I am grateful that you, Madam Speaker, have chosen for our first Wednesday morning debate of the new year the extremely topical subject of pay and conditions for nurses, midwives and health visitors. Out there in the country, a lot of people will be pleased that we have been given this opportunity for such a debate.
First, may I perform the usual courtesy of welcoming the Minister, who has a great opportunity? In one speech, he could guarantee a successful career and make himself popular with the whole country, hugely popular with the health service and entirely popular with hon. Members on both sides of the House. I look to him to rise to an unparalleled occasion. I shall give him a few prompts and hope that he will respond appropriately.
As hon. Members know, in a couple of weeks, the pay review body will recommend what should be paid to nursing staff, midwives and health visitors for the coming year. The Secretary of State for Health said the other day that the country faces a crisis in the health service. The Royal College of Nursing, also in the past few days, has said that the crisis in terms of shortage of nurses in the health service is the worst for a quarter of a century. Midwives say that the number of registered midwives has fallen by 2,500 over the past five years, and that the number of registered and practising midwives is lower than at any time this decade.
I am conscious that the debate is about only some of the people who work in the health service. We could have had a debate a wide-ranging debate about all NHS employees. May I allay their concerns and possible jealousy? We pay tribute to all those who work directly for the health service or are contracted to it. Although I shall concentrate on the largest group in the health service, I hope that—if you are generous, Madam Speaker—we will soon be able to debate the other two large groups, which also have pay review bodies and have their futures determined in the same way: the professions allied to medicine—chiropodists, dieticians, occupational therapists, orthoptists, physiotherapists and radiographers—and related grades and, of course, doctors and dentists. I am conscious that they, equally, play a part in the team, as do those who are not yet covered by the review body procedure, such as psychologists and psychiatrists.
We are grateful to all those people, but it seemed appropriate to debate nurses, midwives and health visitors, not only because they are the largest group, but because they are the group which manifests the most severe problems of recruitment and retention. It is vital to the future of the health service that we find solutions to those problems.
The national health service employs slightly fewer than 1 million people, which makes it by far the largest employer in the country. The review body considers workers in Scotland, England and Wales and recommends for the three countries together. We are discussing the futures of about 750,000 people in these professions. Interestingly, and perhaps relevantly, about 80 per cent. of them are women. As a man, I must say that, had the gender balance in the health service been different during the 50 years of its existence, wages for nurses, midwives and other health workers would not be relatively as low. Everybody in the health service should be paid appropriately, especially those who often have the larger caring and outside-work responsibilities.
The latest available figures show that there are about 600,000 practitioners on the United Kingdom Central Council for Nursing, Midwifery and Health Visiting register, but they also show a lot of alarming trends. I shall spend a couple of moments discussing the background statistics before coming to the argument and where we go from here.
The statistics show that the number of people available, on the list and qualified to work has gone down by about 2 per cent. in the past year, which is the biggest annual decline ever reported. People in the professions are also aging rapidly. We all age rapidly, but the profile of people in these groups is changing significantly. Fewer than one in seven is under 30, and more than one in eight is 55 or over and eligible for retirement. The trend looks unhelpful, because, within about 10 years, a fifth of all nurses will be over 50 and retirements are likely to increase from about 5,000 a year to about 10,000.
That means that we must replace those at one end of the health service who are leaving because of age, but, unhelpfully, we do not appear to have the numbers coming in at the other end. The number of people coming on to the register has fallen by more than a third—from about 19,000 a year to about 12,000—and we have lost a third of that number in the past 12 months. Thus, recruitment has declined over the past 10 years but the last big decline has been in the past year.
Not surprisingly, we have had to look abroad for people to help the health service. Although that issue has been well publicised, we are talking about small numbers—of more than 500,000 employees, only some 4,500 people from overseas work in our health service. We cannot, therefore, hope to rescue the NHS by bringing people from overseas.
Is my hon. Friend aware of a recent survey that shows that at least a third of nurses work two weeks' unpaid overtime a year just to keep the national health service going? Is that not an appalling indictment of the Government's record as an employer, especially given that they continually promote policies on fairness at work?
There are many anomalies, of which that is one. Another is that many nurses and midwives are paid a lower hourly rate for overtime. That goes against normal practice.
I agree with my right hon. and learned Friend. If NHS employees have the option of staying with their current employer and being paid less than the normal hourly rate or going to an agency and being hired back to do the same work at time and a half, the incentive to stay with the NHS is extremely small.
My hon. Friend the Member for Eastleigh (Mr. Chidgey) is absolutely right: there is a huge amount of unpaid overtime. There is also a huge amount of inadequately paid overtime. Those people are expected to do overtime, as many wards cannot cope without it. If we are to keep the work force at its current size, we need 20,000 to 25,000 new nurses and midwives a year, so we must have more pre-registration people as well.
It would be easy for an Opposition spokesman simply to apportion blame, but that does little good. Whatever the history of trends in recruitment, we need to get out of the hole in which we find ourselves. I want to use this debate to encourage people, and unashamedly to put pressure on the Minister and the Government not just to recognise the crisis but to seize what may be the only great opportunity remaining in this Parliament. Health service workers have been let down badly twice in the past two years—first under the previous Government, then under this Government. For the past three years, the pay review body has been asked to do its work and has come up with proposals, and the Government have said that the proposals cannot be implemented—certainly not altogether.
Nothing undermines the morale of people who are not even on average earnings more than being told that those in the private sector and other jobs will move ahead while they must stay at the same level or move backwards. The relative reduction in earnings and take-home pay has been unacceptable, and it would be a tragic mistake if the Government were to stage the pay review body's recommendations again. I call on the Government to say today that they will implement the recommendations in full from 1 April.
Last year, the Secretary of State apologised later in the year that he had had to stage the pay increases. Apologies are fine as far as they go, but they do not make up for £250 less pay in the pocket. My colleagues who deal with Treasury matters have confirmed that the country can afford to make that commitment. It would be a false economy not to pay health service staff what they deserve. If we do not pay them now, we shall not have a health service up to the job in the future, and the long-term cost to the economy will be far higher.
Does the hon. Gentleman accept that the cut in nurses' pay is leading employer bodies to appoint nursing auxiliaries—people who would love to be in the nursing profession—and money is being saved by taking on people at another level?
That is also true. The hon. Gentleman is knowledgeable about these matters. Although the pay review body's recommendations do not apply to Northern Ireland, and the staffing crisis is less great in Northern Ireland than in the rest of the United Kingdom, it is imperative that we continue to recruit and retain staff in Northern Ireland, many of whom have come to rescue the health service in the rest of the United Kingdom, where they enter other grades and often find a better salary reward.
