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Mr. Simon Hughes (Southwark, North and Bermondsey): The Secretary of State referred to patients being discharged into the community and to the welcome review that he has initiated into the number of beds in the NHS. Given those points and the concerns over beds in London, can he tell us whether he has reached any conclusions about the number of beds we need, not in our acute hospitals, but in the community, for respite, recuperation and discharge? If not, when may we have such an assessment? That is one of the pressures of which we are all aware; there must be non-intensive care facilities for people who are nearly ready, but not quite ready, to return to their homes.

Mr. Dobson: Some of the national work has been completed. The London office is now working on the detail of what is needed in particular localities in London. That stretches from intensive care at one end to ensuring that people can sleep happily in their own beds at the other--with various intermediate stages. I hope that we shall be able to make some announcements on that matter before the summer. Some action is already being taken: additional intensive care beds are being provided and, in some places, more is being put into providing reception wards behind the accident and emergency departments, so that such care is better conducted. I hope that we shall have some detailed intentions to announce before the summer.

In the meantime, the NHS in London has been delivering treatment and care to Londoners as never before. Last year, London hospitals treated record numbers of patients. Record numbers of people came off the waiting list, record numbers of emergencies were dealt with and record numbers of out-patients were treated. London's hospitals have made a huge contribution to the record national fall in waiting lists. The final figures are not yet available, but figures for the end of February show that the London total of people waiting for in-patient

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treatment was well below the number that we inherited when we came to power in May 1997, and that the total waiting list had fallen by 37,000 since March 1998. I can safely predict that the next set of figures will show a further drop of several thousand, for which the people involved are to be commended.

Those are not the only changes that we have made to health care in London to make it more modern and dependable. NHS Direct, the 24-hour nurse-led helpline, now covers 1.4 million people in west London and 700,000 million in south-east London, giving Londoners their first access to that most popular and successful service. In west London, the service is being organised, not by the ambulance service, as is usual, but by the Harmoni GP co-operative. At the co-operative's instigation, NHS Direct in west London is already being extended to provide access to GP out-of-hours services, mental health services and social services. NHS Direct will be extended to cover a further 1.9 million people in London by December of this year, and it will cover the whole capital next year.

London can look forward to other services that are currently being tested in other parts of the country, such as NHS Direct not only taking calls, but making them, which is a positive development. Already in West Yorkshire, during troughs in the flow of incoming calls, nurses ring patients to remind them of appointments with their doctors or for screening services; and in the west midlands the service is about to proceed with an arrangement whereby people who have been discharged from hospital are telephoned by NHS Direct to check their progress. The development of NHS Direct will enable dramatic improvements to be achieved in the general standard of health care in this country, especially because, in every part of the country, that development is taking place in co-operation with existing clinicians, doctors, nurses and others.

As everyone knows, one of the major problems besetting health care in the capital has been staff shortages, especially of nurses. The previous Government used to deny that there was a shortage of nurses, but, unlike them, we have not buried our head in the sand. Our efforts to improve nurse recruitment received a special boost in this year's pay awards: the London allowance was increased by 15.4 per cent. That, combined with the national awards, means that a newly qualified nurse in London now starts work on a salary of £17,325, and that two thirds of all nurses in London will be paid more than £20,000 a year.

When the new pay award was announced, we launched a major advertising campaign to recruit nurses and get former nurses to return. I can report that up to now--or rather, up to yesterday; there were probably more calls today--6,046 calls have been made in London in response to the advertising campaign; 840 came from nurses wanting to return to work in the NHS, and 91 such nurses have already returned. They are being further encouraged by the provision of free return-to-nursing courses. Those have proved to be a popular success, as I learned when I visited the Mayday hospital, Croydon to welcome a dozen nurses back to the NHS. They had been on a short three-week course to bring them up to date, which was geared to meet their family needs, such as by not clashing with school drop-off or pick-up times. Nearly everyone who had been on that short course had returned to nursing.

