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Trainee Doctors
4. Mrs. Linda Gilroy (Plymouth, Sutton): What plans he has to increase the number of medical doctors in training. [67162]
The Minister of State, Department of Health (Mr. John Denham): The Government are currently implementing their recent decision to increase the number of undergraduate medical education places by about 20 per cent.--that is about 1,000 extra places--over the next few years. Numbers in postgraduate medical training are also growing to meet future requirements for general practitioners and consultants.
Mrs. Gilroy: I thank my hon. Friend for that reply. In inviting bids for that work, will he welcome and encourage new and innovative practices that complement other measures for developing a national health service for the 21st century? I have in mind the bid from the Exeter, Plymouth and Open universities, which, in addition to having a strong community focus, will seek to develop training through telematics and information technologies which will be the stuff of communication for doctors in the next century.
Mr. Denham: I am aware of my hon. Friend's support for that proposal and sure that she will continue to champion it enthusiastically, but it would be wrong of me to comment on any individual proposals. Proposals for new medical schools will be considered alongside proposals from existing providers by the joint implementation group, which is now implementing the increase in medical school places in England. The group will judge those proposals against the objectives that are set, including value for money.
Mrs. Marion Roe (Broxbourne): Will the Minister confirm that his plans for more doctors include the number of qualified medical students who were due to enter the system anyway?
Mr. Denham: The position is that there will be 1,000 medical school places in addition to the number that we inherited on entering office in 1997.
Mr. Roger Casale (Wimbledon): May I take the opportunity to bring to my hon. Friend's attention the existence of Wimbledon Civic Forum's health forum, which brings together local executives from the health sector and local residents to discuss the future shape of health services in our community? Will he acknowledge that such forums and community health councils have a valuable role to play in promoting transparency and
accountability in the new national health service, and will he undertake to review the future role of such forums and CHCs as important partners in the new NHS?
Mr. Denham: I am very interested in what my hon. Friend tells me: I am not familiar with that forum, but perhaps I shall have an opportunity to become acquainted with it in the not-too-distant future. One of the hallmarks of the new NHS is the way in which we are encouraging wider public involvement and consultation, for example, in the development of health improvement programmes, and co-operation between different parts of the NHS. That helps to overcome the fragmentation and competition that were so characteristic of the health service as it was left by the previous Administration.
Madam Speaker: Order. I remind hon. Members that the question is on the training of doctors.
Dr. Evan Harris (Oxford, West and Abingdon): Yes, thank you, Madam Speaker.
In seven years' time, when the last of the new medical students enter medical school, they will be able to look forward to receiving, five or six years later, a basic salary of £16,710. Will the Minister take this opportunity to correct the information contained in the press release issued yesterday, which stated that a junior doctor or house officer would have a basic salary of £26,405? Junior doctors cannot understand why they are expected to do three years in a one-year pre-registration post, or why the Government consider 32 hours of compulsory overtime at half rate to be included in the basic salary. If that is correct, what are the Government's plans to increase the hours over that basic number?
Mr. Denham:
Yesterday, we implemented in full the recommendations of the pay review body for doctors, which was the right thing for us to do. We are continuing to make progress on the matter of junior doctors' hours: we have increased the funding to the task forces that deal with that problem; and, although I accept that this is not the thrust of the hon. Gentleman's question, we have made it clear that some of the conditions in which junior doctors are required to work--for example, their access to rest and canteen facilities out of hours--should be improved.
Mr. Bob Blizzard (Waveney):
Does my hon. Friend know how many of the new doctors will receive training in the specialised treatment of cancer? The reason I ask that question is the huge amount of unsolicited tobacco advertising that still pours through people's letterboxes. My constituents are delighted that, in the White Paper, the Government proposed to ban such advertising, but can my hon. Friend tell me when that ban will come into effect, as it may have some bearing on the number of cancer specialists who need to be trained?
Mr. Denham:
My hon. Friend raises a number of important issues in his question. We set out our proposals for action to reduce smoking and dependence on tobacco in last year's White Paper, and we are moving ahead on the implementation of those measures. In addition to the need for basic undergraduate training, there is the need to continue postgraduate specialist medical training, for we
Nurses
5. Mr. Andrew George (St. Ives): What assessment he has made of the costs to nurses of on-going and re-entry training requirements. [67163]
The Secretary of State for Health (Mr. Frank Dobson): This Government are committed to encouraging the training of nurses. In this year alone, £72 million will be invested in post-registration training of non-medical staff. As part of our effort to encourage former nurses to return to the NHS, we are investing £4 million this year in local return-to-practice initiatives and free return-to-practice courses. We are also making available £36 million over this year and the next three years to help enrolled nurses to upgrade their qualifications. Ward assistants and other NHS staff can now train to be qualified nurses while retaining their existing pay for the duration of the course.
