased by only between 2 per cent. and 2½ per cent. There is also universal agreement that this is not enough and that we should strive with all our efforts to increase the gross national product beyond this rate. But it must also be agreed that until this is achieved, nothing beyond a limited increase in wages and salaries and dividends is beneficial to the nation as a whole. This argument seems to me to be fairly generally accepted. [HON. MEMBERS: "Nonsense."] I thought that it was.

The question which we have to discuss today is whether there is a unique case for excluding nurses and midwives from this call for restraint, which has been addressed to the nation as a whole. If they are excluded, and if their case is not absolutely unique, we as a Government, in a field for which we are directly responsible, and as a Government who are expected to set an example, will be punching a hole in our economic policies through which, later, a whole multitude of professions and other occupations will pour. Then we will see that our aim to eliminate inflation will have been a failure. The wage-price spiral will once again be resumed and we shall once more see this dismal picture of the professions tagging a long way behind wage increases.

I began by saying that the Health Service is under-staffed, is over-worked and is under-paid. Nevertheless, the picture which the Service presents, as was most forcefully shown by my right hon. Friend the Minister, is one of very steady improvement in every section. It is true that there are geographical areas where there are serious shortages. No one attempts to disguise that that is the case. But if we look, be it at the midwifery service, or be it at the general practitioner service, or be it at the general nursing service, we see that the trend is towards an increasingly well-manned service. We have a general picture where never before in the history of the Health Service have there been so many part-time or whole-time nurses and mid-wives.

This steady improvement is a step in the right direction, and it now makes it difficult to sustain a claim that nurses and mid wives must be treated as being completely unique, and that they should be absolved from the call for restraint which has been addressed to the whole nation. My fear is that, were they absolved from this call, we would see the battle against inflation imperilled—that we would see this particular section, which stands to gain greater benefits than any other in the community, harmed once again, as it has been in the past, by inflation.

None the less, I agree entirely with the remarks of my hon. Friend the Member for Maidstone (Mr. J. Wells) and other hon. Members, that in this Service there are real grievances and problems. The wastage in the midwifery service is a serious problem. So are the anomalies, mentioned by the hon. Member for Orpington (Mr. Lubbock), in the nursing service, where untrained ward orderlies, can receive greater remuneration than nurses with twenty-five years' service. These are anomalies and problems which it is obligatory upon my right hon. Friend to solve. I believe that his decision to receive a deputation of representatives of the nursing profession will be very warmly welcomed throughout the profession.

The steps which my right hon. Friend has to take must be taken within the broad framework of the Government's economic policy, with the purpose of destroying, once and for all, the disastrous wage-price spiral. If and when this can be achieved, the nation will win a certain amount of elbow room. I want to see that elbow room used to increase the salaries of nurses and midwives and the members of the other professions which we are discussing.

I also want to see our economic policies used as a springboard to achieve a relative improvement in the position of nurses and midwives in the community. It is in the hope that the Government are now working upon the next stage of their economic policy, using the success which has attended their efforts so far as a springboard to achieve a relative improvement in the position of these professions, that I support them tonight.

9.28 p.m.

I do not rise now to close this debate. This is one of those occasions when it can go on, as is shown by the number of hon. Members on both sides who wish it to go on. But at this stage, something else might well be said from the Opposition Front Bench about the way in which the debate has gone so far.

I listened very carefully to the noble Lord the Member for Hertford (Lord Balniel), who followed faithfully a large part of the pattern which the Minister set for him. The noble Lord began by declaring that nurses, and those who work in these other professions ancillary to medicine, are over-worked, under-staffed and under-paid. He repeated that declaration at intervals. He said that there were great grievances.

Then I understood him to say that, because the country has had a long period of inflation—lasting, I gather, during the whole of the twelve years of his Government—and because he did not know where else to stop it, he felt that it was right to hold back these very people who are under-paid and make them bear the whole burden of the inflation he regrets. He thus denied the justice of their claim.

I must accept that the noble Lord was sincere, but I find it very hard to understand how he could persuade himself of the justice of what he was saying to these people.

The right hon. Gentleman has put into my mouth words to the effect that I had said that this profession should bear the whole burden of inflation. The whole tenor of my speech was that the appeal for restraint was addressed to the nation as a whole.

The noble Lord's economic lecture was addressed to the nation as a whole, but large sections of the nation, either because they have power to arrange it or because the Government refuse to take steps with them, are able to win increases for themselves in their income. They have been doing it since the start of the pay pause policy, they are doing it now, and they will go on doing it.

What the hon. Member is justifying is what the Minister sought to justify—a deliberate decision to impose it upon the only place where it can be imposed, which happens to be cases, like this, of small people who are quite hard hit and who have considerable grievances and injustices. It is imposed upon them just because they are small, because they cannot win a way out for themselves, because they cannot fight back without injuring their patients, and because the Minister, in this respect, has power that he does not have elsewhere. Without going into the details of the economic lecture, I do not see how one can possibly defend such a course, either as good economics, as a way out of inflation or as justice to the people we are considering.

The Minister made an appalling speech. There were three parts to it. He gave us a long, tendentious, distorted and quite meaningless dissertation on staffing. That occupied twenty-five minutes of his whole speech, which lasted for about thirty-five minutes. He then gave us a party version of the economic lecture, of which we have just heard a rather longer version and which, I gather, the Minister intends to repeat to the deputation in a few days' time. He wound up with a peroration about the glorious future that will come about for these devoted people, more and more of whom, I gather, are to be part-time rather than whole-time, in the grand new buildings which they are to have.

That was all there was to the Minister's speech. There was not at any stage a word about whether the claim was justified. There was no examination of whether the salaries were relatively out of line with comparable grades. There was not even a word of sympathy for these people and there was no examination of the shortages that exist side by side with the figures given by the Minister. There was no word about his own gross continual interference with the negotiating machinery and the conclusion which he expects to be drawn from it, nor was there a single word about why he was not prepared to accept the claim for an independent inquiry into the whole structure of the problems associated with staffing the service.

The things that the Minister did not discuss are what the debate is about. The things that he did discuss are not—or, if they are, they are only peripherally—concerned with it. Let me deal with the question of staffing. I do not know what the Minister, or the hon. Member for Hertford, who also took the point, sought to draw as a conclusion. The only real conclusion of what they said when they have proved that people axe still dedicated enough to want to serve their fellow citizens in the Service is that the Minister regards that as a reason for not raising the salary, but that if the people were walking out he might regard that as a case for raising the salary.

That could be the only purpose of the argument. I ask the Minister quite frankly if he thinks that, in putting that forward as the case—"You cannot have it because these people are so devoted, and because lots of young girls still feel the call for this service"—he thinks that he is living up to the devotion of the very people he is talking about? Does he think that he is making any contribution to raising the ethics in our materialist age?

Does the right hon. Gentleman think that he is making any contribution at all to anything other than conflict and dispute, because even these people, with all their devotion, will at some stage draw the conclusion which the Minister was trying to teach them, and at some stage somebody will learn that they need power and will have to exercise it, whatever the consequences, when they are met with this kind of approach from the Minister? Therefore, I do not see what he has achieved by his argument, even if it had been true.

Even if the Minister's figures show that there is a steady expansion in the numbers coming into the Service, the right hon. Gentleman glossed over some very interesting exceptions to that—the student teachers, the physiotherapists, and others. He knows as well as I do that the general picture of those coming into the service does not justify drawing the conclusion, which he left to be drawn, that this is a Service in which we are getting more and more and better and better manning, and in which we are expanding the provision. Side by side with the figures he gave are the figures that he did not give—for hospitals cutting down wards, hospitals shutting down only recently-built operating theatres, like the ones which his predecessor opened with such a fanfare of trumpets not so very long ago, but which now have had to be shut for want of staff to operate them.

The right hon. Gentleman knows as well as I do, because other people have told him, that side by side with his figures comes a picture of enormous dilution by people who are not skilled trying to cover the jobs of skilled people who are not there. He knows that, side by side with these cases, goes the kind of story, such as the hon. Member for Orpington (Mr. Lubbock) told in his maiden speech, of devoted women working enormously long hours to make up for the absence of others.

These figures are also relevant, and they show the situation at the moment. They show not a Health Service that is giving more and more facilities, but a Service that is not keeping up with the demands that our people are making on it, and which is not keeping up with the need that has grown up over these years. That is the side of the story that ought to worry the right hon. Gentleman.

Although the case for more pay for these people is not wholly made, and is not being made, by them on the grounds of the need to attract more people into the Service, or to retain the people already in it, it is relevant to it, and if the Minister rests, as he did, most of his refusal to grant an increase on the ground that it is not necessary, because people are coming in, I tell him that he is misreading the figures. He is reading only the figures that suit him, but he is leaving out the others, when any impartial examination of the situation in the Service would lead one to conclude that there is ground, even in that limited area, for doing something about salaries. He ought also to do something about conditions and hours of work in order to encourage people into the Service and to retain them there when they are in.

I thought that the right hon. Gentleman was very complacent about the whole thing. Obviously, he does know the other side of the picture. Why did he choose not to put the two pictures side by side? I do not understand. I had the terrifying feeling at the end that he was as complacent as he looked, and was not merely putting up one side of the argument to score a little debating point, but because that was how it looked to him. He was complacent, he did think that the Service was expanding, that the men and women situation was getting better, and that there was no need to do anything about it.

The Minister said that physiotherapists were one of those groups in which things were not as rosy as he seemed to think they were in all the others. He made two proposals to put that side of the picture right. Again, I was horrified, because the man is shown by his outlook. The right hon. Gentleman and I have crossed swords on this before and he knows that I have a great respect for him, more than I have for some of his colleagues. I understand him and his outlook and he always courageously stands by it.

One of the two proposals was to reduce the quality of the teachers by asking the Chartered Society to cut the two-year period, and the other was to cut the service by having patients much more carefully examined to see whether they should be receiving physiotherapeutic treatment. One proposal was to reduce the quality and the other to reduce the service. On that basis, one could solve a shortage of anything.

Although many Tories hide it from themselves, I believe that this is a fundamental Tory doctrine. It is what the right hon. Member for Woodford (Sir W. Churchill) meant when, in an election, he said that under the Tories the social services would be used as an ambulance service, a safety net catching those who fell through everything else, but only those. That is what was behind the Minister's thought today when he was talking about cutting the service and reducing the quality He had in mind something for what the hon. Lady the Member for Tynemouth (Dame Irene Ward) called the very poor, while others would provide privately for themselves elsewhere. This is the attitude which has gone along with all the developments of the idea of more and more private provision through insurance companies, and so on. It is that which terrifies me.

My right hon. Friend spoke of the necessity for physiotherapists. I am sure that he was not referring to those who could get that service privately, but to those who, through medical necessity, needed physiotherapy. The service should be reserved for them and not wasted.

It is wrong to waste the services of physiotherapists upon cases who can no longer benefit from them.

This is the politician deciding that the medical people are wasting services by treating people whom they ought not to treat. This is the Minister saying that he will solve the problem of the shortage of physiotherapists by interfering with the freedom of the medical profession to decide whom to treat.

The right hon. Gentleman has decided that the treatment is being wasted on some people and that he will issue guidance, or advice, or instructions—it comes to the same thing—to tighten up the medical test and to make it narrower and stricter. Anybody who does not get through that net will not have the treatment. [HON. MEMBERS: "No."] That is clearly what is meant, or it means nothing. That is all it can mean.

Anybody who fails to get through that narrower and stricter test shall not have the treatment. By that means the Minister will cut out what he calls waste. Patients who are now being treated will not be treated and he will be able to tell us that he has enough physiotherapists and that that problem has been solved. That is the attitude the Minister took and is the only deduction that can be drawn from what he said then or from his frank statement just now. It will be noted carefully outside the House.

We then received from the right hon. Gentleman a short economic lecture—the sort of lecture that has been repeated time and again. Surely we are entitled to protest at this. At a time when dividends are not restricted by Government action, when rents have gone up because of Government action, when the cost of living is rising in all directions and at a time when people generally are having their incomes increased, the Minister had a bit of a cheek to answer the case that has been made with the kind of arid economic lecture to which we were subjected.

The right hon. Gentleman's argument was quite irrelevant. The nurses have not caused the inflation. They are the victims of it. To say to the victims, "The best thing we can do for you is to make sure that you suffer your hurts without any balm" seems to be adding insult to injury. If the Government want to tackle our economic problems and have an incomes policy they must do many things in many fields which they are not now doing. Merely to take individual groups of people—the poorest, relatively speaking; the minor civil servants, the teachers and now the nurses—and deal with them in this way will do nothing that is adequate to tackle our economic problems. Unless the Government do something constructive for these people they will not alter our methods of production, improve the exports position and obtain the co-operation of management and labour in a national plan.

I urge the Secretary of State for Scotland to deal with the major issues. Is the claim of these workers justified? Do they have a case? I will not go into the figures now, because I am sure that the right hon. Gentleman must be just as aware of them as I am. I urge him to consider their wage scales. The salaries of physiotherapists and all the other ancillary grades should be compared with any like group outside. If the right hon. Gentleman makes that comparison with people who must give up the time required for training and have the limited opportunities for promotion and extra payment, he will then be in a position to say whether or not he thinks that they have a claim.

I do not see how anyone can deny that they have. After all, we are talking about salaries in the £500 to £600 a year range for the sort of training, work and conditions that apply to these people. I would have thought that they are marked out as being under-paid in relation to any other comparable group.

Will the Secretary of State for Scotland do what his right hon. Friend would not do and say whether he accepts what I have said? If he does not, will he frankly say so? We should know the answer. Until the Government frankly declare their attitude towards this subject all the rest of what they are saying is shadow boxing. It seems that the people about whom I am speaking have a very considerable case, and that the 2½ per cent. does nothing to meet more than the tiniest fraction of that case. That figure is ludicrous when compared with the degree and justice of their claim.

If he feels that although they have a case, and are under-paid, he cannot himself do justice to it, why does be resist the independent inquiry which has been asked for? As was put so cogently by my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson), this has been done for many other groups of people. The doctors had their inquiry. What is it that makes it proper in their case, but improper for other people whose hardship is a great deal greater than those for whom the Minister's predecessor granted an inquiry? The Secretary of State for Scotland ought to be frank to the House and tell us what it is.

Is it anything other than a fear on the part of the Minister that the decision would be bound to lead to a different salary structure that now exists and a very considerable increase in parts of it? Is that the only thing which prevents him setting up an inquiry? In other words, has he made a judgment already that his refusal is wrong but is unwilling to let someone else pass judgment on him? If that is not the answer, I ask the Secretary of State to be frank with us and to tell us what it is.

Will the Secretary of State complete the picture, which the Minister only half finished, about the situation in the Service? Will he set frankly alongside his right hon. Friend's figures the figures for shortages of staff which now exist? Will he tell us what they are? We all have had material from various bodies con- cerned. There is no reason to think that the Chartered Society of Physiotherapy would be deliberately misleading in the memoranda it sends round. I have a list of the shortages in the ancillary professions. They vary from 21 per cent. under establishment in the case of physiotherapists to 42 per cent. in the case of therapeutic dieticians. There is 23 per cent. in the case of occupational therapists, 20 per cent. in the case of orthoptists and 24·6 per cent. in the case of remedial gymnasts. Are those figures right? If they are right, what effect does that have on the case the Minister built up? They hide and cloak more serious shortages, particularly of male entrants to these professions.

What is true of this is also true about nurses. There is a great shortage of nurses. We are able to find that by the evidence of our own eyes when we go to hospitals and also by evidence from matrons and sisters in hospitals. It is evident in my constituency as it is in others. It is published in documents issued by bodies which know the position and tell the truth, the General Nursing Council, for example, and the Sheffield Hospital Board, covering my region. There is a long list of places which are being closed. Does the Secretary of State accept, or is he denying, all this information? If he accepts it, it destroys the case which his right hon. Friend relied upon.

I have asked the right hon. Gentleman to tell us frankly what he thinks is the justice of his claim and to tell us why he will not submit it to an independent inquiry. I now ask: if the shortages do exist and are of this kind of gravity at a time when we know that waiting lists are growing and will go on growing, and there will be more and more people to use the service—a factor which the Minister left out of consideration—how does the right hon. Gentleman propose to deal with it, short of cutting the Service down? How does he propose to attract people into it—or does not he want to?

The right hon. Gentleman seemed to think that so long as we went more and more over to part-time working we could get by, and that where we did not we could reduce the Service. Does the Secretary of State accept that interpretation? If not, and if he does not intend to do anything about salaries, how will he close the gap?

There are many other matters to which I should have liked to refer, but many have already been referred to, and what have not will be referred to by my hon. Friends. I leave it there, except to say that the nurses, who are already worried and upset, will be staggered when they read reports of the Minister's speech, as will the members of the ancillary professions. I want to tell them that the problem arises from none of the things which the Government have been discussing this afternoon. The real problem is concerned with social priorities, and the Government's approach to communal spending. The nurses, physiotherapists and others will have their claims met only when we are running a society in which justice is the prior consideration, and are prepared to find the money from our communal productive effort for those services that we deem to be of the highest order of importance.

