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Mr. Paul Burstow (Sutton and Cheam) (LD): This is a useful debate in which to explore staff recruitment and retention. The NHS certainly achieves successes every minute of every day—it saves lives every day, and it changes lives every day. We should place on record our appreciation of the dedication and deep knowledge of the staff, doctors, nurses and other health care professionals and managers, and treat them as one of the greatest, if not the greatest, asset that the NHS possesses. It is therefore right that we are debating the recruitment and retention of staff and the challenges that confront the NHS.

The debate is based on a motion tabled by the Conservative party. I have no particular problems with the motion, which is a statement of the blindingly obvious. It simply lists a series of concerns, many of which have been well rehearsed and are not subject to real debate. Understandably, the Government amendment sets out those aspects of the Government's record that they want to put in the shop window. However, it does not deal with the concerns about recruitment and retention, and I want to consider a few of those.

One of the ways in which we can gauge the state of play in recruitment and retention is by considering the amount that the NHS spends every year on agency staff. According to the latest figures, the NHS spends £4 million every day on agency staff; that is £1.46 billion a year. Every year since the Government came to power,
 
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the cost of agency staff has increased. My criticism of spending on agency staff is, therefore, that it is out of control. That is not only my view, but that of the Audit Commission in its report "Brief Encounters", which was produced a couple of years ago. The Audit Commission found that not only was it rare for trusts to take a strategic overview of their use of temporary staff, but there was significant under-reporting of expenditure on agency staff in the NHS.

Spending is poorly targeted and controlled and lacks strategic direction on questions such as the reason for the use of agency staff. Too often, they are recruited to fill gaps on a firefighting basis rather than as part of a sensible human resources strategy that is designed to provide greater flexibility for permanent staff as an aid to their retention and recruitment.

Sarah Teather (Brent, East) (LD) rose—

Sandra Gidley (Romsey) (LD) rose—

Mr. Burstow: I shall give way to my hon. Friend the Member for Brent, East (Sarah Teather) first.

Sarah Teather: Great minds think alike. Does my hon. Friend share my anxiety about the all-doctor three-month vacancy rate for the North West London strategic health authority, which is currently 4.6 per cent.—higher than the London average—and about the consequent cost implications for temporary staff cover?

Mr. Burstow: My hon. Friend makes an important point, which I want to develop. There are questions to be asked about the age profile of the work force, which will mean a further increase in the number of people who retire and thus in vacancies that need filling. I want to deal with that point later.

The Government's answer to the question about the way in which the NHS deals with the costs of agency nursing has been the introduction of NHS Professionals.

Sandra Gidley: My hon. Friend rightly raised the problem of agency staff, but I assume that he also knows that, although the Government trumpet the fact that they do not use staff from overseas in parts of the NHS, that does not apply to agency staff. High numbers are recruited from overseas and the purchasing agency appears to have no plans to deal with that. Would my hon. Friend like to comment on that?

Mr. Burstow: It is interesting that NHS Professionals, which currently provides a service in approximately one in every four NHS hospitals, can currently cover only 65 per cent. of requests for agency staff. Private agencies provide 25 per cent. of agency staff. It would be useful if the Minister could confirm in her winding-up speech whether the ethical recruitment codes apply to private agencies through NHS Direct. Clearly, that is a cause for concern.

It is surprising that, even with only one in four hospitals buying in to NHS Professionals, the body can meet only 65 per cent. of the demand for agency staff.
 
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The specialist press, especially for nursing staff, is regularly filled with concerns and complaints about the time it takes for people to get their payments. I understand that a report was commissioned to consider the establishing of NHS Professionals and the lessons to be learned from that. Will the Minister tell us today whether the report will see the light of day? Written parliamentary questions show that the Government have not been willing to publish their conclusions and findings from the experience of NHS Professionals.