Mr. George: I am grateful to the Secretary of State for that helpful reply. What advice can he offer my constituent, Rachel Blight, who broke her nursing career after 14 years for the sake of her family and now wants to return to nursing? She has recently paid £350 for her re-entry training, which involves going 35 miles to the local training centre for three weeks of study and two weeks of practical work. If we want to--
Madam Speaker: Order. This is perfect material for an Adjournment debate. Will the hon. Gentleman get to his question now?
Mr. George: Thank you, Madam Speaker. We want to encourage nurses to return to their careers, but do not such conditions represent an obstacle to them?
Mr. Dobson: Certainly, charging people for such courses is an obstacle, which I why I announced last year that the courses would be free. I shall look into why they are not free in the hon. Gentleman's constituency.
Following the pay announcement yesterday and the advertisement campaign that we have started, 2,874 people had telephoned the helpline by 2 o'clock today for further information about returning to nursing. I shall try to give the House an update later.
Dr. Brian Iddon (Bolton, South-East):
On regional television a few days ago, a nurse from the Royal Bolton hospital made the comment--with which I agree--that there is a pool of young people and others who want to enter nursing but are put off by what they see as the high academic qualifications required to enter the profession. Has my right hon. Friend taken that into consideration?
Mr. Dobson:
Many people perceive the present courses as too academic for their liking. We are trying to change the situation to make it easier for people to enter nurse training in various ways. The changes in the past few years certainly put off a substantial number of young people who might well have gone into nursing.
Mr. Tim Collins (Westmorland and Lonsdale):
I welcome any and every means to increase the number of
Mr. Dobson:
All I can say to the hon. Gentleman is that his Government promised that no one would ever have to wait for more than 18 months for in-patient treatment; they did not keep that promise for a single month, but we have kept their promise since April.
6. Ms Sally Keeble (Northampton, North):
What steps he is taking to increase the number of nursing trainees. [67164]
The Secretary of State for Health (Mr. Frank Dobson):
Between 1992 and 1994, the Tory Government reduced the number of nurse student training places from 15,000 to 11,000. The figure never rose much above 13,000 in subsequent Tory years. In January 1997, they announced their plans for an additional 1,300 nurse training places in 1997-98. We managed to add 1,400 nurse training places in that year, despite taking over after the start of the financial year.
For this year, we have increased the number of new nurse training places to 15,000 again--the highest figure for six years. If the Tories had not reduced nurse training in their last five years in office, there could now be an extra 11,000 nurses available to work on the wards.
Ms Keeble:
I thank my right hon. Friend for that answer. Is he aware of the centre for health care education at University college, Northampton in my constituency, which has had a share of the increase, successfully filling 60 extra nursing places over the past year and planning an extra 100 over the next three years? It filled all those places by careful local recruitment and close partnership. Will he join me in paying tribute to University college, Northampton for successfully attracting more people to fill the extra places that the Government have created?
Mr. Dobson:
I would certainly like to congratulate everybody involved in the increase. We have increased the number not only of training places but of applicants per 100 places--from 106 to 120 since we took office.
Mr. Simon Hughes (Southwark, North and Bermondsey):
Why did the Government almost entirely undermine yesterday's welcome announcement, on increasing nursing recruitment by awarding some trainee nurses a pay increase of 11.8 per cent. and junior nurses a decent pay rise, and by not staging the awards, by announcing a pay increase of 4.7 per cent. for two out of three nurses--200,000, or all the rest? When they receive their rise in April, they will be less well off in real terms than four years ago. The Chancellor has £5 billion in the contingency fund. Could that not have been used to pay all nurses a decent increase?
Mr. Dobson:
I do not know whether that would be another charge on the famous Liberal penny. The hon.
In negotiations with nursing representatives, I intend to try to make nursing more attractive to experienced nurses, who will be receiving a 4.7 per cent. increase--well above the rate of inflation--together with increments, in most cases, taking their pay increase for next year up to about 7 per cent. Nevertheless, they need to be encouraged. We want to change the grading system, which at present obstructs their career development and holds down their pay.
Mr. Dennis Skinner (Bolsover):
My right hon. Friend probably agrees with me that we will never satisfy the Liberals, who said in their manifesto that they wanted an extra £700 million for the health service in this financial year and the next one. In reality, £7 billion is going in as a result of the statement the other month. Does my right hon. Friend agree that, in order to ensure that we get enough nurses and other hospital staff, the pay rise needs not only to be adequate but repeated next year? Perhaps he will consider the point that, 20-odd years ago, we found a way of putting the pay of firefighters into the upper quartile. With rare exceptions, the problem was solved.
Mr. Dobson:
As my hon. Friend knows, I am very careful about making individual promises on behalf of the Government. The pay settlement and the changes that we want to make in the career structure of nurses over this coming year are intended to start solving the problems of nurse shortages and the way in which the previous Government ran the health service, which resulted in most nurses feeling as if they had been run off their feet and unable to give patients the attention worthy of their professional standards. We cannot put it all right in one go; this is a start.
