§ Question again proposed, That the original words stand part of the Question.
In that Committee my hon. Friend the Member for Westbury kindly referred to my hospital, St. Mary's. Referring to me, he said, correctly:He is particularly worried about this issue because of St. Mary's hospital on the Isle of Wight. It is a very small hospital for very good reasons: the inaccessibility of the Isle of Wight, the difficulty of getting people to the mainland and the fact that the population doubles in the summer months."—[Official Report, European Standing Committee C, 24 March 2004; c. 28.]What, he asked, would happen to such a hospital if the European working time directive were introduced? The Minister of State is familiar with the hospital because she visited it on 3 March. Unfortunately, however, answer came there none from Ministers in the European Standing Committee; they were unable to explain how a small hospital could employ sufficient consultants to comply with the requirements of the European working time directive. As her hon. Friends left the question unanswered, will the Minister answer it today? [Interruption.] The Government imposed the target. Labour Members seem to be worried—
§ Clive Efford
Targets are measures by which the public can assess the success of the Government. The Government may not meet some of their targets but at least they have some idea of the direction in which they are taking the NHS. The hon. Gentleman's party have no such plans and will set no targets, nor has it given any indication of where it intends to go with the NHS if it is successful at the next election.
My hon. Friends on the Front Bench will not set targets for hospitals; they will set targets for themselves. The customers of the NHS, like those in the 1297 private sector, are perfectly capable of determining whether they are getting the quality of service they want without reference to a range of unnecessary bureaucratic Government targets.
I fear I have run out of time but I want to underline the two points that I would like the Minister to answer: the effect of the European working time directive on St. Mary's and how soon her review of the shortage of dentists on the Isle of Wight will be available, so that that shortage can be corrected.
§ 7.2 pm
§ Ann Keen (Brentford and Isleworth) (Lab)
It is often said that people remember nurses. Nurses remember Governments, and this nurse certainly remembers the Opposition when they were in government.
A few days after the Conservatives were re-elected in 1992, I went to support my local football team— Brentford—and outside the ground were nurses in uniform with collection buckets. They were collecting for accident and emergency equipment for the local hospital. Down the road at Kempton Park, the West Middlesex university hospital stakes were also raising money for vital equipment for my local hospital. A demoralised work force were being asked to beg—literally—on the streets to collect money for equipment.
We are talking about recruitment and retention. That was a demoralised work force. If staff are not cared for, they cannot care for the community of patients that they are unquestionably able and trained to look after. Other services in the hospital were demoralised; they are often called hotel services, but they actually involve people who do vital work. Vital cleaning services were contracted out to the lowest bidder. Dedicated staff had their terms and conditions of employment reduced to poverty, with no employment rights. They worked a full week, yet they were entitled to claim benefits. Of course, there was no minimum wage; the Conservatives opposed that. Unemployment was high, and people were very nervous about leaving to look for other employment. Their skills were not valued, unlike today, when all the training and development needs of all NHS staff are being met.
The motion talks about retention. To retain staff, people must be proud of where they work. Under the Conservative Government, many NHS buildings were in very poor condition. Many were not even just of the last century, but the previous century: workhouse facilities. I worked in them. I know what it was like to be on night duty, wandering around looking for somewhere that could offer some refreshment—tea, coffee or food—at night. Our needs were not met; they were not catered for in any way. That applied right across the board, not just in my own profession, nursing. If people asked for training and development, they were told that there was no money.
Some of the pay review body awards were not always paid in full. When I was employed by Ealing health authority, I was asked whether I was prepared to give back my pay rise because, if I did not, the hospital would have to make cuts. That was in 1992. I tell hon. Members now that I had a very different conversation 1298 today, when I spoke to the chief executive of my primary care trust, John James, who leads Hounslow's PCT, along with Christine Hay. We could contrast the training and development and, yes, we could discuss the improvement in GP recruitment that, without question, has taken place in Hounslow. Many of the GPs who have been recruited are salaried, which makes quite a difference, especially to medical staff who want to return to work after perhaps taking time off to have children or for child care.
Flexibility is so important. The rigidity of the employment of NHS workers in the past put many people off staying in the NHS. The NHS is one of the most brilliant, wonderful sectors in which people can work. The staff are most dedicated. No one joins the NHS, right across the spectrum, because they want to earn vast sums of money. Very special people decide to work in the health service, and they have always deserved better. I am proud of the way that the Government are looking after NHS staff. Without question, the money for training and development is there. Without question, child care makes a difference.