Another measure of staffing pressures in the NHS is the increase in the use of overseas staff, which has already been mentioned. The number of overseas staff has increased from 2,281 in 1996 to 44,442 last year. Nurses constitute the lion's share of the overseas recruits. Currently, 8 per cent. of nurses in England, 28 per cent. of nurses in London and more than half the new entrants to the Nursing and Midwifery Council register are from overseas.

As Ministers know, I have raised concerns about overseas recruitment in Adjournment debates and through written questions for many years. I have expressed anxieties about both the ethics of overseas recruitment and the way in which some of those who come here to work in good faith, especially in the independent sector, are mercilessly exploited by their employers. Those concerns remain, and the Government's code of practice on overseas recruitment, although welcome, offers very little practical protection, particularly for staff outwith the NHS.

My concern is not just this country's reliance on the recruitment of overseas staff for the NHS; it is also the increasing number of home-grown staff who are opting to work overseas. The fact is that the health care work force is becoming increasingly globalised, and competition among industrialised countries for scarce resources is intensifying. We have already seen more than 8,000 nurses leave the UK to work abroad in a single year, and the number opting to work in the United States has more than doubled. Indeed, it has been estimated that the US has a shortfall of more than 1 million nursing staff, and it is coming to the UK and other industrialised countries to recruit nurses to take back to the United States.

My plea to the Government is that they should not rest on their laurels in regard to international recruitment. This matter requires concerted international action, partly of the kind that the Minister described earlier. Surely the Government should take the opportunity provided by their chairmanship of the G8 to propose an international code of good practice for health recruitment, so that we can not only set a good example but ensure that others follow it, especially those industrialised nations with the spending power to recruit not only from each other but from those countries that can least afford to let staff go.

Mr. Andrew Turner: I am interested to hear the hon. Gentleman's argument, in which he seems to equate the United Kingdom with a third-world country.

Mr. Burstow: That is pathetic.

Mr. Turner: Well, I thank the hon. Gentleman for that intervention. What is wrong with nursing staff from this country choosing to work in the United States?
 
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Mr. Burstow: I fear that the hon. Gentleman was not really following my argument, which was that we are in a globalised, competitive environment, and we have to take due heed of that when we negotiate with our partners. We need to have arrangements in place to ensure that we are not withdrawing from recruiting overseas while others are still doing it. There needs to be internationalisation of the arrangements, rather than the UK simply doing this on its own. I certainly do not have a problem with people choosing to work elsewhere; that was not my point. However, if we do not address this issue beyond the domestic level, we shall have serious problems.

Mr. Lindsay Hoyle (Chorley) (Lab): Does the hon. Gentleman have comparative salary figures for nurses and doctors in the United States, the UK and Europe?

Mr. Burstow: No, I do not have those figures immediately to hand, but if the hon. Gentleman would like them, I shall try to find out what they are. However, I am sure that a written question would be able to elicit the information from the Department of Health.

This increasing reliance on agency and overseas staff is likely to increase because of the demographics of much of the UK's health work force. Whether we are talking about nurses, doctors or other key health professional, there is—dare I say it—a demographic time bomb ticking away under the NHS. The fuse for that time bomb was set during the Conservatives' time in government, because they failed to provide the necessary training places and investment in staffing. However, the time bomb is still ticking away today. For example, one in five nurses is over the age of 50—indeed, the Royal College of Nursing goes so far as to say that it is one in four—and a huge number of nurses are due to be lost through retirement over the next few years. The same applies to general practitioners. According to the Department of Health, at the last count there were 3,435 GP vacancies—an increase of 31 per cent. over the year before.

More telling than that is the fact that the number of applicants applying for each post has fallen in each of the last three years. In 2001, there were 6.9 applicants per vacancy, but that figure had more than halved to 3.3 by 2003. Things appear to be getting worse rather than better in terms of recruiting extra GPs, not least because of lifestyle choices resulting in more of them choosing to work part-time rather than full-time, although the Government record these figures only by head count, rather than by full-time equivalence.

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