NHS Personnel

HC Deb 19 May 1999 vol 331 cc1127-78

Mr. Deputy Speaker (Sir Alan Haselhurst)

I should advise the House that the Speaker has selected the amendment in the name of the Prime Minister.

7.14 pm

Miss Ann Widdecombe (Maidstone and The Weald)

I beg to move, That this House notes the proposal of Her Majesty's Government to raise the agreed working hours of junior doctors to 65 per week; notes also its failure to deliver to nurses the pay increases which were promised to be implemented in full from April 1999; notes further the anxiety and disappointment caused to consultants by its failure to implement the recommendations of the Pay Review Body; notes the concerns of Professions Allied to Medicine; and calls upon Her Majesty's Government to recognise that increased expectations followed by disappointment have profoundly damaged morale among loyal and hardworking NHS staff. I suspect that many doctors and many nurses may have been deceived into voting for the present Government at the last election. They were promised more recruitment, shorter hours, better pay, less pressure and shorter waiting lists. They have been cruelly disappointed because the reality is that, today, morale among all who work in our health service is at an all-time low. Labour has milked dry the efforts of our doctors and nurses.

We all remember Labour's extravagant promises before the elections—empty pledges, unconcerned with where the new doctors and new nurses would come from, and with how to solve the problems of recruitment and retention. The hard-working majority in our health service expected those promises to be delivered. Their hopes were raised. They thought then, even if they know better now, that they could trust Labour to deliver. They did not believe that, once the Government had won their own not so hard-working majority, the magic wand would disappear and the only thing that would remain would be the glib quest for easy solutions and tomorrow's headlines.

It is hard to blame those people for being deceived. Imagine being a young nurse three or four years ago and hearing an Opposition spokesman criticising the Government over nurse's pay, saying: Flattening the pay of nurses and other staff is no way to run the Health Service. That Opposition spokesman was the right hon. Member for Darlington (Mr. Milburn). Six months after the election, the right hon. Gentleman, by then the Minister of State, Department of Health was arguing: Any settlement for nurses … at below the level of current inflation would not imply a real pay cut. If that is not Labour hypocrisy, if it is not all hype and no delivery, what is? How disillusioning for our nurses: they were promised so much and, within so little time, badly let down.

Mr. Michael Fabricant (Lichfield)

Would my right hon. Friend be surprised to learn that it is not just nurses who feel betrayed by the Labour party and the Labour Government? Has she read the report in Hospital Doctor magazine, which says: Eighty per cent. of specialist registrars are now planning to leave the national health service"? Is she surprised to learn that, in Staffordshire and the west midlands, people are becoming very disturbed by the huge influx of Egyptian and other consultants who do not speak adequate English, replacing English doctors who have left the NHS?

Miss Widdecombe

I am not surprised, but extremely saddened. That is symptomatic of a situation that has been created by a Government who, in opposition, promised anything to anyone whenever they thought that it might curry cheap favour.

I wonder, for example, what progress the Secretary of State for Health is making on Labour's pledge to set up pilot schemes under which savings from reduced staff turnover would be used to pay extra money to nurses who decide to stay longer in their jobs. For that matter, I wonder whether he even remembers it. I will not altogether blame him if he does not because he has a memory problem.

The Secretary of State did not remember the Prime Minister's pledge to set up a task force on trolleys, so I admit that the chances of his recalling the random utterances of the right hon. Member for Islington, South and Finsbury (Mr. Smith) are probably non-existent. However, I do not think that the nurses have forgotten. They have not forgotten how Labour boasted of its plans to recruit thousands more nurses, although they probably did not expect the interviews to take place in Manila. I am certain that they have not forgotten the Secretary of State's wild boasts about this year's pay award.

To be charitable, I suppose the Secretary of State finally believed that he had something to boast about. There had been all those promises of more pay for nurses before the election, all those Labour spokesmen calling the phasing of pay awards a "deception" and a "betrayal", only to find that, once in government, reality has a nasty habit of biting. It bites smug Labour spokesmen where it hurts.

We all remember that one of the Government's first actions was to stage Labour's first pay award to nurses. The Secretary of State must finally have thought that things were turning out all right. Unfortunately, he allowed his sanctimony to get in the way of the facts.

We welcomed the pay settlement in February, but we did so under the impression that it was going into nurses' pockets. I thought that that was the idea. However, we are now learning that trusts up and down the country are failing to give nurses their money. What is more, they are telling staff that they "have not received authorisation" to pass on the cash.

Mr. Fabricant

The Secretary of State is laughing.

Miss Widdecombe

Laughter is often a hysterical defence when things are going wrong.

Mr. Andrew Lansley (South Cambridgeshire)

Is my right hon. Friend aware that, at Addenbrooke's hospital in my constituency—where some 1,300 qualified nurses are employed—the pay award not only was not paid in April but, by reason of the Government's lateness in distributing the circular, will not be paid in May? It will not be paid, at best, until the end of June.

Miss Widdecombe

That is a betrayal. What on earth is going on? Let us leave aside the fact that the Secretary of State had to raid his modernisation fund to foot the bill for the pay settlement, and then asked the trusts to stump up the rest. Let us leave aside the fact that only one in 15 nurses will receive the higher level of pay settlement. I suppose that I could be persuaded to leave aside the fact, verified by the House of Commons Library, that even after the remaining 14 out of 15 nurses have got their hands on some money—not in April or May, possibly in June—they will still be £53 worse off under this Government than at the time of the last election.

It is a disgrace that the Secretary of State has allowed a pay award—for which he attempted to take so much personal credit, of which he boasted through every newspaper and media outlet that he could find and about which he swaggered in this House when he announced it—to disappear into some form of nether region for which no one seems to have any responsibility.

It is no good, as the Secretary of State has done yet again, just to palm the blame off on to the trusts and to threaten sackings right, left and centre—like he did over waiting lists and the winter crisis, and like he still does over rationing, which he denies exists.

Mr. Nigel Evans (Ribble Valley)

Is my right hon. Friend aware that in the Guild trust, Preston, today, three non-executive directors were dismissed from their posts? Their crime was to whistleblow on the management of their own trust, which led to the suspension of the chief executive and the resignation of the chairman. Their reward was to be told either to resign or that they would be sacked. Today, they were sacked. What message does that send to non-executive directors up and down the country who may find out about mismanagement in their trusts? Will they be rewarded by the Secretary of State for Health with dismissal?

Miss Widdecombe

It is ironic—perhaps it is not ironic; perhaps it is totally to be expected—that that is the action of a Secretary of State who, after the scandal at Bristol, said that whistleblowers would always be protected. He does not protect whistleblowers—he protects his own cronies and himself.

I was talking about how the Secretary of State is always tempted, and always gives in to the temptation, to palm the blame off on to trusts, as he has done over the massive waiting list to get on to the waiting list—a list that has doubled to almost 500,000 since the Government came to power. He seems to treat our health service as if those in it were some sort of underfootmen. He has all the power and shouts the odds, but they have all the responsibility and are told to get out if they complain.

Why does not the Secretary of State accept some responsibility for the situation that he has helped to create? Will he guarantee right now that any nurses who have not received their April pay settlement in full, as he promised they would, will be traced right away and fully compensated? While he is about that, perhaps he would like to apologise. I have to say that, with this Health Secretary, we are more likely to see him escaping over the top of the millennium dome than admitting that he has made a mistake. However, I hope that he is in an apologetic mood, because that is by no means the end of the problems that he has caused to morale in our health service.

The recommendation of the independent pay review body was that a pool of some £50 million should be found as a means of compensating consultants for their work load. After the pay review body reported, the Government—who boasted that they were implementing the recommendations of the pay review body—did not implement that recommendation. In a panic when the motion was tabled, I gather that the Secretary of State had a meeting, and that he is trying to stave them off with vague promises—but, as yet, still no settlement.

The Secretary of State for Health (Mr. Frank Dobson)

As the £50 million is to be disbursed, according to the review body, not in this financial year but in the next financial year, how could we have implemented it this year?

Miss Widdecombe

The Secretary of State could simply have said that he accepted that recommendation and would implement it. Had he done so, the consultants would not have been so upset, and they and the British Medical Association would not have been putting out statements saying that the Government had let them down. They would have had to say that the Government were acting in tune with the review body.

The Secretary of State has a problem. It is not that the Opposition are saying these things—it is the health service personnel who are saying these things. It is they who are thoroughly disillusioned, fed up and demoralised by what the Government are doing. Is it surprising that a survey last year showed not only that morale in the health service was at an all-time low, but that only four in 100 health service employees saw a long-term future in their jobs?

Nowhere is that more important than for our junior doctors. Our new deal for junior doctors was an enormous success. In 1991, six out of 10 junior doctors were still working more than 83 hours per week. By the time of the last election, two in 10 were working more than 56 hours a week. There was still work to do, and we said that. However, we had got those substantial results and we were moving in the right direction.

This Government are moving in a different direction. They are not content with milking our doctors and nurses dry over the winter; they are not content with shipping in 1,000 overseas juniors to work unpaid in posts that would normally pay £30,000 a year. Now, the Government want our junior doctors to agree to work for 65 hours a week for the next 15 years.

It is difficult to be surprised, given the record of the Government. After all, they are happy to use the tactics of fiddle and fudge. They conned the BBC into misleading the public and exaggerating basic junior doctors' pay by £10,000. Significantly, it was not the Government who apologised, but the BBC who had been misled.

Sir Brian Mawhinney (North-West Cambridgeshire)

Does my right hon. Friend recall that when we were reducing the number of hours that junior doctors worked, providing more junior doctor posts and resources and improving the management of the use of junior doctors, it was done with Ministers very involved in the process on a regular basis—including, as I had, regular meetings with the leaders of junior doctors? Is not part of the disgrace now not just that the Government are reneging on those arrangements and trying to drive the hours up again, but that Ministers disdain to have the involvement with junior doctors which characterised our time in office and helped to produce the excellent results?

Miss Widdecombe

Indeed, but this is a highly arrogant Government who dismiss the very people on whom they have to rely. We should not be surprised when this arrogant Government try to pass off an increase of nine hours a week for 15 years as a reduction in junior doctors' working hours. Perhaps the Secretary of State should try it himself. If he had to work hundreds of hours more, we might start to get some results in our health service, although on the evidence of the past two years, perhaps we should encourage him to take a long time off instead.

Mr. John Bercow (Buckingham)

My right hon. Friend referred to the way in which the Government misrepresented the position on the doctors' pay rise. Does she recall that that misrepresentation is based on the premise of junior doctors working not 56 hours a week, as the Government claim, but 72 hours a week? Does she fear that perhaps the Government have another agenda, for even longer hours, of which we have hitherto not been informed?

Miss Widdecombe

There is no iniquity that I would not fear from the Government.

The evidence is abundantly clear. We have the Brussels document. Despite his virtual denial in the House, the Secretary of State cannot deny that the UK has proposed that junior doctors' working time threshold should be raised to 65 hours a week. How did he get out of it? He told the House that he never proposed that to the EU Commission. He did not, because it was in fact proposed to the EU Council. That shows the weaselly depths to which the Government will stoop.

If the Secretary of State had been at all concerned about junior doctors' working hours, Labour Members could have voted with us and with the Liberal Democrats last week in Committee to write the current limits into the Health Bill. If he has no problem with the current limits and does not intend to exceed them, what harm would there have been in writing them into the Bill?

Let us consider the Brussels document, which the Secretary of State tried to deny; the 72 hours on which he calculated the "basic" rate of pay; and the refusal to write 56 hours into the Health Bill. Adding up those three, one need not have a very suspicious mind to work out what the agenda is likely to be.

The Secretary of State never misses a chance to blame our doctors when a tragedy occurs but he is much less concerned with getting to the root of the problems. Take the massive manpower crisis in obstetrics. Hundreds of qualified doctors are fighting for a handful of consultant posts in that specialty, but the Health Bill lacks the detail needed to handle manpower planning issues.

By 2001 there will be 500 obstetricians chasing only 50 consultant posts a year. Hospital Doctor magazine has campaigned for a solution to that problem, which could result in hundreds of doctors leaving the profession. My hon. Friend the Member for Lichfield (Mr. Fabricant) said earlier that, according to one survey, 80 per cent. of specialist registrars in obstetrics plan to leave the health service as a result of the Government's incompetence.

