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Some £1.8 billion has been spent on agency staff. My hon. Friend the Member for Macclesfield (Sir Nicholas Winterton) has a particular interest in midwives; the Royal College of Midwives is extremely concerned about the rising birth rate. It is up by 16 per cent. in London; there are 72,000 more babies. The number of deliveries per midwife has gone up. The NHS maternity services budget is shrinking, as is the NHS midwifery work force. We need more student midwives. There have been fewer training places in the years 2002-03, 2003-04, 2004-05 and 2005-06. Although there has been a significant increase in the number of nurses, there are now cuts in the number of specialist nurses
and posts are being frozen. Some 180,000 nurses are due to retire in the next 10 years, and more than half rated their morale as very poor or considerably poor in a recent survey.
The Department of Health itself has predicted a shortfall of 14,000 nurses by 2010. Independent research shows that the mortality rate in hospitals with the lowest registered-nurse-to-patient ratio is 12 per cent. The number of nurses per patient is literally crucial to the survival of patients. I could go on about physiotherapists. More than 2,000 physiotherapy students graduated in 2007, but only 25 per cent. have a permanent job. Some 49 per cent. have not been able to find one.
We cannot walk down the street without a cardiologist pulling us away and inserting a stent. Yet the 66,000 people newly diagnosed with heart failure and the 345,000 people newly diagnosed with angina are not getting the cardiac rehab for which they are desperate.
Anne Milton: I apologise, Madam Deputy Speaker. The Government have had 10 years to get a grip on the situation, yet there has been an abject failure of planning for our NHS work force. The Government thought that all would be well if they chucked money at the NHS. In fairness, they have done that, but they have not considered what has happened to the money. One could consider it quite a feat that a Government who have given large pay rises to staffparticularly GPs and consultantsshould also have managed to be so disliked and to drive morale down.
We have mentioned targets. I recently had a conversation with an A and E physician who is unable to keep his patients who are waiting for an intensive care bed on at A and E simply because the manager wants them up in the medical ward, where they are less well looked after, so that he can meet his targets. The Royal College of Nursing states that there are serious deficiencies in work force planning and that they need to be addressed. There is an all-time low of health visitors, despite the fact that health inequalities are rising. The Secretary of State himself said last year:
The reality on the ground is that there is a gloomy mood. There has been an awful lot of change in a short period and staff feel overwhelmed by it.
The verdict on the Governments work force planning is definitely D-minus [Interruption.] The Minister is smiling again, but I do not think that NHS staff will share her joy. Could do betterit is a disgrace and appalling. I urge the Minister to stop listening to her officials at the Department who reassure her, and instead face up to the truth. In many areas, the NHS work force is in freefall. The incompetence shown by the Government is outstanding
Mr. Peter Bone (Wellingborough) (Con): I congratulate my hon. Friend the Member for Guildford (Anne Milton) on a powerful exposure of the situation. I know that she would have liked to give way to the Minister, but she could not because of the time limit. The Minister can intervene on me as much as she likes. We are lucky that she is here today; she has detailed knowledge not only from her previous and current roles, but from her intermediate role with the former Chancellor.
I should like to start by praising NHS staff, who are extraordinary people. I am not thinking only of doctors and nurses, but I will single them out for praise. It is no secret in the House that five years ago my wife was diagnosed with liver and bowel cancer. A local GP had the skill to find a little lump that gave the alert. She was immediately sent to the local hospital, which is not in Wellingborough but a considerable distance away. I am grateful that the Minister has agreed to come to north Northamptonshire to look at that problem.
The trick was to phone up in the morning to say that we were on our way. I did that, and was told that no beds were available. I said, Blow thisI am coming anyway. By the time we got there, they had found a bed in a different part of the ward and she had the emergency operation. The skill of the 20 people who were involved in that operation and the recovery period was second to none. The same was the case when she had the emergency liver operation and, again, her life was saved by the NHS. I am pleased to say, touch wood, that she is fully recovered. Sitting in NHS hospitals for long periods at her bedside and observing NHS staff gave me an unusual insight into what goes on. There is no question but that the nurses in those hospitals are absolute angels. However, one of the problems that I noted was that on many occasions they were so short of staff that the nurses on duty stayed on for extra hours to cover and help out. They would also put off holidays to come in to look after their patients. That is a testimony to NHS staff based on my personal observations.
