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7 Feb 2008 : Column 1153

Mr. Henry Bellingham (North-West Norfolk) (Con): The hon. Lady is explaining things very clearly. Is there a problem at the moment with the highly skilled migrant workers scheme, particularly at a time when a number of locally and fully trained doctors are having a great deal of difficulty finding jobs?

Ann Keen: As has been stated—I think the announcement came out today—migrant doctors are always welcome to work in the NHS, as they have been for the past 60 years. Without them, the NHS would not have reached the strength that it has today. However, the scheme involves training places, and that has been decided in a court of law.

In addition, as I said, the investment has helped improve the delivery of treatment and care across the NHS and has driven down waiting times. The health budget has nearly trebled from £35 billion in 1997 to £90.4 billion. That investment in resources and staffing has had a dramatic effect on the health of the nation. Our reduction in the amount of time that people have to wait—

Mr. John Baron (Billericay) (Con): I thank the Minister for giving way; she is being very generous. On the issue of staffing, will she not accept that the Department of Health’s figures have recently shown that the number of managers and bureaucrats has grown at a faster rate than the number of doctors, nurses or consultants during the past 10 years? Does that not reveal a problem with bureaucracy in the NHS?

Ann Keen: The hon. Gentleman’s point is not relevant to the management of a service that is very complex. Health care is not easy to deliver. It requires excellent management and excellent leadership. The managers are not there to be bureaucrats, but to manage a complex system. They manage it professionally and in the best way.

The average in-patient wait for treatment has been slashed from more than 13 weeks in 1997 to around 4.5 weeks now. That is possible only with good management. More than 98 per cent. of patients now wait less than four hours in accident and emergency. That is an amazing, genuine and much-needed improvement. Over 1 million more operations a year are carried out now than in 1997, and 99.9 per cent. of people with suspected cancer are seen within two weeks of being referred. The number of heart operations has more than doubled since 1997.

That has been achieved by investing in staff in the NHS. The service employs many more talented people, and they have shown consistently that they are capable of rising to whatever challenge the future holds. The Government are enormously grateful for the work that they do and want to support delivery with the appropriate resources.

There are, of course, problems that still need to be dealt with, and many challenges to overcome. The Government are looking to continue to improve the NHS at all times. Our assessment is that we are around two thirds of the way through the reform programme that we set out in the NHS plan in 2000.

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Mr. Peter Bone (Wellingborough) (Con): Do the Government know how many whole-time equivalent dentists there are in the NHS?

Ann Keen: I cannot answer the hon. Gentleman now. I shall try to get an answer for him during the debate and, failing that, I shall write to him. However, I can tell him that the health of the nation’s teeth and the state of our children’s oral health are among the best in Europe. I praise the work being done by dental practitioners in the NHS.

The challenge facing us now is to complete the job of reform. My noble Friend Professor Lord Darzi of Denham is leading an in-depth review throughout England. For the first time, we are including clinicians and staff at every level, as well as patients, charities, organisations in the third sector and all the bodies that help everyone in the NHS in developing work force planning. I have the privilege of chairing the work force group, and I am grateful for all the time that has been made available to ensure that the work force of the present and the future—who will take the NHS through the next 60 years—reflect the changing needs and demands of health care in the 21st century.

The interim report from the Lords lays out a vision of a world-class NHS that is fair, personalised, effective and safe. The final report is due later this year, and will set out how we can deliver that vision and secure the NHS for the future.

I want to pay tribute to the staff of the NHS. In particular, I want to praise the work of all those volunteers who are not classified as staff but who are very much part of the work force, as they have been since the inception of the NHS in 1948. Those volunteers give of their time so that patients get that extra bit of care that professionals are sometimes unable to deliver.

In the US, for example, there is no national health provision, and the result is that more than 40 million families there worry every day about how to get the care that they need. We do not have that problem, thanks to the work done by Beveridge and the Attlee Government in 1948. We in this House have a duty to protect the NHS, and to make sure that it has the right work force. The care that it delivers must be safe, progressive and personalised, and that is our goal for the future.

1.23 pm

Greg Mulholland (Leeds, North-West) (LD): I warmly welcome this opportunity to debate this broad topic, although I am not sure what we have learned about NHS staffing from the speech that the Minister has just completed. It made no reference to the real problems experienced by NHS staff.

The Government seem to have a paradoxical approach to their stewardship of the NHS. No one doubts their commitment to trying to make it work better, and it is factually correct that investment has increased. However, their management of the NHS is not delivering the necessary return on that investment, or delivering the real, positive change that the Government themselves recognise as necessary.

At the heart of that paradox is the fact that this Government seek to control everything from Whitehall. Too often, they employ a one-size-fits-all
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approach, yet at the same time they seem to have something of a feudal, divide-and-rule attitude to NHS staff. Their running battles and regular and increasingly bloody skirmishes with different sectors of the NHS are causing resentment, disillusionment and anger among the people on whom we rely for the delivery of health services in this country.