I want to show the effect in cash terms of staging. In the past two years, a grade 2 clinical nurse has lost £248 as a result of staging. Last year, an award of 3.8 per cent. was made, but only 2 per cent. was paid in April and the rest was not paid until December. The rise did not keep pace with the cost of living. The Government are trying to con people by saying that it is all right if the pay increase keeps pace with the target rate of inflation. That is not the real inflation rate. The minimum that the Government must do is pay the real inflation rate—let alone make up for the money that was not paid last year.
In case the Minister says that it is all very well for Liberal Democrats to say that, but it is a huge sum of money, I remind him that the difference would have been £111 million and that the NHS budget is some £45 billion. If that was not money worth spending, we do not know what is. The Government have a huge reserve and could have afforded to pay in full last April. The Liberal Democrats said before, during and after the review that they should have paid, and the country made it abundantly clear in every opinion poll that nurses, midwives and health visitors, and others in similar professions, should have been paid a decent wage. In one respect it is too late, but in another there is still an opportunity.
May I do something slightly unusual and pay tribute to the national, regional and local press, which, over the past year, has clearly understood this issue better than the Government? It is unusual for Liberal Democrats—or other parties, for that matter—to pay tribute to the tabloid press, but The Express, the Daily Mail and The Mirror have consistently argued the case for health service employees to be paid better. They do so because they realise that a large proportion of their readership and the population at large want the health service to succeed. The NHS has lost 140,000 nurses in the past three years and there are some 12,000 nursing and 1,000 midwifery vacancies, so the press's interest has not been out of keeping.
The Liberal Democrats have seven simple-to-express elements of policy on pay and conditions. The issue is complex in many senses because of the complexity of each profession, grading structures, promotion and career development, training, overtime and local discretion. It would be wrong to seek to second-guess the pay review body's recommendations or make detailed proposals for each grade and profession. We shall value the pay review body's work this year as we have for more than a decade. It does an extremely good job and we are grateful for it. However, it is not difficult to reduce what needs to be done to some core propositions. Five of the seven proposals relate to what the Government should do now in terms of payment, and two relate to procedure.
First, whatever the pay review body recommends must be agreed—at least. Perhaps we need to agree to more. Secondly, there must be immediate, not staged, payment. Thirdly, we must put more money on the table to encourage people to enter the health service. When people are deciding on a career, and deciding which degree to study for, they sometimes consider the pay that they will receive once they have attained the qualification. People often realise that entering the health service is not a very good option. If the Government announced in the spring an increase in bursaries, it would make a considerable difference in persuading people to enter the health service rather than other professions.
Fourthly, we ought to reward those who have stayed in the health service. A loyalty payment, a bonus or a back payment of the money that should have been paid last year or the year before—not a huge amount, but something in the hand that said, "Thank you for sticking with us through hard times; things are getting better and we realise it"—would be much appreciated. Fifthly, about 70,000 professionals who have left the health service but remained in the country and are not past retirement age would, given the right encouragement, return to work in the service. We ought to pay them an incentive to return. We should pay more to those who enter the health service, more to those who stay in it, and more to those who return.
I declare an interest, as my wife is a nurse. One issue that is often overlooked in seeking to retain, recruit and encourage the re-entry of nurses into the profession is the cost to nurses of training and retraining. They are treated as if they were highly paid professionals. Will my hon. Friend comment on the fact that nurses often have to undertake training in their own time and at their own expense? In effect, they are being asked to pay for the right to be poorly paid, which adds insult to injury.
I am grateful to my hon. Friend, who knows more about that issue than most. I, too, declare a slight interest, because people in my office have spoken to my hon. Friend's wife over the past couple of days to check what is going on in nursing in rural areas, to ensure that we are not just picking up information from inner-city constituencies. The situation that my hon. Friend describes is a scandal. I know of no other profession in which one is expected to retrain in one's own time or, effectively, at one's own expense. We are short of 12,000 nurses and desperate for people such as my hon. Friend's wife to work for the health service, yet we tell them that we will not pay them to get back up to speed if they want to return. That is not acceptable, and would not be in any other profession.
My hon. Friends and I have put on the table two procedural but important propositions about the way in which this place should deal with public sector pay reviews. First, in the past—I understand why—pay review body recommendations have gone to the Prime Minister, then the Chancellor and have been finally decided by the Cabinet. The House has never had an opportunity to decide such matters. We vote willingly on our own pay, but are never given the chance to vote on key public sector pay—whether it be of the armed forces, teachers, senior officials such as judges, or people who work in the health service.
Liberal Democrat Members are clear that, whatever the pay review body's recommendations, they should never be turned down unless Parliament agrees. If we are all asked to go through the Lobby in favour of or against the recommendation of a pay review body, the views of the country will be far more clearly reflected than if the Government take a possibly partisan decision which often favours the short-term economic interest as opposed to the long-term interest of the nation.
From the spring, there will be a Parliament in Edinburgh and assemblies in Cardiff and Belfast. We shall have four health services, accountable to local representatives. We have always believed that the health service should be more accountable. Therefore, logically, the pay review body should report to the Parliament in Edinburgh and the assemblies in Cardiff and Belfast, as well as to this place, so that what is right for Scotland, Wales, Northern Ireland and England can be decided by the people in those places on the basis of the particular facts. Different recruitment and retention problems and different mixes of professions need different solutions.
Although there are expert groups on nurses, midwives and health visitors, no one has ever compared their pay with that of cleaners or trust chairs. People who chair trust boards, who receive £120,000 a year, have had large pay increases. Yet, at the bottom of the scale, people have ended up on £12,000 a year following pay increases of 2.5 per cent. We take the very strong view that the health service will work together and feel like a team only when everybody's pay is considered collectively and seen to be fair.
We all know—it is almost trite to say—that the United Kingdom spends 5.8 per cent. of its gross domestic product on the public health service and about 6.9 per cent. on health care in total. We are halfway up the league table of European Union countries in public spending on health care, and 13th out of the 15 in total spending. The public are saying to us very loudly, "We want to spend more on the health service." We cannot divorce the pressure for better pay from the fact that the public are willing the health service to receive more. A huge majority of people believe that we need to spend more of our national wealth on our national health.
