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Mr. John Baron (Billericay) (Con): This has been an interesting, if short, debate, with some thoughtful contributions from both sides of the House. Unfortunately, time does not permit me to give credit where it is due.
The issue of targets was, understandably, mentioned on a number of occasions. It is our central contention that, despite the best efforts of NHS staff, to whom we are all thankful for all their hard work and achievements, the NHS suffers from too many Government targets and too much red tape, which clogs it up and reduces its effectiveness, distorts clinical priorities and demoralises staff. That is one of the main reasons why there are so many recruitment and retention problems in the NHS, and why after such a massive increase in spending, there has been only a modest increase in activity. Patients are suffering because they are having to wait far longer than necessary to be treated.
It is worth remembering the scale of the problem. Staff turnover in the NHS runs at about 22 per cent. The national average stands at 16 per cent. In financial terms, the cost to the NHS of about 270,000 people leaving and having to be replaced is about £1.5 billion a year—the cost of 10 new hospitals. A report on the problem published by the Audit Commission back in 2002 cited specific factors such as a lack of professional autonomy, a sense of being undervalued by the Government and bureaucracy as some of the causes of the problem.
There is no shortage of evidence that the Government's targets are distorting clinical priorities and demoralising staff. Last year, for example, a House of Commons Committee heard from the Bristol eye hospital, where waiting time targets for new out-patient appointments had been achieved at the expense of delaying follow-up appointments, with the result that 25 patients went blind. Many other such examples exist; suffice it to say that a further recent opinion poll of doctors found that 82 per cent. thought that the amount of red tape that they have to comply with prevents them from devoting as much attention to their patients as they would like. Some 95 per cent. said that there were times when the pressure to comply with Government targets distorted clinical priorities and adversely affected patient care.
The point is that such targets can and do demotivate staff who are already working under tremendous pressure. Dr. Ian Bogle, the outgoing chairman of the British Medical Association, said last year that the Government's obsession with waiting times and performance targets was suffocating professional responsibility, damaging patient care and leading to fiddled figures on how well the NHS was doing. Indeed, he added:
"We now have a healthcare system driven not by the needs of individual patients but by spreadsheets and tick boxes."
Even Unison's head of health, Karen Jennings, said:
"Hospital staff need to be free to concentrate on clinical needs and priorities instead of chasing crude targets."
It is no wonder that morale among professionals is so low and frustration is so high. Earlier in the year, 500 doctors paid for an advertisement in which they said:
"We once believed that the NHS was the finest healthcare system in the world. Today, few health care professionals would make that claim."
In a recent Royal College of Nursing survey, entitled "Stepping Stones", 10,000 nurses were consulted, and one third said that they would quit the profession if they could. Some 11 per cent. said that they planned to quit the profession in the short term. Although the internal rotation shift system helps to meet demanding targets, it is particularly unpopular, and it is no surprise that the number of nurses leaving to work in the USA doubled last year. Nurses' morale has not been helped by the Government's decision to delay the roll-out of "Agenda for Change".
With morale so low and staff turnover so high, it is not surprising that the NHS has not made the expected progress, bearing in mind the extra money that has been spent. Spending on health has increased by 46 per cent. in real terms since 1997, and no one can deny the Government's good intentions. However, it is a statistical fact that in-patient activity has increased by only 5 per cent. since 1997.
Government targets have significantly increased time spent on administration and bureaucracy. NHS figures show that the number of managers and senior managers has increased at almost triple the rate of new doctors and nurses. The massive increase in targets and bureaucracy means that a lot of the new money has not reached front-line clinical services. For example, an RCN eve-of-congress poll, which was taken only last month, made the point that most nurses have not seen any evidence of increased staffing at work.
Mr. Hutton: That point is made up.
Mr. Baron: The point is not made up; it is from the RCN eve-of-congress poll.
Mr. Deputy Speaker: Order. If Front Benchers want to intervene, I would be grateful if they did so formally rather than chattering from a sedentary position.
