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Mr. Nick St. Aubyn (Guildford): Even in my own West Surrey health authority area, the number of beds in the system has been cut by 25 per cent. since the Government came to power. If the investment is coming through, it follows some of the most savage cuts ever witnessed made in the shortest time on record.
Mr. Milburn: With due respect, the hon. Gentleman is on shaky ground. After all, over just 10 years, his party in government cut NHS beds by 40,000. This year, for the first time in 40 years, the number of NHS beds is growing. Indeed, during the next few years, that number will grow still more precisely because of the investment that we are making in the NHS--investment that the Conservative party still refuses to match. The biggest problem that the NHS faces is a shortage not of cash or even of the latest equipment or modern buildings, but of capacity.
Dr. Peter Brand (Isle of Wight): Does not the Secretary of State recognise that there is still a shortage of cash as a result of the Government accepting two years of Tory spending plans? A lot of the extra spending goes to meet previous deficits. I hope that I can share his optimism that, a year from now, we shall see some real outputs, but the majority of health authorities are still in debt.
Mr. Milburn: That is not the case. I can tell the hon. Gentleman, who is normally more assiduous on such issues, that this year, for the first time in seven or eight years, the NHS overall will balance its books. The extra money does not go to paying off debts. It goes on new hospitals, new primary care premises, extra pay for nurses and doctors and more doctors, nurses, therapists and scientists.
The Liberal Democrats tell us that not enough money is going to the NHS, but at the previous general election they promised a meagre increase of only £700 million a year, which is dwarfed by the amount that we have invested. The Liberals are in danger of becoming the Oliver Twists of modern party politics--they always beg for more and nothing is ever enough. They always want to spend money that they do not have.
The problem in the NHS is not so much a shortage of cash as a shortage of capacity and of trained qualified staff--doctors, nurses, midwives, therapists and scientists--who have the skills on which NHS patients depend. Those staff are the best asset of the NHS and the NHS simply needs more of them. Here, we have made a start.
There are 17,000 more nurses working in the NHS than when we came to office. There are 6,700 more doctors, but we need to do much more. The NHS is still short of doctors, nurses and other qualified staff. The NHS plan, which we published last year, sets out our ambition to have by 2004--compared with the 1999 position--20,000 more nurses, 7,500 more consultants and at least 2,000 more general practitioners working for the health service.
Last week, my right hon. Friend the Chancellor outlined a new £135 million fund to help us to achieve those ambitious plans for staff expansion in the NHS.
Today, I can give the House the details of how we shall deploy those extra resources. I begin with nurses, who are the backbone of our health service. From this Government, they get the recognition and, indeed, the pay rises that they deserve--pay rises paid in full rather than staged. There is extra pay, too, of up to £1,000 in those parts of the country where shortages are greatest and the cost of living highest.
Mr. Michael Fallon (Sevenoaks): Will the Secretary of State reconsider the criterion for his cost-of-living supplement, which classifies the whole of west Kent--including high-cost areas in Sevenoaks and Tunbridge Wells--as not eligible, while towns much further away, such as Swindon and Portsmouth, seem to qualify?
Mr. Milburn: Of course that issue, which the hon. Gentleman has raised with me before, is one that we keep under review. This is the first year in which there will be an increase in the cost-of-living supplement, targeting extra money on areas where we know that, for a variety of reasons--largely to do with property prices--the cost of living is highest. We will continue to keep the matter under review, and I am aware of the representations made by him and, indeed, many of my hon. Friends about the situation in Kent.
Not every nurse shortage problem has been solved, but progress has been made. Under the present Government--but not under the last--nurse numbers have risen every year: they have risen by more than 6,000 in the last 12 months alone. Nurse training places, which were cut in the last Parliament--incidentally, at precisely the time when the right hon. Member for Kensington and Chelsea had his fingers on the purse strings--have risen under this Government. Training places are up by 36 per cent., and there has been a 56 per cent. increase in United Kingdom applicants for nursing and midwifery courses.
There is more that we can now do. We will take three steps. The first relates to nurses who are considering returning to work in the NHS. In the last two years, more than 7,000 nurses who left the health service have rejoined it. Many may not have been in nursing for many years, and may need training to get them up to speed with modern practice. Return-to-work courses last an average of 12 weeks. Currently, there is no direct financial support for nurses during that period of retraining; that is a significant disincentive, which I intend to remove. From next month I will introduce a new payment for nurses, midwives and other health professionals who are retraining for a return to work in the NHS. Each payment will be worth at least £1,000. We will consult nursing and other unions on how best to make the new payments work.
