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National Health Service (Consultants' Contract)

Volume 886: debated on Monday 17 February 1975

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With permission, Mr. Speaker, I would like to make a statement about consultants in National Health Service hospitals.

In my statement on 13th January I told the House of the events leading up to the consultants' rejection of the Government's proposals of 20th December for a new consultant contract and their decision to start industrial action. I indicated that while two principles were not negotiable—that is, the maintenance of the existing differential between whole-time and part-time consultants, and the introduction of a system of payment by items of service—there were other aspects of the proposals which could and should be further discussed. I proposed a return to the negotiating table as quickly as possible.

The consultants responded by asking for clarification of certain points, and although sanctions were continuing, I agreed exceptionally to meetings between their representatives and health departments' officials on 23rd January and 5th February. The clarification talks have been useful, I think, for both sides, but by their very nature they cannot reach the detailed agreement which must come as a result of negotiation. Following those meetings I wrote to the professions on 11th February explaining my position on the points the consultants' representatives put to me. I have placed a copy of my letter in the Library. I also told them that I would be happy to place copies of their replies in the Library, and this I have done.

First, let it be quite clear that a new contract is not being foisted on consultants against their will. They came to me when this Government took office and told me of their long-standing dissatisfaction with their contract. At their request I set up a working party to deal with their complaints. I was not then, and I am not now, forcing—or even urging—them to take a new contract. In common with the majority of contracts of employment for senior professional people, the present contracted commitment for whole-time and maximum part-time consultants is open-ended. It is not limited to 38½ or 31½ hours.

The purpose of my proposals of 20th December was to meet the consultants' complaint that this system did not adequately reward the very long hours many of them do. Their representatives in the joint working party had themselves asked that the consultant's present open-ended commitment should be replaced by a closed contract which would clearly define his basic commitment and ensure that additional work could be contracted and paid for separately.

The Government have accepted this principle and I believe that negotiations should be resumed in order to discuss how it should be implemented. As I told the House on 13th January, and as my hon. Friend the Minister of State spelt out again in the debate on 23rd January, we are not insisting on a precise "nine till five" formulation of the new standard contract, and we accept the need for flexibility, provided the basic commitment is specific enough for a system of extra payments to be built upon it and provided the whole-time differential is maintained.

I also attach great importance to replacing future payments of distinction awards by a new system of financial supplements which would be widely available to all consultants. The aim would be to provide financial recognition for special contributions to the National Health Service, particularly in those specialities or in geographical areas where understaffing has created difficulties. I believe there is considerable support in the profession itself for this kind of change, though here again I am willing to negotiate criteria and methods of payments which would be right for the National Health Service and fair to consultants and which would protect those who have benefited under the old scheme.

Because I recognise that many of these concepts are novel and require considerable discussion, I am anxious that our discussion of them should not hold up the Reviewd Body's repricing of the existing contract, which we want to see completed if at all possible by 1st April. The Government recognise that consultants have had to wait 12 months for their substantive review and that they are due for an increase in pay, and are ready to give the consultants the same assurances that I gave to the general practitioners.

My Department has already submitted its evidence explicitly recognising the need for pay increases, and I have now supplemented this with new figures on the present state of recruitment and the manning of hospitals in the NHS which reinforce the case. I am also today submitting evidence to the Review Body supporting important improvements in the consultants' incremental scale which would considerably shorten the scale and particularly help the younger consultants by removing the present danger of overlap between the senior registrar's and the consultants' earnings. In addition, I have told the consultants that I am willing to submit joint evidence with them on other matters to which they attach importance, such as the introduction of a London allowance for medical and dental hospital staffs and the financial recognition of family planning work. It would, of course, be necessary for negotiations to be resumed for joint evidence to be possible.

Since agreement on more fundamental changes in the existing contract will necessarily take some time, I have, as I have already told the House, offered to invite the Review Body to price the new arrangements without commitment and at a later stage. I am also prepared to ask it to do this within the context of the present review so that the arrangements could enter into effect within the same 12 months period. But it will clearly be possible to do this only if the Review Body has some indication of the lines of the new arrangements before it reports in April on the existing contract. This is another reason why negotiations should be resumed immediately.

Any decision to lift sanctions and resume negotiations rests with the professions' committees, and I understand that they are to meet on Thursday to consider my letter and the replies I have received. I regret to inform the House that in these replies the profession's negotiators, while recognising that there is common ground between us on a number of points, conclude that a recommendation for the immediate lifting of sanctions is unlikely.

I can only hope that after considering my letter and statement today the profession at its meetings on Thursday will decide to resume negotiations and to lift its sanctions which are damaging the Health Service and causing hardship to thousands of patients. I will, of course, inform the House of the outcome.

The right hon. Lady will appreciate that there has not been time to study the correspondence which has been placed in the Library and that her statement is necessarily long and complicated. Does she accept that I certainly express the hope that meaningful negotiations can be resumed in this difficult dispute as soon as possible?

Does the Secretary of State recognise, however, that the anxiety of the consultants does not spring from any belief that she is foisting a new contract upon them but from a belief that, however she may protest against it, the negotiations were being used as a means of eroding principles to which the consultants attach great importance and that it is therefore necessary for her to go a long way to restore the confidence of the medical profession in the genuinity of the negotiations? Will there be any provision for an independent chairman of or independent participation in the negotiations? In other words, will any outside independent person be brought in to help to bring the two sides together? Above all, does the right hon. Lady recognise the necessity of making it plain that she is now interested in promoting the best interests of the National Health Service and of its patients and is no longer interested in promoting the pursuit of Labour Party dogma?

Regarding the last unnecessary peroration by the right hon. and learned Gentleman, I think that, as the Labour Party was the creator of the National Health Service, we can be trusted to be the effective custodians of its interests. This is what our party policy is all about, and we are proud of it.