Health professionals have a good case when they say that, as they are frontline workers who do life-or-death jobs, it is reasonable that their pay should be compared with that of people who do similarly important public service jobs, and with the average wage of the work force as a whole. Last year, while a grade D clinical nurse was paid £12,635, a fire fighter's starting salary was £14,500, and a police officer's and a qualified ambulance worker's £15,500. A teacher's starting salary, at more than £13,000, was also higher than that of a nurse, midwife or health visitor. The average wage was more than £20,000, and the average graduate starting salary—now, all nurses are graduates—was about £16,500.
Since the beginning of the 1980s, the pay of a nurse or midwife has slipped from about three quarters of average pay to much nearer half. I do not think the country thinks that that is acceptable. We must restore the status that is recognised by pay. It is no good saying, as the Government are saying to teachers, that people are very important, while not giving them the money in order that they may do their important job properly.
I do not want to go into the details of the practices to which my hon. Friend the Member for St. Ives alluded, but it nonsensical that nurses should be better off leaving the health service and then returning for regular part-time agency work. That is undermining the health service. However good such agency nurses or midwives may be, they are not part of the team, do not know the patients in the same way and are not present all the time. Everyone in the health service agrees that the doubling of reliance on agency nurses, which was corroborated in figures in a written answer to me just before Christmas, is an unacceptable trend which ought to be ended—let alone the practices of training in one's own time and the like.
The Government keep on saying that if staff are given more money, there will be less for patient care.
Indeed. Patient care can be delivered only if staff are available: it is not a case of either/or. Wages are a significant part of the health service's budget because a large number of staff are needed to deliver high-quality care. There are two components to the staff issue: we need both enough staff and high-quality staff. If we have both, good patient care can be provided in pretty grim conditions. Buildings can be dire, but if equipment and staff are up to the job, people's lives can be saved and the quality of their lives significantly improved.
I hope that, in this Parliament, we do not experience the dishonesty that we experienced twice in the last Parliament. In the last Parliament, the Government said, "We will act on the pay recommendations, but the money will have to come out of existing budgets: we will not give you any more." The same has often been done in the case of teachers. Local authorities have been told that they can pay teachers more, but will have far less money for other purposes as a result.
I am afraid that the Government have already perpetrated a fiddle. In November, the then Minister of State, the right hon. Member for Darlington (Mr. Milburn)—now promoted to the Cabinet—announced the new criteria, or terms of reference, for the pay review body. He had changed those criteria, adding requirements for the body to take into account such factors as the Government's inflation targets, and also to take into account not just the need to recruit, retain and motivate staff, but spending limits.
In the past, the pay review body has always said that its job is to recommend fair pay and conditions for staff, and not to say that, although it would like to recommend a certain sum, it cannot do so, because the Government have said that only so much is available. I fear that, even if the Government implement in full and immediately all that the pay review body has recommended this year, the body will not be allowed to say what the health service requires as it did in the past, because its goalposts have been moved.
Pay for those in the health service should constitute what is needed to recruit and retain the staff who are required to do the job—in the real world, where people must meet real bills. I hope that today's debate will reflect the pressure from the country as a whole, and the public's wish for us not just to say good things about our health service workers, but to pay them properly so that they come, and stay, and come back, to do one of the most vital jobs that the country has to offer.
I think it would be fair to say that our magnificent victory on 1 May 1997 resulted not just from economic factors and the failure of the last Government, but from the fact that, for at least 10 years, many people had felt that it was high time we had a change in order to save the national health service from the Tory Government who had been diminishing its role for so long. It is incumbent on every Labour Member to bear in mind the fact that we were elected for that specific reason—to save the national health service. We established it way back in the 1940s, and now, after 18 years of Tory rule, we must rebuild it.
It should also be remembered that last year the Labour Government decided to recognise the problems in the NHS, and to find sufficient money to put it back on its feet. It would be wrong to give the impression that we expected £21 billion to be allocated in the last Budget. I know of no hon. Member—and I include Tories and Liberal Democrats—who made any reference to such a figure. In fact, it is on record that the Tories' top figure was about £12 billion.
I believe that the Government's decision enables us to feel a little confident about the pay review recommendations for nurses and other NHS workers. I do not think that my speech, or that of the hon. Member for Southwark, North and Bermondsey (Mr. Hughes), will decide their fate; I think that the key ingredient in ensuring better pay for nurses was provided at the moment when the Government decided to allocate that £21 billion.
The Government may feel that the money should be spent in a certain way—that more should be spent in one area, and less in another. Let me emphasise again, as I have for several months, that the decision on pay for nurses and others—including those who clean the wards, for instance—will be a defining factor for the next three years. We cannot afford to hear, day in, day out, arguments from those who are at the sharp end in the NHS.
Unlike the Liberals, who cannot put a real figure on their spending proposals because they spent their extra penny on tax many months ago, the Government must think in terms of an increase of no less than 10 per cent. for nurses and others at the bottom of the pay scale. I hope that it will be more. If it is true that we are 12,000 nurses short, and that the NHS is short of staff at all levels, we must institute a regime that will enable us to change the position.
I agree with those who talk about getting rid of agency nurses. I will go further, and say that I do not approve of the pay review body, which was introduced by the Tory Government to solve some of their problems. I would much prefer the NHS trade unions to be able to engage in proper free collective bargaining like every other trade union. My hon. Friend the Minister should recognise that we have a crisis in the health service, that we must try to overcome it, and that in the next three years—in the run-up to the next election—we ought to be able to say that we not only found the necessary money for the NHS, but found enough for nurses, midwives and the rest.
I agree with what my hon. Friend is saying, but is it not also true that simply saying that there is more money on the table to attract nurses to the profession is not enough? We must recognise that, owing to the 18 years of neglect, training places have not been filled. They have been artificially repressed when the demand has been there. The present Government's task has been impeded by the actions of the last Government, to the point at which we cannot possibly obtain the number of nurses we need in the time available. Training places must be opened up as a matter of urgency—although, at the same time, we must do as my hon. Friend suggests, and cajole the Government into paying our nurses more.
There is no doubt about that. Just before the recess, I went to St. Thomas's hospital with a colleague who was ill, and I had the shock of my life. I have not spent a great deal of time in hospitals. It was late on a Thursday night, and about 30 people were queueing. Some had been involved in scuffles and the like. It should be noted that it was a Thursday, not a Friday, a Saturday or a Sunday. A nurse was trying to deal with all the people who were trying to get on to the casualty ward. My colleague, who turned out to have had a minor stroke, was taken in. During the two or three hours that I spent in the hospital, people with blood on their ties were shouting and bawling at the lone nurse who was trying to deal with the problems. I heard it said that there would be a three-hour wait for a doctor. This was at about 10 pm on a Thursday, in one of our largest hospitals, just over the river. I realised that the nurse was having some difficulty in handling the problem, so I went outside and had to cajole some of those people into realising that she was not responsible for the mess that night.
