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House of Commons

Tuesday 22 February 2005

The House met at half-past Eleven o'clock

PRAYERS

[Mr. Speaker in the Chair]

PRIVATE BUSINESS

HBOS Group Reorganisation Bill

Read a Second time, and committed.

London Local Authorities and Transport for London Bill (By Order)

Order for Second Reading read. To be read a Second time on Tuesday 1 March.

Oral Answers to Questions

HEALTH

The Secretary of State was asked—

NHS Trust Staff

Simon Hughes (Southwark, North and Bermondsey) (LD): What percentage of staff employed by NHS trusts in England on 1 January, or the latest date for which figures are available, were (a) directly employed and (b) agency staff. [216966]

The Minister of State, Department of Health (Mr. John Hutton): The Department does not collect specific information on the numbers of NHS staff who are directly employed or hired through agencies. In 2003–04, the estimated agency spend as a proportion of the total NHS pay bill was 5.4 per cent.—a reduction of almost 7 per cent. from the previous year.

Simon Hughes: Do Ministers accept that under the Labour Government there appears to have been an increase of approximately 50 per cent. in the spend on the health service—which, of course, is welcome—but a 300 per cent. increase in the number of agency staff employed by the NHS in England? Will Ministers say categorically that it is always better where possible to have directly employed rather than agency staff? What will they do to keep driving the numbers of agency staff down and fully employed staff up? That is what patients want, and what all the other workers in the NHS prefer.

Mr. Hutton: The answer to the specific question is yes, of course it is. We are making significant progress in reducing the spend on agency staff, and I referred to the overall figures for the NHS pay bill in my answer.
 
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The   hon. Gentleman might be interested to know that last year in London, where spending on agency staff accounts for about 35 per cent. of the total spend across the NHS, there was a significant fall of about 14 per cent. in the use by the NHS of nurse agency staff. That was partly driven by the excellent work of the South West London strategic health authority, but also by a better and more intelligent use of the framework agreements that we negotiated through the NHS Purchasing and Supply Agency with the nursing recruitment agencies themselves. I am quite confident that we shall continue to see significant reductions in the overall spend on nursing agency staff.

Mr. Patrick Hall (Bedford) (Lab): My right hon. Friend will know that Bedford general hospital featured on "Panorama" last Sunday. The key message that came across was the high quality and strong morale of the whole staff team of both directly employed and agency staff. Will he join me in welcoming and celebrating their professionalism, dedication and commitment to solving problems, which has reduced waiting times, delivered high-quality services to patients and made the best use of the sustained increase in resources that the NHS has received?

Mr. Hutton: I certainly join my hon. Friend in paying tribute to the outstanding work of NHS staff in Bedford and many other parts of the country who are doing a brilliant job in improving the quality of care, reducing the time that patients wait and improving the overall patient experience. The right way to make sure that we continue to do so is to bring the investment in and not introduce charges for hospital operations.

Mr. Peter Lilley (Hitchin and Harpenden) (Con): Will the Minister confirm that that huge reliance on agency staff at immense cost is proof that ultimately one cannot buck the market? Attempts to staff our hospitals with nurses with different pay and conditions mean that we cannot balance demand and supply domestically. We have to import 15,000 nurses a year because we are losing 8,000 British-trained nurses overseas, and nearly one third of nurses with British nurse training go elsewhere. Ultimately, to achieve a balanced domestic supply we must pay a proper rate for our nurses rather than wasting money in this way.

Mr. Hutton: I agree strongly that we need to pay nurses more and give them a better rate of pay. That is precisely what we are doing with "Agenda for Change", which has been negotiated with nurses and the Royal College of Nursing in particular. It gives us an opportunity to make significant progress in this important area—something that was quite invisible when the right hon. Gentleman's party was in charge of the national health service.

Lawrie Quinn (Scarborough and Whitby) (Lab): Does my right hon. Friend agree that a key part of work in the NHS is teamwork and the dedication of directly employed staff on a daily basis? He will know of recent concerns about Whitby hospital in my constituency, so I wonder whether he can help me to facilitate a meeting with the strategic health authority and the primary care trust to make sure that all the key partners who deliver
 
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an excellent service for the people of Whitby and the surrounding district can continue to do so in future? Will he commend those staff and congratulate them on delivering PCT services in one of the largest community hospitals in England?

Mr. Hutton: Yes, the NHS staff in my hon. Friend's constituency are doing an excellent job, and I pay tribute to their commitment and professionalism. I shall certainly help facilitate the meeting that he asked for. That will not be a problem. I also pay tribute to my hon. Friend's outstanding support for the national health service in his constituency.

Mr. John Baron (Billericay) (Con): The Government are well aware that many agencies recruit NHS staff from overseas countries. The recent Save the Children study accused the UK of contributing to the collapse of health systems in many poor countries, and a British Medical Association statement criticised the UK's shameful record of exploitation in taking nurses from developing countries—an issue that the Opposition have raised many times. Given this new evidence, if the Minister accepts that poor countries need their nurses even more than we do, why will the Government not ban the NHS from using recruitment agencies that have not signed up to their own code of practice?

Mr. Hutton: The hon. Gentleman has drawn attention to the matter a number of times, but he always fails to point out that the UK leads the world in the ethical recruitment of medical staff. The code of practice that we have formulated and promulgated, which has now, I am glad to say, been extended to the independent health care sector, is held up as a model of good practice by the World Health Organisation. We do not recruit in developing nations in Africa. On the point that we should support those countries with the cost of training health care staff, I should point out to the hon. Gentleman that in the past five years the Department for International Development has provided more than £500 million worth of aid and development costs for African countries to help them train the nurses and doctors that they need for the future.

