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Dr. Brand: Will the hon. Gentleman give way?
Mr. Hammond: I will not give way because I do not have enough time. Those junior doctors cannot even be sure that their pathway to freedom is clear. The problems of manpower planning and the restrictions on consultants' posts means that many junior doctors face a bleak future in their chosen specialties. As my right hon. Friend the
Member for Maidstone and The Weald said, hundreds of fully qualified obstetricians will be thrown on the scrap heap in the next few years because they have been trained for a specialty for which no consultant vacancies exist, even though the need for such consultants clearly does.
If junior doctors succeed in achieving a consultant's post, what lies in store for them? More problems, I am afraid, Mr. Deputy Speaker. Partly as a result of the improvement in junior doctors' hours under the previous Government, consultants now bear an ever greater workload. The Government have added the whole clinical governance agenda and its duty of quality to thatload while simultaneously casting aspersions on the commitment of consultants to the NHS. The consultants are outraged. The chairman of the consultants committee said of industrial action:
The BMA says in its briefing for the debate that the reality is
In opposition, the Labour party courted the nurses without shame. I do not have time to recount the history of how Labour has dumped the nurses since they came into office, but I repeat what the Royal College of Nursing said after the famous pay settlement for the nurses earlier this year. It was good news for nurses starting out in their careers--one nurse in 15. The RCN said of the award for the other 14 out of 15:
The Minister of State, Department of Health (Mr. John Denham):
First, I congratulate the hon. Member for Runnymede and Weybridge (Mr. Hammond) on being given the responsibility of replying to the debate. I had heard that we might hear from the Trappist hon. Member for Rutland and Melton (Mr. Duncan), who is clearly still maintaining his vow of silence, which he has enjoyed for some time.
There have been some interesting contributions to the debate. Among other things, the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) asked about staff shortages. He will know that my right hon. Friend the Secretary of State told the Select Committee that we would be carrying out an authoritative survey of staff shortages, and that is now under way. We will be reporting in due course.
My hon. Friend the Member for Feltham and Heston (Mr. Keen) spoke about the human cost under the previous Government of disregarding the commitment of people who work hard to provide our national health service. The hon. Member for Broxbourne (Mrs. Roe), in a speech which I think even she would recognise as faintly absurd, conjured an extraordinary picture of the Government's primary care reforms. Among many other things that I would like to put out, it is important to stress that there is no threat to independent contractor status from our proposals.
My hon. Friend the Member for Rother Valley (Mr. Barron) set things straight on the Government record on nurses' pay and reminded us of the damage done by the previous Government with the introduction of the internal market, the two-tier system that that imposed on patients and the effect of short-term contracts on staff.
The hon. Member for Altrincham and Sale, West (Mr. Brady) spoke of local issues but underlined that he was talking about resources in the NHS. He, as did other Opposition Members, failed to explain how complaints about resources can be matched with their condemnation of our investment in the NHS as reckless and irresponsible. One wonders how they would be doing without it.
My hon. Friend the Member for Dartford (Dr. Stoate) spoke of the need to train more doctors and rightly stressed that we are increasing the number of training places for doctors. He also spoke rightly and far more accurately than others of the strength of support throughout the country for our primary care reforms and the commitment to working through those in place.
I would not normally do this--
Mr. Amess:
Will the Minister give way?
The hon. Member for Isle of Wight (Dr. Brand), in an intervention, made a point about access centres. I take the opportunity of stressing that we want to see these centres develop with the support of primary care groups. We recognise the importance of the issue that the hon. Gentleman raised.
The hon. Member for Southend, West (Mr. Amess) shouts at me, as he did every Tuesday and Thursday over the past three weeks during consideration of the Health Bill in Committee. He talked about shortages of consultant radiologists. I would point out that it takes 15 years to train such a consultant. That brings me to a rather central point--
Mr. Amess:
Will the Minister give way?
Mr. Denham:
No. There is very limited time.
Mr. Deputy Speaker (Mr. Michael J. Martin):
Order. The Minister is not going to give way.
Mr. Denham:
I wish to mention all the speakers in the debate, as is courteous. However, I need, too, to answer some of the points that have been made.
If the Opposition's charge in their motion had been that we had not yet solved all the problems that we inherited from the Conservative Government, we would have had to say, "Yes, that is true."
The Opposition's problem tonight is that they have tried to make the case that everything was fine until the last general election, and since then it has gone badly wrong. That claim has no credibility in the House, in the country or, most importantly, among the NHS staff whom we are discussing. There is no more important group of people for the House to discuss.
Although I do not agree with the Opposition motion, I am happy that we are debating the topic. Those million people who change lives and save lives every day in every part of our country are of tremendous importance. There is not a single hon. Member whose family and constituents do not have reason to be grateful to them.
Mr. Amess:
Will the Minister give way?
Mr. Denham:
It is important that those who work in our national health service should be fairly rewarded, that their careers should develop, and that the NHS should make the best use of their skills and commitment.
"Twelve months ago, I would have been surprised to find 80 per cent. of my colleagues supporting. I've noticed an attitude change in the last few months. . . . The profession are saying we've struggled to hold this service together for so long for little recognition. It can't go on."
The chairman of the junior doctors committee added:
"Doctors, both seniors and juniors, are fed up with being taken for granted by the Department of Health".
The BMA chairman says:
"We can't go on like this. . . . We have junior doctors becoming burnt out and disillusioned with medicine."
Consultants are seeking to retire ever earlier as they find the burdens of on-call working unsustainable into their 60s. A crisis is looming. Junior doctors cannot see their career path before them as a result of inadequate planning and insufficient consultant posts. Consultants can no longer work at the intensity at which they are being asked to work, and the Government sit on their hands and do nothing. We have argued and the professions have argued that the Health Bill currently in Committee should include provisions for some form of manpower co-ordination so that these issues are addressed and doctors across the hospital service, both junior and senior, can see a way out of the current mess.
"lengthening hours of work for many doctors and/or increased intensity of work for others. This in turn contributes to a progressive decline in morale and motivation which itself militates against the productivity gains necessary to meet demand for medical services. In short, there is a vicious circle."
But our health service does not run on doctors alone. Nurses and the professions allied to medicine make up the majority of the qualified staff.
"It will not solve the chronic staff shortage."
In opposition, Labour cynically exploited the concerns of the health professions. It raised the stakes. In office, the Labour Government have shamelessly abandoned them and they must now reap the harvest of frustrated expectations, low morale, faltering recruitment and a haemorrhaging of experienced staff from the service.
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