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Sir Sydney Chapman: I am grateful to the Secretary of State for that information. Will he confirm that, in 80 per cent. of health authority areas, the number of patients waiting more than 12 months for operations has increased since his party took office, and that for the first time in 25 years, the number of heart bypass operations has decreased? Does not that underline the fact that the right hon. Gentleman has managed to get his in-patient
Mr. Milburn: No, that is not true. The hon. Gentleman has heard me say before that the allegation from Tory Back-Bench Members that the number of coronary artery bypass grafts and of heart operations in general has fallen is not true. The number of operations is rising. Of course, we need to do more. That is why I have already made the extra earmarked cash available to ensure that we can carry out an extra 3,000 more heart operations this year and next year. I expect to be able to exceed that, largely because of the hard work done by NHS trusts, hospitals, cardiothoracic surgeons, theatre nurses and others up and down the country who have used the money to good effect.
Let me remind the hon. Gentleman of one thing before he starts raising some legitimate concerns that he and his hon. Friend the Member for Ribble Valley (Mr. Evans) raised earlier about access to heart surgery. It is important to remember that, under the Government whom he supported and of whom he was a member, there was no earmarked cash available for heart operations. It was only when this Government took office that we earmarked cash for cancer and heart disease, which are what many hon. Members, and people throughout the country, would regard as the top clinical priorities.
Mr. Clive Efford (Eltham): My right hon. Friend will be aware that increased demand can put pressure on waiting lists during the winter, particularly as a result of people suffering from flu. I congratulate my right hon. Friend on the success of his advertising campaign in increasing the number of people taking advantage of the flu vaccine. [Interruption.] There is some evidence in my area that demand is outstripping supply.
What is the Department doing to increase awareness of the disease in terms of what precautions can be taken in the household and the workplace to minimise the number of people who contract the disease? There is a myth about how the disease is contracted which the Department could do something to dispel.
Mr. Milburn: As my hon. Friend is aware, there is a TV advertising campaign and other types of advertisement precisely to inform the public about what they can do. It is most important to ensure that those at the highest risk of serious illness if they contract the flu take advantage of the facilities that the Government have made available to them, which is to get a free flu jab. [Interruption.] I hear Tory Members alleging that the flu vaccine is not available. That is not true. This year we have ordered 11 million doses of flu vaccine, compared with under 8 million last year. We have also extended the range of people who are able to get access to the free flu jab. It is important that, in every part of the country, the free flu jab is offered to pensioners and others, and that people who want to take advantage of it do so as soon as possible by visiting their GP's surgery for their free jab on the national health service.
Sir Nicholas Lyell (North-East Bedfordshire): On the issue of clinical priorities, is the Secretary of State aware that Addenbrooke's hospital has now had to cancel the prostate operation on one of my elderly constituents for
Mr. Milburn: I am the Secretary of State for social services, so I shall do my best, depending on what sort of day I am having, of course--so far, so good. The right hon. and learned Gentleman raises an extremely important point, which is that, as we now know, what happens in a hospital is directly affected by and directly affects what happens in social services, primary care, community care and, as we heard earlier, ambulance services. That is why we have to encourage much greater co-operation in the local health service. That is also the precise reason why the Government got rid of the internal market, which the right hon. and learned Gentleman supported.
The Minister of State, Department of Health (Mr. John Hutton): East Lancashire health authority is aware of the problem with GP recruitment in its area and is developing a recruitment package that covers all four contractor professions. As part of that process, the health authority is proposing three new applications for personal medical service schemes; exploring the opportunities offered by salaried GPs and nurse practitioners; and reviewing its primary care investment plan to determine what other incentives can be made available through additional investments in GP premises.
Mr. Prentice: That is a good answer, but is the Minister aware that 5.5 per cent. of all the GPs in my area are due to retire in the next five years? That is the highest such percentage of any area in England outside Greater London. Perhaps the way to get younger GPs into areas where there is an acute shortage of qualified GPs is to pay them more. Will the Government apply themselves to that point?
Mr. Hutton: I am very glad that I have said something with which my hon. Friend is happy. As I am sure he is aware, however, we are paying general practitioners more. I am also absolutely sure that, if my hon. Friend wants to develop his concerns about the issue and express them to the health authority, it would be very willing to discuss them with him, as would I. My hon. Friend's area has a particular historical problem with which we have to deal. I am aware of the concerns that he and others have expressed about it, and we look forward to working with him to find a sensible way forward.