Helen Jones (Warrington, North) (Lab): Further to the comments of my hon. Friend the Member for Bedford (Mr. Hall), will the Minister join me in congratulating the staff—both agency and directly employed—at Warrington hospital on the magnificent way in which they worked during and after the fire at the hospital just over a week ago? Will he show his appreciation in a tangible way by considering what can be done to help the hospital through this difficult time, and ensure that it is not penalised for missing targets where that failure results purely from the fire at the hospital?

Mr. Hutton: I shall look at the last point raised by my hon. Friend. There was a tragedy at the hospital, which she has been working closely with her constituents to resolve, and I appreciate the work that she has done. It is right to say that it is not just NHS staff who do an outstanding job for NHS patients. Many agency nurses and agency staff do a brilliant job as well, and it would be wrong to give the impression that that was not the case. They are dedicated to their patients and they do a good job for the NHS.
 
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Continuing Care Report

2. Sandra Gidley (Romsey) (LD): If he will make a statement on the Government's response to the Parliamentary Health Ombudsman's report on continuing care. [216967]

The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): The written ministerial statement that was made to the House on 9 December 2004 outlined our plans to develop a national framework for fully funded continuing care. The framework will improve consistency and ease of understanding and will help to ensure that users' and carers' reasonable expectations are being met.

Sandra Gidley: I thank the Minister for that explanation. There have been 4,000 complaints to the ombudsman since the February 2003 report, which recommended the establishment of clear national minimum eligibility criteria that are understandable to health professionals, carers and patients. It also stated that the local criteria are over-assessed and poorly applied. Why has it taken so long to draw up national minimum standards, and what will the Minister do to make sure that those are properly and transparently applied?

Dr. Ladyman: We started off with 96 different sets of criteria. We reduced those to 28, which we ensured were legally reliable and properly administered before we started the review. The review of the outstanding cases is complete in all but one strategic health authority area, and even that one will be finished shortly, so we have made substantial improvements. In developing the national framework, we must now make sure that we go down to one single framework that is easy for patients and carers to understand and can be reliably implemented by professionals. By establishing best practice, that is exactly what we shall do.

Mr. David Hinchliffe (Wakefield) (Lab): On the issue of long-term care, under the previous Administration there was a significant increase in the number of elderly people institutionalised in private care and nursing homes, and this Government have a proud record of moving in the opposite direction. Will the forthcoming Green Paper possibly set targets for a further reduction? Can my hon. Friend set out roughly how soon we will have the Green Paper and tell us what positive policies it will include on developing alternatives to the institutional care sector inherited from the previous Administration?

Dr. Ladyman: First, I can promise my hon. Friend that the Green Paper will be available shortly. Of course, as a Green Paper, it will not contain specific targets, but I promise him that it will reaffirm the direction of travel—the direction that older people themselves tell us that they want us to take. They want to stay in their own homes for as long as possible. If they cannot do so, they want to move to accommodation where they can maintain their independence. They do not want to be shuffled off into residential care, which is the policy of the Opposition parties.
 
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Mr. Stephen Dorrell (Charnwood) (Con): Can the Minister confirm that the continuing uncertainty and confusion about entitlement to residential care date back to the Coughlan judgment, which was handed down almost six years ago? Is this not a sorry tale of incompetence and bungling by the Government, compounded by the fact that the Minister promised that, by March 2004, all those who had overpaid their charges would receive back their overpayments? How many of those people are still waiting for overpayments that were declared illegal six years ago?

Dr. Ladyman: I will not confirm that it goes back to the Coughlan judgment. It goes back to when the previous Government ordered 96 health authorities to write separate sets of eligibility criteria. The right hon. Gentleman ought to know that; I rather suspect that he was Secretary of State at the time when it was ordered. The fact is that the ombudsman asked us to go back in our review to 1996 precisely because the confusion arose from the point at which the criteria were issued. We are cleaning up the Conservative party's mess, and we are doing so at great expense to the taxpayer.

Mr. Simon Burns (West Chelmsford) (Con): May I tell the Minister that he is living in cloud cuckoo land? This is a miserable episode for the Department of Health. His own deadlines for sorting out the problem have been missed eight times, and the ombudsman has accused the Government of bungling the cases, criticised the Department for issuing unreliable information to her about its review and found that, in half the reviewed cases that she has looked at, the reviews have not been properly carried out. Can the Minister tell us when there will be completion for all the people who have complained? Can he also tell us more about the compensation? Will it be compensation solely for the money that people inadvertently and wrongly had to pay? What will happen to people who had to sell their homes, when it now turns out that there was no reason whatever for doing so?

Dr. Ladyman: Let me deal with that last point first. Since 2001, we have allowed all local authorities to defer payments, so property needs to be sold only after people's death. That is available in every part of this country. It is a policy that means that people do not have to sell their homes, and it would be swept away by the policies of both the Conservative party and the Liberal Democrats if they were implemented. The simple fact is that we have a serious and complex problem to clean up. We had to go from 96 sets of eligibility criteria to 28 sets, and we had to ensure that people could understand them. All the cases in which people requested their review by the March deadline have now been completed. Other cases are coming in continuously, and we are paying compensation on the basis that, where the national health service received unjust enrichment, we are paying the money back to people. We are paying £180 million to clean up a mess left by the hon. Gentleman's Government.

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