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Mr. Dobson: The offer of a bonus to someone who comes back into the NHS that is not offered to the folks who stay would harm morale, not improve it. Some football clubs have learned that to their cost.

Mr. Hughes: I said specifically--the Secretary of State may not have heard me so I shall repeat it--that we should give loyalty bonuses to those who stay.

We obviously share the view of the Secretary of State that family-friendly policies matter hugely. We say clearly to him that, as the review of nursing grades continues, we need to allow people to stay in nursing but continue to be upgraded in salary and career position, and continue to do some hands-on nursing so that it is not necessary to become a manager to be promoted. People will therefore feel able to remain with nursing. I think that the right hon. Gentleman espouses that view.

Thirdly, we are keen, as I hope that the right hon. Gentleman is, to ensure that there is an opportunity for the nursing profession to become one in which people are much more involved collectively with all the other professions in decisions about its future.

The week before I was at Morriston hospital, I was at the junior doctors' forum in Bath. Junior doctors too are not happy. It is often necessary to get three A grades at A-level to become a medical student. The places are very difficult to secure. On qualification a junior doctor works mighty hard. They work harder than most other students for their degrees, and for longer in many instances. They then have to do their training. They often do not know whether they will have another six months' work after the six months that they are in. There is a huge element of uncertainty during the first few years post-qualification.

Many of the junior doctors said to me, "We also feel undervalued. We feel that it is not worth staying. We are concerned that we do not get proper supervision. We have cursory supervision from consultants, who literally look in and look out again. We now hear that the Government are trying to negotiate a maximum limit of 65 hours and not 56." For the first time, the Secretary of State, who was in the Chamber a moment ago, effectively admitted today that the Government--as I understand it, it was the Minister with responsibilities for public health who did the negotiating because she went to the Council of Public Health Ministers--were pushing for 65 hours. Why could the Government not have owned up? Why could they not have said that they pushed for 65 hours because they thought that they had to cover the fact that 20 per cent. of junior doctors were working more than 56 hours? Why have we had a month of obfuscation, denial, pretence and mealy-mouthed weasel words? Own up, Government. Be honest.

When the Government get something wrong, they should say so. Out there, people did not believe them. The doctors did not believe the Government, and the Government let them down. There was an explanation, but the Government should come clean with the country if they cannot do as they wish. They should not try to fool people. People are not fooled, and their morale is undermined.

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The third issue is similar to the others. We are at risk of running desperately short of consultants. My hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris), who was previously a hospital doctor, knows more about that than I do. He has raised in the House and elsewhere not just the subject of the shortage of obstetricians and gynaecologists, to which the right hon. Member for Maidstone and The Weald (Miss Widdecombe) also referred, but the fact that, in many of the career paths, there is a bottleneck. There is a nonsense system whereby people do not have the opportunity to progress up the career ladder and do the jobs that everyone is asking them to do.

My hon. Friend the Member for Isle of Wight (Dr. Brand) is on the Select Committee on Health, which produced a good report that makes it clear that our manpower planning is still nonsense. Our work force planning is not working. We are not managing to make sure that we have the necessary NHS staff at the time that we need them, in the right place and the right post.

Dr. Harris: Does my hon. Friend agree that it seems bizarre that we plan centrally the number of medical students in the health service, we plan centrally the number of higher specialty trainees in the health service by region, but when it comes to consultants--the key end of the bottle that provides the service--there is no central planning? Trusts are left to do as they please, leading to the failure of consultant expansion, the poor quality that that causes, and the lost career opportunities for all those people in whom we have invested and for whom we have planned so carefully to bring them to consultant level.

Mr. Hughes: My hon. Friend makes a point that I understand causes real concern. I ask the Government, as he has done, to change the system, which tries to plan the number of nurses and doctors that we need, but does not plan in a co-ordinated way the number of consultants that we need.

Many of the trusts where there are senior consultants determine the number of consultant posts according to their own traditional patterns, sometimes to protect the interests of existing consultants--their jobs, hours and income--to the detriment of younger doctors who would help to relieve their burden and the burdens on the health service. That is not acceptable. It is old-fashioned and used to be called a Spanish practice. We need to say that, even if it applies to a minority of consultants and a minority of trusts. We should not allow self-interest to determine the number of posts at consultant grade in the health service.

The fourth issue concerns general practitioners. We are facing the prospect of large numbers of GPs retiring and leaving. Some of those retiring were part of the bulge in the health service created by the number of people who took up general practice after the war, many of them from the new commonwealth and elsewhere. Some are retiring because of the pressures of the system and the paperwork, and others because of the fact that the new primary care group structure means that they will have less time to be GPs because they are required to perform a management role. I have recently met a considerable number of GPs who say that they will have nothing to do with primary care groups because they want to be doctors, not paper-pushers. They do not want to go to meetings; they want to get on with being doctors.