I have talked to Meena Singh, who is the director of West Middlesex university hospital—now a modern building, opened by my right hon. Friend the Chancellor of the Exchequer last November. I was employed at that hospital in 1985. I was told at my interview that I would be working in a brand-new hospital by 1987. It took a Labour Government and a Labour Member of Parliament, a Labour nurse, to help to deliver that hospital in 2003. Much hard work took place, but there is, of course, more to do.
Without question, there are recruitment problems with radiographers, as has been acknowledged. We need to consider the mix of skills in the health service professions. My own profession, nursing, has come to the forefront, and many of the duties that nurses now perform will soon be recognised in pay. With "Agenda for Change", nurses can go up a clinical pay structure—a clinical ladder—but the previous Administration of the Conservative party prevented them from doing so by creating managers out of nurses. If nurses wanted to make progress in their careers, they had to go into management.
There is nothing wrong with management. There is nothing wrong with managing the NHS properly. There is nothing wrong with having support staff who are trained in the latest IT skills. I started my working life in the NHS as a hospital clerk. We still need to improve the administration services in many hospitals, as they have not changed much since I worked as a clerical assistant.
Without question, recruitment and retention require the most important aspect of NHS delivery. Without question, we have now increased the availability of treatment for patients, but we have done so with the development of a dedicated staff and with the development of a dedicated Government who are totally committed to the NHS, and without question, everyone who works in the NHS will always remember that.
§ 7.9 pm
§ Mr. David Amess (Southend, West) (Con)
I join all hon. Members in saying a very big thank you to all the women and men who work in our national health service. Without the staff of the NHS there would not be 1299 a national health service. I am sure that I speak for every one of them when I say that they are overworked and underpaid. If any Government can come up with the solution to that particular problem, then I am waiting to hear it.
The last Conservative Government were elected in the last century. I want to talk about this century, in particular about recruitment and retention. I am not suggesting for a moment that I and my parliamentary colleagues had the solutions to all the problems that the NHS faces, but I am sick to death of Labour jargon. What particularly grates with me is the talk of targets and star ratings. The people who work in the NHS are fed up with those two things as well.
I congratulate the chairman of the British Medical Association Council who, when speaking about the burden of targets, said:The one memory that will live long after the sweet taste of negotiating successes and the sour taste of acid encounters with self-serving secretaries of state"—I wonder whom he might have been talking about—have left my palate is the creeping, morale-sapping erosion of doctors' clinical autonomy brought about by micro-management from Whitehall which has turned the NHS I hold so dear into the most centralised public service in the free world.He mentionedThe stifling of innovation by excessive,intrusive audit and the imposition of Department of Health diktats … The shackling of doctors by prescribing guidelines, referral guidelines and protocols… The suffocation of professional responsibility by target-setting and production-line values that leave little room for the professional judgement of individual doctors or the needs of individual patients",and went on to say:Targets are set nationally without any appreciation of what they might mean for individual doctors sitting in consulting rooms with individual patients.On star ratings, the chairman of the British Medical Association said:Nobody should use star ratings to judge how well a hospital is doing. They measure little more than hospitals' ability to meet political targets and take inadequate account of clinical care or factors such as social deprivation. It is grossly unfair on staff working in low-rated trusts that public confidence in them is being undermined.I certainly support everything that those two gentlemen said.
I want to touch on recruitment and retention as they relate to general practitioners, dentistry, the people who work in our mental health services, the people dealing with obesity and those who deal with allergies. The BMA has rightly questioned the Government's claims that GP recruitment targets have been met. The chairman of the BMA's general practitioners committee said:The Department quotes headcount figures but many of the new GPs will be working part-time in general practice. Using the Government's own figures, we calculate that between September 1999 and September 2003 there was at best an increase of 1,323 full-time equivalent GPs in England over the four year period.1300 If hon. Members are honest with themselves, they will all admit that they know from their constituency pressures that not enough GPs are being trained. Again, I look forward to hearing the Government's ideas on how that can be improved.
§ Mr. Amess
No. The hon. Member for Workington (Tony Cunningham) would be angry if I did, because Mr. Deputy Speaker is, I think, hoping to allow one more Back-Bench Member to speak before we run out of time.