This materialistic, so-called affluent society—this society that the Conservative Government has so sedulously cosseted and built up, with the, "Pull up the ladder Jack, I'm all right" mentality; with the encouragement of selfishness, and of putting oneself right regardless of what is happening to other people—is what creates the problem for the nurses and the others of whom we have been talking. No real way out of this situation can be found until a different attitude has been created in society, and there will be no different attitude while the Government, by their actions, and by speeches such as we have heard today, deliberately teach the lesson that power tells, and that unless a person has it and can exercise it regardless of the comfort of other people he can expect to be held back at the end of the queue.

We shall not create a new attitude while the Government teach that lesson. We shall merely see more and more people tumbling to the fact that they must look after themselves, and that the jungle law will apply in the jungle world for which the Government are responsible. We should continue, both in this House and outside it, pressing the Government to change their attitude to nurses and to the other people in the Health Service.

We need a much vaster change than this. When the Health Service was brought in it was a wonderful conception. It was really meant to be a free Service. It was meant to be available to people when they needed it. When I heard the Minister denying that this afternoon—as he has done before—I wondered why he applied that argument to the Health Service and not to water. Why is it right to have some things on tap, regardless of what it costs, but not other things? Why is not health regarded as an essential service?

The Health Service was a wonderful Service to begin with, and it must be made one again. We must return to the original conception. Until we do, successive Ministers will try to hold down what they call the cost and they will be forced again and again to do one or other of the only two things they can do—either to cut the Service or to impose hardship upon those who work in it and make them pay for their devotion. That is the action that the Minister seeks to justify.

10.0 p.m.

The right hon. Gentleman the Member for Belper (Mr. G. Brown) when intervening in the debate said that he thought that it might be of some benefit if he made a few remarks. I have found nothing of any benefit whatever in what he said. I feel that I could well have waited another few hours before I had the benefit of his advice, delivered in his usual moralising manner which becomes quite nauseating on this side of the House after the first twenty minutes or so.

Before the right hon. Gentleman chipped in, we had some very interesting speeches, particularly from this side of the House. I should like to reinforce the plea made by my hon. Friend the Member for Tynemouth (Dame Irene Ward) to the Minister. She called his attention to the Motion on the Order Paper relating to the Review of Remuneration of Professions Supplementary to Medicine. She also called the Minister's attention to the need, in her own words, of calling a spade a spade, of speaking as Geordies do and of trying to say what one means. May I fully support what she said. She put it in far more able words than I could ever expect to do.

My hon. Friend the Member for Hertford (Lord Balniel) had a clear and cogent argument. So far as I could follow it, he seemed to say that the pay pause should continue, but I disagree with him in so much as he said that the professions we are talking about—the nursing and medical professions—are at the bottom of the ladder and are frozen in this pay pause at the bottom. I think they are in a position far lower down the ladder than can possibly be allowed to continue.

I welcome the initiative of the Opposition tonight in introducing this subject for debate. It enables us to focus a spotlight on a profession which is quite unable to support its pay claim by the threat of industrial action. I say that advisedly, although I read in the Evening Standard tonight a heading, "Hospital strike threat". It went on to say that the union leaders of Britain's 200,000 nurses may meet to decide whether or not to take industrial action. I say to the House quite sincerely that that is nonsense.

I am not an authority on the total number of nurses, but I quote exactly what the paper states:

"Calls for hospital strike were made at meeting of union leaders of Britain's 200,000 nurses and midwives today."
To develop my theme, I think it is nonsense to say that the medical profession would ever threaten to strike. [HON. MEMBERS: "Oh."] It would never do so. We have many people employed at all scales and all levels in the medical profession. They realise that whether they want to strike—and I have no doubt that with the treatment which they are receiving at the moment many would like to strike—it is absolutely impossible. How can they strike and leave the hospitals full of sick patients to fend for themselves? How can they possibly strike—even though some hon. Members opposite seem to think that they could.

How could they possibly strike and leave a mental hospital full of mental patients to fend for themselves? Nobody with any sense of obligation could contemplate it for a moment. There are certain professions in the country to whom the moral obligation to remain at work is perhaps nearly as strong—for example, the police, who are virtually forbidden, morally, to strike; but they are on a far different rate of payment from the people whom we are discussing tonight. The police constable starts at £12 a week and receives 42s. a week rent allowance. Hon. Members should compare that with the starting wage of a male nurse of £8 13s. 4d. a week. There are many other occupations and employments for which the word "strike" means very little. The Armed Forces are forbidden to strike because they are governed by Queen's Regulations or other regulations in similar terms. But I challenge any hon. Member to tell me of an occupation the members of which as a whole are paid less and yet who have a higher obligation to remain at work than the members of the medical profession.

I emphasise this moral obligation to remain at work because we all know that in wage negotiations the strong union, representing a strong body of employees, always has the strike ace up its sleeve, perhaps to play after it has laid its other cards on the table. This is a significant factor in wringing out of management or employers the extra 2s. to 3s. a week. But the use of the strike cannot possibly apply to the medical profession.

I turn to a fairly narrow aspect of this subject—the problems of mental nurses and, particularly, male nurses in mental hospitals. Yesterday, in response to a lot of correspondence which I have received and many telephone messages. I visited the biggest mental home in Leicestershire, Carlton Hayes, near Narborough, in my constituency. I had received many letters before I went there, and I went to interview the people who had written to me. Unfortunately, my right hon. Friend is not in his place at the moment. I wanted to tell him exactly what these people want and why this major mental hospital, with a staff complement of 104 male nurses, is having to stagger along with only 56 male nurses on its staff.

When I spoke to the deputy chief male nurse, who took me round and gave me the opportunity to speak to many other male nurses, he told me that out of the 56, in a complement of 104 male nurses, three were leaving this month to take up occupations outside the nursing profession with far more remuneration. The chief male nurse and the whole of the male nursing staff in this hospital are desperately worried men. My right hon. Friend should be worried, too. Certainly the relatives of the patients in this mental hospital are desperately worried, because they know that their relatives in the hospital cannot possibly receive the treatment which we or they would like them to receive and to which they are entitled. That is because of the shortage of staff. I trust that my right hon. Friend will read my speech in HANSARD. I wish to tell him, following the interviews which I had with members of the nursing profession, what is wrong in Carlton Hayes, because in this he may find a pattern for other mental hospitals in the country.

First and foremost we have the burning topic of wages. A male nurse engaged at this big, major mental hospital operating under the new Mental Health Act with all that that means starts there at £8 13s. 4d. for a 44-hour week or an 88-hour fortnight, which is what they work. That £8 13s. 4d. is quite a long way below the scales which the right hon. Gentleman the Member for Belper mentioned when he referred to various branches of the medical service where there were shortages of staff and where there were income categories of £500 and £600 per annum. This category of male nurses get only £400 or so a year. From that £8 13s. 4d. there is a deduction for all meals taken while on duty. The male nurses have to pay for that. There is a deduction for superannuation and a deduction for National Insurance; and, if they qualify for it, which is doubtful, they have to pay Income Tax. Many of them, the chief male nurse tells me, take home something like only £7 10s. a week. I remind my right hon. Friend that we are not talking about some young girl working in a hospital however able and qualified she may be. I am talking about a man who may well have the responsibility of providing for a family and of running a home, and to expect him to do so on such an income as I have mentioned is to my mind ridiculous.

A traffic warden—and what on earth is the good of a traffic warden? I got a ticket—

No, not for the Cup Final, but I got a ticket from one of the traffic wardens the other day. Even before I got the ticket from the traffic warden I really thought, with all due respect to my right hon. Friend the Minister of Transport, that there was very little justification for their existence, and I still do think that there is no justification whatsoever for a traffic warden's receiving far more pay in a week than a male nurse does.

Exactly. The hon. Member has put the words into my own mouth, and I thank him very much.

What chance has the chief male nurse at this hospital of recruiting new staff when two or three miles away there is a thriving engineering firm offering full employment and employing over a thousand people making special grinding machines, a firm offering full overtime for anybody who wants it? What chance has the chief male nurse of getting replacements for his missing staff when the hospital is situated only six miles away from the thriving, busy and bustling City of Leicester?

One might think that there must be some hidden emolument for the nursing staff at Carlton Hayes to make up for the apparently pitiful figure of £7 or £8 a week they are receiving. It might be thought that perhaps they got something else in a hole and corner manner, that perhaps they had subsidised rents for the hospital houses in which they live. Indeed, that was one of the questions which I specifically asked. The answer I got was that, unlike the police, who receive a rent allowance, they receive no rent allowance whatsoever.

Moreover, the rents for the 60 hospital houses owned by Carlton Hayes to house the hospital staff, nursing and otherwise, and which used to be rented favourably for hospital employees living there, so that they paid slightly less rent than they otherwise would have done, have been increased in the last few years by direction of my right hon. Friend the Minister of Health, and now the rents of those houses compare more or less exactly with the rents of similar council houses to let round about.

Moreover, the chronic shortage of staff prevents the chief male nurse from being as selective as he should be in choosing staff. He gets very few applications in response to his Press advertisements. A position in a mental hospital like this does not require anybody; it requires someone with goodness knows how many qualities of skill, patience, understanding and tact. The chief male nurse is unable to sieve the candidates as he would wish, with the result that the general calibre of the male nursing staff is slowly going downhill.

The chronic shortage of staff in this hospital also acts as a discouragement to advancement. The chief male nurse finds that he cannot release for special training for S.R.N, the younger members of the profession who want to get on, because he just does not have the staff to do the jobs in their absence. One finds men—and I was at the hospital only yesterday—in their early 'twenties, newly-married and anxious to get on but finding that in this branch of the Service they are more or less at a dead end. To become a qualified male nurse involves three years' training, and a further two years' training for a general certificate, and it is tragic to see these qualified and dedicated people being forced to leave the profession on purely economic grounds.

As I believe that this debate is to continue all night, I venture to read extracts from the letters of two or three members of the male nursing profession which I think are particularly relevant. They are short extracts, and I am quite sure that hon. Members opposite, being as desperately interested and concerned in this matter as I am, will pay every attention to them—

The hon. Gentleman says that the Opposition are just as interested in the subject as he is. Is he under any delusion at all that it is the Opposition that are taking the initiative in this debate? Vol. 656

I said at the beginning that I was grateful to the Opposition.

The first short extract is from a letter written by George Slough, a male nurse at this hospital. The consensus of his letter is contained in these three lines:
"Is it possible that the Minister of Health does not realise that he is not only dealing with single girls of 18 years but also married men with a family to support? I am a male staff nurse with eight years' experience "—
and let hon. Members listen to this:
"and I take home, after deductions, a meagre £9 odd to support a wife and two young, growing, sons. As you can imagine this does not stretch very far."
Another male nurse at the hospital—H. A. Taylor, R.M.N.—writes:
"In the sphere of mental nursing, it is an accepted fact that male nurses have to supplement their income with part-time work in order to obtain a decent living wage. Can this be truly said to be what your Prime Minister meant when he said his aim was to double the standard of living?"
Here is a further extract:
"The contributory pension scheme asks for 3 per cent. to 6 per cent. of the nurse's wages, no rent allowance, and £5 per year towards the cost of providing uniform. These conditions for police, fire brigade, etc., were obtained after promises of militant action being taken if they were not forthcoming."
I have another letter from a male nurse with fifteen years' experience in this hospital. He is a disillusioned man, who states:
"When I joined the most noble of all professions fifteen years ago, the flame of Florence Nightingale shone bright before my eyes. Since then, the flame has dimmed to nearly the point of extinction, as it has with quite a number of good and dedicated men and women who have left the profession in recent years to earn worthwhile salaries in"
other occupations.

I have files and shoals of letters on similar lines. With the permission of my hon. Friend the Parliamentary Secretary, I will send them to her so that she may study them at her leisure.

I ask my right hon. Friend to act quickly and to instruct the management side to increase its offer of 2½ per cent. I warn him that if it is not substantially increased the chronic situation in this big mental hospital will become worse. Even with an increase of 2½ per cent., the present serious situation will not be contained.

I have confined my remarks to mental hospitals, but I believe that all medical, nursing and professional staffs are underpaid. I have among these papers an official table for England and Wales issued by my right hon. Friend. It refers to the recruitment of hospital staffs from 1955 to 1961. The trend is that since 1955 the percentage of hospital whole-time nurses has increased, the number of hospital part-time nurses has increased, the number of certificated whole-time midwives has increased and the number of certificated part-time midwives has considerably increased.

I tried to relate this table to the information which I obtained yesterday, and it was not until then that I noticed a little note at the bottom of the table saying that these figures did not include mental hospitals. What is the trend in the staffing of mental hospitals? Does it show the same satisfactory increase that the recruiting figures for other types of hospital show? Does it show the same satisfactory trend in staff increases which are shown for mid-wives in my right hon. Friend's table? If it does show that there has been an increase in the staffs of mental hospitals, will my right hon. Friend tell me why the staff of this large hospital in Leicestershire, Carlton Hayes, is so desperately under strength?

Finally, however hard and uncompromising the Chancellor of the Exchequer may be in demanding wage limitations, I ask my right hon. Friend the Minister of Health to deal with this very difficult problem in the Mental Health Service and not to brush it aside with a general answer. I assure him that at Carlton Hayes there is a real, chronic and tragically serious problem which needs investigation and action on his part.

10.25 p.m.

I apologise to the House for appearing in a somewhat unusual garb. I also apologise for the fact that I have not been able to take part in the earlier stages of this debate on nurses' salaries. I sat in the House from 3.30 to 7 p.m. hoping that this debate would begin, and then I had to go away to take part in one of those occasions of Parliamentary hospitality to foreign visitors, which it is the duty of us all to perform from time to time. I hurried back to the Chamber because I was anxious to fulfil a solemn promise that I made to the nurses in my constituency that I would take part in this debate under whatever circumstances or at whatever hour of the day or night it was necessary to do so.

The hon. Member for Harborough (Mr. Farr), who made a most impressive speech on behalf of the efforts which we are making on this side of the House, said that it was inconceivable that nurses would ever strike. But one of the things which has surprised me about their reaction to the contemptible salary offer made by the Government is that they are in a more militant mood than any of us have ever known them, and I suggest to the hon. Member for Harborough that it would be unwise of him, and indeed of any of us, to go on assuming that we can trade indefinitely upon the public spirit and vocational dedication of the nursing profession of this country, because the nurses have just about had enough.

Indeed, one of the things that has inspired me to take part in this debate is the fact that 44 nurses of the Royal Infirmary in Blackburn have been so goaded into an expression of opinion by the Government's policy that they have burst into verse. I have here a long poem signed by 44 nurses from one of the key hospitals in Blackburn. It touches on this very point, and is, I think, symbolic of an entirely new mood in the nursing profession.

I know that there is not time to read the whole poem. [HON. MEMBERS: "Read it all."] Very well, but at the moment I want to quote only two verses as a kind of warning to the hon. Member for Harborough:
"With other professions
Our pay doesn't compare,
And we feel that this
Is most unfair
Between us we work
Round the clock every day,
Who else would do this
For our meagre pay?
If we all went on strike
It would be quite a blow,
In fact, there'd be chaos
If we only went slow.
We don't want to do either
For, of ourselves we must give,
But we are only human
And, we too have to live."
I am not suggesting that the nurses of Blackburn have to be positively frantic before they can burst into poetry, but I suggest that this long poem is a remarkable phenonemon because nurses as a profession are usually fairly reserved people reluctant to push this kind of militancy.

There is another remarkable phenomenon about the present situation to which I think the Government would be well advised to pay careful attention. It is that this reaction is not limited to one small section of the profession, to one sex, or to one rank, or to one branch. It spreads through them all, and, just as I have had this explosion of feeling from 44 nurses at the Royal Infirmary in Blackburn, so I have been deeply impressed to receive by the same post a letter from the matron at St. Asaph's Hospital.

The matron has written to me because she says she is an ex-citizen of my constituency. For about 20 years she was principal tutor at the Royal Infirmary. She has moved on from that Blackburn hospital and is now a matron in a responsible position. She writes:
"May I appeal to you on behalf of the countless nurses whom I have been privileged to train that something be done forthwith to safeguard their status and to recognise the serious load of responsibility which devolves upon them?".
It must be rare for the matron of a busy hospital to write to the Member of Parliament of her former constituency in this strain. I should have thought that matrons on the whole were the last people to write letters to Members of Parliament or newspapers or in any other way to break out of the conventional mode. But this matron has done so, obviously deeply inspired by a sense of public duty.

This matron makes very constructive contributions to our debate which I should like to bring to the attention of the House. She writes:
"In this hospital the following factors pertain:
  • (1) Decrease in the available number of enrolled nurses—between 1st April and 30th September, 1961, the number fell from 20 to eight. These persons state that they cannot afford to practise the art of nursing; and some have gone into industry.
  • (2) Poor recruitment of State-registered nurses who prefer to seek employment in (a) foreign countries, with higher pay, (b) domiciliary fields. The high and early marriage rate aggravates the problem: many nurses find the hours of duty more suited to their domestic responsibilities (often entailing care of dependent and aged relatives).
  • (3) Discontinuation of travelling allowances has increased the financial burden on both skilled and unskilled staff, and has, consequently, affected recruitment. You will also appreciate the difficulty of maintaining a 24-hour service with infrequent public transport.
  • (4) Institution of a 42-hour week for ancillary staff and increased holidays for nurses and midwives has greatly aggravated an already intolerable administrative enigma.
  • (5) Housing and residential accommodation—this is a chronic and insoluble problem whereby the nursing and administrative officers resolve themselves into a 'housing bureau'."
  • There we have from the matron of one hospital an appalling catalogue of disabilities under which the nursing profession labours. The situation that we face tonight is that nursing itself has got into a vicious circle, and the lamentable decision of the Government to impose an arbitrary figure of salary increase unrelated to any of these difficulties or the merits of the case will make the position very much worse.

