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Social Services

Volume 957: debated on Tuesday 7 November 1978

The text on this page has been created from Hansard archive content, it may contain typographical errors.

Hospital Nurses


asked the Sectary of State for Social Services if he will make a statement about his recent meeting with representatives of the hospital nurses' organisations.


asked the Secretary of State for Social Services what representations he has received from the nursing profession about the present state of recruitment of nurses.

On 30th October, I met a deputation from the council of the Royal College of Nursing. The subjects discussed included morale, pay, the numbers entering training and various aspects of the financing and organisation of the National Health Service.

I thank my right hon. Friend for that answer. Does he agree that it is impossible for nurses, and, indeed, other hospital workers, to supplement pay increases by deals based on productivity or profitability? Against that background, what steps can he take to protect the interests and living standards of people employed in the National Health Service?

My hon. Friend will know that the Nurses and Midwives Whitley Council has made representations to me that nurses should be treated as a special case for pay purposes. The case the council presented and the arguments put forward by the Royal College of Nursing when we met will receive very careful consideration. One of the arguments put to me at that time was that nurses are unable to qualify for productivity agreements—it was not suggested otherwise— and that for that reason, especially, we should look carefuly at their case. Of course, at this stage I cannot give any answer to the application.

Can the Secretary of State confirm that he has received representations from district nurses about their training? Will there be provision in his Bill to give statutory effect to that training, which is so necessary?

Yes, we have received representations from district nurses. Provision for their training will not be included in the Briggs Bill, but other initiatives will be taken. This is an issue on which we shall be ready to answer questions and to debate it when we present the Bill on Monday.

Will my right hon. Friend consider with special sympathy the nurses in mental hospitals, who are suffering grievously from various disabilities, not excluding pay? Will he give an undertaking that nurses who fall within the references to low pay in the White Paper on inflation will also receive sympathetic consideration?

Of course, we are much concerned with the situation of nurses in hospitals for the mentally ill and for the mentally handicapped. Fortunately, in the past few years there has been a substantial improvement in the ratio of nurses to patients in such hospitals. There is still a recruitment problem. As my hon. Friend will know, there is a weighting on the pay of these nurses.

Will the Secretary of State congratulate the Royal College of Nursing on its statement that strike action would not be taken? When does he expect to be able to give an answer to the representations about nurses being a special case?

I cannot say at this stage when the Government will be able to make their decision. Two points were put forward by the Royal College of Nursing. One was a plea that there should be some addition to the 10 per cent. during the present phase 3. The second point was for long-term improvements, which would therefore affect phase 4. I made it clear that it was most unlikely that it would be possible for there to be any further pay in the present round. Clearly, that would be in breach of pay policy. In our longer-term considerations, of course, we are looking at the case very carefully.

Hospital Supervisors (Dispute)


asked the Secretary of State for Social Services whether he is satisfied that the strike of hospital supervisors could not have been settled weeks earlier on the same terms.

The dispute was eventually settled on the basis of the salaries offered on 12th September, but the outstanding issue concerned productivity allowances. The staff side was demanding minimum allowances of 15 per cent. of salary for all supervisors, whether or not they were involved in productivity schemes and regardless of whether the schemes were financially viable. A settlement was not possible while the staff side adhered to a demand which was incompatible with the principle that productivity deals must be self-financing. Had that principle been accepted earlier, there could, no doubt, have been an earlier settlement.

Can the Secretary of State explain what it was that Len Murray managed to do in 48 hours that he and his Department had failed to do in more than 48 days of strike and his Government had not done in more than four years in office? Len Murray is not God. Does not the fact that he managed to settle the strike so quickly imply either blinding shortsightedness or great obstinacy on the part of the Secretary of State?

The settlement was reached within the Whitley Council, but I certainly pay a very warm tribute to the role played by Len Murray. He called together the general secretaries of the unions concerned and went through the issues that had been considered by their negotiating officers. As a result of that helpful approach, the staff side took a different position and enabled the negotiations to be satisfactorily concluded.

As the Secretary of State chose to assert in the course of the dispute that

"Patients are dying as a result of this dispute,"
will he publish the names of the patients who have died? If he cannot, or will not, will he apologise to the unions and the trade unionists who were involved in the dispute?