On dentistry, there are large queues when a general dental practitioner accepts new NHS patients, as my hon. Friend the Member for Isle of Wight (Mr. Turner) said. The UK has one of the worst dentist-to-population ratios in Europe. The average ratio in Europe is one dentist for every 1,1540 citizens, but in the UK it is one for every 2,097. There are two reasons for that. First, there is inadequate recruitment of young people to university degrees in dentistry, and, secondly, there is insufficient capacity in our dental schools, about which the Government have said very little. The intake of undergraduates to English dental schools increased by only 1.8 per cent. on the previous academic year, but the capacity of dental schools is not increasing fast enough to meet the increased demand for new dental students, which the Government claim they are meeting. When I asked the Secretary of State for Health what steps his Department is taking to encourage more applicants, I was told that the Government have published a new brochure—my goodness, they are marvellous at publishing glossy brochures—and it will be distributed in places where young people will hopefully pick it up and read it. Interestingly, the Government claim that dentistry is a popular choice for A-level students, with nearly two applications for every available place in dental schools. I hope that we will learn more about that when the Minister responds.
Retention is another problem. Overall spending on dental care in the NHS budget is far too low to meet demand, causing an increasing number of dentists, as we have heard, to turn to private work. Although the Government like to claim that expenditure on dental services has increased since 1997, that is misleading. As a percentage of the total gross NHS expenditure, the funding of dental services has decreased every year since 1997. Dentists are fed up with the treadmill system of the NHS and are spending more time in private practice. I am delighted that two dental practitioners in Southend, West who came to my surgery are going to set up an entirely NHS-based dental practice. They hope to work closely with the primary care trust, and the success of the enterprise will depend on the skills of Irish dentists.
The Select Committee on Health is conducting a short inquiry into allergies. Ministers will shortly appear before it to answer questions, but its members have been shocked by evidence that the problem of allergies has been completely ignored. The number of allergies is escalating, and we heard expert evidence that that is because we are much cleaner, so our immune system has to look for other things to do. The Royal College of Physicians has published an earth-shattering report 1301 entitled "Allergy—the unmet need", but unfortunately until the Select Committee inquiry, the problem received no attention whatever. One third of the population suffers from an allergy, yet only six centres provide full-time specialist allergy services in the UK. To get a better idea of the scarcity of allergy specialists trained to deal with that enormous need, one need only glance at the numbers. There is only one whole-time equivalent allergist-led clinic for every 3.4 million of the population and one allergist for every 2 million people. The Health Committee looks forward to hearing Ministers' response to that problem. There are worrying reports that many GPs are not trained to deal with the problem and simply do not want to address it. Research by Allergy UK, a leading charity on the issue, reveals that many allergy sufferers believe that their problems are not being addressed and that GPs do not have the necessary expertise to deal with them. One patient describing her GP's reaction to her concerns about allergies said:He told me very politely to go away and stop bothering him.I hope the Government will take the comments on allergies very seriously.
Mental health is without doubt the Cinderella service. There is a huge shortage of psychiatrists and physicians to deal with mental health. A study carried out in December by the Commission for Health Improvement found that there wereserious problems nationally with the recruitment and retention of mental health staff.The data show that three-month vacancy rates of 11.3 per cent. within the psychiatry group were higher than in any other specialty. I am delighted to say that a charitable organisation in Southend, West called Growing Together is trying to address the problem.
§ Mr. Amess
I am tempted, but there is one other hon. Member who wishes to speak before the winding-up speeches.
Finally, the Health Committee has led the way in the national and international debate on obesity. All Members of the Committee were shocked and disappointed by the fact that such a serious issue seems to have been ignored until now. It is certainly not just a matter of physical exercise; it has much to do with the content of what we eat.
The problems of recruitment and retention in the areas of health care about which I have spoken reflect the marginalising and neglect of issues that should be critical health priorities for the NHS. These are long-term problems and the country deserves to have them dealt with seriously. It is time for discussion to end and for more action from the Government.
§ Tony Cunningham (Workington) (Lab)
I thank hon. Members for enabling me to speak. In the few minutes that remain, I shall concentrate on local issues of recruitment and retention. There are problems, but it is 1302 important to put them into perspective. In west Cumbria, no in-patients are waiting more than nine months, and no out-patients are waiting more than 17 weeks. There are 167 out-patients waiting more than 13 weeks, compared with the figure 12 months ago, when it was about 600. That represents a fall of about 70 per cent.
The accident and emergency unit in west Cumbria has a proud record: 96.7 per cent. of those in accident and emergency are seen and treated within four hours. That is an incredible achievement and I pay tribute to the staff, who almost perform miracles in the accident and emergency department. With regard to cancer services, 99.9 per cent. of referrals are seen by a specialist within two weeks.
We have 229 more doctors and 1,690 more nurses. One or two hon. Members have mentioned Filipina nurses. In 2002 we recruited 31 Filipina nurses. They have integrated extremely well and do a fantastic job. There have been three weddings and two babies have been born as a result of them coming to the area. The lady who was responsible for the Filipino programme says:It has been a wonderful experience for all concerned. The nurses have settled well into our hospitals and communities and have embraced life in Cumbria. It has proved to be an exceptionally successful international recruitment campaign for the Trust.That is a great record.