We can ill afford to lose those doctors, given that the 7,000 alleged extra doctors about whom the Secretary of State has boasted are actually the ones who were planned to come through medical school in any case and are not extra at all. Those doctors will have to be supplemented by yet more imports, yet the Government failed to support our amendments to the Health Bill, which would have allowed the Secretary of State to make regulations on manpower planning.

Had the Secretary of State swallowed his pride—Which is considerable—and supported us, he could have had the powers to sort out the problems at source. Instead, he has told doctors that he will not back an NHS Executive consultant expansion plan; yet he still tells us that we will get more doctors.

The problem is most forcefully put by Fiona Kew of the British Medical Association junior doctors committee. She says: Babies and mothers die because there is not enough consultant input into their care. This is an ideal opportunity to use these specialists to improve the care of women in pregnancy… but the DoH refuse to provide more consultant posts. Instead, the Government's fudge—taking five years through a series of pilot programmes—makes it appear as though the Secretary of State is simply pulling the covers over his head and hoping that the problems will go away—a bit like a child hiding from a nasty monster—but they do not go away.

All those problems have a huge impact on staff morale, yet the Government, who are directly responsible for increasing expectations then bringing them crashing down, seem unable or unwilling to act.

Mr. David Hinchliffe (Wakefield)

I have given the right hon. Lady prior notice of my question on at least four separate occasions in previous debates, but I have yet to get an answer. We are all aware of the shortages of doctors, consultants and nurses. The only policy that she has proposed in this Parliament for her vision of health has been to make more and more use of the private sector. We all know that the private sector recruits primarily from the health service. Her model would denude the health service of staff, who are already in short supply. What is her answer to that conundrum? I cannot make head or tail of the logic of her policy. She says that she is concerned about staff shortages, but her proposal would make the situation far, far worse.

Miss Widdecombe

The hon. Gentleman cannot understand my policy because his own economics are those of the madhouse. In the public sector, the NHS bears the cost of training, recruitment, treatment, capital buildings, theatres, support staff and everything else. In the private sector, the NHS has contributed only the cost of training and all the rest is spent by outside sources. That is a big net addition that the NHS would otherwise have to find.

If we found it feasible to recommend a substantial expansion of the use of private resources, I would have no difficulty at all in expecting the private sector to take some responsibility for training, and representatives of that sector have told me that they agree. I have never believed in a one-way flow.

Mr. Hinchliffe

Will the right hon. Lady read the transcript of the Health Committee proceedings on the current inquiry into the regulation of private medicine and focus on the questions asked by the hon. Member for Southend, West (Mr. Amess) and my follow-up questions? She will see that when the private sector is asked where it gets its staff, the answer, every time, is the national health service.

Miss Widdecombe

Yes, and one can bet that some of those staff are the obstetricians whom the NHS has trained but cannot find posts for. Would the hon. Gentleman prefer those obstetricians to leave the health care profession altogether rather than taking their training into the private sector, which is bailing out the Government on waiting lists?

Mr. Patrick McLoughlin (West Derbyshire)

Does my right hon. Friend think that one of the reasons why people go to work for the private sector may be that they get the pay increases that they are promised, while the Secretary of State promises increases but does not give them?

Miss Widdecombe

It goes without saying that if the private sector ran itself as the Secretary of State runs the NHS, it would soon have no personnel at all. We have supported not only the doctors, nurses and consultants but the professions allied to medicine. Unlike the Secretary of State, we do not forget the contribution that they make. We have been supporting their campaign for better self-regulation through amendments in the Health Bill.

It would be encouraging—although I do not expect to be encouraged—if the Secretary of State would acknowledge the responsible debate in another place on trying to get better protection for those professions. I ask him to go a little bit further—although, as I say, I expect no encouragement—and agree to our amendments that would ensure that professions allied to medicine were judged by their peers on issues such as discipline and education. We also want provision in the Health Bill for protection of title. If he would agree to those amendments, it would be a fitting acknowledgement of the dedication shown by those professions in the work that they do in our health service.

While the Secretary of State is about it, he could go further and guarantee that no services provided by professions allied to medicine will be lost as a result of the creation of primary care trusts and the diversion of millions of pounds from patient care into extra bureaucracy and superannuation contributions. He will be aware that one of the great strengths of fundholding was the use that fundholding doctors made of professions allied to medicine in giving their patients an integrated health care service. He is nodding; he agrees. I am grateful for that.

Will the right hon. Gentleman acknowledge that demonstrably, not just in theory, some of those services have been lost as a result of the destruction of fundholding and the creation of patient care groups?

Helen Jones (Warrington, North)

We would all accept that there is a need to regulate a number of professions working within the health service. Can the right hon. Lady explain why when in 1989 a report from the NHS management executive recommended a statutory system of regulation for operating department practitioners, who had sought regulation for many years, the Conservative Government did nothing about it?

Miss Widdecombe

Perhaps the hon. Lady would like to go and look at the new clause that we have just tabled. I am sure that she has not yet caught up with it.

Dr. Howard Stoate (Dartford)

rose—

Miss Widdecombe

I have given way generously, and now I want to make some progress. I may give way to the hon. Gentleman later.

One contribution that the Government are determined not to make is to reward NHS staff for working on the millennium new year's eve. What better opportunity could there be to demonstrate that the Government can still be bothered to care about the welfare of our doctors and nurses? Although the right hon. Gentleman may bear more than a passing resemblance to Father Christmas, to our doctors and nurses he behaves like Ebenezer Scrooge.

The Secretary of State has ruled out paying doctors extra money over the millennium new year, and is trying to discourage trusts from making their own good-will payments. Doctors have estimated that for working on millennium night they will be paid £4.02 an hour. I suppose that that is a bit better than the minimum wage.

To meet his ridiculous waiting list pledge, and to bail him out of a dreadful winter crisis, the right hon. Gentleman has drawn heavily on the bank of good will among health service workers, and that account is now slipping into the red. He has argued that trusts should show their appreciation on millennium night by providing transport and hot food. He has made much of his cleverly wrapped 50th birthday present to our health service, but it seems that his millennium gift to the hard-working staff is to be a limp sausage roll, a glass of flat beer and a taxi ride home.

I am not saying, have never said, and would never say, that every last wish of every doctor or nurse must be, or even could be, met, but at the very least the right hon. Gentleman should stop exerting his power to prevent trusts from offering what they feel is right and decent to their loyal and hard-working staff. He often palms responsibility off on to trusts, so if they want to make that gesture, they believe that they can afford it and it is one of their priorities, they should be allowed to do so.

Anything less would be a slap in the face, just like the slap in the face he has given to our doctors—fundholding doctors who have now been dragooned into collectives, losing flexibility and the services that meant so much to their patients. It would be like the slap in the face that he has given to our nurses, who were told first that their pay award would not be staged, but then that it was, and secondly that they would get all the money in April, but then that they would not get it until June at the earliest. Many of them are worse off than when the Government came to power. Fourteen out of 15 of them do not benefit from the higher levels of pay, and the so-called recruitment consists of importing staff, which may have a role to play, but which certainly will not solve all the problems.

The Secretary of State has not only given staff a slap in the face, he has thrown a bath of icy cold water over them. They expected so much, and have been given so little by a Government who have consistently been more bothered about political control than patient care. The Government care only about the next day's headlines; they never finish the job. Where are the super-nurses? Does the House remember those? I do not think that even the nurses themselves remember them. A pledge was given but nothing was delivered. Concerning the trolley task force, too, a pledge was given but nothing was delivered.

The Secretary of State makes pledges all the time, but he delivers nothing—except for junior doctors, whose conditions he is making worse. He is delivering longer hours, fiddled pay figures, longer waiting lists, third-world recruitment, more pressure, and a promise that if staff do not like it, there is always a new deal officer waiting to sign them up for another half-baked Labour scheme.

Does the right hon. Gentleman remember how he had the gall to say, "Let those who are despairing get out of the health service, because I do not want them there." Now he is giving that message to the overwhelming majority of health service workers, who have been told to knuckle down, shut up, work harder, work longer, stop complaining, stop expecting and thank new Labour for the new NHS. The right hon. Gentleman has failed to deliver every promise, and every worker in our health service has been failed.

Before I finish, I will let the hon. Member for Dartford (Dr. Stoate) intervene.

Dr. Stoate

The right hon. Lady professes to be concerned about the plight of the professions allied to medicine. I certainly am, because I have worked with many dedicated and hard-working scientific officers, pharmacists, clinical psychologists, cytologists, phlebotomists and others. Can she tell me why, 15 years ago, the Conservative Government took that group out of the scope of the pay review body, thus allowing their pay to fall by 30 per cent. in real terms? That group of people are in such a parlous state now because of the actions of the previous Government.

Miss Widdecombe

I believe that the hon. Gentleman is genuinely concerned about the professions allied to medicine. He made a distinguished speech on Second Reading—so distinguished that the Government made jolly sure that they did not put him on the Standing Committee on the Health Bill, because that speech was not 100 per cent. loyal. He, too, has been failed by the Government.

The Government have failed the health service, as well as the doctors, the nurses, the professions allied to medicine and, above all, the patients—the British people, who were fooled by the Government saying before the election that there was nothing wrong with the health service apart from the fact that there was a Tory Government, and that they could put it all right.

The Government have not put it all right. The health service is now worse than ever in terms of morale and what the funding is expected to cover, in terms of winter crises, the use of trolleys and just about everything else I could mention. They have given us not a better health service but a worse health service.

The Secretary of State seems to think that that is funny. He either looks in another direction, like somebody following a Wimbledon tennis match, because he cannot face me, or he falls about with laughter, to hide the shame that any decent Secretary of State would feel in his position. I believe that come the next election, the Government's treatment of the health service will guarantee that they will not be in office for long.

7.49 pm

The Secretary of State for Health (Mr. Frank Dobson)

I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof: recognises and applauds the massive contribution the staff make to providing the fairest and most efficient healthcare system in the world; regrets the shambles in the NHS that the Government inherited which was demoralising to staff and damaging to patients; welcomes the action the new Government has taken to make things better for staff and patients alike, including £21 billion extra for the NHS over the next three years, record capital investment in new buildings, equipment and facilities to enable the staff to provide top-quality care, the biggest real-terms pay rise for nurses for 10 years paid nationally in full, proposals for radical pay reform to give fairer rewards to staff who extend their roles, widen their skills and work in teams to care for patients, negotiations on a new consultants' contract to ensure rewards go to those who contribute most to the NHS, ambitious targets to improve the quality of the working lives of NHS staff, including tough action to crack down on violence and racism at work, the promotion of family-friendly employment policies and investment in training and continuing professional development; welcomes the Government's commitment to reducing junior doctors' hours in line with the draft European Working Time Directive vehemently opposed by the Conservative Party and carefully planned so as not to damage improvements in patient care; and accepts no lectures about conditions of service for NHS personnel from a Party that did more in Government to demoralise the staff than any other in living memory and which spends most of its time in Opposition running down the achievements of the NHS staff and saying the Health Service can no longer cope.

The speech we have just heard, and this whole debate initiated by the Tories, is one of the biggest exercises in barefaced cheek that has been seen even in this Chamber. It does, however, provide us with an opportunity to remind people of the state of the national health service that we inherited, and the action we have been taking to put things right.

The Tories left behind them a health service underfunded, understaffed and undermined, with a demoralised and undervalued work force. They had introduced an internal market, which set doctor against doctor and hospital against hospital, and led to a huge increase in bureaucracy and paperwork. For many staff, that internal market, together with the two-tier system that the Tories introduced, betrayed the principles that had led them to join the NHS and was contrary to their professional ethics.

For three years running, the Tory Government failed to implement pay review body settlements nationally and in full. Tory Ministers had encouraged a situation in which many staff were routinely faced with short-term contracts, causing uncertainty for them and their families. Until they were forced by the courts, the Tory Government had denied employment rights to NHS staff transferred to outside contractors. Gagging clauses had become standard parts of staff contracts. Some NHS trusts had withdrawn union recognition. The Tory Government had stopped collecting data on NHS pay levels, so Ministers had no idea how many staff were on low pay. Institutionalised racism held back the careers of many black and Asian staff. No attention was paid to the growing incidence of assaults and abuse of people working in the health service.

