Skip to main content

Opposition Day

Volume 164: debated on Thursday 11 January 1990

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

2Nd Allotted Day

Ambulance Dispute

I must announce to the House that I have selected the amendment in the name of the Prime Minister. In view of the number of hon. Members who wish to participate in the debate, I shall put a 10-minute limit on speeches between 7 and 9 o'clock. I hope that those hon. Members who are fortunate enough to be called to speak before that time will bear that limit in mind.

4.25 pm

I beg to move,

That this House recognises that ambulance staff provide an essential emergency service; notes that four-fifths of all ambulance crews are fully qualified to provide skilled attention to the casualties of accidents and to patients with critical medical conditions and that many of the others are recent recruits; records its appreciation of the commitment staff have shown to the ambulance service and the courage they have often displayed at the scene of accidents; is conscious of the overwhelming public support for a just pay award to ambulance staff and for a pay mechanism to avoid disruption of this emergency service in future years; expresses its dismay that the current industrial dispute has remained unresolved for four months; and calls upon Her Majesty's Government to commence early negotiations to secure a settlement.
Those words record our recognition of the commitment and dedication of the ambulance service. They call for an urgent settlement of the dispute. There is not a breath of criticism in those words of the Secretary of State. The right hon. and learned Gentleman will well understand that that being the case, the motion does not express my innermost thoughts about his conduct in office.
I read in the newspapers—in some surprising newspapers these days—that the Secretary of State is thought to have got himself into a hole. I must advise my hon. Friends that our duty on this occasion is to throw down ropes to the right hon. and learned Gentleman and, heavy though the burden may be, haul him up until he is within reach of a settlement. If that disappoints my hon. Friends, I assure them that there will be plenty of occasions in the future when they can shove him back down the hole.

If we are to rescue the Secretary of State tonight, we need the co-operation of Conservative Members. Some of them have already tried bravely to get the Secretary of State to see the case for a settlement. Perhaps the most remarkable of those was the present Minister for the Environment and Countryside and sometime Parliamentary Private Secretary to the Secretary of State when he was last at the Department of Health. The Minister for the Environment and Countryside wrote to the Secretary of State in December saying:
"I can see the logic of the ambulance staff claim."
I understand that since then he has recanted and has let it be known that he did not understand the full ramifications of the dispute. I have no doubt that the full ramifications—

—of the dispute have been pointed out to him with vigour and clarity. I am in no doubt about that because I read in the Lancashire Evening Telegraph on Tuesday that:

"when visited by the ambulance staff last week, he was very offensive and said we had made his life hell in Government".

I had not intended to intervene so early in the hon. Gentleman's speech, but to be fair to my hon. Friend the Minister for the Environment and Countryside—who is not in his place and who presumably was not warned that the hon. Gentleman would refer to him—it should be pointed out that the management has made a much improved offer since my hon. Friend wrote that letter, and that seems to represent a significant change in circumstances.

I shall return to the management's allegedly improved offer later in my speech. That improved offer would mean converting 6·5 per cent. over 12 months into 9 per cent. over 18 months. I doubt if even the offensive, aggressive and, I read in the article from which I quoted,

"disgusting and disgraceful"
Minister for the Environment and Countryside would try to claim that there was a substantial difference between 6·5 per cent. over 12 months and 9 per cent. over 18 months. But I do not expect to see the Minister for the Environment and Countryside voting with us at the end of the debate.

Nor do we table this motion of studied moderation in the hope that Conserviative Members will vote with us. I have stood at the Dispatch Box often enough to know that if I were to move, "That this January is warmer than usual", that motion would be voted down because it was moved by the Opposition. Indeed, the hon. Member for Harlow (Mr. Hayes) would probably have intervened by now to disagree with me. Therefore, I do not expect Conservative Members to join us in the Lobby tonight, but I ask them to speak for their constituents in this debate and to express the public view.

As the Secretary of State said that, since the hon. Member for Rossendale and Darwen (Mr. Trippier) wrote that letter, there has been an improved offer, does my hon. Friend agree that it would be a good idea if all the other hon. Members who feel the same were to write letters to the press, because that might get the whole thing settled?

Yes. I hope that Conservative Members will treat the debate as a debate about a service in crisis. That service is an emergency service. I repeat that it is an emergency service. The crisis in that service has left people lying in pain and distress for longer than any civilised society should tolerate. It has left people in a state of collapse without the skilled treatment that they need at the point when they are attended.

The Government's amendment expresses appreciation of the police and the Army. I have no doubt whatsoever that thousands of policemen and service men in the past four months have given of their best to provide the best cover that they can. But if we are serious in appreciating what they have done, we must listen to what they say to us about the cover that they can provide.

We must listen, for instance, to Mike Bennett, the chairman of the Metropolitan police branch of the Police Federation, who has stated:
"At the end of the day apart from being totally unqualified to run an efficient service, we are using vehicles which really any self-respecting prisoner would complain about, let alone a patient.
We have a standing instruction not to convey people with head injuries in police vehicles, and yet here we are doing it. The vehicles are not designed for this … they are designed for carrying goods not people … If the money is there why can't it go to solving the dispute?"
There are plenty of cases on record to show that the emergency service that has been brought in as a substitute for the ambulance service cannot cope with emergency calls. Last month I was contacted by Nigel Harris, who is known to Ministers because he appeared at one of their press conferences during the last general election. He is an orthopaedic surgeon. In December, he attended a window cleaner who had fallen three floors. In the course of the fall, the window cleaner had fractured his spine, tibia, ribs, pelvis and forearm. Understandably, the window cleaner was in a state of shock and in acute pain and distress. He was, of course, in fear for his own survival.

It was 50 minutes before a reply could be obtained from the 999 service and two hours and 10 minutes before an Army ambulance appeared at the scene of the accident. When the service men arrived—this is meant to show no disrespect or criticism of them—they did not know how to handle a patient with such multiple fractures and had to be advised by the orthopaedic surgeon how to lift the patient; yet a wrong decision on how to handle that patient could have resulted in paralysis for life.

There are many questions that we could ask the Secretary of State about what he has done in the past four months and about what he tried to say last weekend, but there is only one answer that matters today from the Secretary of State—that is, how he sees the dispute being resolved and how he sees the public getting back a full professional ambulance service.

I have read with care everything that the Secretary of State has said over the past fortnight, and I am bound to tell him that I cannot see in anything that he has said over the past two weeks any strategy for the dispute being settled other than by the unions surrendering their total claim. This is the most serious issue affecting patients in the Health Service at present. It is a dispute that has now been going on for four months. I have put it to the Secretary of State that the priority for him is to make it his job, in the interests of the patients, to ensure that the dispute is brought to an end.

What level of increase would the hon. Gentleman agree for those less highly skilled and qualified ambulance men—the majority of ambulance men? What would he say to the 85 per cent. of Health Service employees who have accepted wage increases in the middle 6 per cent. range?

There are two responses to the hon. Gentleman's last point. First, 85 per cent. of Health Service staff did not settle at 6·5 per cent. Doctors and dentists settled at more than 7 per cent., administrative and clerical grades at more than 9 per cent. and professions allied to medicine at 7·7 per cent. There have been a whole score of settlements in the NHS above that which is being offered to the ambulance staff.

The average public sector pay settlement during the four months of the ambulance dispute has been 8·6 per cent. We cannot know what will settle the dispute until the Secretary of State or his representatives come to the negotiating room and negotiations start. If that average public sector pay settlement of 8·6 per cent. was offered to the ambulance crews, the Secretary of State would find himself within a whisker of settling the dispute. I hope that the Secretary of State and the hon. Member for Northampton, North (Mr. Marlow) will not try to tell us that that settlement cannot be afforded because the Secretary of State cannot find the money. As the chairman of the Metropolitan police branch of the Police Federation pointed out, the Secretary of State has found the money to pay the police and the Army to do the job of the ambulance staff—it is a great deal of money.

The Association of London Authorities estimates that during the dispute the cost of police cover in London alone has been £3·5 million. There are 14 other areas outside London where the police have been active for the past two months. From figures that I obtained yesterday, I estimate that the total cost of police time in those areas has been £4·4 million. On Tuesday the Minister of State for the Armed Forces announced in a written answer that to 30 November the cost to the Army—for which it was billing the Department of Health—had been £850,000. By now that must represent a figure of £2·5 million. If we add together those three figures, the cost of paying the police and the Army to do a job that would be better done through paying ambulance staff to do it is £10·4 million.

There is a poignant resonance to that figure. The difference between the 6·5 per cent. offered by the Secretary of State and the 11·4 per cent. demanded by the ambulance staff is 5 per cent. Each 1 per cent. on the ambulance staff pay bill is £2 million. In short, it would cost £10 million to settle the claim in full.

The Secretary of State has said that, if he found that £10 million, wards would have to close. Why is it that the Government cannot find the money to settle the dispute but can find the same amount of money to prolong it? Why is it that paying ambulance staff to meet their claim would mean closing wards, but paying policeman the same amount to do the job of ambulance staff does not?

There is one reason why the dispute has been so prolonged. That is the happy knack of the Secretary of State for finding the phrase that inflames tempers whenever he intervenes. I did not think so at the time but in retrospect I think that his original strategy of going into hiding and leaving public comment to Duncan Nichol was a wise one, especially in the light of the amount of debris left behind by his recent interventions—the most spectacular of which was his letter to his constituent, Miss Mitchell.

I do not often congratulate the Secretary of State, but may I congratulate him on the candour with which he conducts his constituency correspondence. I am sure that it must be a perpetual delight to his political opponents in his constituency. There are two points at issue between the Secretary of State, Miss Mitchell and the ambulance staff. The first is whether the ambulance service is an emergency service. It has been repeatedly maintained during the past four months that the ambulance service is not an emergency service on a par with the other two.

It was not always thus. In 1978, the current Prime Minister sent a letter to two ambulance persons which made it clear that she then regarded the ambulance service as one of three emergency services. I have no doubt that in recent weeks the Secretary of State has taken aside the Prime Minister and, like the Minister for the Environment and Countryside, she has had the full ramifications of the dispute spelt out to her.

The hon. Gentleman spoke about the so-called Prime Minister's letter, of which I have seen a copy. It was written before the Clegg report, which ruled out some of the things of which the hon. Gentleman talked. It was written by Matthew Parris, who is now a sketch writer for The Times.

I am disappointed to hear the cries of, "Where is he?" because I had thought that the hon. Member for Harlow had secured a mention by Mr. Parris in the press tomorrow. The hon. Gentleman is perfectly correct to say that the letter was signed by Mr. Matthew Parris—I presume the same man—written on notepaper headed in the name of the current Prime Minister and signed on behalf of the then Leader of the Opposition. It is quite explicit in the letter that the office of the then Leader of the Opposition accepted that the ambulance service was one of three emergency services.

In his letter to Miss Mitchell, the Secretary of State contests this claim, on the basis that emergency cases represent one in 10 of all patients carried. I have tried to find out where that figure comes from. It is not an easy figure to find. In a parliamentary question on 19 December, the Secretary of State was asked if he would estimate
"the average time spent by an ambulanceman on transporting (a) emergency cases and (b) non-emergency cases."
The Minister's answer to the question was:
"This information is not available".—[Official Report, 19 December 1989; Vol. 164, c. 165.]
Where does that figure of one in 10 come from? It is available from some local ambulance services. I have the figures for London for the first nine months of last year—the period before the dispute—[Interruption.] I am not sure whether the cameras caught that incident. However, if my hon. Friends look the other way, we may be able to hear the answer in the fulness of time.

I have the figures for the first nine months of last year—before the dispute—for London. They show that, of calls to the London ambulance service in the first nine months of last year, the number of emergency cases was not one in 10 but one in four. I repeat the question: where does the figure of one in 10 come from? If that figure is to be the basis for comparison, can we have the figures for the other two emergency services?

The most comprehensive study of how police spend their time is a study of the Merseyside police. It showed that the police spent 9 per cent. of their time responding to crime incidents, 1 per cent. responding to traffic incidents and 2 per cent. responding to other incidents. That gives a total of 12 per cent. of their time spent responding to incidents, not all of which were emergencies. I would not for one moment suggest that the police are not an emergency service. It would defy common sense to suggest that. However, by the same token, it defies common sense to tell ambulance crews that they are not an emergency service.

On Monday night, the whole country—[Interruption.] It is clear from the events taking place at the back of the Chamber that the Secretary of State has brought his own emergency service with him.

On Monday night, the nation had the opportunity to witness the professional and competent response of the ambulance service to the emergency caused by the pile-up on the M25, when six crews, who have not been paid since October, responded to an emergency call to treat victims of acute injuries. Few hon. Members could look on those injuries, far less know how to begin to rescue the victims. Those crews know that they are an emergency service, and they are mystified and wounded that the Health Service is in the hands of a Secretary of State who tries to deny it.

There is another issue in contention which is perfectly expressed in the letter to Miss Mitchell: whether those ambulance crews are skilled personnel or professional drivers. I understand that the Secretary of State is sensitive on that point. He has accused COHSE of doing a scissors and paste job on his letter. Therefore, to avoid any doubt, I shall read the full paragraph. In context, the statement reads no better than it does out of context. Frankly, in the context of a letter to a 15-year-old girl about her father, it reads decidedly worse than when it is taken out of context.

The letter states:
"The vast majority"—
I ask the House to remember those words—
"of ambulance staff have had no extended paramedical training at all. They are professional drivers, a worthwhile job —but not an exceptional one."
It is clear beyond reasonable doubt from the context that the Secretary of State is describing the vast majority of qualified ambulance staff as professional drivers. Four out of five ambulance staff are fully qualified. That means that they are trained in life-saving skills, can treat head injuries and those with spinal injuries and open wounds. All the fully qualified ambulance staff are trained in resuscitation and the suction of blockages. All of them are capable of carrying out childbirths in emergencies. In their career many ambulance staff have carried out more than 50 births at the kerbside. They are all trained in handling and lifting people with serious fractures. Many of them put themselves at risk in providing those services to accident victims.

The ambulance personnel who responded to the pile-up on the M25 drove through the same thick fog that caused that pile-up and attended the victims in that thick fog. Those ambulance staff who attended some Conservative Members in the Grand hotel did so while one floor of it collapsed.

Increasingly, those ambulance staff are being assaulted by those they come to serve. I have here a letter sent by an ambulance man in Barnsley. It states:
"I have had my spectacles smashed on two occasions … I have been kicked and abused and, on one occasion, threatened with a shotgun … Who is more at risk these days than the ambulanceman from contracting A.I.D.S., or Hepatitis B … We don't stop to ask the injured and dying patient if he is suffering with these diseases—we just get on with doing what has to be done."
That is the job that the Secretary of State describes as "worthwhile" but "not exceptional". What professinal driver needs those skills, takes those risks and undergoes that stress?

The Secretary of State and his Department know about the stress on ambulance drivers. Seven years ago it received a report on stress among ambulance workers. It was a report in the context of a study on whether ambulance staff should be allowed to retire earlier than at 65 years of age. That study found that few made it to the retirement age of 65. Most took early retirement, frequently through ill health. Of the few who made it to 65, the average period of survival in retirement was 2·4 years. We are haggling over a pay award to a group of workers whose mortality rate is one quarter higher than the average for industrial workers.

In the negotiations, to quote the Secretary of State's letter to Miss Mitchell, we are told
"the union side has not budged an inch."
Since the dispute began, the staff side has dropped its demands for enhanced payments for overtime, standby payments to staff on call, an increment for long service and a reduction in working hours. The only two elements that remain are for a higher pay award this year—and staff are willing to compromise on the amount—and for a pay mechanism for future years—and staff are willing to compromise on the formula.

The Secretary of State persists in claiming that the staff side is claiming 11·4 per cent. He knows perfectly well that a long time ago the union side said that it was willing to negotiate that figure. One has only to read his correspondence. On 3 January he received a letter from Mr. Roger Poole which said:
"In your recent television and radio interviews you say we are unwilling to move from the 11·4 per cent. claim. We have stated both publicly and privately that we are willing to enter into serious negotiations with you and, if necessary, lower our sights."
For what it is worth, I shall tell the Secretary of State what, in my judgment, would secure a negotiated settlement. I believe that, if he were to split the difference between his position and that of the ambulance staff, he would obtain a settlement in the first hour. It would cost him £5 million—less than half the increase in his advertising budget for the current year for the Department of Health.

It is clear that the Secretary of State will not succeed in making the ambulance staff settle for 6·5 per cent. even if he tries to disguise it as 9 per cent. over 18 months. The ambulance staff are perfectly capable of spotting that that is 6 per cent. over 12 months. Any doubt about their capacity to spot it was resolved by the negotiations with the Association of Professional Ambulance Personnel.

The House will remember that the Secretary of State discovered the association in late November as a new authentic force representing ambulance staff. He gave it negotiating rights that it had never had before, hoping that it might accept the offer that the other unions had rejected. Unfortunately for the Secretary of State, the members of the association threw out his offer by a majority of 2:1. Moreover, that was a majority of the rump of the members, after half the membership had resigned in disgust at the negotiations being held.

Since November 1989, I am sorry to say that I have been unable to trace any reference by the Secretary of State to the Association of Professional Ambulance Personnel. Nor has he repeated any of the words of praise that he heaped upon it before the ballot took place.

The reason why the Secretary of State could not sell 9 per cent. to the Association of Professional Ambulance Personnel over 18 months or 6 per cent. over 12 months to the other ambulance staff is that the ambulance staff can see that no one else is buying 6·5 per cent. Income Data Service provides a monthly analysis of recent pay settlements. Its analysis of the most recent 83 settlements between November 1989 and February 1990 shows that 72 were struck at over 7 per cent., 56 were struck at over 8 per cent. and 18 were struck at over 9 per cent.

One of those 18 is the pay award to ourselves. At the end of this month, hon. Members will receive a 10·6 per cent. increase in their salaries. We receive that increase because the same increase has already been granted to the principal grade in the Civil Service. I do not see any reason why hon. Members should be ashamed of seeking parity with the principal grade in the Civil Service. For that reason, I voted for the mechanism when the House debated it in 1987. What is more to the point, the Secretary of State for Health voted for that mechanism and so did the Minister of State and the Parliamentary Under-Secretary of State.

I believe that we voted the right way in 1987. It was correct for the House to seek a pay mechanism to settle its pay in future years. Having established that mechanism for themselves, I wonder how they dare table an amendment in the House describing such a pay mechanism for ambulance staff as highly inflationary.

Whenever I turn on the television or radio in the morning, the first thing that I hear is the Secretary of State telling me that he cannot intervene in the ambulance dispute because the management of the Health Service must resolve the issue. May I tell him the views of the management of the ambulance service, as far as they are known? A survey has been carried out, not by the Labour party, or any of the newspapers to which we are affiliated, but by the Financial Times. It found that, of 45 chief ambulance officers, 40 wanted a payment mechanism for settling pay within the ambulance service.

What is stopping them from striking a deal that 40 out of 45 ambulance officers want? The article gives the reason. It quotes Mr. Tom Crosby speaking with characteristic frankness. He says:
"it goes right against the grain of Government policy,"
There we have it from one of the most senior managers of the ambulance service in Britain. The reason why a pay mechanism formula is off limits is not because the management of the Health Service do not want it but because it goes against the grain of Government policy. Responsibility for that policy rests with the Secretary of State.

Will the hon. Gentleman tell the House whether, if he were in the Secretary of State's position, he would accept the pay mechanism originally proposed by the ambulance men and their full claim?

I am disappointed in the hon. Gentleman. I know that he attends our debates on health. I regret that I could not give way to him in the previous debate. I am sure that he was present during the emergency debate in November. That very same question was put to me by the Secretary of State, and I am sure that the Secretary of State has not forgotten it. My answer then, which has not changed, was that I accept that in the present circumstances the negotiations should include negotiation on a pay mechanism for the future. The hon. Gentleman should stop looking at the notes that are being passed to him to pass to the Secretary of State and listen to what I have to say. I have never said that we would go snap on the ambulance unions' demand for linkage to fifth-year firemen. Nor has the union side said that it would stick out for that and that alone, as the hon. Member for Harlow is aware. It has made it clear that it is willing to enter into meaningful negotiations. However, it has said that a pay mechanism must be part of the settlement.

After four months of the dispute, the public would regard it as perplexing if we were to settle last year's pay settlement only two months before the start of negotiations for next year's settlement, without any idea how that pay is to be determined.

I now turn to what has been the most dramatic feature of the dispute.

Will my hon. Friend give way before he deals with that point?

I shall give way on this occasion, but I am conscious of Mr. Speaker's instruction and I am anxious to move to a close so that other hon. Members can speak, so this must be the last intervention.

I am grateful to my hon. Friend. Does he recall that in the late-night debate on 20 December, when the Secretary of State, despite the dispute, reneged on his responsibilities and did not appear, the Under-Secretary of State for Health, who is now here, admitted, in reply to my speech, that the funding of the ambulance service should not be demand-led, that it must have cash limits, and, therefore, the pay policy to which my hon. Friend has referred was automatically cutting into the other services? Is that not something with which nobody in the House or in the country can agree, because surely an ambulance service and an emergency service must be demand-led in order to keep the staff going?

Whether hon. Members agree with those statements that my hon. Friend correctly quoted from the Under-Secretary of State, it must be self-evident to hon. Members on both sides of the Chamber that those propositions are not of the making of Duncan Nichol; those limits are of the making of Ministers in charge of the Department, who must accept responsibility for the consequences.

My hon. Friend leads me on to my concluding point. I also recall that the Under-Secretary of State said in his speech that he was aware from his own constituency experience—I do not think that I misrepresent him—of the powerful public support for the ambulance service. That is the most dramatic feature of the dispute. The degree of public support in this dispute is without precedent both in its sheer scale and in the length of time for which it has been sustained.

