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National Health Service (Morale)

Volume 957: debated on Tuesday 7 November 1978

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asked the Secretary of State for Social Services whether he is satisfied with staff morale in the National Health Service.


asked the Secretary of State for Social Services whether he will make a statement on the level of morale in the National Health Service, and what action he is taking to improve it.

I am not satisfied with staff morale in the NHS.

There is concern among many staff about pay, about resources available for the NHS, industrial relations problems, the structure and organisation of the Service and many other problems. I set out the Government's policies for tackling these problems in the debate on the Address on 2nd November.

Is the Secretary of State satisfied that the Government have put forward enough urgent, practical and immediate proposals to solve the problems which afflict, in particular, district general hospitals such as the one in my constituency, St. Helier? Is he further aware that the idea of trying to solve pay disputes at regional level is to take the whole problem to a much more remote and unsatisfactory level?

There is no intention to require the settlement of all disputes at regional level. The proposed disputes procedure will ensure that when there is failure to settle a dispute at local level, machinery will be available to deal with it at regional level. The procedure is not concerned with pay policies.

As for general policies, I am certain that the priorities set by the Government, and the additional resources which have been made available this year, with further expansion next year, are helping to tackle the real problem of the development of the Service.

Is not the morale of the National Health Service now as low as it has ever been, and has not the Royal College of Nursing recently left the right hon. Gentleman in no doubt about its deep dissatisfaction?

It is easy for Opposition Members to say that morale in the Health Service is low. I have no doubt that they must accept a large measure of responsibility for the drop in morale consequent upon the reorganisation which they imposed upon the Service. They must be aware of the frustration caused by the present structure, which is too complicated, too bureaucratic and sometimes too insensitive to local needs.

Is my right hon. Friend aware that people continue to get a number of problems, such as we have had recently in the National Health Service, because of the truth of the statement by Nye Bevan that silent pain evokes no response? That truth has been learned by the lower-paid workers in the National Health Service. Is not the reality that we shall continue to endure industrial problems until the Government fashion a machine that can honestly address itself to the fundamental problem of raising the level of pay among our low-paid servants?

This is not merely a pay question. Some groups within the National Health Service naturally feel that they want a larger increase in pay and a different structure, and I can understand that. But there are some major problems concerned not only with pay but with resources for the National Health Service, priorities and organisation. I do not believe that employees in the Service are concerned only with pay, although of course it is an issue with which we must deal.

Is the Secretary of State aware that many who work in the National Health Service feel remote from authority and decision-making? I welcome his statement today about the introduction of more industrial relations officers, but does he agree that we need an improved system of line management so that there is better communication between those who manage and those who are managed?

I have no doubt that changes will have to be made to the present system of management. I often find that consensus management is a fine term but an extremely difficult concept to operate, and that it is sometimes very ineffective. I believe that we shall have to make some changes. This is one of the matters that is before the Royal Commission. It is easy for people to say "Why do you not leap to conclusions before the Royal Commission reports?", as Opposition Members seek to do. We must wait for the Royal Commission and take action when it reports. In the meantime, we must take such action as we can to improve the situation. I believe that that is what we are doing.

Is my right hon. Friend aware that, quite apart from the area of pay, there are other problem areas, such as the top-heavy structure resulting from reorganisation and, partly as a result of the Government's blessing, the cuts proposed by the Opposition? In my view, those cuts ought to be fully restored. We should be arguing for a massive injection of money into the National Health Service in the next Budget, if not before. [HON. MEMBERS: "Too long."] Does my right hon. Friend appreciate that the 5 per cent. pay policy for low-paid workers, particularly nurses, would evoke a very different response from the one that we now see, and that in order to resolve this problem we must get away from the 5 per cent. pay policy?

In the last two and a half years we have greatly reduced the proportion of National Health Service revenue that goes to management costs. That has meant a cut of nearly 3,000 management jobs at a time when we have seen an increase in nurses and doctors. As for general resources, this year we plan to spend on the National Health Service £120 million more in real terms than last year. In the debate, while giving specific figures, I announced that there would be a further expansion in resources in the NHS in 1979–80.

Will the Secretary of State take a special look at the state of staff morale in ante-natal clinics in areas of urban deprivation? Will he also give special consideration to dealing with the appalling premises in which many staff are obliged to work and which are, I believe, leading to the unenviable reputation which Britain is getting for increased perinatal deaths and infant mortality?

In reply to the last part of the supplementary question, I point out that we have seen some encouraging figures in the past two or three years. The perinatal mortality rate is declining steadily year by year. I am sure that the House will welcome that fact. In the debate last Thursday I announced that among the problems that we hoped to deal with from additional funds to be made available this year were ways in which we could tackle the high perinatal mortality rate in particular parts of the country.