Many staff were expected to work in run down and sometimes dangerous premises. In April 1997, 16 per cent. of hospitals and other NHS buildings did not comply with fire and other regulations. By 1 May this year, that figure had been reduced to 5 per cent. Staff were frustrated by having to rely on increasingly unreliable equipment. The work force planning system was woefully inadequate, as we now know from the problems with obstetricians and gynaecologists.

Most people working in the NHS were dissatisfied with a rigid pay system that inhibited career development. Rigid hours and working conditions were putting off ever more professionally trained staff, particularly those with family responsibilities. As a result there were shortages of nurses, midwives, therapists, pharmacists, laboratory staff, cyto screeners and in some specialties, doctors. The previous Government had done next to nothing about the problems that were building up. Year after year in speeches in the House and in evidence to the pay review body they denied that there were shortages of nurses, midwives or other staff.

The Tory Government were not just in denial, they were busy making matters worse. They cut the number of nurses in training. Some 15,000 nurses started training in 1992-93. By 1994-95 that figure had been reduced to 10,600 and it never again rose much above 13,000. If the Tories had not cut the number of nurses in training in the 1990s, no fewer than 14,000 more nurses would be available for the NHS today.

Since the election we have made a start on turning things round, but it is only a start. Things cannot be put right overnight. It takes three years to train a qualified nurse and six to train a doctor for registration. The average hospital doctor takes a further seven to eight years before becoming a consultant. We must take long-term action to make things better for the future and take whatever short-term action is available to us to deal with the situation left behind by the previous Government.

Let me start with the nurses. Unlike the Tories, we do not deny that there is a shortage of nurses. Unlike the Tories, we are doing something about it. This year, for the first time in five years, the Government implemented the findings of the independent pay review body nationally, in full, without staging. In their motion, the Opposition have the brass neck to criticise us for the fact that not all staff received the full pay award in their April pay packets. That is a bit rich coming from the people who, in their last three years in government, did not put the full amount into staff pay packets at all and did not put even the staged increase in until shortly before Christmas.

Paying the full amount nationally in one go has put a one-off strain on NHS finances this year because we are meeting the full cost of this year's settlement and the overhang from staging last year's settlement. All nurses got at least 4.7 per cent. Newly qualified nurses got 12 per cent. and 70,000 D grade nurses got 8.2 per cent. On top of that, for Greater London, which is the area with the greatest shortages, the London allowance was raised by 15.4 per cent.

Those increases mean that two out of three nurses will earn more than £20,000 this year and that a newly qualified nurse will get more than £14,000—more than £17,000 in inner London. Virtually all those increases have either been paid in April salaries, or will be paid in May salaries next week backdated to 1 April. There is nothing new in that. It is entirely in line with usual practice in the NHS, following acceptance of the pay review body recommendations by representatives of the staff in the middle of March. Most employers have either already paid the increase, or have programmed their payroll computers to pay it with May salaries. I know of just one trust—Addenbrooke's—that is due to pay out in June. That, the trust explains, is because it is negotiating a local settlement to top up the national award.

Like the representatives of the staff, we want to develop a new pay structure that removes the rigid grading ceilings that hold down the pay and hold back the careers of nurses and midwives. We are extending the role of nurses in line with what the profession wants. We shall introduce nurse consultants to enable highly qualified staff to continue nursing and teaching rather than going into management. The final decision on that has not yet been announced because we have been conducting highly detailed discussions with the profession about the best way to go about it. We have also found places for nurses on the boards of primary care groups. That is important for their professional development and they are making a great contribution and improving their management skills. Together with the professions, we are also addressing the many shortcomings of the system of nurse education and training introduced by the previous Government, which are widely acknowledged to have set back the national health service.

Mr. Simon Hughes (Southwark, North and Bermondsey)

I should like to take the Secretary of State back to the payment of the new pay award. He made his announcement on 1 February. The agreement with the unions and staff was made in the middle of March. Why did the letter of authority not come out from the Department of Health until 8 April? That is given as the major reason why the trusts were unable to deliver the hugely heralded pay settlement in the April pay packets as everyone expected. Was it not important that people should be paid on time?

Mr. Dobson

It is important that people should be paid on time. I have received no complaints from the Royal College of Nursing or any other body representing nurses about any delay, because the payments were authorised at about the same time as in previous years. It is no good the hon. Gentleman shaking his head—unless he has something wrong with him—because that is a fact.

Following the pay announcement in February, we launched a major recruitment campaign. To date about 53,000 people have responded. More than 5,000 of them are qualified nurses who want to return to the NHS—and we expect them to do so—and 650 have already started work. Many of those nurses have taken advantage of the return to nursing courses which, under this Government, are being provided free by the NHS. All those measures will help to address the short-term problem. The response to the recruitment campaign shows that nursing is becoming more attractive, but there is a long way to go.

We are introducing more family-friendly employment policies, the better to allow people working in the NHS to reconcile the demands of their jobs with their modern family responsibilities. We are giving people better opportunities to work the shifts that suit their needs, allowing them to take children to school in the morning or pick them up in the evening or to be around more during school holidays. That approach does not apply just to nurses and midwives. We want it to apply across the board. We must apply it to the people who are traditionally called junior doctors, particularly now that so many more medical students and junior doctors are women.

For a woman, the years taken up as a medical student and a junior doctor coincide with what we usually regard as childbearing years. We need a system that makes it easier for a woman doctor to have a career and, if she chooses, to have babies and bring up children. Of course, these days, quite rightly, many men doctors want to be able to devote more time to their families. That is one reason why the Government are fully committed to further reducing the hours of junior doctors.

The new deal that the previous Government reached with junior doctors was supposed to deliver better arrangements for accommodation and food and a maximum of 56 hours by 1996. Five years after it was agreed, when the Tories left office, the deal was not being delivered for about one in five junior doctors. We have improved matters. The figure has fallen to less than one in six. That is not all that we have done. Far from seeking to make matters worse for junior doctors, we have agreed with the British Medical Association a more rigorous definition of the terms of the new deal, which will be more difficult to deliver and may indeed make the figures appear worse.

Miss Widdecombe

I have asked the following question of the Secretary of State before. I have also asked it of the Minister of State. My right hon. Friend the Leader of the Opposition has asked it of the Prime Minister. We have had no answer. It is a terribly simple question, and I am sure that there is a terribly simple answer, for which we would be grateful.

The question is: if the right hon. Gentleman is so concerned to reduce junior doctors' hours, why did the United Kingdom delegation propose to Brussels that the hours should be 65, not 56, for eight years, and 60 for seven years?

Mr. Dobson

I shall answer that in the course of my speech—[HON. MEMBERS: "Answer it now."] All right, then. Let me read it slowly; perhaps that will help.

The European working time directive sets a maximum working week of 48 hours. The previous Government opposed the directive altogether. They fought its introduction tooth and nail, but, in their hapless way, they did not manage to stop it coming into law. At no stage did the previous Government try to achieve a reduction in junior doctors' hours to anything like 48, and it takes the biscuit that they should try to criticise us for doing so.

Clearly, a 48-hour week for junior doctors cannot be delivered quickly, because of the time it takes to train doctors. We have been negotiating a Europe-wide arrangement that will give Britain enough time to be able to reach the 48-hour target while, in the meantime, permitting a limit on hours that the NHS can live with. Different EU countries have different health systems, different ways of training doctors and different definitions of being at work and being on call.

We have sought to ensure that we have a European law that enables us to continue to reduce the hours, improve the working conditions of junior doctors and provide cover for NHS patients. I am confident we will achieve that. We have not sought to make British doctors work longer hours, and anyone who says that we have is a liar.

Miss Widdecombe

I say, because I have seen the document, that a proposal is before the European Council that 65 hours should be the hours of junior doctors. If the Secretary of State is trying to get from 56 hours to 48, that is laudable and I hope that he succeeds. But I cannot understand how he gets from 56 to 48 via 65. Is he calling me a liar? I have seen the document. Can he give me a simple answer to a simple question? If he wants to reduce junior doctors' hours, why has he proposed a limit of 65 rather than the current 56?

Mr. Dobson

As the right hon. Lady acknowledged in her own speech, 20 per cent. of our doctors work more than 56 hours. It would be ridiculous to propose a 56-hour limit in the Health Bill or in Europe at present because we know that we are not delivering that. The right hon. Lady continually misrepresents us—I shall put it no stronger than that. We intend no increase in any doctor's hours. The object of the exercise is to reduce the hours that British doctors work, ultimately to 48 hours in line with the European directive.

Dr. Evan Harris (Oxford, West and Abingdon)

Will the Secretary of State give way?

Mr. Dobson

No, we have dealt with that point.

Sir Brian Mawhinney

Will the Secretary of State give way?

Mr. Dobson

Yes, I will give way.

Sir Brian Mawhinney

I have been trying to follow the Secretary of State's argument. In the United Kingdom, he talks about 56 hours. In Europe, he talks about 65 to make Europe feel more comfortable. He does not talk about 65 hours for 20 per cent., just about 65 hours. Will the Secretary of State stand up and call me a liar? I do not believe what he is trying to tell the House about the Government's policy on junior doctors.

Mr. Dobson

What the right hon. Gentleman believes is a matter between him, his conscience and the truth.

Unlike the Tory Government, we accepted and implemented the recommendations of the doctors and dentists' review body for this year, in full, without staging. That applied to the junior doctors, consultants and general practitioners. In the case of the consultants the review body recommended that from 2000-01, an extra £50 million should be made available to reward consultants for increases in work load, contribution to the NHS and intensity of work.

The Government, as requested by the BMA, were already committed to renegotiating the contract for consultants. We have fed the review body's recommendation for next year into the renegotiations because they cover the same ground. The doctors' negotiators have stated that they are optimistic that joint proposals from the BMA and the Department of Health can be put to the review body this autumn for implementation in 2000. I share their optimism. A joint approach would clearly be better from every point of view.

That takes me to the other groups covered by review body awards—some of the professions allied to medicine. This year, they received the biggest real terms pay increase in a decade, and for the first time in five years, it is to be paid nationally, in full and without staging. All staff covered have received 4.7 per cent. The starting pay for newly qualified professions allied to medicine has gone up by 8.7 per cent. All basic grade staff will receive at least 8.4 per cent., and some senior grades have received an increase of 7.7 per cent. Yet the Tory motion notes the concerns of Professions Allied to Medicine". That falls short of qualifying even to be described as every assistance short of actual help.

Let us compare this year's settlement with what the professions allied to medicine received under the last Tory settlement. The Labour settlement provides 8.7 per cent. for newly qualified professionals. The Tory settlement provided 3.3 per cent. The Labour settlement is paid in full from 1 April. The Tory settlement allowed 2 per cent. from April, and 1.3 per cent. from December. The Tories delivered far less in the past than they claim.

Neither are the Tories promising anything better now. Only last month in a letter to one of her colleagues, the right hon. Member for Maidstone and The Weald (Miss Widdecombe)—or her research assistant, writing on her behalf—said: We have had to be necessarily circumspect about commenting on pay awards, as our own fiscal policy in respect of public sector pay has not yet been finalised. The line we have taken, and I acknowledge that it is not entirely satisfactory runs something like: 'I would certainly not seek to justify or defend the X per cent. award offered to X by this Government."' That is about as far as the right hon. Lady's policy goes.

Miss Widdecombe

Will the Secretary of State give way?

Mr. Dobson

I will carry on, if necessary. The letter continued: It is worth noting that we excluded laboratory scientists from representation by a pay review body because, unlike some other `professions allied to medicine', laboratory scientists were not entirely dependent on the NHS for employment. The pay review body system was an acknowledgment of the 'monopoly' status of the NHS as an employer, and it was felt that the 'market place' would be a sufficient force to set levels of pay for laboratory workers, given their scope for employment elsewhere. Yet the right hon. Lady will not justify or defend the award offered by the Government.