Miss Ann Widdecombe (Maidstone and The Weald):
May I draw the right hon. Gentleman's attention to one effect of yesterday's announcement and ask him how he intends to ease it? The pay rise granted to nurses, especially new nurses, will have to be met not only by the NHS but by the hospice movement and the voluntary sector, which depend on grants. Is it his intention that those grants should be enhanced, to ensure that the hospice movement and similar concerns are able to afford to pay for good and adequate nursing care?
Mr. Dobson:
One way or another, the hospice movement gets substantial grants from the Government. We want to encourage the hospice movement, and when it submits its applications, they will be carefully considered. The right hon. Lady would not expect me to be able to go any further today on that individual item.
Ms Julia Drown (South Swindon):
Will my right hon. Friend confirm that paying 12 per cent. to newly qualified nurses will be one way of attracting new trainees into the profession? Will he outline to the House some of the other initiatives that the Government are taking to attract more
Mr. Dobson:
Since we came into office we have been encouraging NHS management to introduce family- friendly policies, not just for nursing, but for the entire staff of the NHS, so that they can do their jobs as well as discharging their responsibilities to their families--for example, by offering staff shifts that enable them to take children to school in the morning and bring them back in the evening.
One of the problems is that, in many places, the shortage of nurses is so acute that it is difficult to provide flexible hours because there are not enough staff to go round. That is why we have launched the £5 million advertising campaign on the back of yesterday's pay announcements, in an effort to break out of the cycle of decline that the health service faces. We also want to change the grading system, as I said.
One of the things that I am frequently told by nurses as I go round hospitals and community services is that they get sick to death of equipment breaking down and going on the blink, which is upsetting for patients and disturbing for nurses. [Interruption.] That is why--if the right hon. Member for Maidstone and The Weald (Miss Widdecombe) would keep her mouth shut and her ears open--I have told the management of the NHS to give top priority, in small capital schemes, to replacing equipment that is constantly failing and letting down both staff and patients.
7. Mr. Philip Hammond (Runnymede and Weybridge):
What progress he has made in implementing the proposal to create supernurses. [67165]
The Secretary of State for Health (Mr. Frank Dobson):
Many talented nurses and midwives want to keep on treating patients and training their less experienced colleagues. Up to now, highly skilled nurses who reached the top of their professional grades could better themselves in the national health service only by going into management, so their hands-on skills are lost to patients and colleagues. In future, they will be able to apply to become consultant nurses, instead. We have been discussing the details of that with representatives of the professions, and our plans will be set out as part of our new strategy for nursing.
Mr. Hammond:
The fact is that, since the plan for supernurses was announced with a great fanfare last September, not a single one has been appointed. Indeed, the right hon. Gentleman's Department has instructed trusts not to appoint them. Yesterday, the Government announced a pay rise of 4.7 per cent. for the most senior nurses. I shall not ask the right hon. Gentleman whether that is fair or affordable, but will he tell the House whether he believes that it is sufficient to stem the haemorrhage of skilled and experienced senior nurses from the NHS?
Mr. Dobson:
I sincerely hope that it is. As the hon. Gentleman would know if he had read the details--and if he has not read the details, let me tell him for the first time--a number of discretionary increments are added for people who are at the top of the more senior scales, which make it possible for their pay to go up by more than 4.7 per cent.
With regard to the proposals for consultant nurses, we made it clear that we would introduce them after we had had thoroughgoing discussions with the representatives of the professions, so that we did not create trouble by establishing them. Those talks are still going on. [Interruption.] I can tell the right hon. Lady that doctors, nurses and midwives welcome being consulted about such matters, and not having measures imposed on them, as the previous Government did.
Ms Harriet Harman (Camberwell and Peckham):
I congratulate my right hon. Friend on his forthright recognition that one of the ways to keep senior and experienced nurses in the health service is to recognise that most of them have family responsibilities for young children or elderly relatives and that, as well as invaluable work in the NHS, they also do invaluable work at home. I draw to his attention the industrial tribunal case of Hale v. Wiltshire Health Care NHS trust in which the trust was found guilty of discriminating by changing nurses' work patterns in such a way that they were prevented from taking their children to school. Will he ensure that all NHS managers implement his family-friendly policies?
Rev. Martin Smyth (Belfast, South):
Although I welcome the attempts to improve the standard of pay and other matters, such as training for nurses, does the Secretary of State agree that the average patient speaks of a supernurse as one who gives tender nursing care? Is he aware that there is some concern that, with the professionalisation of the nursing profession, some nurses are so busy that they cannot spend the time with patients that patients require?
Mr. Dobson:
I have already said that many nurses find that they are run off their feet and feel that they cannot give individual patients the attention that they deserve. We want to deal with that, in part by increasing the number of nurses available so that there is a bit more time for patients. We must recognise that everyone still expects nurses to provide tender loving care for the individual patient, while, at the same time, nursing is becoming infinitely more demanding and complex, as new and incredibly complicated pieces of equipment come on to the wards and pharmaceutical products become more complex. It is very difficult for an individual nurse to reconcile those needs and it is vital that we have more nurses to enable them to do so.
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