It is important that we do not finish up with one nurse at St. Thomas's hospital between 10 o'clock and 1 o'clock trying to deal with 30 people in the casualty department. I suppose that that situation could be mirrored throughout Britain. That is why training and all the rest have to go along with the other policies.
When he talked about England, Scotland, Wales and all the rest of it, the Liberal Democrat spokesman gave the impression that there might be different pay rates for different regions. I happen to be first and foremost a trade unionist and I do not want national pay negotiations to be broken up. It is conceivable that the existing method of pay bargaining will result in more and more break-up, with the result that pay can be negotiated locally. People will then get more pay in some parts of the country and, where unemployment rates are high, they will get considerably less. I can imagine some of the Liberal Democrat Members from Cornwall and the south-west, where pay is traditionally lower, playing merry hell if they found that pay negotiations had been broken up in that fashion. National pay rates are important across the board.
I understand the hon. Gentleman's argument and I have always said that there should be national pay negotiations and national pay rates—I took on the Tories about that when they were in power—but, as he is aware, from later this year, the health service in Scotland will be accountable to the Scottish Parliament. We are not talking about different regions in England, but the four countries of the United Kingdom—different nations. It will be illogical and completely against the wishes of the people if they cannot negotiate their own pay for their own health service. However, that does not mean that, throughout England, we break up the national pay strategy. I support him on that, but Scotland, Northern Ireland and Wales are different countries.
Frankly, I do not go along with that fancy idea. People can call it devolution or whatever they like, but I used to be a coal miner before I came here and I cannot conceive of a situation where, if we had a lot of pits in Scotland—we do not because the Tories closed most of them—we should have miners being paid one rate in Derbyshire and Yorkshire, another in Scotland and another in Wales. I am not in favour of that.
As a trade unionist, I believe that it is important that we have national pay negotiations. The moment that we have inroads into that proposal, the lowest common denominator in pay sets the pace. The result will be lower wages for all at the end, not the highest common factor.
When my hon. Friend the Minister winds up, and in his representations at other levels, will he bear it in mind that we have to strive to get rid of the internal market, to ensure that we get more nurses, to improve training, to have a pay increase of at least 10 per cent. for those at the bottom of the pay scale, and to ensure that the national pay scale system remains, irrespective of devolution and all the rest that is on stream?
It is refreshing to hear analysis when there was a lack of it from the hon. Member for Southwark, North and Bermondsey (Mr. Hughes)—in fact, the hon. Gentleman was determined not to engage in any analysis or to blame anyone.
Does my hon. Friend accept that the greater problem in the NHS is the lack of acute beds, which were systematically closed year on year in every health district in the British Isles? Throughout the period of Conservative rule, those acute beds were wasted away. During the current crisis, the problem is not just at the front of the house—my hon. Friend referred to accident and emergency—but at the back of the house, where the beds have not been available, with the result that people have been stuck on trolleys in corridors. Does he not accept that that is a critical part of the problem?
Everyone knows that that is one of the problems that we have to resolve. That is one reason why the £21 billion was important. The decision by the Labour Government in the past few months to find £21 billion can help us to resolve that issue. It is one that can be resolved only if the Government take on the system within the NHS that was left to us by the Tory Government, which meant that all those decisions could be taken, that all the trusts could be set up and that the power that used to exist in the NHS was disseminated through the trusts. We have to deal with that as well.
I welcome the fact that we have that additional money to spend. I hope that it will be spent wisely and that we will ensure that, at the core at what we do in the NHS, those people who provide the services will get a much better pay deal as a result of the efforts of the Government to find sufficient money, as they have during the past few months.
I congratulate the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) on his success in the ballot. The debate is important. I also welcome the Minister of State to his first opportunity to show his ability at the Dispatch Box.
It is interesting to note the Labour Members who are present; I put aside the Minister and I do not really know the hon. Member for Wythenshawe and Sale, East (Mr. Goggins), but I assume that he is his Parliamentary Private Secretary. At least I know where I stand with the other four Members who are present—that will damage their careers. We certainly know where we stand with the hon. Members for Bolsover (Mr. Skinner) and for Wolverhampton, North-East (Mr. Purchase); I forgot the Whip, the hon. Member for Weaver Vale (Mr. Hall).
I do not know whether the father of the hon. Member for Chorley (Mr. Hoyle) would have been pleased with what he said to the Minister for Local Government and Housing yesterday about rate capping. I did not agree with a word that the hon. Gentleman said, but at least he had the guts to take on his own Minister. The hon. Member for Leyton and Wanstead (Mr. Cohen) was first elected at the same time as me, although we share nothing in common politically, except perhaps on animal welfare. He was entirely right before Christmas in wanting a debate on the bombing of Iraq. Those four hon. Members are certainly not part of the rubbish that was sold to the British people on 1 May.
I am delighted that the Liberal party has initiated the debate. I am somewhat confused about the position of the Liberal party these days. This morning is a perfect opportunity to find out where it stands. One of its Members, the right hon. and learned Member for North-East Fife (Mr. Campbell), was made a privy councillor in the new year's honours list. I congratulate him on that. Over the weekend, he was interviewed on television. He dismissed completely all the difficulties of the Government over the Christmas period and said that he would continue to support the Labour party as long as it continued with its policies on health and education. What we have heard this morning does not seem to bear out that out—and that privy councillor was sitting here earlier. As ever, the Liberal party wants to have its cake and eat it.
—and his colleagues have changed the name of their political party on four occasions, so, okay, it is now the Liberal Democrat party, but all I say to the hon. Gentleman, who was elected on 1 May 1997, is that we want to know where the Liberal party stands on the issue. Does it support the Labour Government? Does its leader want a position in the Cabinet, or, this morning, are we to take seriously—its Members were massed on two Benches—its attack on Her Majesty's Government?
I know that, when the Minister of State stands up, he is going to have quite a bit of briefing that will blame everything on the 18 years of the Conservative Government and say nothing at all about the Liberal party. I do not think that Conservatives and the rest of the country will accept that.
Like the hon. Members for Southwark, North and Bermondsey and for Bolsover, I should like to pay tribute to the work done by health visitors, nurses and midwives in the United Kingdom. We owe all of them a great debt of gratitude. However, I should like to deal with the difficult matter of pay, which is all about management of the economy and setting priorities, which the Liberals, or the Liberal Democrats—unlike the hon. Member for Bolsover, who at least clearly stated his priorities—never want to face up to.
