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7.49 pm

The Secretary of State for Health (Mr. Frank Dobson): I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:

The speech we have just heard, and this whole debate initiated by the Tories, is one of the biggest exercises in barefaced cheek that has been seen even in this Chamber. It does, however, provide us with an opportunity to remind people of the state of the national health service that we inherited, and the action we have been taking to put things right.

The Tories left behind them a health service underfunded, understaffed and undermined, with a demoralised and undervalued work force. They had introduced an internal market, which set doctor against doctor and hospital against hospital, and led to a huge increase in bureaucracy and paperwork. For many staff, that internal market, together with the two-tier system that the Tories introduced, betrayed the principles that had led them to join the NHS and was contrary to their professional ethics.

For three years running, the Tory Government failed to implement pay review body settlements nationally and in full. Tory Ministers had encouraged a situation in which many staff were routinely faced with short-term contracts, causing uncertainty for them and their families. Until they were forced by the courts, the Tory Government had denied employment rights to NHS staff transferred to outside contractors. Gagging clauses had become standard parts of staff contracts. Some NHS trusts had withdrawn union recognition. The Tory Government had stopped collecting data on NHS pay levels, so Ministers had no idea how many staff were on low pay. Institutionalised

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racism held back the careers of many black and Asian staff. No attention was paid to the growing incidence of assaults and abuse of people working in the health service.

Many staff were expected to work in run down and sometimes dangerous premises. In April 1997, 16 per cent. of hospitals and other NHS buildings did not comply with fire and other regulations. By 1 May this year, that figure had been reduced to 5 per cent. Staff were frustrated by having to rely on increasingly unreliable equipment. The work force planning system was woefully inadequate, as we now know from the problems with obstetricians and gynaecologists.

Most people working in the NHS were dissatisfied with a rigid pay system that inhibited career development. Rigid hours and working conditions were putting off ever more professionally trained staff, particularly those with family responsibilities. As a result there were shortages of nurses, midwives, therapists, pharmacists, laboratory staff, cyto screeners and in some specialties, doctors. The previous Government had done next to nothing about the problems that were building up. Year after year in speeches in the House and in evidence to the pay review body they denied that there were shortages of nurses, midwives or other staff.

The Tory Government were not just in denial, they were busy making matters worse. They cut the number of nurses in training. Some 15,000 nurses started training in 1992-93. By 1994-95 that figure had been reduced to 10,600 and it never again rose much above 13,000. If the Tories had not cut the number of nurses in training in the 1990s, no fewer than 14,000 more nurses would be available for the NHS today.

Since the election we have made a start on turning things round, but it is only a start. Things cannot be put right overnight. It takes three years to train a qualified nurse and six to train a doctor for registration. The average hospital doctor takes a further seven to eight years before becoming a consultant. We must take long-term action to make things better for the future and take whatever short-term action is available to us to deal with the situation left behind by the previous Government.

Let me start with the nurses. Unlike the Tories, we do not deny that there is a shortage of nurses. Unlike the Tories, we are doing something about it. This year, for the first time in five years, the Government implemented the findings of the independent pay review body nationally, in full, without staging. In their motion, the Opposition have the brass neck to criticise us for the fact that not all staff received the full pay award in their April pay packets. That is a bit rich coming from the people who, in their last three years in government, did not put the full amount into staff pay packets at all and did not put even the staged increase in until shortly before Christmas.

Paying the full amount nationally in one go has put a one-off strain on NHS finances this year because we are meeting the full cost of this year's settlement and the overhang from staging last year's settlement. All nurses got at least 4.7 per cent. Newly qualified nurses got 12 per cent. and 70,000 D grade nurses got 8.2 per cent. On top of that, for Greater London, which is the area with the greatest shortages, the London allowance was raised by 15.4 per cent.

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Those increases mean that two out of three nurses will earn more than £20,000 this year and that a newly qualified nurse will get more than £14,000--more than £17,000 in inner London. Virtually all those increases have either been paid in April salaries, or will be paid in May salaries next week backdated to 1 April. There is nothing new in that. It is entirely in line with usual practice in the NHS, following acceptance of the pay review body recommendations by representatives of the staff in the middle of March. Most employers have either already paid the increase, or have programmed their payroll computers to pay it with May salaries. I know of just one trust--Addenbrooke's--that is due to pay out in June. That, the trust explains, is because it is negotiating a local settlement to top up the national award.

Like the representatives of the staff, we want to develop a new pay structure that removes the rigid grading ceilings that hold down the pay and hold back the careers of nurses and midwives. We are extending the role of nurses in line with what the profession wants. We shall introduce nurse consultants to enable highly qualified staff to continue nursing and teaching rather than going into management. The final decision on that has not yet been announced because we have been conducting highly detailed discussions with the profession about the best way to go about it. We have also found places for nurses on the boards of primary care groups. That is important for their professional development and they are making a great contribution and improving their management skills. Together with the professions, we are also addressing the many shortcomings of the system of nurse education and training introduced by the previous Government, which are widely acknowledged to have set back the national health service.

Mr. Simon Hughes (Southwark, North and Bermondsey): I should like to take the Secretary of State back to the payment of the new pay award. He made his announcement on 1 February. The agreement with the unions and staff was made in the middle of March. Why did the letter of authority not come out from the Department of Health until 8 April? That is given as the major reason why the trusts were unable to deliver the hugely heralded pay settlement in the April pay packets as everyone expected. Was it not important that people should be paid on time?

Mr. Dobson: It is important that people should be paid on time. I have received no complaints from the Royal College of Nursing or any other body representing nurses about any delay, because the payments were authorised at about the same time as in previous years. It is no good the hon. Gentleman shaking his head--unless he has something wrong with him--because that is a fact.

Following the pay announcement in February, we launched a major recruitment campaign. To date about 53,000 people have responded. More than 5,000 of them are qualified nurses who want to return to the NHS--and we expect them to do so--and 650 have already started work. Many of those nurses have taken advantage of the return to nursing courses which, under this Government, are being provided free by the NHS. All those measures will help to address the short-term problem. The response to the recruitment campaign shows that nursing is becoming more attractive, but there is a long way to go.

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We are introducing more family-friendly employment policies, the better to allow people working in the NHS to reconcile the demands of their jobs with their modern family responsibilities. We are giving people better opportunities to work the shifts that suit their needs, allowing them to take children to school in the morning or pick them up in the evening or to be around more during school holidays. That approach does not apply just to nurses and midwives. We want it to apply across the board. We must apply it to the people who are traditionally called junior doctors, particularly now that so many more medical students and junior doctors are women.

For a woman, the years taken up as a medical student and a junior doctor coincide with what we usually regard as childbearing years. We need a system that makes it easier for a woman doctor to have a career and, if she chooses, to have babies and bring up children. Of course, these days, quite rightly, many men doctors want to be able to devote more time to their families. That is one reason why the Government are fully committed to further reducing the hours of junior doctors.

The new deal that the previous Government reached with junior doctors was supposed to deliver better arrangements for accommodation and food and a maximum of 56 hours by 1996. Five years after it was agreed, when the Tories left office, the deal was not being delivered for about one in five junior doctors. We have improved matters. The figure has fallen to less than one in six. That is not all that we have done. Far from seeking to make matters worse for junior doctors, we have agreed with the British Medical Association a more rigorous definition of the terms of the new deal, which will be more difficult to deliver and may indeed make the figures appear worse.

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