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Agency Nurses

3. Tom Brake (Carshalton and Wallington): If he will make a statement on the use of agency nurses within the NHS. [19657]

The Minister of State, Department of Health (Mr. John Hutton): We are taking action to ensure that the use of agency nurses represents good value for money and the highest possible standards of patient care. NHS Professionals will, by April 2003, provide a comprehensive and cost-effective service for all NHS trusts. The London agency project will also offer a better value for money service for the NHS in London.

Tom Brake: The Minister will be aware that, in 2000–01, 574 per cent. more was spent on agency nurses than had been budgeted for, which works out at £6 million per trust. Will he explain how many more permanent nursing staff he expects to be recruited and retained as a result of his initiative? Permanent staff are needed for continuity, and that is what patients want.

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Mr. Hutton: I agree with the hon. Gentleman's point. London has historically had a very high dependency on agency nursing, and we need to tackle that problem. We can do so in two ways. First, we can increase the number of whole-time equivalent nurses working in the NHS in London. We are making good progress on that. In fact, there are more whole-time equivalent nurses working in the Croydon health authority and in the Merton, Sutton and Wandsworth health authority this year than there were in September 1996. That is progress, and I hope that the hon. Gentleman welcomes it.

Secondly, we can tackle the problem in the way that I have outlined through the development of NHS Professionals. Three trusts in London use the NHS Professionals service now, but by April 2003, it will cover them all. The London agency project will also ensure better value for money and offer the possibility of significant savings. We now have 29 commercial agencies contracting with the NHS in areas of shortage such as accident and emergency, operating theatres and critical care. The hon. Gentleman is right that we need to tackle this problem, and this is the right way to go about it. I think that the means that I have described will provide the solution.

Andrew Mackinlay (Thurrock): What measures are in hand to ensure the tracking and recording of agency staff, bearing it in mind that recent police investigations have been hampered by the fact that some trusts have been unable to demonstrate who they employed, when and in what circumstances? Is this not indicative of the nonsense of using agency staff? What is being done to contain, control and record them, and to provide a historical record to enable us to see who has been hired in the past?

Mr. Hutton: I strongly agree with my hon. Friend on that point. Again, there are two ways for us to make progress on the problem. From next April, for the first time, the National Care Standards Commission will set new national minimum standards for nursing agencies, which will cover precisely the issue that he raised. There is also the possibility of dealing with these issues through NHS Professionals, which will be the in-house agency that deals with temporary staffing solutions, and which will tackle precisely this issue. Many concerns have been raised about inappropriately trained staff working in environments in which they clearly should not be working, and we will not tolerate that.

Mrs. Marion Roe (Broxbourne): Does the Minister accept that until the Labour Government make working in the national health service an attractive proposition, there will continue to be a shortage of nurses? Will he kindly tell the House how many nurses are expected to retire in the next five years, and how many are expected to be recruited from United Kingdom training courses?

Mr. Hutton: The hon. Lady is perfectly right that we need to make the NHS a more attractive place for people to work in, and that is precisely what we are doing. That is why 17,000 more nurses are working in the NHS this year than in the last year of the Conservative Government. We are making progress in all those areas. Clearly, nurses will retire from the service, but our commitment to recruit an extra 20,000 nurses will compensate for those who are leaving. We are talking about increasing the number of

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nurses available to people in the NHS, not cutting it. The hon. Lady would benefit from reflecting on the record of her party. One of its parting bequests was to cut the number of nurses in training for the NHS.


4. Lynne Jones (Birmingham, Selly Oak): If he will make a statement on how specialist HIV work will be protected and monitored under primary care trust commissioning. [19658]

The Minister of State, Department of Health (Jacqui Smith): For the year ahead primary care trusts must honour existing agreements, financial and otherwise, negotiated by regional specialised commissioning groups and current specialised service commissioners. Implementation of the sexual health and HIV strategy will include effective performance management through the use of, for example, information collected under the AIDS (Control) Act 1987.

Lynne Jones: As my hon. Friend will know, last year saw the greatest number of AIDS cases—or HIV infection cases—ever recorded. Many organisations, including the Birmingham-based charity Freshwinds, have said that the mainstreaming of HIV prevention work is premature. I know that health authorities will be commissioning the work for next year, but is there not a case for postponing the new arrangements at least until a review of the AIDS (Control) Act reports has been conducted, and robust measures are in place to identify instances in which primary care trusts are not taking their responsibilities seriously enough and are not catering for the needs of vulnerable groups such as gay men and asylum seekers?

Jacqui Smith: My hon. Friend is right to mention the large number of new HIV infections identified in the past year. One reason may well be the increase in antenatal testing, which I am sure we all agree is very important. The reflection of that in higher figures for infection enables us subsequently to treat the women involved to make it less likely that the infection is passed to their children.

My hon. Friend underlined the need to monitor what is produced in the system. We should aim for a system in which more services are commissioned at PCT level, because that will allow more flexibility and responsiveness in decisions about the delivery of local treatment and care. We need to ensure that the targets identified in, for example, the sexual health and HIV strategy—which include a 25 per cent. reduction in new HIV infections by 2007—are monitored. As we move to a locally responsive system, it must be ensured that we deliver on those targets.

Mr. Peter Viggers (Gosport): Can it really be true that, as stated in a parliamentary answer to me, the national health service is recruiting HIV-positive nurses from sub-Saharan Africa, and that that poses no health hazard?

Jacqui Smith: I do not know of the specific case to which the hon. Gentleman refers, but if he writes to me I will certainly respond. It is important for us to recruit

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people, from this country or from overseas, who both meet the necessary health requirements and can contribute to the national health service.

Careful controls apply to those employed in our health service who may be HIV-positive. I do not think that raising particular cases is helpful in ensuring that we recruit the numbers that we require, or in avoiding stigmatising people with HIV while making certain that NHS patients have the necessary protection.

Mr. Neil Gerrard (Walthamstow): As the Minister knows, the AIDS (Control) Act requires health authorities to report on the use of the ring-fenced budget. Does she accept that, given that health authorities in their present form will disappear—along with that ring-fenced budget—we need to get on with reviewing the Act, so that when the budgets go to primary care trusts there will be a mechanism to track what they are doing and establish whether they are spending effectively?

Jacqui Smith: It is true that the Act currently requires health authorities to report annually not just on the spending of their money but on the number of new infections, treatment provided and investment in HIV prevention work. In April 2002, the requirement will pass from health authorities to PCTs, so we can go on monitoring that activity.

My hon. Friend is also right that we should review the operation of the Act to ensure that we have information, not just locally but nationally, to enable us to measure the outcomes of investment in the tackling of HIV, and our success in lowering levels of infection.

Sandra Gidley (Romsey): Traditionally, health authorities have been allocated money for prevention and money for treatment and cure. Everybody must get the prevention message across when the budget effectively goes into the primary care trust pot, but the incidence of HIV varies around the country. It is low in my area, but extremely high in parts of London. Will areas with a high incidence be vired more money to cope with the larger problem or will they be expected to manage on the existing budget?

Jacqui Smith: No, a revised allocation formula was developed to ensure that PCTs receive a share of funds in line with the number of residents with HIV receiving treatment in their boundaries. That will be incorporated as a component of the unified formula to ensure that money is distributed to the areas that need it for treatment.

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