I do not think for one minute that this is an evil, nasty Government who want to destroy our NHSquite the reverse. They came to power in 1997 after my side had been kicked out, partly on the basis that there were 24 hours to save the NHS because those evil, terrible Tories had made a complete mess of it. I do not agree with that analysis, but that is what they thought. The Prime Minister, in his role as Chancellor, believed that throwing money at the NHS would solve the problem, and that is what he did. The amount of money going into the NHS in real terms has doubled since 1997, and it is now topping about £100 billion a year. That is equivalent to the amount that we will pay the European Union over the next few years, but that is another issue, which we have been debating in this Chamber for some time. While I am on the subject of the EU
Mr. Bone: Yes, they will. Having sat through the hours of debate on the EU, I was surprised to hear yesterday that the new treaty would give the EU some control over our national health service, the implication being that because ours is not a competitive system like those in the rest of the EU it can interfere with our staffing levels. There was not enough time for the Minister to answer that question, but it is an issue that we need to be concerned about; perhaps we can discuss it in another debate.
The Minister kindly mentioned the volunteers in our health service, who do a tremendous amount of work, obviously unpaid, and are an integral part of it. Let me single out one groupCrazy Hats, which is based in my constituency and works to support breast cancer victims. It is a small charity that started from nowhere and has done exceptionally well. It has supported Kettering, Northampton and Leicester hospitals and raised an enormous amount of money. One of its methods is the annual walk round Wicksteed park, which my hon. Friend the Member for Kettering (Mr. Hollobone) and I will do in the next couple of weeks. The volunteers in our NHS, as well as the paid staff, do an enormously important job, and they have the gratitude of the whole country.
Let me talk about something that I do in my constituency that has a bearing on this subject. My party is very keen on keeping in touch with what people thinkit is always having opinion polls and focus groupsso I thought, If its good enough for my party, its good enough for me and my constituency. We run a so-called tracking poll by putting out our Listening to Wellingborough and Rushden survey all the time in different parts of the constituency. Among other questions, we ask local people what are the issues that really concern them, and the NHS consistently comes up as the second most important issue in the area. When one analyses the sub-questions, one sees that the main issue is the lack of availability of health care and the lack of staff.
I want to relate a very distressing story that is worth repeatingI have mentioned it before in the Chamber. It concerns a constituent of mine whose husband was in Northampton general hospital, which is one of the two hospitals that serves my area. He was elderly and quite ill, and unfortunately he was not being fed. Food was being placed at the end of his bed, but he was somewhat blindthat is not very good wording but I think that the Minister will take the pointand had a slight mental problem. In any case, he was a person who needed treatment. The food was put at the end of the bed, but then people came round two hours later and took it away because he was unaware that it was there. When his relatives put a sign above the bed saying, My father cannot see the foodcould you feed him? the answer came back from the poor nurse, Im afraid we do not have time to feed the patients. That poor man begged to go home to die at home. He said that it was like being in a hellhole. Unfortunately, he got two hospital-acquired infections, and he did die at home. There is something wrong with a system that allows that to happen. I know that the Government would not want it to happen, but the Minister will know that I am not making it up.
The Minister will not be surprised to learn that my area, north Northamptonshire, is the worst funded part
of the NHS in the whole country, and the knock-on effects on staffing will be clear to everyone. The Government rightly work out, with considerable time and expense, a national capitation formula to work out how much each primary care trust should have each year to deal with its needs. Unfortunately, that is based on retrospective information, which does not help my constituents in an expanding area. Nevertheless, it would be okay if we received the national capitation formula. As the Minister knows, in each and every year since that formula was brought in, we have not received the full amount. Over the past four years, £120 million has not been provided to my local PCT because, we are told, other areas are overfunded. However, if there is a national capitation formula and that is the minimum amount that should be available in an area, why is my area not getting it? If we had £120 million more in north Northamptonshire, the hospitals there would have more nurses and we would have fewer problems.
Staffing levels also have a direct effect on some of the treatments that are allowed in my areafor instance, IVF is not done, or is given a very low priority. I am much more concerned about the condition of wet-eye age-related macular degeneration.
In parts of the country, hospitals can treat that condition very easily with injections. A patient would probably need three injections a year, for two or three years. The cost is a mere few thousand pounds. If we had a real national health service, my patients would not have to worry because there would be enough staff to provide those injections. I know that the Minister has been helpful on this matter, and so has the Prime Minister. As far as they possibly can, they have urged the PCT to give those injections. The situation is nonsensical because if people do not have the injections in a short period of time, the staff are not available to give them
I should have declared an interest at the beginning: I am a member of the Select Committee on Health. In the excellent speeches so far, we have heard that there are not enough staff in certain areas, while there are too many people applying for jobs in others. We have investigated this matter in the Health Committee and taken evidence, and we have heard that the Government recognise that there are not enough people available, that the staffing levels are wrong, and that there are dentist shortages. The fact that many dentists have left the NHS to go private has reduced the number of staff doing NHS dentistry. The Government ought to know, so that they can deal with the problem, how many whole-time equivalent NHS dentists there are. Unfortunately, I understand that they do not collate that figure. This wonderful national service is planning the provision of NHS dentistry, but it does not know how many dentists it has. It knows how many it has trained, but if it does not know how many it has got or how many it needs, it may end up providing too little training, or too much.
