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10.29 am

Mr. Harry Cohen (Leyton and Wanstead): I congratulate the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) on securing the debate. I thank the hon. Member for Southend, West (Mr. Amess) for his concern for my career. I am not too worried about that. My career suffered long ago because I speak my mind. I propose to do the same in this debate. His difficulty was

13 Jan 1999 : Column 235

his failure to speak his mind when the Conservatives were in power. He is still trying to draw a veil over their poor record on the NHS.

I am proud to be a vice-chairman of the Royal College of Midwives. Our midwives do a magnificent job and provide an outstanding service--perhaps the best in the world. They save many lives and I should like, as well as their wonderful service here, their skills to be exported worldwide. They provide terrific value for money, caring for two for the price of one. In more senses than one, that should be regarded as new labour.

Midwives should not be taken for granted as they are. In recent years, they have suffered a serious deterioration in pay and working conditions. The pay of midwives, nurses and health visitors has slipped behind that of comparable professions since the 1980s. As I pointed out to my right hon. Friend the Secretary of State on Monday, their pay has slipped over the past decade from 85 to 76 per cent. of average earnings.

There are two reasons why midwives' pay has not kept pace with other public sector pay. The first is the local pay arrangements set up by the previous Government. The trusts simply did not pay. They were prepared to pay for more managers and to become more business-oriented, but they ignored their staff and did not pay extra to nurses and midwives. The second factor is the "Changing Childbirth" report, with which I agree. It dealt with important issues that we must come back to. Greater flexibility and choice and more midwifery support are important. "Changing Childbirth" gave midwives more responsibility, but, instead of being paid more for it, many of them were paid less. They were cheated and did not even receive the minimum F grade that they were supposed to get. Some trusts paid the minimum F grade by lowering staff from G grade. That has resulted in shortages so serious that the Audit Commission questioned in its 1997 report whether there were enough midwives nationally to

The number of midwives registered with the United Kingdom Central Council has fallen by 2,500 over the past five years to the lowest figure this decade. Some 60 per cent. of qualified midwives are not practising and there is a 21 per cent. turnover rate of nurses and midwives according to the Nursing Times this month. That shows the extent of the shortages. Only one midwife in 10 is under 30. That shows the failure to recruit to midwifery. Up to 25 per cent. of midwives could retire in the next five to 10 years. That shows how serious the crisis is. Nearly 50 per cent. of midwives work part time--an increase of 13 per cent. over the past 10 years. I agree that more flexibility is needed in the service, but there is clearly a shortage.

I see that the Whip wants me to wind up within three minutes, so I shall keep my remarks brief. The shortages are serious. The increased pressures that they put on midwives have led to problems of stress in the workplace and an increase in staff sickness. Many are not staying in the profession because of that.

I agree with my hon. Friend the Member for Bolsover (Mr. Skinner) that this is a defining moment for the Government. The NHS is vital to our society. It is much loved by the people and it is vital electorally. Getting it

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right means putting all the pieces of the jigsaw in place. The Government have made a good start by putting in more cash--three times more than the Liberal Democrats asked for in their manifesto.

Mr. David Rendel (Newbury) rose--

Mr. Cohen: I am sorry, but I do not have the time.

Getting rid of the internal market and the business approach are good steps, but there are three other pieces of the jigsaw to be filled in: more beds, because they were cut too much; more training for nurses, midwives and doctors; and more pay. Proper pay is essential to attract and retain people. I repeat the call that I made earlier this week. We need a substantial pay rise above inflation for nurses and midwives.

10.35 am

Dr. Evan Harris (Oxford, West and Abingdon): I shall concentrate on the pay award for nurses and midwives, because that is what people will be expecting to hear about. Failing to invest in decent pay for nurses is a huge false economy. The issue is not whether the pay rise is affordable, but whether not giving a decent and fair pay rise is affordable. People do not understand why that cannot be done.