Miss Widdecombe

The right hon. Gentleman knows very well that we have welcomed the pay awards that the Government have announced, even if the Government have not delivered them. He will be aware that I would never make the irresponsible comments that people try to lead me into before any announcements are made. They encourage me to bargain with the Government and ask the Government to give large increases in advance of what is announced by the independent pay review body. Therefore, I have always advocated circumspection; but the right hon. Gentleman knows, because it is on the record in Hansard, that we have always welcomed the pay rises that he has announced. I will welcome them even more when they are delivered.

Mr. Dobson

I would not like to be welcomed by the right hon. Lady. Her form of welcome is: I would certainly not seek to justify or defend the … award offered by the Government. That is the sort of welcome that she gives in private correspondence.

So the Tories may be concerned, but they are not sufficiently concerned to do anything. That is the truth about the charges that the Tories have levelled in this debate against the Government. We are not extending the hours of junior doctors. We are reducing them, and the Tories know it. We are paying the nurses their full pay increases with effect from 1 April, and the Tories know it. We have accepted the review body recommendations on consultants' pay for this year, and the Tories know it. The review body has just awarded the professions allied to medicine their best real-terms pay increase for 10 years, and the Tories know that too. So the Tory motion gets no marks for technical merit and, like every work of fiction, owes everything to artistic licence.

The most revealing aspect of the Tory motion was what it left out. It did not refer to the offers that we have made of up to 6.9 per cent for some medical laboratory scientific officers—the ones whom the right hon. Member for Maidstone and The Weald wants to rely on market forces. We offered them and trainee cyto-screeners that amount, and up to 11.2 per cent to qualified cyto-screeners. These are part of the continuing negotiations with non-pay review body staff which will be carried forward very soon with an improved pay offer.

Nor did the Tory motion refer to all the welcome changes that the new Government have brought to the NHS, which are designed to be better not just for patients but for the staff. For a start, we are building new hospitals and modernising old ones. We have already started work on 15 major hospital building projects—part of the biggest building programme in the history of the NHS. This year, more than £100 million is being invested specifically in improving accident and emergency departments, to make them both better for patients and safer for staff. Another £;100 million from the lottery is being invested in new and better equipment to diagnose and treat cancer on top of the £350 million already earmarked for renewing unreliable hospital equipment this year.

Nor did the Tories make mention of the action that they neglected to take to reduce assaults on and abuse of people working in the NHS. Since the general election we have given this a high priority. For the first time, we have conducted a national survey of the incidence of violence against NHS staff. We have set trusts tough targets for reducing violence. Accident and emergency departments are being equipped with closed-circuit television, layouts are being improved and staff are being equipped with alarms. Hospitals have been instructed to log all violent incidents and to prosecute any offenders. We will shortly publish new guidelines produced by officials from my Department, the Home Office and the Lord Chancellor's Department designed to deter assaults and abuse and to make sure that the criminal justice system takes harsh action against any who do offend. Hospitals are now required by law to be involved in local crime and disorder partnerships.

Staff who provide services in the community are also being helped by better security measures. These will improve the working lives of people in the NHS, and so will our commitment to get rid of short-term contracts. The routine use of short-term contracts left staff and their families in a state of insecurity. NHS employers have been told to end the practice of routinely offering short-term contracts and to use them only to provide cover for staff on maternity leave and other short-term factors. On top of that, we have made it clear to NHS employers that gagging clauses in staff contracts must become a thing of the past. Whistleblowers on the staff should have nothing to fear, provided of course that they tell the truth.

Miss Widdecombe

So why sack them?

Mr. Dobson

I cannot sack any NHS staff. That comment just displays the ignorance of Opposition Members.

This Government are also taking action to end the institutionalised racism to be found in some parts of the NHS. We have changed the arrangements for allocating distinction and merit awards so that the proportion of black and Asian doctors getting awards has increased by 50 per cent. in the first year. We have almost doubled the percentage of black and Asian members of the boards of health authorities and trusts and we have been taking other measures to improve the situation for black and Asian staff.

I do not pretend that the changes that we have set in train will put everything right as quickly as we would like, but we have made a start, both with immediate measures to deal with the staffing crisis that we inherited and with long-term changes designed to provide more and better qualified staff in five, seven, 10 or 12 years' time. Both are being carried out by this Government. Both should have been done by the Tory Government. But they were not and that is why any Tory criticism of what we are trying to do amounts, as I said at the beginning of my speech, to bare-faced cheek.

8.17 pm

Mr. Simon Hughes (Southwark, North and Bermondsey)

We welcome the debate and the fact that the Conservative party has chosen this subject. It is our perception that there is extremely wide concern, distress and lack of morale in the health service. The last debate on these issues was the one that I initiated on 13 January, which was on the pay and conditions of nurses, midwives and health visitors—the first debate on that subject for 10 years. Although we might find technical reasons to differ with the motion tabled by the Conservatives, because the nature of the complaints seems valid to us, unusually, we did not table our own amendment. We thought that it was more important on this occasion to register that, in spite of the good things that the Government have done and their best intentions, so far they have not cured the fundamental problem of a health service in which huge number of workers do not believe that the Government are saving it or coming to their rescue.

At the very beginning of the year, on several occasions, not least the winter flu outbreak, the Secretary of State or one of his Ministers came to the House and made a statement of support for the workers in the health service. On 11 January, the Secretary of State said: First, on behalf of everybody in the country, I want to thank all the people working in the health service and local social services for the huge effort they have been putting in to ensure that everybody gets the treatment and care that is needed. We all agree with that. He continued: Over the past few weeks, nurses doctors, midwives, health visitors, cleaners, kitchen staff, managers, porters, ambulance staff, laboratory scientists, therapists, pharmacists, telephonists, clerical, administrative and maintenance staff and social services staff have all performed wonders on our behalf …I thank them all. They have done us proud."—[Official Report, 11 January 1999; Vol. 323, c. 35-39.]

I shall now read a letter dated 26 April from one of my constituents, who is a nurse. It reads: Dear Simon Hughes, I am writing to tell you of my deep distress and anger at the way the nurses' pay rise has been treated by the NHS. I work for the Guy's and St. Thomas health trust and when I rang salaries to find out why the nurses had not been given their rise in April, I was first asked why I expected a pay-rise and secondly told we might get it in July if we were lucky. I then spoke to the personnel department at the … trust, who blamed the N.H.S. Executive for not sending out a letter of instruction to the trusts in time. They had managed to do this for the medical staff, who got their pay-rise when promised. This is typical. Nurses are the disregarded underclass of the N.H.S. Nobody gives a damn about us in real terms. All we get are well-meaning clichés and no action. The Labour Government promised that this pay award would not be staged or deferred, but that has obviously not happened. Labour boasts that 50,000 calls have been made to the back-to-nursing 'phone line. Nurses vote with their feet and leave the health service. No amount of cosmetic tinkering will reverse this unless pay and conditions improve. I know that you take a close interest in this health trust and feel sure you do not approve of this high-handed and arrogant approach to nurses' pay. I hope that you will be able to help us to get what was promised to us by the present Labour Government. I do not know the nurse who wrote that letter. To my knowledge, I have never met this nurse, although the nurse in question lives only a few hundred yards from my house. I have read out the nurse's words; they are not my words. They are from a nurse who feels that the Government have let down nurses. We say that, if that is what they feel, that is what we must believe. That is a view that is widely felt in the national health service.

Mr. Dobson

The instructions to the national health service about doctors' pay were issued sooner than those about nurses' pay because there has to be agreement with the representatives of the staff and the doctors agreed considerably sooner than the Royal College of Nursing. One of the other reasons for the delay in producing the letters, so I am told, is that the text has to be agreed by all the unions with which we are in negotiations. As far as I know, everybody should be paid in May if payment has not been made in April.

Mr. Hughes

I am grateful to the Secretary of State. I know him well enough to know that, when he thinks that something has been done wrongly, he lets people know his views. If the NHS and the Government, who are accountable to the nation, thought that increased pay for nurses was important, he should have exclaimed to civil servants and managers of the NHS, as I have heard him exclaim to other people on other occasions, that that delayed payment was not acceptable. Indeed, it is not acceptable. Whatever the processes, it was not acceptable for the Government not to have given the instruction until after the beginning of the financial year. I hope that this never, ever, happens again.

I first picked up this concern at Morriston hospital in Swansea during the last week in April, when nurses came to me. I did not ask them to raise the matter with me. They told me that they had just received their pay slips and that the pay increase did not feature in them. I made inquiries and I asked my assistant to phone every NHS region in England, one trust per region. I was told that no trust had paid the increase in April. My assistant phoned Bromley in London, Kettering in the south-east, Gloucestershire Royal NHS trust in the south and west, Allington in the eastern region, Wolverhampton health care in the west midlands, Barnsley in Trent, Blackpool Victoria in the north-west and Harrogate Healthcare. Not one had paid.[Interruption.] I do not know what the hon. Member for Crawley (Laura Moffatt) said. Most of those asked said that they hoped to pay this month.

What does this do for morale? Nurses were told, "You are hugely valued. We think that you are important and you will get a big pay rise." Then there was nothing. That is not good enough. I let the case rest there. I look to the Secretary of State to ensure that that does not happen again. It is no good saying that we love nurses when we kick them in the teeth when it comes to their pay packet.

Secondly, there is common ground in the House that we need to have a package of measures to make people want to come in to, stay in, or return to, the NHS in all the professions, but particularly nursing, which is the largest. I ask the Secretary of State to consider with his colleagues whether it is not time—this applies to other professions in the NHS and beyond—to examine ways in which we can assist better those who might consider coming into nursing and the other professions. For example, we used to offer bursary schemes to those in the armed services.

There are ways in which we could give people extra funding in return for a commitment to stay. We could offer loyalty payments for those who do not disappear. There could also be packages that make it worth while to cover the cost of retraining—a matter that the Secretary of State and I have debated before—those who have left the health service but need to come back. Such packages would mean that people would not be out of pocket. There are some people who have to travel to courses to train before they are allowed back into the health service. Packages to pay for all this would give an incentive to return. In other words, there would be a premium to come back and make a commitment of three or five years to the NHS.

If we have about 12,000 or 14,000 nursing shortages and if about 70,000 of the 140,000 qualified nurses are not in the NHS, we have enough people potentially, if they are willing to come back. Some have responded. The Government have taken initiatives to try to persuade them to respond, but there has been no financial incentive for them to do so. It would cost so little to provide one in terms of the total budget of the health service. The cost would be worth it for their sake and for the patients' sake. The return of those people would speed up treatment times. At the same time, the morale of the health service would improve because people would not be trying to cover jobs that are left vacant.

Mr. Dobson

The offer of a bonus to someone who comes back into the NHS that is not offered to the folks who stay would harm morale, not improve it. Some football clubs have learned that to their cost.

Mr. Hughes

I said specifically—the Secretary of State may not have heard me so I shall repeat it—that we should give loyalty bonuses to those who stay.

We obviously share the view of the Secretary of State that family-friendly policies matter hugely. We say clearly to him that, as the review of nursing grades continues, we need to allow people to stay in nursing but continue to be upgraded in salary and career position, and continue to do some hands-on nursing so that it is not necessary to become a manager to be promoted. People will therefore feel able to remain with nursing. I think that the right hon. Gentleman espouses that view.

Thirdly, we are keen, as I hope that the right hon. Gentleman is, to ensure that there is an opportunity for the nursing profession to become one in which people are much more involved collectively with all the other professions in decisions about its future.

The week before I was at Morriston hospital, I was at the junior doctors' forum in Bath. Junior doctors too are not happy. It is often necessary to get three A grades at A-level to become a medical student. The places are very difficult to secure. On qualification a junior doctor works mighty hard. They work harder than most other students for their degrees, and for longer in many instances. They then have to do their training. They often do not know whether they will have another six months' work after the six months that they are in. There is a huge element of uncertainty during the first few years post-qualification.