As hon. Members will know, nurses are the backbone of the national health service and provide 80 per cent. of direct patient care. However, there are between 12,000 and 13,000 empty nursing posts in Britain. Moreover, the turnover rate of registered nurses is high—currently at 21 per cent., whereas it was 12 per cent. in 1992.
There are also widespread problems in recruiting nurses. The Government know all about those problems. A survey of 73 NHS trusts, shows that 78 per cent. of trusts now report recruitment problems. The percentage reporting such problems was just above 50 per cent. in 1997 and was 33 per cent. in 1996. The statistics show that, regardless of what the Minister says today, there is a growing recruitment crisis. As the hon. Member for Southwark, North and Bermondsey said, the nursing profession also faces a "retirement bulge".
The first brief that I shall use today came from the Royal College of Nursing, which would have supplied the brief to any hon. Member who asked for it. That organisation states that
The Government's decision in January 1998 to stage the nurses' pay award"—
Yes. However, the brief states that the decision in 1998
had a devastating effect on nurses' morale.
The hon. Member for Oxford, East and Abingdon (Dr. Harris), supported by the hon. Member for Newbury (Mr. Rendel), wants to attack not only the Conservatives but the Government. The Liberal Democrats want to have their cake and eat it.
I am grateful to the hon. Gentleman for giving way. I am especially grateful that he has now started to talk about nurses' pay. He has listed a number of problems in nursing. Does he accept that one of the issues affecting not only recruitment but retention of nurses is the constant regrading process, in which senior nurses have to apply for their jobs and are reappointed at a lower grade? It is the most demoralising process for a professional. Does he agree also that that process is a consequence of trusts being told to do their own thing—thereby destroying a national pay and career structure in the United Kingdom?
Unlike the hon. Gentleman, I was a Member of Parliament when nurse regrading was developed. Like the Secretary of State—who takes responsibility for everything that happens in his Department—I should be very happy to defend the previous Government's 18 years in office. However, nurse grading is not the straightforward matter that the hon. Gentleman implies that it is.
The Royal College of Nursing wants specifically to compare nurse grading with teacher grading. The college believes that the position of nurses has become much worse compared to that of teachers. I do not know whether the Minister thinks that it is sensible to have such a relative decline.
The Royal College of Nursing believes that the only way in which nurses can earn extra money is by working unsociable and extra hours. The college believes that it is wrong for such a situation to continue, and that retention of nurses would be much improved if there were a real career development plan. Perhaps the Minister will be able today to tell us about such a plan. The Royal College of Nursing also wants the Government to develop family-friendly employment policies, and believes that serious health and safety priorities in the NHS must be addressed.
Two months ago, the hon. Member for Moray (Mrs. Ewing), the parliamentary leader of the Scottish National party, sat next to me at a midwife rally, which was an interesting occasion. Such rallies were held regularly throughout the 18 years of the Conservative Government, and Labour Members and spokesmen were always there to address the masses, by whom they were applauded. Two months ago, when I attended, and spoke to, a rally, some Labour Members showed up, although no Minister was available to do so.
Yes, I know. However, I should like to deal with the point about the Minister not being at the rally. During the rally, the Health Secretary's special adviser came in, looking extremely worried, and passed a bit of paper to the front of the audience. The audience was subsequently told that Baroness Hayman would meet a delegation a little later in the day. My word, it certainly takes great guts and courage to meet a delegation privately.
The Government did not say to the electorate, "Hang on; we'll have to wait two years for reform because the Conservatives have left the health service in a terrible mess. It is very sad that people are dying and operations are not being performed, but you'll have to wait at least two years. The Chancellor of the Exchequer has told us that 1999 is the year of delivery, and we can't do anything immediately." The Government should have had the courage during the general election to face up to that difficult audience.
I owe a great debt of gratitude to midwives. The rally that I attended two months ago was attended also by midwives from Southend and from my former constituency of Basildon. Midwives in Southend would like me to say that the midwifery situation there is good. Southend hospital does not have problems in recruiting midwives. Midwives from Southend were at the rally to support midwives in Basildon.
I was present at the birth of all five of my children, all of whom were delivered at Basildon hospital, and some of the midwives at the hospital have become great friends of mine. Midwives at Basildon face grave problems, which are shared by midwives across the country. In the past five years in the United Kingdom, for example, there has been a decrease of 2,500 in the number of midwives. Increasing numbers of midwives—a 13 per cent. increase in the past 10 years—are working part time. There is also a high wastage rate of midwifery students.
Health visitors are perhaps not as well represented as the other two groups of health service workers. Nevertheless, they, too, do a very valuable job.
I tell the Minister that I do not doubt for one minute that the Labour Government are genuine in their aspirations. On his return to the United Kingdom, the Prime Minister said that he wanted to be judged not on the Government's difficulties during the Christmas recess but on his achievements in health and education. I should be more than happy to make such a judgment. The British people, too, will make such a judgment.
It was a gross deception, on 1 May 1997, to give the British people the impression that the health service would be transformed quickly. The Secretary of State has now accepted that the health service is in crisis. Nevertheless, about six weeks ago, the Minister for Public Health said that there is no rationing in the health service. That statement was laughable. The Government have to be more straightforward in dealing with the difficulties in the health service.
The wonderful men and women working in the health service are of course overworked and underpaid, as health service workers always have been. Ultimately, however, it will be up to the Government to tell us their priorities. Achieving those priorities will depend entirely on the Government's management of the economy. The press has recently reported rumours about giving certainly student nurses a substantial pay increase. I should welcome such an increase. I welcome also the opportunity provided today by the hon. Member for Southwark, North and Bermondsey to share our views on such important matters.
I congratulate the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) on securing the debate. I thank the hon. Member for Southend, West (Mr. Amess) for his concern for my career. I am not too worried about that. My career suffered long ago because I speak my mind. I propose to do the same in this debate. His difficulty was his failure to speak his mind when the Conservatives were in power. He is still trying to draw a veil over their poor record on the NHS.
I am proud to be a vice-chairman of the Royal College of Midwives. Our midwives do a magnificent job and provide an outstanding service—perhaps the best in the world. They save many lives and I should like, as well as their wonderful service here, their skills to be exported worldwide. They provide terrific value for money, caring for two for the price of one. In more senses than one, that should be regarded as new labour.
