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Nurses

4. Mr. John Randall (Uxbridge): How many nurses he plans to recruit from overseas over the course of the next 12 months. [137639]

The Secretary of State for Health (Mr. Alan Milburn): We have not set a target, but according to the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, 7,361 overseas applicants were admitted to the nursing register in the year to 31 March 2000.

Mr. Randall: I thank the Secretary of State for his reply. What measures is his Department taking to ensure that the national health service is sticking to its own guidelines in not contracting nurses and midwives from South Africa, through private recruitment agencies, when there is strong evidence that those agencies are still actively recruiting?

Mr. Milburn: The hon. Gentleman makes an extremely important point. We have issued guidance to the NHS--I think that we issued it either late last year or earlier this year--and it certainly tells the trusts that they should not actively recruit from any developing country. There are surpluses of nurses in some developing countries, such as India, Pakistan and elsewhere. Inevitably, nurses from those countries will sometimes apply, of their own volition, to come to this country, and they make an extremely important contribution, as the hon. Gentleman will agree. Certainly, from my point of view, we should not seek to recruit from developing

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countries; we want those countries to develop their own health care systems. Where appropriate, we shall recruit from overseas.

The hon. Gentleman will be aware that I recently signed an agreement with the Spanish Government, for example, to bring nurses to this country, provided that they have the appropriate qualifications, including the appropriate English language skills. I am convinced that they will make an extremely important contribution to health care in our country.

Mr. Mike Gapes (Ilford, South): Will my right hon. Friend take this opportunity to thank all the nurses and doctors from overseas who are playing such a vital role in our national health service? Can I draw to his attention the nurses from the Philippines, who have made it possible for two new wards to be opened at King George hospital in my constituency in recent months?

Mr. Milburn: I am happy to do that. Nurses and doctors and, indeed, other staff from overseas have long made an important contribution to the work of the NHS in many parts of the country, particularly London and the south-east. I know that that is the case in my hon. Friend's constituency. I tell those hon. Members who seem to be more concerned about the accents of those doctors and nurses that what counts is not their accents, but their excellence.

Mrs. Caroline Spelman (Meriden): Is not the level of overseas recruitment simply an indictment of the Government's efforts to bring back our own nurses and to stem the tide of nurses leaving the NHS through frustration, exhaustion and despair? Raiding the third world is not the answer. I thank the right hon. Gentleman for his answer on the sources of recruitment to the NHS, but what measures will he take to ensure that there are guidelines for the private recruitment agencies to stop nurses being drawn from some of the poorest countries?

Mr. Milburn: The hon. Lady seems to be on a kamikaze mission. She seems to think that we have problems in the NHS because a shortage of nurses suddenly arose on 1 May 1997. If she stopped to think about it and, more importantly, to examine the facts, she would realise that she is 100 per cent. wrong. Let me remind her of her record when the Conservative party was in office. [Interruption.] I like to think of these sessions at Health questions as a form of regression therapy for Conservative Members, to try to help them to face up to their past, rather than simply forgetting it.

Mr. John Bercow (Buckingham): Get on with it.

Mr. Milburn: If the hon. Gentleman will stop shouting and listen for a moment, I will give him some facts; he might learn something.

In 1992-93, there were 16,340 NHS-funded nursing and midwifery training places. By the end of the last Parliament, that had fallen to 14,980. The truth is that the shortages of nurses that we are now seeing are directly related to cuts in training places that the Conservative Government made. The increased investment that we are making, still opposed by the Conservative party, is paying

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dividends. We have more nurse training places, 10,000 more nurses, big pay rises and an NHS that is at last expanding, whereas for 18 years it was contracting.

Bed Blocking

6. Mr. Ian Bruce (South Dorset): How much is planned to be spent on providing NHS nursing care to residents of private nursing homes in each of the next three years; and how many NHS hospital beds will be unblocked as a result. [137641]

The Minister of State, Department of Health (Mr. John Hutton): The Government have estimated that the additional cost to the Exchequer of providing free nursing care, as outlined in the NHS plan, will be £420 million over the next three years. Free nursing care will form part of a package of measures to improve care for older people, including an investment of £900 million by 2003-04 in intermediate care and related services, which will help reduce delayed discharge.

Mr. Bruce: The whole House will be concerned that £420 million over three years will not pay for the nursing care of all those people who are currently in private nursing homes. Was it really an announcement that the Government made, or was it simply spin? Perhaps I can ask the Minister another question, just to clarify the matter. By how much does he believe that fees will be reduced in private nursing homes as a result of the Government's announcement? How much per week will patients save because they are being paid for by the Government?

Mr. Hutton: With the greatest respect to the hon. Gentleman, I do not think that he understands what he is talking about. The £420 million that I identified in my answer to him relates to those who are at present meeting all the costs of their nursing care. That additional money will help to reduce those costs. The service will be provided free as an NHS service, as it always should have been. For 18 years the Conservatives failed to grasp that. Of course there has been a significant change. The announcement will save about 30,000 people up to £5,000 a year. None of the changes will have the effect that the hon. Gentleman suggests.

We are increasing social services spending in real terms every year. In the previous Parliament, the real-terms increase in social services spending was 0.1 per cent. Under the Labour Government and into the next spending review, the real-terms increase in social services spending will be 3.4 per cent. So I am afraid that the hon. Gentleman is speaking a complete load of nonsense.

