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The Secretary of State for Health (Mr. Alan Milburn): Under the NHS plan, we will provide 7,500 more consultants and at least 2,000 more general practitioners by 2004. We will also provide 1,000 more specialist registrars, to provide further growth in consultant numbers beyond that period, as well as 450 more GPs in training.
Sir Geoffrey Johnson Smith: As the 2,000 extra doctors announced in the NHS plan included both those who were leaving general practice and those in training, is it not time for the Secretary of State to consider the proposals of the British Medical Association, and to discuss with the association how the number might be increased?
Mr. Milburn: Yes; and I have always made it clear to the BMA and others that we regard the 2,000 figure--which, incidentally, represents a net increase of 2,000, consisting of extra recruits minus those who will be retiring and so forth--to be a floor, or minimum. If we can do more, we will.
While there will be substantial increases in the number of GPs and doctors generally during the next four years or so, there will be an even greater increase in the number of doctors in future years. We have already provided an extra 1,100 medical student places, and there will be a further 1,000. That represents a 40 per cent. increase in the number of medical students who will come through the system in the next five, six, seven and eight years, and will make a substantial difference to the quality not just of primary care but of the acute care services mentioned by my right hon. Friend the Member for Copeland (Dr. Cunningham).
It is all a question of investment, and how much we are prepared to put in. The Government have made a clear choice. We are prepared to invest in the NHS and in social services; the question for the right hon. Member for Wealden (Sir G. Johnson Smith), and for his hon. Friends on the Front Bench, is whether they are prepared to match our levels of expenditure and investment--and not just in the NHS.
The hon. Member for Runnymede and Weybridge (Mr. Hammond) nods. Perhaps he will nod again in response to this question: is he prepared to match our investment in social services? If he is not, elderly care services will suffer, as will services for vulnerable children and disabled people.
It should be remembered that the party whose members bleat about the number of bed blockers in hospitals will increase that number. It will also reduce the range of rehabilitation services in the community, and once again elderly people will end up paying the price for the Tories' failure to invest.
Mr. Bruce Grocott (Telford): I welcome the increase of £23.4 million for Shropshire health authority, which is more than double the increase achieved--if that is the right word--in the last full year of Tory government, 1996-97. Does my right hon. Friend agree that what our health service needs is certainty of funding in the future, so that planning can take place and doctors and nurses can be recruited? Does it not also need an administrative structure that is responsive to patient needs? Finally, does it not need another Labour Government?
Mr. Milburn: My hon. Friend is right about that, as he is about so many other things. What the NHS needs is sustained investment, not just for one year but over a period of years, and that is precisely what is happening. For instance, health authorities will receive average real-terms increases of 6.23 per cent. this year and 5.85 per cent. next year. Let me remind my hon. Friend of the position during the last two years of the last Government: the increase was 1.1 per cent. in 1996-97, and 0.85 per cent. in 1995-96.
Dr. Evan Harris (Oxford, West and Abingdon): Does the Secretary of State agree that additional doctors will not complete the picture unless there are additional staff beds for those doctors to treat patients in? In Oxfordshire, the John Radcliffe is absolutely full to bursting, with no beds in nursing homes available for patients to be
Mr. Milburn: One of these days, the hon. Gentleman will have something positive to say about the NHS. I look forward to the day. On the situation in Oxfordshire, he is right: we have made more money available. As he and the Conservative party are always complaining about the need to ensure that local health services are in the driving seat in determining how best to spend the money, that is an issue for the local health service to resolve.
On bed numbers, my hon. Friend the Minister of State, my hon. Friend the Member for Barrow and Furness (Mr. Hutton), is right. For 30 years, the number of beds in hospitals has been falling. A total of 40,000 beds disappeared in the last 10 years of the previous Government alone. The number is finally rising again precisely because of the investment that the Government are making and will continue to make.
The Minister of State, Department of Health (Mr. John Denham): Our proposals for a new Nursing and Midwifery Council provide for the separate registration of midwives and the regulation of their practice.
Mr. Simpson: I am grateful for that answer. My hon. Friend will know that, in the review that was commissioned by the Department on the delivery of midwifery services, recommendations were made about the creation of a statutory midwifery committee and about the nature of the representation of midwives on the new Nursing and Midwifery Council. In response to representations that have already been made by midwives in the House before Christmas, can he say whether midwives will have equal representation with nurses on the committee and whether they will have a separate and independent midwifery committee?
Mr. Denham: My hon. Friend will understand that it would be premature to anticipate the result of the consultation, which is still continuing, but I can confirm that midwives will have equal representation with the other professions that will be regulated: nurses and health visitors. The new council will have a duty to set training standards for midwifery. The issue of a separate midwifery committee has been raised during the consultation. I simply confirm that we are considering those representations.
Mr. Denham: I am pleased to say that we have more than enough midwifery applications, despite the fact that there are now 55 per cent. more training places for pre-registration midwifery than three years ago. There are not enough midwives at the moment. As so often, the reason is that the previous Government failed to invest in training enough professional staff for the NHS. This Government are investing in those extra training places. We are attracting the applicants and those midwives will become available to the NHS.
The hon. Gentleman will welcome the fact that, this month, with the Royal College of Midwives, we are launching a new campaign that is designed to attract qualified midwives back to the NHS. We have had tremendous success with our return to nursing campaign. This month, we are extending that to the midwifery profession because we need more midwives in the NHS.
Mr. Jonathan Shaw (Chatham and Aylesford): I welcome my hon. Friend's announcement that there will be a separate body for midwives. I met midwives in the Medway maritime hospital. They were concerned about their ability to be able to influence policy at both a national and local level. They were particularly concerned about the number of midwifery-led units in hospitals and wanted an increase. Obviously, recruitment is crucial, but does he not agree that midwives have a distinct and unique role to play both in influencing and in assisting NHS policy as we move forward with the NHS plan?
Mr. Denham: I welcome my hon. Friend's comments, but for the avoidance of confusion I should make it clear that I did not say that there would be a separate body for midwives. There will be a Nursing and Midwifery Council on which midwives will be represented, as will nurses and health visitors. I was responding to the proposal that there should be a separate midwifery committee. I can confirm that that issue has been raised in consultation and we are actively considering it now. We accept the importance of the midwifery profession and will look to reflect that in our final proposals.