    The shortage of nurses is leading to very long hours of work for which the nurses get no overtime. What is more, we are now in the ironical situation that not only do they not get any overtime by the nature of their salary contract but they cannot be allowed time off in lieu because of the very fact of the shortage of nurses, which these conditions are helping to perpetuate.

    Therefore, we have this farcical situation, which is demonstrated, for example, in a hospital in Doncaster, a case which my hon. Friend the Member for Barking (Mr. Driberg) drew to my attention as he was not able to be here tonight. He was written to, as many of us have been, by nurses from hospitals in all parts of the country. This is almost a volcano of emotion that is bursting out of constituency boundaries. Nurses are writing to any Member of Parliament whom they think will make a noise about their situation in the House of Commons.

    My hon. Friend had a letter from a former constituent working in a Don-caster hospital, who said:
    "I know that most of the trouble is the staff shortage but if they carry on much longer as they are doing, they will have no staff at all. I am a first-year student nurse doing my turn on night duty. This is a 110-hour fortnight for which we get paid for 88 hours. Therefore, this means that I and the rest of the night staff are working 22 hours for just plain nothing. Is this right in this day and age?… If we were paid for the hours we work or had days off in lieu, it would be something. I like my work, but I would like it a lot more if better working conditions were made."
    My hon. Friend took this up with the hon. Lady the Parliamentary Secretary to tine Ministry of Health and he received the following reply:
    "Nurses in general, as opposed to psychiatric, hospitals have never been entitled to payment for excess hours worked, and there is clearly no question here of giving time off in lieu of excess duty as this would simply transfer the burden from one set of nurses to another."
    Can one have a more classic example of the bureaucratic mind faced with a human problem? There is a shortage of nurses because of the working conditions and the salary conditions, and when the nurses say, "You cannot get recruits because of the conditions", they are told that the conditions must continue because there are no recruits. Is it beyond human wit or the humanity of the hon. Lady to break through this vicious circle? This, surely, is the Civil Service mind at its worst.

    I do not have to go to Doncaster for evidence of the effect which this kind of bureaucratic attitude is having on recruitment. Like other hon. Members, I have had a shoal of letters on this subject, some from outside and some from inside my constituency. Someone who describes herself as a former student nurse at the Royal Infirmary in Blackburn writes:
    "When I commenced training seven years ago I was one of twenty-four. Now I am one of two left, working in hospital."—
    It is a different hospital—she has moved elsewhere.
    "The rest are working in hospital abroad or doing private nursing. I am sure that if we had a salary that was comparable with other professions more nurses would qualify and practice in their own country."
    And so this salary decision of the Minister is declared by nurses and matrons throughout the country to be directly responsible for the chronic and dangerous shortage of nurses.

    I am sure that the hon. Lady the Parliamentary Secretary would be the first to agree that we, in my sex and hers, are used to being exploited. I would have hoped that she would be a better ally with me against the exploitation of my sex and hers which the nursing profession has suffered for so long. We have been used to being cast against our will in the rôle of underpaid ministering angels when what we would really like is a living wage.

    As the hon. Member for Harborough has pointed out, however, more than the exploited sex is involved. Men are involved, too, married men with families who are, as the hon. Member pointed out, engaged in mental nursing. I shall not say that that makes the case more serious. I am against exploitation in all its forms. I am against particularly the exploitation of my sex on the assumption that the little women will remain single anyhow and, therefore, be fair game to do the dirty, underpaid work of the world.

    I point out to hon. Members, in case this is an argument that has more weight with them, that involved in this decision are married men with families, who are being expected to keep a vital service going on what every hon. Member would contemptibly dismiss as being nothing approaching a living wage.

    A massive amount of evidence has been brought to my attention in the letters which I have received. I quote one of them:
    "I am a charge nurse at Brockhall Hospital, Langho, near Blackburn, the staffing problem of which is so acute on account of the small number of trained nurses available, and in the ensuing years there are not going to be sufficient trained staff to take charge of the wards. Only a monetary increase in salaries as forwarded by the Staff Side of the Whitley Council will bring in the nurses to run our hospitals, which are at present in a state of breakdown.
    "I plead with you to use your strong influence in the House of Commons "—
    he is obviously somebody who knows me well—
    "and press the Health Minister to implement a satisfactory salary scale to ease the tension of an exhausted nursing staff who are doing more than their fair share to keep the hospital service from complete breakdown.
    "I would add that in the mental field of hospital nursing, the majority of our trained nurses are married men who are denied any overtime by virtue of becoming trained nurses and are existing on meagre wages after superannuation, National Health and Income Tax have been deducted."
    Many hon. Members can repeat that kind of plea many times over. It is not peculiar to one constituency or one locality. It is endemic in the whole nursing service. This evening we have to ask what we are to do about it. I am sure that we all agree that those who have written to us are not firebrands by nature, or by inclination, are not greedy, not lazy, not clock-watchers, not people who are seeking an easy time in life. They are some of the hardest working people in our community and some of the most reasonable.

    Because of that, we have traded upon their spirit. We cannot trade on it indefinitely. Typical of their attitude was that which was reflected in a letter which I received from the Royal College of Midwives. They wrote, "We do not want more than our fair share of what is available; we are not asking for something extra; we are just asking for a fair deal." By the very definition of his policy, the Minister has set out to refuse it to them.

    That is intolerable. I do not like the assumption that underlies the Government's whole attitude in this debate—"We can drive these people further still; they are not the sort of people who will hit back, for they care too much about their patients." That is true, but if there is any decency in British political life, the people who are not ready to take it out of their patients should be the first to have the consideration of the House.

    I conclude by quoting again from the admirable poem sent to me, most unpredictably, by the 44 nurses of the Royal Infirmary in Blackburn:
    "We try to comfort the weary,
    Ease those in pain,
    Struggle with life—
    Though, sometimes in vain;
    The very best we can give
    On our patients we heap,
    Doesn't this seem important.
    Or is life so cheap?
    So cheap—that they
    Who serve in this way,
    Are barely considered
    When they ask for more pay.
    The recently offered rise of
    Two and a half per cent.,
    We take as an insult,
    Is that, how it was meant?
    So please, Mrs. Castle,
    Though you're busy it's true,
    Speak to the Government,
    We're relying on you.
    Explain to the Members
    So that each understands,
    And perhaps finish by saying,
    'Your life's in their hands '."

    10.50 p.m.

    I see that the hon. Lady the Member for Blackburn (Mrs. Castle) has been supping, as is her custom, with her usual relish at a table groaning with grievances. I have never heard a more one-sided account of a fantastically good service as the National Health Service as she has delivered tonight.

    I shall not dispute the details, but what she said was a one-sided account. It is a pity that she went to her dinner and did not wait to hear what my night hon. Friend had to say about certain aspects of the Health Service. If she had, perhaps she would not have put us in the position of listening to such a dismal story of a pathetic Service. [An HON. MEMBER: "Did you hear him?"] I heard him very well indeed. Perhaps the hon. Lady and some hon. Members who were not here at the time might be reminded of some of the facts. They would not, I think, suppose from the information we had from the hon. Lady that in point of fact for the last ten years of this "miserable nursing profession" whose conditions are so poor that no one wishes to work for it, recruiting in the nursing and midwifery services increased by 16½ per cent. full-time and 132 per cent. part-time, excluding that in the mental hospitals, and 10 per cent. nursing and 62 per cent. midwifery staff in hospitals.

    This is the other side of the picture which the hon. Lady chose to ignore. Other hon. Members who took part in the debate very rightly drew attention to the fact that salary scales in the nursing profession do not bear very fair comparison with certain other professions. This is one reason why I want to take part in the debate. We might also remember though that in the last decade there have been six general salary increases for the nursing profession which have been put into effect by the present Government, the last as recently as December, 1960, which was a percentage increase of 5 per cent. That, incidentally, followed a salary increase which dated from 1st March, 1959.

    Another fact I have not noticed mentioned by my right hon. Friend, or indeed any hon. Member in the debate, is that the nurses' own pension scheme was last year reported to have run into the red to the tune of £80 million. What was the action of this "parsimonious" Government? It was to help to pull the nurses out of their pension difficulties to the tune of £40 million. I look at the salaries prevailing in the nursing profession ten years ago with those prevailing today, and one knows that with the six general increases there has been a considerable increase in the level.

    Will the hon. Member go a step further and compare those salaries which impress him so much with his own?

    I do not see the exact relevance of what the hon. Member says. I am making a simple statement. The hon. Member knows my salary scale as well as his. I do not know whether I would liken my responsibilities with those of a matron responsible for 1,500 beds who at the time when the hon. Member's party was in power could enjoy a salary of £930 to £1,000 and in 1961 finds that her salary scale has gone up to £1,391 to £1,643. Perhaps it would be an impertinence on my part to compare my responsibilities with hers. Nevertheless, if we are in the comparing mood, some people might not think it a particularly adverse comparison.

    In any case, I am sure the hon. Member realises that that is the sort of irrelevant interruption which contributes very little to the debate when he knows that the point of my remark was that it has been consistently ignored on his side of the House that in the last decade there have been six general increases in salary for the nursing profession. Compared with the time when the present Opposition went out of power there has been a significant increase even taking into account the rise in the cost of living. There has been a significant improvement. It is not correct to suggest by any implication that under his Administration the nursing profession did better then. They did not; they did worse, as did practically every profession I can think of.

    I thought my right hon. Friend made a number of interesting points about the recruitment, but his speech left me with a sense of anxiety. Obviously, one has to accept the facts which my right hon. Friend gave. The trend of recruitment is one of expansion. If conditions in the nursing profession were so miserable, one would have expected that, far from there being an increase, there would have been a decline in recruitment. My right hon. Friend proved quite conclusively to me at least that this was very encouraging news. It was a trend in the right direction. On the other hand, during the debate one has heard far too many stories of shortages in different parts of the country.

    In some parts of the country, there are no shortages. Nevertheless, I have the impression that there are too many shortages in too many hospitals in too many parts of the country. I ask myself, therefore, whether recruitment is going fast enough and whether the quality of those recruited is high enough. It seems to me that there are one or two steps which the Government might consider taking in the coming months. I shall come to those shortly. Before I do so, I shall quote from a letter I have received which, I believe, gives a clue to at least one of the two major disappointments which the nursing profession has experienced recently.

    The first of those disappointments was over the way the negotiations have been conducted. I have here a letter from a nurse at a hospital in my constituency —hon. Members will know that I have in my constituency more hospitals, perhaps, than are to be found in most—who is a member of the Royal College of Nursing and who represented the Royal College on behalf of ward sisters and the pediatric branch on the staff side in the recent negotiations. She says:
    "We understood that the negotiations should continue despite the pay pause and the awards could be made although the operative date would have to await the Chancellor's decision to modify or lift the pay pause".
    I suppose that this nurse had in mind the sort of award recently made to some members of the Armed Services. Tonight, for instance, we read in one of the London evening newspapers that certain members of the Armed Services have received half of their pay award. The rest, we are told, will come later when we have moved out of the period of wage restraint—if it can be said that we can ever move out of a period of wage restraint. The impression was that, as the pay pause was working at present, they could not expect to have all the pay award. This is obviously what the nurses felt when they were told that their pay claims would be considered on their merits. They thought that people would go into the matter and say, "All right. You deserve x per cent. more, but, because the pay pause is at present operating, you must unfortunately forgo a certain percentage of the increase". The fact that it was not put in this way accounts to a large extent for the anger which has been expressed. That is certainly what I gather from the correspondence which I have received.

    The second disappointment lies in the fact that the financial inducements to stay on in the service do not appear to them to be good enough. I can best illustrate this by giving the salary of a ward sister, a nurse of some training and experience. I believe that the most she can earn is about £12 to £16 a week. The interesting thing which crosses my mind and which, I assume, has crossed the minds of many ward sisters, is that at the very beginning of her work as a ward sister she receives the same amount of money as a three-year trained non-graduate teacher, but when she reaches her thirties she receives £300 to £400 less than a three-year trained non-graduate teacher of the same age.

    That is just the time when anyone who has taken on a responsible job and has gained some experience at it feels that he ought to have some sort of tangible reward, which at least compares with the tangible rewards which other people in similar professions are getting. The feeling that higher wages do not match higher responsibilities is very strongly felt by the professions supplementary to medicine. Some hon. Members have talked of physiotherapists. I have the Moorfields Eye Hospital in my constituency, and I paid the orthoptists a visit recently. The main point they made to me was that after seven years, when they were holding responsible posts, they reached a dead end financially. This is what causes resentment to set in.

    The resentment stems from the fact that some people feel tempted to leave their occupations. One hears from time to time that this is the point in a person's career when she says, "I will chuck it. I do not feel that I am getting on in the way I should. I will leave it and get a job outside the profession". This makes a dedicated member of the profession resentful and almost ashamed because she gives way to this temptation. It makes her feel angry with authority, because she feels that authority undervalues her experience at that time in life when she wants to make a little extra and put something aside for old age.

    Members of these professions are also angry because they feel that society has presumed too much on their public spirit. This is the impression I formed from the correspondence I have received. It seems to me that if, at bottom, theirs is a financial grievance, the right way to tackle it is to have a look at the wage structure. I am sure that this applies just as much to the teachers' problem that we faced last year. It is not so much an all-round wage increase that we want in the nursing professions and similar professions as that selective groups within those professions, particularly those who have got some position of authority, feel the need for extra financial assistance.

    I can see how difficult it is to determine what is or is not a fair wage for professions like the nursing profession. The Government White Paper on "Incomes Policy: The Next Step" made it clear that comparability cannot always provide a fair yardstick on which to base a wage claim. I can see that it is attractive to say that because such-and-such a group receives £X hundred a year another similar group should also receive £X hundred. But there are cases when that yardstick must not be used

    I can appreciate the difficulties in the nursing profession, especially when using productivity as a basis on which to demand an increase in salaries, although it is true that in 1960, 500 fewer midwives delivered 100,000 more babies than in 1955. I know that the infant mortality rate has gone down, so that we can assume that midwives do their job properly. But there are other parts of the nursing profession where productivity is no guide. The truth is that the services of too many groups like nurses have, in a sense, been monetarily undervalued for too long.

    Despite this, people have been willing to come forward, but whether they will be so willing to come forward, or to stay in posts of responsibility so readily, in the future I beg leave to doubt. One reason why they stuck at these jobs for so long and for such a pittance—far less than they receive today—was that professions like nursing had an aura of security around them which did not apply to other jobs. But with full employment in most areas of the country, other jobs have security to offer. This great advantage of the nursing profession, therefore, no longer exists. Nursing and similar professions no longer have a monopoly of security, and they are caught up in a vicious wage-cost inflation which makes their position particularly poignant.

    An all-round wage increase is not necessarily the answer. Too often people have assumed that the present wage scales are a deterrent to recruitment. My right hon. Friend showed that apparently they have not acted as a deterrent. Too often we underestimate the fact that in this and other similar professions there are other features which are an attraction. An example is that of people who become Members of Parliament. Salary could be an attraction but not the primary attraction. One of the great features of nursing is that those who enter the profession do so of their own volition because they want to do that job and are happy to do it. To be doing a job which one wants to do and enjoys doing is a great satisfaction which is often denied people.

    The question of trying to relate the wage levels of professions such as nursing to the national economy is basically a question to which the National Economic Development Council should give close attention. We certainly want guidance on it. In the meantime, I and many of my hon. Friends hope that my right hon. Friend will institute an inquiry. He said that there had been an inquiry some years ago, but it appears that another is necessary into the wage structure of the nursing profession. There is no doubt that at a certain level in the profession there is dissatisfaction and discontent with the present structure.

    11.07 p.m.

    As we discuss this question tonight there are men and women throughout the country who are waiting with patience and, unfortunately, in many cases with pain for a bed in a hospital. There are many vacant hospital beds simply because we have not the nurses to tend them.

    How does this anomaly arise? It arises because we are dealing with another facet of full employment. It will be increasingly difficult to get girls to take up nursing when other girls, with far lower educational qualifications, can go into comfortable five-day week jobs and get much more money than a nurse can ever get.

    We must pay attention to this. Hon. Members have said time and time again in the debate that the wage paid is not everything, and that is true, but it counts for a good deal. If the wage is not everything, let us look at one or two other problems. Nursing must go on for twenty-four hours a day and 365 days a year. Nurses must work when other people are sleeping and when other people are playing. If we add the fact that they are relatively ill-paid, we have the answer to the question, why are we so short of recruits and why are hospital beds empty when so many people are suffering?