One of the problems that we have with recruitment and retention is the isolation of west Cumbria—we are quite a distance from the nearest motorway, and so on. However, we have a fantastic quality of life: relatively low house prices, compared with London; the lowest crime rate in the country; and some of the finest schools. If there are any doctors or nurses out there watching the debate, west Cumbria is a superb place to come and work.
However, quality of life is not enough. There are two things that we must do. First, we must try to get a medical school in west Cumbria. Four new medical schools have been created recently and there have been three collaborations between universities. If more people were trained at a medical school in the area, there would be a greater chance of them putting down roots and staying there.
Another thing that would help with both recruitment and retention is a brand new hospital. A brand new community hospital is currently being built. It is a multimillion pound development that will be a huge bonus for the people of Workington, but we need a new district hospital in west Cumbria. I think that the figures suggest that by 2010, about 100 new hospitals will be built in this country. I hope that once all the machinations have been gone through and the consultations have taken place, west Cumbria will get a brand new hospital.
We have talked about targets and all sorts of things,but the vast majority of NHS users whom I speak to—I am sure that other hon. Members would say the same thing anecdotally—tell me what fantastic treatment and service they had. Regardless of the problems with recruitment and retention, there is no doubt that we have seen a huge improvement in the NHS throughout the seven years for which we have had a Labour Government.
§ 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.
1304 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. 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, 1305 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 1306 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.
§ The Minister of State, Department of Health (Ms Rosie Winterton)
I thank the Opposition for initiating today's debate because, once again, it has given the Government and labour Members the chance to highlight our genuine progress in rescuing and rebuilding our national health service after years of neglect and under-investment by the Conservative party. It also gave my right hon. Friend the Minister the opportunity forensically to expose the threadbare nature of the Opposition's policy.
The vast increases that we have made in the numbers of dedicated and committed health service workers, who work so hard to provide front-line services to patients, have been crucial to rebuilding the NHS. Patients show much greater appreciation of the work of those staff than Conservative Members, who take every opportunity to snipe, complain and undermine the morale of health service staff.
Let me provide the facts. There are 19,400 more doctors and 67,500 more nurses working in the NHS than in 1997. An increase of 27 per cent. has occurred in the number of scientific, therapeutic and technical staff since 1997. Medical students have increased by more than 60 per cent. since 1997, and between 1997 and 2003, the number of nurses entering training increased by 53 per cent. The total NHS work force is now at its highest level.
We fully acknowledge that there are some recruitment problems. We have taken several steps to deal with them, and I shall tackle some of the points that hon. Members raised later. First, let us consider what the Opposition say about bureaucracy, red tape and targets. I want especially to examine the comments of the hon. Member for Billericay (Mr. Baron). The number of targets has been slashed. Three years ago, there were 108 targets, now there are 62. That is less than one target for every £1 billion of expenditure in health and social care.
§ Mr. Baron
The Minister clearly needs to check her figures carefully, because there are at least a couple of hundred targets, as well as a further couple of hundred aims and aspirations. The other point that we are making is that those targets have had a minimal effect 1307 despite the increased expenditure, and average waiting times have risen over the last four years. Will she respond to that point?
§ Ms Winterton
I should like to ask the hon. Gentleman whether he knows any organisation that will be spending £90 billion a year which does not set objectives and targets. In relation to targets, we make no apology for halving the maximum waiting time from 18 months to nine, or for the fact that 19 out of 20 people are now seen, diagnosed and treated in accident and emergency within four hours.
We have decentralised power and funding, and more than 80 per cent. of funding is now going directly to primary care trusts. The suggestion by the hon. Member for Billericay that the NHS is awash with managers is complete rubbish. Since 1997, only 13,000 of 224,000 new NHS staff were managers—5 per cent. of the increase. Furthermore, only 40,000 of the 1.3 million employees—less than 3 per cent.—are managers.
I should now like to deal with some of the points raised by hon. Members. The hon. Member for Sutton and Cheam (Mr. Burstow)—who, by the way, did not outline a single Liberal Democrat policy—raised the issue of agency staff. That is something that we need to deal with, and we are taking a number of measures to do so. He talked about NHS Professionals, and about the private sector using agency staff, and those are issues that we can look at in relation to the code of practice for using overseas staff. Indeed, we are already doing so.