Secondly, there will be more help for nurses with child care responsibilities. About 50 per cent. of nurses have children, and many find it difficult to combine their family and work responsibilities. In the NHS plan, we committed ourselves to spending more than £30 million by 2004 to provide more child care, including 100 on-site nurseries. Today I intend to go further: I will increase spending by half--by £15 million--over the next two years, to provide a further 50 new NHS nurseries. I can confirm that no new NHS hospital development will get the go-ahead unless it contains plans for such a workplace nursery.
Thirdly, we will increase the incomes of student nurses, midwives and therapists. For much of the 1990s, the student bursary was frozen; in the last three years we have increased it. Each of the 50,000 students currently studying for a nursing diploma now receives £4,805 a year.
Student nurses are crucial to the future of the health service. One in six currently give up a course before completing it, and that must change. Student nurses deserve more than they are getting now. I can announce that, from September, each student nurse studying for a diploma will receive a £500 bursary increase. That is a 10.4 per cent. rise, and it will extend to all NHS-funded students studying for degrees. It is the biggest increase since the bursary was introduced in 1989.
Let me say something about family doctors. General practitioners do a brilliant job for the NHS. They are working under real pressure; we have shortages of GPs, and we need more of them. Under the last Government, GP training numbers fell by more than 20 per cent., which has cost the NHS more than 700 family doctors. After big reductions in the number of GP registrars in the mid-1990s, their numbers have risen by more than a quarter.
In the NHS plan, we said that we wanted to increase GP numbers by at least 2,000 by 2004. We have already taken action to improve both recruitment and retention, but today I can go further still.
First, we want to retain GPs in the NHS. So today I can announce that GPs who continue working in the NHS beyond 60 will receive a golden thank-you payment on their 65th birthday as an incentive to remain in general practice. On their 60th birthday, £10,000 will be set aside. On their retirement, they will receive the lump sum plus interest.
Secondly, many family doctors have left general practice but could be persuaded to return--[Interruption.] Even the hon. Member for Isle of Wight (Dr. Brand) might be persuaded. With the prospect of a general election around the corner, he should think about it. It might be a good career opportunity for him.
The improvements that we have already made to the GP retainer scheme have enabled more than 1,000 GPs, mainly women, to keep in touch with practice. I intend to do more. From next month, I propose to pay up to £5,000 to GPs on the scheme who return to a permanent post, either full-time or part-time, in the health service.
Thirdly, I want to deal with the imbalance between the supply of GPs and the health needs of the poorer parts of the country. The Government are determined to tackle the health inequalities that scar our nation. We have set new demanding targets to help us do so. Currently, the areas with the greatest health needs often have the lowest numbers of family doctors. The introduction of the new personal medical services contract is of course helping to deal with that historic problem.
Today, we can take another step. From next month, we shall make payments of £5,000 to every new GP who chooses to practise in an under-doctored or deprived area for at least three years. Places that will benefit include Barnsley, Brighton, Bristol and Birmingham. The new incentives will be good for family doctors, good for the
health service and, above all else, good for families in those parts of the country where, for too long, there have been shortages of GPs.Our country as a whole is short of family doctors. So today I am making available extra funding for training GPs and for supporting newly qualified GPs in all parts of the country. There is one further step that I want to take to make general practice a more attractive career for young doctors. I have already announced the £5,000 extra for GPs who choose to work in deprived areas. I can also announce that, wherever they work, in any area, north or south, rich or poor, every new family doctor will receive a £5,000 payment for working in general practice in the health service.
Details will be discussed with GP representatives, but the package that I have been able to announce today will involve new GPs in all parts of the country receiving £5,000, with new GPs in the poorest parts of the country receiving a total of £10,000. Those measures are an important recognition of the work that family doctors do and the need to make their careers more rewarding.
The measures that I have taken today--for nurses, midwives, therapists and GPs--will help to expand the numbers of those key staff working in the health service. In the next few years, the measures will help to bring more family doctors than ever before, and an average of 5,000 extra nurses per year, into the NHS. Consequently, patients will receive better, faster treatment.
As a Government, we can make that investment because of the choices that we have made. As the Budget makes clear, our choice is for economic stability, for targeted tax cuts that are affordable and for extra investment in our key public services. As announced in the Budget, spending growth will now average not the 3.4 per cent. annually that was promised in the spending review, but 3.7 per cent. annually in the next three years. That investment is targeted at our priorities: health, education, transport and the fight against crime.
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