Midwives should not be taken for granted as they are. In recent years, they have suffered a serious deterioration in pay and working conditions. The pay of midwives, nurses and health visitors has slipped behind that of comparable professions since the 1980s. As I pointed out to my right hon. Friend the Secretary of State on Monday, their pay has slipped over the past decade from 85 to 76 per cent. of average earnings.
There are two reasons why midwives' pay has not kept pace with other public sector pay. The first is the local pay arrangements set up by the previous Government. The trusts simply did not pay. They were prepared to pay for more managers and to become more business-oriented, but they ignored their staff and did not pay extra to nurses and midwives. The second factor is the "Changing Childbirth" report, with which I agree. It dealt with important issues that we must come back to. Greater flexibility and choice and more midwifery support are important. "Changing Childbirth" gave midwives more responsibility, but, instead of being paid more for it, many of them were paid less. They were cheated and did not even receive the minimum F grade that they were supposed to get. Some trusts paid the minimum F grade by lowering staff from G grade. That has resulted in shortages so serious that the Audit Commission questioned in its 1997 report whether there were enough midwives nationally to
provide a safe service and adequate support to women".
The number of midwives registered with the United Kingdom Central Council has fallen by 2,500 over the past five years to the lowest figure this decade. Some 60 per cent. of qualified midwives are not practising and there is a 21 per cent. turnover rate of nurses and midwives according to the Nursing Times this month. That shows the extent of the shortages. Only one midwife in 10 is under 30. That shows the failure to recruit to midwifery. Up to 25 per cent. of midwives could retire in the next five to 10 years. That shows how serious the crisis is. Nearly 50 per cent. of midwives work part time—an increase of 13 per cent. over the past 10 years. I agree that more flexibility is needed in the service, but there is clearly a shortage.
I see that the Whip wants me to wind up within three minutes, so I shall keep my remarks brief. The shortages are serious. The increased pressures that they put on midwives have led to problems of stress in the workplace and an increase in staff sickness. Many are not staying in the profession because of that.
I agree with my hon. Friend the Member for Bolsover (Mr. Skinner) that this is a defining moment for the Government. The NHS is vital to our society. It is much loved by the people and it is vital electorally. Getting it right means putting all the pieces of the jigsaw in place. The Government have made a good start by putting in more cash—three times more than the Liberal Democrats asked for in their manifesto.
I am sorry, but I do not have the time.
Getting rid of the internal market and the business approach are good steps, but there are three other pieces of the jigsaw to be filled in: more beds, because they were cut too much; more training for nurses, midwives and doctors; and more pay. Proper pay is essential to attract and retain people. I repeat the call that I made earlier this week. We need a substantial pay rise above inflation for nurses and midwives.
I shall concentrate on the pay award for nurses and midwives, because that is what people will be expecting to hear about. Failing to invest in decent pay for nurses is a huge false economy. The issue is not whether the pay rise is affordable, but whether not giving a decent and fair pay rise is affordable. People do not understand why that cannot be done.
The hon. Member for Wolverhampton, North-East (Mr. Purchase) talked about the loss of beds. He gave the impression that they were lost because people went around with screwdrivers dismantling them. They were lost because nurses were lost. The hardware is there, but the nurses to staff the beds are lacking. We shall not be able to increase the number of beds available in the NHS unless we bring nurses back. The beds crisis in the NHS that the Secretary of State speaks of is caused by a nursing staff crisis. We have to make the necessary investment.
It will not be acceptable for the Government to pull a stunt when the pay award is announced. Increasing pay for the lowest-paid nurses may be welcome, but it will not be enough. It will be a cheap option, because increasing the pay of the cheapest is not the same as dealing with the middle-ranking nurses, who are leaving in large numbers. Implementing the pay award in full will not be enough without some atonement for the staging of the pay award this year.
When the Conservatives staged the pay award in January 1997, the then shadow Chief Secretary to the Treasury, the right hon. Member for Oxford, East (Mr. Smith)—the hon. Member for Southend, West (Mr. Amess) should be aware that I am the hon. Member for Oxford, West and Abingdon—roundly condemned the decision, saying that it was the price of economic failure. A year later, a Labour Government did the same. The gap between expectations and delivery demoralised nurses. Not only should the Government not stage this year's award—I do not think that they would dare—but they should return to each nurse the £250 that they lost because of the staging in 1997 and 1998 and call it a "debt of atonement". We have still not heard an apology from the Government to the nurses and to the patients who have suffered from the lack of nurses. Cash will mean more than just an apology.
The hon. Members for Bolsover (Mr. Skinner) and for Leyton and Wanstead (Mr. Cohen) repeated like a broken record the arguments about the Government's generosity in funding the NHS. There has been no such generosity over the past two years, which, added to the previous 18 years, have brought the NHS to its current state. Library figures, which the Government have never challenged, show that the Government's real-terms increase in funding for the NHS in England in 1997–98 and 1998–99 is around 2.4 per cent. per year, compared with the Conservative record over 18 years of 3.1 per cent.—a level of funding that brought the NHS to its knees. Even the generous increases to come in the next three years will produce a real-terms increase in funding over this Parliament of only 3.7 per cent. That extra 0.6 per cent. compared to the Tory record does not make the difference between saving the NHS and failing to do so. My local health service has told me that, next year, in the first year after the comprehensive spending review, it will have discretionary spending of only 1 per cent. in real terms with which to give nurses a decent pay award above inflation. The Government should give serious consideration to providing extra revenue from the forecast Treasury surplus to allow health authorities to fund a fair pay award for nurses and retain some extra funding for growth in services, particularly mental health services.
I conclude by urging the Government not only to be fair, but to recognise the wrongs that have been done both during their period in office and the Conservative party's period in office. They must recognise that we shall not have a decent health service unless we are prepared to pay for it. As my hon. Friend the Member for Southwark, North and Bermondsey said, we must start the debate about how we are to raise the percentage of gross domestic product that we spend on the health service so that the service can meet the expectations of patients, users, relatives and carers in this country.
The Government must take urgent measures not only on pay but on the whole approach taken to nurses and midwives to ensure that the NHS is not stopped from developing by a short-sighted false economy and a shortage of the professionals upon whose hard work and dedication patients and those responsible for the running of the NHS all depend.
I congratulate the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) on ensuring that we have a chance to debate the staff of the NHS. I believe firmly that the Government were elected on pledges, and the backbone of our pledges was on the NHS. That is crucial, and we must never lose sight of that. In fairness to the Government, everyone should support and welcome the £21 billion that has gone towards saving the NHS. The NHS has been neglected over 18 years. It was not at the forefront of the previous Government's thinking, and their support for the NHS dropped year on year. We have seen a revival of the NHS, and we can all be proud of that £21 billion.