The hon. Member for Sutton and Cheam also asked about the dental work force review; we shall be publishing that shortly. I have to say to the hon. Member for Southend, West (Mr. Amess) that it was a bit of a cheek for him to talk about training places in dental schools when the Tories closed down two such schools themselves, but I am glad to hear that our money is getting through, and two new dental practitioners are now opening.
I should like to thank the hon. Member for Isle of Wight (Mr. Turner) for his kind comments about my visit to his constituency. I am glad to hear that I progress is being made there in regard to dentistry, but I will look into why the report to which he referred has been delayed. My hon. Friend the Member for Wakefield (Mr. Hinchliffe) talked about the need for preventive health measures. He also congratulated the Government on their investment in training and family-friendly policies,and mentioned the time that he had spent working in accident and emergency alongside his daughter. He talked about targets, and when I meet people who work in A and E, they say that the four-hour target has led to different ways of working, to the better patient experience that he mentioned, and to a higher quality of care for patients.
My hon. Friend the Member for Brentford and Isleworth (Ann Keen) eloquently spoke of her own experience of the dark days of the Tory Government, but pointed out that we needed to increase the number of radiologists. My hon. Friend the Member for Workington (Tony Cunningham) spoke eloquently, too, about recruitment and retention, as well as about the need for medical schools, and made a request for a brand new hospital in his constituency.
The Opposition motion before us today talks about demoralised staff, but what really demoralises staff is being constantly undermined and talked down by 1308 Conservative Members. Far from helping to recruit more staff to the NHS, the attitude of the Conservative party acts as a barrier to recruitment. That attitude shaped 18 years of Tory rule, wrecking our health service.
Amazingly, the Conservative party has learned nothing. The Tories want patients to shop around with their patient passport, which allows only those who can afford to pay to jump the queue. The Tory policy is for longer waits, new charges and choice only for the relatively well-off who can afford to pay thousands for their operations, and no amount of expensive Tory relaunches will hide the reality of their policies. They are not in the interests of patients, and not in the interests of staff. They are more extreme than the policies that brought the NHS to the edge of ruin.
Labour brought the NHS into being, and Labour is repairing the damage done by the Conservative party. That is why we are investing the largest ever amount of money in the health service. That is why we have increased the number of people working in the NHS by 224,000. We have done that because we care about the NHS. We want to see a health service of which our dedicated and compassionate NHS staff are proud, and a health service that provides high-quality services for all in our society, and not just for a privileged few. The NHS is improving, and we cannot let the Tories wreck it again. That is why I urge the House to reject the motion and vote for the Government amendment.
§ Question put, That the original words stand part of the Question:—
§ The House divided: Ayes 158, Noes 282.1311
|Division No. 200]||[7:46 pm|