Consistently, the ambulance staff have been beating the Secretary of State in the opinion polls by majorities of 8:1. On the "Newsnight" poll, when asked whether their sympathies lay mainly with the ambulance staff or with the Government, 65 per cent. of Conservative voters sided with the ambulance staff, leaving only 19 per cent. to side with the Government. That is the sort of margin that the Prime Minister will no doubt claim as a triumph if she is re-elected next year by the 1922 Committee. The Secretary of State can write off the Labour voters, he can ignore the centre voters, but I ask him at least to accept the verdict of his own supporters.

Nor are those just idle responses to pollsters who have caught the public in the right mood. The public out there are backing their vote in the opinion polls with their money. One reason why the Secretary of State will not starve the ambulance workers back to work is that the public will not let him. I visited Waterloo ambulance station yesterday and I was told that the day before, Tuesday, it received the largest collection it had ever received in donations since the start of the dispute. The public continue to give their support as generously as the ambulance staff give their commitment.

There is, though, one measure available in this building to hon. Members by which they can measure the degree of public support. They can even feel that degree of public support. It is contained in the 100 boxes in the vaults of the Journal Office which contain the petition that my right hon. Friend the leader of the Labour party received from the ambulance staff and which I presented in the Chamber in the week before Christmas. That petition contains 4·5 million signatures, more than the combined majorities of all Conservative Members. It is the biggest petition ever presented to Parliament in our history.

Every schoolchild is taught that one of our liberties is the right to lobby and petition Parliament. The public have exercised that liberty on an historic scale in this case. No Parliament can persist in ignoring an expression of public opinion on that scale without bringing itself into disrepute. No Government in eastern Europe would ignore such an expression of the people's will.

I hope that the Secretary of State, who is about to take the Floor, will not treat us to another of his lectures that the public do not understand the issue; that the public are taken in by the propaganda and hairstyle of Roger Poole. The country is weary of the Secretary of State's homilies, of the idea that he knows better than all the rest of us and that he will take on all 4·5 million petitioners.

Democracy turns on a belief that, upon occasion, the public are right and the Government wrong. This is one of those occasions. The public are right to insist that the ambulance staff deserve a fair and just reward and that patients and public deserve a pay mechanism so that never again will this emergency service be exposed to disruption.

The vote tonight is not between the Government and the ambulance staff; it is a vote between the Government and the public that they are ignoring. I appeal to Conservative Members to join us in making this a debate that not even the Government can ignore.

5.5 pm

I beg to move, to leave out from "House " to the end of the Question and to add instead thereof:

"recognises the important contribution made by the skilled and dedicated service of ambulance staff; regrets that some have seen fit to take action against patients in furtherance of a pay dispute; appreciates the work of the police and Army in maintaining an adequate emergency service; supports the Secretary of State for Health and the National Health Service Chief Executive on their handling of the dispute; and urges them not to give way to demands for a higher inflationary pay settlement or any formula or other arrangement that would automatically trigger future pay increases which could only have an adverse effect on patient services."
I suppose that I should be grateful to the hon. Member for Livingston (Mr. Cook) for what turns out to be a helpful rope that he is passing to me with the motion. Having listened to him, I am not altogether convinced that that was his principal motive. I think that he tabled the motion rapidly, or announced his intention of doing so rapidly, after a flurry of press reporting.

I have no recollection of any occasion when a debate on the Floor of the House of Commons has speeded up the resolution of an industrial dispute, and I do not think that that was the hon. Gentleman's prime motive either. Nevertheless, it gives me a valuable opportunity to explain to hon. Members exactly where I think we are now and, most importantly, where we shall be going in order to resolve the dispute which, obviously, no hon. Member wants to continue or ever wanted to start.

The hon. Gentleman referred to a difficulty. I have seen many difficulties in health policies during the years that I have been in the House of Commons. In my recollection, every Secretary of State for Health, in all three Governments that I have seen, has been a controversial figure in a controversial service. I take no objection to that. I do not think that I have set a new record yet, as I have clear recollections of Barbara Castle, but I may be on the way. I knew that when I took on the task.

I also believe that if a Secretary of State takes on the process of reforming the NHS, he is likely to make himself an even more controversial figure, because this is a giant service and in every giant organisation any process of change causes understandable uncertainties, sometimes fears, and even anger.

Will the right hon. and learned Gentleman give way?

No. I shall not give way at this point.

I have always told those outside and those in the House, friends and opponents alike, to look at my actions and to realise that I base my actions, decisions, policies and statements on the NHS on a passionate, personal commitment to that service. It is my determination to make sure that during my period of office the NHS is made a better service for its staff and its patients.

A better NHS requires an even better ambulance service than we have at the moment, and that thought has not just occurred to me during the industrial dispute. Over the years, we have not paid enough attention to the ambulance service inside the NHS. A higher proportion of its staff need extended training that gives the life-saving, paramedical skills to those who are required to deliver the accident and emergency services, and those better-trained staff need to be spread more evenly throughout the country.

We also need to develop a service that concentrates increasingly on the tasks that a Health Service ambulance service is required to perform. Once I have dealt with the short-term points made by the hon. Member for Livingston, I shall touch on the future of the service and relate that to the key problem of the current dispute and how it is to be resolved.

Order. Obviously, the Secretary of State does not wish to give way at this point.

I shall give way, as I always do in this House—but at an appropriate stage, when I have dealt with the substance of the dispute.

I shall deal first with the points made by the hon. Member for Livingston concerning the handling of the dispute and the remarks that I was alleged to have made about ambulance men. There is a particular difficulty in respect of public sector disputes. In every industrial dispute—I have been engaged in several—its reporting in the press and by the other media, and debates in this House, are ultimately never the arena in which the dispute is resolved. The private sector has the advantage that day by day publicity and media events do not play a significant part in its disputes in the way that they do in protracted public sector disputes.

Throughout the ambulance dispute, I have sought to make three key points. I shall make them again in this debate, and enlarge upon them. They are the only points that I can helpfully make to the general public in the day-to-day exchanges. First, the claim is excessive and not justified by comparison with other Health Service staff who have not taken industrial action. Secondly, the management's offer is fair and generous, and it should be accepted. Thirdly, the industrial action organised and taken by the trade unions concerned is against patients and patient services, and it cannot be justified—as industrial action in any essential service cannot be justified. For four months, I have stuck to those points fairly doggedly, while also paying tribute to the caring nature of the work done by ambulance staff and the service itself.

It is inevitable that my message has not always proved popular. It is not possible to represent the case of the Health Service and of the employers against a group of people who are held in such high public respect as are ambulance staff, who can produce a popular message. It is not possible to produce stories day by day of the kind required by the newspapers and the other media in doing their job and make them popular. Those who present the ambulance service claim, who describe in moving terms its work, and who appeal to the public on behalf of what we all know to be an extremely popular group of people can always be appealing—not least in the run-up to Christmas —[HON. MEMBERS: "Shame."]

Order. The hon. Member for Livingston (Mr. Cook) was given a very fair hearing, and the Secretary of State is equally entitled to a fair hearing. Constant barracking does little to maintain the reputation of this House.

Order. I shall remain on my feet for as long as is necessary to allow the Secretary of State to receive a fair hearing.

On a point of order, Mr. Deputy Speaker. You will recall that, in the hearing of the House, the Secretary of State gave an assurance that he would give way at an appropriate point in his speech. The right hon. and learned Gentleman made three specific assertions, as he had every right to do, concerning the dispute. At that appropriate point, my hon. Friend the Member for Lewisham, Deptford (Ms. Ruddock) rose in her place in the hope that the Secretary of State would give way. Is it conducive to good order in this House if a right hon. or hon. Member, having indicated that he will give way at an appropriate moment, refuses to do so when it is reached? Is that not against the traditions of this House?

That is not a matter for the Chair. I remind the hon. Member for Newham, South (Mr. Spearing) that other right hon. and hon. Members will have an opportunity to participate in the debate.

I am attempting to dispose as quickly as possible of the aspect known as the handling of the dispute. I want then to move on to the reality of the dispute, the present position, and what the dispute is all about. I do not wish to give way at this point.

I believe that I have disposed of the handling of the dispute, save for that matter upon which the hon. Member for Livingston chose to dwell. He referred to the incident that was the only reason why he tabled the motion—my alleged insult to ambulance men in an extract clipped from a letter sent to one of my constituents. It is within the recollection of the whole House that that incident was the sole reason why the hon. Member for Livingston leapt in and decided to debate the ambulance dispute.

On a point of order, Mr. Deputy Speaker. The motion on the Order Paper is in my name, as it is appropriate that it should be in the name of the Leader of the Opposition. I took the decision to table a motion on the conduct of the ambulance dispute and expressed a desire to achieve a speedy and satisfactory solution to that dispute many days before Christmas.

It is the privilege of the Opposition not to disclose the precise terms of an Opposition Day debate much before the day itself. I ask the Secretary of State to withdraw completely everything that he just said.

I shall answer that statesmanlike intervention, but I shall not withdraw my remarks. I am relying on the public utterances of the hon. Member for Livingston in making my comments. I believe that the motion was tabled without any consultation with the ambulance staff trade unions and that no one directly concerned with the dispute is of the opinion that the right hon. Gentleman's decision to table it has done anything to speed the resolution of the dispute. A debate on the Floor of the House certainly cannot do so. I continue to believe that that was not the Opposition's prime motive, but shall move on.

Further to that point of order, Mr. Deputy Speaker. I do not want to delay the debate, but the Secretary of State made a direct allegation that was entirely misplaced. Naturally, I hoped—as I presume all right hon. and hon. Members did—that the dispute would have been resolved well before today. However, as my right hon. and hon. Friends know, the decision to use this day to debate the dispute if it had not been resolved was taken well before Christmas. I simply ask the right hon. and learned Gentleman to withdraw his remarks, because he is unnecessarily diverting this House and public opinion.

Of course I accept the right hon. Gentleman's word, although he also confirmed that the final decision to proceed today was taken—as it must have been—last week. I am relying on the public utterances of the hon. Member for Livingston.

I am glad that the right hon. Member for Islwyn (Mr. Kinnock) is here, because the one further point concerning the handling or conduct of the dispute with which I wish to deal, before I come to the substance of my argument and give way to those hon. Members who have been rising, is the alleged insult that I am meant to have made against ambulance men—last week or at any other time. I make it clear that my views about the ambulance service and the men and women who work for it are identical to those of the general public. I do not know anybody who does not hold the ambulance service and its work in very high regard—[HON. MEMBERS: "You!"]

The arguments of those who support the ambulance men are sometimes based on the proposition that, if one has respect for the work that the ambulance service does—I expressed that respect repeatedly in my letter to my constituent—it follows that one should settle their pay claim at whatever level those who represent them persist in claiming in an industrial dispute—[HON. MEMBERS: "No!"] I am delighted to hear that denied.

It has been a feature of the dispute throughout that those conducting it on behalf of the ambulance men have sought to allege that their action has been provoked in some way, either by a member of the Government or by one of the Government's supporters. Before my letter to my constituent was used, in an amazingly edited form—four words of an extremely long letter—a campaign had been in progress for about a fortnight against my hon. Friend the Minister for Health, who was being accused of making provocative remarks to ambulance men in her area. [HON. MEMBERS: "Oh, what a shame."] My hon. Friend's reputation did not allow that allegation to be sustained. Moreover, I understand that my hon. Friend the Member for Maidstone (Miss Widdecombe) is now being accused of having provoked the strike in Kent by her remarks on the "Kilroy!" programme yesterday. This is all ridiculous.

I repeat that I hold the work of the ambulance workers in very high regard. Of course we all applaud their emergency work and we admire the caring nature of the rest of their work. Nothing in my letter contradicts that. Having said that, it is a fact that is relevant in evaluating the ambulance men's claim that, as far as anyone can judge, about one in 10 of the patients whom they carry are accident and emergency patients. That does not just mean "999" patients. In the National Health Service, emergency patients include people who are seriously ill being moved straight to hospital on the advice of a doctor.

The flurry and excitement in the Box during the speech of the hon. Member for Livingston arose when officials went to look for a photostat of the page from the Clegg report from which the one-in-10 figure was extracted. I remind the House that the Clegg commission was set up by the previous Labour Government. Of course, the proportion varies from place to place. More up-to-date figures are available from York health authority. Each year an annual digest of ambulance figures appears, and one might have thought that the hon. Member for Livingston would have consulted it concerning the current figures. The digest shows that, over the country as a whole, about one in 10 patients carried are accident or emergency cases.

The Secretary of State will appreciate that the pay of Members of Parliament is based on an automatic formula, although he would probably say that 80 per cent. of us are only professional debaters—[HON. MEMBERS:"We are."] Conservative Members can speak for themselves. The right hon. and learned Gentleman would probably say that for 80 per cent. of her time the Prime Minister is merely a professional ambulance chaser, yet her pay too is calculated on an automatic formula. What about giving the ambulance men an automatic formula to take them out of the political arena?

The hon. Gentleman may have an automatic formula, but I do not and nor does the Prime Minister.

Will the right hon. and learned Gentleman give way?

No. I do not think that the point made by the hon. Member for Cardiff, West (Mr. Morgan) has the slightest serious relevance to the debate, although, incidentally the pay rise that I am to receive this year is 4·7 per cent.

If the hon. Member for Cardiff, West is worried about the amount that he is to receive following the resolution of the House, he is welcome to give the surplus to a medical charity of his own naming.

I shall give way a few times but I would ask hon. Members to intervene on serious points, and as I make progress.

Will the right hon. and learned Gentleman give way?

Certainly not. There are some hon. Members to whom I will not give way at any stage during my speech.

When wounds have healed, perhaps, but not at the moment. I should hate to be responsible for the hon. Gentleman being named in the Chamber after what happened in Committee.

It is also extremely relevant that only just over one in 10 of the ambulance staff have full extended paramedical training that we have described. There is a clear distinction, as everyone in the service knows, between that training and the six weeks' training which the trained ambulance man undergoes and to which the hon. Member for Livingston referred.

The whole point of my letter to my constituent—[HON. MEMBERS: "Give way!"] I shall give way in a second, when I have finished this point.

The whole point of my letter to my constituent—and it is an extremely important point in the dispute and the discussions—is that, in my opinion, the proportion of people with extended paramedical training should be increased. More important, that view is shared by the management of the service and Duncan Nichol's offer has been based on a widening of the differential between the paramedics and the rest and on the aim of moving to a service in which we train many more people. It is a disgrace, for example, that there are only eight in London.

I shall give way to the hon. Gentleman. I am sure that he is a welcome sight to ambulance men when on his feet if not when prone.

Does the Secretary of State agree that paramedics have four skills over and above the skills of other trained ambulance personnel? The Secretary of State says that he is keen to ensure a more highly trained and better-qualified service. One of the four extra skills that the paramedics have is in the use of defibrillators. Can he explain why the necessary equipment is not provided by the state and is not part of the equipment of any standard ambulance? If he is so keen on a more highly qualified service, why does he not give the ambulance men the equipment and training, rather than merely words from the Dispatch Box?

That is a valid point; I think that we should. I shall check the facts and write to the hon. Gentleman, but I do not think that he is correct in believing that such equipment is not available anywhere. Let us be clear what we are talking about. Extended training to the full standard takes two months' full-time study and includes training in infusion, intubation, defibrillation and the administration of drugs. It is certainly right that we need more people who can do those things and that we need fully equipped ambulances—[Interruption.]

On a point of order, Mr. Deputy Speaker. Many of us on the Conservative Benches are having great difficulty hearing what the Secretary of State is saying, thanks to the hooligan babbling on the Opposition Benches.

I take the hon. Gentleman's point, and I wish that the House would give as fair a hearing to the Secretary of State as it gave to the hon. Member for Livingston (Mr. Cook). Constant heckling does little to enhance our reputation.

I advise the Secretary of State that of the 325 defibrillators in service in the ambulance service in Scotland, not a single one has been provided from Health Service funds. Every single one has been provided by charity arrangements. Every single defibrillator that I have met on my way round the ambulance stations has been obtained by the staff of that station either through donations or by seeking sponsorship. If the Secretary of State is serious, I entirely agree that we should seize upon the common ground—expanding the number of paramedics in the Health Service. Will he tackle the scandal of the lack of funds provided for training? In London that has caused a six-year waiting list for people who want that training.

The hon. Gentleman says that he wishes to increase investment in the ambulance service, and the amount of training, which he knows is costly. He would set those back if he allows excessive pay claims to take the resources required for such improvements.

I must be allowed to move on. We have described, and I hope agreed, the basis on which we are considering the service. Surprisingly, there seems to be almost universal agreement on the desire to upgrade the status and career prospects of those in the service, and to improve its quality.

The Secretary of State did not know the position—ignorant twat.

The hon. Gentleman obviously reads the newspapers in the morning before he comes to the Chamber, and shouts about them in the afternoon. This morning, there was a description of a two-tier service of the kind that I, and the management, can see us moving towards. The description said that I have not been to Wiltshire—

On a point of order, Mr. Speaker. Is "ignorant twat" a parliamentary expression?

Order. It is grossly discourteous, and it is the kind of expression that I hope not to have to hear in the Chamber again.

I visited the Northumbria service about 12 months ago, when I opened a new ambulance station in the constituency of my hon. Friend the Member for Hexham (Mr. Amos). I talked to Laurie Caple, the chief ambulance officer there, about all that he has done to improve the Northumbria service which, I am sorry to say, is being disrupted at the moment by industrial action being taken by some, if not all, of the staff.

If the Opposition will stop shouting about it, I think that we have agreed to get a better ambulance service within the National Health Service.

Returning to the subject of pay, I think that everyone agrees with the point of my letter to my constituent—that part of an ambulance man's work requires paramedical training, that that ought to be increased, and that the paramedics' work is extraordinary compared with other workers within the Health Service. It was a feature of the management offer at the time that there should be a higher pay rise for paramedics compared to the rest of the staff. As my letter in the Nottingham Evening Post makes clear, the unions resisted the offer at the time, saying that it was divisive and elitist. At the Whitley council they demanded that the money that the management wanted to give for paramedical training should be distributed among all the men. If the House wishes to hear good news, as far as I can tell from public statements, that is the first point on which the trade unions have moved for many months. We appear to have accepted that special attention will be paid to the paramedics in the service.

It seems remarkable that the Secretary of State has been so reluctant to give way. Presumably it is because he is incapable of dealing with the points raised. Will the Secretary of State explain why only one ambulance person in the county of Staffordshire has received special paramedical training, and he had to undertake the training in his own time, not in work time?

That should be changed, and that is what we are seeking to change. I agree with the hon. Lady that the future of the ambulance service lies in tackling those deficiences. It does not lie in the support of industrial action and excessive pay claims, which is what the hon. Member for Livingston has concentrated on. The future of the ambulance service is one thing that is worth fighting for during this industrial dispute. The House must want to understand the underlying policy of the management of the Health Service and of the Government during such a damaging dispute. I did not want this controversy. We should be devoting time to more important issues concerning the Health Service.

The judgments that I exercise are managerial and political. All right hon. and hon. Members must watch this damaging dispute and ask, what is its underlying cause? Why do the management not move to the extent that the hon. Member for Livingston advises them to do?

During the recess I wrote a much longer letter, in my own fair hand, and distributed it to the chairmen and managers of the Health Service. They are under great strain during this dispute. I sent copies of the letter to every hon. Member. It sets out the underlying problems in the dispute, and the underlying policy problems that would face management if we took the no doubt well-intentioned advice of some of my hon. Friends and of Opposition Members, who have commented in the media that we should move substantially from our position and buy off the industrial action.

One key underlying problem that is political as well as managerial, because it dominates the interests of patients, is that the money about which we are talking, and with which people make so free during debates, comes from the NHS budget. The arrangement whereby those budgets are cash-limited was introduced by the previous Labour Government, and I do not believe that anybody would seriously argue that we should return to completely open-ended financing. In the past two years we have allocated—

I shall give way when I have finished this point.

In the past two years we have allocated huge resources to the NHS. Those resources were increased last year and this year. An underlying dilemma of the Government's health care policy is to get the correct balance between fair rewards for staff, which is in the interests of all the staff concerned, and the expansion and improvement of services for patients. When one is in opposition one can exercise the privilege of running away from that dilemma, but one can never do that when in government. If we spend more on pay than is fair and justified we shall be able to spend less on patient services; that underlying truth should be apparent to all.

I do not think that the scale and the sensitivity of the Health Service budgets to pay rises is understood by many people. The Health Service is labour-intensive, and 70 per cent. of its costs are made up of pay. When other industries, or other organisations, have difficulties with pay claims—

Will the right hon. and learned Gentleman give way?

No. When I finish this passage I shall give way to the hon. Member for Leeds, West (Mr. Battle).

At Question Time today we heard that industry and other organisations are in trouble on the pay front. However, the difficulties in other organisations are dwarfed by the problems that excessive pay claims pose to a service that employs more than 1 million people. The total pay bill of the National Health Service is £13,000 million each year. When people talk about a little bit of movement on a pay claim, they must realise that 1 per cent. means £130 million. For groups in the Whitley council 1 per cent. would mean £40 million, and that is the entire budget of a major teaching hospital. The entire budget of a large district health authority is £140 million.

As right hon. and hon. Members know from health authority members and managers in their own constituencies, any movement in costs makes all the difference between growth and a stagnation or reduction in services.

We have exercises in the Department of Health, and we make various assumptions about possible Whitley pay movements next year, what other movements in costs there may be and their effect on our plans to develop services. I cannot tell hon. Members exactly what assumptions we made about Whitley council pay, as the managers will obviously not make that public before starting negotiations, but I can tell them that a very small shift in the reality during the year can make all the difference between growth in services nationally and stagnation.