    The hon. Member for Holborn and St. Pancras, South (Mr. G. Johnson Smith) said that girls go into the nursing profession because they want to do nursing. We talk about the dedication of nurses. I am beginning to find this a sickening phrase. We pay the nurses lip-service—and we refuse to pay them.

    I was talking to a hospital matron some time ago when this question of the dedication of nurses arose. She went rather further; she was very blunt about it. She said, "If a nurse comes to me and shows the slightest interest in salary I have no interest in having that nurse in my hospital, because a nurse must, of course, be absolutely dedicated." What a lot of arrant nonsense this is. Is it pretended that somebody will be less dedicated because we recognise her worth and pay her accordingly? It is really time we got away from this sort of hypocrisy.

    This is tied up with the Government's policy on wages. I think the Government were wrong in that policy, and I think they acted rather stupidly over the pay pause. If it was right for the Government to intervene in the wages question, was it right to make a one-way street of it? If it was right to intervene on the wages question and say, "If wages increase that will injure the economy", is it not equally right to intervene when wages are low, as they are in the Health Service, so that it suffers in consequence, because it cannot get the people it needs? This 2½ per cent. was a terrible insult to all the people engaged in the Service. The hon. Member for Holborn and St. Pancras, South said the superannuation fund was in the red. Having regard to that, and having regard to the higher salaries and non-contributory pensions of the higher Civil Service, it was an outrage that those people should call upon nurses to accept a salary increase not exceeding 2½ per cent.

    I hope the Minister is not going to say in reply that we cannot afford to give nurses more. I must anticipate him, and I say to him that I do not think we can afford not to. I think we must afford in any circumstances to see to it that these nurses have an increase. They should not wait for another commission; they should not wait for another committee of inquiry. This should be treated as a matter of extreme urgency, and they should be given an increase now.

    I believe—and I speak now as a trade union official—that if this pay pause were to be broken by the Government for the nurses none of the trade unions would exploit that breach. They would accept it, I think, as fair and just to people who have been long suffering. I also believe that if the Government were to breach their own pay pause the Government would receive acclaim from the public.

    The Government propose to spend £500 million to £700 million in the next 10 years on hospitals. That is a sizeable sum by any standards, and I think it is laudable that they do it, but how ironical it would be if, having the modern buildings and modern equipment, we were still to have inside the hospitals the Victorian attitude towards the people who staff them. If we are to have the hospitals staffed properly we have certainly got to alter our attitude towards the nurses' pay and conditions.

    What a tragedy and an irony it would be, if we are expecting the hospitals to continue with the blood transfusion from colonial and Commonwealth nurses, and we could not get these people. How many more beds would be empty? The Minister in an answer the other day said it would be about 7 per cent. Surely to goodness what we ought to do is to recognise the problem for what it is? We talk about standards, and I do not object to that, since these standards affect human life, but really there is only one standard.

    To me, it seems to be very wrong indeed that even under our present hospital system those with the ability and the willingness to pay can get beds without much delay, whereas the ordinary individual, unless the case is very urgent, has to wait weeks and months for a bed because we cannot decide whether or not we mean what we say when we talk about our dedicated nurses. For heaven's sake, let us stop this exploitation, let us pay the nurses properly, and let us do something about it quickly.

    11.15 p.m.

    Of the many contributions to this debate I do not think there has been one in which there has not been the suggestion of a review of the pay of either the whole of the nursing staff or, as was said by my hon. Friend the Member for Holborn and St. Pancras, South (Mr. G. Johnson Smith), of the senior part of it.

    The debate has been divided into three parts. In the first part, doctors were referred to. There is frustration among many members of the medical profession who choose to stay in this country and specialise. Many of those people study for a number of years after taking their degrees, and after spending a time as house surgeons in hospitals. They go on to acquire fellowship of the Royal College of Surgeons or membership of the Royal College of Physicians, but they often have to wait until they are in their forties before getting a part-time or full-time consultant appointment. Even when they get the appointment, it often means moving very far from their homes, from their friends, and from the hospitals in which they trained. The Minister should look into the genuine shortage of senior hospital appointments if he wishes to encourage those in the top end of the profession—those who specialise—to use their skills in the United Kingdom.

    I am not satisfied with the statistics about the number of doctors going abroad. Various figures have been quoted today, but the Ministry does not seem to have adequate knowledge of the number of doctors who go abroad, how many stay abroad and how many return. I know that a large number of men who were at university with me have had to emigrate in order to find the jobs and the rates of pay they expect as professional men. I therefore ask my right hon. Friend to look particularly at the statistical side of the matter.

    Not a lot has been said about the professions supplementary to medicine but here, again, there is a case for a particular or special review. The other day I received a letter from a physiotherapist. He was an Army officer who was blinded during the landings at Salerno. He stayed on for three years' training as a physiotherapist, only to be offered a salary of £550 a year, rising, after a number of years in practice, to £650. It has already been pointed out that a London parking meter attendant gets £600 or £700 a year. One hesitates to draw comparisons with other professions, but is it right that that physiotherapist, in a full-time, responsible position cannot, as he told me, afford to give his two children a professional education if he wishes to?

    The major part of the debate has been spent in discussing the situation of our nurses. It is freely admitted that many provincial hospitals are under-staffed. I have heard complaints about this from hospitals in this country and in Northern Ireland. The hours of work for nurses have been reduced recently from 48 to 44. But the nurses work a longer week than many other people connected with the hospital service. Nurses work on day and night shifts without any extra pay, and they work on Sundays and public holidays. They receive only four weeks holiday a year, and the pay scale in this country is much lower than in most other countries.

    The International Council of Nurses publishes reports from about 30 or 40 countries giving the terms of service and the hours of work of nurses. Throughout the world there has been a general rise in the pay for nurses. It is most marked in Scandinavia. In Denmark there has been a 70 per cent. rise since 1957. In Sweden the figure is 45 per cent. In the United Kingdom it is only 25 per cent. The reports give many other figures of hours and rates of pay. In Belgium and Finland the rates of pay are about £600 or £650. In Denmark the figure is £700 and in Sweden £800. In Britain it is only £525. In the Scandinavian countries nurses are paid extra for night work and Sunday work and their salaries are tied to the cost of living. In those countries the salary scales rise more sharply than in this country.

    So far as they can be compared with this country, the salary scales in Canada and the United States rise from £900 for a newly trained nurse to £2,800 for a hospital matron. I suggest that these figures reveal how far Britain is lagging behind in respect of pay for these very important people. Hospital sisters with three or four years' training who enter the service of an oil company, such as Shell, and go to Borneo or Singapore, are offered £2,000 a year. There may be certain disadvantages in going abroad, but the rate of £600 or £700 offered in this country cannot be compared with a salary of £2,000. Some students qualify and then decide to specialise in some branch of nursing such as midwifery which has been mentioned during the debate.

    In order to take the two-year training as midwives, nurses have to revert to student grades of salary, that is to say, they revert to a third-year grade, the salary for which is £336 per annum from which is deducted £128 for board and lodging. Is it right that trained nurses who decide to become midwives and who have already done three or four years in the nursing service should have to revert to this very low salary scale which leaves them with barely £200 a year after they have paid for board and lodging? I believe that it is in these poor salary scales that one finds the reason for the shortage of nurses, particularly in such specialised fields of the service such as midwifery.

    Much has been made today on both sides of the House, and particularly by my right hon. Friend the Minister of Health, of the White Paper on "Incomes Policy: The Next Step". If it is true that in this country we are going to have to wait until the wage pause and the following steps have taken effect before there is a general rise in the pay of nurses, we might have to wait a very long time.

    Surely the whole policy of the Government at the moment is one of continuing wage control. It is not just a one, two, three or even five-year policy. It is a policy which along with the National Economic Development Council is intended permanently to fix wages in this country and to relate them to rises in productivity. Paragraph 3 of the White Paper quotes the speech made by the Chancellor of the Exchequer in the House on 18th December, 1961. It says:
    "He explained, however, that, given the complexities of the problem, a long-term incomes policy of this sort would inevitably take a considerable time to work out. The Government hoped, however, to make steady progress towards that end."
    As part of this complex long-term in-comes policy, I would suggest to my right hon. Friends on the Front Bench that they should look particularly at the special circumstances of nurses. The Government admit in paragraph 5 of the White Paper that there may be particular circumstances in particular cases. They say that arguments based on increases in the cost of living and on the shortage of labour should not apply.

    I say to my right hon. Friend the Minister of Health most sincerely that if he is going to argue that because there is a shortage of labour in one field the income of those engaged in it should not rise out of keeping with the rise in productivity in the rest of the community then the corollary must also be true. Even though one admits that the number of student recruits to nursing has risen, if the corollary is true simply because the number applying has risen, it does not show that their incomes should not rise or should stay in step with other incomes where special reasons attach to the case.

    The Government cannot have it both ways. They cannot say, on the one hand, that because there is a scarcity of labour in a certain field of activity that incomes can rise sharply and, at the same time, not admit the truth of the other case. I wish to press this most strongly on my right hon. Friends.

    As a number of hon. Members wish to speak even though the hour is late, I will conclude by saying that after studying all the rates of pay which I have quoted to the House tonight and which are to be found in the official reports, one is left with the feeling that because of the dedication and the responsibility of the nursing and medical professions their members are being exploited by the public and by the State as a whole. They are exploited by the public as well as by the Government, because the public foot the bill in the end. It is all very well for the right hon. Member for Belper (Mr. G. Brown) to say that the Government should pay or do this or that. It is not the Government but the country that must pay.

    I say most sincerely that we have had our medical services on the cheap for far too long. Any hon. Member who has been to France or the United States and faced the possibility of being ill there will know what one has to pay for medical services abroad. The fact that members of the nursing profession undertake that they will not strike because they are dedicated to their profession is no reason why the rest of the public should exploit that position.

    Even if it means an increase in the National Health stamp in order to pay the nurses and other professions supplementary to nursing and the doctors reasonable remuneration, the Government should put this fairly and squarely to the public. The Government cannot build, as they are suggesting, a wages policy which is based on an unsound foundation. There is a very special case here, particularly for nurses and the other medical professions that I have mentioned. There is an urgent need to get the basis right here and now. It should not be put off to an unknown date. The Government should start now on a fair and firm foundation and admit freely and frankly that nurses and other medical professions are underpaid. They should agree to have a thorough and complete revision of the salary scales, and start on that basis with the national policy.

    11.32 p.m.

    Whenever one hears the hon. Member for Belfast, East (Mr. McMaster) one becomes more and more surprised to find him sitting on the Government side of the House and not on the Opposition benches. Judging by most of the speeches I have heard him make and the Divisions in which I have seen him take part, he always seems to be on this side spiritually and frequently physically. Presumably, one can explain this only by the fact that he is an Irishman and feels that, although he is with us, he must sit on the other side of the House in order not to be conventional.

    In the case of the speeches made by some other hon. Members opposite, it would take far more effort to be courteous and chivalrous than one can muster at this time of the night. However, one is pleased to see that the Secretary of State is enabling us to continue this debate, because this is a subject on which there is a great deal of feeling on this side of the House and a number of hon. Members want to make brief, snappy speeches in the time that remains.

    I regret very much that the hon. Member for Holborn and St. Pancras, South (Mr. G. Johnson Smith) is not at the moment in his place. He made a particularly offensive attack on one of my hon. Friends in a speech which I thought was in large part insulting to nursing staff in general. One thing which must be made clear is that hospital staff do not want sympathy. They are fed up with slushy sentimental references to Florence Nightingale. With the greatest respect to that deceased lady, I think that the memory of Florence Nightingale has done more damage to the living standard of staff in the National Health Service than anything else. Every time they ask for the sort of standard of living which is accepted as normal for any other section of the community, there is always someone, as we have seen tonight, with the insufferable arrogance to tell them that they have no right to mess about with ordinary wage negotiations because they have chosen a vocation. Nurses take up nursing for exactly the same reason that other people become shorthand typists or work in factories or go on the stage—because they have to sell their labour to obtain the means to live and they prefer to nurse rather than to do other jobs.

    The fact that they perform a service and work in an industry which is essential to the community and do a job for which all of us are extremely grateful is no excuse at all for using this against them to dodge what is their night to have a decent living. There is too much of this business that they choose to go into their jobs. Of course they do. The hon. Member for Holborn and St. Pancras, South chose to come into this House, as we all do. [An HON. MEMBER: "Not for long"] There is evidence that there are a great many people who will choose to put him outside next time. They will not be Liberals. As we discovered this afternoon, their spurt of enthusiasm has been short-lived. We had four of them here earlier and they have now, as I believe is the colloquial expression, "knocked-off" for the night. Apparently we are not to be honoured with their presence any more. But British democracy has functioned effectively without their help for years past and probably will be able to do so in the future.

    Hon. Members have made contributions to this debate which have either been naive to an unbelievable extreme or have been sheer unadulterated humbug I do not know which. Several hon. Members said, with voices quivering with emotion that they thought the Minister should examine the possibility of setting up a committee. They do not want a committee. One cannot keep a family with a committee. One does not achieve anything specific with a committee. The Chancellor of the Exchequer set up a committee to examine the economic problems which faced the country and he came here a week afterwards to say that we were millions further into debt than we were before. Committees do not achieve anything.

    We on this side of the House do not care very much whether the Minister sets up a committee or not. As he explained earlier, he has already made up his mind. He knows what the answer is. We know his policy towards people in the National Health Service. We know why the right hon. Gentleman came into office. He came in not as a great Minister of Health, not as a person with a great background of reforming social zeal but as a person who had an enormous and justifiable reputation for being severe and being able to regulate the finances of the State. His purpose in coming into the Ministry was not to assist and expand the Ministry but to control expenditure within the Service, and that is the task with which he finds himself faced.

    There is another comment which I want to make, because it was objected to earlier by the hon. Member for Holborn and St. Pancras, North, whom I am glad to see is now present. When he was comparing the salaries of nursing staff under the Labour Government and salaries under the Conservative Government, I asked the simple question whether he would go one step further and compare these with his own salary. I think that that was a perfectly relevant point to make. By what right does the hon. Member arrogate to himself a salary which no nurse in the National Health Service could ever hope to obtain? Why does he think that the nurses are not too badly off? When a matron in charge of a hospital with 2,000 mental patients could not hope to get the basic salary which he gets as a Member of Parliament, why should he think that that is the way things ought to be? He is entitled to express the belief that some of us are entitled to higher levels than others.

    If one says that these people in the Health Service are not entitled to the same standards as other people and that they are a sort of industrial coolie group who should be on that kind of salary level, it is a fair argument. It would be interesting to know how many hon. Members opposite would have the courage to make it on their platforms, but it is the only argument that the hon. Member can substantiate if he says that the nurses are not too badly off when the most eminent members of their profession can never hope to attain a salary anywhere near his own.

    A number of other hon. Members came in and made similar contributions. Over and over again, they made the point that the Government should look at the situation. As I mentioned in an intervention, the general secretary of one of the trade unions within the National Health Service sent a telegram to the Prime Minister. He got a reply, dated 26th March, not from the Prime Minister, but from somebody whose signature I cannot even decipher. [An HON. MEMBER: "The Prime Minister has gone to Stockton."] He may have gone to Stockton, but it will not do him much good.

    The reply stated:
    "The Prime Minister has asked me to reply to your telegram about the nurses' and midwives' pay claim, and to say that in following the guidance of the Minister of Health and limiting their offer to an increase of 2½ per cent."—
    then came the simple answer to an organisation representing 50,000 hospital workers—
    "the Management Side of the Whitley Council were acting in accordance with the Government's policy in incomes as set out in the recent White Paper."
    Do hon. Members opposite, including the hon. Lady the Member for Tynemouth (Dame Irene Ward), want us to have another committee so that it will tell us the same after meeting at public expense for some months? This business of standing up on the back benches and saying, "And I want the Minister to know that we are not prepared to be satisfied with this is attractive for the local paper, but we all know that everything about which we complain, on both sides of the House, in this issue this evening does not just happen. It is the direct result of Government policy.

    Hon. Members opposite cannot have it both ways. They cannot come along in righteous indignation all over the place with bags of moral fervour. The hon. Member for Harborough (Mr. Farr) objected to my right hon. Friend the Member for Belper (Mr. G. Brown) bringing morality into the question. I understand the hon. Member's objections. As soon as one talks about morality, the benches opposite are immediately occupied with people who are obviously physically and mentally uncomfortable at such references.

    Far be it from me to go into too much detail about whether any lady Members are comfortable or uncomfortable at this stage in the proceedings. The important point is that hon. Members cannot attack what is happening in the National Health Service without attacking the Government, because this is a Government decision.

    Staff in the National Health Service—and I know a lot of them—need to wake up to the fact that it is no good writing indignant letters to Tory Members of Parliament and voting Conservative at the next General Election, because the political reality is that this sort of thing is the inevitable result of a Conservative Government, who see people in different groupings and have a different attitude to these things.

    The Minister of Health, in one of those revealing asides which he makes from time to time, mentioned his views about physiotherapists. I hope that I do not misquote him, but I understood him to say that physiotherapists should not be wasted on those who can no longer benefit from them. That was what I understood him to say.

