What percentage of staff employed by NHS trusts in England on 1 January, or the latest date for which figures are available, were (a) directly employed and (b) agency staff.

The Department does not collect specific information on the numbers of NHS staff who are directly employed or hired through agencies. In 2003–04, the estimated agency spend as a proportion of the total NHS pay bill was 5.4 per cent.—a reduction of almost 7 per cent. from the previous year.

Do Ministers accept that under the Labour Government there appears to have been an increase of approximately 50 per cent. in the spend on the health service—which, of course, is welcome—but a 300 per cent. increase in the number of agency staff employed by the NHS in England? Will Ministers say categorically that it is always better where possible to have directly employed rather than agency staff? What will they do to keep driving the numbers of agency staff down and fully employed staff up? That is what patients want, and what all the other workers in the NHS prefer.

The answer to the specific question is yes, of course it is. We are making significant progress in reducing the spend on agency staff, and I referred to the overall figures for the NHS pay bill in my answer. The hon. Gentleman might be interested to know that last year in London, where spending on agency staff accounts for about 35 per cent. of the total spend across the NHS, there was a significant fall of about 14 per cent. in the use by the NHS of nurse agency staff. That was partly driven by the excellent work of the South West London strategic health authority, but also by a better and more intelligent use of the framework agreements that we negotiated through the NHS Purchasing and Supply Agency with the nursing recruitment agencies themselves. I am quite confident that we shall continue to see significant reductions in the overall spend on nursing agency staff.

My right hon. Friend will know that Bedford general hospital featured on "Panorama" last Sunday. The key message that came across was the high quality and strong morale of the whole staff team of both directly employed and agency staff. Will he join me in welcoming and celebrating their professionalism, dedication and commitment to solving problems, which has reduced waiting times, delivered high-quality services to patients and made the best use of the sustained increase in resources that the NHS has received?

I certainly join my hon. Friend in paying tribute to the outstanding work of NHS staff in Bedford and many other parts of the country who are doing a brilliant job in improving the quality of care, reducing the time that patients wait and improving the overall patient experience. The right way to make sure that we continue to do so is to bring the investment in and not introduce charges for hospital operations.

Will the Minister confirm that that huge reliance on agency staff at immense cost is proof that ultimately one cannot buck the market? Attempts to staff our hospitals with nurses with different pay and conditions mean that we cannot balance demand and supply domestically. We have to import 15,000 nurses a year because we are losing 8,000 British-trained nurses overseas, and nearly one third of nurses with British nurse training go elsewhere. Ultimately, to achieve a balanced domestic supply we must pay a proper rate for our nurses rather than wasting money in this way.

I agree strongly that we need to pay nurses more and give them a better rate of pay. That is precisely what we are doing with "Agenda for Change", which has been negotiated with nurses and the Royal College of Nursing in particular. It gives us an opportunity to make significant progress in this important area—something that was quite invisible when the right hon. Gentleman's party was in charge of the national health service.

Does my right hon. Friend agree that a key part of work in the NHS is teamwork and the dedication of directly employed staff on a daily basis? He will know of recent concerns about Whitby hospital in my constituency, so I wonder whether he can help me to facilitate a meeting with the strategic health authority and the primary care trust to make sure that all the key partners who deliver an excellent service for the people of Whitby and the surrounding district can continue to do so in future? Will he commend those staff and congratulate them on delivering PCT services in one of the largest community hospitals in England?

Yes, the NHS staff in my hon. Friend's constituency are doing an excellent job, and I pay tribute to their commitment and professionalism. I shall certainly help facilitate the meeting that he asked for. That will not be a problem. I also pay tribute to my hon. Friend's outstanding support for the national health service in his constituency.

The Government are well aware that many agencies recruit NHS staff from overseas countries. The recent Save the Children study accused the UK of contributing to the collapse of health systems in many poor countries, and a British Medical Association statement criticised the UK's shameful record of exploitation in taking nurses from developing countries—an issue that the Opposition have raised many times. Given this new evidence, if the Minister accepts that poor countries need their nurses even more than we do, why will the Government not ban the NHS from using recruitment agencies that have not signed up to their own code of practice?

The hon. Gentleman has drawn attention to the matter a number of times, but he always fails to point out that the UK leads the world in the ethical recruitment of medical staff. The code of practice that we have formulated and promulgated, which has now, I am glad to say, been extended to the independent health care sector, is held up as a model of good practice by the World Health Organisation. We do not recruit in developing nations in Africa. On the point that we should support those countries with the cost of training health care staff, I should point out to the hon. Gentleman that in the past five years the Department for International Development has provided more than £500 million worth of aid and development costs for African countries to help them train the nurses and doctors that they need for the future.

Further to the comments of my hon. Friend Mr. Hall, will the Minister join me in congratulating the staff—both agency and directly employed—at Warrington hospital on the magnificent way in which they worked during and after the fire at the hospital just over a week ago? Will he show his appreciation in a tangible way by considering what can be done to help the hospital through this difficult time, and ensure that it is not penalised for missing targets where that failure results purely from the fire at the hospital?

I shall look at the last point raised by my hon. Friend. There was a tragedy at the hospital, which she has been working closely with her constituents to resolve, and I appreciate the work that she has done. It is right to say that it is not just NHS staff who do an outstanding job for NHS patients. Many agency nurses and agency staff do a brilliant job as well, and it would be wrong to give the impression that that was not the case. They are dedicated to their patients and they do a good job for the NHS.