Hon. Members will know when I have finished this passage when I give way to the hon. Member for Leeds, West.

I can tell all hon. Members what is my political judgment in the dispute, and what is my political—with a small "p"—priority. Next year, in April 1991, we propose to reform the NHS: the coming winter will end the last year of an entirely unreformed service. The winter of next year will not be dominated by cancelled operations, closed wards and cuts in services, which would be caused if the current industrial action were successful. I will not contemplate the cancellation of operations and the turning away of patients.

My hon. Friend the Member for Langbaurgh (Mr. Holt) has always been open with me: as he has frequently told me, he has supported the ambulance men's claim from the word go, and he continues to speak out evermore vigorously on their behalf. Although I respect his views, let me tell my hon. Friend that if we conceded the claim he would come to me next winter and tell me that his district general manager was complaining about underfunded pay rises, while cutting services and cancelling operations in my hon. Friend's constituency. I know from my hon. Friend's record that he will be equally vigorous and outspoken about that.

I am grateful to the Secretary of State. May I make it absolutely clear that I feel that he could have strengthened the Government's position in regard to fighting inflation if he had conceded a modest increase to the ambulance men several months ago, at the same time making it abundantly clear that, whatever industrial action was taken by other public employees, there would be no backing down by the Government? I should have thought that that would have commanded public support throughout the country, and I stand by what I have said.

Let me say with the greatest respect to my hon. Friend that I have been—obviously—very closely involved in the dispute for the past four months. I can tell him categorically that there has never been a moment when a comparatively small movement on the employers' side would have produced the response from the unions that he believes it would have produced. The reason for our activity last weekend, and for the exchange of letters to which I have been trying to draw everyone's attention —because they are the basis on which Duncan Nichol is offering talks—is that we are seeking to move on, while trade unions that have not changed their position since last October are behaving as though small changes did not interest them at all.

I am sure that the Secretary of State will confirm that each year he has to go to the Chancellor of the Exchequer with his departmental bid. Is he now telling us that the bid put in by his Department last year for the ambulance workers was lower than the rate of inflation? If so—as he seems to be confirming—why can he not go back to the Chancellor, who has a £14 billion surplus, and obtain the money that the ambulance workers need?

The public spending settlement for the current financial year—the year that we are discussing—which was the first that I negotiated, was based on a Whitley council staff assumption that I can now disclose: it was very close to the 6·5 per cent. at which the bulk of the service has settled. A total of 84 per cent. have settled for 6·5 or 6·8 per cent. Some have received more, because the management is not inflexible, and some of those groups—particularly medical secretaries, operating department assistants and junior clerical staff—had an extremely good claim. Had we not given them such awards, we should have found it difficult to recruit and retain staff whom we wanted.

The public expenditure assumptions that we made last year—the basis on which I settled with my right hon. Friend the present Chancellor of the Exchequer in deciding the amount that we are now spending—would have dealt with the amubulance men's case. The whole dispute is an accident—[Laughter.] It is an accident as far as the trade unions are concerned: they settled for 6·5 per cent. last summer. No one on either side of the Whitley council thought that the ambulance men would be difficult this year, and Roger Poole and his negotiating team actually settled for 6·5 per cent. last summer and recommended it to their members. They solemnly believed that the ambulance men would go along with the remainder of the staff, who had accepted the 6·5 per cent.

There are two reasons why that did not happen. First, the ambulance men were surprised with a ballot; secondly, when they went back for a second ballot, it coincided—an unhappy coincidence—with the railway dispute. Just as the ballot papers were in the men's hands, the railway management conceded an increase of 8·8 per cent.

The money that we are spending in the Health Service this year is entirely adequate to finance a fair and reasonable offer for the ambulance men, and £6 million more will be spent on their pay this year if the management's current fair and reasonable offer is accepted.

Many people may feel that accidents require emergency services!

Mr right hon. and learned Friend has the overwhelming support of all who believe that the NHS deserves the kind of priority that he has described; nevertheless, if a no-strike, no-industrial action agreement could be reached with the ambulance men, would it not be worth settling at around 8·6 per cent., which would cost about an extra £5 million or £6 million?

With the greatest respect, I must return to the point that I made earlier, when I tried to touch briefly on the handling of the dispute. I do not say this only to my hon. Friend the Member for Staffordshire, South (Mr. Cormack); I could have said it to many people over the past three or four months.

It is absurd to suggest that industrial action can be discussed and negotiated on television, radio and the Floor of the House of Commons. We are all agreed that such matters should be pursued through talks. Let me answer my hon. Friend by saying candidly, first, that I do not believe that the trade unions involved would contemplate a no-strike agreement: their constitution certainly does not include no-strike clauses, as does the constitution of the Royal College of Nursing—which is the basis of its review body status.

I also do not believe that we can link the pay of any group in the NHS with automatic formulae or with people outside the service. That would undermine the ability of managers to obtain the crucial balance between patient services and pay: that must be within their control, not led by outside influences.

No. I have given way far more often than did the hon. Member for Livingston, and I do not propose to do so again.

I am very grateful.

Is it not the case that, if a link with either inflation or another group of workers is yielded to all ambulance men, it will lead to a total breakdown of the Whitley machinery? However imperfect and cumbersome that machinery may be, such a breakdown would surely lead to chaos in this year's pay round.

My hon. Friend was the chairman of a district health authority. He is quite correct. We should destroy good industrial relations in the National Health Service if we allowed one Whitley council group to be automatically linked to another group outside the National Health Service.

I read in the newspapers that I am under pressure from my Back Benchers. I am under very strong pressure from my Back Benchers not to give way to the hon. Gentleman.

The key question is what is to happen now. That is what the whole House wants to know. All disputes have to be resolved, and we need to know how this one is to be resolved.

On a point of order, Mr. Deputy Speaker. Is it in order for a Minister to say that he does not intend to allow an hon. Member to intervene as a result of pressure from his Back Benchers?

Whether he intends to give way is entirely a matter for the hon. Member who has the Floor.

What happens will depend on Roger Poole and his team. Those hon. Members who wish to know exactly where we stand should do what I have recommended those outside the House to do: to study the exchange of letters between Roger Poole, Duncan Nichol and myself about the basis on which talks could be resumed. There was confusion at the weekend in the reporting, but there has been no confusion about the position and there has been no change in it whatsoever. We have had repeated talks, in public and in private. The trade unions are not putting anything, either publicly or privately, to the Health Service management that has not been heard before, either at ACAS in October or at the last Whitley council meeting in December. A proposition has been put to Roger Poole which he must consider. He has one public line, which we all know. It is, "Come on, Ken, let's sit down, have talks and settle it." The talks with Duncan Nichol, which is where they should take place, cannot go on for ever if the same things are said every time a meeting is held, and then suddenly feelings are aroused because the talks have broken down once more.

The Health Service management has made it clear that the 9 per cent. claim that Roger Poole is pursuing is unacceptable and cannot be afforded by the NHS. The formula is not acceptable, either, for the same reasons as were advanced by Governments and managements throughout the entire time that I have been a Member of Parliament. That view is held strongly by the management, the district health authority chairmen and the chairman of the relevant Whitley council, David Rennie, whose letter appears in this morning's press.

When Mr. Poole says that he is prepared to come to the management and say something new, we all hope that talks will again resume. I am delighted that no hon. Member has tried to intervene on that point.

Normally it would be a delight to hear the hon. Lady's intervention, but not at this moment.

Duncan Nichol wrote a letter in which he said that he would be prepared to have talks on the position that I have clearly set out. Understandably, journalists and Members of Parliament then asked me what he would say if the talks were resumed. I am accused of having occasionally lost my cool in the dispute, but I have not yet turned round and said to anybody, "That was a silly question to ask." In a recent early-morning radio programme I was persistently asked that question, after an invitation to talks had been issued. I could not say, "I shall now tell you publicly what Duncan Nichol wants to say if the talks are held." We have reaffirmed emphatically several times, as I did publicly at the weekend, that there is no question of the NHS making more money available. There is no question of any formula.

People try to give helpful advice on industrial relations. They ask, "Does that not mean that you are rather boxed in?" Of course it does not. Many of those who have commented throughout on the dispute have not followed any of the details. They have followed the froth—[HON. MEMBERS: "Oh!"] Oh, yes. The management made a final offer last year to the Association of Professional Ambulance Personnel and the TUC unions. Since then the management has said, and I support it, that there is no more money and that there is no formula. The final offer has been publicly available for weeks. The exchanges between Duncan Nichol and Roger Poole have also been available for weeks. I am sure that no hon. Member who takes part in the debate and criticises our offer will have read the final offer. So far, I have not been interviewed by anybody who has read it. I have never been faced by an opponent, such as the hon. Member for Livingston, who has betrayed any sign of having the first idea of exactly what we have offered, or of knowing where we are in the discussions.

Let me read paragraph 4 of the offer. It proposes that the management and staff sides should undertake
"a joint review of the 1986 salaried structure in the light of 3 years' experience, designed to take the ambulance service into the 1990s. There will be no preconditions as to scope or timing of the implementation of any agreements reached."
The paragraph goes on to refer to important matters, as I know from my discussions with the management, who are not ciphers. They have to determine the negotiations. They have strong views about the details of the negotiations, since they have to deliver the better ambulance service which I am requiring them to deliver as a matter of policy. The paragraph refers to flexible local arrangements and improved productivity, because productivity in the National Health Service, as in other services, can release the resources required for paramedical training and the additional pay that the staff require. All that is in the final offer and provides scope for further discussions.

No, I will not—[HON. MEMBERS: "Give way!"] No. One can be a little more expansive in answers to questions to hon. Members than one can be outside. I have gone further into the substance of the discussions here than it has been possible to do outside.

That is the offer in Duncan Nichol's latest letter concerning the discussions that should now take place, on a basis that is designed to take the ambulance service into the 1990s. It is no good stepping up industrial action in pursuit of 11·4 per cent., or 9 per cent., or any industrial formula.

I cannot resist listening to what the hon. Gentleman has to say. He has been waiting to say it for a long time.

It is no use the Secretary of State talking about an ambulance service for the 1990s when we do not have one in 1990. So long as he stands behind Duncan Nichol and instructs him to say that no more money is available, there can be no settlement. There will therefore be further disruption in the months ahead. He is simply calling for unconditional surrender by one side. One cannot negotiate on that basis.

I am sure that the hon. Gentleman was trying to be helpful. The Labour party could be helpful if it urged the resumption of talks on the basis that the management has set out for the unions. They should seriously consider the offer. All of us have other important work to do in the NHS. No one wants patient services to be disrupted for a moment longer.

I wish to concentrate on the NHS reforms. Duncan Nichol wishes to concentrate, with his management team, on providing better services for the NHS. The ambulance workers have better work to do. They should be doing what they do so well—caring for sick and injured people and providing a good, reliable service to the National Health Service. I urge them to resume those duties confident that sensible talks will take place between management and trade unions.

5.59 pm

It is an extreme distortion and perversion of reality for the Secretary of State to juxtapose the pay of ambulance men and women with the equipment that should be available in the National Health Service. It is even more perverse when we consider that we have a £14 billion surplus. Some of that money could be used to increase the wages of ambulance men and women and to provide the National Health Service with the equipment that it needs.

I found it strange that the Secretary of State made so many references to publicity. The Government are not normally shy about spending taxpayers' money to maximise their own political publicity. They did it with water, gas, Telecom and electricity and the Secretary of State did just that in a futile way during the ambulance dispute, when he attempted to appeal directly to union members over the heads of their union representatives, asking them to abandon their demands for a decent pay increase and a linked pay formula. Unfortunately, among many other things, the Secretary of State failed to understand that the ambulance men and women decided to do what the Government suggested—they took the union back into the control of its members and demanded action against the pitiful pay award that the Government had offered.

This afternoon, in a speech lasting nearly 55 minutes, the Secretary of State said that there were three key points to the dispute. First, he said that the claim was excessive. He obviously believes that the pay of ambulance men and women is excessive. I should like to see him survive on the pay that they receive for the hours that they work and then tell the Chamber in all honesty that their pay is excessive. Secondly, he said that the management's offer was fair and justified. The offer was 6·5 per cent. During Prime Minister's Question Time this afternoon the right hon. Lady told us that the rate of inflation was 7·6 per cent. Perhaps the Secretary of State would like to explain to the House, to the country and to the ambulance men and women how a pay award which is less than the rate of inflation, which represents a salary cut, is fair and generous. It certainly escapes me. His third point was that industrial action was against the patients. He is a fine one to talk, having called in the police and the Army, who are doing their best but are providing inadequate services to deal with our emergencies. Every time the inadequacy of training and equipment was pointed out to him, the Secretary of State said, "That is a very good point. There should be more." Saying that in the House of Commons does not pay ambulance men and women a decent wage and does not ensure that the National Health Service has the proper resources to do its job.

The Government's record in the ambulance dispute is dishonourable and arrogant. They have changed their attitude before and during the dispute. Much reference has been made to a letter that the Prime Minister wrote to an ambulance man in Somerset on 22 August 1978 when she was Leader of the Opposition. The Government make great play of what happened in the latter part of 1978 and the beginning of 1979. The Prime Minister said then that she accepted that ambulance services were part of the emergency services, as were the police and the fire brigade, but that they deserved a pay award that was linked in the same way as that of the police and fire services. I have a copy of the letter and I am happy to read it out if hon. Members do not believe that it exists, but I know that the Government are aware of the letter.

Earlier this week the Prime Minister claimed that her Government acted on sound convictions and principles. But they are the convictions and principles of distortion, fair weather ideas and changing their mind about their principles when it best suits them.

What is so unreasonable about ambulance workers asking to be linked to a pay review body? We have one, civil servants have one, and so do many other workers and services. The Secretary of State says that the ambulance service is not an emergency service. He admitted in his speech today that not all emergency calls come through the 999 service. He talked about referrals by GPs and patient admission. But he did not mention referrals between hospitals. In the south-west patients can be transported from Cornwall to Bristol by emergency ambulance to the nearest hospital able to treat them. Nor did he mention the fact that the ambulance service is used to take terminally ill patients to hospices to spend the last painful hours or days of their lives.

The Secretary of State went on to talk about the structure of the service. He tried to divide up the ambulance service, saying that some staff are only drivers and others are crew. He should examine the career structure of ambulance men and women. When they enter the service, they have to learn how to drive the ambulances and qualify to drive them at speed. They also have to acquire the qualifications that he mentioned, which enable them to carry out emergency treatment. He should also remember the physical problems and the great stress that ambulance workers suffer because of their job. They have to scrape people off the motorways. They have to take care of dying children. They have to make an effort to resuscitate people and save their lives. Those workers pay an enormous price in terms of their own health, and at times it is necessary for qualified workers to be transferred from the emergency services to the services that are not on the front line for health reasons or because of stress.

The Secretary of State mentioned his letter to health authority chairmen—it is a truly extraordinary letter—which I have read. He must make up his mind. Is he interfering and directing the dispute? During his 55-minute speech he changed his mind several times about his role in it.

It is necessary to remind hon. Members—particularly the Secretary of State—of the contents of the letter, which is dated 3 January and which was circulated to hon. Members on that day. He said:
"No Secretary of State has ever settled the pay of any group of NHS workers".
In that case, why is he setting the absolute limit on the pot of money that is available to be negotiated? Is that not intervention? He continued:
"Moves of that kind would undermine the authority of NHS management".
The Government's action has shown that, unfortunately, the management of the National Health Service are Government puppets. They have done much to undermine the integrity of the management involved in the dispute.

Having said that he is not involved in decisions, the Secretary of State said:
"There are other very important policy reasons which make Duncan"—
he is referring to Duncan Nichol—
"and me, management and Government, quite determined to get the right result to the present dispute."
The Secretary of State told us this afternoon that he is not directly involved in the settlement of the claim, although he clearly has in mind the outcome to the dispute that he wishes to see. That is the hidden agenda.

What the Government are up to when they talk about the ambulance service of the 1990s is its privatisation. The Secretary of State announced two privatisations in November. My region in the south-west is undertaking a review of privatised services. It is linked to the concept of multicontract privatisation in the Health Service, which is how the process has had to evolve. It is necessary for the negotiation of multicontract privatisation that the ambulance service is split between what the Secretary of State euphemistically calls a taxi service, or professional drivers, and the emergency service.

Is my hon. Friend aware that there are two private hospitals in the north-east, one of which is in my constituency and the other in Newcastle? Mr. Laurie Caple, who is the head of the Northumbria ambulance service in my area, has set aside a number of ambulances for people attending private hospitals. We in the north-east believe that that is a small step that will become a big step in the future.

I am grateful to my hon. Friend for that information. The role of the Whitley council must be profoundly undermined now to pave the way for privatisation.

I am worried that we shall be faced with the grotesque scenes that are not uncommon in the United States, where private ambulance services rush to an accident and can be seen arguing about who got there first and who should therefore take the patient to hospital.

My hon. Friend has been talking about privatisation. Does she accept that the dispute could have been solved with a tiny fraction of the money that the Government have thrown away on publicity, dodges and fees for the City in the £2 billion cost of privatisation?

I agree with my hon. Friend. The dispute could have been solved for a fraction of the £217 million that the Government will spend on the National Health Service reforms, which will mean its destruction. Rather than spend that money on so-called organisation, they should have spent it on services, pay and equipment. In his letter, the Secretary of State hints strongly that that is the future of the Health Service and of the ambulance service in particular. He says:

"The organisation of the ambulance service is likely to make much greater distinction in future between the emergency work and the routine patient transport services."
That is because privatisation and multicontracts will require the division of the service.

Does the hon. Lady agree that the word "privatisation" is an incorrect description of what may be a process involving competitive tendering for services, which has led to hundreds of millions of pounds worth of extra resources being available for patient care in the Health Service?

I should be delighted to debate the virtues of privatisation of the National Health Service, but that is not what we are discussing. So far, the contracts that have been negotiated, particularly for catering and laundry, show that three multinationals dominate—for profit and not out of public-mindedness—and that standards are dropping.

We should not be surprised that the true agenda is the privatisation of the ambulance service and that the pay claims of ambulance men and women have got in the way of that. The Secretary of State says in his letter:
"Pay negotiations for ambulance staff in future must allow for more … flexibility".
He later continues:
"It would be a disaster for the NHS if every year the Whitley Council pay round opened with a bench mark award to ambulance staff based on some generous formula of the kind that the police have."
It is obscene that the right hon. and learned Gentleman can say in a letter that he is not prepared to pay ambulance men and women the same as the police. What is wrong with being as generous to those men and women as he is to the police?

This is the gem of the letter. It says:
"We all know"—
the right hon. and learned Gentleman is referring to the people whom he identified—
"rather better than the general public, that hundreds of thousands of other NHS staff who work alongside ambulance men … do not regard ambulance men as any kind of 'special case.'"
All I can say is that if those thousands exist, which I doubt, they are not among the 80 per cent. of the public who are loudly telling the Secretary of State to pay up and shut up.

We are sick to death of the Government, particularly the Prime Minister, acting as some latter-day vampire, attending every disaster, saying how wonderful the emergency services are but then refusing to pay them a decent wage. Some people have considered carrying a card that says, "Should I be in an accident and be admitted to hospital, I do not wish to be visited by the Prime Minister."

Perhaps the Secretary of State can explain to us what convictions and principles are involved in saying to the ambulance men and women, "We must pay you less, and we must cut your pay now in preparation for privatisation". Perhaps the Secretary of State can explain why he has engaged in vicious union-bashing and why he advertised, with public money, to break the dispute. Perhaps he can explain why he continues to use the inadequate services of the police and the Army and why he uses intimidation, such as suspension without pay. Can he explain, while he is doing all that, what happened to that famous offer to the Association of Professional Ambulance Personnel—on which it was going to be balloted—which has disappeared into the mists of time, never to be mentioned again?

How much longer must his dispute be prolonged and at what cost to the public, and to ambulance men and women? It is about time that we said loudly and clearly that we have one of the best ambulance services in the world. If we intend to keep that service, we must pay the staff who work in it the money to which they are entitled. That is a decent principle and that is a decent conviction. I ask the Secretary of State to return to the negotiating table and to make those principles come to life.

6.20 pm

I hope that the House will exonerate me from attempting to reply to the many points made by the hon. Member for Bristol, South (Ms. Primarolo), as I know that many hon. Members want to speak in the debate.

Personally, I regret that we are having this debate today. It will not help the necessary process of negotiation, which one hopes would lead to settlement, which is required urgently. Industrial disputes cannot be settled across the Floor of the House any more than in a television studio. They require the peace and seclusion of private discussion without the intrusion of cameras or of running commentaries, whether from below the Gangway or in a studio. However, the Opposition have decided to stage this debate, as is their right, so we must make the best of it. I hope that none of us will say anything that will make it harder to resolve this continuing and damaging dispute.

I scarcely need to remind the House that the dispute is now in its 18th week. It is doing no one any good and it is time that it was settled. The longer it goes on, the greater the hardship to the clients of the ambulance service because the deficiencies in the temporary arrangements will become increasingly apparent.

All credit to the Army and to the police for what they are doing, but they are not as well trained or as well equipped as the professional ambulance crews. The longer the dispute goes on, the greater will be the legacy of bitterness in the ambulance service after it is finally resolved. The longer it goes on, the deeper each side will dig itself in and the harder a settlement will become.