    What we like about the right hon. Gentleman is his honesty in these matters. On that philosophy there are many old-age pensioners who could not benefit from physiotherapy. There are many people who in the long run could not benefit from physiotherapy because they are going to die and cannot be saved. It makes their last years more comfortable, but it does not cure them.

    We believe that a comprehensive National Health Service should be available to any person who can get a doctor's certificate saying that he needs it. There are people who are found to be in need of medical treatment which they cannot get precisely because the right hon. Gentleman, who should have been defending the Service, has been running it down.

    He came out with some very interesting arguments. To listen to the right hon. Gentleman one would think that there was nothing wrong with the Service. He asked why there should be all this fuss about the shortage of staff. He said that he did not want to quantify the situation for the years ahead. Of course not, but we are asking him to look at the situation now. Let us take the example of radiographers, whom the right hon. Gentleman does not regard as being scarce because he did not include them in the exceptions. There are two commercial firms in London offering a 24-hour radiography service. As the right hon. Gentleman knows, there are hospitals in London which cannot guarantee to carry on a 24-hour radiography service. If his State hospital service has to call in a commercial firm to do this essential service, there is something wrong with the administration.

    The right hon. Gentleman spoke of nurses and gave the apparently attractive answer that we wanted to encourage more married women to return to nursing. He got many cheers from hon. Members behind him who said that this was a good policy. But it is the worst possible policy which could be applied to the nursing profession, because married women clearly want the most convenient hours. That is understandable. Married women want to work from eight in the morning to five in the afternoon and they want week-ends and bank holidays and no night duty and no split shifts.

    I have in my hand a letter from the physician superintendent of the leading mental hospital in my constituency and the final paragraph says:

    "It is felt that more use could be made of part-time trained nurses in Mental Hospitals, particularly female staff that have married".
    That is the opinion of a very wise and capable medical man.

    The hon. Member has a faculty for missing the point. If there is a serious shortage of nurses, of course one is keen to get nurses from any quarter, and in some cases married women are the only hope for people who are trying to keep the hospitals going. But the hon. Member and other hon. Members with the same attitude should have a chat with full-time nurses and should ask them if they are happy about the influx of married women with families who, quite naturally, cannot work the uncomfortable hours. It merely makes the position that much worse for the staff who are already there. It is not only salary which makes it difficult to fill nursing and other hospital posts. It is the matter of the awkward and unpleasant and difficult hours which have to be worked. If many married women are brought in, the situation is intensified. The hon. Member's medical superintendent may be left in the position of having no alternative but to bring in married women, but I am saying that if the Government produce a situation which deliberately encourages that, in the long run it does more harm to nursing recruitment than does anything else.

    The hon. Member for Harborough made great point of the fact that doctors and the medical profession generally do not take part in strike action. There was a particularly unscrupulous general secretary of the British Medical Association who, when we were eating our breakfast cereals, could be heard inciting doctors all over the country to take action. There was most blatant political propaganda from him. He may not get his reward in another place, but he has had it here in this House. If the hon. Member thinks that doctors are happy and content with the present position, I would be prepared to arrange a meeting, in pleasant surroundings, of the Greenwich Branch of the British Medical Association with the right hon. Gentleman and the hon. Member, who can tell them that on the whole there is no serious trouble about the doctors. One gets the impression that although the right hon. Gentleman and the Parliamentary Secretary know the position—

    The hon. Member will know, being a master of the art, that there is a great difference between the fact and drum banging and bluff, a great difference between the fact and what one intends to do. I was referring to medical staff, student nurses male and female, who have told me that no matter what some militant drum banger may say they have no intention whatever of going on strike because they feel morally quite unable to do so.

    I accept that from the hon. Member. I do not think that the nurses would strike. That is one of the things which upsets me, because if there were any danger that they would, the right hon. Gentleman would not have the guts to implement the policies he is bringing in. The whole debate is not just an argument about whether nurses ought to have a 2½ per cent. increase or not, or a question of whether a particular rate of pay is reasonable or not. This is a major debate on a major issue of principle. As the hon. Member inferred, it is a question of whether we kick the weak because they are weak and for no other reason. No hon. Member has suggested that the social contribution of these people is anything other than first-rate. No hon. Member on either side of the House would suggest that the rates of pay are reasonable. Only one argument can be put to justify the present situation. That is that the Government can get away with it. That in itself is appalling.

    Another issue involved is whether employers and employees should be allowed to settle their salaries between themselves. How can the Minister or anyone else expect employees to have faith in collective bargaining machinery when the results of that bargaining machinery are implemented only if they are satisfactory to the Minister? I know that he could say that this has always been the situation in the Health Service and obviously the Government must have some right of intervention when Government money is being spent. From a purely personal point of view which does not involve anyone else, I should like to see a situation, if the Government are to intervene directly, in which they have representatives on the Whitley Councils representing the Minister. Let us not have this situation where, when there is negotiation and the management side agree with the staff side, the Minister steps in and says that, on second thoughts, he will not pay.

    The whole future of the hospital service is involved. The Government may produce all sorts of glossy figures and arguments to show that the position is really very good, but there is no one in the Health Service who is not worried at the gradual decline of standards on the nursing side of the Service. There are hospitals where the situation is now becoming positively dangerous for the patients because of lack of qualified staff. On the figures alone—and this is a situation which the Minister apparently does not find particularly worrying—we are at the moment short of 25,453 nurses. I should have thought that that was something to worry about, but the whole burden of the right hon. Gentleman's speech was that there was no real need to be worried. But the actual shortage of nurses in numbers is only part of the story.

    The General Nursing Council has for a long time been talking about education standards in nursing, and from 1st July next, or 1st June—I am not sure of the date—it is to allow certain minimum education qualifications, two O-level passes in the G.C.E. and certain undefined standards of competence in five other subjects. This is the best we can do—two O-level G.C.E. passes-but the Minister has had to intervene and say that even that standard cannot be introduced in mental hospitals. If patients in this country are to be nursed by people of whom it is too much to ask that they should have two O-level G.C.E. passes, this is something which hon. Members opposite who think seriously about nursing cannot regard with complacency.

    The short answer is that, if it were not for unskilled staff and completely untrained staff in hospitals assisting the nurses, the whole of our National Health Service would collapse. If there were a ban upon immigration of the kind with which some of the more enthusiastic hon. Members opposite toy—

    That is so. The Prime Minister's successor has been very good at keeping them quiet.—[HON. MEMBERS: "Who?"]—I should have thought that the Leader of the House was steadily becoming a one-man Cabinet. He is spokesman on the Metropolitan Police Force, he is the one who deals with Central African Affairs, and with the Common Market—

    I am sorry. I did not mean to refer to the Leader of the House. I meant the Home Secretary.

    It is the only job he has not got. Reverting to my hon. Friend's remark about the Prime Minister's successor, may I point out that my right hon. Friend the Member for Leeds, South (Mr. Gaitskell) has not intervened in the matter at all?

    I think that my hon. Friend has been overtaken by events. I do not imagine that even hon. Members opposite will put up with the present management until the next General Election.

    I shall leave that point because I am being drawn away from the path of righteousness.

    If hon. Members opposite were successful in banning immigration to the extent which some of them want, our hospitals could not continue. We welcome into this country girls who wish to take up nursing training.

    I do not think that my hon. Friend has been very generous to the right hon. Gentleman the Home Secretary. He has forgotten to say that the whole of the vast arrangements for Civil Defence have been primarily his responsibility and his work, and that he has been responsible for the digging and the construction.

    I believe it was a Socialist economist who first set the principle for digging holes and then filling them up again. This looks like another field in which we might find the right hon. Gentleman.

    Nobody minds, and everybody is pleased, when girls from the Commonwealth or our colonial territories come to this country to train as nurses.

    One of the problems which face the nursing profession and the poor British taxpayer—and the hon. Member for Tynemouth made a valid point about the need to avoid wasting money at a time when it is thought that money is being saved—is that an enormous number of people are trained by the National Health Service for professions which they have no intention of following within the Service. Many girls from our overseas territories come here for training, and we are pleased to have them, but they do not intend to stay here. We see many coloured student nurses, but seldom a coloured sister, because a coloured sister can go back to her own country and get a good job. Over 5,000 people in this country are in industrial nursing. Industry finds no difficulty in getting qualified nurses, because it outbids the National Health Service. The Service trains laboratory technicians, but Glaxo, I.C.I, and Oxo take them afterwards. We are training people to use elsewhere the abilities they acquire.

    I am worried about the number of people who come into nursing—not as professional nurses but as ward nurses—straight from the local labour exchange, without any qualifications at all. We are pleased to have them; we could not function without them, but it is a sad state of affairs. As for professional nurses, there are more unqualified and non-qualified ones than trained ones.

    The students are the biggest group of nurses in the profession. Therefore, the situation as it affects students is important. It is no good saying that we are not doing so badly in nursing recruitment when, at the same time, we are doing badly in student nursing. At 20 years of age a third-year student nurse collects £259 a year, after paying board and lodging. After paying National Insurance and superannuation in addition, she if left with about £4 a week, for a 44-hour week—if she is lucky.

    This evening's Evening News contains an advertisement from Barclays Bank, offering a number of clerical vacancies for single or married women up to 27 years of age. The commencing remuneration depends upon age and experience, but at 16 years of age the minimum salary would be £385 a year, rising to £650 a year at the age of 27, with a non-contributory pension scheme, sports and social facilities, and a generous marriage gratuity. There is another advertisement for a secretary at £16 a week—W.C.I, contact Museum 8090.—[HON. MEMBERS: "Oh."] The trouble is that one is joined by the bawdy-minded after midnight. The same paper advertises vacancies for clerk-typists at £15 a week. Does the Minister think that a girl, after three years' training, will work for £4 a week when she can pick up a newspaper and have a selection of jobs, with much more pleasant conditions, much shorter hours and no awkward hours, which offer not a few pounds more but three or four times as much?

    There are some girls in the world who think that hospitals offer more pleasant conditions than do banks, thank heaven.

    Student nurses who have to wash bed pans frequently find hospital work much more unpleasant than outside work. The ancillary worker, the manual worker, who washes filthy linen, who washes the faeces from it and the solid filth, gets an extra payment for it—Is. a day, I believe.

    One cannot compete with such remarks as that. The hon. Member has a comfortable life.

    The only point I was trying to make—and I am not seeking to have a big argument with the hon. Member—is that most nurses regard nursing as a vocation.

    If the hon. Member had had his priorities differently organised and had placed his interest in nurses before his interest in his dinner, he would have heard that point made several time;, and answered. Of the nurses, 30,000 are men. They have families, and they cannot keep their families on the hon. Member's patronising remarks about a vocation. They want to buy clothes for their families and they want to go on holiday, as the hon. Member does. They would love to be in a position in which to talk about holidays can be as amusing as it is to the hon. Member. They would like to have as much money in a month as he has in a week. They want a decent standard of living. If the hon. Member can understand that point, then the debate will have been worth while, because at least one sinner will have returned to the fold.

    The hon. Member, who came into the debate late, should not have intervened from a sitting position if he had not wanted me to answer and he should not have made insulting remarks about those who cannot speak here for themselves if he had been frightened of someone being unkind to him.

    The fully qualified staff nurse, with three years' training, joins at a salary of £525 a year, and after six years she can rise to £656. Out of habit I refer to "she", but this is probably the only profession in which men were assimilated on to women's rates of pay. The equal pay award meant that men went on to rates of pay formerly designed for women. These are male rates, paid to males and females.

    Let us look at the position in Government Departments. Let us look at the Services, which are controlled by the same people, by the Government and the Cabinet. If the same girl with the same qualifications, a State-registered nurse, joins one of the three Services, she is on a salary scale of £584, rising to £666 in four years. The position is even worse than that because in the National Health Service they are not given board and lodging, whereas in the Armed Services board and lodging are provided. The comparison is with the £239 a year extra which a person with exactly the same qualifications and also working in the public service gets in the Forces, and the reason, of course, for this is, that the Services are regarded as key services which have got to attract nurses. I should like the right hon. Gentleman when he winds up—

    much later to tell us why it is that in the Services a State-registered nurse, trained in a civilian hospital, can get £239 a year more for doing precisely the same job she would do if she were in a civilian hospital

    To give another example of this sort of meanness of the Government in dealing with medical people—and we must not forget that this is not a matter of nurses only but of others, too, in the National Health Service. Here is an example which I passed to the hon. Lady the Parliamentary Secretary recently. It was raised with me by members of the B.M.A. in my own constituency. In the recent smallpox scare doctors worked very long hours giving vaccinations. After some negotiation it was decided they should get 5s for each successful vaccination. Then they discovered to their horror and surprise that the 5s. for each successful vaccination was to be taken out of the doctors' salary pool. So the doctors were to pay themselves for the extra hours they put in doing vaocinations.

    I am not quite sure that my hon. Friend's information is quite correct. Perhaps the Minister will verify it.

    As I understand it, my doctors were complaining that they received no fee at all for vaccination of adult persons. If that is true, the statement made by the hon. Member is not quite correct.

    I hope the Minister will throw some light on this situation because there is some interest in this among doctors.

    The position is this. The doctor does not get paid for a vaccination but is paid 5 s. for filling up a form. A local health authority doctor does the vaccination, while an industrial doctor fills up the form. So it is an industrial doctor who gets the 5s.

    This seems to me to get more Gilbentian as we go on. We should like to know from the right hon. Gentleman all about this issue, because it has been raised with us by constituents and we should like to know the answer to these questions. Is it possible for a person who is not giving the vaccination to receive the payment for it? Even if it is possible, and whoever gets the 5s., where does it come from? Does it come from the doctors' pool and are the doctors paying themselves? Not all hon. Gentlemen opposite are as bad as they sound, and some of them at least would agree that in common justice, if the medical profession is to have some recompense for what were very long hours—I think we have all seen the queues outside the vaccination centres at midnight and after—that recompense should not come from the doctors' salary pool and ought to be provided by the Government, and that the doctors should not be fiddled in this way. We look forward—much later, as my hon. Friend said—to hearing the Minister dealing with these points.

    What are the effects of all this? The right hon. Gentleman seemed to suggest that there was really nothing much wrong with the set-up at present, but the plain fact is that there are ten thousand empty hospital beds. To take a comparatively local example, about two years ago the poor, suffering taxpayer paid out £160,000 for a new wing at Sutton and Cheam Hospital. Since then, every bed in that wing has been empty because of lack of staff. Again, in Leicester, it was decided to make a special attempt to get nurses conditioned to a 44-hour week—incidentally, many nurses still have not got a 44-hour working week—but the Leicester authorities found that that could be achieved only by leaving empty 183 beds—and that, in an area in which there are 6,786 people on the hospital in-patient waiting-list.

    Those are not theoretical things; they are not abstract arguments. We are talking about people, measured in their thousands, who are sick, but deprived of medical treatment because of Governmental policy. We have talked about hospital staff, and we feel full sympathy for them, but we are not now talking of staff but of patients who are suffering.

    All along, the Government's attitude to salaries calls for much question. Leaving out of account whatever views there may be on the merits of the nurses' salary claim, we are entitled to ask the Minister why it took him from 11th August of last year to 13th February of this year to give the nurses a proper answer to their claim. He may well have decided that the claim was not justified—that is another matter—or he may well have thought that it was not the time to give them salary increases, but would any Minister keep the miners waiting for six months in similar circumstances? Would any Government be prepared to tell the dockers "We shall not even give you an answer for six months"? Would they tell the engineers, when they put forward a claim, not only mat they would not grant an increase—that can sometimes be justified—but would not even treat them as having a right to negotiate for a period of six months?

    Regardless of the amount involved, and views as to whether this is the right economic time to give a salary increase to a large section of the community, we are entitled to ask whether there has not been a deliberate devaluation of the negotiating machinery; and whether the Minister has not taken advantage of the comparative industrial and political weakness of these people in order to treat them with a contempt that he would not dare to apply to more strongly organised sections of the community.

    The secretary of the Middlewood and Wharncliffe group of mental hospitals recently reported that that important group was 20 per cent. understaffed, and he made the specific point—and I have given the name of the group, and the statement can be checked; it has been published—that mental patients who were going to work outside the hospitals were earning more money per week than were the nurses who looked after them inside. That was not put as a joke; it was a serious statement made by that group secretary. It is impossible to justify that state of affairs. It is not moral or sensible. It is certainly a completely demoralising state of affairs for any section of the community. But it is the sort of situation which is bound to exist in the state to which the Minister has brought the National Health Service.

    We are now faced with a situation in which the same staff works in two hospitals. People come off night duty and then take a part-time job during the day time in another hospital to try to make up their money. The Minister will be aware of this, examples have been quoted, and it is not something new which has just burst on the country. These people have a vocation. They love the job, and that is why they stay and put up with that state of affairs. But why should they have to go to these lengths just because they love the job?

    It is not only a question of nurses. There are other people in the National Health Service besides nurses. We have heard a great deal about the manual workers who earn more than the nurses, and that is true. But it would be a great mistake to delude ourselves into believing that manual workers in the National Health Service receive a reasonable rate of pay. They are paid abominably. Take the porters as an example. These people are unskilled, but they are doing an important job of work which has to be done. We pay them £9 5s. 8d. a week, that is, the State—not some terrible hard-faced private employer. It is the responsibility of the community. After they have paid their National Insurance and their superannuation, these men, some of whom have families, take home £8 10s. a week.

