---

David Taylor (North-West Leicestershire) (Lab/Co-op): The hon. Gentleman seems to be tip-toeing around the most important figures, which are performance indicators in respect of nursing. At the moment, the number of nurses employed within the NHS is heading rapidly towards 400,000—an increase of almost a quarter since 1 May 1997. Is it not the case that, when the hon. Gentleman was wringing his hands in Westminster Hall at the plight of nursing, the
 
22 Jun 2004 : Column 1268
 
Government were ringing the advertising agencies to recruit even more of that valuable resource to our prized national health service?

Mr. Lansley: The hon. Gentleman is trying to make a partisan point—[Interruption.] These are the Houses of Parliament and it is our responsibility to promote the interests of the NHS. What I am doing now is promoting the national health service's interest in recruiting and retaining more nurses. It will be good if we can reach 400,000 nurses. Why not? It will be one of the benefits of introducing the changes that I sought to encourage in "Agenda for Change", but we cannot do so simply on the basis of overseas recruitment. The Royal College of Nursing made it clear that 10,000 people from third-world nations registered to work as nurses in the UK over the two years leading up to 2002–03 and that many of them came from the Philippines, South Africa and India, but argued that it was unsustainable for us to deprive developing countries of that number of nurses when they were trying to meet their own health care needs.

Mr. Henry Bellingham (North-West Norfolk) (Con): My hon. Friend will be aware that the Queen Elizabeth hospital in my constituency, which also serves the constituents of my right hon. Friend the Member for South-West Norfolk (Mrs. Shephard), has embarked on a policy of recruiting a large number of Philippino nurses. They make excellent nurses, but, as my hon. Friend rightly says, that policy is not sustainable, which is why we need much more focus on retention and far more imagination on the part of the Government in their attempts to retain hard-working nurses who are leaving the NHS.

Mr. Lansley: My hon. Friend makes a very good point. He is absolutely right. He and I know—as do Government Members—that when recruitment from the Philippines was first taking place, it was done in conjunction with the Philippines Government on the basis that their nurses were so good. That has been my own experience in hospitals in my constituency. They make extremely good nurses. I was talking the other day to the chief executive of another hospital, who endorsed that view. However, there comes a point at which our recruitment from such countries simply cannot go on.

I want to make some progress and we have only a couple of hours. I want to continue and finish my speech, but I also want other hon. Members to have the opportunity to contribute.

I should say more about "Agenda for Change". I recall talking to hospital nurses who were engaged in the process of preparing for that agenda, and I know the enormous effort that was required. It was a valuable effort, but they were working to a definite timetable. When I spoke to them—in late April, if I remember correctly—they believed that they were aiming for October. I can only endorse what amounts to deep irritation on the part of the RCN, which is putting in so much effort to implement "Agenda for Change" for the nursing profession, that the Secretary of State told its conference that the Government were aiming for October but put the date back to December only a few days later. I hope that we will hear why that was necessary and what can be done to offset the very demoralising effect on nurses.
 
22 Jun 2004 : Column 1269
 

On consultant contracts, every consultant that I have spoken to believes that the Government operated on the basis that consultants were skiving off in order to go out on to the golf course. I do not believe that that is so. I do not suppose that Ministers believe that it is, but that is what consultants think. They also think that the proposal is being implemented in a way that is completely mad.

Consultants' job plans show that, on average, each does about 12.5 programmed activities a week. Hospitals are supposed to get 10.8 programmed activities, but the primary care trusts are not necessarily passing them through. Perhaps the Minister will tell the House how many PCTs pass through the money that the Department says it has given them for the contract. In any case, consultants are as a result being constrained to 11 programmed activities a week, or even only 10. The contract will mean that consultants will be paid more to do less.

Alternatively, consultants will not sign the contract. Their attitude will be, "If the Government are going to treat me as though I were a production-line worker, that is how I will behave." If consultants have to clock on and clock off, they will behave accordingly. That is not good enough.

In an Opposition day debate a short while ago, I asked the Minister about implementing contracts for staff and associated specialists. Happily, he has made it clear that contracts should now begin to be negotiated, but how soon will that happen? The conclusion reached by the pay review body has demoralised staff and associated specialists. They were linked to the consultants who are not signing up to the new contract, and they are therefore not due to get any substantial increase.

GPs believe that the contract has been designed to reduce their work load. I do not quite see it that way, and it would be interesting to know whether the Minister does. It seemed to me that the aim was to enable GPs to manage their work more effectively and to use a range of specialists to do so, in a framework that delivered better care to people with chronic diseases. I hope that GPs will see the contract in those terms, but communication with them has been too ineffective for that to be the case.

I am seriously worried about the extent to which NHS Direct seems to be gearing up to take over responsibility for out-of-hours services. The result will be that those services will no longer be GP-led, but will be delivered by NHS Direct. The Secretary of State is supposed to be reviewing NHS Direct, among other bodies. However, the advertisements that are now appearing show that it is looking for a chief operating officer and a medical director, as well as directors of finance, service development, nursing, corporate affairs and communications, human resources and of information and communications technology. It is all expansion in NHS Direct at the moment. A reading of the Estates Gazette shows that, across the country, NHS Direct is buying twice the amount of space that it has already in order to accommodate its new size. That shows where growth is taking place in the NHS, although it may be happening nowhere else.
 
22 Jun 2004 : Column 1270
 

I turn now to some specific specialities. People in the NHS understand that we must know where the constraints are before we can deliver a better service. For example, we need twice as many neurologists as we have at present. Relative to population size, we have a quarter as many neurologists as France has. We need to double the number available here if we are to meet National Institute for Clinical Excellence guidelines on multiple sclerosis, or on the standard of care required for Parkinson's disease.

On radiology, 80 per cent. of hospitals covered by the recent National Audit Office report cited lack of skilled staff as a constraint. Vacancy rates for diagnostic and therapeutic radiographers have risen.

Since 1996, the number of midwives has risen by only 186, which severely constrains our ability to provide the necessary choice to people seeking maternity care. For example, some hospitals—one of them is in my constituency—cannot provide a midwife-led unit simply because they cannot recruit the number of midwives needed.

The Minister of State, Department of Health (Mr. John Hutton): The hon. Gentleman just said that we needed twice as many neurologists in the NHS. I understand from The Independent and other newspapers that the proposals that he is about to announce mean that there would be no national targets for the NHS—including work force targets. Will the hon. Gentleman explain that contradiction?

Mr. Lansley: Yes I will, and I am grateful for the question. Our proposals for the care of people with multiple sclerosis or Parkinson's disease, for instance, are based on NICE guidelines. The NICE guidelines for multiple sclerosis were published last November. At the moment, NICE produces guidelines, but no one is under a requirement to implement them. We need at the same time to see where the capacity constraints will be. That includes things like diagnosis. But then it will be the responsibility of primary care trusts to commission that care. This is not elective surgery; this is chronic disease management.

Dr. John Reid: So there will be no targets?

Mr. Lansley: No, there will be a responsibility to commission care. If hospitals know that they have commissioners seeking the delivery of a service to a standard, they can put in place the necessary consultant posts.

---