Mr. Baron: Department of Health figures show that, although some of the longest waits have been addressed, average waiting times for hospital operations have steadily risen, from 90 to 99 days, over the past four years. Government Front Benchers shake their heads in disagreement, but that fact comes from Department of Health figures and has been admitted by Nigel Crisp, the chief executive of the NHS, and I look forward to the Minister's response on that point.
Low morale and the recruitment and retention problem mean not only that patients must wait for longer than necessary, but that some patients do not get treatment at all. Let us take chiropody as an example. Recent chiropody statistics show that many hundreds of thousands of mostly elderly people are being denied essential NHS foot care. They show that more than 800,000 new patients are referred for foot care each year, but the NHS only treats around 2.2 million such patients a year. The vast majority of such conditions are not curable, and single episodes of care are in the minority,
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which means that hundreds of thousands of NHS patients are simply removed from the list without treatment.
At the end of last year, the Society of Chiropodists and Podiatrists stated:
"NHS capacity is shrinking as a largely static NHS chiropody/podiatry workforce is deployed to support an increasingly difficult caseload. Sadly, those with lower priority needs are likely to be 'bumped' out of the system even though their needs are well above simple nail care."
For many elderly people, good foot care often means the difference between relying on other people and independence. Elderly people should not suffer that lottery, and the Government should act to resolve the crisis.
It is not only NHS patients who suffer from the Government's recruitment and retention problems. We heard in the debate how many developing countries are losing their much needed medical staff to the NHS, but the Government refuse to implement proper controls to ensure that that does not happen. The problem is particularly important with regard to nurses. Last year, for the first time more than half of new entrants to the nursing work force were from overseas, and many of them were from developing countries.
A recent Department for International Development report highlighted the fact that one quarter of the total influx of nurses to the UK came from countries on the Department of Health's list of developing countries from which NHS recruitment is prohibited. The Government have repeated their position that recruitment from prohibited developing countries does not take place, because the NHS is recommended to use only those agencies on the approved list that have signed up to the Government's code of practice on ethical recruitment, but that measure is simply not good enough.
In written answers, the Government have admitted that they cannot give the current figure for agencies that have not signed up to the code, and that they have no mechanisms in place to ensure that their code is being adhered to.
In short, the Government are all over the shop on the issue. Conservative Front-Bench Members have been pressing them on it for some time. We have called on the Government to ban the NHS from using recruitment agencies that are not on the approved list. That is a relatively simply precaution, and we have tabled early-day motion 457 to that effect. The continual failure to adopt that simple measure suggests to many that the Government are happy to turn a blind eye to sloppy recruitment procedures so as to solve their recruitment and retention problems.
Recruitment and retention problems reflect the fact that, although some improvements have been made in the NHS—we all welcome them—progress is not what it should be, given the amount of money invested. Why else does the NHS have such a high turnover of staff? That is the fault not of the professionals who work in the NHS but of the Government. They still cannot understand that their approach is fundamentally wrong.
Politicians must stop interfering. The Government must stop bombarding staff with targets and micro-managing the NHS. The NHS has been a political
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football for too long. Politicians must learn to trust the medical professionals and allow them to get on with their job. Bureaucracy and targets often come between NHS staff and their patients. Targets simply ensure that the NHS responds to the Government, not patients' needs and care. The time has come to scrap targets and the star rating system and give all hospitals true freedom, so that they are accountable to patients and not bureaucrats.
Such an approach will usher in an environment in which doctors and nurses, freed from political targets, choose to stay because they enjoy the freedom to deliver a standard of care to patients of which they can be proud. That environment will mean that the NHS, for the first time in a long time, can realise its full potential and become a patient-centred health service. It will reflect the fundamental difference in approach between the Conservative party and the Government, in that we have greater faith in the individual than in the state. I urge hon. Members to support our motion.
7.36 pm
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