I was glad to note that the right hon. and learned Gentleman expressed the hope that the negotiations could be resumed. I ask him to couple that hope with the necessary corollary that sanctions which are damaging the interests of thousands of patients in the NHS can be lifted on Thursday so that those negotiations can take place.

The whole purpose of the two clarification meetings which have exceptionally taken place and of the exchange of correspondence was to reassure the consultants about certain misunderstandings which may have arisen. I recognise that right hon. and hon. Members have not yet had the opportunity of reading my letter, which has been placed in the Library today, but I am confident that when they have done so they will realise that there is no case whatsoever for refusing to get back to the negotiating table.

Is my right hon. Friend aware that the House will deeply appreciate the seriousness with which she takes this matter, her assiduous efforts to arrive at a solution to the problem and her realisation that the consultants, who in the main are dedicated men and women, have a case for increased remuneration? Will she confirm that she is adhering to the principle that consultants who serve the National Health Service full time will not be disadvantaged compared with part-time consultants who supplement their incomes in other ways?

Yes, I can happily give my hon. Friend that assurance. I have told the consultants that, contrary to some mythology that was spread around, I am not proposing to outlaw or to prevent them from engaging in private practice. But I have also said that part of the longstanding compromise to this effect, which was first initiated in 1948, is the existence of the differential in favour of consultants who decide to concentrate all their thoughts and energies on the NHS. It would be intolerable for me to go back on that very fair principle.

I assure my hon. Friend that I recognise that the consultants have a case for a pay increase. When hon. Members study my statement they will see the lengths to which I have gone and to which I am still prepared to go to see that their case is put fully and fairly to the Review Body in its considerations, which we hope will result in a report by 1st April. Therefore, there is no ground whatsoever for the dispute to continue.

The consultants asked for a new contract. I did not initiate it. I am not trying to impose one on them. I suggest that we should get together in giving points and joint evidence to the Review Body to get the urgent need for a pay increase met quickly and then take more time discussing the details of a complicated contract to take the place of the present contract.

Does the right hon. Lady recognise that what is in question here is the career structure for consultants, that the promotion pyramid is far too broadly based, and that therefore we also have in question the number of consultants' posts? Does she recognise that, apart from the question of consultants' posts, there is still a great deal to be done to discipline the progression of consulants so that they do not believe that they have a freehold on those posts as soon as they are appointed to them? Finally, does the right hon. Lady recognise that the profession would very much hope to be allowed to put its own house in order on this aspect and that it should not be imposed by the Department?

No, certainly not; I am not imposing. But I am offering to discuss. I agree that the scale needs shortening drastically, particularly to help the younger consultant who at present faces an overlap of the senior registrar's earnings on his own. We have been asked for our support in that respect and we have given it. For the rest, I repeat that all these matters are for negotiation.

Will my right hon. Friend confirm that, while she has made it clear to the consultants that she is not against private practice, she will continue to make it abundantly clear that she is opposed to private practice in National Health Service hospitals, which is a very different matter? Is she aware that there is great concern in the country that sanctions are being continued by the consultants and that it is to be hoped that these will end rapidly? Will she tell the House whether the merit awards in their new reincarnation, as it were, will be made public so that every doctor working in a hospital knows exactly who gets merit awards and what the amounts are?

My hon. Friend is entirely right on the first point. I have made it clear—and the consultants are aware of it—that this Government intend to proceed with the fulfilment of the Labour Party manifesto commitment to phase private beds out of the NHS. Discussions which were separately proceedings on that matter have been interrupted because of this dispute. However, that remains our policy.

My hon. Friend is right to deplore the damage that sanctions are doing. I hope that the whole House will unitedly and loudly call for the lifting of sanctions as quickly as possible.

It is our intention that the financial supplements awarded under our proposed new system should be made public and should be on the basis of clearly defined and publicly known criteria.

On two occasions the right hon. Lady mentioned the overlap between senior registrars and consultants. Will she make clear that it is her intention that this overalp should disappear from future arrangements?

Yes, Obviously it is not for me to fix the incremental scale. It is for the Review Body. However, we accept that the present scale is unsatisfactory in a number of respects. It needs to be considerably shortened. We are giving evidence to the Review Body to the effect that the scale should be so reviewed as to prevent this overlap from taking place.

Will my right hon. Friend accept that the great majority of right hon. and hon. Members will be ever grateful to her for making today what will prove to be a very useful statement? We all hope that the consultants will respond to the generosity of that statement by lifting their sanctions next Thursday. Does my right hon. Friend recognise that the major problem facing a conclusion of the dispute is money? We appreciate her difficulties in not being able to anticipate the outcome of the Review Body's study of this matter, but will she accept that, even if the Review Body ultimately came up with as much as a global lift of 35 per cent., that would still be within the guidelines set by the TUC?

That would depend on the basis on which the argumentation was advanced. But I must say that the figure quoted by my hon. Friend is rather different from the one in the letter to me from the Hospital Consultants and Specialists Association, which I have placed in the Library today. That letter demands an increase of 119 per cent., "or else".

Can the right hon. Lady answer that part of the question put to her by my right hon. and learned Friend the Member for Surrey, East (Sir G. Howe) which referred to independent participation in the negotiations? Does she think that it is possible to have an independent chairman?

I am glad that the hon. Gentleman reminded me that I had not replied to that part of the right hon. and learned Gentleman's question. The answer is "No". The proposal is to use the normal negotiating machinery. I think that the professions felt this to be right. The independent element comes in when we reach the point of pricing the contract, or the arrangements which flow from the negotiations. This is the job of the Review Body, and it is independent of the Government. There is the normal negotiating machinery—the joint negotiating committee—and it seems to us and, I think, to the professions that that is by far the best medium for negotiations.