Since 1978, direct care staff in England have increased by 76,000. Nevertheless, the Health Service is not immune to the recruitment difficulties experienced by many large employers, particularly in London and the south-east, and faces the same declining pool of suitably qualified school leavers as they do. No single solution exists to this problem, but we have recently announced a range of initiatives designed to improve recruitment and retention, on accommodation, grading structure and training.
Is my right hon. Friend aware that there are new facilities at Wexham Park hospital in my constituency that are not fully used because of difficulties in recruiting sufficient numbers of suitably qualified nurses, and that the high cost of housing in east Berkshire is one of the principal reasons for those recruitment difficulties? Will he consider moving away from national rates of pay to allow the payment of premium rates in areas of high housing costs to help overcome some of these recruiting difficulties?
I know of my hon. Friend's connection with Wexham Park hospital, and that a modest improvement in recruiting is taking place there. He will be pleased to know that, already, several Whitley council management sides are seeking to negotiate, with our support, pay and grading structures that will enable the NHS to use staff more flexibly and take account of factors such as skill shortages and the pay rates needed to recruit and train staff in local labour markets. I know that my hon. Friend and the staff will welcome that.
Does the Secretary of State agree that the greatest barrier to recruitment in the National Health Service today is the low morale of its staff, and that that low morale is based on their belief that the Government are not committed to the Health Service? What does the right hon. Gentleman propose to do to improve the morale of staff in the service?
Like the hon. Gentleman, who served the National Health Service well for many years, I gather—[Interruption.] I fully accept that he did. Like him, I recognise the problem of morale. However, I genuinely ask him and hon. Members on both sides of the House whether the morale of the service, which has existed for 40 years, and into which vast amounts of money have been placed, and continue to be placed, will be improved by the quality of debate that we have been having in the last few minutes. I doubt it.
I shall seek to do what I said I would do earlier—to encourage health authorities to improve recruitment by, for example, increasing male recruitment and by making greater efforts to attract and recruit mature entrants. Many of the things that health authorities are now doing, as well as the large resources that are being put into the NHS, will make people realise the Government's commitment to it.
Does my right hon. Friend intend to tackle the two great problems that exist in the north-west Thames area in particular, as well as in the south-west Thames area, of a declining percentage of those leaving school choosing to go into the nursing profession and the fact that, at the same time, there are declining school rolls?
My hon. Friend is absolutely right. The change in demography is one of the fundamental problems that we face. We are considering very carefully the UKCC project 2000 proposals, which is looking at ways of widening the entry gate for nurses as well as encouraging qualified staff to return to nursing. Obviously, at this time, it is important that we do all that we can to encourage that.
Will the Secretary of State express a view on whether the new subsistence payments will increase or reduce his recruitment problems? Is he aware, with the blood transfusion service, that that new arrangement will result in a cut of more than £10 a week for staff who are paid less than £100 a week? If that is so, is the right hon. Gentleman really surprised that the result of that arrangement has been to provoke outrage among those penalised? Will he reconsider this arrangement, which is patently unjust and is hitting hardest those who are lowest paid?
I am delighted that the hon. Gentleman has raised that point. The changes in entitlement to day subsistence, over which there has been some industrial action, formed part of an agreement that was entered into freely by the staff side. Nevertheless, the management side has today made it clear that it is willing to discuss the issue further if the staff side so wish. I imagine that that is exactly what the hon. Gentleman is saying. Therefore, I hope that the staff will accept that offer and, as the management has requested, take all possible action to prevent further industrial action in the meantime.
My right hon. Friend will be aware that a high proportion of qualified and trained nurses leave after a period of service to marry and raise a family. Is he satisfied that the NHS, in the same way as the private sector, offers re-employment conditions that are sufficiently flexible to attract nurses back after they have raised a family?
My hon. Friend is on to a very important point—the key issue of trying to attract trained nurses who wish to come back into the NHS. My hon. Friend will know—as hon. Members on both sides should know—that 7,100 such nurses did come back to the NHS in 1986–87. Clearly, I am not satisfied that we have sufficient incentives and sufficient flexibility within the management structure to ensure that a larger number of that pool of trained nurses is attracted back into the Health Service.