The Secretary of State for Health (Ms Patricia Hewitt): The NHS has a long history of welcoming nurses from overseas. We have also increased the number of nurses that we train in Britain by more than 60 per cent. since 1997. Those nurses should, of course, have the opportunity to progress in their careers. The Government recently changed the work permit arrangements so that in future, junior nurses from overseas can be appointed only if there is no suitable candidate from the UK or the rest of Europe.
Mr. Vara: I am grateful to the Secretary of State for that response. Given that many nurses are approaching retirement age, what assurance can the Secretary of State give that British-trained nurses alone will be able to replace them?
Vacancies are at their lowest level ever, and we are employing more than 85,000 more nurses than we were in 1997. That substantial increase has meant that newly qualified nurses have found it difficult to get jobs. The advantage of the managed migration policy is that where shortages ariseand there are shortages in specialist jobs in the NHSthey can be included in the shortage category so that employers can obtain work permits for nurses from
abroad without having to show that there is no suitable domestic candidate. That is a flexible system that can respond to changes in our own labour market. Given the present situation of newly qualified staff, it is clearly right that we should take junior nursing jobs out of the shortage category.
Mr. Jim Devine (Livingston) (Lab): I welcome the initiative by my right hon. Friend. Does she agree that there is no such thing as an ethical recruitment strategy from overseas, from developing countries? Countries simply recruited from underdeveloped countries to fill the gap, and they lost out in the end.
Ms Hewitt: I am grateful to my hon. Friend for supporting the action that we have taken, but I do not agree about whether it is possible to have an ethical recruitment policy. On that particular issue, we have led the waynot only by making it very clear that the NHS itself and staffing agencies that work for the NHS are not allowed to recruit directly from developing countries that desperately need their own staff, but by entering into agreements with countries such as the Philippines or India whereby they train more nurses than they can possibly employ, andcertainly before we made this changeby being willing to employ those staff here. I also refer my hon. Friend to the excellent work of my right hon. Friend the Secretary of State for International Development and the investment that we are putting infor instance in Malawi and other parts of Africato help countries to train the health care workers that they so desperately need to care for their own population.
Mr. Stephen Dorrell (Charnwood) (Con): Is not what the Secretary of State euphemistically refers to as managed migration a panic reaction by the Government to the sharp rises in the number of unemployed newly qualified nurses? What steps are the Government taking to ensure that those numbers do not go on rising, and that we are not ploughing resources into training nurses and offering them the prospect of work, but no jobs at the end of the training?
Ms Hewitt: The right hon. Gentleman is quite right: as I said a moment ago, there are real difficulties this year for many newly qualified nurses and indeed others, including physiotherapists, in getting jobs. We have therefore been working with NHS employers, and the chief nursing officer at the Department recently issued guidelines that will make it much clearer that, for instance, the director of nursing within each trust should be working with colleagues right across the local health communitywith other NHS organisationsto ensure that vacancies are created and filled wherever possible by newly qualified staff; that private agency temporary staff are reduced; and that in their place, where necessary, newly qualified staff are taken into NHS banks, where they can be offered part-time or full-time work in order to progress their training.
There are a number of practical steps being taken in different parts of the country and we will go on ensuring that that happens in order to support our own newly qualified nurses. I am not sure whether the right hon. Gentleman supports or opposes the action that
we sensibly took, as the problem became clear, to ensure that we do not continue to recruit junior nurses from outside the United Kingdom and the rest of Europe. I think that that is the right step to take, and I would be interested to know whether he and his party support it.
Rosie Cooper (West Lancashire) (Lab): What dispensations are available to NHS employees who are identified for redundancy or have been made redundant, with regard to recruitment and employment in independent treatment centres in organisations such as Southport and Ormskirk hospital in my constituency?
Ms Hewitt: There are still several thousand vacancies across the NHS, and we have already taken steps to ensure that wherever possible, vacancies are ring-fenced for staff who are facing redeployment or even redundancy in their current positions. There is already a policy, which goes back a couple of years, of ensuring that staff who have been made redundant from NHS employment can, despite the additionality rule, seek immediate employment in an independent sector treatment centre that is also working for NHS patients.
Mrs. Nadine Dorries (Mid-Bedfordshire) (Con): A midwife who lives in my constituency and works at Bedford hospital arrived in this country seven years ago, trained as a nurse, became a midwife and has now been told, as part of the consultation process at Bedford hospital, that she is likely to lose her job. Nearby Lister hospital has made an announcement of 500 redundancies. My constituent has been told that her chance of securing another job as a midwife anywhere in the region is zero. Does the Secretary of State feel that my constituent, who is now applying for a job in Waitrose, has been let down by the Government, along with all the other nurses who came to this country seven years ago to train?