|Allan, Richard||Davey, Edward (Kingston)|
|Amess, David||Davis, rh David (Haltemprice & Howden)|
|Atkinson, Peter (Hexham)|
|Bacon, Richard||Djanogly, Jonathan|
|Baker, Norman||Dorrell, rh Stephen|
|Baldry, Tony||Duncan, Alan (Rutland)|
|Barker, Gregory||Duncan, Peter (Galloway)|
|Baron, John (Billericay)||Fabricant, Michael|
|Beggs, Roy (E Antrim)||Fallon, Michael|
|Bellingham, Henry||Field, Mark (Cities of London & Westminster)|
|Bottomley, Peter (Worthing W)||Flight, Howard|
|Bottomley, rh Virginia (SW Surrey)||Flook, Adrian|
|Forth, rh Eric|
|Brazier, Julian||Foster, Don (Bath)|
|Breed, Colin||Fox, Dr. Liam|
|Brooke, Mrs Annette L.||Francois, Mark|
|Burnett, John||Gale, Roger (N Thanet)|
|Burns, Simon||Garnier, Edward|
|Burnside, David||George, Andrew (St. Ives)|
|Burstow, Paul||Gibb, Nick (Bognor Regis)|
|Butterfill, Sir John||Gidley, Sandra|
|Calton, Mrs Patsy||Gillan, Mrs Cheryl|
|Cameron, David||Goodman, Paul|
|Campbell, rh Sir Menzies (NE Fife)||Green, Damian (Ashford)|
|Carmichael, Alistair||Hague, rh William|
|Cash, William||Hammond, Philip|
|Chope, Christopher||Harvey, Nick|
|Clappison, James||Hayes, John (S Holland)|
|Clarke, rh Kenneth (Rushcliffe)||Heald, Oliver|
|Collins, Tim||Heath, David|
|Cormack, Sir Patrick||Hendry, Charles|
|Curry, rh David||Hermon, Lady|
|Hoban, Mark (Fareham)||Roe, Dame Marion|
|Hogg, rh Douglas||Russell, Bob (Colchester)|
|Holmes, Paul||Sanders, Adrian|
|Horam, John (Orpington)||Sayeed, Jonathan|
|Howard, rh Michael||Selous, Andrew|
|Howarth, Gerald (Aldershot)||Shephard, rh Mrs Gillian|
|Jack, rh Michael||Shepherd, Richard|
|Jackson, Robert (Wantage)||Simmonds, Mark|
|Jenkin, Bernard||Simpson, Keith (M-Norfolk)|
|Jones, Nigel (Cheltenham)||Smith, Sir Robert (W Ab'd'ns & Kincardine)|
|Kennedy, rh Charles (Ross Skye & Inverness)||Spelman, Mrs Caroline|
|Spicer, Sir Michael|
|Key, Robert (Salisbury)||Spink, Bob (Castle Point)|
|Kirkwood, Sir Archy||Stanley, rh Sir John|
|Knight, rh Greg (E Yorkshire)||Steen, Anthony|
|Laing, Mrs Eleanor||Streeter, Gary|
|Lait, Mrs Jacqui||Stunell, Andrew|
|Lamb, Norman||Swayne, Desmond|
|Lansley, Andrew||Swire, Hugo (E Devon)|
|Leigh, Edward||Syms, Robert|
|Letwin, rh Oliver||Tapsell, Sir Peter|
|Lewis, Dr. Julian (New Forest E)||Taylor, John (Solihull)|
|Liddell-Grainger, Ian||Taylor, Dr. Richard (Wyre F)|
|Lidington, David||Taylor, Sir Teddy|
|Loughton, Tim||Teather, Sarah|
|Luff, Peter (M-Worcs)||Thomas, Simon (Ceredigion)|
|McIntosh, Miss Anne||Tonge, Dr. Jenny|
|Mackay, rh Andrew||Tredinnick, David|
|Maclean, rh David||Trend, Michael|
|McLoughlin, Patrick||Turner, Andrew (Isle of Wight)|
|Malins, Humfrey||Tyler, Paul (N Cornwall)|
|Mawhinney, rh Sir Brian||Tyrie, Andrew|
|Moore, Michael||Viggers, Peter|
|Moss, Malcolm||Waterson, Nigel|
|Murrison, Dr. Andrew||Watkinson, Angela|
|Osborne, George (Tatton)||Webb, Steve (Northavon)|
|Ottaway, Richard||Whittingdale, John|
|Page, Richard||Wiggin, Bill|
|Paice, James||Willetts, David|
|Paterson, Owen||Williams, Hywel (Caernarfon)|
|Pickles, Eric||Willis, Phil|
|Prisk, Mark (Hertford)||Winterton, Ann (Congleton)|
|Pugh, Dr. John||Winterton, Sir Nicholas (Macclesfield)|
|Redwood, rh John||Young, rh Sir George|
|Rendel, David||Younger-Ross, Richard|
|Robertson, Hugh (Faversham & M-Kent)||Tellers for the Ayes:|
|Mr. David Ruffley and|
|Robertson, Laurence (Tewk'b'ry)||Mr. Geoffrey Clifton-Brown|
|Adams, Irene (Paisley N)||Bradley, rh Keith (Withington)|
|Ainsworth, Bob (Cov'try NE)||Bradley, Peter (The Wrekin)|
|Alexander, Douglas||Bradshaw, Ben|