Does the hon. Gentleman accept that some of that money at least will be wasted by the Government's failure to put money into local authorities, which will mean cuts in social services and therefore more health service spending?
I am sorry that I gave way if that is the best that we will get this morning. It is about the NHS, and supporting the NHS is the £21 billion that is there for the NHS to spend. We must remember the staff, who ought to be at the forefront of our minds. I believe that the Government take on that responsibility well. The Government will ensure that the staff are happy because if the staff are unhappy the NHS will fail to work. We must bring forward those recommendations to ensure that we attract people to the NHS and then retain them. Those are the crucial messages that we must send out—not only have the Government put in £21 billion, but we care about the NHS workers, and that will come across loud and clear when my hon. Friend the Minister replies.
I should like my hon. Friend the Minister of State to congratulate the staff of the Chorley and South Ribble hospital on the way in which they have managed to cope with the flu epidemic in the north-west. Those dedicated and loyal staff ensured that the hospital remained open, and I wish to put on the record the House's congratulations to them on the work they put in over Christmas. Christmas is a time when people expect to be with their families, but the staff did not hesitate or shrink from the job they are paid to do. They came in and volunteered to keep the hospital going. It would be nice if we could reward their dedication somewhere along the line.
The NHS is not only about nurses but about doctors, auxiliaries, porters, and everyone involved who plays a part. It is important to keep the NHS together and continue to reward the staff. We must ensure that the Government never turn away from that pledge. I was proud to be elected in 1997 and I was proud to see the investment in the NHS to ensure that it has a viable future—a future in which the Government can take pride. I hope that we can go into the next election with a clean record on health.
There is always more that we can do. There always will be matters on which people will say that we are failing. That will continue as health evolves. There always will be a need for more funding. I know that we will not shrink from that, and I am proud to have been elected into this Labour Government.
First, I welcome the Minister of State, Department of Health, the hon. Member for Southampton, Itchen (Mr. Denham) to the Dispatch Box. We served on the Select Committee on Social Security together and it is good to have the opportunity to spar with him again. We can see a pattern emerging here. Whenever the Government are in crisis and a Minister resigns, we lose someone from the health team. A Minister goes and a new one comes. In that spirit, I wish the Minister of State continuing and rapid promotion.
We have a lot to thank the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) for this morning, as he has raised this very important topic. The hon. Gentleman knows that I am ever reasonable and it is more often than not that I agree with him—particularly with his analysis of the problems that the NHS faces, and his reasonable attacks on the Government for failing to admit that rationing inevitably exists in the NHS. I disagree with some of the solutions that he advocates, and he fails particularly to explain how the NHS can be properly funded. Calling always for more is one of the privileges of permanent opposition. I can see the merits of the wish of the hon. Gentleman for Parliament to vote on pay levels but, again, I must ask him where the money would come from. He never says.
The hon. Gentleman did not say much about midwives, although that is one of the topics of his debate. However, I understand that he was pressed for time. My hon. Friend the Member for Southend, West (Mr. Amess) pointed out that I have spoken to midwives a number of times, and they are indignant at the way in which their case been handled by the Government. A Minister would not even turn up to either of their two lobbies of Parliament, and they feel strongly that they need a re-evaluation of their grading.
Midwives also feel strongly that childbirth is not just about going to modern, central hospitals—it is about home births. I say that with feeling, as I was a home birth. Believe it or not, I was a 10 lb baby. I do not quite know what went wrong since. [Interruption.] I see my hon. Friend the Member for South Staffordshire (Sir P. Cormack) coming in. I do not know what size of baby he was.
The debate is largely about nurses, and their plight is critical. The Royal College of Nursing estimates that, across Britain, 12,000 to 13,000 full-time posts are unfilled. The turnover of nurses leaving their jobs has dramatically increased since the general election; so, indeed—in a survey of NHS trusts—has their judgment as to whether or not they have a recruitment problem dramatically increased since the general election on 1 May 1997. Whereas about 33 per cent. thought that they had a problem, it is now 78 per cent. I fear that it is creeping up to 100 per cent. who feel that they have a problem.
As the Royal College of Nursing has said, the decision in January 1998 to stage the pay award was absolutely devastating to morale. Nurses feel that that was a betrayal of everything that they were promised by the Labour party in opposition. It is the policy of Her Majesty's official Opposition to say that the Government must honour any pay review recommendation in full, and do it in one go without staging. In that sense, we agree with the hon. Member for Southwark, North and Bermondsey and with the first two points that he outlined this morning.
I must pass swiftly over what the hon. Member for Bolsover (Mr. Skinner) said. He made a lot of noise and called for a lot more. He is either in tune with the Labour Government or he is, once again, split from it. We shall soon find out on which side of that divide he sits.
The plight of nurses, midwives and health visitors is but a part of a set of wider problems in the NHS that are made much worse by the Government. When the Government are told that a hospital should stay open, they shut it. When they are told that a hospital should shut, they keep it open. Their pressure on the whole system to fiddle the waiting list figures is affecting patient care for the worse. The recruitment and retention problem in the nursing profession has been made critical by those actions. They have patients waiting on trolleys and corpses in container coolers waiting to be buried. What the Government do for nurses, midwives and health visitors will be a crucial test for them. We and the country are waiting to see whether they pass or fail this critical test.
I welcome the opportunity to respond to this important debate on a key group of national health service staff who do such a tremendous job, often in less than ideal circumstances. Like other hon. Members, I shall concentrate on nurses, midwives and health visitors, but I, too, acknowledge the contribution of all who work in the health service throughout the year.
I congratulate the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) on his success in obtaining the debate. However, his comments and those of the hon. Member for Oxford, West and Abingdon (Dr. Harris) would have had more credibility if those hon. Gentlemen had had the grace to acknowledge what the Government have done and the extent to which we have exceeded the promises made by the Liberal Democrats at the last election.
In their election manifesto, the Liberal Democrats promised to spend an extra £540 million each year on the NHS. In our first two years, we have put in an extra £2 billion. As my hon. Friends the Members for Bolsover (Mr. Skinner), for Leyton and Wanstead (Mr. Cohen) and for Chorley (Mr. Hoyle) said, over the next three years, we shall put in an extra £21 billion, which is far and away more than the Liberal Democrats ever promised.
I thank the hon. Member for Rutland and Melton (Mr. Duncan) for his kind words. His promises would have more credibility if we all had shorter memories.
