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14 Nov 2002 : Column 182—continued

Mr. Dawson : What does the hon. Gentleman think of the commitment to clinical priority and need of a consultant who told one of my constituents that he could not perform his operation on the NHS for approximately 10 months but that he could fit him in in the next fortnight if he wanted it done privately? What would he say to the consultant heart surgeon who responded to a question from me about waiting lists by stating, XWe are dealing with more people, older people and sicker people than ever, with techniques that we were never able to use before."

Dr. Fox: The hon. Gentleman makes some important points. First, there will always be a difference between waiting times in a publicly funded service and those in a private service. That happens in every other country. The Secretary of State said today that the two sectors would continue to exist side by side. However, we should get proper value in the NHS for the consultant time for which we pay. All hon. Members would agree with that.

One problem, especially with cardiology, which the hon. Gentleman mentioned, is that management determines theatre time according to the maximum waiting time targets rather than according to clinical need, because funding depends on it. A reason for consultants' hostility to the Government's proposed contract is their fear that that trend will continue and worsen.

The hon. Gentleman made valid points, but the answers are much more complex than he suggests. Even if we accept the general points, pretending that a specific case is generic is typical of the Government's approach to health care.

The Government believe that they must always present the health care system in as rosy a light as possible. If they cannot distort what is happening, they change the presentation of the overall figures. One in eight hospital managers admits to distorting targets to fit the Government's NHS figures. One manager recently said:


What sort of ethics is that on which to run a system?

Let me cite another example. The Government knew that their target of 2,000 extra GPs by 2004 would not be met, and they therefore merged two targets. They now say that 15,000 new GPs and consultants will be in place by 2008.

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Delays for cancer treatment as opposed to diagnosis remain lengthy despite the Government's continual bragging. The number of patients who start radiotherapy within the Government's four-week target fell from 68 per cent. in 1998 to 32 per cent. in 2000.

Some Ministers are experts at breaking promises. For example, #50 million was promised for palliative care but only #4 million has reached the hospices. What is more, and worse, the Minister of State, who is not in his place, had the gall to launch the scheme in his constituency, but its hospice has not yet received any money.

The cumulative effect of centralisation, distortion and downright deception is shown in the plummeting morale of those who heroically work to keep the NHS running. The deprofessionalisation that they suffer is obvious in a growing crisis in the work force. For example, 24 per cent. of nurses on the UKCC register are over 50 and therefore eligible to retire soon. One third of all new entrants in 2001 were from outside the United Kingdom. NHS Professionals, which was set up to end the reliance on commercial nursing agencies, is in financial crisis, with up to #10 million in unpaid bills. It also relies on the very agencies that it was meant to replace.

The Royal College of Nursing claims


What about nurses who leave the UK? A total of 6,021 left in 2002. That is the largest number for 10 years. Most headed for Australia or New Zealand.

Despite a Government pledge to recruit 2,000 extra midwives by 2004, the number has fallen since the target was set. The Royal College of Midwives said that there are now 45 fewer midwives than when the Government set the target.

James Purnell (Stalybridge and Hyde): Is not the hon. Gentleman's problem his inability to say that he would match our spending? Will he deny the widely circulated rumour that he asked the shadow Chancellor for such a pledge in order to solve the problem, but that his request was turned down?

Dr. Fox: I would not discuss with the hon. Gentleman any confidential conversations that I held with my colleagues. On expenditure, we will set amounts that are appropriate to our plans. The Government have set expenditure that is appropriate to their plans. Clearly, they are not delivering. The hon. Gentleman falls into a common trap for Labour Members. They believe that simply throwing money at the problem will solve it. One cannot solve the problem of a lack of professional people by throwing money at it. People have to be attracted into the professions. Demoralisation throughout the NHS makes recruitment and retention more difficult.

If nurses are demoralised, let us consider consultants. They have become increasingly disillusioned by the restrictions on their clinical freedom, manipulation of waiting lists and the burden of red tape. Let me give one example. Professor Irving Taylor, professor of surgery at University college London listed the various bodies

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that assess, appraise and validate his performance and activity. Nationally, they are: the General Medical Council, the UK Council for Regulation of Healthcare Professionals, the National Clinical Assessment Authority, the National Care Standards Commission, the Commission for Health Improvement, the National Patient Safety Agency and the cancer accreditation teams.

The bodies in Professor Taylor's hospital are: the clinical governance committee, the continuing professional development committee, the professional advisory panel, the clinical audit committee, the annual consultant appraisal, the junior doctors' hours action teams, the pre-registration house officer and senior house reviews for postgraduate dean, and the specialist registrar review for postgraduate dean and Royal College of Surgeons.

The university organisations are: the internal quality assurance committee, the staff review and development committee, the annual university appraisal, the quality assurance agency, the research assessment exercise, the peer review of teaching and the research governance committee. Twenty-two different bodies examine his professional life. Yet the Government were going to cut red tape.

Glenda Jackson: I am intrigued by Conservative party policies. Does the hon. Gentleman argue that he could attract more professionals to the NHS by reducing the amount of money that they would be paid? Does he claim that he would increase professional standards through training? When the Conservative party was in office, it reduced training places for nurses and doctors. Is reducing wages and educational opportunities the way in which to attract more professionals and to increase competence?

Dr. Fox: The hon. Lady is making Conservative policies up; we will determine the genuine policies. We can attract people to any profession if they are given professional satisfaction, the freedom to value their vocation and are allowed to use the skills that they have developed without interference by someone who has little understanding of what they do well.

I shall give an example of the way in which to demoralise nurses. A nurse with whom I worked for a long time, and who must have performed thousands of ear syringings tells me that she now has a 12-page protocol for ear syringing. Someone else is trying to tell her how to do a job that she has performed for many years. That is the way in which to demoralise and fail to retain professional people. We have experienced the effects of deprofessionalising the teaching profession. Surely we do not want that to happen in the nursing and medical professions.

Mr. Dawson: Will the hon. Gentleman give way?

Dr. Fox: I have already given way to the hon. Gentleman.

One of the other problems is that consultants have had pressure put on them to remove the longest waiters from the list irrespective of clinical urgency, and that has been done by failing to treat an increasing number of people waiting for under six months, resulting in the bunching up described in the recent King's Fund report.

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Consultants were also outraged by the sheer clumsiness of the handling of the proposed new contract. In particular, they were upset by the Department of Health's presentation, which made it clear to them that management would use the new contract to instruct doctors what to do and which patients to see. That became a headline issue as a result of the infamous Xslide 9" of the Department of Health's presentation. Everyone in the profession talked about it. It was big news. It appeared in the medical press. Yet the day after the contract was rejected, the Secretary of State said that he had never heard of it. That makes him either the most clueless or the most disingenuous Secretary of State that we have had for a long time.

But if anyone thinks that we have problems with consultants, they should look at general practice. One of the biggest problems—


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