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9.21 pm

Dr. Howard Stoate (Dartford): Opposition Members have spent a great deal of time talking about money and pay within the NHS. Of course, money is extremely important--it is almost certainly the most important issue affecting NHS staff. That is why I am so surprised that

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they should table the motion, particularly as they have made clear their opposition to the national minimum wage, which will give a number of NHS workers a good deal.

The Conservatives also oppose the £21 billion extra that the Government have found for health--they called it reckless and irresponsible. Where do they think the money will come from to give nurses, doctors and others a decent pay settlement if not from our comprehensive spending review--which found the money in the first place, and which they opposed?

The hon. Member for Poole (Mr. Syms) referred to a document from the Manufacturing, Science and Finance Union which shows how the wages for professions allied to medicine have been eroded over the past fifteen years. How can he be surprised? The Tory Government took those groups out of the pay review body and allowed their pay to be eroded by 30 per cent. over the past 15 years. In other words, Tory policies led to the problems in the NHS that we are trying so hard to put right. It strikes me as odd that the Conservatives should talk to us about money when we are trying to put more money into the pockets of health workers, while they are clearly opposed to that.

During the 1980s, I was a junior doctor, and I was working for about £30 a week. For that, I was working, on average, 104 hours per week. The money that I was receiving was not time and a third for overtime, but one third of normal time. I was paid a flat rate for my first 40 hours. After that, I was paid one third of my normal wage. I was on call for that many hours a week with that little pay.

The new deal for doctors has put that right to a large extent. Now, we see that just one in six doctors works more than 56 hours a week. However, it is not just about money or work. A third aspect, which Tory Members have clearly failed to take into account, is the amount of stress and anxiety experienced by junior doctors.

It is one thing to be working 104 hours a week and to be earning £30 a week. It is quite another to face the stress and strain of being on call alone at night with three, four or five wards to look after, plus emergencies coming from casualty as well as a coronary care unit and GPs on the phone wanting advice and help.

We certainly need more junior doctors in this country, and there is no way in which a responsible Government can put right the situation for junior doctors until we have trained more doctors. Until we put right the recruitment problem, we cannot reduce the hours. If we do not solve the problem, we would make the situation far more dangerous. The only way in which we can improve the lot of junior doctors is either to train more doctors--which we are doing--or to make the current doctors work even harder still to cover the gaps left by their colleagues who are taking a well-earned rest. Clearly, that would be an irresponsible move for any Government, which is why we have to phase in the reduction of junior doctors' hours over the next few years.

Dr. Harris: I was taken aback by what the hon. Gentleman said about junior doctors. Does he agree that producing more junior doctors to share the work load is, in itself, harmful if insufficient new consultant posts are created? Does he feel that the Government should bring

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back a central or regional manpower planning policy to ensure that there is consultant expansion, and that trusts do not wriggle away in pursuit of the bottom line?

Dr. Stoate: As a member of the Health Committee, the hon. Gentleman will know that we produced a report on staffing in the NHS. Of course it is important for the Government to take an overall view of work force planning, to ensure that the doctors of the future can help the health service, the trusts and the hospitals to provide a service that is so clearly needed.

For some extraordinary reason, we have been told tonight that GP recruitment has fallen off only since the introduction of primary care groups. That is simply not the case. GP recruitment came to an absolute standstill with the introduction of the new contract for GPs in 1990. I clearly remember many of my colleagues retiring early because they could not face the rigours of the new contract imposed on them against their collective will. It forced them to carry out procedures that they knew would be bureaucratic and largely fruitless in improving patient care. They had to go through the hoops simply to meet a series of Government targets designed to make the health service look better than it was.

A whole generation of young doctors was disillusioned and put off general practice, so when good practices wanted to recruit new staff they found it virtually impossible to do so. When I was training to be a GP, perhaps 50 or 60 candidates would apply for a good GP post, but that went down to four or five, some of whom were of such poor quality that they could not even be interviewed. That was clearly the fault of the previous Government, who imposed a regime on GPs that was unacceptable, unhealthy and clearly not in the patient's interests.

The two-tier system, about which we have already heard tonight, forced doctor against doctor and put patients in an impossible position. I could recount story after story of the difficulties that it caused for me when hospitals would ring up and ask if I had a contract to refer patients, because they could not take them if I did not. That was an intolerable situation for GPs.

Now we have primary care groups. It is extraordinary that Conservative Members should attack them as somehow divisive or difficult. To set at rest the mind of the hon. Member for Southwark, North and Bermondsey (Mr. Hughes), there is no compulsion for GPs to take part in primary care groups. They are members of the groups just as they were members of commissioning groups in the previous system, under which decisions were made on their behalf even if they never attended a meeting. The same applies to primary care groups: those who want to work with nurses, social workers and others can do so, but those who want to sit back and let the decisions be made for them are equally welcome to do that.