I made it very clear immediately I saw the statement which was on the Press Association tapes that I had been misquoted. I did not say that I had any evidence that patients had died. I said that consultants had told me that patients were dying and that there was no doubt—it was accepted by both sides, negotiators as well as management—that patients' lives were at risk. That was the issue.

Is the Secretary of State aware that no one on this side of the House is in any doubt whatever that the consequences of the dispute were absolutely disastrous, both in terms of lives and in terms of the waiting lists?

Is it still, on reflection, the right hon. Gentleman's view not merely that the claim made by the unions was in excess of the limits allowed under the pay policy but that it was their intention, as he suggested on Thursday, to use their claim to smash the pay limit?

The Secretary of State shakes his head, but does he not recollect that when I said that it was as good a way as any of smashing the pay limit he is quoted in Hansard as saying "That is right"? Therefore, presumably, he thought that it was being used to smash the pay limit. Is not this as strong an argument as one could have to show that the existence of a rigid pay limit actually provokes disputes that would not otherwise happen?

No. I certainly did not say that it was the clear intention of the unions to do this. I said that there was very little doubt that if the unions succeeded in getting an agreement outside the pay policy—and I have to say, as I did in the House to the right hon. Gentleman, that that had nothing to do with the 5 per cent. —the central issue would be whether productivity agreements were self-financing. That was the issue on which the discussions centred during the last two or three weeks of the dispute. I certainly did not suggest that it was the intention of the unions to smash the pay limit. I said that if we, or management, had accepted the submission made by the unions, a severe dent would have been made in pay policy, which would not have been tolerable.

Sickness Benefit


asked the Secretary of State for Social Services whether it is his intention that the linking of periods of sickness should be used to disqualify people from receiving benefit when later periods lie in a year for which their contribution record entitles them to benefit but earlier periods lie in a year when they are not qualified for benefit.

The present linking rules for satisfying contribution conditions for short-term benefits can occasionally prolong the effect of a deficient contribution year. I am considering whether any change in the present arrangement is desirable.

I am grateful to my hon. Friend for that answer. He will be aware that his right hon. Friend told me that the purpose of the linking rule was to make sure that the qualifying days for sickness did not have to be repeated over and over again when someone returned to work for a short period. However, will he, when looking at the unfortunate effect of this rule, undertake to ensure that it is made retrospective to cases currently under consideration?

I can give no assurance about retrospection, simply because I do not think that the legislation would allow that. If we make a change, it will have to apply for the future. I am not yet convinced that there is a strong case for a change, but, of course, I undertake to look at the matter without prejudice. As my hon. Friend has acknowledged, there are considerable advantages in the present procedure for a large number of claims.

Supplementary Benefit (Review)


asked the Secretary of State for Social Services if he will make a statement on the review of the supplementary benefits system.


asked the Secretary of State for Social Services if he will take steps to reform the supplementary benefits scheme.

We published a report by officials in July to provide a basis for public discussion of the issues raised by the review, and we asked for comments by the end of the year. Neither the Government nor the Supplementary Benefits Commission are at this stage committed to any of the options in the report. When the period for public consultation is over, we shall start to formulate proposals for the future of the scheme, and these will in due course be laid before Parliament.

I thank the Minister for his reply. May I ask when the Government expect to receive the separate report which they commissioned on the payment of supplementary benefits during trade disputes? Does the right hon. Gentleman agree that, with unemployment remaining so high, there can be no justification for the taxpayer subsidising those who voluntarily withdraw their labour and, in so doing, cause others to be laid off work?

I remind the hon. Gentleman that the rules are followed in any trade dispute. We live in a civilised society, and we intend to continue with the supplementary benefit scheme as it is at present. The answer to the first part of the hon. Gentleman's supplementary question is that we do not at present propose to review the position.

Does the Minister accept that there is a need for some urgency in dealing with the complexity of the scheme to which the officials' report particularly paid attention? Does he agree that many in need are elderly or confused—perhaps both—and cannot easily understand the multiplicity of schemes? Is the right hon. Gentleman aware that in some areas, such as housing, there are three separate schemes and that people do not know which would best suit them? Will the Minister look at that point sympathetically and quickly?

