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Clive Efford: Targets are measures by which the public can assess the success of the Government. The Government may not meet some of their targets but at least they have some idea of the direction in which they are taking the NHS. The hon. Gentleman's party have no such plans and will set no targets, nor has it given any indication of where it intends to go with the NHS if it is successful at the next election.
Mr. Turner:
My hon. Friends on the Front Bench will not set targets for hospitals; they will set targets for themselves. The customers of the NHS, like those in the
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private sector, are perfectly capable of determining whether they are getting the quality of service they want without reference to a range of unnecessary bureaucratic Government targets.
I fear I have run out of time but I want to underline the two points that I would like the Minister to answer: the effect of the European working time directive on St. Mary's and how soon her review of the shortage of dentists on the Isle of Wight will be available, so that that shortage can be corrected.
7.2 pm
Ann Keen (Brentford and Isleworth) (Lab): It is often said that people remember nurses. Nurses remember Governments, and this nurse certainly remembers the Opposition when they were in government.
A few days after the Conservatives were re-elected in 1992, I went to support my local football team—Brentford—and outside the ground were nurses in uniform with collection buckets. They were collecting for accident and emergency equipment for the local hospital. Down the road at Kempton Park, the West Middlesex university hospital stakes were also raising money for vital equipment for my local hospital. A demoralised work force were being asked to beg—literally—on the streets to collect money for equipment.
We are talking about recruitment and retention. That was a demoralised work force. If staff are not cared for, they cannot care for the community of patients that they are unquestionably able and trained to look after. Other services in the hospital were demoralised; they are often called hotel services, but they actually involve people who do vital work. Vital cleaning services were contracted out to the lowest bidder. Dedicated staff had their terms and conditions of employment reduced to poverty, with no employment rights. They worked a full week, yet they were entitled to claim benefits. Of course, there was no minimum wage; the Conservatives opposed that. Unemployment was high, and people were very nervous about leaving to look for other employment. Their skills were not valued, unlike today, when all the training and development needs of all NHS staff are being met.
The motion talks about retention. To retain staff, people must be proud of where they work. Under the Conservative Government, many NHS buildings were in very poor condition. Many were not even just of the last century, but the previous century: workhouse facilities. I worked in them. I know what it was like to be on night duty, wandering around looking for somewhere that could offer some refreshment—tea, coffee or food—at night. Our needs were not met; they were not catered for in any way. That applied right across the board, not just in my own profession, nursing. If people asked for training and development, they were told that there was no money.
Some of the pay review body awards were not always paid in full. When I was employed by Ealing health authority, I was asked whether I was prepared to give back my pay rise because, if I did not, the hospital would have to make cuts. That was in 1992. I tell hon. Members now that I had a very different conversation
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today, when I spoke to the chief executive of my primary care trust, John James, who leads Hounslow's PCT, along with Christine Hay. We could contrast the training and development and, yes, we could discuss the improvement in GP recruitment that, without question, has taken place in Hounslow. Many of the GPs who have been recruited are salaried, which makes quite a difference, especially to medical staff who want to return to work after perhaps taking time off to have children or for child care.
Flexibility is so important. The rigidity of the employment of NHS workers in the past put many people off staying in the NHS. The NHS is one of the most brilliant, wonderful sectors in which people can work. The staff are most dedicated. No one joins the NHS, right across the spectrum, because they want to earn vast sums of money. Very special people decide to work in the health service, and they have always deserved better. I am proud of the way that the Government are looking after NHS staff. Without question, the money for training and development is there. Without question, child care makes a difference.
I have talked to Meena Singh, who is the director of West Middlesex university hospital—now a modern building, opened by my right hon. Friend the Chancellor of the Exchequer last November. I was employed at that hospital in 1985. I was told at my interview that I would be working in a brand-new hospital by 1987. It took a Labour Government and a Labour Member of Parliament, a Labour nurse, to help to deliver that hospital in 2003. Much hard work took place, but there is, of course, more to do.
Without question, there are recruitment problems with radiographers, as has been acknowledged. We need to consider the mix of skills in the health service professions. My own profession, nursing, has come to the forefront, and many of the duties that nurses now perform will soon be recognised in pay. With "Agenda for Change", nurses can go up a clinical pay structure—a clinical ladder—but the previous Administration of the Conservative party prevented them from doing so by creating managers out of nurses. If nurses wanted to make progress in their careers, they had to go into management.
There is nothing wrong with management. There is nothing wrong with managing the NHS properly. There is nothing wrong with having support staff who are trained in the latest IT skills. I started my working life in the NHS as a hospital clerk. We still need to improve the administration services in many hospitals, as they have not changed much since I worked as a clerical assistant.
Without question, recruitment and retention require the most important aspect of NHS delivery. Without question, we have now increased the availability of treatment for patients, but we have done so with the development of a dedicated staff and with the development of a dedicated Government who are totally committed to the NHS, and without question, everyone who works in the NHS will always remember that.
7.9 pm
Mr. David Amess (Southend, West) (Con):
I join all hon. Members in saying a very big thank you to all the women and men who work in our national health service. Without the staff of the NHS there would not be
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a national health service. I am sure that I speak for every one of them when I say that they are overworked and underpaid. If any Government can come up with the solution to that particular problem, then I am waiting to hear it.
The last Conservative Government were elected in the last century. I want to talk about this century, in particular about recruitment and retention. I am not suggesting for a moment that I and my parliamentary colleagues had the solutions to all the problems that the NHS faces, but I am sick to death of Labour jargon. What particularly grates with me is the talk of targets and star ratings. The people who work in the NHS are fed up with those two things as well.
I congratulate the chairman of the British Medical Association Council who, when speaking about the burden of targets, said:
"The one memory that will live long after the sweet taste of negotiating successes and the sour taste of acid encounters with self-serving secretaries of state"—
I wonder whom he might have been talking about—
"have left my palate is the creeping, morale-sapping erosion of doctors' clinical autonomy brought about by micro-management from Whitehall which has turned the NHS I hold so dear into the most centralised public service in the free world."
"The stifling of innovation by excessive, intrusive audit and the imposition of Department of Health diktats . . . The shackling of doctors by prescribing guidelines, referral guidelines and protocols . . . The suffocation of professional responsibility by target-setting and production-line values that leave little room for the professional judgement of individual doctors or the needs of individual patients",
"Targets are set nationally without any appreciation of what they might mean for individual doctors sitting in consulting rooms with individual patients."
On star ratings, the chairman of the British Medical Association said:
"Nobody should use star ratings to judge how well a hospital is doing. They measure little more than hospitals' ability to meet political targets and take inadequate account of clinical care or factors such as social deprivation. It is grossly unfair on staff working in low-rated trusts that public confidence in them is being undermined."
I certainly support everything that those two gentlemen said.
I want to touch on recruitment and retention as they relate to general practitioners, dentistry, the people who work in our mental health services, the people dealing with obesity and those who deal with allergies. The BMA has rightly questioned the Government's claims that GP recruitment targets have been met. The chairman of the BMA's general practitioners committee said:
"The Department quotes headcount figures but many of the new GPs will be working part-time in general practice. Using the Government's own figures, we calculate that between September 1999 and September 2003 there was at best an increase of 1,323 full-time equivalent GPs in England over the four year period."
If hon. Members are honest with themselves, they will all admit that they know from their constituency pressures that not enough GPs are being trained. Again, I look forward to hearing the Government's ideas on how that can be improved.
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