Mrs. Gwyneth Dunwoody (Crewe and Nantwich): Has my hon. Friend estimated how much local authorities would benefit from having available to them that amount of money to provide alternatives to private homes, which, after all, are in it for profit?

Mr. Hutton: I think that the new investment that we are making available through the spending review provides an opportunity for a new relationship to be created between local authorities and the independent sector providers. That is to be welcomed. Of course we need to make sure that the quality of care provided in private homes meets the

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standards that we expect in the NHS. That will be done, but we have an opportunity to build important new services for older people, which will improve their recovery from illness, speed up their discharge from hospital and allow them to resume their independence and return home much more quickly than ever before. That is precisely what the public want us to do.

Mr. Nick Harvey (North Devon): Is the Minister not concerned that 760 nursing and residential homes have closed in the past year, with the loss of 15,000 beds? Is he aware that one health authority alone has said that it already has 160 patients staying in hospital because there is nowhere for them to go out in the community? That is before winter pressures have seriously mounted. How many more patients do the Government maintain it will be possible to treat at home? Will that compensate for the 15,000 beds lost in the past year? Would not the best way of guaranteeing an end to bed blocking be to accept the royal commission recommendation of free residential or home-based personal care for all?

Mr. Hutton: Of course, we look at the situation very carefully indeed. We want to ensure that there is sufficient capacity, both in the NHS and the independent sector, to ensure that the NHS works efficiently and that we do not have unnecessary delayed discharges. The hon. Gentleman might be aware that evidence that we submitted recently to the Select Committee on Health shows that the number of delayed discharges is coming down.

Of course, we need to keep a constant eye on the situation, and we are providing more home-based packages of intensive care for increasing numbers of people, which is helping to offset some of the reductions in capacity in the nursing home sector. However, we do need to plan strategically in the future--and to involve central and local government and the independent sector in that planning--on the whole issue of capacity and what we do to support the independence of older people. We are now starting to take those steps. In all fairness, I know that the hon. Gentleman is with us on that, but in 18 years of government the Conservative party never managed to establish that dialogue with the independent sector. The Conservative party, which claimed to be the champion of the independent sector, never quite got round to sitting around a table to talk to representatives of the independent sector about the future.

Dr. Howard Stoate (Dartford): My hon. Friend will be aware that the new private finance initiative hospital in Dartford, serving the residents of Dartford and the constituency of my hon. Friend the Member for Gravesham (Mr. Pond), is up and running, but there are still far too many delayed discharges--currently around 40--owing to the inability of social services to fund and manage significant care packages to ensure that people can be removed into their homes when they are ready.

What plans do the Government have to respond to a bid by the health authorities and social services departments in Kent for extra funding for winter pressures to try to alleviate that problem, so that people can be moved through the system, thereby freeing up more acute beds for emergency use?

Mr. Hutton: We will consider very seriously any requests for additional resources from the health

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authorities and social services in my hon. Friend's constituency. He might be aware that we recently made available nearly £1.8 million of additional resources to cover the winter period, for both the East Kent and West Kent health authorities. I hope that those resources will go a significant way to deal with what I know are quite acute pressures in my hon. Friend's constituency.

Mr. Philip Hammond (Runnymede and Weybridge): Will the Minister confirm that, over the past two years, there has been an unprecedented loss of nursing and care home beds, and that the result is an unprecedented level of bed blocking in many parts of the country, which is already undermining the Government's NHS winter strategy? Will he confirm that inadequate levels of social services fee funding and increased Government regulation are further exacerbating that problem? Will he tell the House who he holds responsible for that state of affairs?

Mr. Hutton: All of us on the Government Benches know exactly what game the hon. Gentleman is playing. He wants his winter crisis for the NHS this year, and he will do anything that he possibly can--including ignoring the facts that I have tried to outline to the House today--to reach his conclusion that there is a crisis. There are problems in some parts of the country, and of course we accept that. We are looking very carefully at what we can do to improve the situation, and we are providing record resources to social services to help them to tackle that problem.

It may be a difficult fact for the Conservative party to come to terms with, and I can hear some chuntering from Conservative Back Benchers on this point, but Conservative Members will never acknowledge their contribution to the crisis--the problems--with which we are now dealing. The hon. Gentleman may talk about these issues as much as he likes, but he cannot possibly deny that under the Conservative party, there were real-terms increases in social services funding of 0.1 per cent., whereas under the present Government, the figure is 3.4 per cent.

Mr. Chris Pond (Gravesham): Does my hon. Friend recognise that, whereas some Opposition Members might savour the idea of a winter crisis, Labour Members very much support the joint bid by Kent county council and the health service in Kent for extra funds for domiciliary care? Will he also look carefully at the possibility of reopening a ward in Gravesend and North Kent hospital, to ease the burdens on the acute hospital this winter?

Mr. Hutton: As I said earlier, we are aware of the problems in Kent and we are working closely with the health authorities and social services to find sensible solutions. The type of option that my hon. Friend has just outlined may be something that the health authority and social services need to consider together, but I do say to my hon. Friend and other hon. Members that the best way to ensure that all our constituents receive the best possible care and treatment during the winter is for health and social services departments in all parts of the country to work together as closely as possible. Perhaps then we shall see an end to the puerile party political posturing of the hon. Gentleman and his friends; I hope that we shall.

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