Ann Keen: I thank the hon. Gentleman for giving way; he said that he would not mind if I asked him to do so. I believe that I can now inform him that the total head count numbers are healthy. In March 2007, there were 21,041 dentists on NHS lists, an increase of more than 4,000 since 1997.
Mr. Bone: I am grateful for the Ministers intervention because she makes my point. The Government know how many dentists there are, but they do not know how many whole-time equivalent dentists there are. They do not know how many of those dentists are working for only a fraction of the time. They may be counting my dentist, who requires me to go private because he has come out of the service. He treats children on the NHS, so he would be counted as an NHS dentist, but he is not what we would call an NHS dentist. I do not want to be awkward about this, but the Government really need to look at the issue. I know that they want to improve the situation, but they need to know the figures.
Mr. Baron: My hon. Friend touches on an important issue. All too often, the Government talk about head-count numbers but not full-time equivalents. In response to a point raised earlier by my hon. Friend the Member for Macclesfield (Sir Nicholas Winterton) about midwives, the Government have suggested that there has been a massive increase in the head-count numbers, but if one looks at the number of full-time equivalent midwives, one finds that the situation has hardly changed at all. That would account for a lot of the shortages.
Mr. Bone: I am sorry, but I did not catch what the hon. Member for Rhondda (Chris Bryant) said. Does he want to intervene, or is he just chuntering? [ Interruption. ] I see he does not want to intervene. Oh, he does.
I know that the Government do not want what is happening, but it is happening none the less. Yesterday I was told that for the first time ever the hospital had to cancel a cardiac rehabilitation session because of the lack of staff. The Government would say that there are enough staff, but in reality that is not the case. The senior nurse to whom I spoke was dismayed at having to cancel the session. I know that the money is there and I guess that the former Chancellor lies down in a darkened room at night, and the Under-Secretary has
probably seen him banging his head against a wall, saying, Look, weve put all this money inwhy hasnt it worked? Everybody knows that that is the case and everybody is concerned about it.
Ann Keen: The results on heart disease are impressive. We have achieved our targets on improvements for all coronary artery disease, even though the hon. Member for Guildford (Anne Milton) does not appear to believe that that is a priority.
Mr. Bone: I am grateful for the intervention. I know that the Government are in favour of targets, but the fact that we have doubled the amount of money that goes into the NHS but increased outputs by a maximum of only 25 per cent. is a problem, and I think we all accept that. I do not know where the black hole is. I do not believe that the money has gone into staffing, but it may have gone into reorganisation. When we reorganised Northamptonshires PCTI cannot understand whyfrom three PCTs to one, the cost of that, with hiring and firing people and so on, appeared to be a complete waste of money.
Anne Milton: I am sure my hon. Friend agrees that treating heart disease is crucial but that the Government are failing to put the resources into cardiac rehabilitation, which is just about the most cost-effective, non-interventionist measure possible. Forty-nine per cent. of physiotherapists have not got jobs and could undertake that cardiac rehabilitation.
One of the knock-on effects of the funding formula is that we do not have any cardiac rehabilitation worth mentioning at Kettering hospital. People have to go to Bedfordshire to get it. They describe the problem as a postcode lottery, but I disagree. If it were a postcode lottery, my constituents would have a chance of winning now and again. However, it is not a lottery but a decision made in Whitehall to underfund the people in my area and the east midlands. We heard earlier that much more money will be spent on NHS staff in Scotland than in other parts of the country.
Spending on the NHS constitutes one of the largest parts of public expenditure. It is alleged that the NHS is the third biggest employer in the world. It was said that only the Red Army and Indian Railways employ more people. Unfortunately, that is not true. Now that Indian Railways has been privatised, the NHS has moved up to second place, and I daresay the Red Army is being cut back.
I hoped that the Under-Secretary would tell me how many times the former Chancellor had had to go into a darkened room and bang his head against a wall to try to solve the problem. She probably did not want to divulge that information.
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