|Allen, Graham||Brennan, Kevin|
|Anderson, Janet (Rossendale & Darwen)||Browne, Desmond|
|Atkins, Charlotte||Buck, Ms Karen|
|Bailey, Adrian||Burden, Richard|
|Baird, Vera||Burgon. Colin|
|Barnes, Harry||Byers, rh Stephen|
|Barron, rh Kevin||Cairns, David|
|Bayley, Hugh||Campbell, Alan (Tynemouth)|
|Beard, Nigel||Campbell, Mrs Anne (C'bridge)|
|Beckett, rh Margaret||Campbell, Ronnie (Blyth V)|
|Bennett, Andrew||Casale, Roger|
|Benton, Joe (Bootle)||Caton, Martin|
|Berry, Roger||Cawsey, Ian (Brigg)|
|Best, Harold||Challen, Colin|
|Betts, Clive||Clapham, Michael|
|Blackman, Liz||Clark, Mrs Helen (Peterborough)|
|Blears, Ms Hazel||Clark, Dr. Lynda (Edinburgh Pentlands)|
|Borrow, David||Clark, Paul (Gillingham)|
|Clarke, rh Tom (Coatbridge & Chryston)||Hoon, rh Geoffrey|
|Hope, Phil (Corby)|
|Clarke, Tony (Northampton S)||Hopkins, Kelvin|
|Clelland, David||Howarth, rh Alan (Newport E)|
|Clwyd, Ann (Cynon V)||Howarth, George (Knowsley N & Sefton E)|
|Coffey, Ms Ann||Howells, Dr. Kim|
|Cohen, Harry||Hoyle, Lindsay|
|Colman, Tony||Hughes, Beverley (Stretford & Urmston)|
|Cook, Frank (Stockton N)||Hughes, Kevin (Doncaster N)|
|Cook, rh Robin (Livingston)||Humble, Mrs Joan|
|Corbyn, Jeremy||Hutton, rh John|
|Corston, Jean||Iddon, Dr. Brian|
|Cousins, Jim||Illsley, Eric|
|Cranston, Ross||Irranca-Davies, Huw|
|Cruddas, Jon||Jackson, Helen (Hillsborough)|
|Cryer, Ann (Keighley)||Jamieson, David|
|Cryer, John (Hornchurch)||Jenkins, Brian|
|Cummings, John||Johnson, Alan (Hull W)|
|Cunningham, Jim (Coventry S)||Johnson, Miss Melanie (Welwyn Hatfield)|
|Cunningham, Tony (Workington)|
|Curtis-Thomas, Mrs Claire||Jones, Helen (Warrington N)|
|Darling, rh Alistair||Jones, Jon Owen (Cardiff C)|
|Davey, Valerie (Bristol W)||Jones, Kevan (N Durham)|
|David, Wayne||Jones, Lynne (Selly Oak)|
|Davies, rh Denzil (Llanelli)||Jones, Martyn (Clwyd S)|
|Davies, Geraint (Croydon C)||Joyce, Eric (Falkirk W)|
|Dean, Mrs Janet||Keeble, Ms Sally|
|Dobbin, Jim (Heywood)||Keen, Alan (Feltham)|
|Dobson, rh Frank||Keen, Ann (Brentford)|
|Donohoe, Brian H.||Kennedy, Jane (Wavertree)|
|Doran, Frank||Khabra, Piara S.|
|Dowd, Jim (Lewisham W)||Kidney, David|
|Drew, David (Stroud)||Kilfoyle, Peter|
|Eagle, Angela (Wallasey)||King, Ms Oona (Bethnal Green & Bow)|
|Eagle, Maria (L'pool Garston)|
|Efford, Clive||Knight, Jim (S Dorset)|
|Ennis, Jeff (Barnsley E)||Ladyman, Dr. Stephen|
|Fisher, Mark||Lammy, David|
|Flint, Caroline||Lawrence, Mrs Jackie|
|Foster, rh Derek||Laxton, Bob (Derby N)|
|Foster, Michael (Worcester)||Lazarowicz, Mark|
|Foster, Michael Jabez (Hastings & Rye)||Lepper, David|
|Levitt, Tom (High Peak)|
|Foulkes, rh George||Lewis, Ivan (Bury S)|
|Francis, Dr. Hywel||Lewis, Terry (Worsley)|
|Gapes, Mike (Ilford S)||Liddell, rh Mrs Helen|
|Gerrard, Neil||Love, Andrew|
|Gibson, Dr. Ian||Lucas, Ian (Wrexham)|
|Gilroy, Linda||Luke, lain (Dundee E)|
|Godsiff, Roger||Lyons, John (Strathkelvin)|
|Goggins, Paul||McAvoy, Thomas|
|Griffiths, Nigel (Edinburgh S)||McCabe, Stephen|
|Griffiths, Win (Bridgend)||MacDonald, Calum|
|Grogan, John||McFall, rh John|
|Hall, Mike (Weaver Vale)||McGuire, Mrs Anne|
|Hall, Patrick (Bedford)||Mclsaac, Shona|
|Hamilton, David (Midlothian)||McKechin, Ann|
|Hamilton, Fabian (Leeds NE)||McKenna, Rosemary|
|Hanson, David||Mackinlay, Andrew|
|Harman, rh Ms Harriet||McNulty, Tony|
|Harris, Tom (Glasgow Cathcart)||MacShane, Denis|
|Havard, Dai (Merthyr Tydfil & Rhymney)||Mactaggart, Fiona|
|Healey, John||McWilliam, John|
|Henderson, Doug (Newcastle N)||Mallaber, Judy|