The hon. Member for Wolverhampton, North-East (Mr. Purchase) talked about the loss of beds. He gave the impression that they were lost because people went around with screwdrivers dismantling them. They were lost because nurses were lost. The hardware is there, but the nurses to staff the beds are lacking. We shall not be able to increase the number of beds available in the NHS unless we bring nurses back. The beds crisis in the NHS that the Secretary of State speaks of is caused by a nursing staff crisis. We have to make the necessary investment.

It will not be acceptable for the Government to pull a stunt when the pay award is announced. Increasing pay for the lowest-paid nurses may be welcome, but it will not be enough. It will be a cheap option, because increasing the pay of the cheapest is not the same as dealing with the middle-ranking nurses, who are leaving in large numbers. Implementing the pay award in full will not be enough without some atonement for the staging of the pay award this year.

When the Conservatives staged the pay award in January 1997, the then shadow Chief Secretary to the Treasury, the right hon. Member for Oxford, East (Mr. Smith)--the hon. Member for Southend, West (Mr. Amess) should be aware that I am the hon. Member for Oxford, West and Abingdon--roundly condemned the decision, saying that it was the price of economic failure. A year later, a Labour Government did the same. The gap between expectations and delivery demoralised nurses. Not only should the Government not stage this year's award--I do not think that they would dare--but they should return to each nurse the £250 that they lost because of the staging in 1997 and 1998 and call it a "debt of atonement". We have still not heard an apology from the Government to the nurses and to the patients who have suffered from the lack of nurses. Cash will mean more than just an apology.

The hon. Members for Bolsover (Mr. Skinner) and for Leyton and Wanstead (Mr. Cohen) repeated like a broken record the arguments about the Government's generosity

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in funding the NHS. There has been no such generosity over the past two years, which, added to the previous 18 years, have brought the NHS to its current state. Library figures, which the Government have never challenged, show that the Government's real-terms increase in funding for the NHS in England in 1997-98 and 1998-99 is around 2.4 per cent. per year, compared with the Conservative record over 18 years of 3.1 per cent.--a level of funding that brought the NHS to its knees. Even the generous increases to come in the next three years will produce a real-terms increase in funding over this Parliament of only 3.7 per cent. That extra 0.6 per cent. compared to the Tory record does not make the difference between saving the NHS and failing to do so. My local health service has told me that, next year, in the first year after the comprehensive spending review, it will have discretionary spending of only 1 per cent. in real terms with which to give nurses a decent pay awardabove inflation. The Government should give serious consideration to providing extra revenue from the forecast Treasury surplus to allow health authorities to fund a fair pay award for nurses and retain some extra funding for growth in services, particularly mental health services.

I conclude by urging the Government not only to be fair, but to recognise the wrongs that have been done both during their period in office and the Conservative party's period in office. They must recognise that we shall not have a decent health service unless we are prepared to pay for it. As my hon. Friend the Member for Southwark, North and Bermondsey said, we must start the debate about how we are to raise the percentage of gross domestic product that we spend on the health service so that the service can meet the expectations of patients, users, relatives and carers in this country.

The Government must take urgent measures not only on pay but on the whole approach taken to nurses and midwives to ensure that the NHS is not stopped from developing by a short-sighted false economy and a shortage of the professionals upon whose hard work and dedication patients and those responsible for the running of the NHS all depend.

10.40 am

Mr. Lindsay Hoyle (Chorley): I congratulate the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) on ensuring that we have a chance to debate the staff of the NHS. I believe firmly that the Government were elected on pledges, and the backbone of our pledges was on the NHS. That is crucial, and we must never lose sight of that. In fairness to the Government, everyone should support and welcome the £21 billion that has gone towards saving the NHS. The NHS has been neglected over 18 years. It was not at the forefront of the previous Government's thinking, and their support for the NHS dropped year on year. We have seen a revival of the NHS, and we can all be proud of that £21 billion.

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