I fully endorse what the hon. Lady has said. The review is basically meant to look at the complications of the present supplementary benefit scheme, not least those concerning housing need. We want to move towards simplification so that those who are entitled to benefit can claim and receive that benefit.

Does my right hon. Friend agree that the first priority for change in the supplementary benefit system is that long-term unemployed people should be given the long-term rate of benefit? Is he aware that the present system is discriminatory in that some people receive less than others? Does he appreciate that many recipients are old or disabled or live in areas of high unemployment?

I am extremely sympathetic to the point made by my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley). The Government would like to proceed along the lines that he has suggested. It is a matter of resources, but dealing with this problem is a high Government priority.

In the light of the review, does the Minister agree that a combination, on the one hand, of wages kept low and taxation kept high and, on the other hand, comparatively high social security benefits, has disastrously undermined the incentive to work? Does he not think it grossly unfair that next week the Government will give a 7·1 per cent. rise in benefits to those who do not work—including many who have no intention of working—and at the same time are keeping the increase in wages of those who do work down to 5 per cent?

The hon. Gentleman's attack on the unemployed is greatly to be deprecated. People who are unemployed, the vast majority through no fault of their own, are entitled to State benefit. They have contributed towards those benefits through taxation. I remind the hon. Gentleman and the House that when benefits rise next week a single person on supplementary benefit will receive £12·45 and a married man with no children will receive £25·50. Perhaps the hon. Gentleman would like to try to live on that.

While thanking my right hon. Friend for that reply, may I ask him to take it from me that we would like a little more flexibility? Is he aware that some people do not draw supplementary benefit and thereby lose other substantial benefits? Will he look into that matter at the same time?

I endorse the point made by my hon. Friend. That is one of the areas on which the review is concentrating.

Has the Minister examined the sensible proposal in this year's Supplementary Benefits Commission's report on help with heating costs, and can he say what action he proposes to take further to help elderly people who may face a bleak time this winter because of the increasing expense of heating?

The Government are about to introduce increased heating allowances for this winter. They are aware of the problem. Heating costs and the overlapping effect is one of the issues that will be discussed and considered under the review.

Earnings Rule


asked the Secretary of State for Social Services whether he will bring forward legislation to abolish the earnings rule.

Whilst it remains the policy of this Government to phase out the earnings rule for retirement pensioners, this cannot be done until the necessary resources can be spared. This is the conclusion reached following our review of the earnings rule, a report of which was laid before the House on 24th October.

Is it not now clear that the Government's earlier estimates of the cost of abolition were far too high and that the House was seriously misled? Will the Government now get on with it and abolish this unfair and very cruel rule?

The figure will be lifted next week from £40 to £45, and a person will have to earn more than £66 before the pension is completely phased out. If we were to abolish the rule completely in one stroke, it would cost £124 million a year in public expenditure terms. If the rule were abolished, women between the ages of 60 and 65 and men between 65 and 70 who were in full employment on full pay would get the pension.

Will the Minister reaffirm the commitment of the Government to proceed in this matter? Does he accept that, following the representations which he sought on "A Happier Old Age", many of the people who put forward views were reflecting the inadequate level of pension, as opposed to pension increases, and that this is one way of getting round the problem?

When my right hon. Friend laid the report before the House, he reaffirmed the Government's decision that we are in favour of ending the earnings rule at the appropriate time, and I endorse that this afternoon. We want to see it ended. Now that we have indexed the earnings rule, and as it increases in line with earnings each year, that, in a way, is also phasing out.

Hospital Workers (Disputes)


asked the Secretary of State for Social Services what steps he intends to take to avoid the possibility of lives being lost as a result of any future industrial dispute among hospital workers.


asked the Secretary of State for Social Services what proposals he has to improve industrial relations in the health services.


asked the Secretary of State for Social Services whether he will enter into discussions with all trade unions involved in the National Health Service with the object of agreeing basic ground rules for industrial action by National Health Service workers so as to reduce the danger to patients resulting from industrial action.

My aim is to improve NHS industrial relations so as to avoid industrial action that can harm patients. I put forward proposals recently for a new local disputes machinery designed to resolve problems speedily where they arise; consultations are proceeding on the reforms to the Whitley system recommended by Lord McCarthy; and greater emphasis is being put on industrial relations training and the importance of the personnel function in the NHS. I hope shortly to explore with leaders of the professions and unions what scope there is for resolving national pay disputes without resort to action that puts patients at risk.

