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Helen Jones: Does my right hon. Friend agree that when talking about NHS staff, in addition to doctors, nurses and associated therapists we should include the vast numbers of support staff, such as cleaners, health care assistants and porters, who offer the NHS a valuable service, whose chances at work have been vastly improved under this Government and whom the hon. Member for South Cambridgeshire (Mr. Lansley) failed even to mention?

Mr. Hutton: That is a telling point, as 0.25 million more people work for the NHS today than in 1997, and
 
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many of those jobs are in the support roles to which my hon. Friend referred. Not only are there more jobs, but a better training infrastructure is in place to support skills development, with individual learning accounts being properly invested in and supported by central Government for the first time.

We will know one thing for sure after today's debate. The Tories have no plans whatsoever for recruiting more doctors or nurses. We have set out our plans for recruiting more doctors and nurses up to 2008. What are their plans? They either do not have any—I suspect that that is the case—or they will not tell us. Why not? Do they plan to recruit more or fewer than we have set out? If they cannot answer any of these questions today, their attack on the Government's record can only be described as a mixture of pure opportunism and naked hypocrisy. The Opposition complain about staff shortages, but they have no plans whatever to address them. How utterly pathetic.

Despite the record increases in staff numbers and in staff training, it is still true that there are many skills shortages in parts of the NHS. There are several reasons for that. Some of the shortage is due to long-term historic under-investment, some of it is down to the fact that we are trying to expand our services and therefore our capacity as quickly as possible, and there is always a time lag between the investment that is made in training and staff development and that capacity becoming available to the NHS.

That is why we have recruited extra staff, particularly nursing staff, from other countries, but we have done so with a clear view of the importance of protecting the health care systems in developing countries. No other developed country has taken the steps that we have taken to ensure that international recruitment is conducted fairly and ethically. The code of conduct that we introduced in 2001 set out clear principles and priorities.

Only recruitment agencies that sign up to the code can be used by the NHS for international recruitment. More than 170 agencies have so far done so. When there is evidence that the code is not being complied with, we have taken action to remove those agencies from the approved list. The Department monitors compliance through data supplied by the international recruitment co-ordinators based in each strategic health authority. Two agencies have so far been removed from the list for non-compliance. I have arranged for a copy of the code to be placed in the Library.

We have sought Government-to-Government agreements on international recruitment with Indonesia, the Philippines, Spain and India. A separate agreement with South Africa was signed last year. That focused on creating opportunities for health care staff in both countries to undertake limited placements in each other's health care systems. I hope the first staff will begin their placements later this year.

We will recruit internationally only with the agreement of the host country, and we will always respect and act on its wishes. We have a clear view of which countries we will not recruit from. The list is based upon the Organisation for Economic Co-operation and Development development assistant committee's list of aid recipients and includes the vast majority of sub-Saharan countries.
 
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The World Health Assembly recognised the importance of this issue at its recent meeting in Geneva. There is an increasingly global aspect to the issue. The challenge for us is to manage international recruitment sensibly and in a way that affords health care staff the opportunity to improve their own skills. That is precisely what we want to see. That is why I was particularly pleased that the World Health Organisation expressed its support for the agreement that we reached with South Africa as a model for other countries to follow.

The code of practice has been in place for nearly three years. This is a good time to review its operation. My right hon. Friend the Secretary of State announced recently that we were looking at every aspect of the code to see how we could improve its effectiveness. I will keep the House informed of the progress of that review.

Laura Moffatt (Crawley) (Lab): Does my right hon. Friend accept that there have been even more benefits as a result of recruiting people to the NHS from other countries? It is right and proper to protect the health care systems of those nations, but the NHS has benefited from new experiences, new technologies and sharing those experiences. In my local group of hospitals, it has been a massively beneficial event, which we very much welcome.

Mr. Hutton: There is no doubt at all that overseas staff have made an immense contribution to the national health service for many years. I have seen many hospitals throughout the country, as I am sure other hon. Members have, where nurses from the Philippines, India and other countries continue to make a huge contribution. It is right and proper that we pay tribute to the work that they are doing.

Mr. Andrew Turner rose—

Mr. Hutton: I have been generous in giving way and I am conscious that others want to speak. I want to make progress now.

I was speaking about international recruitment. My question to the hon. Member for South Cambridgeshire is: what would he have done instead? What did his party do in office to deal with the same issues? The answer is nothing at all. Here again, his attack on our actions has all the hallmarks of expediency, not principle.

The hon. Member for Billericay (Mr. Baron) says that we should direct NHS trusts to comply with the NHS code of practice. That was his view in a letter to The Times. How does that square with the policy of the hon. Member for South Cambridgeshire—that Ministers should stop telling NHS trusts what to do all the time?

Clive Efford (Eltham) (Lab): Does my right hon. Friend agree that targets are a means by which the Government can set out where they intend to take the national health service? If the Opposition are not prepared to set targets, is that not an indication that they do not intend to deliver anything for the NHS except what we have seen in the past?

Mr. Hutton: My hon. Friend is absolutely right. I shall deal in my concluding remarks, which I hope are not too far away, with the place and role of targets in any sensibly managed public health care system.
 
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I believe that there are some fundamental inconsistencies in what the Opposition have been saying which serve only to highlight once again just how threadbare their arguments are. We are enforcing the code sensibly and with the least possible bureaucracy. I think that that is the right way of proceeding.

Of course, it is one thing to recruit staff—and we have an excellent record to be proud of—but another to retain them. If we are going to succeed, we need to offer attractive terms and conditions for all our staff. We intend to do that. That is what the new contracts for GPs and consultants and "Agenda for Change" are all designed to do. It is what our investment in extra child care and nursery places for NHS staff will help secure, and what new part-time, school-time and flexible working arrangements are designed to support.