Ms Hewitt: The hon. Ladys constituent and many other staff are facing an extremely difficult situation at the moment, as are some of the newly qualified staff to whom I referred. I assume that her constituent has already secured settlement, as she has clearly been making a valuable contribution to the NHS here for the past seven years. However, the fact remains that every hospital that is in financial difficulties, or that simply wishes to make itself more effective, is doing everything possible to avoid compulsory redundancies. When those are unavoidableas in some cases they arehospitals are also putting in place every support possible to ensure that staff, who have sometimes given years of service to the NHS, are supported to get other jobs in the health service.
Mr. Andrew Lansley (South Cambridgeshire) (Con):
Will the Secretary of State admit that we have gone from a period of expansion to one of contraction for the nursing work force? Some 5,500 extra nurses were recruited the year before last, but 5,500 nursing posts are now to be lost in our hospital sector. It is not just nurses leaving education who cannot find a job, because, as my hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries) made clear, nurses in employment are losing their jobs. In the context of overseas recruitment, will the Secretary of State admit
that? Is that not the reason why the shortages criterion has been removed not just from junior nursing posts, but from the whole of bands 5 and 6, which means that most nursing posts are affected?
Ms Hewitt: We have indeed removed bands 5 and 6, which cover the jobs for which newly qualified nurses apply, from the shortage applications. I am glad that the hon. Gentleman recognises the enormous increase in the staffing of the NHS. There are more than 200,000 additional staff and more than 85,000 extra nursesand that was made possible by the additional investment that he and the rest of the Conservative party voted against.
The hon. Gentleman talks specifically about nurses and other staff in hospitals. The reality is that as hospitals become more effective and the NHS takes advantage of changing medical practicefor example, by employing more nurses in the community and reducing the number of emergency admissionsthere will need to be fewer acute beds and thus fewer staff in some of our hospitals. He really has to decide whether he believes that the NHS should use the best medical practice to give the best care to patients and get the best value from the increased investment that we have made, or whether, along with voting against the increased investment, he is also giving up on any pretence of using that investment to the best effect for patients.
Mr. Lansley: It is a complete fiction that more nursing posts in the community are being created. In the last year for which we have figures, there were 500 fewer district nurse posts and 800 fewer health visitor posts. If the Secretary of State knows what is going on, she must have based her policy on a new set of work force supply and demand figures. Two years ago, the Department of Healths work force projection said that we would be short of 40,000 nurses by the end of the decade, and that we would need to recruit 12,000 overseas nurses a year. What is the Secretary of States current projection?
Ms Hewitt: The work force projections that the Department of Health undertakes are all based on local projections of need developed by individual hospitals and other parts of the NHS. It is already clear that when the assessments of requirements for training places were made some years ago, several hospitals overestimated their requirements. A minority of hospitals were, even at that point, overspending their budgets at the expense of other parts of the NHS, yet also taking on new staff and commissioning new training placesand now they cannot find jobs for all the nurses who have been trained. That situation is extremely unsatisfactory and unfair to the staff involved.
We still have not heard whether the hon. Gentleman thinks that we have done the right thing. The great advantage of the managed migration policy and the new system for shortage occupations is that when we see a problem emerging, as we did earlier this year, we can take action to ensure that newly qualified nurses from abroad do not continue to seek employment here. If the situation changes in future years, we can alter that. The fact is that we have substantially increased the number of training places, by over 60 per cent., so we have no shortage of nurses at the moment.
7. Mr. Ian Austin (Dudley, North) (Lab): Pursuant to the answer of 20 June 2006, Official Report, column 1792W, on hospital cleanliness (west midlands), what systems have been recently introduced to improve hospital cleanliness in the west midlands. 
The Minister of State, Department of Health (Andy Burnham): The former strategic health authorities which have been merged to form NHS West Midlands established their own steering groups. The membership of these groups was wide-ranging and their remits included hospital cleaning as well as infection control. Relevant action plans are now being taken forward as a result of the input from these groups.
Mr. Austin: I thank the Minister for his answer, but will he come to Dudley again to visit our new £180 million hospital, where he can see for himself a revolutionary microfibre cleaning system that is helping to combat infections? I recently met Sue Macmillan, who showed me how the system reduces infection and improves cleanliness. We can never achieve 100 per cent. perfection, but is that not a great example of the way in which extra investment, together with new facilities and ways of working, has delivered improvements for patients?
Andy Burnham: I recently made an unannounced visit to Dudley, where I saw my hon. Friends hospital for myself. It is, indeed, impressive, and the microfibre cleaning system used there is being evaluated by the Department to see whether or not it can make a broader contribution. Will he pass on my thanks to Sue and her team for the excellent job that they are doing? Cleaners across the NHS do a fantastic job but I am sure that, like me, the hon. Gentleman remembers the billboards at the last election that said, How hard is it to clean a hospital? It was a denigrating attack on the people who keep our hospitals clean, and I am sure that it was approved by the right hon. Member for Witney (Mr. Cameron). However, I am happy to pay tribute to Sue and her team, and I am sure that my hon. Friend would wish to pay tribute to many other cleaners across the NHS.
