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Miss Begg: I am very pleased with what the Minister has said, particularly his assurance that one Department will take responsibility for the issue that I raised. I hope that we will be able to come up with a definition, although it will be difficult, so that we can legislate not only on schemes such as Women Empowering Women but on the whole range of such scams, which are outrageous and must be outlawed. I thank my right hon. Friend very much for his response.
We believe that we have conceded every point, including the one about doubling the roll-over, made by society lotteries in their submission to the Select Committee. We believe that our actions will not damage the national lottery. If lotteries are to serve their useful purpose for good causes, we must strike a balance. There is no doubt that society lotteries do an tremendous amount of good, and that is why we regulated to allow them to move in the direction that they wanted.
The problem is that we are not beginning with a clean sheet. There are already 120 casinos operating in this country, so it will be extremely difficult to apportion development opportunities. The Department has received several representations on the subject, and I am prepared to revisit it. However, we will take a lot of convincing to move away from the position set out in the White Paper and the consultation document. We have gone a long way towards assisting development, which is very important to Blackpool and other areas, and we are introducing other measures, such as hypothecation in the business improvement tax, which is the responsibility of the Office of the Deputy Prime Minister.
There is also the question of land use planning. If we bring all the factors together, we can involve the private sector and, at the end of the day, there will be a judgment as to whether the private sector wants to get involved. Putting in pilot schemes and giving special favours to certain areas is a dangerous course to follow. We have not closed the door on that issue and we are prepared to listen, but we would want some persuading before we moved away from the position in the White Paper.
Mr. Gordon Marsden: I well understand the concerns that my right hon. Friend the Minister expressed on pilots, but will he reflect on the fact that an advantage of the pilot is not necessarily that it confers a commercial advantage on one particular resort casino, but that it enables various issues and concerns to be trialled and met before the scheme is rolled out generally?
Mr. Caborn: I understand that argument, but there is also the question of special pleading. One must be careful in achieving a balance and in making changes in legislation. There is special pleading from the casinos and from others who want to protect their current position. If we look at previous legislation, we find that it was restrictive and gave some people comfortable and privileged positions for a good number of years. People tend to defend privileged positions very strongly and there are vested interests to take into account.
It would be difficult to justify pilot schemes, even by the criteria that my hon. Friend has put forward eloquently. I am bound to say that, to some extent, that falls into the category of special pleading. Nevertheless, we will revisit this matter and we are open to discussion. However, we would want some convincing before moving from the position as set out in the White Paper.
My officials will look at Hansard and if there are points that I have not dealt with, I will come back to them. If we have not done so in the next two or three weeks, hon. Members should contact my Department for full answers to their questions.
Vera Baird (Redcar): At the last election, we pledged that 20,000 nurses would be recruited to the national health service by 2004. The biggest constraint, we said, facing the NHS was no longer financial resources but human resources. Consequently, the Government have since deployed a highly successful recruitment campaign to get new nurses into the NHS.
At Redcar and Cleveland college in my constituency, there is an access to nursing course. It is an intensive course, and takes a year. Successful students receive a level 3 qualification, enabling them to seek university experience. Redcar and Cleveland is a highly successful college, and led by its respected principal, Mr. Old, it has concentrated efforts on widening access to further and higher eduction.
The Redcar constituency is in Teesside and suffered for generations from post-industrial decay, inner-urban poverty and social deprivation. It has the well recognised health inequalities that go with that total picture. Unemployment is 7.6 per cent., or more than twice the national average. Clearly, Mr. Old and the college's efforts, and those of his staff in widening access, are particularly appropriate.
Last year many people who enrolled in the access to nursing course were women over 21, and many were single parents. They were benefiting from the new deal for single parents, which was aimed at getting exactly this target group into work. Their tuition fees are paid, as are their fares. They get some extra benefit and a book allowance.
In addition, such students make the most enormous personal effort. Many of them have been out of education for a decade. Many did not do particularly well or make much effort when they were at school. They will not have seen themselves as studious, nor even, in Redcar, as people who would ever have a job, let alone a profession. Many will have started the course with real excitement but with real doubt as to whether they could make it. If they had children, they had to juggle the role of parents with entry into the unfamiliar and daunting world of study.
The college is good at student support, and 36 students passed. Historically, 80 per cent. of the successful students on Redcar and Cleveland's nursing course have gone on to complete their nursing training, principally on the nursing courses at Teesside university. This year, only five of the 36 got a university place to carry on their training to become nurses. There are universities further afield, but there are at least 50 miles to travel in each direction, and the Redcar and Cleveland college intake mainly comprises people who need to study locally because of family commitments. As part of the "making a difference" programme, the courses at Teesside university were designed to be exceptionally family friendly. Its nursing diploma and degree courses are very good and highly sought after; they are graded "excellent in quality" by the Department of Health.