After 18 weeks, I find the prospect of prolonged trench warfare dismal. If we reject that prospect, as I suspect most hon. Members do—and certainly our constituents do—we have to accept that there must be compromise. I realise that "compromise" is a dirty word to some hon. Members, but I suggest to the House that a decent measure of compromise is the necessary lubricant of parliamentary democracy. It is certainly the lubricant of good industrial relations and, as the House knows, I had quite a bit of experience in years past in industrial relations. Rather than the macho aim of "winner takes all", we should follow the alternative aim of Lewis Caroll, who once wrote:
"Everybody has won, and all must have prizes."
In that spirit, I proposed some 10 days ago on "Newsnight" that an "honest broker" should be appointed to mediate privately between the two sides. I must explain that, although I gave an interview of about seven minutes in the studio, only one sentence finally appeared on television, such is the way of the cutters of programmes.

It was a jolly litle analogy—I was trying to lower the tension—in which I reminded viewers that Christmas was the season of pantomime and that it appeared to many of my constituents that my right hon. and learned Friend the Secretary of State and Roger Poole were cast in the role of the ugly sisters while the public, the poor old Cinderella, was suffering as Cinderellas do in this world. It seemed that what was needed was a Prince Charming. I suggested that the Select Committee on Social Services or even the hon. Member for Eastleigh might fulfil that role. As a result, I found that my proposal was taken up by the trade union side.

I have had numerous discussions with the trade union side. I am satisfied that a settlement is conceptually possible if there is a genuine willingness on both sides to reach such a settlement. I shall resist the temptation to suggest to the House what the basis of such a settlement might be, because I shall adhere to my own rule of not attempting to negotiate across the Floor of the House.

The only advice that I offer the negotiators comes again from Lewis Carroll:
"Take care of the sense, and the sounds will take care of themselves."
Let us not be distracted by the sounds! There are some background features of the dispute that may not be wholly appreciated by all hon. Members, and certainly not by most of the public. First, this pay claim appertains to 1989 and not to 1990. It is the one unfulfilled claim in the public sector for last year. When settled, it will be backdated to April 1989, so fears about knock-on effects on other groups in the NHS are ill founded.

Secondly, the trade unions are now preparing themselves for the 1990 pay round, and there the most important single factor, as always, is the anticipated rate of inflation. I suggest to the House that what happens at Ford and, above all, what the mandarins in the Civil Service receive is far more likely to set the framework for public sector pay norms in 1990 than what may happen in the ambulance dispute, which is now old hat in terms of pay negotiations.

Thirdly, it is important for us all to recognise that the pay system in the NHS, with its 1 million staff, is not an elegant hierarchy of ascending reward for ascending qualifications, ascending work load or ascending responsibility, based on detailed job evaluation. On the contrary, it has grown up haphazardly over the years, and that haphazard character struck us on the Select Committee as a source of incoherence in the system.

The Select Committee produced a report last March on the Whitley system in the National Health Service. We said:
"In the course of this enquiry we have been struck by the complexity of the systems for negotiating and determining pay and conditions of service of NHS staff. There are, at present, three different mechanisms for the determination of pay in the NHS. Around 40 per cent. of staff have their pay and conditions of service negotiated in one of the functional Whitley Councils … Nurses, Midwives, Health Visitors, Professions Allied to Medicine and Doctors and Dentists are covered by Pay Review Bodies. The remainder (around one per cent.) including general and senior managers, building operatives and maintenance staff, have their basic pay determined directly by the Secretary of State for Health."
For the 40 per cent. whose pay is determined by Whitley councils, there are six different functional Whitley councils in the NHS, of which the ambulance Whitley council is one. We also said:
"we received evidence indicating that the structure of the councils presents a number of obstacles to efficient and effective negotiation."
The most obvious criticism of the whole system was made by Lord McCarthy, when he pointed out that, despite the apparent existence of two sides in the negotiations, there are in fact three parties: management, staff and Government. The management and the Government representatives are combined in the management side, which consists of
"Employers who do not pay and paymasters who do not employ."
It is not surprising that the main criticism that is expressed by the staff side organisations is:
"although Management Side representatives are, in theory, free to negotiate with the staff sides of the Whitley Councils, in practice settlements can only be reached when there is prior approval from the Secretary of State or even the Treasury."
Roger Poole of NUPE gave us colourful evidence of what it was like to negotiate from the trade union side in a Whitley council. Time prevents me from quoting paragraph 40 of our report, but I commend it to the House.

This criticism is important in understanding the present dispute and why the trade unions wish to talk to my right hon. and learned Friend as well as with Mr. Duncan Nichol. I am convinced that the process could be assisted by the appointment of an honest broker if the two sides are reluctant to go straight into formal talks. In that context, it is worth remembering that no formal conciliation or arbitration system is presently available within the NHS. Last March, the Select Committee recommended that
"the Government take the initiative in getting discussions started between the Management and Staff sides with the purpose of developing a mutually agreed arbitration procedure. We suggest that arbitration should be a last resort and that a strict timetable should be established and adhered to for issues referred to arbitration."
Do we not now wish that the Government had adopted our recommendation? As they did not, I offer the House my Prince Charming approach, which is rather more appealing than the prospect of continuing trench warfare. As I remain available to act as a little lubricant upon the grinding wheels of negotiation, it would not be appropriate or me to cast a vote tonight. The Government may not see the need for any lubricant at the moment, but they will do so before the dispute is finally resolved. I am a patient man.

6.31 pm

I have listened with great interest to the debate. The Secretary of State may have convinced himself, but, I am terribly sorry to say, he did not convince me. My colleagues and I will vote with the official Opposition this evening.

I agree with hon. Members who have said that it is a pity that this whole sorry business, to coin a phrase, has come to this. The Secretary of State did not want a debate and wishes that there were no debate, but matters have come to this for three reasons. First, the Government, Ministers or civil servants have been or are incapable of understanding the natural reaction of ordinary people.

Secondly, with great respect to him, the Secretary of State may be an extremely able man in some respects, but he has demonstrated that he does not have a clue about how to conduct industrial relations. Thirdly, there is no doubt about whether the Secretary of State has much of a clue about how to conduct public relations.

When other people were getting 7 per cent., 7·5 per cent., 8·8 per cent., 9 per cent. and, in odd cases, more than 11 per cent., the Secretary of State said to the ambulance workers, "You must settle for 6·5 per cent. because that figure was talked about some months ago." Anybody who understands the reaction of ordinary people will understand that men will not accept 6·5 per cent. when other people are being offered greater increases. Anybody who thinks that they should accept 6·5 per cent. must be living in cloud-cuckoo-land.

A more realistic offer should have been made. That is how industrial relations are usually carried on—not with employers saying, "Tell us by how much you are prepared to reduce your claim before we meet you." Usually, both sides meet, and the employer says, "There is no way you will get 11 per cent." The unions then ask, "What will you offer us? 7 per cent.?" The employer then says, "I am not prepared to go to 7 per cent." Slowly but surely they reach a consensus. However, if one side says, "Unless you tell me by how much you are prepared to reduce your claim, I am not prepared to meet you to discuss it," there is no way in which progress will be made.

The Secretary of State has demonstrated that he does not have a clue about industrial relations. I find it difficult to understand to whom we should be speaking in this dispute. As the hon. Member for Bristol, South (Ms. Primarolo) said, the Minister says, "It is nowt to do with me—it is up to some fellow called Nichol. He is doing the negotiations, not I." Within 24 hours he was on television saying, "If Nichol gives any more, he is not getting it from the Government." He went on to say, "He can give more, but it must come out of his existing budget. However, he must not give more, because it would create a precedent for national pay negotiations."

I am perplexed about whether I should criticise the absence of a statement by the Secretary of State or Mr. Nichol. We now have the Prime Minister sticking her oar in. She says, "We shall not give another penny." Who on earth is doing the negotiation? It is a clear demonstration that the Government are incapable of conducting good industrial relations and negotiations.

Over the weekend it appeared to be leaked that there was more money on the table or that more money was available if the parties could meet. On Monday, the Secretary of State said, "There is no more money. I never said that when I met the press reporters. They have got it wrong." That rings a bell. I am sure that I have heard that before in the past six months in relation to other matters. Ministers have secret meetings with reporters, and they then say, "I am speaking off the cuff, on a lobby basis." When their comments appear in the papers they say, "I never said that. I never meant to say that." That is a strange way to perform.

I was the managing director of a company—I am riot now, thank God. It would not be tolerated in private industry if a managing director did the negotiating and the company chairman constantly made public statements about what the managing director was allowed to negotiate. The Government should not tolerate it, either.

The hon. Gentleman would be absolutely accurate in his description if his description were accurate, which it is not. If he had bothered to read the first edition of The Sunday Correspondent, he would have seen precisely what happened at the so-called meeting. It appears that a journalist from a newspaper—I shall not name it, to spare his blushes, but everyone knows the name —rolled up late, thought he had a good story, did not consult his colleagues, and splashed the story on the front page. All the other newspapers whose front-page stories were totally different rushed in like the Gadarene swine. That is how the confusion arose. It is not because of my right hon. and learned Friend the Secretary of State—convenient as it may be to blame him.

I am not blaming the Secretary of State for the fact that that appeared in the paper. I am talking about what appeared in the paper. Such meetings take place. It is not the first time that we have heard of them. As soon as certain stories appear, Ministers say, "It was a private dinner. I did not say that." It is confusing. We do not know whether we are coming or going.

I am grateful to my hon. Friend the Member for Harlow (Mr. Hayes). I issued a press release this morning. One newspaper got it wrong and the other six followed.

On the serious point raised by the hon. Member for Rochdale (Sir C. Smith), I have made repeated attempts to make clear the difference between the chairman and the managing director. The hon. Gentleman drew a good analogy. The managing director of the National Health Service, although we call him the chief executive, is Duncan Nichol. The negotiator of ambulance men's pay is Mr. David Rennie, the chairman of the Whitley council. He conducts negotiations on behalf of the management side, with the chief executive, Duncan Nichol, obviously being closely involved in the management side's view.

The hon. Gentleman will be aware, if he is conducting a serious discussion about good industrial relations, that one cannot have long negotiations and suddenly find the chairman intervening personally, pushing the managing director out of the way, saying that he intends to take over the negotiations and ordering everybody to pay more. That would create chaos. Some car companies used to do that in the 1970s and it destroyed the authority of their managements.

The problem is that some politicians such as the hon. Gentleman will not accept that and, because they can only question me, they insist on turning the whole thing into a political issue involving the Prime Minister and me, when the Prime Minister and I and my hon. Friends are supporting the management in its position because it is a sensible position for the National Health Service and its patients.

I gather that the chairman is now somebody called Rennie and that a man named Nichol is the managing director. We are not sure where the Secretary of State fits into the jigsaw. The right hon. and learned Gentleman now appears to be saying, "I am merely making statements in support of what Messrs. Rennie and Nichol are saying." I did not get that impression from his remarks earlier in the debate. I thought that Messrs. Rennie and Nichol were being told by the Secretary of State how far they could go and that if they went further they would have to find the money from elsewhere. I understood the right hon. and learned Gentleman to be saying that that money was not available elsewhere because that would involve closing hospital beds, that a terrible situation would ensue and that the NHS would collapse—all for the sake of £5 million. I did not find that argument convincing.

Reference has been made to a union called APAP, the Association of Professional Ambulance Personnel. In December 1988, the hon. Member for Torridge and Devon, West (Miss Nicholson) and I led a deputation to the hon. Member for Derbyshire, South (Mrs. Currie), who was then the Parliamentary Under-Secretary of State for Health and Social Security. I am delighted to see her in her place. We appealed for the recognition of APAP. That appeal had been going on for three years. Prior to our visit, there had been various early-day motions on the subject.

We found the hon. Member for Derbyshire, South helpful and courteous and extremely knowledgeable about the subject under discussion. I had nothing but praise for her attitude during that discussion, and I wrote to the Prime Minister saying so, although I regret that it resulted in the hon. Member for Derbyshire, South having to resign.

The Government did not give the union recognition at a time when it would have been in a position to influence affairs. They waited until its members were in the midst of industrial action, and suddenly APAP was given recognition, presumably in the hope of that action splitting the unions. What did they expect the members of APAP to do in that situation? They were already out, working to rule. It was too late for recognition to be given. I mention that only to illustrate the Government's ineptitude in these matters. They recognised APAP in the middle of a dispute.

I have discussed the matter this week with representatives of APAP. I accept that APAP has lost some members, but nothing like 50 per cent. of its membership. It has also recruited some members during the dispute. I am assured that, come the end of the dispute, its membership will be about what it was at the beginning, although there will be some change in its constitution.

I first met deputations from APAP about six years ago. Ministers have always wanted to recognise APAP. I am delighted to hear that, as I should have expected, my hon. Friend the Member for Derbyshire, South (Mrs. Currie) dealt with the hon. Gentleman's deputation sympathetically. We did not recognise APAP earlier because NUPE, COHSE and the others were bitterly opposed to it. Industrial action was threatened. The hon. Gentleman will recall the time when they used to ask the management to sack ambulance staff who went about wearing APAP pin stickers, so much did they disapprove of the trade union.

The position was reached when obviously we could not regard the objections of NUPE and COHSE, when the Whitley council at that stage could not even meet because they would not attend meetings. I trust that the present position has not been a setback to APAP. It is up to the ambulance men and women themselves to decide what union they should join, and whatever union they choose to join should take part in the negotiating process.

The timing of the recognition was a bit of a goggle in terms of industrial relations. Indeed, I wrote to the successor to the hon. Member for Derbyshire, South, acquainting him with the discussions that had taken place in December 1988. He replied saying that he was aware of them and that he saw no reason to disagree with what the hon. Lady had said at the meeting that we had with her. I have given an example of the Government's attitude to industrial relations and how not to conduct them.

We come to public relations and the Secretary of State's classic comment that ambulance personnel are professional drivers. Such a comment could be made only by somebody who did not know much about the ambulance service. This letter was written to me on 5 January by a lady in Rossendale:
"During his career to date my husband has been both physically and verbally abused by patients and members of the public, particularly when attending incidents late at night and in the early hours of the morning. He has been pursued by a man brandishing a pick-axe handle in the middle of the night while he was endeavouring to treat and transport the man's badly beaten wife to hospital; he has narrowly escaped a knife attack while treating a stabbed youth; he has delivered babies, climbed into vehicles after road traffic accidents, regardless of his personal safety, to treat and comfort trapped occupants, he has picked up victims' severed limbs from the roadway, comforted bereaved relatives and much, much more. He is not unique—he is merely a member of today's highly dedicated and skilled ambulance service … My last remaining remnants of hope for a satisfactory conclusion to this unnecessary dispute were torn asunder by Mr. Clarke's recent description of ambulance personnel as 'professional drivers'."
That is typical of the feeling of a large number of people, and I am sure that the right hon. and learned Gentleman regrets expressing his view. He should now publicly withdraw the comment and apologise for making it.

Everything in that letter about that ambulance driver from Rossendale is absolutely true. I can say that because my brother was a member of the ambulance service for 14 years until he was invalided out about two years ago. He, too, picked up limbs and dead bodies from the motorway, delivered babies and dealt with cases of cardiac arrest. My brother was not a paramedic. Indeed, when he joined the ambulance service, there were no paramedics in this country. Initially the Government resisted the idea of having paramedics, as they were known in the United States but not in Britain. In my view, the argument about paramedics is a bit of a red herring.

I shall give way, but I hope that Mr. Speaker has taken note of the many interventions in my speech. I am flattered by them, but I am anxious not to delay the House for too long.

Does the hon. Gentleman believe that such medical qualifications are acquired by experience or that, as people have suggested to me at my surgery, ambulance drivers need to go on courses to obtain qualifications? If the latter, does he agree with the Minister that many more such courses are required?

It takes 12 full weeks to train a paramedic. In other words, he must be seconded on to a course for that time. Many of the qualifications that paramedics have are acquired on local, rather than national, courses. Many people believe that the £500 being offered to paramedics applies to those who are nationally trained. There are 200 ambulance men in Lancashire who have been trained in specialist skills, but they have not been nationally trained. As the offer stands, not a single member of the Lancashire ambulance service—I checked this yesterday—will qualify for the £500 for paramedics, although they have done a great deal of training.

The four skills that a paramedic must have relate to the administration of some drugs, administering drip lines to patients, administering special airways to patients and—I mentioned this point in my earlier intervention—the ability to use defibrillators. However, defibrillators are not provided as standard equipment on ambulances anywhere in this country. Indeed, every defibrillator that has been provided so far has been provided either as a result of charity or as a result of the efforts of the ambulance men themselves, who have run dances, whist drives and concerts and done all the other things that people do to raise money. It is not on for the Secretary of State to hide behind the paramedic qualification at this stage of the argument.

I now refer to the future and in a moment shall therefore be more conciliatory about paramedics. The first thing that the Secretary of State must do is to be prepared to increase the offer of 6·5 per cent.—

The Minister is shaking his head. I know what he is saying—he is saying that the offer is 9 per cent., but it is for 9 per cent. over 18 months, which is 6·5 per cent. over 12 months. The Secretary of State must not assume that because people work in the ambulance service they are idiots. Ambulance staff can and have worked all this out. They know the offer perfectly well. Quite honestly, the amount of money involved is very small.

I want to make it absolutely clear that I am not in favour of an 11 per cent. increase. I am not even in favour of a 10 per cent. increase. However, I believe that somewhere between 6–5 per cent and 10 per cent. there is a figure that could be negotiated and reached.

I refer now to the second thing that the Secretary of State must do. If he did them both, he would settle the dispute quickly. He must establish some sort of pay review body for the ambulance service. I agree with him again that it must not be a pay body that relates ambulance staff pay to the pay or increases of other services. However, pay review bodies are already in existence in the National Health Service. Both nurses and doctors have had their own pay review bodies for over six years. Making such a pay review body available to the ambulance service, together with a small movement in the pay offer, would settle the dispute and I urge the Secretary of State to think again.

The Secretary of State referred to the joint review that has already been agreed, of the 1986 salary structure. I appeal to the right hon. and learned Gentleman. There is a need to review the ambulance service, its structure and everything about it. Many things about the future of the ambulance service need to be discussed. However, I have to tell the Secretary of State—and I am sorry to have to do this—that one should not discuss basic changes to the service in the middle of a wage dispute. One should sit down and discuss them rationally and logically at quiet moments in history when both sides are looking for solutions that they can evolve together. One should not try to do it when both sides are around the table thinking that they are at loggerheads and have a dispute to sort out.

I believe that the principle that the Secretary of State has evolved about the future of the ambulance service is right. What is wrong is his timing. He must settle the dispute and then get down to sorting out the future of the ambulance service and the other things that have been mentioned, such as pay for overtime and for unsocial hours, and incremental pay rises for long service. All those things should be discussed in the context of a new concept for the ambulance service for the 1990s. However, the Secretary of State must get this dispute out of the way before sitting down to bring effect to the joint review that I am glad has already been agreed. I urge the Secretary of State to get the dispute out of the way because once he has he will find that he has a lot of constructive support within the House and the ambulance service.

I hope that the Secretary of State will press the ambulance negotiating body to come back to the table and to have another go, and when he has, I hope that he will shut up and let those concerned get on with the service. I hope that he will stop making public statements because it appears that every time he opens his mouth he exacerbates the position.

I am sorry that attitudes appear to have hardened in the Government. I regret that and advise the Government that they will, too. They must give a little in pay and in future review promises because the alternative is to try to batter the ambulance personnel into submission. If they do the former, it will be to their credit. If they do the latter, it will be to their discredit and shame because this service is second to none in its loyalty, skill, dedication, professionalism and concern for others. To batter that group of people into submission would mean an embittered service for many years to come. It might finish the present dispute and the ambulance personnel might go back to work, but they would go back with such bitterness in their soul that I believe that it would be felt for years throughout the Health Service. More than that, it would be both unfair and unjust.

I appeal to the Government and to the Secretary of State to see some sense now and to urge the negotiating body to sit down again around the table and to reach a settlement that will bring honour to both sides, with neither side winning and with each side earning respect.

6.56 pm

First, may I offer my thanks to the hon. Member for Rochdale (Sir C. Smith) for his kind personal remarks about me? I hope that he will forgive me if I do not join him in the Opposition Lobby tonight, because I intend to give full support to my right hon. and learned Friend the Secretary of State. However, the hon. Gentleman knows—and, like the hon. Member for Livingston (Mr. Cook), he has heard me say in the House—that I admire the ambulance service very greatly.

The ambulance men and women in my own area of Derbyshire offer an outstanding service. I think that they are worth about £200 per week. Therefore, I looked up exactly what is on offer to the ambulance men and women in my area. This is what I found. The qualified and the leading ambulance men and women in my area are to be offered over £11,000 per year. That is the pay scale, and there is possibly overtime on top of that. I think that the unqualified staff—or rather the non-qualified staff, which is a less pejorative way of describing them—are worth at least £150 per week, and that is exactly what is on offer in my area. In my area, leading ambulance staff are being offered £228 per week basic, qualified ambulance staff are being offered £211 per week basic and non-qualified ambulance staff are being offered £153 per week. That is a great deal more than many other people in my constituency are living on. I repeat that that is the basic rate, and there is overtime on top of that.

I think the ambulance personnel are worth it, and that is why I urge them, in the interests both of themselves and of my other constituents, to accept that offer. Apart from anything else, that is the pay scale until September this year, and there will presumably be more money after that. I hope that they will accept it. In London, it is more. I have not mentioned paramedics. Like Staffordshire, we have hardly any in Derbyshire. However, those are the pay rates and the pay scales that are on offer to my constituents. There is well over £200 per week for those with qualifications. I hope that they will accept it.