Many of the junior doctors said to me, "We also feel undervalued. We feel that it is not worth staying. We are concerned that we do not get proper supervision. We have cursory supervision from consultants, who literally look in and look out again. We now hear that the Government are trying to negotiate a maximum limit of 65 hours and not 56." For the first time, the Secretary of State, who was in the Chamber a moment ago, effectively admitted today that the Government—as I understand it, it was the Minister with responsibilities for public health who did the negotiating because she went to the Council of Public Health Ministers—were pushing for 65 hours. Why could the Government not have owned up? Why could they not have said that they pushed for 65 hours because they thought that they had to cover the fact that 20 per cent. of junior doctors were working more than 56 hours? Why have we had a month of obfuscation, denial, pretence and mealy-mouthed weasel words? Own up, Government. Be honest.

When the Government get something wrong, they should say so. Out there, people did not believe them. The doctors did not believe the Government, and the Government let them down. There was an explanation, but the Government should come clean with the country if they cannot do as they wish. They should not try to fool people. People are not fooled, and their morale is undermined.

The third issue is similar to the others. We are at risk of running desperately short of consultants. My hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris), who was previously a hospital doctor, knows more about that than I do. He has raised in the House and elsewhere not just the subject of the shortage of obstetricians and gynaecologists, to which the right hon. Member for Maidstone and The Weald (Miss Widdecombe) also referred, but the fact that, in many of the career paths, there is a bottleneck. There is a nonsense system whereby people do not have the opportunity to progress up the career ladder and do the jobs that everyone is asking them to do.

My hon. Friend the Member for Isle of Wight (Dr. Brand) is on the Select Committee on Health, which produced a good report that makes it clear that our manpower planning is still nonsense. Our work force planning is not working. We are not managing to make sure that we have the necessary NHS staff at the time that we need them, in the right place and the right post.

Dr. Harris

Does my hon. Friend agree that it seems bizarre that we plan centrally the number of medical students in the health service, we plan centrally the number of higher specialty trainees in the health service by region, but when it comes to consultants—the key end of the bottle that provides the service—there is no central planning? Trusts are left to do as they please, leading to the failure of consultant expansion, the poor quality that that causes, and the lost career opportunities for all those people in whom we have invested and for whom we have planned so carefully to bring them to consultant level.

Mr. Hughes

My hon. Friend makes a point that I understand causes real concern. I ask the Government, as he has done, to change the system, which tries to plan the number of nurses and doctors that we need, but does not plan in a co-ordinated way the number of consultants that we need.

Many of the trusts where there are senior consultants determine the number of consultant posts according to their own traditional patterns, sometimes to protect the interests of existing consultants—their jobs, hours and income—to the detriment of younger doctors who would help to relieve their burden and the burdens on the health service. That is not acceptable. It is old-fashioned and used to be called a Spanish practice. We need to say that, even if it applies to a minority of consultants and a minority of trusts. We should not allow self-interest to determine the number of posts at consultant grade in the health service.

The fourth issue concerns general practitioners. We are facing the prospect of large numbers of GPs retiring and leaving. Some of those retiring were part of the bulge in the health service created by the number of people who took up general practice after the war, many of them from the new commonwealth and elsewhere. Some are retiring because of the pressures of the system and the paperwork, and others because of the fact that the new primary care group structure means that they will have less time to be GPs because they are required to perform a management role. I have recently met a considerable number of GPs who say that they will have nothing to do with primary care groups because they want to be doctors, not paper-pushers. They do not want to go to meetings; they want to get on with being doctors.

Mr. Kevin Barron (Rother Valley)

We are improving the health service.

Mr. Hughes

I respect the hon. Gentleman, but I have seen enough round the country to worry me greatly. That, added to the current pressures and the shortage of GPs, will be a serious problem in a few years. In some areas, we could be as short of GPs as we are currently short of dentists in the health service. If we do not anticipate that problem and take action, we will be in big trouble.

Mr. Barron

My area has the highest patient:GP ratio in England and Wales. Under this Government, GPs in the health service are working to help us with those problems, instead of being the small independent contractors who held the service back for years.

Mr. Hughes

Like the hon. Gentleman, I believe that the gaps in private general practice offering to work under contract for the health service had to be plugged by salaried GPs.

My hon. Friend the Member for Isle of Wight asked me today whether I had seen the front page of GP General Practitioner this week. It is dated 21 May, so, unless I am mistaken, it still has not officially come out, but I happen to have a copy. The headline is "Salaried GP posts collapse". It quotes Dr. Roger Chapman as saying: The £4 million was not enough and there is no new money. It seems that the proposal was to fill the gaps with salaried GPs, but the money is not there to do it. The initiative may have helped in the hon. Gentleman's area and in others, but it does not seem to have done what it was billed to do.

With regard to professions allied to medicine and other workers not covered by the pay review bodies, there is no case now for pay review mechanisms not to cover everyone who works in the health service, including those who are currently excluded.

I shall ask a couple of questions and end with a couple of propositions, as I know that others want to speak in the debate.

Mr. Robert Syms (Poole)

The MSF—Manufacturing, Science and Finance union—briefing paper from its lobby of Parliament asked whether this year's pay round had made matters better or worse for many of its staff. It states that the position is significantly worse, and that almost all the skilled and professional staff got 2.8 per cent. on basic pay, with nothing on leave and allowances, even though, since 1984, many of those categories have fallen back 30 per cent. in their pay.

Mr. Hughes

The headquarters of the MSF are in my constituency. I am aware of the union's concerns, which the hon. Gentleman rightly raises. I am concerned not just about the people who belong to that union and the professions allied to medicine covered by the pay review bodies, but about the people outside that group—for example, ancillary workers in the health service, such as cleaners.

I visited a hospital the other day in the south-east of England which, at the pay that it offers, cannot get the cleaners that it needs. That is in the county's principal general hospital. The reason is that the pay rate down the road at Tesco is twice as much. The hospital does not have the cleaners that it needs and it is worried about that, as there are clearly health and safety implications for a hospital more than for anywhere else.

Neither the hon. Member for Poole (Mr. Syms) nor I is being alarmist. We are simply reflecting what people are telling us as we go round the country about the desperate state of morale, pay and conditions in the health service.

I shall put two questions to the Minister. I have heard the Secretary of State's evidence before the Select Committee about the number of nurses that we are short of. My first question, which I hope the Minister will answer at the end of the debate, is what was the total shortage of professional staff in the health service when the Government came to office in 1997 and what was it in April 1999? I believe that it has gone up over the past two years, if one adds the figures for doctors, GPs, nurses, dentists and so on.

Secondly, what is the Government's target ratio of doctors to population, consultants to population, nurses to population and junior doctors to population? Many of the tables show that we are comparatively well off in the number of nurses, but we are badly off in the number of doctors, relative to the number of people in the United Kingdom. If that is the case, we must seriously address how to respond to the aspirations of all those young people who want to enter medicine and other health professions and become public servants in the health service, but for whom the system does not deliver.

The Minister must also tell us what is to be done in respect of millennium pay for public sector workers. Liberal Democrats believe that there must be an acknowledgement of the duty that we may impose on those in the emergency services—including the health service—during the period of the millennium celebrations. The matter must be nationally agreed. It is nonsense to leave it to local pay bargaining, negotiation and pressure. That applies not only to the health service, but to the ambulance and other emergency and public services.

Our urgent view is clear; I have stated it previously. The health service will not get out of its staffing hole unless it owns up to the need for a real-terms increase in funding—in terms of the gross domestic product. One could try to get people out of the health service—the route proposed by the Tories, from which we dissent—but, until a real increase is the accepted norm, we shall always struggle. I have never heard the Government make that commitment.

What is needed is a package of specific measures, including financial ones—not merely warm words and glossy advertisements—to draw people into the professions and retain them. We need work force planning for all professionals and grades in the health service—not merely for some of them. It would be better for that to be based on cross-party debate and agreement, rather than on Government denials of a major crisis. It should not be left for opposition parties to bang on the door. We and the Tories may agree on few things and disagree on many things. We may have criticisms of their record in office. That is in the past. At present, there is a crisis in morale in almost all professions in the health service. The two-year mark that the Government have just passed has not changed that; if they do not act soon, things will get worse—not better.

8.40 pm

Mr. Alan Keen (Feltham and Heston)

We are debating the conditions of service in the national health service. I shall talk about a case that will have been going on for four years by September of this year—the Hillingdon hospital dispute. Before I do so, I note that the shadow Secretary of State for Health, the right hon. Member for Maidstone and The Weald (Miss Widdecombe), mentioned a commission on trolleys. Having listened to some of the contributions from Members on the Opposition Benches, it would not take long for a commission on who is off their trolley to arrive at its conclusions.

I was also reminded that at the West Middlesex University hospital, which will be rebuilt as a result of the Government's policies, patients were shifted around the hospital, from ward to ward and from ward to operating theatre, on what we called milk floats. Under this Government, that hospital will be replaced by a modern, new building. The previous Government took £10 million from the sale of the South Middlesex hospital to rebuild the Chelsea and Westminster hospital. Originally, that money had been promised to the West Middlesex. We shall at last have a decent hospital in the constituency of my hon. Friend the Member for Brentford and Isleworth (Ann Keen).

In relation to the Hillingdon hospital dispute, I remind hon. Members of what the duties of domestic staff in the health service used to be. There was a member of the domestic staff on each ward. That person not only cleaned the ward, but was often the only visitor for many patients. Members of the domestic staff used to go shopping for patients. Several years ago, their jobs were changed dramatically when the cleaning of hospitals was put out to contract.

Some of the women at the Hillingdon hospital have worked there for 30 years; at first, they worked directly for the NHS and then for the contract cleaners. That second system worked quite well until about four years ago last April when the Pall Mall company took over the contract. The company decided that it would be better—at least for its directors—if the pay of the domestic staff was reduced from about £3.50 to £2.50 an hour. Fifty-five mainly Asian women decided that, on principle, it was not acceptable to have their pay reduced by about 30 per cent. They came out on strike and have been on strike ever since. At one stage, they were the only people who believed that they could win. However, they were determined. They attended tribunals and maintained a picket line on every day of the year—including Christmas day, Boxing day and new year's day. I was on a token picket line with them on Christmas day last year.

The multi-million pound Pall Mall company was the original guilty party; it was part of the Davis group and has since been taken over by Granada, which is a member of the Low Pay Commission. Of the original 55 strikers, about 18 are left. They attended the latest tribunal which was held last week between 12 and 14 May. Those people have won on every occasion that they attended a tribunal. They are ordinary women who had never been involved in disputes; they are the nicest and most reasonable strikers I have ever met during my long career of involvement in industrial disputes. All that the women wanted was their jobs back at a reasonable rate of pay. They pressed on and, as I said, they have won at every tribunal; however, the company they want to be their employer continues to refuse to take them back. At the final tribunal last week, at which Granada appealed against having to take the workers back, the company lost once again.

I did not attend last week's tribunal, because I was on duty here, but I was astonished to hear of an admission made at that tribunal by Granada's senior manager of human resources—a man to whom I have spoken on several occasions when offering to try to bring the dispute to a happy conclusion, because I know the strikers so well. He appeared to me to be a reasonable and honourable man, but he admitted that it was he who had typed out a petition and forced people who were working at the hospital to sign it by threatening them with the loss of their jobs: the petition said that the signatories did not want the strikers back in any circumstances. He did that despite the fact that 220 doctors, nurses and ancillary workers had signed a petition saying that they would welcome the Hillingdon hospital strikers back.

That is how matters now stand. It has been the most honourable dispute I have seen, involving the most honourable strikers that I have ever represented, and the previous Government should be ashamed that the situation could have reached such a level.

I am speaking about industrial disputes because there has been criticism—even from Labour Members—of the current Government's proposals on changing the Employment Relations Bill; we felt that they did not go far enough. However, there have been three major disputes in west London alone that would have been rendered completely unnecessary by legislation introduced under the Labour Government. The Hillingdon hospital is one of those, because Pall Mall would not have been able to reduce pay from £3.50 an hour to £2.50 an hour under the National Minimum Wage Act 1998, so that four-year strike would never have happened. Let us think of how much suffering those women and their families have had to endure during that period.

