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Resolved,

That this House recognises that the all postal pilots in June 2004 were part of a process of testing alternative voting mechanisms for the benefit of making voting easier and more convenient for electors; further recognises that turnout in European elections had fallen to its lowest ever level in 1999 and that all postal pilots assisted in making the 2004 European election turnout the UK's highest ever; welcomes the fact that voter participation for the European elections in the pilot regions more than doubled in 2004 compared with 1999; believes that allegations of fraud have been reported disproportionately and that there is currently no evidence to show that all postal ballots are more susceptible to fraud than traditional elections; recognises that further reforms will be necessary to widen participation and engagement in the electoral system; and further believes that the integrity of elections and referendums, including the proposed referendums on elected regional assemblies, is adversely affected by declining turnout which puts in jeopardy the democratic mandate.

 
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NHS Recruitment and Retention

Mr. Deputy Speaker (Sir Michael Lord): I must tell the House that Mr. Speaker has selected the amendment in the name of the Prime Minister.

5.15 pm

Mr. Andrew Lansley (South Cambridgeshire) (Con): I beg to move,

That this House recognises the central role of NHS professionals in delivering high quality healthcare through the NHS; notes the need for substantial increases in NHS staffing to meet future demand for healthcare; further notes that the levels of bureaucracy, red tape and imposed targets within the NHS demoralise NHS staff; regrets the problems in the implementation of the consultant and GP contracts; further regrets the delay in progress on 'Agenda for Change'; expresses its concern over staff shortages in general practice, hospital specialties, nursing, especially community nursing, midwifery, radiography and biomedical sciences; is alarmed at the extent of recruitment of health professionals from developing countries which are unable to sustain the loss of such staff; and urges the Government to give the NHS the freedoms and incentives needed to support a growing workforce.

This week we will have a series of debates—some in this Chamber and some outside—on the national health service and health care in this country. I hope that we can start with a shared perspective, which is that no serious progress would be possible, however much we might wish it, however much we might invest in the national health service, however much we might introduce choice in the national health service, and however much we might introduce competition in the provision of the national health service, without the skill, hard work and commitment of NHS professionals and health care professionals generally.

Today is our chance to show that we value the work of NHS doctors, nurses and health care professionals generally. That matter is not something to which I have turned as part of my current Front-Bench responsibilities. I hope that the House will be aware, and I know that the Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton), is aware, that as a Back Bencher, I secured a debate in Westminster Hall in November 2002 on nursing and nurses' pay and conditions. That was the only debate on those subjects in this Parliament so far—the previous one was in 1999.

As a preface to our discussions, it is a pity that we do not debate more regularly pay and conditions, the prospects for recruitment and retention and the contribution made by NHS professionals to the NHS. One of the things that the Audit Commission's survey of NHS professionals made clear was the importance of the extent to which those professionals feel that they are valued by the Government and the public, and the fact that the lack of understanding that they are valued is one of the reasons why people leave the NHS. It is therefore right that we demonstrate that they are valued, that we do that together, and, although it may not be easy to achieve this afternoon, that we do it in a spirit of consensus.

There are 1.3 million staff in the NHS—they represent one in seven of all public sector employees and about one in 20 of the whole UK work force. It is vital that we discuss that work force. It is not a subject to which the Government have given time, so I hope that it will be
 
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recognised that it is right for the Opposition to give some of our time to understanding and reflecting on that work force.

We will need to discuss a number of issues, and I want to start, as I did previously, with nurses. The congress of the Royal College of Nursing met in early May—just over a month ago—and some information was presented on how nurses feel about the NHS. It was interesting to note, for example, that only 30 per cent. of nurses believed that the number of permanent nursing staff had increased over the past four years at their hospital. Clearly, something is not happening to make nurses perceive that the front-line resources are getting through. When we asked doctors the same question, two thirds said that they did not perceive that the resources that they heard were going into the NHS were getting to the front line. It is vital that they do see that happening.