    Of course, they can work on Sundays and at nights on double shifts. They can work a 60-hour week, and if they do, they may even be able to afford to take their families on holiday. But why the devil should a man have to work like that in order to be able to take home more than £8 10s. a week? No one should be expected to keep house on £8 10s. a week. No hon. Member has the right to suggest that £8 10s. is a reasonable wage for anyone in public employment.

    One could argue that these people are not trained. Their work could be described as humping, carrying, pushing and pulling. But let us consider the case of a head porter, a man who may control a staff of over seventy. That is a reasonably responsible job. His gross rate of pay is £12 18s. After he has paid his National Insurance and superannuation, he takes home less than £12 a week. Is it seriously suggested that such a man is not entitled to more than £12 a week?

    Take the case of a head cook, a person who is doing a skilled job. I cannot cook. The Minister of Transport can. But on the other hand he cannot run the transport services. Ever since the right hon. Gentleman has been Minister of Transport we have had less transport and now we have reached the stage where the right hon. Gentleman pays someone £24,000 to do his job for him. A head male cook responsible for a staff and for the preparation of 9,000 meals a day, gets £13 10s. a week gross. These are manual workers.

    Consider the case of the professional workers, for example, dark room technicians, the people responsible for assisting the radiographers. Without their help the radiographers could not develop their prints. If he makes a mistake when the right hon. Gentleman goes for his annual check-up and suddenly comes back with a plate showing him to have a heart, all sorts of things could result from that—merely from not having a properly trained person to do the job. What does such a man get? After all, he is doing a good job.

    I think that is unkind. The right hon. Gentleman obviously has a heart. It is merely that he mislays it for much of his political life.

    The rate of pay of a dark-room technician at the age of 25—a man of that age could be married and have a family—is less than £8 a week. The absolute maximum rate of pay for a dark-room technician aged 29—the great horizon, the Shangri-la to which he looks forward—is £535 gross a year. In the face of these facts, are we really entitled to say that the only answer we have is to set up a committee, that we think the position is serious, that we ought to do something about it but that we cannot do anything about it at present because there is an economic crisis and that the Chancellor is grappling with economic difficulties? Every time the Chancellor grapples with an economic difficulty he comes back six months later with a bigger one. I believe that a lot of people on both sides of the House wish that the right hon. and learned Gentleman would stop grappling because the country is getting into a terrible state because of it.

    How much do we spend—taking up the point made by the hon. Lady the Member for Tynemouth—on hidden expenditure and how much does it cost us? Can the Minister tell us how much we spend on advertising for staff which we cannot get because we will not pay them properly? This is a major piece of expenditure, and the problem arises directly out of Government policy. A lot of public money is involved, so we are entitled to ask specifically how much we spend on advertising throughout the country.

    The hon. Member for Kidderminster (Mr. Nabarro) believes that we should look at this sort of expenditure very closely. I can quote one hospital in the London area which last year spent £4,000 on advertising for staff. The hon. Member who spoke on behalf of the Liberal Party when its members were here earlier in the day before it got dark and cold, whereupon they all went home, mentioned the fantastic figure of something like £100,000 being spent with the Nursing Mirror alone. I must say that that figure struck me as a rather large one, but the cost of advertising these vacancies in the National Health Service at the moment is certainly astronomical.

    This is not only a matter of advertising vacancies. There is a new service growing up. People are finding commercial profit out of the National Health Service, out of the public exchequer, by providing services which the National Health Service cannot provide for itself. An agency operates to provide medical secretaries, and the National Health Service pays twice the price that it would pay to its own secretaries to medical entrepreneurs to got them from outside.

    There are private commercial concerns providing a 24-hour radiography service. There are catering services, contract gardening and cleaning services, essential services which the Minister of Health cannot provide for himself. Private concerns are providing these essential services and are lining their pockets in the process because of the meanness of the Ministry in not paying its own staff properly.

    I do not want to speak for long in this debate, but I thought that some sort of introduction to the subject was essential. To be serious, it would be agreed on all sides that the recent smallpox outbreak frightened everybody. It frightened all who had children. No doubt it frightened hon. Members opposite. It frightened me, and it frightened my constituents. There is something almost obscene about death by this insidious disease. There is something about it which frightens even the bravest man who in other circumstances might well perform acts of gallantry.

    But we should not lose sight of the fact that every one of those smallpox cases was looked after by volunteers prepared to risk their lives in the service of the community. At least one died as a result of a cold-blooded decision voluntarily to take this risk. They were not all nurses. We make a mistake if we confine this to nurses. There were old ladies who scrubbed floors, porters who pushed patients, laboratory technicians who carried out tests, and nurses. In every section there was no shortage of staff to nurse the patients, and the staff did the job well. They underwent the risks because they had a vocation and felt that they had a responsibility to society. For that reason society has a responsibility to them.

    I do not believe there is a possibility of widespread strike action in the hospital service. I have worked in this sphere and cannot imagine widespread industrial action in it. We can all feel secure; if our children are taken seriously ill, they will get devoted care. These people will not let us down. Precisely because they cannot fight for themselves, we believe that the House has an obligation to fight for them. It is time hon. Members opposite stopped talking about their vocation and what they might do in the future and got down to the realisation that if only they will apply political pressure to their own Front Bench, they have it in their power —and they know it—to change the situation which they have said they find so distressing.

    12.32 a.m.

    I wish to take up a few points made by the hon. Member for Greenwich (Mr. Marsh). Forgetting what he said at the end, if he looks at HANSARD tomorrow he will find that at the beginning of his speech he said that the spirit of Florence Nightingale is dead and that people enter the nursing profession simply as a matter of finding employment and the highest paid job.

    If the hon. Gentleman will look at HANSARD tomorrow he will find that that is what he said. He completely changed his tactics at the end, but at the beginning he said that people do not enter the profession in a spirit of service.

    What I said about Florence Nightingale at the beginning, and I stand by it, was that her memory has done more damage to people in the hospital service than anything else because it is exploited by hon. Gentlemen opposite.

    The hon. Member went on to say that people enter the profession nowadays simply because it is something in the labour market which offers an attraction. That is quite wrong. People enter nursing because they believe it is a vocation. I am not suggesting that this is an excuse for not paying them, but the reason why most people enter nursing is that they like it and because they realise that it is a service. That is not what the hon. Member said at the beginning, as he will see from HANSARD tomorrow.

    The hon. Member went on to make some pertinent remarks about pay. He criticised my hon. Friend the Member for Holborn and St. Pancras, North (Mr. G. Johnson Smith) on pay. He compared £1,600 a year for a matron, quite rightly and reasonably, with the hon. Member's salary of £1,760, but he forgot to say that my hon. Friend has expenses out of that for secretaries and various other matters. I do not believe that one can make comparisons of that nature between the two types of salary. I am sure that many hon. Members on both sides of the House would agree with me.

    The hon. Member also criticised what my hon. Friend the Minister said about physiotherapists when he remarked that there came a time when perhaps in a patient's treatment the physiotherapist could render no further service. I agree that if a time comes when he can no longer give beneficial service it should not be given. There are cases of people who go the round of hospitals for treatment. I had a case the other day of a man who had been at no fewer than nine hospitals endeavouring to receive treatment. That man had nothing wrong with him, to the best of my knowledge, and I investigated his case pretty thoroughly.

    If he visited nine hospitals for treatment he obviously needed mental treatment.

    The hon. Member is entitled to his opinion. I investigated the case and discussed it with the doctors, and I am convinced that he had no need of treatment whatsoever. I do not say that that sort of thing happens very often.

    I appreciate and accept what the hon. Member says, but the point made by the Minister, to which we objected, was that he implied that members of the medical profession were treating patients who do not require treatment and that the politicians would take the decision.

    With the greatest respect, I do not consider that that was what my right hon. Friend either meant or said. That is why I interrupted the right hon. Member for Belper (Mr. G. Brown) when he made that remark.

    I should like to take up a point which the hon. Member for Greenwich made about smallpox. I hope that it will be mentioned when my right hon. Friend the Secretary of State for Scotland winds up the debate. The country has been extremely worried about it. I ask my right hon. Friend to confirm that the Labour Government abolished compulsory vaccination with the result that though vaccination itself is a free service the giving of a certificate is not a free service. I hope that my right hon. Friend will clear up this point. There has been a great deal of misunderstanding throughout the country about it.

    Nobody in his senses would suggest that the Health Service is perfect. There are difficulties and shortages of staff and there are points where I am certain the Service could be improved. But my right hon. Friend has done a great deal. He has not by any means been a destroyer of the Service. He has done what has been possible to build up both the hospital building programme and other spheres.

    The hon. Member for Greenwich made a valid point about certain shortages. He spoke quite rightly about the shortage of radiological staff. There is a firm in London which carries out that service because of shortage of hospital staff. I am sure that if my right hon. Friend's attention had been drawn to it at an earlier stage he would have put it right. I am sure that he will now do so, but it is expensive.

    I hope that the Minister will take note of the point, because it was raised in July last year. If we raise it again, sooner or later he will see to it.

    I think that the hon. Member will agree that hospitals have been allowed to have this work done by private contract if they have not been able to provide the service themselves.

    The hon. Lady the Member for Blackburn (Mrs. Castle) spoke about strike action. We all appreciate that any suggestion of strike action from the nursing profession would not be well received. Some quarters may have discussed the possibility of strike action, but in principle the medical profession, nursing and the professions supplementary to medicine would be opposed to that form of action. I say this for one reason. We have all said, on both sides, that these professions deserve good treatment. They provide a special service, and they know that if they resorted to strike action they would forfeit their right and the attitude which the country has towards them.

    There are difficulties in the National Health Service. The number of letters that we have all received from constituents illustrates, not only the feeling in the nursing profession, but the great lobbying power of an organised force when it gets into motion. I have spent the last two days answering a large number of these letters.

    The fact is that there is a shortage in certain directions. One of the difficulties, however, is that no overtime is provided for in the Service and salaries have lagged behind those of other services. One must realise that salaried workers always lag behind weekly wage earners. An important matter which has not yet been mentioned is that the status of the professions supplementary to medicine and of the nursing profession has to be revised. The nursing profession finds difficulty in accepting the odd hours that it is called upon to serve.

    My right hon. Friend said that the number of nurses was increasing. We must consider, not so much the increase in the number of nurses entering the profession, but, far more, the requirements of the Service. One cannot say that we need an increase of 2, 5 or 8 per cent. on the previous year. What we can do is to set the requirements for the next year against the numbers actually in the Service. The position should be viewed simply in terms of the requirements of the Service and not in percentages.

    One of the matters which many people have power to alter is the hours and working conditions of the nurses. I refer particularly to many of the young nurses. This is a matter to which, I hope, my right hon. Friend the Minister will give thought. Many young people who join the Service are made to work hours which are quite wrong, not because of their length, but because of the times of going on or off duty. Nurses are human, like anybody else. No nurse wants to go on duty at 7, 8 or 9 p.m. This means that the whole evening is spoilt and a nurse cannot go to the cinema or anywhere else. I am sorry that some of the senior staff in hospitals do not co-operate to stagger the hours, so that the younger people could enjoy social life. I know that this is one of the penalties of nursing, but a great deal could be done by senior members of the nursing profession to make life easier in terms, not of work, but of hours, to make the work more attractive for the younger, newly-joined members of the profession.

    I have been one of those who have always maintained that there is far too great a barrier in status between doctors and nurses and the professions supplementary to medicine. People do three or four years' training, and doctors seven years, but in principle there is far too great a distinction in the terms of service and the conditions of the two sides of the profession. There is a case for the structure of the physiotherapists and of the other auxiliary professions to be reviewed in this light. We must look upon the nursing profession, physiotherapists and the doctors as one team and consider their wage structure accordingly. In radiology the doctor can work for private fees outside the National Health Service, but the radiographer who is working inside the Service and doing the job cannot get remuneration for the private work which he or she does. That is quite wrong. I disagree with the attitude that nurses and radiographers and physiotherapists and others should not enjoy the same sort of privileges as doctors. If there were a review of the structure of status within the Service of the various people who work in it, then they would work more as a team. Fewer distinctions of the sort which I have mentioned would go a long way towards solving the problem which these people have rightly posed to us.

    Mention has been made of the shortage of beds for midwifery cases. Many of us are concerned about this and feel that women should be able to have at any rate their first baby in hospital, if they wish. But I am certain that the increased building programme which my right hon. Friend is encouraging will solve that problem in the future.

    One of the great reasons for the shortage of beds and shortages in the medical profession in general is that diagnosis of disease is improving more and more, and many diseases which would not have been recognised only twenty years ago are now being treated. That is especially true of mental diseases. The need for beds is thus increasing. But it is nevertheless true that there are people who, if they are not battening on the Service, are getting treatment which is overloading the Service and which they do not need. I am sure that many hon. Members will agree that doctors throughout the country are frightened of refusing to give a certificate for an illness. They know that if they do not give it, the patient will cause trouble with the Ministry and kick up a fuss.

    I think that many general practitioners will agree that there are many people who do not need their services but who cause the doctors to give them. I do not say that it is a great number, but there are these cases. It should be our policy to give the best possible treatment to the patient, but when we have reached the stage of knowing that he cannot benefit from any further form of treatment, we should think very carefully about whether he should be given further treatment.

    There is no question but that there is a shortage, but we should look round the Service not to cut it but to see whether we can economise slightly. We have also to take a much longer view than we now do. Every hon. Member is sorry that this pay claim was made at an unfortunate time when there was a wage freeze. I should like the whole structure of the medical profession and the professions subsidiary to it to be reviewed and put in the same context as the National Economic Development Council. I cannot see any difference between those people who work with their brains and those who work with their hands. Their conditions should all be considered together as part of a national wages structure. I hope that that will be taken into account when the N.E.D.C. gets going. I hope that the Council will consider not only the workers and managements in the factories, but somehow be able to correlate the wage earner with the salary earner. One cannot always measure responsibility by the amount of pay, but the rewards of the industrial wage earner and the salary earner and those in the professions should all be taken together in an effort to gear wage and salary increases to the national economy and the national production level.

    12.50 a.m.

    The hon. Member for Clapham (Dr. Glyn), with whom I was once abroad, is an excellent companion and a very loyal one. If I were in a fight I cannot think of anyone else I would choose to have with me, but tonight his loyalty to the Minister has tended to overthrow his professional judgment.

    Take, for example, the unhappy man he described as going round the hospitals. The very fact that he went there was proof positive that there was something essentially wrong with the man. We have all had patients with whom we could find nothing physically wrong, but their continual complaints and psychological attitude showed that there was something wrong. Such a person would lead me to think that he needed some advice and attention. I admit that my general reaction if I had a massive surgery and a heavy visiting round, perhaps fifty or sixty people waiting for me to see them, would be to give the poor wretch a bottle of medicine. That may not be good medical practice, but it does not alter the fact that the fellow would be in need of some medical assistance.

    This is what is wrong with the Health Service, despite the much vaunted claim of the Minister today. Any Martian Colonel Glenn listening to what the Minister said would believe that he was talking about a miraculous Health Service which exists really in the Minister's imagination only. The remark which the Minister made about physiotherapists has got to be answered. I hope that the Secretary of State for Scotland will answer it. He probably has more responsibility in these matters, for he sits in the Cabinet which imposes Treasury strictures on the Service, while the Minister has to accept orders from the Cabinet. The Minister should be in the forefront of any argument to promote and expand the Health Service, but from what we hear there is not much of a fight put up.

    The Minister has to justify his remark about physiotherapists. Are there people in the Service ordering physiotherapy for those who do not need it? I suppose that it is on the basis of some doctors ordering the treatment for some patients for whom allegedly it is of no medical value. I could not accept the other interpretation that we should stop physiotherapy and write off patients as dead ducks anyway. I could not accept that Dracula4ike interpretation even from the Minister. I prefer the other, that the Minister believes that some doctors are incompetent to the extent of ordering the treatment unnecessarily. The Minister has to answer this point because when members of the profession read his statement they will want the point answered to their satisfaction and the satisfaction of those of us who loyally try to practise medicine and think that we are doing our best in extremely trying conditions. It is all very well for him to make these statements in a soft comfortable office, but people are working hard in medicine and they do not like these taunts made by those whom they regards as ignorant politicians. Allegations have to be justified. When some ignorant criticisms were made by hon. Members opposite about doctors over-prescribing, there had to be two committees set up to prove ultimately that doctors were not over-prescribing. It is in the records of the House that apologies were made by Ministers and that that criticism as a general attack was shown to be ignorant and unfounded.

    Let the Minister now answer this one. When the medical Press prints his speech at the weekend, it will blazon abroad that we are now accused of a new sin. I hope to see some sort of justification attempted by the right hon. Gentleman.