Another major dispute occurred in west London when Noon's refused to recognise the GMB, despite 70 per cent. and more of the work force voting for union membership. Noon's has now given in, because it knows that the Employment Relations Bill will force it to do so, but the suffering the dispute has inflicted need never have taken place. In my constituency, the Lufthansa Skychefs strike—although it is hardly a strike—would have been rendered unnecessary by the same legislation. During an industrial dispute, on being given notice of a series of one-day strikes, Lufthansa Skychefs sacked the strikers immediately. That happened on three occasions and now 300 people have been sacked. Those sackings would have been illegal under the Employment Relations Bill.

The difference in the attitudes of the previous Government and the current Government is clear. Many hon. Members do not understand what workers have to face when they are forced into circumstances such as those which the workers at Hillingdon hospital have had to endure. We should all be ashamed that all those ordinary women have now had to go four years without work, and we should all wish them well now that the tribunal has finally awarded against Granada.

8.49 pm

Mrs. Marion Roe (Broxbourne)

My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) has spoken eloquently about the enormous difficulties affecting NHS staff, and the appalling proposal to worsen conditions of service by increasing to 65 the hours that junior doctors will be expected to work. That the best medical care is provided by keen, alert and wide-awake young doctors, not by those who struggle to stay attentive as they are ground down by excessive hours of work, is recognised by the whole population—the whole population, that is, except for the Secretary of State for Health and his henchmen.

The previous Conservative Government worked extremely hard to reduce progressively the hours worked by those highly valued medical men and women who are the core of tomorrow's health care system. Yet, at a stroke, the Secretary of State has thrown away all those hard-won improvements. He will not be able to deceive the public, who will see that the health service is not safe in his hands. Like the nurses who were robbed of their full pay rise and the consultants who are frustrated by the Government's failure to implement review body recommendations, doctors throughout the profession are suffering.

I wish to address the conditions of service for doctors who provide primary care for our population. Since the inception of the health service, general practitioners have provided the bedrock of care for the population and have acted as the gatekeepers for access to secondary care. More than 90 per cent. of all medical care is provided in the primary sector. Since the election of the Labour Government, GPs have seen their conditions of service decline steadily. They have been dragooned into primary care groups—in many cases, against their will—and they have seen the enormous benefits of the fundholding system snatched away from them. The fruits of the fundholders' labours—the entrepreneurialism that led to the creation of innovative primary care centres—have been largely destroyed.

The community clinics at GP surgeries, which were so valuable in improving the quality of care and providing effective and rapid local services, have been snatched away by a compulsory money-saving exercise by primary care group boards, which are constrained by debt that has resulted from inflexible and inappropriate financial instructions from the Department of Health to health authorities. Although primary care group boards currently enjoy a majority of GP members in most instances, they have the power to compel a practice or a doctor to follow board policy on pain of withholding practice finances.

In addition, if doctors are seduced into primary care trusts, they will lose their majority, their authority, the control of their staff and their premises. The individualist, independent practitioners will end up as salaried doctors working to the guidelines and protocols set for them by the National Institute for Clinical Excellence, which is driven by rationing rather than by quality. Let there be no doubt: Professor Rawlins, the chairman of NICE, has made it clear that no product or treatment will be recommended if there is no money to fund its introduction.

Mr. Philip Hammond (Runnymede and Weybridge)

My hon. Friend spoke of doctors being seduced into primary care trusts. She may be interested to learn that, under the Health Bill as currently drafted, they will not need to be seduced: doctors can be forced into primary care trusts without their consent.

Mrs. Roe

I am grateful to my hon. Friend for setting the record straight. I take his point: doctors can be forced into primary care trusts.

Conditions of service will be desecrated by protocols that will prohibit the patient from receiving the best—which was a concept guarded carefully by the previous Conservative Government—and which will deliver the cheapest service. The concept of "never mind the quality, feel the width" was never more apparent.

What about the GP who shows initiative? He risks a visit from the thought police of the Commission for Health Improvement, who are able to come into his practice, see and do whatever they like, say whatever they wish and charge him for the costs of the exercise. Conditions for GPs whose partners or colleagues are involved in PCG work have also deteriorated. Inadequately reimbursed for the costs of the locums that they need to employ, they will either be unable to fulfil their PCG roles properly, or will end up subsidising the Government's primary care hyperbole out of their own pockets.

What about conditions for the poor patients who must tolerate those ill thought through ideas? How many sick people will be unable to see the doctor of their choice because he is away at the PCG doing administrative work? Half a million consultations—a number equivalent to the whole population of Sheffield—will be lost each month and patients will have to receive their care from locums, if they can be found.

We should remember the Labour party's theme tune for the previous election. In my view, things have not got better; they have become more expensive, more bureaucratic and more confused; things have only got worse. Burdened with a new range of targets which must be met to enable them to claim the £60 million promised by the Government in recognition for hard work already undertaken, doctors' overall work load is rising inexorably. The demand for surgery attendances increases year on year. Expectations about quality improvements are for ever applied as GPs are required to embrace clinical governance, to prescribe more generic drugs and to improve their education.

Doctors are having to contend with an increasingly litigious population that demands more and more from the finite resources that practices can offer. Legal claims against GPs rose by 15 per cent. last year alone. Ten years ago, a GP had a one in 500 risk of being sued in any year; now that risk is one in 35. Complaints are rising exponentially as GPs fail to meet patients' expectations generated by a Government with no vision and even less consideration. All those demands must be met by a profession that has a recruitment crisis and is starved of the funding for key developments, and what can all that do but destroy morale and suppress enthusiasm?

We must recognise the deteriorating conditions under which GPs are being forced to work. We truly lament the decline in conditions of service that they are having to face, the loss of a service that was the envy of the world and the development of a system that will fragment primary care. All that will result in the provision of a rag-bag service in supermarkets and railway stations, and through NHS Direct, the value of which is highly questionable. The outcome will be the loss of consistency of care that has become a byword for the management of patients by United Kingdom GPs.

We are prepared to stand as the champions of primary care and as advocates for the comprehensive services that GPs can now provide. GPs should be supported in their provision of services, with conditions that allow them the flexibility and freedom to provide the best services. The Government's actions have resulted in one fundamental change. The GP can no longer say, "I shall do my best for you." He can say only, "I shall do what they will let me do for you." That is a sad reflection on the Government's policy.

I urge the Secretary of State to think again, to support rather than harangue, to encourage rather than discourage, to build rather than destroy and to restore the conditions of service for GPs to allow them to provide the care for which they are renowned.

8.58 pm

Mr. Kevin Barron (Rother Valley)

My right hon. Friend the Secretary of State said, in opening the debate, that he felt that the Opposition had what he called barefaced cheek in putting their motion on the Order Paper. I am not sure which Opposition motion has the most barefaced cheek—this one or the one that we debated a few months ago about national health service waiting lists, which rose considerably under the previous Government. The circumstances described in the motion and the problems in the NHS are those that we inherited in 1997.

I am amazed that the motion has been tabled, but I am pleased that the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) and his colleagues have put their names to it because I believe in a Government facing an Opposition, and I have been waiting a long time for such a development.

I listened to both the opening speeches made from the Opposition Benches. The words "barefaced cheek" did not immediately spring to my mind, but the words "mealy mouthed" did. The Opposition did not attack nurses' pay, but they are now attacking the administration behind it. They say that—although the Government have agreed with the pay review body and agreed that the nurses can have the money straight away, at the beginning of the financial year—the trusts are not administering the pay rise properly and that they are the problem. [Interruption.] I wrote this down: the right hon. Member for Maidstone and The Weald (Miss Widdecombe) said, among many other things, that the trusts are failing to give nurses the money.

The hon. Member for Southwark, North and Bermondsey said that he felt that people did not expect the Government to kick them in the teeth. If this year's nurses' pay award is a kick in the teeth, the nurses have been waiting many years for the Government to do that and to give justice where there has been no justice for a long time.

Mr. Simon Hughes

I want to make sure that the hon. Gentleman and I understand each other. He knows that we welcome the fact that the pay award must be paid in one go and is not phased. That is clearly better than phasing an award, which his Government did last year, and the Tories the year before. The kick in the teeth—I do not blame the trusts at all—is that no increase was paid, although the Government said in the press release that the award would be paid in full in April. That was not the fault of the trusts—they were given permission too late to be able to do anything.

Mr. Barron

The hon. Gentleman used the words in that way; let me tell the House some of the other words he used. He read out a letter from a nurse from his constituency who said that the Government had a high-handed approach to nurses pay. if they do, that is most welcome and something that we have been waiting for—it will achieve justice for many years to come.

The hon. Gentleman talked about his travels around the national health service—he always gives us an update in these debates—and told us what people are saying. Some people might be saying what he says they are saying, but the question for him is whether he agrees with them that workers do not trust the Government or that there is widespread concern and distress in the NHS.

The right hon. Member for Maidstone and The Weald said that NHS personnel are thoroughly disillusioned, fed up and demoralised with the Government. If that is what the motion is based on, the Opposition ought to go back to the NHS to talk to people. I remember my postbag at the time when people really were fed up with the Government and demoralised by what they were doing. We regularly received letters from members of the NHS professions because of what the previous Government were doing to the NHS. I do not think that I have received two such letters since the Government took office two years ago, because we are doing the right things for the NHS.

Let us run through what the nurses' pay award in February meant. My right hon. Friend the Secretary of State rightly said that the nurses are to get their biggest real-terms pay rise for 10 years. For the first time in five years, the award is being paid nationally in full and with no staging. That is hardly kicking anybody in the teeth. Starting pay for newly qualified nurses will rise from £12,855 to £14,400, which is a 12 per cent. increase. There will be an 8.2 per cent. increase in basic pay for 70,000 grade D nurses. Other nursing grades are to get a 4.7 per cent. increase in basic pay, although inflation is running at about 2 or 2.5 per cent. I hardly think that that is an attack on nurses and people working in the NHS.

More than 200,000 members of the Royal College of Nursing are working in the NHS and they are getting that type of benefit. For the first time in the history of the NHS, the starting pay for all newly qualified nurses will be more than £4,000 per annum. The inner-London allowance will increase from £1,910 to £2,205 from 1 April. The outer-London allowance will increase from £1,360 to £1,570. That means that starting pay in inner London for all newly qualified nurses will be £17,325, which is a marked increase on what they had in years immediately gone by.

As well as that basic pay, nurses receive, on average, an extra 11 per cent. from the allowances, which means that an average grade D nurse on the minimum of the scale will get about £1,600 extra. That is hardly an attack on NHS personnel working in those different grades. The Opposition try to talk down these increases instead of congratulating the Government on bringing to the nursing profession the justice for which it has waited so long.

The Opposition motion does not seem to be supported by the Royal College of Nursing, which recognises what the Government are doing. The royal college welcomes the debate and has sent hon. Members a briefing, which says:

The Government have taken some significant steps towards addressing the NHS nursing shortage, with the 12 per cent. increase in starting salary for junior nurses, the publication of NHS Human Resources Strategies for England, Scotland and Wales, and the launch of discussions on the Agenda for Change proposals to modernise the NHS pay system. I agree with the RCN on that. It goes on to say: However, it is clear that many more changes are needed throughout the NHS before nursing becomes an attractive profession again. The RCN believes that pay is the single most important way in which nurses' morale can be boosted and nursing valued again. However, there are a number of other vital issues which the NHS must also address.

Mr. Hammond

Does the hon. Gentleman acknowledge that the president of the Royal College of Nursing said that the 4.7 per cent. pay increase would do nothing to stem the flow of nurses out of the profession?

Mr. Barron

She may have said that, but it is not in the brief. I have just read what it says. The RCN believes that pay is the single most important way in which to boost nurses' morale, but not the only way. I shall refer to the areas in which their morale has been battered over the years.

My right hon. Friend the Secretary of State referred to family-friendly employment policies. I mentioned GPs when I intervened on the hon. Member for Southwark, North and Bermondsey. The NHS is now able to employ general practitioners: they have had independent contractor status for the past 50 years. Fifty-eight per cent. of nurses have caring responsibilities for dependent children or dependent adults, yet only now after, all these years, is the NHS beginning to adopt flexible employment practices. It should have done that 50 years ago. We must ensure that we retain nurses who leave the service because of the pressures of the system.