Is it not tragic that members of a Service which is dedicated to preserving and saving life should themselves have been responsible for endangering lives, and all for the sake of some marginal improvement in conditions of service? Surely this sort of thing must not happen again.

I hope very much that it will not happen again. Naturally, I deplore any action which puts patients' health at risk, whether the action is taken by supervisors, ancillary workers or doctors. I hope that we shall never again have action similar to the events of the past few weeks, when issues which should properly be resolved in the Whitley Council become the cause of an unnecessary and damaging dispute. That is why I believe that the leaders of organisations within the Health Service must try to find, on national as well as on local disputes, a way through to minimise industrial action.

Order. I must call first those hon. Members whose Questions are being answered.

Does the Secretary of State agree that one way to improve industrial relations in the Health Service is to build up the links between hospitals and their local communities? In this connection, does he agree that the press statement dated 23rd October, which advocated the setting up of a national complaints scheme, will seriously undermine local autonomy and the authority of local hospital managers?

The document that was presented does not deal with the question of a national complaints procedure. It says that the procedures for dealing with disputes should be agreed between management and union representatives and should be brought to the knowledge of all concerned. Disputes that are not resolved by officers of the authority should be considered quickly by the authority itself or by a group of members appointed for this purpose or, in the event of the authority being unable to resolve the dispute, be referred to an informed but independent body. This is, of course, at regional level, not national level.

The other main advantage is that, pending the outcome of the processes, management and unions would accept that the status quo applies and that normal working should continue.

Does the Secretary of State agree that until more authority is delegated on the management side it will be most difficult to settle disputes where they arise, which is in the hospital or on the job? Given that we shall continue to have disputes no matter how well the system is improved, will the Secretary of State try to negotiate with the union some form of Geneva Convention that industrial action is not open-ended but restricted so that patients do not suffer in the way that they have done in recent industrial disputes within the NHS?

There are two different questions here with regard to the delegation of authority to the management side. It is important that both the management and staff side behave with the maximum responsibility, especially because they are concerned with the Health Service. As for a "Geneva Convention", nothing would please me more than a declaration from the representatives of Health Service workers, including doctors, that they were prepared to refrain from the use of industrial action.

However, I do not believe that we could impose such a requirement upon them. Most organisations—including, I suspect, the BMA—would not accept the requirement, but we must have some acceptable ground rules. We must ensure the co-operation of all in protecting patients' interests.

I welcome my right hon. Friend's recent initiatives, but do not the events of the last two years show that it is no good just tinkering with the Whitley machinery, even under the McCarthy recommendations? Until the basic problem of low-paid workers within the Health Service is tackled on a massive scale, we shall continue to have industrial disputes.

It is not just a question of low paid workers in the National Health Service. Some of those involved in industrial disputes have been at the higher end of the pay scale, including consultants and others with extremely responsible positions. There is no reason to suggest that it is just pay policy that causes industrial disputes. We must work to achieve better disputes machinery, which is the aim of this initiative, with the support of the leaders both of the professions and the unions.

Because of the many low-paid workers in our hospitals, their importance despite their low pay, the difficulty that they have in taking industrial action, and the fact that they cannot have productivity deals, does my right hon. Friend agree that the only equitable way to deal with their wages is to link them to average industrial earnings?

I shall not be drawn into how, during the course of the next few months, we should deal with the succession of pay claims that will come in from different groups within the National Health Service. We have to deal with them carefully and sympathically. Some will undoubtedly fall within the category of low-paid workers defined by the Government in the White Paper.

The Secretary of State must now be aware of the deep anxiety not only in the House but in the country about the use of industrial action within the National Health Service where it creates dangers for patients. Will he now take a firm initiative to try to bring the parties together to get a declaration, a patients charter as it were, to protect the interests of patients—

All those who are involved with patients—in order to give meaning and effect to the sentiment that the Secretary of State included in his annual report, which is that the interests of the people who serve must come first?

