Does the Secretary of State accept that the new deal for junior hospital doctors can be implemented only with the co-operation of the nursing profession as nurses must adapt their role and take on new responsibilities? Is it not unfair that nurses should be awarded a pay increase of only 2 per cent. whereas junior hospital doctors are to receive an increase of 4.3 to 5.8 per cent?
I certainly acknowledge that the implementation of the new deal has implications for the nursing work load as well as that of junior doctors. I might have hoped that, in mentioning the implementation of the new deal, the hon. Gentleman would have welcomed the 2,400 new doctor posts that were created under that programme. The hon. Gentleman referred to a 2 per cent. pay increase for nurses. As he knows, that is not the position. As the review body recommended, the Government accepted the proposition that nurses' pay should be negotiated locally, subject to a floor of 2 per cent.
Is my right hon. Friend aware of the warm welcome that will be given to the steps that the Government have taken to ease the work load of junior doctors? Will he confirm that there is now 99 per cent. compliance with the targets to reduce on-call contracted hours for junior doctors to 72 hours per week?
As I said to the hon. Member for Leicester, South (Mr. Marshall), the implementation of the new deal affects the work load of nurses. My hon. Friend is right to say that the new deal for junior doctors has led to a dramatic reduction in the absurdly extended hours that junior doctors used to work. The review body on nurses also reported:
The allocation of resources for the NHS for 1996–97 means that most providers should be able to reward staff for improvements in efficiency and effectiveness while delivering increased volume of quality of care to patients."
The review body regarded that as a "win-win" outcome for the NHS.
Is the Secretary of State aware that the hospital trusts in Leeds have sent all nurses a letter saying that, from 1 April, they will be covered by new and independent bodies and that their terms and conditions could change? Will it not be the case that in future nurses will be held in reserve and hired and fired on zero-hour contracts that will undermine the profession as young potential nurses will not want to join a profession that has no apparent career structure?
No. The hon. Gentleman is wrong on virtually every count. By agreement with the unions, new nurses joining the NHS are being recruited on local contracts. The holders of existing national contracts continue to benefit from the terms of those national contracts and the trusts continue to be bound by them.
Does my right hon. Friend accept that we have the best and most professional nurses in the world in our national health service and that we have recognised the special work that they do by the independent pay review body, although there is now an element of local pay bargaining? Does my right hon. Friend accept that there is some concern that, because of the pressure under which nurses are now obliged to work, some people believe that we are taking the care out of nursing and that only the treatment matters when, in a vocational profession such as nursing, care is equally as important as the treatment?
My hon. Friend is right to say that we are blessed in the health service with an immensely dedicated nursing work force, among other professions in the service, and to stress the broader aspects of care for which nurses are famed and their contribution respected. I am sure that my hon. Friend will welcome the fact that, since 1979, at a time when earnings in the rest of the economy have risen 36 per cent. in real terms, the Government have seen nurses' earnings rise by a total of 70 per cent. over the same period. That shows the value that we attach to the nursing profession.
Will the Secretary of State stop being complacent and admit that the British Medical Association is concerned, as we are, about the effect on patients of a shortage of nurses and doctors in accident and emergency departments? Does the right hon. Gentleman agree that there are in most A and E departments shortages of specialist nurses, junior doctors, middle-grade doctors and even consultants? What action does the Secretary of State plan?
The hon. Lady is still playing the record that she played before Christmas, and she has been proven wrong by events. Before Christmas, the hon. Lady said that we would run into a shortage of junior doctors in A and E departments. I told the House last week that we conducted an audit on the subject a few weeks ago and found that 5 per cent. of junior doctor posts in A and E departments were vacant. The hon. Lady was wrong before Christmas and she remains wrong now.