The ambulance men are a proud part of the National Health Service. That is why they have attracted so much public support. However, most National Health Service staff have settled in large numbers for an increase of around 6·5 per cent. The nurses have settled for 6·8 per cent. I attended a meeting of the Derby branch of the Royal College of Nursing last week and asked at the end why nobody had spoken up for the ambulance men. The nurses said, "Because we settled for 6·8 per cent. and we feel that on the whole it is a reasonable settlement."

That is the settlement for the nurses after three years of gaining qualifications and of full-time study, and after their refusal to go on strike. I have a feeling that, if that is good enough for my nurses, it should be good enough for my ambulance men as well.

The hon. Member for Livingston made the comparison with the global figures for the public sector, but I must respectfully remind him that that figure includes large numbers of people working for local councils. It is precisely because large pay increases have been given by local councils recently that people in my constituency, in the remainder of Derbyshire, in Birmingham and in other areas are complaining bitterly about the community charge that is being set by those councils. We can pay people what we like, as long as we are prepared to foot the bill through community charges and business rates. Many of my constituents are now counting the cost and wondering whether that was wise.

Nor is it appropriate to make the comparison with the doctors and nurses review bodies' reports that are due shortly. That is next year's pay rise, and the ambulance men can negotiate another rise next year. To suggest that the pay rise to doctors, after a minimum of five years' full-time study, should be the same as the pay rise for ambulance people is taking equality to preposterous lengths. That is not right or acceptable.

I hear the demands from all sides for arbitration, independent review bodies and long-term linking. Some of those arguments are misplaced. As my distinguished colleague, my hon. Friend the Member for Eastleigh (Sir D. Price) said, we have had a Whitley council system for years, and it has been revised half a dozen times. As the hon. Member for Rochdale pointed out, if I had my way I would have had APAP on it as well. To accept some of the proposals for arbitration would drive a coach and horses through the Whitley council system.

Some of us might like the end of national collective bargaining for pay rates in a business as diverse as the Health Service, which covers the entire country. However, that is not the way to do it just yet. I invite the hon. Member for Peckham (Ms. Harman), who will reply on behalf of the Opposition, to say whether the Labour party is in favour of the Whitley council system or wants to abolish it. If it wants to abolish it, what does it want to put in its place? Would the Opposition support local pay bargaining? I would, because some of my local people would do better under it than under national pay bargaining, which is based so heavily in London. That should be a matter of record.

We should be aware that if the Government give in on this dispute, NUPE, among other unions, has plenty of other groups lined up with demands that are just as deserving. I am not challenging the ambulance service as being undeserving. The case for those other groups will be just as slickly presented by Mr. Roger Poole. If we are talking about presentation and trying to give people nicknames, perhaps his nickname should be "Angel Face". He presents things in an immaculate way and makes a good case for his members. However, it is all presentation.

If Roger Poole or any of the other senior ambulance people went on television in my area and said, "I am being offered £228 per week basic and I do not think it is enough," some of the support expressed for them in areas such as mine, where many people are earning less than that, would fall away.

I have not heard anyone say what has been offered. If Mr. Poole and some of the others, who earnestly and honestly and quite rightly are arguing for big pay rises, told people what they are earning, some of the support would diminish. Mr. Poole and the other leaders say that the ambulance men are a special case. Butter would not melt in their mouths. I would not trust them as far as I could throw them.

I am happy to give way to the hon. Gentleman, who I understand is sponsored by NUPE.

I am happy to inform the House that I am sponsored by NUPE. I am proud of that, as it is an excellent union. While the hon. Lady is delivering her oration attacking the ambulance staff and their apparent greed, would she tell us what the comparative pay rates are for the police and fire services, which do equally valuable emergency work at the scene of accidents and save lives?

The NHS, for which I once had a small amount of responsibility, is a major and important public service. The way that the comparisons are done is within the Health Service. Each group has its Whitley council. It is a fiendishly complicated, cumbersome and old-fashioned negotiating system. I would be delighted if it were banished and my local hospitals and health authorities were given the power to negotiate the pay deals that seem appropriate. Ministers have been pressed many times by hon. Members on both sides to make the link with the police and fire service. It is not appropriate or necessary and, in my view, it should not be done.

I am happy to call in aid a previous Labour party member. In 1979 I was a member of the Birmingham area health authority. My hon. Friend the Member for Solihull (Mr. Taylor) will recall that the west midlands had a major dispute in the ambulance service. There was also a major dispute in London at the same time. I looked up the discussions in the House at that time. On 22 January 1979, in response to a private notice question by the then Member for Reading, East, Sir Gerard Vaughan—a Conservative party spokesman—the then Secretary of State for Social Services—now the noble Lord Ennalswas obliged to put down his point of view. Just as now, there was "widespread disruption" and "no emergency cover" available in various places. The London service was the "most serious example" and it had "refused to cover emergencies". He announced that he had
"authorised the use of Army ambulances".
My hon. Friend the Member for Solihull will remember that the west midlands was also an area where the ambulance crews had refused to provide an emergency service. The then Secretary of State said that that service would be
"provided by the police and voluntary organisations."
He said:
"The ambulance men have put their case — It will not be strengthened by some of them adopting what will be seen as a callous attitude to the lives and health of their fellow men … Enough is enough. Only the innocent will suffer if Health Service workers allow their anger to run out of control. They have made their point … There can be no point now in taking it out on the injured, the sick, the old and others who depend on the health service."
Amen to that.

I am conscious of the 10-minute rule on speeches.

It is almost 10 years to the day that the then Secretary of State said:
"I must make it clear to the House that this Government cannot and will not abdicate their responsibility and let wages rip. That is the road to disaster. The only results would be a return to mounting inflation, … cuts in public services, high taxes … and more on the dole. Those who will suffer most from all this will be the low paid and those on fixed incomes, such as pensioners. This is the law of the pay jungle."—[Official Report, 22 January 1979; Vol. 961, c. 28–9.]
I rest my case. I support the Government.

I remind the House of Mr. Speaker's announcement at the beginning of the debate that there is a 10 minute limit on speeches.

7.9 pm

For 18 weeks there has been one of the most serious national industrial disputes that this country has ever witnessed. Despite 18 weeks of lies, abuse and attacks, the resolve of the ambulance workers—those brave and heroic men and women—has not been broken by the Government. Their attempts to force those workers to take a pay cut, both as a direct attack on their own living standards and, as has been made clear tonight, as a preface to the attack on other public workers, should be resisted by all working people.

The only point of contact between myself arid Conservative Members—notably Department of Health Ministers—is our mutual recognition that a victory for the ambulance workers would lift the hopes, aspirations and spirits of millions of workers in this country. It would show that the Government are not invincible. In their own terms and in the wider context, the ambulance workers deserve our support. In 1986 they were supposed to get parity with the fire fighters, but there is a £60 gap between their pay.

The hon. Member for Derbyshire, South (Mrs. Currie) could not give the figures, so I shall give them for her. An ambulance worker starts on £147 a week and after 10 years, when fully qualified, gets £202. A fire fighter gets £210 to £262 and a police constable, £194 to £302. I do not have time to give all the examples, but ambulance workers are equally deserving as emergency service workers. They are not the third among equals, but deserve parity in treatment with fire fighters and police.

No two disputes are the same. One factor which marks out this dispute is the willingness of ambulance workers to take everything that is thrown at them and not, until today, take strike action. It was only today in West Sussex that their frustration finally boiled over and the first strike action of the ambulance service took place. In the rest of the country there is not a strike—that is a lie which we must nail—but a lockout.

The substitution of insufficiently trained police and Army officers with inadequately equipped police vans and Army jeeps for ambulance workers and ambulances has cost lives. We raised that issue in previous debates on the ambulance service. I did not ask the Minister to take my word for it then and I do not do so now. He should listen to David Williams from St. Thomas's hospital across the water, who stated in The Independent on 5 January that there had been a 30 per cent. increase in the number of deaths in St. Thomas's hospital alone since the substitution of the police and Army for the professional ambulance crews. Over a period of eight weeks, 36 people —eight more than in the same period last year—died in his casualty department. The Government are costing lives.

My hon. Friend the Member for Livingston (Mr. Cook) raised a number of points which he and I have tried to raise in previous debates. Time prevents me from stressing them this evening. However, one or two need a quick mention. The Secretary of State repeated tonight that, if more money is to be given to the ambulance workers, it must come out of patient services, training and equipment. What a despicable trade off it is to say to the working people in this country, "Lengthen your hospital waiting lists, wait a few minutes more for a life-saving ambulance so that we can pay a decent wage to ambulance workers".

It did not worry the Secretary of State, Ministers and Tory Members when, in July 1987, I forced a Division on the pay-linking system for Members of Parliament pay. The Secretary of State went through the Aye Lobby and voted for an £80-a-week increase for 1988, a £30-a-week increase for 1989 and a £50-a-week increase from the end of this month for himself and other Members. A £160-a-week increase in 24 months is more than the gross pay of someone who works for a week in the ambulance service. That is hypocrisy—the same sort of hypocrisy that sees the Prime Minister chasing ambulances to Clapham and King's Cross, praising all the emergency services, then singling out the ambulance workers for attack as the Government have done this past 18 weeks.

If time permitted, I could state what is happening in these non-professional services. I have here a police ambulance report form completed just before Christmas. Under "injuries suffered", it states: "high temperature". For the treatment given it gives the van's call sign. What good is that to a hospital? Compare that to the detailed and proper report forms that professionally trained crews take to hospitals, then understand why people are dying in casualty departments: it is because they are not receiving the treatment they so richly deserve.

We have witnessed the contemptible moral blackmail of insurance cover being withdrawn, first, unsuccessfully, in London, then and tragically successfully—in the west midlands. That forced the crews to decide between going out and saving lives with no insurance cover or following the diktat of regional health officials. That is industrial sabotage. Such escalation of the dispute is entirely at the behest of the Secretary of State, no matter how he tries to wriggle out of it tonight.

It is not often that I can come to the Chamber and claim without fear of contradiction to be speaking on behalf of 90 per cent. of the British people, but I can do so tonight because 90 per cent. of the population want the dispute solved, with the ambulance workers getting a decent rate of pay and a living wage. Therefore, there is no need for me to spend my last three or four minutes stressing that. Instead, I shall state how the dispute should be won.

During the past 18 weeks, I have spent much time at rallies and individual and group meetings, discussing the dispute with ambulance workers. Time and time again I have told them that I, as a Socialist—and I suspect all Labour Members—would never ask ambulance workers to go out on indefinite strike. We, as ordinary working people, rely on the emergency service and the essential service that they provide. It is not their job alone to defend their wages and conditions or the services which they provide, but the job of all working people. After 18 weeks, it is about time to move towards that.

On Saturday, there will be a rally in Trafalgar square, London, of tens of thousands of people. On 30 January, there will be a national day of action. I appeal to working people throughout the country to support that, because it is to be welcomed. At noon on 30 January, there is to be a 15-minute action of national solidarity. Millions of people will take the opportunity to poke two fingers up at the Government's treatment of ambulance workers and the NHS in general.

If we are to have successful collective rallies, demonstrations and meetings, we shall need more than 15 minutes: we shall need a whole day. My hon. Friend the Member for Livingston brought the largest petition—4·5 million signatures—to the House that we have seen this century. Staggering amounts of money have been collected on the streets—thousands of pounds a day are collected in Coventry to keep families going. Opinion polls and the public generally support the ambulance workers. However, despite those facts, I cannot imagine that, if we all come on to the pavements for 15 minutes on 30 January and think about the three essential services, particularly the ambulance service, we shall, through mass telepathy, get a message through to the Prime Minister. She just does not listen; she disregards people's opinions.

A few days ago an article in The Independent suggested that the main failing of the dispute was that the ambulance workers had no economic power. On 30 January, those with economic power must use it. The Confederation of British Industry, the chambers of commerce and the Institute of Directors should be forced to phone up No. 10 to say that their profits and stocks and shares are being hit by the dispute, and that therefore the Government must settle and sort out the Secretary of State. That is all that Tory Members understand. When the dispute affects their money, their stocks and shares, we shall see real pressure placed on the Government.

But even if I were wrong and, for only 15 minutes on Tuesday 30 January, every bus and train in the country stopped, every shop closed, every school, pit, factory and office stood still and every dock was idle, that would demonstrate that, without the ordinary people of this country, society in Britain does not tick. Would that not give the same feeling, albeit encapsulated in a short space of time, as that expressed in Leipzig, Prague, Bucharest and Budapest—that, when working people are organised, they have the power to shift Governments? If Governments can be shifted over there, one or two people might get the idea that we can shift them over here, and that would not be such a bad thing.

I ask all workers to make official at least that demonstration of 15 mintues on 30 January. As the council workers of NALGO did yesterday in Coventry, I also ask other workers to extend the action they have planned for half a day. Those who support the Secretary of State do not include the whole Cabinet, his right hon. and hon. Friends or all the press. The Government's isolation on this issue is almost total. If we can tip that support over the edge on 30 January, the ambulance workers' justifiable claim can be met. The Secretary of State is finally reaching the stage when his position is "unassailable"; perhaps, after 30 January we can help him on his way.

7.18 pm

The British people would be well advised to take careful note of the words of the hon. Member for Coventry, South-East (Mr. Nellist) and the manner in which he delivered his remarks this evening.

The hon. Gentleman's remarks are also being described as first rate and excellent by other Opposition Members. Pity help the people of this country if the hon. Gentleman and his colleagues ever again have power over them.

I speak in this debate because I have, and always have had, a genuine interest in ambulances. I was a member of the Northumbria ambulance service committee for several years during the important time when it was being restructured under the able leadership of the chief officer, Laurie Caple, to whom my right hon. and learned Friend the Secretary of State referred. I do not apologise for referring to that service. It has shown the way to other services and shows how sterile and out of date are the remarks of the hon. Member for Livingston (Mr. Cook). It also shows how out of touch with reality are the views and attitudes of the Opposition on the ambulance services and their development.

We have heard about training. When I was on the committee to which I referred, one of the things that I most enjoyed was attending the occasions when members of staff received certificates for higher qualifications which they had achieved through hard work and effort. They were deeply proud of their achievements and those of us who were involved in the service were equally proud. They received pieces of paper bearing their accreditations. However, they could not and still cannot receive the other form of paper—financial reward for their work and the qualifications that they achieved. We all know the reason for that. It is the inflexibility and intransigence of the trade unions who claim to serve some of the staff. I deeply regret that.

Several hon. Members referred to the Whitley council. It is a form of straitjacket, as we all know. However, both management and employees willingly entered into that straitjacket. The terms and conditions were clear for all to see. When the council brought benefits to the unions, the unions were happy to accept them. It is no wonder that when the unions turned down the settlement negotiated by their leaders through the Whitley council and tried to obtain a better reward outside it, they were referred to the terms and conditions and told that it was not possible to go outside the council. Why should they be allowed to take the good and leave the bad? Their leaders found the offer and the proposals acceptable, They were good, not bad. The offer was in line with other National Health Service settlements for people who also work with and give emergency assistance to those who are ill. They include the nurses, who accepted a 6·8 per cent. pay rise.

I intervene only because of what the hon. Gentleman said about Northumbria. Will he explain to the House whether the intransigence of members of the ambulance service in Northumbria has brought about the problems there? If so why is the position so different in Durham, Cleveland and Cumbria, where a 999 service continues to be provided? I can tell him the difference. We have a manager in Northumbria who is irresponsible and does not care about the future of the service. He has brought the service to a halt.

It is sad that the hon. Lady is completely out of touch with reality and does not appreciate that many other services look to the example set by Northumbria in its plans to produce a better service for patients, better control and better morale among staff. Does she not realise that when the present chief officer to whom she was so unkind came to Northumbria, £3,500 per annum was being spent on staff training? Now, after a few years, £120,000 has been spent on training within that service and many other services come to Northumbria to find out how that has been done. That proves that good leadership in an ambulance service produces results for the patients and for everyone. That is something that we should consider. I hope that in my own area of west Yorkshire we can achieve something similar. Whether Opposition Members like it or not, that is the direction in which services are moving.

Several hon. Members have spoken about what ambulance workers do. Everyone knows that there has always been an emergency and a non-emergency ambulance service. In rural areas, a non-emergency service has often been provided, using motor cars or minibuses, not ambulances. What is so wrong with that?

The hon. Member for Livingston said that 25 per cent. of calls, or one in four, in London were emergency calls. The official figures for Northumbria show that 7 per cent. of the workload is emergency calls. The figures for the rest of the country are between 5 and 15 per cent. It is clear that what the Secretary of State has said is true. It is backed up by the statistics and it is no good arguing otherwise to help the ambulance workers' case.

I hope that the dispute will be settled before long. Any settlement must be based on a realistic assessment of the future of the service. The dispute cannot be settled simply by beating the management or, as some union leaders seem to want, by beating the Government. That is not what the future of the ambulance service is about. We want what is good for the service, for patients, for good health care and for the expansion and financial strength of the ambulance service. We want pay differentials for different skills. The unions must concede that. If they continue to insist on flat rate increases across the board, what will be the reward for excellence and hard work? No one runs a business that pays everyone exactly the same basic wage.

No. I have about one minute to go and I wish to finish what I have to say. The hon. Gentleman may then have a chance to take his turn.

The ambulance workers do a job which the public view with sympathy. That works two ways. First, it makes it difficult for management to argue about a wage claim. It also places an immense responsibility on ambulance workers not to use or abuse their position in order to obtain an award that is not justified. If they argue and settle their case in other ways and on the basis of their skills, I shall fully support whatever settlement is arrived at. The claim must be settled in such a way that there is a positive return to the Health Service and to those who enjoy the services that it provides.

The ambulance service is regarded in an especially good light by the public and by patients. Even this dispute has not changed that. So far, those who claim to lead the ambulance staff have not persuaded their members of the merits of the award that they have negotiated. They have their work cut out to show that they really can lead the ambulance staff. They have failed to do so and to show where the return will come from.

7.28 pm

The failure to settle this dispute is appalling. It is a disgrace and a scandal to allow the disruption of an emergency service to continue into its fifth month. This afternoon we have seen that the Secretary of State's attitude is a triumph of pigheadedness over reason and common sense. He has no support in the country among the public. A majority of Conservative voters are opposed to his policy. We know that there is no full-hearted support for him in the House because we have heard the disagreement and opposition of Conservative Back-Bench Members this evening.

There is also disquiet in the Cabinet, if only because of the political damage that the dispute is doing. At one time it seemed that the Secretary of State had a promising political career. I suspect that that is no longer the case. His bluff and cheery manner is suitable for some matters, but his behaviour and attitude since he has been Secretary of State for Health have alienated almost everyone in the National Health Service. He has not endeared himself to the country and his cavalier attitude has made him heartily disliked throughout Britain. He has completely misjudged the position.

As we saw this afternoon, the Secretary of State's approach is to tough it out, to seek to humiliate the ambulance crews and to drive them into the dust. But the right hon. and learned Gentleman has misjudged the depth of the ambulance crews' grievance and the feelings of the British public. The public want him to give some ground to settle the dispute. In doing so, he might lose face, but that is better than losing lives as the dispute continues.

This tragedy should not be dealt with by banter across the Chamber. The dispute has already claimed lives. It is killing people. In an emergency the police and the Army can step in for a couple of days, but they cannot provide an emergency service month after month. They are inadequately trained and they have inadequately equipped vehicles which have already been involved in accidents. The police are unhappy doing the job that they have been called upon to do and the chairman of the Police Federation has confirmed that.

Many of our constituents are placed at risk every day. We hear of police and Army ambulances turning up late and of crews without the skills to do the job. That is no criticism of the police or the Army. They have not been trained to do the work. The dispute is costing lives and hon. Members should have a sense of responsibility.

The Secretary of State has also misjudged the British people's basic sense of fairness. At the time of the King's Cross and Clapham emergencies and the Brighton bombing statements made in the House praised the emergency services. The Prime Minister usually takes advantage of such occasions for a photo opportunity. But when it comes to pay, it is a different matter. The pay of ambulance crews has slipped behind comparable groups. Fire fighters are paid £60 a week more and the police are paid £110 a week more. In those circumstances, a pay offer that is less than the rate of inflation, in effect asking them to take a pay cut, is not realistic.

Ambulance men are not being stirred up by agitators. The union negotiators were willing to settle at a lower figure, but the matter went to a vote and the crews turned down their recommendation. We have heard the Government's rhetoric about the need for ballots, but when a ballot goes against them, no one takes any notice of what the members say, despite all the talk of handing the unions back to the members.

The ambulance crews have a deep grievance and the Secretary of State must now regret his remark about their being just professional drivers. It would help if he apologised for such an insulting remark.

No, he is not. It would not be so bad if ambulance men were paid the going rate for drivers, but they are not.

We know that things are not well in the ambulance service. We know that London is several hundred ambulance men short and that there is a high staff turnover. The ambulance service is underfunded and underequipped and staff morale has been undermined. The Government want a two-tier ambulance service. They want to privatise most of the ambulance service and that has undermined morale. But now the ambulance men are fighting back, and with great dignity. They have not gone on strike; they have been locked out. They are anxious to deal with emergency calls, but often those calls are diverted and they are prevented from doing so. They have been told that their vehicles are uninsured and that they will be prosecuted if they take their vehicles out.

The Government and the Secretary of State have misjudged the British public's support for the ambulance men. Are the Government not interested in what the public think? The petition has been signed by nearly 5 million people, and in every opinion poll 80 per cent. demonstrate their continued support after almost five months of the dispute. They want the Government to stop the intimidation and their hostility to the ambulance crews.

At some stage the dispute will have to be ended by negotiation, but this afternoon the Secretary of State said that he will talk only if the union announces its surrender beforehand. Before it reaches the negotiating table, it must write letters explaining what it will give way on. Unless it does that, he is not willing to talk, nor is he willing to accept arbitration or any independent view.