Mark Pritchard (The Wrekin) (Con): May I put on record my thanks to both public and private sector cleaners? The trouble is, however, that often they are cleaning wards that are full of litter from the Governments bureaucracy and red tape. To be serious, is the Minister confident that MRSA, VRSA and ESBL superbugs have left the Princess Royal hospital in Shropshire? If he cannot tell the House that they have done so, why has the only isolation unit in Shropshire at the Princess Royal hospital been closed?
The latest figures for 2005 for west midlands hospital trusts rated more than 30 sites either good or excellentnone was unacceptablefor hospital cleanliness. There is therefore a good record in the hon. Gentlemans region. However, on the question of whether we are satisfied, no, we are not complacent about the issue. It is crucial that trusts, from the chief executive down, put hospital cleanliness and control of
hospital-acquired infection at the top of their list of priorities, because patients expect to be treated in a clean and safe environment. I give the hon. Gentleman a categoric assurance that that is what trusts should do, but he should take pride in the trusts in his region and constituency, because they are doing a good job.
The Minister of State, Department of Health (Ms Rosie Winterton): Data from the counter-fraud security management service show 43,097 incidents of physical assault against staff working in mental health and learning disability settings in 2004-05. A report published today by the National Patient Safety Agencya copy has been placed in the Library and I have asked for further copies to be distributed to Opposition Membersshows 558 reports of physical abuse of patients, including 122 reports of incidents relating to sexual safety between November 2003 and September 2005.
James Brokenshire: I thank the Minister for her response and for providing me with a copy of the report a few hours ago, but it is remarkable that that was prompted by Health questions, rather than previous freedom of information requests from Mind, the charity. The NPSA report is detailed, and it deserves close examination, as it recognises the important work of health professionals. However, many people are concerned about the safety of patients and the need to protect them against assault in mental health units. The report shows that there were 562 cases of patient abuse by a third party in a mental health setting, and from my reading of the graph, there were a number of cases of severe harm and, indeed, death. Can the Minister confirm that, and say what steps are being taken to minimise the risk of people in need of urgent medical treatment suffering even more trauma as a result of the actions of third parties while they are in the care of the national health service?
Ms Winterton: I certainly share the hon. Gentlemans concern about some of the issues raised in the report. We should bear in mind the fact that about 1 million people are treated in specialist mental health services every year, but of course we take many of those allegations very seriously. In the report, in collaboration with NPSA, the Department has looked at examples of best practice which implement the guidance set out by the Department to ensure high levels of patient safety. These matters are ongoing and we will continue to examine the issues raised by the report, so that if anything else needs to be done to ensure patient safety, we will do it.
Adam Afriyie: My concern is for those who are facing mental health challenges, who are perhaps the most vulnerable members of our society. In 1996 the Prime Minister made a clear commitment to the ending of mixed-sex wards. Ten years later, people have a right to know why patients are still suffering abuse at the hands of the Governmentpeople who come to the national health service in their hour of need are found to have been abused. My question to the Minister is simple and can be answered yes or no. Will she now make the commitment to ending the use of mixed wards for mental health in-patients, and will she do it today?
Ms Winterton: Let us be clear: 99 per cent. of mental in-patient wards meet the requirements that have been laid down by the Department. Those requirements are that there should be separate sleeping accommodation and separate toilets and bathrooms. We also recommend that trusts could consider whether it is appropriate for wards to be completely male-only or female-only. Those issues are often debated, and the hon. Gentleman should recognise that. In some circumstances it is right that there are areas where males and females can go. That, in a sense, makes it a normal setting. There are also those who prefer that in some instances there should be completely separate wards. We have told trusts that where it is appropriate, they should consider such matters. As I said, there is 99 per cent. compliance in mental in-patient wards. We are working with the remaining 1 per cent. to ensure 100 per cent. compliance.
Lynne Jones (Birmingham, Selly Oak) (Lab): I share the concerns about the delay in the publication of the report, which I understand was available last November, but I commend the Government for collecting the information. We already knew from a report from the Healthcare Commission last May about the high levels of violence in mental health and learning disability units, which it attributed to the high level of staff vacancies, the lack of experienced staff in in-patient units, the overcrowding and the lack of a therapeutic and structured care system in wards. That was last May. Have things got better since then, and if not, why not? Will the Minister take urgent action to address these very difficult issues?
Ms Winterton: We are continually seeing improvements in mental health services, particularly with some of the community teams that have been set up so that there is less need for the in-patient care scenario. We have seen the development of those teams over the past five years, accompanied by massively increased investmentabout £1.7 billion extra has gone into mental health services. I recently announced £140 million in capital investment to improve in-patient services for people with mental health problems.
Taken together, all these things mean that services are improving. That is not to say that we do not take reports such as this extremely seriously, or that we are not doing everything that we can to ensure that the existing guidance accords patient safety the highest priority.