    The Minister was a great man with his party in 1956. There are many cans tied to his tail, and perhaps this will be another one. He tied one can to his tail in 1956 when, at the Ministry of Housing and Local Government, he said that in twelve months, that is, by November 1957, the equation of demand and supply of houses would be solved. He said that when he was trying to promote the Rent Bill. We know that that was a grossly untrue remark. Only the most ill-informed and incompetent statistician could possibly arrive at such a conclusion. The right hon. Gentleman is without doubt—we have had some experience of his like in Scottish history—the James VI of this Administration. He is easily the cleverest of them but at the same time he is the most foolish. In making remarks of this kind he puts up an incredible performance.

    In 1957, the right hon. Gentleman gave us the miserable story about old-age pensioners cheating the nation out of 2s. 4d. on the tobacco concession. What a mean mind this man had to imagine that that can be a sound argument for withdrawing a concession. I remember that day very well and the three words, "or did they?". I remember the late Hugh Dalton taunting the Minister for arguing about the pennies and halfpennies of the elderly. What an attitude to take!

    We can expect more of the same kind because this is the way the Minister's mind works. This is the approach of the Ministry. One can hardly expect the Secretary of State for Scotland to try to compensate in any way for the failings of the Minister of Health. Perhaps the previous one, perhaps a Labour Secretary of State I can think of, but not this one. The present Secretary of State is trailing behind the Minister of Health in everything he does.

    In 1945, the Scottish Hospital Surveys which were completed then—it took sixteen years for the Ministry to make a survey at all, despite many pleas from this side—said:
    "The first aim of the hospital service must be to ensure that every patient requiring hospital treatment can obtain it without delay."
    Have we at any time since 1945 had a situation where that was true? Is it true today? Of course not.

    I remember a pathetic man coming to me on the day of the General Election in 1959 and telling him that he would vote for me. He said he was sorry that he had not been to see me earlier—[Laughter]. I will tell the House what he told me, and then perhaps hon. Members will not laugh. He said he had been prevented from coming to see me earlier because he had been very busy at home, and he then handed me a letter he had received informing his wife that she was to go into the local hospital for an operation. He told me that she had been on the waiting list for two years. I said, "I am glad that she has at last got a bed. I hope everything goes well and the operation is successful ". It was then that he told me that she had died six months before.

    This is the whole point. There are many people—I do not know how many—who have been waiting for admission to hospital for a long time who are not yet in sight of being admitted. Some waited too long and are no longer with us. What a commentary on our situation today! It is quite wrong for the Minister, with his equations of demand and supply, to make speeches about the rising number of nurses—we have never had more, he says—and about the tremendous number of doctors, as if all our problems are solved. What nonsense! The Minister, with his equations of supply and demand, should tell us what is the present equation of demand and supply in relation to the waiting lists, the beds, and the nurses.

    The fact is that we have closed many beds. I do not need to point out to The Ministers, with their White Paper, Hospital Plan for Scotland, that in every item relating to the number of beds to be estimated for 1975 there is this pathetic footnote:
    "This table omits convalescent and general practitioner beds, and unclassified, unstaffed beds".
    We know that there are many hospitals with large blocks of wards which have been completely unserviced for many years. We know that this is entirely due to the fact that we cannot attract young women into the nursing profession as we used to be able to do. Before the war it was said that unemployment was the best recruiting sergeant for the Army. No one has more respect for nurses than I have. They have been my helpmates all my working life, and many of my profession marry nurses, as proof of their tremendous admiration for them though I have not paid that tribute yet. But that does not weaken my argument that many nurses coming into the profession before the war came in because it was a reasonably good job, and a respectable and constant job.

    Now, full employment has changed all that, and despite the fact that there are many trained nurses, there is a considerable shortage. This is a challenge to the Minister, who made one of the most complacent speeches that any Minister of Health has made since the National Health Service came into being. It was an incredible speech. I can only hope that he made it purely for propaganda purposes, to deceive his hon. Friends and the country. It would be incredible if he were so incompetent as to believe that what he said today presented a true picture of the present situation.

    The introduction to the White Paper refers to the 1945 surveys of the hospital service in Scotland and defines three aims of the ideal service. I have referred to the first—that every patient requiring hospital treatment can obtain it without delay in the hospital most suited to his needs. The second is that the hospitals axe provided with accommodation, equipment and staff sufficient for this purpose, and the third that the efficiency of the service and the standard of treatment will be maintained and enhanced.

    Let us examine the White Paper further. A large section is devoted to what is meant by those three aims, in relation to medical practice. Since the hospital surveys were written in 1945 medicine has been revolutionised. First, we have drugs that are able to combat successfully many respiratory diseases that used to bring life to an end in the sixth and seventh decades. In other words, many of our old people who would have been carried off by pneumonias and other chest diseases are now with us. Because of that, and because of the increase in population, we have a larger number of people to deal with, and a different kind of pattern of disease.

    Not only have drugs saved many people from an earlier death; we have now entered into the realm of having to treat on a large scale the diseases of old age. We are faced with an entirely new problem in specialisation—the challenge of a large and a growing population is equalled only by the challenge of specialisation in medicine, and from the subject of specialisation in medicine I am driven back to the subject of nursing.

    Paragraph 46 of the White Paper says:
    "So far as nurses are concerned, a general hospital must contain a considerable range of specialties if it is to offer the variety of nursing experience required by the General Nursing Council for recognition as a training school for the General Register.… For the same reason, the highly specialised units in, for example, neurosurgery, which make exceptional demands on trained staff must wherever possible be located at the hospitals with training schools.… An increasing number of hospitals are beginning to have training schools both for the General Register and for enrolled nurses, which adds to the demand for facilities."
    That is an excellent idea, but there is a strange remark later in the White Paper. It is pointed out that there was only one major teaching hospital built in Scotland since 1914, which was in Aberdeen.

    That is the whole point of my criticism. Instead of grubbing around in this way and treating nurses as some section of the great industrial army which must bear the brunt of the battle, as hon. Members opposite see it; instead of referring, as the hon. Member for Hertford (Lord Balniel) did, to a loophole through which all the other professions will stream, we ought to realise that the time is long overdue for a complete and radical review of the financial structure not only of the nursing profession but of the entire Health Service.

    I can never understand how doctors have acquired such influence with the Conservative Party. Certainly they have the assistance of the Minister of Housing and Local Government, but I do not think that he pays much attention to organised medicine nowadays. Whatever the reason, the doctors had the Royal Commission, the Pilkington Commission, set up in 1957, which has done a lot to try to improve the doctors' position in this country. The Minister skated over the recent article in the British Medical Journal by Dr. Seale, but he has not disproved what was said in that article. He must give us more facts. I hope that the article is wrong, because I do not want to think that members of my profession are leaving the country in such numbers. Irrespective of the party in power, this will be a colossal problem if we are to have a chronic shortage of doctors. If we have a chronic shortage for the ordinary service, what chance shall we have of getting doctors in the specialised services for which we need men more and more?

    The fact is nevertheless that we are losing doctors. Perhaps we do not know the exact numbers, but if we are losing them it must be for a good reason. Let us try to find out what it is and why doctors want to leave the country. Has the Minister asked himself why most doctors take out insurance policies for hospital treatment instead of having it in the N.H.S. hospitals? Has he ever asked himself why a medical man makes sure that his own family is not treated in an N.H.S. hospital? Certainly that is so with many medical men. We have had an article in a paper pointing out that Ministers are not treated in N.H.S. hospitals. I am not complaining that people wish to have a free choice not to be treated in an N.H.S. hospital, but if I were the Minister of Health—and I hope that the present Minister has the same thoughts—I should want to know why the Service is so unpopular with the principal people working in it. I should ask myself those questions—and I might get some not so surprising answers. Part of the answer lies in the shortage of staff in the hospitals, and part of the reason for that shortage is that the remuneration is not good enough. It is a very simple point.

    The Conservative Party has made no case on this issue in the debate. I have listened to every speech, and not one hon. Member opposite has failed in some way to pay tribute to the nurses or to admit that they have a good case. One hon. Member suggested that they ought to have a salary award similar to that made to the Services—an award which would be paid in instalments, with back pay. Hon. Members opposite are falling over each other to make the case that some consideration should be given to the nurses' pay. It is difficult for hon. Members opposite. But, as Jimmy Maxton once said, if one cannot ride two horses at the same time one should not be in a circus.

    As my right hon. Friend the Member for Belper (Mr. G. Brown) said in an excellent speech, there is not much point in having a national wages policy if we start on a rotten foundation. The foundation on which salaries in the Health Service are laid is a charity foundation. It is fundamentally so. The Labour Government had a lot to do in their time and they could not do everything. Hon. Gentlemen opposite imagine we ought to have done it and seek to compare the Labour Government's term of office with the Conservative Government's term as though the years when the Labour Government were in office were comparable with the years of the Conservative Government. They imagine all those years were comparable and that a reasonable comparison can be made between them.

    Even putting that aside, the fact is that a complete reformation of the structure of staff remuneration in the Health Service could not take place in its early years but wait until its later years. Now the Government, by their wages policy, are hitting hardest a profession which can least bear it. I have had more letters from Edinburgh—of all places—this week than from any other part of Scotland about this subject. Edinburgh is Scotland's only Tory city. Edinburgh is the most anglicised and middle-class city in the whole of Scotland, and yet I have had the most angry and militant letters from Edinburgh—from matrons of hospitals even. I would never have dreamed when I was a young impecunious houseman that a matron would write to me about her salary. I never dreamed this day would come, yet here it is. I sympathise with them, everyone. I know how hard they work. I have been in practice and I have been in a good many hospitals, and hospitals in Edinburgh, and I can visualise how uphappy these women must feel. And most of them would never dream of voting Labour. In a daring moment they might think of voting Liberal, but usually they would for respectability's sake vote for the Conservative Party. And yet these women are writing to me and to hon. Members on both sides of the House asking for their consideration.

    But in relation to this matter of the remuneration of nurses and midwives the only people who can change this decision are not on the Whitley Council or on the Government Front Bench, for they have made up their minds and they have got to stick to this policy it is the hon. Gentlemen behind them. In this regard the Government will not listen to us on this side at all. Hon. Gentlemen opposite are really the only ones who can do anything for the nurses and midwives in this country. If they do not exert sufficient pressure on the Minister to make his life a perfect hell, if they do not nag and push him, the nurses will be left with the 2½ per cent. award, this miserable pittance which everyone of the hon.& Members opposite behind the Government Front Banch has said ought to be higher.

    If hon. Gentlemen opposite want to table a Motion calling for a committee of inquiry to reform the wage structure of the professions supplementary to medicine and of the nurses and all the rest, I for one will sign it, and I hope that my hon. Friends will, too. If we get sufficient signatures from both sides perhaps that will oblige the Minister to change his policy. I am not referring to the Motion already down on the Notice Paper, but to something much more specific, and demanding what the award should be—and a much higher one than that presently offered. If such a Motion is put down the debate may have done some good, but if hon. Gentlemen opposite, who tonight think they have done their best, do not put it down, in spite of their speeches tonight, then those same speeches will have been so much humbug. The Parliamentary Secretary says, "Hear, hear." She has not made a speech yet. No doubt she will make one later in response to the many questions my hon. Friends have asked and wish to ask about this matter.

    But it is a very grave matter that the nursing profession has reached the stage of objecting to this as they have. It shows that the Government have managed to antagonise them as they have, indeed, also antagonised the teachers, the police, the firemen—antagonised practically every one of all the respectable professions and trades in the land who in many cases are not at all identified with the trade union movement or with militant trades unionism. They have managed to do it. Is it any wonder they have their Orpingtons? Is it any wonder that people who think they are middle class, in attitude if not in income, are revolting, and turning to other liberators? Of course, they do not for the moment accept us in the Labour Party. That time will come, because I think people will ultimately realise that the only way in which we can have a larger Consolidated Fund from which we can spend more money on awards of this kind, and a larger proportion on the Health Service and on education, is by having a growing volume of wealth.

    I recently re-read the General Election speeches of the right hon. Gentleman the Secretary of State for Scotland—a form of masochism on my part—and found that his one great, astounding dialectical argument, which he thought felled every Labour man in the vicinity, was to ask where the Socialists were to get that £1,000 million to finance their programme. Little did he know that two years later his own Government would have to find £600 million of that £1,000 million. Where did that come from?

    Our only choice is in the rate at which we encourage the growth of the Health Service. We have no alternative. I hope that the time will come in this House when we no longer argue between parties by saying, on the one side, that we spent so much in 1950-something and, on the other, that we spent so much more at another date, but that we will talk in terms of a rising percentage of the national income. When we spend more on social services than on defence and the like, a really good Government will be in office. Instead, we get this indirect pat on the back for the Labour Party, when the party opposite say that when Labour did anything good all they must do is keep up with it and all will be well.

    I suggest that that is the point about the nurses. I know that hon. Members opposite, particularly when they or their relatives have been ill, have every admiration for the nurses, and would be delighted to see them treated as they should be, but the nurses cannot be properly paid if we do not allocate money from the national "kitty." We have a wrong climate of opinion at the present time, and an entirely wrong approach by a Minister entirely unsuited for his task. He ought to be known as a rebellious Minister and one in favour of spending money, because he has the agony of health priorities to go to bed with at night. He knows that he has to spread his money over a Service where he can never have enough. It would be better if he had a treasury full and overflowing rather than have that constant agony of priorities.

    But that is not the Minister we have. That is neither his nature, nor does his political record exhibit it. That is why we all feel so sad about things in the National Health Service, so understaffed, so under-paid. One would not imagine that that is what we are arguing about tonight, but rather that if the Minister had his way all was well with the Health Service. We have never had a chance to debate these two new hospital plans. We are to embark on a national hospital plan; indeed, that is part of the present-day Tory propaganda for the 1963 General Election—"Pie in the sky."

    I do not know how many roads we have had built in Scotland—on paper. I remember that in one year alone we had no less than three road programmes. They all added to the same thing, of course, but they were given three tremendous splashes of publicity. My own constituency, which has for some months had an unemployment rate of 7 per cent., and where the average has not dropped below 5 per cent. in the last ten years, has had its problems solved by the Secretary of State at least once—on paper. Hon. Members can imagine what the unemployed said when I told them the good news on paper.

    A lot of bureaucratic errors have been made—

    Perhaps my hon. Friend will allow me to correct him in one particular. He spoke of "pie in the sky," but that expression has a fairly respectable political connotation. The policy today, it seems, is "Pie in the sky—when the clouds have dissipated."

    I am obliged to my hon. Friend. I shall look forward to hearing him speak later. I see that he has come well-armed.

    I was saying that the crux of this hospital plan, irrespective of whether it is put into operation by hon. Gentlemen opposite or hon. Members on this side of the House, depends on getting staff, and not just ward orderlies. I have a great regard for those men and women who act as ward orderlies and who come into the hospitals to do the chores. Nothing is more disgusting than some of the jobs which have to be done in a hospital. But at the same time there is a mountain of difference between ward orderlies and fully-trained nurses.

    Perhaps that is part of the reason why the insurance organisation set up to provide private nursing homes is so popular. Is it because some doctors do not disregard the talent of other doctors in the National Health Service but whose services may be available privately wish to have better nursing than is provided in the Health Service? I suggest that the Minister ought to be concerned about this. He should be able to say that any treatment which is provided in a private nursing home can be improved on by the National Health Service. But can he say that?

    The Minister says that it is far better. I suggest that he should give some examples to prove that. He had better prove to the private organisations that they are wasting the money of the public, and that doctors are badly informed about the facilities in the hospitals. They should be discouraged from taking out insurance when the treatment is so much better in the National Health Service. It may be interesting to know how many Ministers of Health have been treated under the National Health Service. I do not like to hear critical things said about the National Health Service, and I think that these things should be looked into.

    But, to get back to my point. Unless we are able as a nation to raise the standing of the nursing profession in its own eyes by paying the nurses properly. Let us not have Sisters finding at the age of 27 that they have reached the top of their profession; or a matron getting less money than many other people in less demanding and responsible positions. We cannot continue to have this state of affairs. Until we can revolutionise the financial conditions we shall never get the staff which is needed, or wipe out the waiting lists of patients or have a sufficient number of doctors in the hospitals. I think that the Government have failed, and they will continue to fail unless they change their system of priorities and realise how vitally important it is that much more money should be spent on the National Health Service, with nurses and midwives given first priority when salaries are raised.

    1.25 a.m.

    A long time ago I thought that I should be making my speech at about seven o'clock in the evening. But I have found the debate of such intense interest that I have held back until 1.25 a.m., I think, however, that it will be for the convenience of hon. Members if I speak now.

    On a point of order, Mr. Deputy-Speaker. May I take it that the speech of the Under-Secretary of State for Scotland—[HON. MEMBERS: "The Secretary of State"]—I am sorry, the Secretary of State for Scotland—

    As far as I am concerned, the Secretary of State for Scotland rose to speak and he caught my eye. I called the Secretary of State for Scotland. That is all.

    Can the Secretary of State for Scotland tell us whether the Parliamentary Secretary to the Ministry of Health will be making a contribution later on, before lunch, so that she may respond to the comments which will be made between now and later? Obviously there are a number of hon. Members who wish to speak. If we could have a contribution from the hon. Lady it would be of benefit, because she could answer the many questions which are to be raised.