We are also still reaping the results of botched contract negotiations and inadequate work force planning. Taken together, those problems are holding back the NHS, at a time when it should be allowed to prosper and flourish.

The 2006 Health Select Committee report branded work force planning in NHS a “disastrous failure”. More recently, Lord Darzi’s report outlined the need for an overhaul of work force planning and the commissioning of education and training. So far, however, it seems that very little has changed.

There is an overall equation that at the moment simply does not balance. Staff have been taken on with no long-term thinking but simply to achieve centrally imposed targets. People have been laid off or denied training places so that NHS trusts can balance their books. Like MPs all over the country, I have had junior doctors, nurses and physiotherapists visiting my surgery or writing me letters because, after all the hard work that they have done—and all the training that they have received at great cost to the taxpayer—they simply cannot find a job.

Yet huge amounts of money—some £1.18 billion in 2005-06—are being spent on agency nurses. They are hired at huge cost to the taxpayer, but better planning would mean that a great proportion of that money could be spent on health care and on areas where there are real gaps in NHS staffing.

Of course, the Department of Health has increased the number of training places and encouraged more people to apply for them, but it did not ensure that sufficient jobs would be available down the line for newly qualified professionals. On the one hand, there are real concerns over staffing levels—especially in maternity and other areas—and about the overuse of agency staff but, on the other hand, we have disillusioned young people unable to pursue their chosen careers. The careers that those people want to pursue are needed and valued by society, yet nurses are currently leaving the country in their thousands.

Mr. Bone: I am listening to the hon. Gentleman with interest, and I agree with much of what he has said. Does he agree that so many people leaving medical school are not getting jobs because medical professionals from Europe and elsewhere have been encouraged to come into the NHS? Is not that part of the mixture that is causing the problem?

Greg Mulholland: That is an interesting question, but the overall approach to staffing in all sorts of areas simply does not add up. I mentioned maternity services: we all know that there has been a failure to recruit enough midwives to provide the one-to-one care that the Government have promised. Birth rates are rising, many midwives have retired, and the problem can only get worse. If it continues, the chronic shortage
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of midwives could also force the closure of small childbirth centres across the country—just when the Government, quite rightly, are pushing forward with trying to give women real choice about where and how they have their babies.

I turn now to the increasingly damaging row between the Government and GPs, in particular over extended hours. The Government are trying to paint that row as one between them and the “unrepresentative” British Medical Association, not doctors. The Government are trying to suggest that the BMA is not willing to offer more extended opening hours, but all the doctors to whom I have spoken say that they support some form of appropriate extended hours. As a result, they feel that they are being ignored and dictated to.

Everyone agrees that extended hours are a good thing and, crucially, doctors agree with that too. The doctors in my constituency—indeed, all the GPs and their representatives to whom I have spoken—have made it clear that they would be more than happy to offer extended opening hours to their patients. However, they also have a very good idea of their own practice and their patients’ lifestyles and needs, so they have different suggestions as to how extended opening hours could be offered to fit both their practices and, crucially, their patients’ demands.

Ann Keen: The so-called dispute with the BMA is about a 10-minute difference between what we want patients to receive and what the BMA is proposing. That is in the context of an investment of £158 million. We believe that GPs will support the interests of their patients.

Greg Mulholland: That is exactly the kind of approach that is doing so much damage. It is about dictating, not listening. The row must be resolved by working together with doctors, and in partnership with GPs. The experience with dental contracts has shown that an imposed solution that is not acceptable to the medical profession will not work. Members may be slightly surprised to see me waving the flag for conflict resolution and peace, but it is vital for the future of primary care that a solution be reached with doctors. I hope that the Government and doctors sit down together to work through the issue, and that a flexible, sensible solution is found that works to the benefit of all.

We need partnership, a much more flexible approach and much more local decision making, including on NHS staffing. We need real, long-term, strategic work force planning across the NHS. Instead of top-down solutions from Whitehall, we need solutions that are tailored and adapted to different needs and situations across the country.

Ann Keen rose—

Greg Mulholland: I will give way, but I am not sure whether I get any more time for doing so.

Ann Keen: Lord Ara Darzi’s review does exactly what the hon. Gentleman wants: it involves clinicians and patients. My question to the hon. Gentleman is: does he support the Ara Darzi review?

Greg Mulholland: I support the review of the current situation, but the Government have been in power for almost 11 years, and it seems a bit late for a complete overhaul of the way in which we run our NHS.