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Of course, the Mayday has become more attractive by its having benefited from the recent opening of a new accident and emergency unit.

Many students of nursing and young nurses require good-quality secure accommodation that is near their place of work. Regrettably, much of that accommodation was sold off under the previous Government and a lot of what remains is in a deplorable condition. I am having talks with the hospital authorities concerned and the Housing Corporation in an attempt to turn back the tide and provide somewhere decent, affordable and convenient for nurses to live, because a modern work force need somewhere safe and decent to live.

Mr. Simon Hughes: I agree with the Secretary of State's last point. On the nurses' pay issue, I have learned in the past few weeks that, although the pay award was very welcome, many nurses were frustrated to discover that they had not received the increase in their April pay packets. I do not want to be over-critical at this stage, but can the Secretary of State address the problem whereby pay awards announced with great flourish in January and February do not come through before September? That is a disgraceful situation, and many nurses feel badly let down.

Mr. Dobson: Most nurses have received their pay increases and, as far as I know, no one will be kept waiting until September. If anyone is kept waiting that long, the chief executives of the trusts concerned should receive their P45s and insurance cards in September. Like every other hon. Member, I believe that it is quite unacceptable to keep people hanging around in that way.

Mr. Alan Duncan (Rutland and Melton): The right hon. Gentleman always wants to sack people.

Mr. Dobson: If the people in charge of large organisations that depend on many loyal staff cannot sort out their pay systems for five, six or seven months, I think it is wholly appropriate to contemplate doing without their incompetent services.

Mr. Duncan: I also said that the Secretary of State should give the trusts the money to pay for the awards in full. According to many trusts, the money that they have received does not cover the awards that were announced in the House.

Mr. Dobson: Those chief executives should be more careful about what they say because virtually the whole of the increase was met--

Mr. Duncan: Virtually.

Mr. Dobson: Yes, virtually. I try to tell the truth in the House and I am rather careful about what I say. Virtually all the increase was met from the allocations that the trusts had already received and knew about. The additional sums were found, as we intended, from the modernisation fund. Very few trusts have had to find much money. That is in marked contrast with the previous Government's total refusal to fund any pay increases in some cases. The previous Government provided no additional resources in some years to meet trusts' pay obligations.

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Now that the pressure for internal competition is out of the way, a group of 35 inner-London trusts have done the sensible thing and have got together to promote better recruitment arrangements and to make working in London more attractive. They intend that work to cover not just nurses and midwives, but pharmacists and other groups as well.

At my instigation, trusts are now pursuing rigorous anti-violence policies: logging incidents, liaising with police, changing working practices, issuing staff with personal alarms, installing closed circuit television and changing the layout of buildings. I am told by those concerned that the new policy has already brought benefits in the modernised A and E departments at the King's College and Mayday hospitals. Our commitment to renew and modernise all A and E departments will deliver similar improvements in every part of the capital.

London is a multicultural city and the ethnic origins of a quarter of its population are black or Asian. Some ethnic groups have special needs and London's NHS must cater better for those needs, which include tackling heart disease in the Asian population, stroke prevention in the Caribbean population, and the take-up of breast and cervical screening among Asian women.

Many people from ethnic minorities have also felt excluded from the decision-making processes of the NHS. At the general election, we promised to make NHS boards more representative of the communities that they serve. Since we came to office, 53 per cent. of our appointments in London have been women and 24 per cent. have come from an ethnic minority background. The previous Government had a target that every health authority or trust with an ethnic minority population of 10 per cent. or more should comprise board members from an ethnic minority. That was all very well as a target, but they did not get around to achieving it.

Sixteen trusts and health authorities in London serving areas with more than 10 per cent. ethnic minority populations did not meet that target before the general election. Now all but three of them do. In total, 46 NHS boards in London have one ethnic minority member; 17 boards have two such members; and three boards have three. [Interruption.] I did not catch what the right hon. Member for Kensington and Chelsea (Mr. Clark) said.

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