1. Dr. Richard Taylor (Wyre Forest) (Ind): If he will make a statement on the ranges of expenditure in 200102 by (a) acute trusts and (b) primary care trusts on salaries to non-NHS nurses, midwives and health visitors. 
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): Expenditure on non-NHS nurses, midwives and health visitors by NHS trusts in 200102 ranged from nil to £17.7 million, with an average of £2.1 million. The range for PCTs was nil to £2.1 million, with an average of £150,000.
Dr. Taylor : Does the Minister agree that a high spend on agency nurses carries with it a possible adverse effect on the continuity of care, and therefore on the standard of care? Is it not therefore unwise to have included in the list of trusts for foundation status the two with the highest spend on non-NHS or agency nurses?
Miss Johnson: It is also a matter for the NHS to supply more staff itself. We are therefore working to reduce the costs involved, and to increase the role of NHS professionals in this regard. Currently about 40 per cent. of trusts are involved, and many more may see the advantage both to standards of care, as the hon. Member for Wyre Forest (Dr. Taylor) says, and to the cost benefits of using NHS professionals in future.
Mrs. Alice Mahon (Halifax) (Lab): On the question of agency midwives, there is a shortage of NHS midwives across the country. Will my hon. Friend consider the suggestion from the Royal College of Midwives to
Miss Johnson: I agree that it is important that there should be more midwives, and I recognise that there are still needs in that area of the NHS. Lively discussions are taking place on the arrangements in further and higher education, and perhaps it would be best to get through those discussions before we move on to the suggestions that my hon. Friend has made. We will, however, bear them in mind when considering future developments.
Mr. David Tredinnick (Bosworth) (Con): Does the Minister agree that it is not only expenditure on health visitors and midwives that we should be looking at? We should also consider expenditure on a whole range of integrated health care services, given that 75 per cent. of the population want a wider range of services, including herbal medicine, acupuncture, osteopathy and chiropractic, which is effectively in the mainstream now. What is the Minister doing to ensure that, in this new world of greater consultation, she is listening to what the patients want?
Miss Johnson: I hope that the hon. Gentleman will accept that it is also important to see big increases in expenditure and doctors in the NHS as well as recognising a wider role for other services. I am sure that he will want to congratulate staff in his own constituency, where there have been big increases in numbers and in the projects that have been built in the acute sector, along with the completion of new hospital facilities. We all owe NHS staff many thanks for the work that they do.
On the hon. Gentleman's wider question, of course it is important that other facilities should be offered to patients, but I am sure that he would agree that the 23 NHS-run treatment centres, the two independent sector centres and the 42 walk-in centreswhich are a noveltyare also an important part of the development. We see a lot of development taking place in primary care as well as in the acute sector, and I hope that he recognises the advantage of that.
Mr. John Baron (Billericay) (Con): The Minister will be aware that last year, for the first time, more than half the new entrants to the nursing work force were from overseas. The Government will also be aware that their own code of practice on ethical recruitment, although adhered to by NHS trusts, has not been signed up to by all the agencies that the NHS uses to recruit nurses from overseas, and that, partly as a consequence of that, Britain has taken about 7,000 nurses from South Africa since Nelson Mandela first pleaded with us in 1997 not to do so. If the Minister accepts that poor countries need their nurses even more than we do, and given the current reliance on agency nurses in the NHS, when will the Government stop poaching nurses from developing countries and ban the NHS from dealing with agencies that do not sign up to their own rules?
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): The number of speech and language therapists employed in the national health service has increased by 22 per cent. since 1997, and the number of people in training has increased by 31 per cent. since 19992000. These are significant improvements on the very difficult position that the Government inherited, and we are driving further improvements by encouraging service re-design, by developing joint working between health and education, and by developing the roles of support staff to make the best use of professional skills.
Angela Watkinson : I thank the Minister for that reply, but he may be interested to know that the Barking and Dagenham primary care trust has found it impossible to recruit speech therapists for a number of years, so it is quite unable to meet the demand. What hope can he extend to my constituents Mr. and Mrs. Handley for their son Ross, and Mr. and Mrs. Mee for their daughter Courtenay? Their children are simply not receiving the speech therapy that they so desperately need.
Dr. Ladyman: I should point out that although Barking and Dagenham may currently be having problemsI would be the first to admit that things are not yet as good as I would like them to bethe situation is a lot better than it was in 1997, thanks to the fact that there are now 1,090 more speech therapists working in this country, and thanks to the 32 per cent. increase in training places. As a result, there is hope that the hon. Lady's constituents will, in future, be able to find the speech and language therapy that they need.
John Cryer (Hornchurch) (Lab): I represent a constituency in the London borough of Haveringthe same borough as the hon. Member for Upminster (Angela Watkinson). It is true that there is a shortage of speech therapists going back some years, particularly in outer London. That shortage is certainly connected to the high cost of living in the south-east. I recognise what my hon. Friend says about the increase in training provision and in the number of speech therapists, but can something be done to address this specific problem in the south-east, where the cost of living affects the recruitment of speech therapists?
Dr. Ladyman: My hon. Friend has made a very constructive suggestion that the local primary care trust certainly needs to explore. We are looking at service design and at different ways of working to improve the efficiency with which we use speech and language
Mr. Boris Johnson (Henley) (Con): Speech therapy is among the many services provided by the head injuries unit at the Townlands hospital, in Henley. How is it possible, at a time when this Government are allegedly pumping umpteen billions into the NHS, that it should be seriously contemplated that that hospital close? Will the Minister do everything in his power to live up to his Government's promises and stop the closure of this valued and much-loved local hospital?
Dr. Ladyman: The reconfiguration of hospital services, as the hon. Gentleman perfectly well knows, is a matter for local decision. We have devolved these matters to local areas so that local people can be involved in local decisions. If I were in a position to ask the hon. Gentleman the sort of question that he has just asked me, I would ask him how many speech and language therapists there would be if we carried out his plans to cut spending by 20 per cent.