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The Government should stop trying to look tough all the time, stop alienating staff and stop alarming patients. They should come up with workable solutions that meet local health care needs. For now, the skirmishes carry on. They are draining and distracting for all sides, and are not conducive to the provision of health care, which clearly requires Government, local health care organisations and the professionals to work together. The Government are ignoring the cause of our nurses, have lost the trust of our junior doctors, and are now at war with GPs. They are trying to control instead of guide, dictate instead of empower, and micro-manage instead of devolve. That is not the way for the NHS to achieve its potential, and it is time for a change of approach. It is time, at last, for the Government to listen.

1.32 pm

Mr. Richard Spring (West Suffolk) (Con): On behalf of everybody present, and indeed on your behalf, Madam Deputy Speaker, and the behalf of every Member, may I pay tribute to the wonderful work done by doctors, consultants and nurses, and the ancillary workers who are often the unsung heroes of the NHS? As the hon. Member for Leeds, North-West (Greg Mulholland) says, there are tensions within the NHS. It is therefore simply beyond belief that not one Labour Member of Parliament intends to speak in this debate on NHS staffing. I hope that when the Minister makes her final comments, she will apologise for that, as it sends out a curious message to all those in the NHS who are under considerable stress.

In recent years, the NHS has faced a number of problems, not least in Suffolk. The county has been hit by cash crises, service cuts, closures and redundancies. Our hospitals are continually on black alert. In the past 10 years, the number of available beds has been cut from 1,501 in 1996-97 to 1,194 in 2006-07. What is really sad is that community nurses and doctors have told me that the local hospital, the West Suffolk hospital, is being forced to discharge patients prematurely. Of course, the hospital is doing everything in its power to mitigate those unfortunate circumstances, but the situation has arisen because of very tight finances. The problem is that there are insufficient numbers of intermediate care beds, ever-increasing pressures on staff, and a top-down, centralised, target-driven culture that continues to drive front-line clinicians in our NHS to despair. That is well known.

Chris Bryant (Rhondda) (Lab): I often hear the argument that there is too centralised a system in the health service, and many of us would sympathise with it, but there is a corollary: everybody also complains about the postcode lottery. There is a contradiction in many people’s arguments. How does the hon. Gentleman resolve that contradiction?

Mr. Spring: Of course the hon. Gentleman is right to say that there are difficulties. Naturally, the problem that it is possible to obtain a certain form of treatment in one part of the country but not another has to be resolved, but I am not really talking about that. I am talking about a culture that has caused people to be pushed out of beds prematurely—that is the view of community nurses and doctors—simply because of the
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pressures of centralised targets and control. That is quite different from the dilemma that he rightly mentions. There is a great sense of despair among many of those who work in the NHS. The result is that our GPs are forced to pick up the pieces, which is difficult. I was talking to a GP in my constituency about that only yesterday.

Having targets for capacity in our hospitals raises the risk of superbugs such as clostridium difficile and MRSA. There have already been worrying increases in the number of superbug cases in some of the hospitals in the eastern region. Both West Suffolk and Ipswich hospitals have experienced increases in C. diff infections among patients over 65; in contrast, nationally there is improvement to the problem. Vomiting and diarrhoea bugs are commonplace. It is truly horrific that some elderly constituents of mine are now scared to go into hospital because of those bugs.

I reiterate that our doctors, nurses and ancillary workers do a wonderful job, but they are struggling to cope. Job cuts have simply not helped the situation. I acknowledge that, as the Minister said, since 1997 the number of staff employed in the NHS has grown, but since September 2005, some 38,000 jobs have been cut from the NHS. Last year, almost 7,000 nursing jobs were lost. The total number of qualified nursing, midwifery and health visiting staff employed by West Suffolk Hospital NHS Trust has decreased by 9 per cent. since 2004. The number of professionally qualified clinical staff has decreased by 8 per cent. since 2003.

Ann Keen: The vacancy rate for nurses is 0.5 per cent., which is the lowest level for six years. The nursing work force are to be congratulated on that.

Anne Milton (Guildford) (Con): It’s the number of nurses.

Ann Keen: The hon. Lady mentions nurses; they are an important part of the work force. In fact, they are the largest part of it. It is important that we get our facts right.

Mr. Spring: I note that the Minister does not contradict the fact that I mentioned about the diminution in numbers. It is based on information that is beyond dispute; the figures are official statistics.

Sir Nicholas Winterton (Macclesfield) (Con): I am sure that the Minister knows what I am about to ask my hon. Friend. There is a shortage of midwives in the national health service—a fact that is widely publicised by the Royal College of Midwives itself. There is also a shortage of student midwives. If the Government are to meet the guarantees in the Midwifery Matters strategy, the midwifery profession in the health service must be provided with more money, so that it can ensure safety in birth and the delivery of post-natal work.

Mr. Spring: I am most grateful to my hon. Friend for making that point. He is entirely correct; the UK birth rate is increasing appreciably, so not only has there been a shortage of midwives but with the rising pattern of births the situation can only get worse.

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