|Henderson, Ivan (Harwich)||Mann, John (Bassetlaw)|
|Hendrick, Mark||Marris, Rob (Wolverh'ton SW)|
|Hepburn, Stephen||Marsden, Gordon (Blackpool S)|
|Heppell, John||Marshall-Andrews, Robert|
|Hesford, Stephen||Martlew, Eric|
|Heyes, David||Meacher, rh Michael|
|Hill, Keith (Streatham)||Merron, Gillian|
|Hinchliffe, David||Miller, Andrew|
|Hodge, Margaret||Moffatt, Laura|
|Mole, Chris||Simpson, Alan (Nottingham S)|
|Moonie, Dr. Lewis||Singh, Marsha|
|Moran, Margaret||Skinner, Dennis|
|Morgan, Julie||Smith, Jacqui (Redditch)|
|Morley, Elliot||Smith, John (Glamorgan)|
|Mountford, Kali||Smith, Llew (Blaenau Gwent)|
|Mudie, George||Soley, Clive|
|Munn, Ms Meg||Steinberg, Gerry|
|Murphy, Denis (Wansbeck)||Stewart, David (Inverness E & Lochaber)|
|Murphy, Jim (Eastwood)|
|Naysmith, Dr. Doug||Stewart, Ian (Eccles)|
|Norris, Dan (Wansdyke)||Stinchcombe, Paul|
|O'Brien, Mike (N Walks)||Stuart, Ms Gisela|
|Olner, Bill||Sutcliffe, Gerry|
|O'Neill, Martin||Tami, Mark (Alyn)|
|Organ, Diana||Taylor, Dari (Stockton S)|
|Osborne, Sandra (Ayr)||Taylor, David (NW Leics)|
|Owen, Albert||Taylor, Dr. Richard (Wyre F)|
|Palmer, Dr. Nick||Thomas, Gareth (Clwyd W)|
|Perham, Linda||Timms, Stephen|
|Picking, Anne||Tipping, Paddy|
|Pickthall, Colin||Touhig, Don (Islwyn)|
|Pike, Peter (Burnley)||Trickett, Jon|
|Plaskitt, James||Turner, Dennis (Wolverh'ton SE)|
|Pollard, Kerry||Turner, Dr. Desmond (Brighton Kemptown)|
|Pond, Chris (Gravesham)|
|Prentice, Ms Bridget (Lewisham E)||Turner, Neil (Wigan)|
|Twigg, Derek (Halton)|
|Prescott, rh John||Tynan, Bill (Hamilton S)|
|Primarolo, rh Dawn||Vaz, Keith (Leicester E)|
|Purnell, James||Walley, Ms Joan|
|Quin, rh Joyce||Wareing, Robert N.|
|Quinn, Lawrie||Watts, David|
|Reed, Andy (Loughborough)||White, Brian|
|Reid, rh Dr. John (Hamilton N & Bellshill)||Whitehead, Dr. Alan|
|Robinson, Geoffrey (Coventry NW)||Wills, Michael|
|Rooney, Terry||Winterton, Ms Rosie (Doncaster C)|
|Roy, Frank (Motherwell)|
|Ruane, Chris||Wood, Mike (Batley)|
|Ruddock, Joan||Woodward, Shaun|
|Ryan, Joan (Enfield N)||Worthington, Tony|
|Salter, Martin||Wright, Anthony D. (Gt Yarmouth)|
|Savidge, Malcolm||Wright, David (Telford)|
|Sedgemore, Brian||Wright, Tony (Cannock)|
|Shaw, Jonathan||Wyatt, Derek|
|Sheridan, Jim||Tellers for the Noes:|
|Shipley, Ms Debra||Mr. Nick Ainger and|
|Short, rh Clare||Jim Fitzpatrick|
§ Question accordingly negatived.
§ Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.
§ MR. DEPUTY SPEAKER forthwith declared the main Question, as amended, to be agreed to.
§ That this House welcomes the Government's record extra investment in the National Health Service which has resulted in increases of 19,400 more doctors and 67,500 more nurses since 1997; supports the extra investment in training which has increased the intake of medical school students by 61 per cent. and nurse training students by 53 per cent. since 1997; notes that over one million NHS staff will benefit from improved terms and conditions; recognises that the international recruitment of healthcare professionals has already made a significant impact on the delivery of NHS services; notes the Government's commitment to ethical international recruitment, with its robust Code of Practice, the first of its kind in the world, ensuring that NHS organisations do not recruit staff from developing countries without the agreement of their government; and welcomes the sharing and transfer of experience and ideas that international recruitment brings to the health service.