Oddly, in the context of the continuing campaign for nursing recruitment, the university was given no extra funding this year to increase its number of places. There are 401 places on the nursing training course this year, just as there were last year. Both the director and the deputy director of the school of health and social care tell me that although they have to be innovative with clinical placements, they could never take all the applicantsbut they could increase their places by another 50 a year. It is startling that funding for expansion of this high-quality course, in an area of highly successful recruitment of a target group into training, in a place of high unemployment with a shortage of nurses, has just stopped.
Health care assistants are an excellent source of recruitment to nursing. As trust employees, they already have a good insight into the role of the nurse, so wastage is very low. Often, the employee does the practical part of their training with the home trust, so the local rewards are reaped early in the training process and the benefit is likely to be permanent. Tracey Christon is a health care assistant. She is a 28-year-old Redcar resident, a single parent with one little girl. She has worked at East Cleveland community hospital for 10 years. She is very good, and almost as soon as she went there her ward manager told her that she would make a good nurse. Tracey felt too young at 18 to be sure what she wanted to do, but by three years ago she had decided. She studied for national vocational qualifications and quickly got to level 3. She was rightly encouraged, in all good faith, by her ward manager and by Lanbaurgh primary care trust, her employer. She was told that if she got a place at university, she could be seconded on her salary to train, then come back to work as a nurse.
This year, Tracey got a place at Teesside university on the nursing diploma course. But four health care assistants applied for secondment from Lanbaurgh PCT, and only two secondments were available. Tracey was not offered a secondment. Neither was another applicant, not a constituent of mine, but no doubt just as distressed, feeling just as rejected and feeling, too, that the whole nursing recruitment campaign had misled them. The chief executive of the Lanbaurgh PCT tells me that if he could have four secondments, he would definitely want them. He clearly has faith that all four of his employees should be advancing their careers exactly as they wish.
In Middlesbrough and Eston PCT, the other PCT in my constituency, there is an urgent need for practice nurses for GP practices. There are eight secondments for those in Tees this year. The area has at least three PCTs. The chief executive of the Middlesbrough trust tells me that he would like to have all eight for his own trust, so critical is the need for practice nursing training.
Teesside has a shortage of nurses. It is an acute problem because, as I have said, in common with other socially deprived areas, it has considerable health inequalities. As at 30 March, the South Tees trust had whole-time equivalent vacancies of 50.6 nurses. Tees and North Yorkshire, which has been succeeded, save for the mental health functions of the two local PCTs that I have mentioned, has 27.2 whole-time vacancies. North Tees
FurtherI think that this is commonplacein particular in district and community care nursing, nurses are ageing. There is an estimate from the Royal College of Nursing that nationally a quarter of these nurses are due to retire in the next five years. I do not have any local figures for that.
South Tees has recently carried out a successful recruitment drive and brought 12 Spanish nurses over to work. Hartlepool has recruited some nurses from the Philippines. I appreciate the difference between recruiting qualified nurses for remedial work and recruiting for training. The university deputy director of the health and social care school tells me that it will continue to fail to meet local targets for training and recruitment if it does not recruit overseas.
I have no criticism of overseas nurses. If I have the good fortune to come across any of the new Spanish people who have moved into Redcar, I shall no doubt drive them out with my appalling south American Spanish. I shall try to persuade them to offer me paella. They will add real interest to the Teesside culture. However, we have high local unemployment. The context of a group of local people who are desperate to become nurses, of many nursing places that we are desperate to have filled, of insufficient funding for university places and insufficient secondments for health care assistance, suggests that some cogs are coming loose or even falling off the wheel of the machine in my area.
The County Durham and Tees Valley workforce development confederation plans the work force needs and supplies and commissions the education and training for all the health trusts in its area. I have spoken to two people from the confederation. They tell me that the transition from the old trusts to the new may have meant that historical data on demand for secondments have been mismatched. They say that the confederation has been a victim of its own success in recruiting among health care assistants. They say that all the health care assistant secondments in the confederation's area have already been taken up. They say that they will respond by looking elsewhere in the budget to see whether they can help Ms Christon.
The two representatives say that the confederation needs to become more sophisticated in meeting the demand. They say also that overall the confederation is meeting its targets, but they appreciate that there are areas in which that is not happening quickly enough. They make it plain that they too are working within a budget and have limited room for manoeuvre.
I am grateful to have received briefings after obtaining this debate from the RCN and from Unison, the health care assistants union, and also for the information that I have quoted which was given me by all the health care stakeholders to which I have referred.
I am not in a position to define whether the problem, and it is a local one, is one of too few resources or of inaccurate targeting. I do not know whether it is both or neither. However, I ask the Minister to give attention to this issue. There are a number of people in my constituency who have been thwarted in their ambition to serve the community in which they live as qualified nurses. They have been led to believe by our recruitment