    The right hon. Member for Belper (Mr. G. Brown) spoke a very long time ago and I thought that we were Box and Cox on the thing, but it did not seem a very sensible dung to me if, indeed, as long ago as that—

    I must be allowed to finish a sentence without a point of order being raised.

    If the right hon. Gentleman was on a point of order, perhaps he would say what it is. He was, in fact, replying to a point of order and he has no right to do so. There must be some limit, Mr. Deputy-Speaker, to the abuse of the House by Ministers. My hon. Friend raised a point of order, and no Minister is allowed to reply to it. That is the prerogative of the Chair alone. I desire to put a point to the Chair. In the course of seventeen years in the House I recall an unhappy night when the closure was moved on the Third Reading. I am sorry to say that it was moved by a Labour Chief Whip, and some of us voted against it. Later we were given an assurance that it was a misunderstanding. We get to know the procedure of the House rather rarely. Unless the closure is moved, it is surely obvious that the Minister should not rise to reply before the observations have been made.

    If the good fortune of the Minister in catching your eye, Mr. Deputy-Speaker, on the first time that he rose to his feet—[HON. MEMBERS: "Order."]—I do not know to whom the cries of "Order" are addressed, but I am glad to know that I am in order. If the good fortune of the right hon. Gentleman in catching your eye, Mr. Deputy-Speaker, at the first moment that he rose to his feet is fortuitous, then I rise on a point of order to suggest that, on reflection, it is inconvenient. If, on the other hand—

    I hope that the hon. Member is not criticising the Chair in its right to select speakers. The right hon. Gentleman caught my eye and I called him. I go no further than that. Mr. Maclay.

    On a point of order. I was saying that, on reflection, I have known cases where Mr. Speaker has called a Member and then when it has been pointed out that there has been a misunderstanding Mr. Speaker has corrected himself and has expressed regret that there was some misunderstanding. This has happened at Question Time and in debate. I am suggesting that on the Third Reading of the Consolidated Fund Bill, when hon. Members are still rising to speak—hon. Members who have been here all day—it would be deeply to be deplored if the calling of the Secretary of State became misunderstood or misinterpreted. That is why I wonder if you, Mr. Deputy-Speaker, would permit the hon. Lady the Parliamentary Secretary, who has sat here patiently all day, to intimate that she will take advantage of the opportunity which remains to her and reply to other speeches if the Secretary of State persists in his intention of speaking now.

    I beg the Secretary of State to reconsider speaking now, because the reason which he gave was that the debate had taken a long time. He said it was so long since my right hon. Friend the Member for Belper (Mr. G. Brown) spoke that he thought he should speak. He also said that he had hoped to speak at about 7 o'clock and that he thought six hours later was a bit of a do. In point of fact, the debate did not open until 6.30 p.m.

    This is a matter of the liberty of the House. There are some hon. Members who have been sitting here hour after hour since 3 p.m. in the hope of taking part in the debate, which we all regard as important. I gave notice to the Minister twelve hours ago that I wanted to raise—

    I am seized of the hon. Member's point. As far as the point of order which he raises is concerned, it is perfectly in order for the Chair to call the right hon. Gentleman to speak. That is what the Chair has done. No doubt the hon. Member's remarks have been heard in all parts of the House, but the Chair has called the right hon. Gentleman the Secretary of State for Scotland to speak, and I call Mr. Maclay.

    Far be it from me ever to argue with the hon. Member for Oldham, West (Mr. Hale), but it seems to me that we have sorted this out fairly sensibly. This seems an appropriate moment for me to speak.

    I congratulate the hon. Member for Orpington (Mr. Lubbock) upon his interesting speech. He said he would not follow two of what he understood to be the customs of the House, first about talking very much about his constituency, and secondly about remaining entirely uncontroversial. I shall not follow one of the conventions—which is to say that we hope we shall hear a lot more of the hon. Member. I do not say that to be rude to the hon. Member, but only last week I was reminded by the hon. Member for Kilmarnock (Mr. Ross) that 14 years ago I said those very words to him and have been regretting it ever since. I repeat that no reflection is meant upon the hon. Member for Orpington.

    The hon. Member for Greenock (Dr. Dickson Mabon) spent a good deal of time in an extraordinary attack on the Minister of Health, particularly in relation to physiotherapy in hospitals. He reproved the Minister, and so did the right hon. Member for Belper (Mr. G. Brown) and the hon. Member for Greenwich (Mr. Marsh), over what he said about physiotherapy. The accusation was that the Minister was being a politician and telling the doctors how to prescribe physiotherapy for patients. If the hon. Member for Greenock, a doctor himself, is so wrong over this, perhaps a number of his other charges can be taken to fall, too.

    What the Minister has done is to commend to hospitals advice given by the independent Standing Medical Advisory Committee which, as the hon. Member knows, consists wholly of doctors. The following is the advice to which my right hon. Friend was referring, which went out under cover of a note from the Department:
    "The Standing Medical Advisory Committee has prepared a note on the provision of physiotherapy in hospitals. After reviewing recent changes in the application of physiotherapy, it emphasises the need to make the best possible use of physiotherapy services and advises:
  • (i) the avoidance of unnecessary treatment;
  • (ii) the precision in the prescription of physiotherapy;
  • (iii) the periodical review by a doctor of all cases, normally not less frequently than once a month."
  • It goes on in paragraph II (ii):
    "Investigation of the patients attending physiotherapy departments will often show that a proportion have been under treatment for long periods and with infrequent review by doctors. This is more apt to occur in departments without adequate consultant supervision of the day-to-day work within the department and there may be a variety of reasons for it."
    It goes on:
    "Patients suffering with chronic disorders … may be referred by consultants in the first instance and reviewed by them in the early stages but sooner or later this type of patient tends to be transferred to the review clinics of less experienced and junior staff who may come and go at short intervals. Thus in time these patients tend to look to physiotherapists rather than doctors for continuity of advice and treatment."
    This was what my night hon. Friend was referring to. It was advice produced not by a politician but by a committee composed wholly of doctors.

    I congratulate the right hon. Gentleman on his excellent smokescreen. He is loyal. That is not what the Minister said. The Minister is on record three times. He said something entirely different. His interpolation to my hon. Friend the Member for Greenwich (Mr. Marsh) and my night hon. Friend the Member for Belper (Mr. G. Brown) is on the record. His words were that physiotherapy will not be made available to patients who cannot profit from it. I am trying to be absolutely fair to the Minister of Health, but he has made a serious blunder and the sooner he apologises for it the better.

    I will not pursue it any further: If the hon. Member will look at what I said and get hold of the documents and look at what my right hon. Friend said he will see that there is no inconsistency of any kind.

    A number of other detailed points have been made and it will be difficult for me to pick up more than a few of them. I should like to clear one in particular straight away. It is the question of vaccination. There was some confusion about it. The position is quite clear. Vaccination is free for the patient. There is a registration fee paid by the local authority. It is true that that is part of the pool but that in turn is completely in conformity with the Pilkington Report on which the pool is based. I think that dears that point.

    Throughout the debate people have spoken with a great deal of emotion on both sides of the House. My hon. Friend the Member for Harborough (Mr. Farr), my hon. Friend the Member for Maidstone (Mr. J. Wells) and my hon. Friend the Member for Belfast, East (Mr. McMaster) spoke with equal conviction, some of them attacking the Government's general policy in certain respects and others not. Hon. Members opposite, of course, have steadily criticised what the Government are doing, but common to my night hon. Friend and myself and to our hon. Friends is our intense admiration for the nursing and related professions.

    The hon. Member moans and makes sad noises and says "The same old stuff". I admit that many of their speeches are sincere, but hon. Members opposite try to pose the whole time as the sole champions of certain sections of the community. This is utter nonsense.

    Throughout the debate there has run a good deal of emotion. The hon. Lady the Member for Blackburn (Mrs. Castle), who spoke earlier and now has come back to us in another manifestation, talked of a volcano of emotion. That is the trouble with the debate. There has been a steady attack—

    It has been an emotional attack, because it has not got down to thinking of what the Government are doing. If we get into another inflationary spiral, the people who will suffer most are members of the professions, and nurses above all. The object of what we are all doing is to see that the value of money is maintained and the country remains solvent and effective and that we have adequate production in the long run to do what we all want, which is to make the adjustments to salaries in many of the professions which I personally would like to see better than they are. But it would be folly, knowingly and wickedly, because one's emotions are touched by one or two professions, to take action in relation to them which would bring down everything we are trying to do, above all for those very professions.

    My right hon. Friend has referred to my speech and I have also been attacked by the hon. Member for Greenwich (Mr. Marsh).

    He misunderstood my speech. I was not attacking the Government. I approve of the Government's pay pause and wages policy. What I suggested was that within the policy a special case could be made for nurses.

    I was not criticising. My hon. Friend made an extremely interesting speech. I was interested in what he said.

    What I now have to say may be dull and hon. Members may say that it is not relevant to what they said, but I want to have on record, and I want the House to hear, some of the facts of the situation, such as the dates of the last salary awards and decisions in the various sections of the profession. For the nurses, a revaluation by the Whitley Council was carried out in 1959 which worked out, I think, at an average of about a 15 per cent. increase, with a further increase of 5 per cent. from 1st December, 1960. Physiotherapists, occupational therapists and radiographers had new scales effective from 1st January, 1961; dieticians, 1st March, 1961; almoners and psychiatric social workers, 1st November, 1959; and pharmacists, 1st January, 1960. Medical laboratory technicians have had one recently.

    It is only right that that should be appreciated when all this emotion has been engendered today—and I understand it—without anybody checking back to see what has happened and the dates when it happened. My right hon. Friend the Minister gave figures of recruitment and the growth in the services, but that was discounted by all hon. Members opposite as if it was irrelevant to the situation.

    The right hon. Gentleman has mentioned all the dates. Can he tell us, in words of one syllable, whether in his opinion the salaries are sufficient?

    I will answer. I have never been aware of any salary claim in which I have been involved, on one side or the other, whether as a Member of Parliament or a businessman, when I have not been quite convinced that there was an extremely good case for the people asking for the increase.

    Of course, I have great sympathy with the claims. The question is whether it would be in anybody's interest, above all the people themselves, if the claims were granted, with the consequences that that could have.

    Two lines of criticism have run through the debate. One is that the National Health Service is not getting and will not get, the numbers and quality of people that it requires, that the situation is bad and that the Government's incomes policy will make it worse. That about sums up what has been said. My right hon. Friend quoted figures—hon. Members opposite criticised him for doing so—which show that the numbers in post in nearly every grade have been, and are, increasing. I make no apology for returning to the figures, because in a matter of this kind we must argue from the facts.

    I take nurses first as the largest group. The numbers of whole-time nurses have risen in the last ten years in England and Wales by 20 per cent. and in Scotland, I am glad to say, by 25 per cent.

    I will come to that. To an increasing extent in both countries, with the earlier age of marriage, we will have to depend on part-time nurses as an essential part of the nursing service and not merely as a useful supplement. I appreciate what the hon. Member for Greenwich said, but I see this question in too wide a range over all my responsibilities as Secretary of State.

    We are dealing with what still is such a narrow band that is available for all these jobs that I hope that attacks will not be made on the possibility of people coming back who can give invaluable service on a part-time basis. That will be necessary not only in nursing, but in teaching and among doctors. Over the whole range, if we are to staff all the critically important posts, they must be staffed in this modern society, which is getting more and more complex and requires the whole time a higher standard of training and basic ability.

    What has happened with the part-time nurses? In England, the numbers have risen by almost 100 per cent., and in Scotland by about the same. It is a gross over-simplification to suggest that pay is the only element in the whole problem of getting nurses.

    It sounded very much like it all through the debate, although I agree that most hon. Members qualified it when they thought about it.

    Working conditions are also involved in a very big way. Despite the increasing pressure of the work in hospitals, it has been possible to come down to the 44-hour week, or rather, the 88-hour fortnight. I appreciate that some problems arise from that, but that has been a vary important move. A good deal of the drudgery has been taken out of nursing by the revision of procedures and the initroduction of work study. Not a single hon. Member opposite touched on that critical part of what is going on in the nursing profession—the immense amount of work which is being done to try to improve the conditions of work, something which everyone wants to see. It has been tragic that for years qualified nurses have had to do duty which, with proper organisation and management, they should not have to do. They are now able to give more time to their essential job. It is largely a question of organisation.

    Another point on the staffing figures which we have to remember is that we have had a slowing down, in Scotland at any rate, in the intake. That has coincided with one of the periods in the war when the birth rate was low. We are just beginning to move into the proper bulge which will be leaving school fairly soon.

    The night hon. Gentleman should not ask what a proper bulge is. There is every reason to hope that nursing will continue to attract its full snare of recruits and my right hon. Friend and I and the hospital authorities will make every effort to ensure that that is so.

    The right hon. Member for Belper asked what we were doing to encourage recruiting. All that I have been saying is part of the programme for the encouragement of recruiting—new buildings and methods of work and so on.

    The trend of numbers of medical auxiliaries was upwards in almost every case in the last year and the numbers of student radiographers has been much more satisfactory than it was a year or two ago. As my right hon. Friend said, the one ancillary profession in Which the number has remained relatively stable has been physiotherapy, and there has been a special problem with the shortage of teachers. However, with the help of the Chartered Society, a special course has been started to provide more teachers quickly.

    In Scotland we were satisfied that it was not a question of the shortage of recruits but that the main problem was shortage of schools. I am glad to say that we are opening a new school in Aberdeen next autumn and making plans for yet another in Dundee. Because of the rather wide range of my duties as Secretary of State, I constantly come up against many of these problems of recruitment and training—teachers, social workers, probation officers and so on, as well as professions within the Health Service.

    We have to face the fact that there is a relatively limited number of people with the basic education and the inclination to take up one or other of these various kinds of professional work. The same applies to almost every other country and there would be no point in believing that we would solve the problem in the professions which I have mentioned simply by attracting recruits from one into another. One merely adds to the inflationary spiral when one does that, and it is the old story of robbing Peter to pay Paul. We believe that the problem is best approached by having an education policy which is generally aimed at increasing the number of people with the higher education which will enable them to go into these professions. I can assure hon. Members opposite that almost every civilised country has a shortage in the band of people equipped for this kind of job.

    I want now to refer to the shortage of doctors and doctors going overseas. I do not want to go into detailed statistics, although I agree that the statistics are not as good as they might be. In Scotland we are trying to get some figures and my right hon. Friend is trying to get some better statistics to show what is going on. Scottish doctors have always gone overseas.

    Quite a lot of them have gone to the South as well, and the South is a great deal better for that. If what hon. Members have said about the shortage of doctors were wholly true, a great many are coming back to Scotland because in the last ten years the number of registrars has increased by 70 per cent., the number of senior medical staff by 60 per cent. and the number of consultants by 40 per cent. We have figures for house officers only since 1953, but the increase there has been 20 per cent. and in the same ten years the number of doctors in general practice in Scotland has increased by 15 per cent.

    The hon. Member for Greenock made a fuss and tried to convey the idea that the National Health Service was in a pretty bad way. I do not think he did any service by that. He seemed to think that it was slowing down and coming to a stop. I am sorry to give more Scottish figures, but they are indicative of what is happening south of the Border. The total staff beds are up from 58,000 in 1948—a convenient date because statistics started then—to 63,500 in 1960. Senior staff consultants are up from 646 to 977, nursing staff from 20,550 to 29,442, patients discharged 383,000 to 561,000, first attendances by new out patients 1,262,500 in 1948 to 2,228,922. This shows an immensely vigorous expanding and effective Service.

    Of course, there is an expanding demand. As hon. Members opposite must know, it is extremely difficult to get an accurate figure for shortages because the nurse-patient ratios are changing the whole time, there are different methods of treatment and differences in the handling of the work in hospitals. We can get general figures, but I do not think they mean a great deal. I am not for a moment pretending that we do not need more nurses, but the whole tendency is for the figures to improve and increase over the years and there is no sign at the moment that that process has been set back seriously.

    The right hon. Gentleman promised us that he would deal with vacancies. He has not reached it yet and I do not mind how long he goes on speaking, because it will be interesting to hear about the vacancies. Is it not true that nurse-patient ratios are constantly changing upwards and recruitment of nursing is not going up with them? One of the major arguments of G.P.s, who after all are the backbone of the Service, is that we cannot each treat 3,500 patients. It ought to be 2,500.

    The hon. Member is making a good case. We do need a bigger and better Health Service. I entirely agree with him and my right hon. Friend is doing more than any Minister of Health has done for many years to achieve it. I remember a speech—I am afraid that I do not remember who made it—in this House about ten years ago in which it was pointed out that there could never be a moment when we had everything we wanted in the way of a National Health Service. Practices are changing, one method of treatment goes out and another comes in, one illness disappears and new ones come. The real question is whether we are setting about in the right way to build up the Service. I submit that we are. If we were not doing all that we are doing in relation to pay and salaries in the pay pause, with the full knowledge of how hard it may seem to many people, we would be doing the greatest disservice.

    Where would the hon. Member stop? He does not mind whether money loses its value, the overseas balance of payments goes wrong and productivity goes down. We have heard the emotional approach. No one has a greater admiration for the nursing profession than I have, but I think it wrong not to realise that we are working in the way which we believe to be the best to secure everything they want.