The RCN refers to career progression, which is another issue that my right hon. Friend addressed. The Government have some good proposals to develop the potential of nurses to help them to get on in the profession. We should not ignore that.

My right hon. Friend also mentioned violence in accident and emergency departments, and threats to staff. About 12 months ago, the then Health Minister, my right hon. Friend the Member for Darlington (Mr. Milburn), gave a speech about violence to NHS staff. It received some derogatory comments from people working in the NHS. In some areas, stress caused by the likelihood of attacks is a major factor affecting people's decision on whether to stay in their job. The Government are setting targets that health trusts must meet to get such violence out of the system and to make the workplace safe for NHS staff. We must ensure that they do not have the stresses that they have had in the past.

I realise that in opposition we sometimes have to put awkward arguments that get thrown back in our faces. I sat on the Opposition Benches from 1983 until two years ago. The Opposition motion takes the biscuit when we consider how NHS staff were treated during that time. We are talking about a party that imposed an internal market on the national health service, and forced hospital staff to compete with colleagues in other hospitals—doctor against doctor, and, by extension, patient against patient. The hon. Member for Broxbourne (Mrs. Roe) said that the end of fundholding was a great loss. I must tell her that, for most of the time that the system operated, the vast majority of patients were disadvantaged by fundholding, because the patients of fundholders were jumping hospital queues. There was no pain measurement; the measurement related to whether the Government had created what they did create—a two-tier health service meaning that those who were not served by a fundholding general practice might have to wait until the following financial year before getting into the local hospital, regardless of their pain. The Conservatives still try to defend what I have always considered to be an indefensible situation, but we all know what really happened.

The staff did not like the two-tier health system, which forced them to keep new developments and better ways of treating patients secret so that hospitals would not undermine their competitive advantage over their neighbours. The Government want to ensure that we share the practice in the NHS. The National Institute for Clinical Excellence, and other organisations that are being set up, are about improving patient care. They are not about central diktats and telling clinicians what they should or should not do; they are about sharing the practice, so that all of us, as patients, get a better deal in the health service than we have in the past.

Another aspect of morale in the NHS—it was mentioned by my right hon. Friend the Secretary of State—concerns short-term contracts. If any one thing has lowered the morale of NHS personnel, since the early 1980s when the practice began in catering and cleaning, it is short-term contracts. NHS employees wanted to know that their jobs were there, and would be there for many years.

What was done was done in two ways. First, there was the internal market, which acted in very marked ways; secondly, there was the question of the funding of the NHS. It was much better for trusts to employ people on short-term contracts, which meant that staff did not know whether their wages would be lower in the following year than they had been in the preceding year. They did not know whether central Government were prepared to continue to fund them, and whether they could continue to provide staff with what most of us would consider to be reasonable pay and conditions and reasonable longevity in terms of employment.

Other things have created morale problems in the NHS over many years. A nursing recruitment crisis has been caused by years of training cuts and complacency, for instance. My right hon. Friend the Secretary of State mentioned the thousands that we have lost in the last five years in terms of nurse training. It will be difficult to turn the corner, but we have begun to do so.

Not once was my right hon. Friend challenged by Conservative Members on the reason for the present crisis in nursing. The hon. Member for Runnymede and Weybridge (Mr. Hammond) says that it is about the fact that nurses were given only a 4.7 per cent. pay increase this year, but that is bunkum, and the hon. Gentleman must know that it is bunkum—as would anyone who had talked to nurses about the fact that they have been batted from pillar to post, and have also had to deal with the additional work imposed on them by the internal market.

There is also the problem of overseeing the spread of gagging clauses in staff contracts, forbidding staff from telling the truth about what is going on. That, too, causes problems of morale in the NHS; that is another corner that we must turn.

The Opposition may be able to have a go at the Government on a number of counts, but I do not think that they can do so on the basis of the money that is coming into the NHS, or the way in which the Government are taking on the responsibility of getting rid of the morale problems that we inherited in May 1997. I know that the Opposition have to table motions such as this, but they should take advice now and again. This motion completely misses the mark, and some of its rhetoric will be seen by the NHS as being way off the mark.

The Government will take a long time to put right the wrongs that have demoralised the health service, but the first two years have been good years, during which they have begun to make progress. I am sure that, in years to come, there is much more to come from the Government in putting right the wrongs that they inherited.

9.15 pm

Mr. Graham Brady (Altrincham and Sale, West)

I shall try to keep my remarks brief because I have something to say and because I am aware that many of my hon. Friends wish to participate in the debate, as do Labour Members.

I want to talk about some of the reality of what is happening in the NHS—not the rosy view that we have heard from the Secretary of State for Health and from the hon. Member for Rother Valley (Mr. Barron), but some of the truth. I shall discuss some of the things that are affecting my constituents and that are coming to light as time goes on.

I refer not only to the fact that nurses in the Trafford Healthcare NHS trust did not receive their pay rise in April, as they had been promised. That is a matter of timing and perhaps is not that significant in overall terms. I am more concerned about what the implications of that are, what the reasoning behind it was and what it tells us about the true situation of the NHS under the Government's stewardship.

I want to talk in particular, because it is a useful example to illustrate the position, about Altrincham general hospital. On 10 May, Trafford Healthcare NHS trust announced to the press that two of the three wards would be closed in July. The announcement was made four days after local elections in the borough of Trafford, which were closely fought, and in which the Labour party held on to its majority by just three seats. The trust chairman is a Trafford Labour councillor, yet the announcement was made four days after the local elections.

The announcement was made without any consultation whatever with the public, or the community health council. It was made without any consultation even with the health authority. I find it impossible to believe that the decision was taken between Thursday 6 May, when the local elections took place, and Monday 10 May, when the announcement was made, so the inescapable conclusion is that the decision was made before the local elections, that it was suppressed and that no consultation could be undertaken because it was a politically sensitive issue.

The result of the decision was announced in a blatant fashion just four days after local elections, without anyone in the local community having been consulted, or even told about it. The arrogant treatment of the community that I represent and the disregard for a well-respected, well-loved institution in my constituency are staggering. It is a picture of the way in which the NHS is being run under the Government markedly different from that which Labour Members have described.

A few days ago, I asked the Department some questions. I have had confirmation that the regional executive knew something of the decision on 8 April—again, some confirmation of what is really going on in the borough of Trafford and in my constituency.

The devastating thing—the implications of which go far wider than Altrincham general hospital—is the reason that was given for the closure of the wards by the chief executive of Trafford Healthcare NHS trust to the chief officer of the community health council on Monday 10 May, when the decision was announced. He said that the trust was left with no choice because the Government had not funded the nurses' pay award, which had forced it to make savings by closing wards.

That is a different picture from that which the Secretary of State sought to give earlier. He sought to take credit for having given what he said was a generous pay award. It would have been generous if he had actually given it. In fact, he left the trust scratching around looking for ways to save money, to cut services and to remove wards. Reducing the wards from three to one has put the whole hospital under threat of closure. We have to ask how long it will be before that other ward is closed under the Government's stewardship. The whole reason for that is that the Government, who claim to be looking after the NHS and to be funding the nurses' pay award, are doing nothing of the sort. They are putting one figure in the press, and making sure that the vast majority of nurses are awarded a different figure, and not even on time. More scandalously, they are not providing the funds for it. That is resulting in the closure of wards, and it will result in the closure of many more across the country in the months and years to come. That is what Ministers must address.

Ministers will have to start giving some real answers to people who are seeing the NHS suffer under their stewardship. They cannot carry on giving out platitudes and press releases which bear no relation to the truth. My constituents have seen what the Government think of the NHS—they see it as a public relations opportunity and they care nothing about providing services for people. That is what the Government will have to address.

9.21 pm

Dr. Howard Stoate (Dartford)

Opposition Members have spent a great deal of time talking about money and pay within the NHS. Of course, money is extremely important—it is almost certainly the most important issue affecting NHS staff. That is why I am so surprised that they should table the motion, particularly as they have made clear their opposition to the national minimum wage, which will give a number of NHS workers a good deal.

The Conservatives also oppose the £21 billion extra that the Government have found for health—they called it reckless and irresponsible. Where do they think the money will come from to give nurses, doctors and others a decent pay settlement if not from our comprehensive spending review—which found the money in the first place, and which they opposed?

The hon. Member for Poole (Mr. Syms) referred to a document from the Manufacturing, Science and Finance Union which shows how the wages for professions allied to medicine have been eroded over the past fifteen years. How can he be surprised? The Tory Government took those groups out of the pay review body and allowed their pay to be eroded by 30 per cent. over the past 15 years. In other words, Tory policies led to the problems in the NHS that we are trying so hard to put right. It strikes me as odd that the Conservatives should talk to us about money when we are trying to put more money into the pockets of health workers, while they are clearly opposed to that.

During the 1980s, I was a junior doctor, and I was working for about £30 a week. For that, I[...]was working, on average, 104 hours per week. The money that I was receiving was not time and a third for overtime, but one third of normal time. I was paid a flat rate for my first 40 hours. After that, I was paid one third of my normal wage. I was on call for that many hours a week with that little pay.

The new deal for doctors has put that right to a large extent. Now, we see that just one in six doctors works more than 56 hours a week. However, it is not just about money or work. A third aspect, which Tory Members have clearly failed to take into account, is the amount of stress and anxiety experienced by junior doctors.

It is one thing to be working 104 hours a week and to be earning £30 a week. It is quite another to face the stress and strain of being on call alone at night with three, four or five wards to look after, plus emergencies coming from casualty as well as a coronary care unit and GPs on the phone wanting advice and help.

We certainly need more junior doctors in this country, and there is no way in which a responsible Government can put right the situation for junior doctors until we have trained more doctors. Until we put right the recruitment problem, we cannot reduce the hours. If we do not solve the problem, we would make the situation far more dangerous. The only way in which we can improve the lot of junior doctors is either to train more doctors—which we are doing—or to make the current doctors work even harder still to cover the gaps left by their colleagues who are taking a well-earned rest. Clearly, that would be an irresponsible move for any Government, which is why we have to phase in the reduction of junior doctors' hours over the next few years.

Dr. Harris

I was taken aback by what the hon. Gentleman said about junior doctors. Does he agree that producing more junior doctors to share the work load is, in itself, harmful if insufficient new consultant posts are created? Does he feel that the Government should bring back a central or regional manpower planning policy to ensure that there is consultant expansion, and that trusts do not wriggle away in pursuit of the bottom line?

Dr. Stoate

As a member of the Health Committee, the hon. Gentleman will know that we produced a report on staffing in the NHS. Of course it is important for the Government to take an overall view of work force planning, to ensure that the doctors of the future can help the health service, the trusts and the hospitals to provide a service that is so clearly needed.

For some extraordinary reason, we have been told tonight that GP recruitment has fallen off only since the introduction of primary care groups. That is simply not the case. GP recruitment came to an absolute standstill with the introduction of the new contract for GPs in 1990. I clearly remember many of my colleagues retiring early because they could not face the rigours of the new contract imposed on them against their collective will. It forced them to carry out procedures that they knew would be bureaucratic and largely fruitless in improving patient care. They had to go through the hoops simply to meet a series of Government targets designed to make the health service look better than it was.

A whole generation of young doctors was disillusioned and put off general practice, so when good practices wanted to recruit new staff they found it virtually impossible to do so. When I was training to be a GP, perhaps 50 or 60 candidates would apply for a good GP post, but that went down to four or five, some of whom were of such poor quality that they could not even be interviewed. That was clearly the fault of the previous Government, who imposed a regime on GPs that was unacceptable, unhealthy and clearly not in the patient's interests.

The two-tier system, about which we have already heard tonight, forced doctor against doctor and put patients in an impossible position. I could recount story after story of the difficulties that it caused for me when hospitals would ring up and ask if I had a contract to refer patients, because they could not take them if I did not. That was an intolerable situation for GPs.

Now we have primary care groups. It is extraordinary that Conservative Members should attack them as somehow divisive or difficult. To set at rest the mind of the hon. Member for Southwark, North and Bermondsey (Mr. Hughes), there is no compulsion for GPs to take part in primary care groups. They are members of the groups just as they were members of commissioning groups in the previous system, under which decisions were made on their behalf even if they never attended a meeting. The same applies to primary care groups: those who want to work with nurses, social workers and others can do so, but those who want to sit back and let the decisions be made for them are equally welcome to do that.