Jonathan Shaw (Chatham and Aylesford) (Lab): The hon. Gentleman said that "we" asked doctors? Is that "we" the Conservative party?

Mr. Lansley: It was we, the Conservative party, who asked doctors. We did it through a reputable research company and published the results, so that seems perfectly reasonable to me.

On the issues relating to nursing, we know that during the past 10 years the average age of nurses has increased from 37 to 41. We know that half the rise in the number of nurses registered in the UK is the result of overseas recruitment, and there are issues about the sustainability—[Interruption.] If the Secretary of State has something that he wishes to tell us, no doubt he will intervene.

The Secretary of State for Health (Dr. John Reid): Yes, the hon. Gentleman mentioned the increase in age. A large number of nurses came back to work in the health service when they got a new Government who were putting in the investment, giving the support needed and increasing the number of nurses.

Mr. Lansley: I welcome the increase in the number of nurses. It is absolutely right that we should attract nurses back into the national health service. If the Secretary of State has read my speech from November 2002, he will know the precise reasons that I presented for that. I made it clear that Addenbrooke's, a major employer of nurses in my constituency, would need "Agenda for Change", that a reflection of the valuation of nurses should be considered by the pay review bodies—which the Government's evidence to the pay review bodies had not sufficiently reflected—and that Addenbrooke's would need to make changes such as improving working lives. Addenbrooke's is a model employer in the ways in which it has addressed the issues in improving working lives, such as non-discrimination, supporting staff, opposing harassment and putting together family-friendly policies and child-care arrangements for nurses. I do not dispute any of that. That is exactly where we want to go, but the Government should not believe that the overseas recruitment of nurses is a sustainable basis on which to undertake the expansion of the nursing work force in the NHS in years to come.
 
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Mr. Peter Pike (Burnley) (Lab): Will the hon. Gentleman recognise that prior to 1997—in my first 14 years in this House—I continually fought here and in my constituency against hospital closures, the reduction in the number of beds and massive cuts in the national health service, year after year? I cannot believe that the hon. Gentleman, in what he is now saying, fails to remember what his party did when in office.

Mr. Lansley: What the hon. Gentleman says is interesting. We are today talking about the work force, and also about what can be achieved in the NHS. We have had an increase in the number of nurses and in the number of doctors. It is interesting to note that under the previous Conservative Government, in the seven years leading up to 1997, the number of consultants in the NHS increased by 30 per cent. In the seven years since 1997, it has increased by 34 per cent., so to a large extent the trends in numbers of doctors have been very similar during those periods.

I will accept that matters in relation to nurses are different, but one of the problems with which the Secretary of State and his colleagues have wrestled—The Sunday Times illustrated this by its reporting of leaked documents from inside the Government—is what appears to be a substantial reduction in the productivity of the NHS. The Secretary of State knows that changes in working hours and in NHS structures have meant that although there has been a 14 per cent. increase in the number of nurses, on a whole-time equivalent basis, in recent years, we have had only a 5 per cent. increase in activity in the NHS.

On increase in activity, let us look at finished consultant episodes. The Minister of State has been good enough to respond to a question that I put on finished consultant episodes, which are a measure of in-patient activity in hospitals, and include day cases. Between 1990–91 and 1995–96, a five-year period before the 1997 election, there was an increase in finished consultant episodes from 8.8 million to 11.07 million—about 2.25 million additional finished consultant episodes. In the five years from 1997–98 to 2002–03, the number rose from 11.5 million to 12.76 million, an increase of 1.25 million episodes. So, over a five-year period, whereas there was an increase of 2.25 million under a Conservative Government during the period of the internal market reforms, there was an increase of 1.25 million under the present Government. That has resulted not from a reduction in the number of nurses—the numbers of nurses, consultants and doctors was increasing—but because, simply in order to stand still in the NHS in the light of all the additional impositions, changes in working hours and contractual arrangements, about 10 per cent. of the increase went into adjustment. The level of increased activity was, in fact, very small.

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