Even if the Secretary of State could not look behind and see the looks on the faces of Conservative Back Benchers as he was making his speech, it must be obvious that the Government have got this wrong and have misjudged the situation. Before more lives are lost and more damage is done to the ambulance service, the British public want the Government to give some ground and sit down to negotiate an end to the dispute.

7.36 pm

We have heard a number of views about the Government's approach to the ambulance dispute, and the Government have been chastised for not spending what was claimed to be a budget surplus of about £14 billion. But it is the very use of that budget surplus to repay past debt and so reduce the Government's liability to interest payments that has enabled more money to be spent on the NHS.

I and my hon. Friends who represent the north-west of England have fought a bitter campaign which, I am glad to say, has been ably rewarded by the Department of Health giving the North Western regional health authority extra money, over and above planning assumptions that were put before the public last August. I am sure that I and my hon. Friends do not wish our efforts in campaigning for the good health of the north-west to be hijacked as a result of the industrial dispute.

The last major group of Health Service workers in the north-west and elsewhere are using their industrial muscle to try to secure a pay award above those agreed to by other groups in the Health Service. Is it right that they should win that extra money, to the detriment not only of other Health Service workers who did not push their cause but of patients who would inevitably suffer as budgets would have to be adjusted? I and my hon. Friends have received many representations from our constituents on the subject of Health Service finance and I shall not let them down tonight by removing those patient services from our hospitals.

The Independent has been quoted a number of times and I, too, have sought solace in its pages. Peter Jenkins comes to the nub of what the dispute is about when he says:
"The point is that the Government cannot allow 22,000 ambulancemen to set an inflationary pay norm for more than a million NHS employees. That is what the dispute is about."
In the present circumstances, I have great sympathy with my right hon. and learned Friend the Secretary of State and Duncan Nichol, the chief executive of the NHS. Like them, I was once responsible for negotiating wage claims before I entered Parliament. Duncan Nichol has a proud record in the Health Service. He was the general manager of the Mersey regional health authority and I had the pleasure of serving with him on that authority. By good management, he made it one of the most rapidly developing health authorities in the country. He understands the human dimensions of the dispute and the difficulty of reaching a pay agreement in which a line has to be drawn. He acknowledges, too, his overriding responsibility to all the patients of the National Health Service for whom resources must be made available.

The most difficult decision to take in any dispute is to draw the line. In the case of the Ford dispute, one final offer is replaced by another final offer. How can anyone involved know the true situation and how much the management can, and cannot, afford? At least the ambulance management had the courage of their convictions and said in the last pay round, "No more. So far, and no further."

I sought first-hand information about the dispute from those directly involved, by talking to a number of the staff on duty at my local ambulance station. I place on record my praise for ambulance workers in west Lancashire who, despite differences of opinion with their managements, are working as well as they can to provide good accident and emergency service. I praise, too, the management, who worked closely with the unions in a difficult situation to provide a high level of cover.

I was struck by the ambulance workers' sincerity and listened carefully to their views. The Government's offer might have greater credibility if the issue of the resources available for skills training were properly addressed. Ambulance workers have far greater commitment to, and a pride in, the service and quality of care that they provide than is generally realised. They state categorically that they never dream of going on strike. When I spoke to them about the provision of defibrillation equipment, for example, I found myself sympathising with their point of view. Perhaps there is a case for re-examining the way in which the Health Service pays for special skills in the ambulance service. I am sure that my right hon. and learned Friend the Secretary of State fully appreciates the importance of skills training, but it is important also to be sensitive to the way in which that aspect is presented to ambulance staff. They may say to their health authorities, "We have been offered extra money, but can we really obtain the training and equipment that will be required? Do you have the resources to provide them?"

Perhaps my right hon. and learned Friend the Minister for Health will look again at the resourcing of skills training. If there are adequate opportunities to achieve higher qualifications, response from ambulance workers may be much more positive and light could be glimpsed at the end of the tunnel in respect of the negotiations.

The ambulance men have embarked upon a bitter dispute, and, understandably, they are supported by the general public—many of whom, like myself, have received excellent service from that sector of the Health Service. But perhaps the ambulance staff and their union should reconsider their action in the light of the information that in London in the new year the service received 60 per cent. fewer calls as a consequence of announcements about the lack of availability of ambulances.

That calls into question what should be the precise nature of the service. I suspect that many members of the public pick up a telephone and call for an ambulance even when they do not really need one. When the dispute is over, the service will be subject to close scrutiny, and it will never be the same again. I wonder whether the union appreciates what sort of Pandora's box it has opened by taking the stand that it has.

The hon. Member for Bristol, South (Ms. Primarolo) raised the issue of privatisation. Whenever an effort is made to increase the efficiency and effectiveness of a part of the Health Service, privatisation is mentioned. There is probably a good case for examining the provision of non-emergency ambulance services and for putting that element out to tendering, perhaps within the ambulance service itself. Such a development would require the unions to re-establish their relationship with management if they are to win those in-house tenders. In any event, the union may come to regret its action in having pushed the dispute to the brink.

One should pay attention to calls for comparability with the police. Ambulance staff tell me that police officers involved in a particularly traumatic accident are allowed to stand down for a couple of hours to regain their composure, but ambulance crews are not. I wonder how many other aspects of ambulance crews' terms and conditions of service could be improved in a package that would add to the credibility of the cash offers that my right hon. and hon. Friends support.

My message to ambulance staff is, "Thank you for continuing to provide an accident and emergency service, but look again closely at the advice that you have been given. It may not lead where you hope that it will."

7.46 pm

I speak not only on behalf of Plaid Cymru but for the Scottish National party, which is very concerned that this totally unnecessary dispute is being prolonged by a Government who seem to have lost all sense of justice.

The public in my constituency and elsewhere cannot understand why the Secretary of State for Health has allowed himself and his colleagues to become embroiled in a dispute that they cannot win. The ambulance service has the overwhelming support of the public, who will not allow the Government to treat their personnel in a callous and insensitive way.

I have experience of the high regard in which ambulance men and women are held by my constituents. The caring, dedicated, efficient and unsparing way in which crews undertake their duties is rewarded by a level of support that is rarely matched by any other profession.

Ambulance personnel from Holyhead in my constituency wrote to me saying:
"The ambulance services throughout Great Britain have striven,"—
this is the most important part of the letter—
"through increasing Tory party degradation, to maintain a decent level of accident and emergency cover, in many cases by suspended non-paid ambulance crews, which, judging by the overwhelming public support, is well appreciated. There were over 4·5 million signatories showing support for the ambulance staff, and we therefore think it is high time that the Government listened to the electorate and resolved the 4-month dispute."
My constituents do not like members of the Government suggesting that ambulance crews are nothing more than professional drivers or taxi drivers in uniforms. Such phraseology is hurtful to ambulance staff, and I deplore it. When the Minister for Health responds, I urge her to confirm that the Government withdraw those statements.

Some years ago, Gwynedd health authority proposed drastic cuts, which at worst would have meant the closure of two ambulance stations in my constituency and a third ceasing to provide 24-hour cover. That led to a campaign against the cuts. I was aware then of the general public's support for ambulance personnel and the work of ambulance stations. Petitions attracted thousands of signatures and public meetings were extremely well attended. The size of the public response forced Gwynedd health authority to withdraw the proposals and I believe that public support will eventually lead to the Government increasing their offer to ambulance personnel to achieve an honourable settlement.

I also know the difficult circumstances under which ambulance personnel work. In my area I know of ambulance crews operating old vehicles, which have run up extremely high mileages and should have been replaced long ago.

Having listened to the debate and to ambulance personnel, I ask myself why the public are behind the ambulance men's claim. Essentially, they do not accept that ambulance personnel should be paid less than others working in the emergency services. They believe that they should be paid the same because they are committed to providing an emergency service. That is an extremely powerful argument and the Government are wrong to deny its force.

The wage claim should be seen in its proper context. The current basic pay of an ambulance man or woman is £7,340 on entry. That is 30 per cent. less than that of an equivalent police constable and 40 per cent. less than that of an equivalent fireman. The average weekly wage of an ambulance man or woman is £141. One cannot stay in London's Dorchester hotel for even one night at £141. The perversity of that comparison illustrates my point perfectly. The hon. Member for Derbyshire, South (Mrs. Currie) said that £150 was a decent wage for ambulance men. I wonder what she would make of that comparison.

The present rates of pay of ambulance men are substantially below those of their colleagues in other emergency services, and they would fall even further behind those colleagues if they accepted the 6·25 per cent. that is currently on offer. In September 1989, the police received a 9·25 per cent. increase and firefighters settled for 8·6 per cent. Where, in the name of humanity, is the justice in that? How can the current offer be considered fair when average earnings increased by 8·75 per cent. in the year to August 1989?

It seems to me that in this, as in so many other areas of policy, the Government are now completely out of touch not only with current pay settlements but with public opinion. The Secretary of State seems to be more beleaguered by the hour as he vainly struggles, even today, to advocate a weak—indeed a lost—cause.

The Secretary of State should also accept the need for an independent formula similar to the formula under which the pay of hon. Members is fixed. That would end the need for industrial disputes. It would also restore some dignity to the whole affair, and we should not have this unseemly public wrangling, which becomes more acrimonious by the day.

It is highly significant that both the Police Federation and the Fire Brigades Union are seeking to persuade the Secretary of State to institute parity and a pay mechanism for ambulance crews. They know—they should because they are also part of the emergency services—that the present disparity is inherently unfair and that they want their colleagues to be treated fairly. They believe that the Government are being intransigent and stubborn.

Ambulance men and women have chosen their career so that they can be of service to the community. That is why they are not out on full-time strike as a result of the dispute. They have shown their devotion to duty time after time, disaster after disaster. They have been hailed as heroes by the Prime Minister and others. They have been championed for their courage. I have seen their human responses to tragedy and death and watched them carry out their task with dignity. The Government should now match that dignity by paying them a decent wage and setting up machinery to ensure that this kind of dispute never has to happen again.

7.55 pm

I very much regret that we are having this debate at all. It does nothing to add to the sum total of human knowledge and, as a very distinguished Labour Employment Minister said, debates in the House of Commons on industrial disputes only tend to lengthen those disputes.

That is not what you said in 1979; the Opposition were asking for a debate every day.

The right hon. Member for Birmingham, Small Heath (Mr. Howell) intervenes from a sedentary position. As he is a Privy Councillor and bound to be called in a moment, perhaps he will do me the courtesy of keeping quiet, even if he will not listen. He is not helping matters at all.

I regret that we are having this debate, because it gives people the opportunity to enter into petty party-political arguments. That is precisely what we have had tonight. It does not help ordinary men and women who are desperately frightened to dial 999 for fear of what will happen to them, and it will not help the unions. At the unions' invitation, I have had almost daily contact with their representatives over the past seven weeks or so, and I know that they want an honourable settlement. This debate will not help them to make up their mind about the next step forward.

One of the great hurdles in the way of a speedy settlement of the dispute is that the wrong signals have been given out by both sides. It has become a political, rather than an industrial, dispute and that is most regrettable. We have had megaphone diplomacy and trial by television, in which Ministers and trade union leaders have been put on the spot and have made off-the-cuff remarks. That has precluded sensible negotiation.

Over the past few weeks, some of us have been trying —perhaps not terribly successfully—to feel our way through the morass of mistrust and misunderstanding on both sides. Trust has to be restored; otherwise, we shall not achieve a speedy end to the dispute. [Interruption.] I hope that Opposition Members are listening.

In my contact with the unions, I have discovered that they fully appreciate the political realities of the dispute.

They realise that the Government and management want a speedy and honourable end to the dispute, but not at he risk of a public sector wage explosion or of encouraging other trade unionists to pursue wage claims by industrial action. That is absolutely clear. The unions accept that in good faith.

As I said, one of the great tragedies of the dispute has been that the wrong signals have gone out. Look at what happened as a result of one sloppy piece of reporting in a Sunday newspaper last week. The unions were led to believe that my right hon. and learned Friend the Secretary of State was giving a nod and a wink not to new money but to old money in the National Health Service budget. That is nonsense, and we know it. So, where do we go from here?

I believe that a window of opportunity has opened. The next few days are crucial, and it is vital that my right hon. and hon. Friends, in particular the ministerial team, and the management and union negotiators put themselves into a state of purdah. They should not try to conduct negotiations over the airways, because that has failed so miserably in the past. Sometimes talks which were close to settlement have failed as a result.

The window will only be open, I suspect, for a matter of days. There is a basis for negotiation, and there is common ground, if only both sides could see it. There have been concessions from the management side—or effectively from the Government—of an extra £6 million — [Interruption.] It makes no difference; at the end of the day, that is where the money comes from—the Government. The Secretary of State has put an extra £6 million on the table. I believe that the first part of the dispute can be settled by reshuffling that £6 million.

The unions have made two significant concessions publicly in the past two days. It is worth paying some attention to those concessions, because the press have not. Roger Poole made it quite clear that he would not be pressing for the full 11.5 per cent. We seem to be negotiating downwards—perhaps down to the rate of inflation for this year, but I do not know. I do not speak for him, or for the Government, but it is worth negotiating about.

During a BBC programme the other day, Roger Poole said that he would not be pressing for linkage with the emergency services. We are not talking about linkage, arbitration or pay review bodies. We are talking about an honourable settlement. We are talking about a mechanism that will protect the value of that settlement, so that we never have this sort of dispute again. A dispute that involves ordinary people, which is what the ambulance men and women are, will be taken out of the political arena.

I understand that the Government and the Health Service management may have some reservations about an across-the-board pay mechanism, but there is no reason why there cannot be parity if it is a parity weighted in favour of those people who work on emergencies. Public sympathy, quite rightly, lies with those people who scrape bodies off the road, and help heart attack victims. We should encourage people who deal with emergencies, and we should pay them well. We want a highly trained, highly motivated and well paid emergency service.

My hon. Friend has only just come into the Chamber and he will have the opportunity to speak in a moment. However, as he is a dear friend and can buy me a drink in a moment, I shall give way.

I know that my hon. Friend has taken a great deal of interest in the details of the dispute. Has he given any thought to who might chair the review body? Perhaps he has Professor Clegg in mind for the job.

I regret that my hon. Friend, uncharacteristically, has not been listening. I said that a review body and linkage to the emergency services should be ruled out. I suspect that a pay mechanism could be a basis for discussion and negotiation, but not if it is across-the-board, or could be inflationary, as has been suggested in the Government's amendment—and I shall support that amendment tonight. We need a mechanism that will help emergency workers in particular.

Some of my hon. Friends have mentioned the deplorable state of some of the emergency services, and the number of paramedics. I was horrified to learn that there are only eight paramedics in the London ambulance service, whereas Essex, which is a good deal smaller, has 30. The number depends on the dedication of chief officers in the service. I hope that once the dispute is settled there will be an initiative to encourage the training of paramedics. When one looks at the situation in other parts of the country, for example Yorkshire and Essex, one sees that it can be done if there is the will.

I am sorry, but I am running short of time.

There has been a lot of criticism of my right hon. and learned Friend the Secretary of State, and I regret that. During the dispute, he has been in an impossible position, because there has been so much media hype. We all know that he cares deeply and passionately about the Health Service. He is like a man on a tightrope: we see him walking across; we wish him well; we hope that he does not fall; but none of us wants to be there with him. The best way to move towards an honourable settlement is not to crush one side to the ground. There should be no victory for either side. I support the amendment tonight, but I wish to encourage the Government to be flexible, as I have suggested in my speech.

8.5 pm

At present, we are in an unbelievable situation in Britain, if one cares to step back and look at it. Trained, skilled ambulance crews are waiting in their stations, ready to work and prepared to deal with any emergency. They turned out the other night on the M25, and over Christmas for every emergency.

The police are trying to operate an ambulance service in police vehicles that are not equipped or safe for the job. They are no more than freight vehicles but they are carrying people around in them. The police do not know what they are doing, and they would be the first to admit that they are frightened by that.

When ordinary people ask a police station, or the 999 service, if they can have the telephone number of the local ambulance station to get an ambulance to come to the scene of an accident, they are denied that information. The police have been instructed not to give it out.

Army vehicles, with all-terrain and all-weather tyres, are skidding around the greasy roads in London, and that is very dangerous. They have ill-experienced crews and no equipment, and they are completely incapable of doing the job. They would also be the first to admit that. Young soldiers, policemen and women are scared out of their wits every night when they are sent out on 999 calls. However, skilled crews are waiting in every ambulance station who are ready, able and willing, and they are prepared to do the job.

Who is putting people's safety at risk? Is it the ambulance crews, who are in their stations ready to go out and deal with any emergency? I think not. I think that the person responsible is the Secretary of State and there is no point his hiding behind Duncan Nichol and everybody else.

If I were a psychiatrist, I should say that the last 20 minutes of the Secretary of State's speech showed some counselling angst. He was saying that nobody understood him. He was saying that there is a conspiracy among newspaper journalists and television reporters to misrepresent what the Government are saying. It comes ill from the Tory party to say that, when it has the support of 95 per cent. of the newspapers in Britain.

Readership of The Guardian is about 400,000. Tragically, sales of The Sun reach 4 million every day. That is a big difference, but perhaps the hon. Gentleman is not very good at arithmetic and cannot work it out.

The Government are on a hook of their own making. They thought that the ambulance workers were not serious about their claim. They were serious about their initial pay claim, and they are serious about it now, because they care about the service. Many highly skilled and trained ambulance workers can no longer afford to stay in the service.

Hon. Members should ask London ambulance workers about their position. They cannot afford to buy housing in London because their salaries are so low, and they cannot obtain council accommodation because there is none to be had and none on offer to them. They would like to look forward to a lifetime in a service that they love, doing a job that they enjoy, but they cannot afford to stay in it.

The ambulance men have presented a reasonable claim: they want parity with the fire and police services. Is the ambulance worker who arrives at the scene of an accident really worth £60 a week less than a fireman—and an even larger amount less than a police person who is directing traffic, among other things? No: all those workers are equally valuable and equally necessary in their own way. Why are the ambulance workers being treated so badly?

Conservative Members are always paying tribute to the ambulance service—and I readily join them in that, for I have witnessed and experienced their work—but have Conservative Members considered the trauma involved in pulling children out of car crashes? Has any of them imagined what it was like to pull people out of the Clapham disaster, and all the other disasters that we have seen, and then, a few hours later, to be back on the job not knowing what the next task would be? Have Conservative Members considered the abuse that ambulance men receive—for instance, on a Saturday night, when they pick up drunks who may take a swing at them? And, after all that, they are told by the Secretary of State that they are no better than qualified drivers.

I do not wish to be disrespectful to qualified drivers; they too do a valuable job. An ambulance worker, However, does a much more valuable job than merely driving a vehicle. This is not a taxi service or a freight service, but an emergency service that is the envy of many other countries.

The Government thought that they could face out the ambulance workers and win the dispute. They thought that they could make it go away by means of their usual tactic of smearing the union leaders and workers concerned—saying that they do not care, and that they are hasty, greedy, brutal and brutish. Then they discovered that the majority of people simply did not believe any of that, because they have some experience of the ambulance service.

It is no accident that a petition expressing support for the ambulance workers contained nearly 5 million signatures. It was the biggest petition ever presented to the House, certainly in the past 150 years. Every day there are queues of people in the Holloway road in my constituency, waiting to sign petitions and to put money into the collecting buckets. They want the ambulance men to win and to be paid decently, because they want the security of knowing that there is a proper ambulance service.

The Government's con trick has failed. They are now pleading that that is because Roger Poole is so good on television. Compared to the Secretary of State, Roger Poole is very good on television, but I know that he would not mind my saying that the public support for the ambulance men is not just because of him: it is due to the public's perception of the service, and of the justice of the men's claim.

The Secretary of State ought to realise what is going to happen. He is a long way into the dispute. He keeps saying that it is nothing to do with him, that he cannot afford it, that Duncan Nichol is doing the negotiation and that conceding the men's claim would unleash a spate of further NHS pay claims. There are several points there. First, Duncan Nichol is now earning some £70,000 a year, following an increase in his performance-related pay, while heaping abuse on the ambulance workers. The Secretary of State, like most hon. Members, has a guaranteed annual pay rise because of the linkage arrangements, although I understand that he has not managed to obtain quite the same pay increase in his role as a Cabinet Minister; we shall pass the hat around for him if he is hard up. Is he really in a position to lecture the ambulance workers about their perfectly reasonable pay claim? Of course he is not.

The Secretary of State keeps saying that accepting the claim might lead to other demands in the Health Service. What he fears is that it would lead to a public examination of the low pay received by many Health Service workers. We treat our health workers scandalously. They are threatened with privatisation if they ask for a pay rise, and, if they ask for one, they are told first it would have a knock-on effect on another sector, and then that it would affect patient care. What is affecting patient care is the obsession of central Government with creating a market economy within the NHS. The reason why 140 hospital beds have been taken out of use in the Islington health authority area is not the greed of health workers, but the meanness of the Government who o have underfunded the authority.

The Government's long-term objective—which, I think, is behind the dispute—is the breaking up of national negotiations and the privatisation of the ambulance service. They know perfectly well that, if they succeed in privatising any service, the power of workers to negotiate pay rises is reduced, because they are subjected to the competition of the unemployment queue.

Tonight's debate is very timely. Millions of people will have heard what the Secretary of State really said, and will have observed the meanness of his attitude. Those people will again demonstrate their support by signing petitions, collecting money and taking part in the stoppage on 30 January, and at some point in the not too distant future we shall see that same Secretary of State, at that same Dispatch Box, announce a settlement—and a big rise in the ambulance workers' pay.