The Parliamentary Under-Secretary of State for Health (Yvette Cooper): The NHS plan sets out proposals to increase the number of nurses, midwives and health visitors in the NHS by 20,000 in the next four years. That is why we are expanding training commissions; improving pay; supporting international recruitment; encouraging family-friendly working practices; and encouraging more staff to return to the NHS.
Mr. Bradley: I welcome that response, which will be welcomed also in The Wrekin and in constituencies across the country. However, can the Minister explain what action she and her colleagues are taking to recruit--and, crucially, to retain--other professional and technical staff? Would not such action help, and is it not time that such staff were included in the pay review body arrangements?
Yvette Cooper: My hon. Friend will be aware that discussions on the future of the pay system are under way. We believe that, across the board, the pay system needs to be modernised to provide fair and affordable settlement across the NHS and to support expansion of the NHS. There were already 10,000 more nurses in place in September 1999 than there were in September 1997, and there have been other increases in the work force, too.
Mr. Archy Kirkwood (Roxburgh and Berwickshire): I should be pleased if the Minister could tell us what conversations on recruitment and retention she has had with the Royal College of Nursing since July, and what tangible progress has been made. Although some of us were interested to hear the Secretary of State say--rightly--that under-capacity is holding back development of the NHS, the president of the Royal College of Surgeons recently said that it would take 10 years before those problems were properly and adequately dealt with. Will it take 10 years before we get the recruitment and retention of nurses right?
Yvette Cooper: Christine Hancock of the Royal College of Nursing is on the NHS modernisation board, and continuing conversations are being held on recruitment and retention. There has also been much progress on nurses, such as the fact that, in the first two years of this Parliament, we have put in place 10,000 additional nurses. Considerable progress still needs to be made, but it will take time. One of the reasons why it will take time is that the previous Government cut the number of nurse training places: that is what has made it so difficult to get in place the additional nurses that we need.
Will my hon. Friend put further pressure on health authorities and trusts actively to examine their working patterns and shift rotas so that nurses who want to return to work are if possible offered the flexibility that they need to combine their work and family responsibilities?
Yvette Cooper: I can certainly reassure my hon. Friend that we are very keen to increase family-friendly working practices across the NHS. That is why we have a £30 million child care initiative to support staff across the NHS. The Government strongly value the important contribution that people, especially women, can make
Yvette Cooper: Given that the previous Government cut the number of acute beds in the NHS by 43,000 between 1979 and 1997, it would hardly be surprising if the number of specialist nurses had fallen during that period. We are committed to increasing the number of nurses in the NHS, not just by 20,000 across the board, but by expanding the number of senior nurses, including nurse consultants. My right hon. Friend the Secretary of State has announced that an extra 141 nurse consultants will be appointed.
Dr. Fox: I take that rather second-rate evasion to mean that, yes, Christine Hancock was telling the truth. I wonder when Ministers will start to take responsibility for the health service, more than four years into their term of office. [Hon. Members: "Four?."] They are well into their fourth year, and were they to be in office for 40 years, they would still be harking back to the Conservative Government. Is it not true that the 15,000 nursing vacancies and the 12,000 nurses who leave each year are a testament to the Government's failure in office? Is not that compounded by the lack of morale generated by the Government's endless political interference; the lack of authority for ward sisters; the lack of vaccine for patients; the return of TB to our cities; and a winter crisis that now goes on all year--all of it under a Prime Minister who says that Labour never understood the size of the problem? How can nurses, or anyone else, have any faith in a health policy that is such a complete shambles?
Yvette Cooper: Given that the hon. Gentleman is clearly so sensitive about looking back at the previous Government's record--for example, the cut in nurse training places from 15,000 to 11,000 in two years and the failure to restore the figure to the previous levels under the previous Government--perhaps we should look to the future. The Government are already increasing the number of nurses in the NHS. We have a commitment to expand the NHS and to invest additional money, year on year, in increasing the NHS--[Interruption]
Mr. Speaker: I cannot have the hon. Member for Woodspring (Dr. Fox) shouting across at the Minister. He asked a question; the hon. Lady is answering it. [Interruption.] She may not be answering it to his satisfaction, but she is answering it.
The hon. Gentleman has said that he wants to spend more than £500 million on subsidising private health insurance and more than £300 million cutting the tobacco tax against which his party voted. We have set out where