Terms such as "patients charter" are easy to mouth. The arrangements are much more difficult to establish. Instead of continually criticising, the right hon. Gentleman might respect the fact that, for the first time since the Health Service was created, the Secretary of State brought together the leaders of the professions and of the trade union movement and reached an agreement putting forward proposals to deal with non-Whitley Council issues. As I have already said, it is now my intention to consult with that same group to see whether we can work out some ground rules that will ensure that disputes about pay can be dealt with without industrial action.

Supplementary Benefit Recipients


asked the Secretary of State for Social Services what has been the increase in the number of people drawing supplementary benefit, including dependants, since December 1973.

About 900,000 as at November 1977. A change in the method of estimation prevents exact comparison with 1973.

We are dealing here, as the Minister and the Government know, with means-tested benefits. It remains the announced policy of Her Majesty's Government to reduce the dependence upon means-tested benefits, yet since December 1973 the number of people being means tested has increased by 1 millon. In other words, the greatest increase since the war in such benefits is being presided over by this Government. Does the Minister agree with those facts? What do this Government intend to do about the situation?

The Government's policy is, of course, to reduce unemployment. That is one of the major areas where there has been an increase in numbers. We are also committed to reducing reliance upon means-tested benefits, and a number of non-means-tested benefits have been introduced during the life of this Government. In future years, our new pensions scheme will reduce still further the number of pensioners who have to resort to supplementary benefit.

On the other hand, it must not be forgotten that it is one of the aims of this Government—and, I hope, of the whole House as well—to ensure that people who are entitled to supplementary benefit but are not at present claiming it are encouraged to do so, and that must lead to some increase in the figures.

Does my hon. Friend agree that one of the main factors in accounting for the increase in the number of families with children which are dependent on supplementary benefit is the general large increase in the number of one-parent families? Is it not time that the Government looked seriously at the case for a separate and more satisfactory system of income support for these families?

We are well aware of the problem of one-parent families which are dependent on supplementary benefit, and my hon. Friend is quite right that the numbers are increasing, just as the number of one-parent families in the population as a whole is increasing. But to introduce a simpler benefit so as to take one-parent families off supplementary benefit would be very expensive and would raise difficult questions of priorities between two-parent familes and one-parent families and other disadvantaged groups which have a claim on our resources.

Is the Minister aware that the situation where some families claim supplementary benefit and some get local authority rebates is worsening? Will he take steps to help the local offices to deal with the necessary claims of many families who would be better off with the rebate than with supplementary benefit but where the information is inadequate to get them on to the right benefit at the right time?

I agree with what the hon. Lady said. One of the reasons why the number of supplementary pensioners has decreased is the introduction of the housing finance benefits. The special exercise that we mounted in 1975 to identify claimants who would be better off getting a rent rebate or allowance or a rate rebate also helped. The exercise had a major effect, and we shall consider the possibility of repeating it. But it is, frankly, wasteful of our manpower resources, which are a top priority.

Family Practitioner Committees


asked the Secretary of State for Social Services if he will now take action to ensure the right of attendance by representatives of all community health councils to their respective family practitioner committees in view of the hostility expressed at the yearly conference of family practitioner committees, and the fact that only 50 per cent. had heeded his request for admission.

In addressing the closing session, my right hon. Friend made very clear his view that all family practitioner committees should invite observers from community health councils to the non-confidential part of their meetings. My right hon. Friend urged most strongly those committees that had not done so to think again. I hope they will respond. If not, we shall have to consider what further action should be taken to achieve our objectives.

Although most of us have been concentrating on the mess-up in the Health Service caused by the Conservative reorganisation, has it not been even more disastrous for the family doctors? As the family doctor is becoming more and more isolated both from the profession and from his patient, is it not vital that the Minister should proceed with the second point that he made in his answer and take action to get the community health councils well and truly involved with family doctors?

I am sure that family practitioners would benefit from closer involvement with representatives of the community. My right hon. Friend and I still hope that we can make progress on a voluntary basis so that local arrangements are made, rather than resort to compulsion. But we must ensure that, in the end, the family practitioner committees have community health council observers present at their non-confidential proceedings.

Is the Minister aware that the more we can develop the community hospital—what used to be called the cottage hospital—the closer can be the links between the general practioner and the hospital service? That, surely, is what reorganisation was all about.