8.15 pm

I was surprised to hear my hon. Friend the Member for Harlow (Mr. Hayes)—who has just left his seat—say that he regretted that we were having this debate tonight, because he seemed to have been having a continuous debate on the subject for many weeks. My hon. Friend felt that tonight's debate would not add to our understanding of the position. I, too, feel sorry that we are having the debate in such circumstances, but I believe that it has enabled us to gain a deeper understanding of the dispute. I agree with my hon. Friend the Member for Fylde (Mr. Jack), who said that it had opened a Pandora's box, and that the management of the ambulance service will be different in the future because of the greater knowledge and understanding that has emerged.

I dislike all disputes, but surely this dispute is the best possible example of the need for reforms in the National Health Service. I dislike disputes in the Health Service most of all because the service is far too important to be fought over in this way. I am, however, surprised at the extent to which those who are committed to its success have been able to maintain it. I have not received a single letter concerning a specific failure to provide patient care, nor have any of my colleagues to whom I have spoken. That is a remarkable tribute to National Health Service workers' determination to maintain standards, and to look after the vulnerable members of society—especially the elderly and the mentally ill—who rely so much on the non-accident and non-emergency aspects of the service.

Any attempt to resolve the dispute through a return to the old days of beer and sandwiches at Downing street would be entirely the wrong approach, and I must differ with Opposition Members who feel that that is the way in which to treat the Health Service. The hon. Member for Islington, North (Mr. Corbyn) said that we treat our health workers scandalously, and that it is wrong for the Government to look to market-economy measures. I say that it is scandalous to treat health workers as Opposition Members would like to treat them, with collective bargaining systems that are entirely unresponsive to the need for extra skills. Ambulance workers need more training, and the way to provide for that is to allow them local negotiation.

I was appalled by the remarks of the hon. Member for Durham, North-West (Ms. Armstrong), who attacked the general manager of the ambulance service in Northumbria. Let me quote some of what I have read in the Sunday press. The Sunday Telegraph tells us:
"The Northumbria Ambulance Service has drawn up plans to become self-managing under the Government's Health Service reforms."
If ever there was an example of the need for those reforms, it is the current dispute. The report continues:
"If it does opt out in 1991, it will become a model for the future. Already health officials in Newcastle upon Tyne are planning for a future in which ambulance drivers will receive £3,000 a year more than today—with no strikes."
That is what we should aim for. I understand that the service also intends that every driver of every ambulance should be fully skilled as a paramedic.

The article continues:
"Northumbria is an outstandingly efficient service. Skilled management has brought big savings and the service has started selling its expertise to the private sector. Northumbria's free enterprise includes a radio-paging service, ambulances, vehicle maintenance and first-aid training. This is the thin end of the wedge for the Health Service and local government, where an end to national bargaining would appear to have great awards."
The Sunday Correspondent also carried an article on Northumberland's example to the rest of the Health Service. It says:
"There the service was re-organised in the mid-I980s: five ambulance stations, 73 vehicles and 79 staff were cut. The transporting of elderly people to day hospitals was hived off to a separate service, still run by the health authority. But the rest of the work (43 per cent. of the total journeys) carrying out-patients, is now contracted out to private companies which run taxis and minibuses.
The result, according to Laurie Caple, the director, has been improved emergency response times (from 83 per cent. answered within 14 minutes to 98 per cent.) and shorter waiting times for out-patients."
Amazingly, with this better service,
"he is also saving £2·6 million a year on a total budget of £10 million. Mr. Caple would like the freedom of local pay bargaining: and he would increase the pay of the paramedics. That ambition … has until now been anathema to the ambulance staff and their unions. It explains the duration of the dispute—and the increasing frustration of those responsible for prosecuting it."
I received in my post today a letter from Mr. Bob Abberley, the parliamentary officer for the five ambulance unions. He gives me his mobile, his home and his office telephone numbers. Enclosed with the letter is the briefing material on the ambulance dispute, as the unions see it. It contains a most extraordinary statement. The briefing paper says that the NHS chief executive
"has refused to hold further talks unless the unions reveal their … position before a meeting is called. The unions cannot do this because they believe that would undermine the whole bargaining process."
That is a most extraordinary statement. The unions are undermining the whole bargaining process. They have the Whitley council, although it is not much better than the old Burnham council. The unions are undermining that process by trying to reach an agreement here.

The hon. Member for Livingston (Mr. Cook) said that he thought that the unions would settle for 50 per cent. less than their claim. What grounds does he have for making that statement? Is he trying to reach a settlement across the Floor of the House? What an absurd way to try to manage the National Health Service. It has to work within the cash limits that were introduced by a Labour Government. The NHS has to live within the cash limits discipline.

My message to the unions is that they should work within that discipline. That is what Mr. Nichol is trying to do, that is what he is paid to do, and that is what everybody else has to do. We have to seek a flexible method of local pay bargaining that will reward skills and provide us with a much more highly skilled ambulance service than we have now and a far more satisfied and much better motivated work force. Ambulance personnel will then be rewarded for their additional skills and their dedication. I commend Northumberland for setting an example that I hope the rest of the country will follow. We should provide the flexible pay bargaining structure that the ambulance men so obviously need.

8.23 pm

The Secretary of State's arrogance and conceit are matched only by the Government's arrogance and conceit and that of the vast majority of Conservative Members. A few Conservative Members have referred to the need for a settlement. The two sides must be brought together. The debate will not have helped to bring them together. Those Conservative Members have obviously been looking at their parliamentary majorities and the opinion polls, which show strong support for the ambulance men.

I pay tribute to the marvellous work that ambulance men do. I am a former HGV 1 driver, right at the top of the list of professional drivers. If I were to be involved in an accident, I should prefer ambulance men to come to my aid rather than an HGV 1 driver, because their skills are completely different. The ambulance man does not deserve to be called a professional driver; he is far more than that. The Secretary of State should spend a little time with ambulance men during the night and on emergencies if he wants fully to appreciate the duties that they perform on behalf of the public.

The Secretary of State is not speaking on behalf of the Health Service. If he were, we should not be here this evening. He said that a 1 per cent. increase in pay would cost about £340 million. It was the most significant statement that he made. It was a clear message that the Government are deliberately seeking to keep down Health Service costs. The Secretary of State referred to the fact that 70 per cent. of costs are due to wages. He should have said that in no circumstances will the Government link Health Service workers to the wages structure of any other workers.

People work in the National Health Service because they want to serve the public. They are the Cinderellas; they put patients before wages. They have not been prepared to take industrial action and put people's lives at risk, so their wages have gradually been eroded. We should all be ashamed. The vast majority of people of this country are prepared to pay, either through their taxes or through their national insurance stamp, for an adequate Health Service.

All this tinkering round the edges is designed to bring about privatisation. The Government want to split up the NHS, but privatisation does not lead to El Dorado and all kinds of wonderful benefits. It gives an increase to the few, but after privatisation the vast majority have to suffer wage cuts. The Secretary of State for Transport should be here. He is not afraid to give wage increases above 6, 8 or 10 per cent. He gave a huge wage increase to the head of British Rail, Bob Reid.

The Prime Minister talks about Victorian values. In Victorian times the worker had to doff his cap to the management. The Prime Minister wants us to return to such Victorian values. I do not. Management and employees should be part of the team and should provide a service. The Secretary of State has put himself into a trap of his own making, and he does not have the gumption or the courage to admit that he is wrong.

The work of ambulance men cannot be compared with other jobs. Of course ambulance men perform a job different from that of nurses. The Secretary of State really should get off his backside and resolve the nurses' outstanding wage claims. Many cases have been waiting for two years to be resolved. Ambulance men are different from the police and the fire brigade, but they perform a similar function.

Job evaluation is also important. The unions are prepared to talk, but it would appear that management is not. I used to be on the Whitley council. Nichol can only work within the terms set down by you and the Government. If you want to resolve the dispute, you should not keep sending letters through the post and sending Nichol back to the negotiating table, because he has no power. Get off your backside, get back to the table and get negotiating. You are setting the terms; it is not Nichol. You say that industrial action is putting patients at risk, but it is not the ambulance men; it is the fact that you are refusing to budge.

I apologise. I was referring to the Government, the Secretary of State and the Minister. I could think of something else to call him.

We really want to resolve the dispute. For Christ's sake let us get the two sides round the table negotiating because they cannot negotiate through the media or by letter. They have to get round the table and discuss it. There is a whole range of possible options, but I know the biggest stumbling block. I have been involved with management before and only a stupid management creates disputes. The reason why there is no early result is that no one wants to lose face. People are dying and a little loss of face would not go amiss in saving lives.

8.31 pm

I begin by paying tribute to the ambulance men. Many years ago I trained as a Royal Life Saving Society instructor and examiner. I spent some time in my teens teaching first aid and I was involved with the emergency services. I have also been a member of the Thames rescue service, so I know what a fully-trained ambulance man can do in an emergency. We all owe them a great debt of honour for the fine service that they provide throughout the country.

The dispute turns on one issue—whether there should be a formula for the settlement of future pay disputes in the ambulance service. That is not a new question. I was interested to hear my hon. Friend the Member for Derbyshire, South (Mrs. Currie) draw attention to the ambulance dispute of 1979. On that occasion the former Minister of Health, now Lord Ennals, was refused access to a hospital because a shop steward, I think representing NUPE, said that he was not genuinely ill. That was rather distressing for all involved.

I also read the debate in the House on 21 February 1979 about the ambulance service industrial dispute. It was a goldmine of remarks from the Labour party. I was trying to discover what the Opposition propose and their attitude to these matters. Perhaps I can draw attention to column 427 where a Mr. Pavitt—I do not know who he was— [Interruption.] I am sorry, I understand that he died last week. I am a new Member, and I did not know that. Mr. Pavitt said:
"In the longer term, is not a revision of the whole of the Whitley Council machinery within the National Health Service overdue?"
He asked that question referring specifically to the ambulance service. Lord Ennals, the then Labour Minister, replied:
"On the second question, the important report that was produced by Lord McCarthy was carefully studied. It led to considerable changes. It may very well be that other changes may be proposed. Certainly the Government are ready to look at them. We have already had a careful look at the way in which the Whitley Council system works. Basically it works well."
That was the attitude of the Labour party then and it does not appear that there is any good reason for it to have changed since.

In the next column, Mr. Arthur Lewis asked:
"Is the Minister aware that ambulance workers, rightly I think, claim that as they have always been allied to the life-saving services, such as the police and the firemen, they should be treated like them?"
The Labour Minister of Health replied:
"However, it must be recognised that only 10 per cent. of the time and duties of ambulance men is spent dealing with emergencies. The rest is spent dealing with non-emergencies. Therefore, that emergency 10 per cent. is an important part of their task."—[Official Report, 21 February 1979; Vol. 963, c. 427–28.]
The Labour Government then asked Professor Clegg for his proposals.

On 14 September 1989 The Times reported that the ambulance men
"should be seen as part of the emergency arm of the health service rather than the health arm of the emergency service. They cannot realistically be considered in isolation from other staff in the health service, some of whom are no less essential in meeting the immediate needs of accident victims and other urgent cases".
This year, 94 per cent. of NHS staff settled their pay without recourse to industrial action. The vast majority of them have settled at around 6·5 per cent. Almost 500,000 nurses, for example, received a 6·8 per cent. increase. It would be manifestly unfair to those workers to give additional rises to ambulance staff simply because they have taken industrial action. Moreover, it would be disastrous if every year the NHS pay round opened with a benchmark award to ambulance staff based on some generous formula similar to that of the police. For the reasons that I have just given, the two services are not strictly comparable, although 10 per cent. of them might be. I pay tribute to those 10 per cent. who have paramedical skills. However, 90 per cent. of the work is routine. The Independent reported on 1 November that 12 per cent. of the work undertaken in the average county involves those skills.

I draw attention to a newspaper which I know has the sympathy of many Opposition Members. On 18 September 1989 The Guardian reported that one
"option which would be opposed by the Unions would be to separate emergency from non-emergency work. Much non-emergency work is no more difficult than mini-cab driving."
My right hon. and learned Friend the Secretary of State was accused of being callous because of his alleged remarks—if I could I would underscore the word "alleged" in Hansard, as that is not strictly what he said.

My hon. Friends the Members for Leeds, North-East (Mr. Kirkhope) and for Bolton, North-East (Mr. Thurnham) referred to the service adopted by Northumbria where such a two-tier system works extremely well. Private contractors deal with 40 per cent. of non-urgent cases and the two-tier system that has been working for some years has generated savings of £2·6 million on a budget of £10 million. That money has been invested in improved services such as defibrillator machines and greater training for emergency crews. Overall, the response times in Northumbria, which is one of the largest ambulance regions in the country, have improved. One third of the 370 dedicated accident crews have full paramedic training and basic training is given to the drivers of private line buses.

Wiltshire is another county that uses trained crews only for emergencies or where specialist crews are needed. Its system is backed up by a plethora of different initiatives, some of which are voluntary and some private taxi arrangements, for people who need to attend outpatient departments or hospital for other reasons. One of the chief complaints that hon. Members occasionally hear is when people have had to wait for an ambulance. Usually they are not serious cases, such as people who have been run down by a car or involved in an accident, but they have been told that an ambulance will pick them up from their sheltered accommodation at, say, 11 am but have had to wait two or three hours. I am aware of someone who had to wait eight hours. The reason for the delay, which they all understand and accept, is usually that the ambulance had been called away to an emergency, had returned to the station and as it was about to collect them had been called out to another emergency.

Northumbria and Wiltshire set out to improve the system for patients who merely needed transport. As a result of reorganisation, Wiltshire was able to increase its number of paramedics because it diverted the money that it saved into further training. Fifty per cent. of all ambulance crews in Wiltshire have full paramedical training, which is a major improvement for patients. We heard earlier in the debate that there are only eight paramedically trained people in London, and my hon. Friend the Member for Harlow (Mr. Hayes) said that there are 30 in Essex. The national average is 12 per cent.

My hon. Friend informs me that there are six in Cleveland. Last year, the county of Wiltshire responded to 13,500 emergency calls, 61 per cent. of which were attended within eight minutes—the Department of Health target is 50 per cent—and 98 per cent. within 20 minutes, for which the Department's target is 95 per cent. The savings made have gone into extra cover, new vehicles and equipment.

Perhaps we should take the opportunity of this debate not to discuss the dispute—many hon. Members agree that the debate will not advance the resolution of the dispute —but to say what sort of service we want in the future: a faster-responding, higher-qualified and better-paid service.

8.42 pm

I am delighted to put on record the views of the people of the west midlands about the provocative way in which the dispute is being conducted by Sir James Ackers, who is chairman of the West Midlands regional health authority.

I should also like to deplore some of the comments that the Secretary of State has made during the dispute, such as his sneers about taxi drivers.

It is no good the Secretary of State shaking his head, because we all know that those comments are on record.

I have taken the trouble to find out about the earnings of taxi drivers. The London taxi drivers association tells me that the average wage in London is £15,000, and in Birmingham it is £14,000.

I did not say that the Secretary of State had called them taxi drivers; I said that they had been called taxi drivers. The right hon. and learned Gentleman referred to them as drivers, but taxi drivers were referred to.

It is clear that in the west midlands we are engaged in trench warfare. A most disgraceful letter, the like of which I have never seen in all my public life, was sent by the regional general manager of the West Midlands regional health authority to ambulance workers, who have been locked out. The facilities to provide the same service as throughout the rest of the country have been withdrawn. Telephone lines have been cut. Yesterday, I saw people waiting to work but not being allowed to receive telephone calls. That is being done at the behest of the Secretary of State and the regional chairman, who sits on the National Health Service Policy Board and is in part responsible for this dispute. He has returned to the west midlands to conduct trench warfare, which no other regional chairman has done.

When the chairman wrote that provocative letter, I promptly took action on behalf of six Birmingham Members of Parliament, including two Privy Councillors, and asked for a meeting, which was refused. I got in touch with the Secretary of State's office, but he took no action. It is only because this debate is being held that we have been offered a meeting tomorrow, which we shall attend. I shall tell the chairman, in terms that I cannot use here, what I think of him for telling six Members of Parliament that they have no right of audience. He is paid to run a public service, and the Secretary of State should remind him of that. If membership of Parliament, parliamentary accountability and the right of our constituents to be heard mean anything, the Secretary of State should get rid of that chairman at once for refusing that basic right.

On 18 December, the regional general manager, Mr. K. F. Bales, wrote a letter to each ambulance man. He told them that if they use their ambulance they will be liable to prosecution for driving an uninsured vehicle, for driving a vehicle without road tax and—this is the most important —that any passenger whom they carry may be prosecuted under section 12 of the Theft Act 1968.

Passengers—what a ludicrous proposition! If we had a disaster on the M6 near Birmingham such as that which recently occurred on the M25, ambulance men could not turn out because of that written notice.

It is no good the Secretary of State shaking his head. If people are told that they may be prosecuted under the Theft Act, they would be foolish to turn out unless they had a letter telling them that the notice had been rescinded. One could imagine the havoc on the motorway while all that is going on. Ambulance men would say, "Although we should like to attend, we cannot do so until the notice has been withdrawn."

Can hon. Members imagine what would happen if they turned out to tend to people who were seriously ill? A policeman may get into an ambulance and say, "Before you drive your ambulance, I must warn you that under the Theft Act 1968 you are liable to be prosecuted and that anything you say may be taken down and used in a subsequent criminal investigation." The Secretary of State is laughing.

I should like to respond to the right hon. Gentleman's suggestion, which might be taken seriously in the west midlands. If ambulance crews turned out in response to a control room, as they did on the M25, what the right hon. Gentleman has said would not apply. It is not true, and when he has time I shall explain to him why.

It is true. I visited the control room at the ambulance station in Henrietta street in my constituency, which is the largest ambulance station in Europe. The controller was not present because he had had to go somewhere else. As the Secretary of State has had all the telephones cut off, how will controllers convey messages? That is the state that the Secretary of State has got the service into in the west midlands. I beg him to look into it. Like everyone else, I want the dispute to be resolved, but we do not want it conducted in the west midlands on the basis of trench warfare, with elected representatives being refused meetings and ambulance men's telephones being cut off. That is a disgraceful way to handle any industrial dispute.

I was president of a trade union for 12 years, and I am a consensus man. I say with respect to the Secretary of State that one should never go into an industrial dispute unless one knows the way out of it. That is what the Secretary of State does not know. He has not asked himself how we get out of this dispute—which is what we want. We shall get out of it by asking a simple question, which he has not asked himself: what is the worth of an ambulance driver? We have been told that, if we give some ambulance drivers more, others in the ambulance service will have less. The reason why the Secretary of State will not go to arbitration or to ACAS is that arbitration would address the question that he will not address: what is the worth of an ambulance driver compared to anyone else, not only in the Health Service? That question must be answered at some time in this dispute, and it is the question that every trade unionist and every employer has to ask himself at some point.

When Ford workers are being offered 10 per cent., when we read that people in the Health Service will be offered considerable sums and when the Secretary of State, I and other hon. Members have part of our salary fixed by reference to some Civil Service machinery to avoid future disputes, it is no good the Secretary of State saying that what is good for the Civil Service, the police, the armed services, Members of Parliament, doctors and nurses is not good for ambulance men. That is a fundamental contradiction in logic and in fairness.

The reason why the Secretary of State has the whole population against him is that they believe in fairness, whatever their political views, and they do not see the treatment of the ambulance service as fair and just.

On the question of what the ambulance men are worth, my right hon. Friend will recall that in 1977, at the time of the Ford strike when the Ford company broke through the Callaghan pay lines and paid 18 per cent., the present Prime Minister said that people should be paid what they were worth.

The Secretary of State complains about this debate. I was a member of the Cabinet wages committee at that time. Not a week went by when the Opposition, who were led then by the present Prime Minister, did not have a debate in this Chamber, so let us not have these crocodile tears.

I want to congratulate Sandwell and other local authorities. If the Secretary of State will not provide an ambulance service for our people, the local authorities must do it themselves. Sandwell tells me that it has dealt with 93 emergency cases in the eight days since it set up its service, which it says is higher than average. Calls are overwhelmingly coming in from doctors. I am glad to know that that service has been provided, and if there is to be no movement in the dispute, there is an obligation on us all to provide a service for our constituents. I am not interested in the course of the dispute and this debate should not concern that, but it should be about the right of British citizens to a decent ambulance service, which it is the statutory responsibility of the Secretary of State to provide.

The Army is doing excellent work, but it cannot provide that service. I heard that only the other day three policemen impeding Army ambulances had been knocked down because the ambulances could not stop in time at the crossing. That is typical of what is happening. We must get this matter right. We must get people to sit round the table and to negotiate. My plea to the Secretary of State is for him to stop the provocative action and to start talking. Let us have a civilised solution to this problem.

8.53 pm

It is clear that the time has come for both sides to sit round the table, to be locked in a room, if necessary, to stay there until a solution is found and to accept that there must be give on both sides until a solution is found. That is what is required by my right hon. and learned Friend the Secretary of State, the whole House and the nation.

I speak as one who has been affected by the dispute. A member of my own family needed an ambulance a few days ago and was picked up by the Army, who did a notably good job in the circumstances. The whole dispute has been brought home to me in a big way. A few weeks ago, I was sitting on a London Underground train and saw a lady opposite me being taken very ill. I immediately found someone to support her and I walked up and down the compartment to find a doctor. I found a nurse who gave the lady artificial respiration and I stopped the train at the next station where the ambulance service was summoned. The ambulance men did a notably good job in getting the lady fit to leave the train. I heard that she died a little while afterwards, although it was not for want of anything that the ambulance men could have done. It was an impressive sight to see the ambulance men working with everything that they had to revive a lady who was obviously dying. They did a fine job and I remember that.