GPs' pay has been mentioned. For nine of the 11 years of Lady Thatcher's Administration, the pay review body's recommendation was either not paid in full or staged, whereas the new Labour Government have paid the GPs' pay award in full and exactly according to the body's recommendation.

Rev. Martin Smyth (Belfast, South): There has been a tremendous emphasis on the medical and nursing staff.

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Does the hon. Gentleman accept that there is also a danger looming in the way in which we are treating laboratory technicians, who are vital in an age of high-tech medicine? To tell them that they could get jobs elsewhere is to forget that they want to work in the health service, where they are needed.

Dr. Stoate: I thank the hon. Gentleman for that contribution. I have already said that I think that the professions allied to medicine were treated shabbily under the previous Government. They deserve far more respect and a far better deal.

I want to share with the House a report that I released to the press this evening with the hon. Member for Isle of Wight (Dr. Brand), who co-chairs with me the all-party group on primary care and public health. We conducted an inquiry into the effectiveness or otherwise of the primary care groups. We invited outside groups to come and tell us what their experiences were, what they thought was happening in the primary care groups and what they wanted.

I am sure that the hon. Member for Isle of Wight will contradict me if he does not agree, but I noted that the majority of the people who came to our sessions, representing all aspects of medicine, as well as patient groups, were broadly in support of primary care groups. They thought that they were the way forward, being more democratic and accountable, allowing patients to have proper access to uniform quality of care throughout the country, ending postcode rationing and a two-tier system and bringing transparency, openness, honesty and decency. The vast majority of the groups who gave evidence to us were wholly behind that principle. Of course there are difficulties and problems in some areas, and not all GPs, all social workers or all nurses are happy, but the vast majority clearly accept the principle that that is the right way forward.

Obviously, as with any new system, there will be teething problems, and it will take some time for the primary care group to bed down and decide whether it wants to go for trust status or stay with PGC status.

Dr. Peter Brand (Isle of Wight): Does the hon. Gentleman accept that the one thing that will destabilise primary care groups and trusts is the continued development of an alternative primary care system through NHS Direct and walk-in clinics, without reference to local health improvement programmes? Should not the Government be a partner in the health improvement programmes that primary care groups are supposed to deliver?

Dr. Stoate: The hon. Gentleman raises an important point about NHS Direct and drop-in centres. We shall have to see how those new institutions work in integrating health care. I hope that they will be able to integrate care with GP co-operatives and primary care groups to provide a seamless service. Clearly there are problems in the inner cities, especially with out-of-hours care, and NHS Direct has already proved its case as a worthy way of addressing some of those problems. Time will tell how it develops, and I am sure that the Government will closely monitor the pilot schemes and carefully evaluate the outcomes.

Another aspect that we have not touched upon is the Government's programme of building new hospitals. The first private finance initiative hospital is to be built in

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Dartford. It is currently well on schedule and is due to be completed early next year. It will not only improve patient services and make care for Dartford and Gravesham patients far better, but dramatically improve conditions for staff.

I used to work in the Joyce Green hospital and the West Hill hospital, both in Dartford, and both to be replaced by the new hospital. Both of them were seedy and rundown, built for a bygone age and entirely unsuited to modern medical care. They were inefficient, too, especially as the ward blocks were a long way apart.

I used to cycle round those ward blocks if there was an emergency in one of the wards. I cycled down the ward, jumped off my bike and put it by the nurses' station in the middle of the ward, and applied cardiac massage to a patient. That was not all that long ago--at least, I like to think that it was not long ago; other hon. Members may have a different view.

Those were rundown Victorian fever hospitals, built to look after TB patients. TB went away but the hospitals remained, and we are still living with that. Now, at long last, we are getting rid of that, and next year we shall move into a brand new state-of-the-art hospital.

Of course, the private finance initiative has had its problems and its critics. The Select Committee on Health is investigating the subject now. The next generation of PFI hospitals will be based on the experience of the current generation, and I dare say that the Government will think hard about altering some of the contracting and pricing arrangements to ensure that the country gets better value for money from the next generation.

We have taken a brave step. It took the Labour Government to take that step, and to change the law when we came into office so that PFI deals could go ahead, and the hospital that Dartford and Gravesham so sorely needed could be built, and will deliver the services on time for the people of Dartford.

The doctors and nurses to whom I speak are pleased with the new facilities where they will work. They are overjoyed by the fact that they will work in modern conditions that will enable them to give an excellent service to the patients of our area.

The Government have come up with many initiatives, and have found not only the money but the means to deliver good services, and also to improve staff conditions. I cannot think what the Opposition are whingeing about. We have a good Government, providing a good and improving national health service. The Secretary of State has said that he wants it to improve year on year.

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