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Mr. Kevin Barron (Rother Valley): We are improving the health service.

Mr. Hughes: I respect the hon. Gentleman, but I have seen enough round the country to worry me greatly. That, added to the current pressures and the shortage of GPs, will be a serious problem in a few years. In some areas, we could be as short of GPs as we are currently short of dentists in the health service. If we do not anticipate that problem and take action, we will be in big trouble.

Mr. Barron: My area has the highest patient:GP ratio in England and Wales. Under this Government, GPs in the health service are working to help us with those problems, instead of being the small independent contractors who held the service back for years.

Mr. Hughes: Like the hon. Gentleman, I believe that the gaps in private general practice offering to work under contract for the health service had to be plugged by salaried GPs.

My hon. Friend the Member for Isle of Wight asked me today whether I had seen the front page of GP General Practitioner this week. It is dated 21 May, so, unless I am mistaken, it still has not officially come out, but I happen to have a copy. The headline is "Salaried GP posts collapse". It quotes Dr. Roger Chapman as saying:

It seems that the proposal was to fill the gaps with salaried GPs, but the money is not there to do it. The initiative may have helped in the hon. Gentleman's area and in others, but it does not seem to have done what it was billed to do.

With regard to professions allied to medicine and other workers not covered by the pay review bodies, there is no case now for pay review mechanisms not to cover everyone who works in the health service, including those who are currently excluded.

I shall ask a couple of questions and end with a couple of propositions, as I know that others want to speak in the debate.

Mr. Robert Syms (Poole): The MSF--Manufacturing, Science and Finance Union--briefing paper from its lobby of Parliament asked whether this year's pay round had made matters better or worse for many of its staff. It states that the position is significantly worse, and that almost all the skilled and professional staff got 2.8 per cent. on basic pay, with nothing on leave and allowances, even though, since 1984, many of those categories have fallen back 30 per cent. in their pay.

Mr. Hughes: The headquarters of the MSF are in my constituency. I am aware of the union's concerns, which the hon. Gentleman rightly raises. I am concerned not just about the people who belong to that union and the professions allied to medicine covered by the pay review bodies, but about the people outside that group--for example, ancillary workers in the health service, such as cleaners.

I visited a hospital the other day in the south-east of England which, at the pay that it offers, cannot get the cleaners that it needs. That is in the county's principal general hospital. The reason is that the pay rate down the road at Tesco is twice as much. The hospital does not

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have the cleaners that it needs and it is worried about that, as there are clearly health and safety implications for a hospital more than for anywhere else.

Neither the hon. Member for Poole (Mr. Syms) nor I is being alarmist. We are simply reflecting what people are telling us as we go round the country about the desperate state of morale, pay and conditions in the health service.

I shall put two questions to the Minister. I have heard the Secretary of State's evidence before the Select Committee about the number of nurses that we are short of. My first question, which I hope the Minister will answer at the end of the debate, is what was the total shortage of professional staff in the health service when the Government came to office in 1997 and what was it in April 1999? I believe that it has gone up over the past two years, if one adds the figures for doctors, GPs, nurses, dentists and so on.

Secondly, what is the Government's target ratio of doctors to population, consultants to population, nurses to population and junior doctors to population? Many of the tables show that we are comparatively well off in the number of nurses, but we are badly off in the number of doctors, relative to the number of people in the United Kingdom. If that is the case, we must seriously address how to respond to the aspirations of all those young people who want to enter medicine and other health professions and become public servants in the health service, but for whom the system does not deliver.

The Minister must also tell us what is to be done in respect of millennium pay for public sector workers. Liberal Democrats believe that there must be an acknowledgement of the duty that we may impose on those in the emergency services--including the health service--during the period of the millennium celebrations. The matter must be nationally agreed. It is nonsense to leave it to local pay bargaining, negotiation and pressure. That applies not only to the health service, but to the ambulance and other emergency and public services.

Our urgent view is clear; I have stated it previously. The health service will not get out of its staffing hole unless it owns up to the need for a real-terms increase in funding--in terms of the gross domestic product. One could try to get people out of the health service--the route proposed by the Tories, from which we dissent--but, until a real increase is the accepted norm, we shall always struggle. I have never heard the Government make that commitment.

What is needed is a package of specific measures, including financial ones--not merely warm words and glossy advertisements--to draw people into the professions and retain them. We need work force planning for all professionals and grades in the health service--not merely for some of them. It would be better for that to be based on cross-party debate and agreement, rather than on Government denials of a major crisis. It should not be left for opposition parties to bang on the door. We and the Tories may agree on few things and disagree on many things. We may have criticisms of their record in office. That is in the past. At present, there is a crisis in morale in almost all professions in the health service. The two-year mark that the Government have just passed has not changed that; if they do not act soon, things will get worse--not better.

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