The new arrangements for primary care that have been agreed as part of the national negotiations are now being successfully implemented. These new arrangements recognise that delivering primary medical care to patients is not the sole responsibility of a general practitioner, but the responsibility of a group of clinicians working together to cater for what can be the somewhat complex and individual needs of patients. That is why this is a new practice-based contract covering all primary medical care contractors—GPs, nurses, other health professionals and practice managers.

Let me remind the House of the benefits that the new contractual arrangements will bring to our constituents. This is a something-for-something deal in which primary care professionals are rewarded for the outcomes that they achieve, and not just for how many patients they treat, as has been the case in the past, and there are extra rewards for providing a quality service. The new contract provides an unprecedented level of investment in primary care to improve services to patients and revitalise general practice. As a direct result, UK expenditure on primary care will rise from just £6 billion in 2002–03 to £8 billion by next year—an increase of more than 33 per cent.

Some 99.9 per cent. of existing GP contractors signed the new general medical services contracts offered to them by their local primary care trusts in April. All practices have been paid on time, too; again, that is in direct contrast with what happened when the Opposition introduced their changes to the old GP contract in 1990, when GP practices experienced serious delays in receiving accurate payments. Primary care trusts are currently in the process of agreeing new locally enhanced contracts with practices, to deliver additional new services for patients in their area. That is all underpinned by a new minimum guaranteed spending level.

On the consultant contract, we have invested substantial extra resources—some £250 million more by 2005–06—to reward the NHS consultants who do most for the NHS and to secure real changes in the way in which patient care is delivered. The new contract is designed to provide over time a 15 per cent. increase in consultants' lifetime career earnings while improving basic starting salaries and ultimately having a corresponding impact on the value of their pensions. The new contract also provides a stronger, unambiguous framework of new obligations, with more consistent and equitable recognition for on-call duties
 
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and more effective job planning, based on a partnership approach, enabling consultants and employers to prioritise work better and to address excessive workloads.

Following the outcome of the British Medical Association's ballot last year, NHS trusts have been reviewing the job plans of more than 20,000 consultants. That was always going to take time, but by the beginning of this month, four out of every five consultants who expressed an interest in the contract had received their final job plan offers. More than a third have now accepted work under the new contract. Progress to date has been slower than I would have preferred, but I expect the figures to improve significantly over the next few weeks.

We are also making good progress on "Agenda for Change". As of 11 June, more than 70 per cent. of staff in "early implementer" sites have been matched to their new pay bands and, on average, just under half of all staff in those sites have moved on to the new pay system. In some trusts, that figure is as high as 98 per cent. National roll-out will begin on 1 December 2004 with the collective agreement of the NHS trade unions. It was originally envisaged that that would start in October. The delay was made primarily to allow some unions extra time for their second ballots to take place.

We remain fully committed to implementation of "Agenda for Change". We are clear about one thing: all the union members who have already voted for "Agenda for Change" will receive the improved terms and conditions that will go with it from 1 October. That has never been an issue, and those members of staff will be unaffected by implementation, beginning in December.

The Government are investing £1 billion in the first year of the implementation of the new pay system. Under "Agenda for Change", a newly qualified nurse will earn a minimum of £18,114, putting nurses' salaries on a par with teachers' starting salaries for the first time, and a porter will earn at least £10,762—both figures have increased by just less than 50 per cent. compared with 1997. None of that would have happened under a Conservative Government, and we know that the potential service and staff benefits fully justify the investment.

For the first time, "Agenda for Change" will bring fair pay based on the important principle of equal pay for work of equal value, with appropriate rewards for those staff who take on additional duties and responsibilities. We are also working on measures to enable staff to work more flexibly. The NHS childcare strategy has provided central funding of more than £70 million to develop 140 new on-site nursery facilities, which will provide an extra 6,000 new nursery places for NHS staff.

The Health Care Commission will inspect all NHS trusts against progress in those areas, which is something that the hon. Member for South Cambridgeshire would stop. The hon. Member for South Cambridgeshire wills the ends, but never the means, and in the process, he panders to the interests of producers rather than championing the interests of patients, which is exactly the same place occupied by the Liberal Democrats—no change there, either.

The hon. Member for South Cambridgeshire said today that a Conservative Government would scrap all NHS targets. Maximum waiting times for NHS
 
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patients, which the Tories introduced, would be abolished under a new Conservative Government, who would also provide no guarantees on how long people wait in accident and emergency departments. A new Conservative Government would have no ambition to reduce death rates from cancer and coronary heart disease; they would not provide the right to see a GP within 48 hours; they would not specify minimum numbers of extra nurses and doctors; and they would not require new drugs to comply with National Institute for Clinical Excellence guidelines. What a total betrayal of the public interest! Conservative plans would provide not only no targets, but no accountability either. It would be the postcode lottery all over again, and the public will not wear it.

We are not claiming today that every problem in the NHS has been solved—it has not—nor do we say that the NHS cannot improve still further, because we know that it can. Our argument today is that the NHS needs a clear strategy of investment and reform. Investment will allow NHS capacity to grow, and reform will allow us to deliver our services more efficiently, with greater responsiveness to the needs of patients, and greater and equal choices for patients over when, where, and how they are treated. Those choices are based on need, and not on ability to pay.

The hon. Member for South Cambridgeshire cannot deliver either of those objectives, because he fundamentally misunderstands the nature of the challenges facing the NHS and the changes that are needed in order to respond to them. I invite all my hon. Friends to follow our course, and to treat the Opposition motion with the contempt that it deserves in the Lobby tonight.

6.18 pm

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