I am sure that that is true, but it will take some time. In the meantime, community health councils wish to be more closely involved with the work of family practitioner committees.

Will my right hon. Friend give the House a clearer idea of how long he will allow the family practitioner committees to comply with his request and the repeated requests of other Ministers? Is he aware that the family practitioner committee in Staffordshire has repeatedly refused to allow in observers from the South-East Staffordshire community health council, that much the same applies throughout the country, despite repeated advice from his Department, and that he should put a time limit on this?

I note the suggestion made by my hon. Friend, and I have in fact discussed the problem of the Staffordshire community health council and the family practitioner committee with representatives of the community health council. I am afraid that I cannot impose a time limit. Progress depends upon how rapidly family practitioner committees respond to our initiative.

Pensioners (Christmas Bonus)


asked the Secretary of State for Social Services if he will make a statement on his intentions concerning the payment of a Christmas bonus to pensioners.

As my right hon. Friend announced on 17th October, we propose that a Christmas bonus of £10 will be paid in the week beginning 4th December to more than 10 million retirement pensioners, widows and the chronically sick and disabled. A Bill for this purpose was introduced on 2nd November. I shall publish in the Official Report details of the categories who will receive the bonus.

The whole House will welcome this decision by the Government, but is the Minister aware that the bonus is now worth less than half what it was when it was first introduced by the Conservative Government in 1972? Bearing in mind that pensioners, of all people, are those hardest hit by inflation, why have not the Government done something to upgrade the bonus to compensate for the fall in the value of money?

Pensions will be increased substantially this year because they are kept in line with earnings as opposed to prices. Since this Government came to office, pensions have increased in real terms by more than 20 per cent.

With regard to the £10 bonus, of course the Government would have liked to do more. Quite frankly, we virtually emptied the contingency reserve to meet the £10 bonus this year.

Will the Minister and the Government consider extending this bonus to one-parent families, for whom Christmas can be a very trying time, both emotionally and financially?

We considered those people along with other categories, such as the long-term unemployed. Again, it was a matter of finance. The bonus itself will cost £106 million, and including other categories would have meant more public expenditure, but I certainly take note of what the hon. Gentleman said.

Is my right hon. Friend aware that for pensioners this Christmas bonus is now here to stay? Therefore, instead of having to pass a separate Act of Parliament every year, would it not be a good idea to pass one now in perpetuity? If we do not do that, we are in the position of being accused of "pensioneering" when we leave the announcement until the end of each year.

As my hon. Friend knows, the Government reintroduced the bonus last year, and we are paying it again this year. What happens in future years will be a matter for Parliament.

Following are the details:

Categories who will receive the Christmas bonus

A Christmas bonus of £10 will be paid in the week beginning 4th December to those who, in that week, are entitled to—
  • Retirement pension;
  • Supplementary pension;
  • Widow's pension under the national insurance, war pension or industrial injuries schemes;
  • Invalidity pension, including non-contributory invalidity pension;
  • Attendance allowance;
  • Invalid care allowance;
  • Unemployability supplement or allowance payable under the industrial injuries or war pension schemes.
It will also be paid to any war pensioners over pension age who are retired but not receiving one of these benefits.
The cost, which will be borne on the contingency reserve,will be about £106 million.
National insurance retirement and widow pensioners paid by order book will get their bonus automatically when they go to the post office for their pension for the week beginning 4th December. Others who qualify will be paid by Giro cheque or payable order issued by offices of the Department of Health and Social Security.

Eltham And Mottingham Hospital


asked the Secretary of State for Social Services if he will make a statement on the future of services provided at the Eltham and Mottingham hospital.

This hospital is to close and its present services are to be transferred to other hospitals in the Greenwich and Bexley area.

Does not the Minister understand that the fragmented services to which he refers at this hospital are the very services which should be kept in the middle of a community? Does he not want to avoid the mistakes that successive Secretaries of State for housing and education have made by concentrating all services in large, impersonal "people factories" instead of keeping hospital care and community work where it should be?

Yes, but the area in question has had the benefit of considerable capital investment in recent years. Two large new hospitals have been built, one at Greenwich and the other at St. Mary's, Sidcup. There are a number of other hospitals in the area as well. I therefore do not accept the validity of the hon. Member's argument.

National Health Service (Morale)


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.