The background to today's debate is, in part, the recent pressure on the NHS and on emergency admissions in particular. In a statement to the House on Monday, my right hon. Friend the Secretary of State acknowledged the impact of the recent surge in the numbers of people needing to visit their doctor, call an ambulance or be admitted to hospital. He paid tribute to all the NHS staff who are coping, despite the fact that their own numbers have been depleted through illness.
My hon. Friend the Member for Chorley invited me to congratulate staff in his local hospital. I send my congratulations to all the staff who have worked so hard over recent weeks.
My right hon. Friend set out the measures that have been taken to cope with winter pressures. Some £159 million has been allocated for schemes to provide extra beds, more round-the-clock operations, early discharge schemes supported by community nurses, and partnership projects with social services. Last week, we published details of almost 2,200 schemes being carried out by health authorities. Today, we have published further details of 185 partnership schemes being carried out jointly by the health service and local social service departments in a combined effort to deal with winter pressures.
Over the past week, parts of the NHS with particular problems that could be eased by extra cash have been given access to the £50 million contingency fund. Those measures are making a real difference to the ability of the NHS to cope with the present situation.
All over the country, people are working flat out to deal with winter pressures. The publication of the joint partnership proposals today shows that they are not doing so on their own. People working in social service departments in local councils are doing their bit to bolster those efforts. Huge demands on the NHS are being met by an unprecedented level of partnership between hospitals and councils.
In spite of those measures, the NHS is still under real pressure, and part of the problem is the shortage of nurses. Unlike our predecessors, this Government acknowledge that there is a shortage. We have put in place a range of measures to put things right in the medium to long term. There is no one-stop quick fix.
As the debate has highlighted, an imminent issue is the recommendations of the pay review body, which are due shortly. Despite the invitation of the hon. Member for Southwark, North and Bermondsey, I am not sure that it would be a career-enhancing move if I announced the results of that process today. The House will understand that I cannot anticipate our response today. We shall respond at the appropriate time.
Would it not be a career-enhancing move, and would it not enhance the Government's reputation, if the Minister took this opportunity to apologise to the nurses and midwives in the health service for the staging of last year's pay award? He could do that without any commitment to the financial compensation that I mentioned earlier. Now is his opportunity.
In response to the hon. Gentleman, I shall set out the approach that we have taken in our evidence to the pay review body. As my right hon. Friend said on Monday, we hope that the independent review body will propose a settlement which is fair to nurses and midwives and affordable for the national health service, and which the Government will be able to implement in full. As we said in our evidence, there is a case for an enhanced increase in starting pay for newly qualified nurses.
The Government are pledged to modernise the NHS, to make it modern and dependable for the 21st century. The programme of modernisation will be delivered only with the support of staff, which is why we must ensure that we can recruit and retain staff, get the numbers of staff right and ensure that they are paid fairly.
Pay matters, of course, but it is not the only issue and it must be seen in its proper context. Most surveys of nurses show that there are many important factors in attracting them to work in the NHS, to stay in their jobs or to return. It does not diminish the importance that nurses attach to pay to recognise that those surveys raise issues that are often of equal or greater importance than pay. Other important issues for nurses include better resources to do the job, help with child care, more opportunities to develop skills, a better career structure and measures to tackle violence against staff.
The Government are taking action across the range of issues of concern to nurses and to the NHS. We are providing the funding to employ more nurses, we are taking action to increase nurse training and to improve the conditions of work for nurses, we are encouraging qualified nurses back into the nursing profession, we are taking action to improve the career prospects for nurses and we want to take further action on pay reform.
The roots of the current shortage of nurses lie in the previous Government's cut in the number of training places. Our own surveys carried out shortly after we came into office confirm that trusts were having difficulty recruiting and retaining qualified nurses. We have put in place a raft of measures to put matters right, so that we can look forward to year-on-year increases in the number of qualified nurses, as a result of our commitment to nurse training.
An extra £60 million is being invested in nurse training next year and nursing students are being given favourable NHS funding support in comparison with other students. As part of the comprehensive spending review, we are investing an additional £18 billion in the NHS in England over the next three years, which will enable up to 15,000 more nurses to be taken on over the next three years, and an extra 6,000 additional nurse training places are planned to address the shortfall that we inherited.
The hon. Gentleman must forgive me—I have three minutes left.
I can refute the claim by the right hon. Member for Maidstone and The Weald (Miss Widdecombe) that the Government cut back by 3 per cent. a planned increase in the number of places for 1997–98. The reality is that, in January 1997, the then right hon. Member for Loughborough promised that there would be additional 1,300 places for new nurse training. Far from cutting back on that, we achieved an additional 1,418 nurses in training in that year.
The numbers applying for nurse training are increasing—16,800 students applied for Project 2000 nursing and midwifery courses in 1996–97 and almost 2,000 more applied in 1997–98.
We are not just increasing the number of training places. Some £50 million was allocated last September to expand the number of part-time nursing courses, provide bursaries to enable 2,700 enrolled nurses to upgrade their qualifications and provide opportunities and financial support for other NHS staff, such as health care assistants, to become qualified nurses. More than 1,000 staff will benefit from that scheme over the next three years.
The aim of providing up to 15,000 more nurses, midwives and health visitors is a challenging one. Training is one part of the answer, but we must also promote nursing as a career, attracting back nurses who have left the profession for whatever reason. More than 100,000 nurses are on the register but are not practising. Some of those nurses could return to nursing tomorrow, whereas others would need support in refreshing their professional skills. That is why, at the Royal College of Nursing congress last April, we announced a further £4 million for local investment in "return to practice" initiatives, building on an allocation of £10.5 million in 1997 to support return to practice and continuing professional development.
As well as getting more people into nursing, the Government want to hold on to the nurses that we have. We expect employers to use family-friendly employment policies to respond to the demand for more flexible patterns of working, in order to secure and keep the staff that they need.
Those matters are important, but pay rates matter too. I said that we hope that the independent review body will propose a settlement that is fair to nurses and midwives and affordable for the NHS, and that the Government will be able to implement in full. We also recognise that we need a modern, fair and effective pay system that supports us in paying nurses, midwives, health visitors and other NHS staff fairly, in a way that enables them to give their best for patients in a new, modern and dependable national health service.
When we came to office, the Government said that we wanted to return to national pay for the NHS if it could be matched with meaningful local flexibility. I know that many nurses and others working in the NHS share my wish for better career progression and more modern conditions of service that are relevant to the way in which people now work—