My remarks will fall into two parts. First, I shall comment on the medical side of the ambulance drivers' work and, secondly, I shall comment on other aspects of their work. I shall base my remarks on discussions with ambulance drivers in my own constituency with whom I have kept in contact. I had a long talk with them not long ago, on the emergency services and what some call the non-emergency services. The emergency services staff said —and I do not know whether their figures are right—that there are 2,000 ambulance drivers in London, of whom 200 are medically well qualified. They went on to say that there are only eight paramedics in the whole of London, and that figure has already been quoted to the House. They also said that only 20 people a year could become medically qualified as ambulance drivers—not to paramedic level, but to an advanced level.

I was glad when I heard my right hon. and learned Friend say this afternoon that he did not think that there were enough courses for ambulance drivers to improve their qualifications and knowledge. He obviously means that there will be more and, indeed, there must be more. It would be unsatisfactory and unfair if 2,000 ambulance drivers in London—less the 200 who are already well qualified medically—wanted to become qualified and could do so only at the rate of 20 a year. I know by his immediate response in the debate that my right hon. and learned Friend does not intend that. However, I draw the matter to his attention because it is an important factor in the morale of the ambulance drivers and in their representations to him about future qualifications.

My hon. Friend and I are broadly in accord. It is not necessary in any ambulance service for everyone to have that high level of training, but it is desirable that a much higher proportion should. I agree that the way to that should be paved, probably by local flexibility and productivity agreements, to release the resources to pay for it, as has happened in Northumbria and Wiltshire—as my hon. Friends the Members for Bolton, North-East (Mr. Thurnham) and for Stockton, South (Mr. Devlin) have already said.

I am grateful to my right hon. and learned Friend for that clarification, which brings me to the second part of my remarks, which concern the non-emergency ambulance service. That is also important. It arranges for the collection of patients to take them for treatment and for their collection from hospital or place of treatment after they have been treated. It has been very unsatisfactory in London for a long time. Now is the time to tackle it. It must be a problem for management rather than for ambulance drivers.

Day after day, I receive letters and representations from constituents saying that, in advanced age, they have sat at home and waited for an ambulance to come at the appointed hour of 9 am. By 4 o'clock it has not arrived, and by 5 o'clock they give up. That is unsatisfactory. Sometimes, the ambulance picks them up on time and gets them to hospital, but they must wait for up to eight hours for the ambulance to take them home. That is damaging for patients' morale. There must be many occasions when the treatment for which they have been taken to hospital is undone by the long, damaging and hungry wait. They get no food, and there is no one to talk to. They must sit and wait. I look to my right hon. and learned Friend the Secretary of State to improve the non-emergency service across London and the rest of the country.

The present dispute touches the hearts and families of everyone. No one can say with certainty that he or she will never require the aid of an ambulance driver or worker. Therefore, there is natural sympathy for that fine body of people. I know them well in my constituency, and I regard them highly. There is a discipline upon everyone—hon. Members, the ambulance men and those who employ them —to see that their conditions of employment are always fair. They must give, management must give, but a solution must be found, and found soon.

9 pm

There is general agreement among hon. Members that we must look for a long-term settlement and not just a short-term ceasefire in the dispute. The problem is not just to solve the current pay element but to make sure that we never face this problem again. It is clear that both management and unions are increasingly desperate for a face-saving formula, but a marginal pay increase and a vague commitment to a future review body are just not enough. We do not want any more accidents.

There are many underlying causes of the dispute. It goes much deeper and further back than current pay levels. There is a deep-seated morale crisis in the ambulance service, and it is based on several factors. The lack of recognition of their status and the language used throughout the dispute have not helped. There is a clear lack of training opportunities. Again, that has been fundamental to ambulance personnels' response to the offer of increased pay for paramedics. There is an absence of any meaningful reward for being trained. Although a remedy has been offered, it is limited by the lack of training. There is resentment at the lack of overtime pay. Many people would be surprised to know that ambulance workers' overtime is paid not at time-and-a-quarter, time-and-a-half or double-time rates, but at ordinary rates.

There is no acknowledgement of the experience and expertise that are acquired after several years' service. An ambulance worker who has been employed for 10, 20 or 30 years gets only three extra days' holiday in recognition of that experience. Many hon. Members know that if one needs an emergency ambulance and one is attended to by someone with 10 or 20 years' experience, one's chances of survival are much higher than if one is attended to by a new but enthusiastic recruit who has not yet learnt to use all the tools of the trade.

The debate has revolved around whether the ambulance service is an emergency service. Most members of the public know that, in an emergency, one dials 999 if one needs a fire engine, police car or an ambulance. Enormous relief, gratitude and respect are accorded to ambulance personnel when they answer such calls.

Yesterday, on the 5 o'clock programme on Radio 4, a letter was read out from the mother of a girl who had been critically injured in a road accident. When her daughter was on the way to a good recovery, the mother sought out the hospital consultant under whose care her daughter had been to thank him for his dedication and expertise. He said that she should thank the ambulance people who delivered her daughter alive to the hospital. Without that expertise a life would not have been saved.

Whether we are talking about 999 calls or people visiting hospital for chemotherapy, radiotheraphy or dialysis, they are all seen as life or death matters. It was stated in a recent radio programme about London that on a typical Saturday night the fire brigade received 140 999 calls, whereas there were 2,000 calls for ambulances. Those figures must be seen in the context of what the fire brigade and the police do. For example, much of their work is routine, and all fire brigade calls are 999 calls.

When firemen are not on active service, they are not doing other more routine work. Generally speaking, they are training to ensure that they keep fit. They do that in their various fire stations, and to many people that is thought of as leisure activity. I am not knocking that, but compare it with ambulance workers who undertake their emergency work in addition to their other duties.

The Secretary of State may not have seen the justice of the ambulance men and women's cause, but the overwhelming majority of the public have. They recognise the emergency nature of their work. The 6·5 per cent. offer is frequently compared with the 6·5 per cent. accepted by the nurses, but the nurses accepted that settlement before inflation was as high as it is today. Further, the nurses' settlement followed a substantial, exceptional and wholly deserved increase in 1988, when the Government were forced to respond to a public outcry over the level of nurses' wages. There is now a similar public outcry on behalf of ambulance workers.

There must be an independent review body. The dispute must be settled by a binding pendular arbitration process, and it would be fair to expect a no-strike agreement in return for a commitment on the part of management to submit offers and claims to binding arbitration in the event of disagreement.

It has been said time and again in the debate that there are inadequate facilities for training paramedics. It is clear that the ambulance personnel will set themselves adamantly against allowing the Government to take the paramedic route, as it were, out of the dispute without giving a clear commitment about access to that type of training. If paramedic and general skills training for ambulance personnel is to be made more widely available, so that ambulance workers will have the opportunity to upgrade their skills and salaries and embark on more of a career structure, that course may be reconsidered. At present, so few ambulance workers have access to such training that they feel that, in fairness to their colleagues, they cannot accept it.

We need a long-term formula to solve the dispute. Nothing short term will do. It must involve an independent pay review body, binding pendular arbitration and probably a no-strike agreement. It must include more and better paramedic training and an acknowledgement of the status of ambulance personnel and their emergency role. Above all, Britain's ambulance personnal must be acknowledged as fulfilling that vital emergency service on which all of us may at some stage depend.

9.8 pm

I agree with the Secretary of State and others who have said that there can be few more inappropriate places to try to make progress in resolving the dispute than a debate in the House of Commons. But at least it gives us the oportunity rationally, if not calmly, to consider some of the longer-term problems—which the hon. Member for Greenwich (Mrs. Barnes) outlined—of the ambulance service, its public perceptions and its principal characteristics.

It is not surprising that, although the public may be ignorant of the details of the dispute—particularly the fact that the ambulance workers have received an offer of 6·5 per cent., which has been accepted by 94 per cent. of other National Health Service workers—they have a great deal of sympathy for the ambulance workers' case.

One of the first things that I did when I heard that the dispute was in train was to talk to the local ambulance workers in my constituency of Kidderminster. I pay tribute to those people. They are loyal, hard-working and sensible people who obviously have a great commitment to their service. Their rate of staff turnover, if that exhibits loyalty, is extremely low. On the other hand, they did not have a clear definition of what was required of them. Their job was not particularly well-structured and there was no real incentive to improve their professional qualifications.

In short, they are imprisoned inside a salary structure that is inappropriate to their different abilities and qualifications to the extent that a leading ambulance man with 15 years' experience and with paramedic qualifications, who has spent no fewer than five months on off-the-job training to gain those qualifications, is paid only £3,000 more than a new recruit who has possibly only two weeks' training in first aid and has good driving skills. That lack of differentiation across the ambulance service is wrong and is possibly perpetuated by the way in which the service is organised.

People's perception is that old people or out-patients are transported in ambulances that to all intents and purposes are appropriate to the highest kind of ambulance care, and they perceive that use as not necessarily appropriate. Again, it is not appreciated by the public that, although 15,000 of our 22,000 ambulance staff have qualified training and between 12 and 18 months relevant experience, in most cases—except for the paramedics—those qualifications amount to nowhere near the skills levels of senior nurses who are paid £12,000, which is only £500 more than the wage offer that has recently been made to leading ambulance men in the current pay negotiations.

Under those circumstances, irrespective of comparability and the effect of any wage increases on public sector pay, irrespective of the possibility that a large pay increase will undermine management and the Whitley structure, and irrespective of the fact that a large pay increase would lead to a fall in patient services or even to a decline in morale among other NHS staff who have not decided to take industrial action in prosecuting their pay claims, surely, on a true skill basis alone, across-the-board increases irrespective of the degree of skill, the local geography and the local labour markets would be totally unjustified in terms of the long-term good of the ambulance service. The Government are therefore right to resist them.

However, that is not to say that the ambulance service does not have a case for restructuring or for higher pay. Indeed it does, but that should be achieved within the framework of changes to the 1986 agreement and in the pay and conditions of ambulance staff.

I shall outline four elements that such an agreement should contain. First, subject to national guidelines on standards of service, the ambulance service should be as decentralised as possible, because then decisions could be more responsive to the needs of the local labour market and to what the local community needs. As long as the national negotiations confirm a pay package that protects the real value of ambulance workers' pay, questions of relative pay, merit pay and skill differentials should be decided as locally as possible.

Secondly, the organisation of the service should be as local as possible. We have already heard that, in Northumberland and Avon, 43 per cent. of the cases for which the ambulance service is used to provide transport for the elderly are covered by a separate service—albeit one that is county council funded. The out-patient services are farmed out to local taxi firms and 10 per cent. of accident and emergency resources are concentrated on that service, which is increasingly a paramedical service.

That sort of organisation would have a number of advantages. Staff would be deployed more appropriately according to their skill, and vehicles and capital equipment would be used more effectively. Also, savings would be available to be ploughed into a better quality service, and, possibly most importantly, the professionalism that the ambulance workers possess could be better rewarded through a clearer idea of the tasks demanded of them.

Thirdly, there should be greater incentives for paramedical qualifications in the ambulance service. A £500 increase to gain qualifications that take between five and eight months off-the-job training is not significant. That should be considered without delay to improve the professional qualifications and the drive of the ambulance men.

Fourthly, if the ambulance service were divided so that 10 per cent. was primarily orientated towards accident and emergency and staffed with people with better qualifications, we could ensure that capital spending was primarily orientated towards that service. Defibrillators and other capital equipment that are supplied to ambulance services in my area and other areas only through voluntary subscription could be provided through Government or local authorities. Obviously, that would improve the quality of the newly specialised accident and emergency service.

Those should be some of the goals in the long term. In the meantime, the Government are right to hold the line on the dispute, while offering to consider the structure, pay and conditions of the ambulance service in the medium term.

9.16 pm

Every hon. Member who has attended the debate will be left with three overriding impressions. The first will be the clear, overwhelming public support for the ambulance service in its dispute with the Government, and its dispute is with the Government alone. The second will be the genuine desire among almost all hon. Members for a settlement to the dispute.

Sadly, the third impression is a new one from tonight's debate. It is absurd for Conservative Members to suggest that it is inappropriate for the House to discuss a dispute that is now in its 18th week. We cannot settle the dispute across this Table, but it has to be settled across a table in the end. We should discuss the issues and consider which way forward is appropriate.

The sad and new impression that comes from tonight's debate is the total intransigence of the Government's position. Many Conservative Members have told the Government that they cannot take an intransigent and entrenched position and expect to negotiate from it. It has been conceded by many Conservative Members that the union position is flexible on the amount of the settlement and on the mechanism by which it might be reached. That is clear and undeniable. If the Secretary of State—as he has indicated by shaking his head on several occasions, whenever those issues have been raised—does not believe it, he should put it to the test. He cannot put it to the test if he says in advance of entering into negotiations—which is his present position—that there can be no movement on the terms of the wage settlement or the indexing arrangement. One cannot negotiate on that basis.

The debate is an accident that he has created because he was initially complacent about it. Subsequently he has moved from insensitivity to condescension. If I may offer the Secretary of State some advice in a friendly spirit across the Floor, he should get himself off the screen and confine himself to the negotiating room. That is where the dispute must be settled, and quickly. It cannot be settled on a take it or leave it, total surrender offer of 6.5 per cent. The dispute started in 1989 and if it had been settled some time ago it may have been possible to settle near that figure. I have no intention of advising any of the parties to this dispute about where to settle. Further, it is clear that, in present circumstances, that offer is no longer viable. It is no way forward for the Secretary of State now to say, "Take it or leave it".

The Secretary of State must remove the other obstacle to settlement: the Prime Minister. In recent months, the dispute and pay claim have been turned by the Prime Minister into a test about wages policy for the whole of the public sector and the country. That is the ultimate logjam which the Secretary of State must have the courage to face up to. He must also have the courage to lose face—if that is how he sees it. I assure him, as other hon. Members have already, that he will gain much respect if he is prepared to reconsider his position, return to the Cabinet, persuade his colleagues to accept his views, bring the proposals back, sit round a table and hammer out a settlement in the short time available. In his heart, he knows that such a settlement can be reached.

The ambulance workers are a dedicated, hard-working and skilled group of people. They are committed to improving the service and hate the dispute as much as hon. Members do—in fact, they want a settlement even more than we do. There are two blockages to a settlement and I urge the Secretary of State to find the courage, dignity and statesmanship to remove them, sit down at the table and find a settlement.

9.22 pm

If I were to pick out one word from the speech of the hon. Member for Coventry, North-West (Mr. Robinson), it would be "settlement", which we all seek. The Government, ambulance men and the National Health Service all seek that elusive settlement. If I were to sing a duet with the hon. Member for Greenwich (Mrs. Barnes), who has levitated up the stairs a little, it would be to reflect on one of her last words —to call for an element of pendulum bargaining as a way forward for the dispute and the service. My right hon. and learned Friend the Secretary of State might reflect on that for the future.

I start, as many hon. Members have done, with a salute to the ambulance service and its personnel. I have always had a high regard for those who work in the ambulance service. If I needed reminding, I was given a reminder one morning just over a year ago when there was a train crash at Clapham junction in my constituency. I saw the ambulance workers at first hand and was there alongside them as they battled to save lives and did so, and then battled to remove the dead. Theirs was a fairly gruesome and awesome task that morning and underlined the sort of work that many ambulance men face day by day. That is why we have a great feeling for the ambulance men and it is right for that feeling to be reflected in speeches from both sides of the House.

During this sad dispute I have talked to ambulance men and women from my area. It is clear that they do not like being in dispute and want to find a way out. The paradox is that it was started by union action. The right hon. Member for Birmingham, Small Heath (Mr. Howell) referred to entering a dispute and finding a way out; I hope that that was in union members' minds when they entered the dispute. It is important to find a way out that is fair and affordable. Sadly, when in dispute, it is not always possible to find a way out that contains both factors. Therefore, we must look for that element of compromise to end this problem.

My message to the Health Service management is to keep looking for solutions and keep explaining in simple and clear terms what they are offering. It is clear from talking to my ambulance men that they do not always understand precisely what is on offer. When the offer was increased from 6·5 per cent. to between 9 and 16 per cent. over 18 months, they immediately took the figure on an annual basis and came up with a figure of 6 per cent. They thought that they were being offered an overall reduction. They did not understand that it was backdated to April and that pay in the pocket now is not a straight sum. The management of the NHS must get that message across.

The ambulance men and their union leaders must bear it in mind that perhaps the country and the Health Service cannot afford the solution that they seek. It is a fact that excessive—or perhaps I should say high—pay settlements can trigger inflationary spirals in the economy and could trigger a spiral in the Health Service. It is unrealistic to think that, while the ambulance service is within the Health Service, there will be no knock-on effect if the ambulance men receive a high pay reward. That may be sad, but it is a fact.

The effect of a high wage settlement in the Health Service now can be only a reduced service. A letter of 10 January from the chairman of the South West Thames regional health authority to London Members of Parliament said that 75 per cent. of NHS costs are pay-related. That means that high pay awards above the budget that has been prepared can result only in closures of beds and wards, postponed operations and delays in improving the Health Service. I beg the ambulance men and women to reflect on that when they seek a way out of the dispute. I hope that both sides will come together soon to find a solution. I hope that my right hon. and learned Friend the Secretary of State will play his part in looking ahead to the future. If the British people express one view, it is that they want such a dispute never to occur again.

We must consider the structure of the negotiation procedures. Discussions with my ambulance men and women lead me to believe that they would be willing to consider a no-strike agreement for the future in return for some sort of assured settlement. If they do not achieve parity with other emergency services, they will seek some structure linked to a no-strike agreement or possibly alternative ambulance services. I believe that that is the way forward. The people working in the ambulance service do not want the strike to continue. I hope that they and the management will come together to ensure that patients do not suffer from the dispute and that the ambulance men return to work to provide the service which we know that they provide so well.

9.27 pm

I shall take only a short time to support what my right hon. Friend the Member for Birmingham, Small Heath (Mr. Howell) said about the conduct of the dispute in the west midlands. I sincerely believe that the action of Sir James Ackers was reckless in the extreme. He put people's lives at risk by locking up ambulances and removing insurance cover and the road fund licence. He did so of his own accord without the authority of the regional health authority. He did that purely as an executive action. It was an example of Ramboesque management, simply to prove his credentials to the Secretary of State as a member of the executive health board. It is not on for public officials to conduct themselves in that way and then refuse to meet Members of Parliament to discuss what has happened. Our constituents' lives were at risk and we are as much entitled to put our case here as we are to put it to the Minister's officials in the west midlands. That is what a devolved health authority is all about. Sir James Ackers refused access until he knew about the debate today.

In the meantime, local authorities have taken action in the west midlands. The hon. Member for Wyre Forest (Mr. Coombs) talked about making the ambulance service local. It was perfectly OK when it was run by the local authorities. People got a decent 999 service from the local authorities before and that is the way forward, not a privatised local service.

Everybody knows that there has to be a solution, and the sooner it is found, the better for all concerned. There will have to be give and take and above all the solution will have to include a negotiating mechanism that will guarantee that this vital group of workers will never again have to take such action. The Government cannot escape their responsibility in achieving that.

9.30 pm

We are in the 18th week of a dispute of great seriousness, yet today the Secretary of State has told us nothing new, nothing positive, nothing to suggest that he has any clear idea of the way forward from here.

The Secretary of State's speech will fill the public with deep dismay. People are concerned that a vital emergency service has been suspended and that ambulance crews have been subjected by the Government to a campaign aimed at belittling and undermining them, and people are concerned about the huge sums of public money that the Government have squandered in their conduct of the dispute.

It is costing £23,000 every day for the police to provide cover in the west midlands; £26,000 every day for police cover in south Yorkshire; £10,000 every day for police cover in west Yorkshire; and £60,000 every day for police cover in London. The bill for that and for other police and Army work will be sent to hard-pressed district health authorities that are already closing beds and wards in an attempt to meet their budget deadline by the end of the year without going into deficit.

The money spent on continuing the dispute would easily have met the ambulance men's pay claim in full. The Secretary of State uses public money to prolong the dispute, but says that he cannot use public money to do what the public really want, and that is to settle the dispute.

The reason why there is a dispute at all is that the Government offered ambulance crews a wage increase below the level of inflation—in effect, a wage cut. That would have been unwelcome to any group of workers, but it is particularly unwelcome to ambulance workers, who have seen a comparative decline in their pay over recent years.

In 1986 ambulance crews' earnings were 6 per cent. below average male earnings. That gap has now widened, so that their earnings are 16 per cent. below. In 1986 ambulance crews had parity of earnings with fire fighters. Now they have fallen behind by £60 a week. Ambulance workers' pay is now so low that many have to claim housing benefit and family credit to make ends meet. Yet it is that group of public employees who have been asked to see their standard of living cut.

It is not that a decent pay award to the ambulance crews would set some sort of dangerous precedent, as the Secretary of State would have us believe. Other groups of public workers have won increases above the rate of inflation. For example, the police have won more than 9 per cent., fire fighters 8·8 per cent. and, as has been mentioned, senior civil servants and Members of Parliament nearly 11 per cent. Now the newspapers are full of stories that the Secretary of State's front man in this sorry affair, the NHS chief executive, Duncan Nichol, is about to receive a pay rise that is worth more than 50 per cent. of what an ambulance worker earns in an entire year.

Has my hon. Friend noticed the newspaper coverage of the fact that Conservative councillors in some areas have supported the ambulance workers? Has she heard today of the strange events in Stirling, where Mr. Alan Hogarth, personal assistant to the Parliamentary Under-Secretary of State for Scotland, the hon. Member for Stirling (Mr. Forsyth), and Mr. Peter Finnie, the Conservative party agent in that area, were caught red-handed secretly tape recording the district council's discussions on the dispute?