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Mr. Hutton: The hon. Gentleman must know that he is wrong about that. We publish figures on both head counts and whole-time equivalence, and I am sure that he will want to correct that statement. My question to him on international recruitment is perhaps historical, but I think that it is important. When we had the election in 2001, his party was promising to recruit something like 4,000 more doctors a year than we were planning to. He has just lectured the House, in very polite terms, about the dangers of international recruitment, but can he tell us where those extra doctors would have come from, if not from international recruitment?
Mr. Burstow:
I think that the Minister has misconstrued what I was saying about international
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recruitment, perhaps to make a political point. The point is surely that, when it comes to recruiting from overseas, there needs to be an ethical framework that is not only pursued by this country in making individual agreements with individual countries. It must be an arrangement that involves other countries as well. That is the context. I do not have a problem with a globalised market in terms of health care. But given that in the last year for which there are figures, 44,000 staff have come from overseas, that demonstrates the extent to which the NHS is reliant on those staff to provide health care in this country.
Mr. Burstow: I am spoilt for choice. I give way to my hon. Friend the Member for Somerton and Frome (Mr. Heath).
Mr. David Heath (Somerton and Frome) (LD): My hon. Friend is being generous with his time. May I return to the point about general practitioners? I am a little alarmed to be told by long-established practices in my constituency that for the first time for many years, they are not having the opportunity to train new GPs in their practices this year, not because of any deficiencies in the training that they are providing, but because of funding at a higher level. Does he share my concern that at a time when we need new, young GPs, apparently, practices in Somerset that are willing to provide that sort of training in a perfect setting are not allowed to do so?
Mr. Burstow: Certainly, I share my hon. Friend's concern, and I am sure that the Minister will address it.
I want to address the issue of the demographics of the GP work force, because it causes concern to many Members on both sides of the House, and particularly to my hon. Friend the Member for Brent, East (Sarah Teather). The number of GPs who will meet the mandatory retirement age of 70 in the next few years is set to rise rapidly, particularly in London and the west midlands. Looking forward, two thirds of the 4,000 GPs who qualified in south Asian medical schools are due to retire by 2007. A lot of today's work force difficulties, however, must be seen as a legacy of the last Conservative Government. Poor work force planning, a reduction in training places, and cuts in staff left the NHS with chronic staff shortages. In 1983, the Conservatives recruited 37,000 nurses, but by 1995, that had dropped to 6,000. By the time that the Conservatives had left office, the figures that I have seen suggest that at least 51,000 fewer nurses were working in the NHS.
The legacy of staff shortages, however, was made worse by this Government's decision to stick to the Conservative spending plans for the first two years after coming into office in 1997. It was not until the NHS plan that a concerted effort was begun to tackle work force issues. Clearly, there is a long way to go to tackle the shortages that have been outlined so far in today's debate.
That brings me on to the issue of contracts, in relation to GPs, consultants and "Agenda for Change". Clearly, there is concern about slippage in the implementation of "Agenda for Change" among the work force, but the
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Minister's comments today are undoubtedly welcome. The implementation of the consultants contract, however, has stretched the capacity of personnel staff in the NHS to the limit. As has been mentioned, the British Medical Association survey earlier this month found that eight months after doctors had voted yes to the new contract, around a quarter of NHS hospital trusts had still not implemented the contract in full. The Minister has told us today that only a third of consultants currently work to the new contract. He has at least indicated some regret that progress has not been as rapid as it should have been. Clearly, it needs to be more rapid if we are to see the improvements that we all want in that respect. But we also need to raise concerns about capacity. One of the consequences of the new consultants contract is often that consultants work fewer sessions, which means less capacity in the NHS.
Taken together those contracts are welcome developments, and over time they should deliver significant improvement to the working lives of the staff and to the quality of care for patients. However, implementing all those changes during the same year, against a background of continuing staff shortages, runs the risk of reducing NHS capacity. When all those changes are combined with the impact of the working time directive, some serious risks are posed to the NHS in terms of its ability to deliver the Government's wider agenda on issues such as choice.
The Minister of State, the hon. Member for Doncaster, Central (Ms Winterton), who will respond to this debate, has responsibility for dentistry. I want to pose one quick question to her. When does she expect the work force review in relation to dentistry, which has been long awaited, to be published? It was commissioned back in July 2001, and given to the Government in the autumn last year. We are told that it will be coming shortly. How long is shortly? It would be useful to clarify that, not least because when the Commission for Health Improvement examined dentistry, it found that 26 per cent. of people have not seen an NHS dentist for more than two years, and 8 per cent. have never seen one. Half the population are not registered with a dentist. Staggeringly, there was a 70 per cent. increase in the number of people having to contact NHS Direct on dentistry matters between November 2001 and February 2002. When will that survey be published?
Public health is a very live issue today, and we expect a White Paper in the autumn. In March this year, the Faculty of Public Health Medicine published a report on the specialist public health work force, which made sorry reading. It warned:
"There is strong evidence to suggest that the current numbers of consultants and specialists in public health, health protection and academic public health in the UK are insufficient for the work that is required."
It went on to point out that deficiencies in staff numbers had been known since the national survey of communicable disease function undertaken by the NHS executive in 1997, but that
"important deficiencies have not generally been rectified despite the addition of significant new responsibilities to these consultants."
Just when will the Government come forward with a work force plan to ensure that that part of the work force is increased? Do they agree with the faculty's figure of a need for a 40 per cent. increase in the consultant work force in that field?
Just recruiting more staff to meet ever-increasing demands on the NHS is not a sustainable policy. As Derek Wanless found in his first report on health funding, if the NHS continues much as it is at present, it will cost an extra £30 billion a year to provide health care by 2020. There is a need to tackle the causes of ill health, both through preventing and postponing the onset of disease and through better controlling the spread of infection.
I shall not rehearse the need to tackle health-care acquired infections, an issue that we debated yesterday in some detail under the Health Protection Agency Bill.
Jonathan Shaw: Will the hon. Gentleman tell the House what his policies are? He is just giving us a commentary on the issues that the NHS faces. What are his solutions to the problems that he has set out?
Mr. Burstow: I am speaking to the terms of the motion. The hon. Gentleman should read the motion, tabled in the name of the Leader of the official Opposition, which is simply a list of the problems. I am not going to give the hon. Gentleman what he wants today, but I am more than happy to debate Liberal Democrat health policies in Government time.
On infections, the National Audit Office has said that 100,000 people every year pick up infections while in hospital. Research by the Public Health Laboratory Service has found that patients with health-care acquired infections stay in hospital on average 2.9 times longer—about 14 days extra—than those who do not pick up infections. That implies that about 1.4 million bed days are lost every year as a direct consequence of infections picked up in the NHS, which is the equivalent of seven and a half average-sized district hospitals. The potential capacity gain for the NHS from tackling issues of infection, and really bearing down on that problem, would be huge.
Work force issues are and will remain a critical factor in the NHS's ability to deliver. There are many issues still to be tackled in developing a work force strategy in this country, but what is clear, if not perhaps to every Member present today, is that we as a House must continue to applaud, reward, recognise and value the staff of the national health service as its greatest asset. Today's debate is not about Liberal Democrat policy but about the Government's record. That record is not as good as the Minister and the Government would like us to believe, and we have outlined why that is. When the elections come, we will demonstrate why this Government's record does not justify their being returned to office.
6.39 pm
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