GPs' pay has been mentioned. For nine of the 11 years of Lady Thatcher's Administration, the pay review body's recommendation was either not paid in full or staged, whereas the new Labour Government have paid the GPs' pay award in full and exactly according to the body's recommendation.

Rev. Martin Smyth (Belfast, South)

There has been a tremendous emphasis on the medical and nursing staff. Does the hon. Gentleman accept that there is also a danger looming in the way in which we are treating laboratory technicians, who are vital in an age of high-tech medicine? To tell them that they could get jobs elsewhere is to forget that they want to work in the health service, where they are needed.

Dr. Stoate

I thank the hon. Gentleman for that contribution. I have already said that I think that the professions allied to medicine were treated shabbily under the previous Government. They deserve far more respect and a far better deal.

I want to share with the House a report that I released to the press this evening with the hon. Member for Isle of Wight (Dr. Brand), who co-chairs with me the all-party group on primary care and public health. We conducted an inquiry into the effectiveness or otherwise of the primary care groups. We invited outside groups to come and tell us what their experiences were, what they thought was happening in the primary care groups and what they wanted.

I am sure that the hon. Member for Isle of Wight will contradict me if he does not agree, but I noted that the majority of the people who came to our sessions, representing all aspects of medicine, as well as patient groups, were broadly in support of primary care groups. They thought that they were the way forward, being more democratic and accountable, allowing patients to have proper access to uniform quality of care throughout the country, ending postcode rationing and a two-tier system and bringing transparency, openness, honesty and decency. The vast majority of the groups who gave evidence to us were wholly behind that principle. Of course there are difficulties and problems in some areas, and not all GPs, all social workers or all nurses are happy, but the vast majority clearly accept the principle that that is the right way forward.

Obviously, as with any new system, there will be teething problems, and it will take some time for the primary care group to bed down and decide whether it wants to go for trust status or stay with PGC status.

Dr. Peter Brand (Isle of Wight)

Does the hon. Gentleman accept that the one thing that will destabilise primary care groups and trusts is the continued development of an alternative primary care system through NHS Direct and walk-in clinics, without reference to local health improvement programmes? Should not the Government be a partner in the health improvement programmes that primary care groups are supposed to deliver?

Dr. Stoate

The hon. Gentleman raises an important point about NHS Direct and drop-in centres. We shall have to see how those new institutions work in integrating health care. I hope that they will be able to integrate care with GP co-operatives and primary care groups to provide a seamless service. Clearly there are problems in the inner cities, especially with out-of-hours care, and NHS Direct has already proved its case as a worthy way of addressing some of those problems. Time will tell how it develops, and I am sure that the Government will closely monitor the pilot schemes and carefully evaluate the outcomes.

Another aspect that we have not touched upon is the Government's programme of building new hospitals. The first private finance initiative hospital is to be built in Dartford. It is currently well on schedule and is due to be completed early next year. It will not only improve patient services and make care for Dartford and Gravesham patients far better, but dramatically improve conditions for staff.

I used to work in the Joyce Green hospital and the West Hill hospital, both in Dartford, and both to be replaced by the new hospital. Both of them were seedy and rundown, built for a bygone age and entirely unsuited to modern medical care. They were inefficient, too, especially as the ward blocks were a long way apart.

I used to cycle round those ward blocks if there was an emergency in one of the wards. I cycled down the ward, jumped off my bike and put it by the nurses' station in the middle of the ward, and applied cardiac massage to a patient. That was not all that long ago—at least, I like to think that it was not long ago; other hon. Members may have a different view.

Those were rundown Victorian fever hospitals, built to look after TB patients. TB went away but the hospitals remained, and we are still living with that. Now, at long last, we are getting rid of that, and next year we shall move into a brand new state-of-the-art hospital.

Of course, the private finance initiative has had its problems and its critics. The Select Committee on Health is investigating the subject now. The next generation of PFI hospitals will be based on the experience of the current generation, and I dare say that the Government will think hard about altering some of the contracting and pricing arrangements to ensure that the country gets better value for money from the next generation.

We have taken a brave step. It took the Labour Government to take that step, and to change the law when we came into office so that PFI deals could go ahead, and the hospital that Dartford and Gravesham so sorely needed could be built, and will deliver the services on time for the people of Dartford.

The doctors and nurses to whom I speak are pleased with the new facilities where they will work. They are overjoyed by the fact that they will work in modern conditions that will enable them to give an excellent service to the patients of our area.

The Government have come up with many initiatives, and have found not only the money but the means to deliver good services, and also to improve staff conditions. I cannot think what the Opposition are whingeing about. We have a good Government, providing a good and improving national health service. The Secretary of State has said that he wants it to improve year on year.

Mr. Robert Key (Salisbury)

My constituents, too, are grateful for our splendid new hospital, but they know that their hospital was built under a Conservative Government. Does the hon. Gentleman suggest that his wonderful new hospital did not even see the drawing board until after the general election?

Dr. Stoate

Although the Conservative Government thought up the idea, it took a Labour Government to change the law to allow it to happen. That is the difference. The Conservatives can come up with the ideas, but it takes a caring Labour Government to deliver on those ideas and turn them into reality. I am proud to be the Member of Parliament for the constituency that will have the first PFI hospital in the land.

9.35 pm

Mr. David Amess (Southend, West)

I did not believe one word uttered by the hon. Member for Dartford (Dr. Stoate) and I did not recognise the health service described by the Secretary of State. The health service is in crisis. Morale has never been so low. I blame three people: the leader of the Labour party, the leader of the Liberal party and the Secretary of State for Health.

The leader of the Labour party gave an inept performance at the Dispatch Box today. He could have been Harry Enfield delivering the sermon of platitudes. Conservative Members are entitled to be angry. For 18 years, the Labour party tried every trick in the book to undermine the national health service. Labour Members built up people's expectations, saying that if they voted Labour on 1 May 1997, the new Government would save the national health service.

I have received grubby little letters that have been sent to Conservative party members exhorting them to give money to the Labour party. They say: In 1948, it was the Labour Party who created the NHS, giving the people of this country the care they deserved based on need, not their ability to pay. Now, in government again, we have found an extra £21 billion to begin to undo the damage content just to sit back and watch this once great service decline still further. … Do you want better hospitals with more beds and more nurses to care for the sick? That rubbish has been torn up and thrown in the bin by every Conservative activist. It is a disgrace. The Labour party is peddling a lie about the £21 billion.

The Liberals have about six useless pledges. I am sick of Liberals—

Dr. Harris

Liberal Democrats.

Mr. Amess

Okay. I am sick of the Liberal Democrats and their crocodile tears. They have made a grubby little deal to join up with the Scottish Labour party. They are sharing power in Scotland and in Southend. They also bear the blood of the national health service on their hands.

The Secretary of State is primarily responsible for the lowest morale in the NHS in my life time. The so-called health service reforms are a shambles. All my hon. Friends in the Standing Committee considering the Health Bill on Tuesdays and Thursdays can see that the Government are making a mess. They cannot deal with the amendments that we are ably tabling. They are not accepting any of our arguments. The General Practitioner has said that "Chaos" reigns on the eve of reforms. The Government do not accept that there is rationing or that they fiddle the waiting list when they should be addressing waiting times.

I have evidence of the chronic shortage of consultant radiologists. A letter from the clinical director of a local trust says: there will inevitably be some delay in the reporting of Radiological examinations over the next few months. There will also be delays with ultrasound scanning, in particular inpatient work. Everyone understands how serious that it.

This dreadful Government have misled the nurses, the doctors and everyone who works in the health service. I salute the women and men who work in Southend general hospital. They do a magnificent job in spite of this rotten Government, who have done everything that they can to undermine them. A few weeks ago I was walking round the hospital talking to a range of people employed there. Every one of them was dissatisfied with the Government. The Government led people to believe that voting Labour on 1 May 1997 would transform their lives and give them a better deal. In fact, hundreds, thousands, even millions of people have realised that the rotten Labour Government have broken promise after promise, letting the British people down when it comes to the health service.

9.40 pm

Mr. Philip Hammond (Runnymede and Weybridge)

We have heard some excellent speeches from the Conservative Benches and some complacent speeches from Labour. Our national health service is a vast organisation. The 1 million people who work in it are its very essence. The way they are treated and the state of their morale are crucial to the quality that the NHS can deliver. That is why we tabled our motion.

The sad fact is that, two years into a Labour Government, we have had two years of frustrated expectations, interference with clinical judgments, meddling from central Government and selective abuse by the Secretary of State. Morale in the health service is at an all-time low. The chairman of the British Medical Association's junior doctors committee has described relations between the medical profession and the Department of Health as being in a state of cold war. He went on to say that things are definitely getting worse.

It is a fundamental principle of good personnel management that one does not raise expectations that one cannot meet. Labour's spin doctors did a great job on NHS staff before the general election, promising the earth. The not-so-subliminal message was "Vote Labour, and all your problems will be solved." Two years on, the day of reckoning has arrived. When the movie comes to be made of the first two years of the Labour Government, the title will be "Mind the Gap". There is a gap between what they promised in Opposition and what they are delivering in office, between what they say they are doing and what is really happening in our health service and elsewhere.

Staff in the health service must live not only with their own disillusion. They are at the sharp end and have to deal with the general public from day to day, and they must live with the frustration and disillusion of their patients, people who heard the Government's rhetoric about huge and fictitious sums of money allegedly being pumped into the health service. Patients see the Secretary of State on television congratulating himself on his so-called achievements on waiting lists, and they struggle to reconcile that with the reality that they find—a struggling health service of endless delays, even for an out-patient consultation. Increasingly, they find explicit rationing of drugs and services.

My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) said that many people in the health service believed Labour's pre-election rhetoric. It is probably fair to say that the Government inherited a substantial fund of good will among NHS staff two years ago. That fund has been dissipated by the stresses placed on staff and the system by Labour's transparently political waiting list initiative, and by the persistent distortion of clinical priorities and interference with clinical judgments. Morale has been sapped by understaffing, reorganisation of the primary sector and the pressures of underfunding and winter crises.

General practitioners, the linchpin of our primary care-led system, have had to fight the Government tooth and nail to secure their place in the new primary care groups. They had to ensure that they were properly remunerated for the time that they put into setting up and managing the groups. They had to protect their infrastructure budgets and to safeguard their status as independent contractors. Morale among GPs has never been lower. The 50-odd per cent. who were fundholders find themselves forced to withdraw services that they had previously been able to offer to their patients. They can no longer offer their patients the freedom and choice that they had become used to. No wonder there is a continuing recruitment crisis in general practice.

In our hospitals, the situation is, if anything, worse. Junior doctors are incensed by what they see as the Government's treachery in seeking to renege on the new deal. Since its introduction by the previous Government in 1990, the new deal has seen a progressive reduction in junior doctors' working hours. In 1991, 58 per cent. of junior doctors were contracted to work more than 83 hours per week. By 1998, only 16 per cent. were contracted for more than 56 hours per week. That is not good enough, but it is a dramatic improvement.

The discovery that the Government were secretly attempting to persuade Brussels to extend for another 15 years the derogation for junior doctors and to increase to 65 the number of hours per week that they can be forced to work has outraged the junior doctors and sent morale plummeting. The BMA has condemned the Government's negotiations with the EU as a cynical attempt to renege on the New Deal". The BMA has expressed its outrage at the development and described it as "the height of hypocrisy." It has called the Government's actions a sign of the utmost bad faith which has led to "anger and disillusionment" among doctors.

No one believes the Secretary of State's explanation because no one whose intentions are genuine argues for a 65-hour week when the current week is 56.

Many junior hospital doctors already find themselves working inhumanely long hours for a master who appears intent on making them work longer hours still. Many people will have been outraged to learn that junior doctors are paid for their overtime work at 50 per cent. of their normal rate. That means that a junior doctor dealing with casualties and emergencies in the dead of night or at the weekend earns £4.02 per hour.

Dr. Brand

Will the hon. Gentleman give way?

Mr. Hammond

I will not give way because I do not have enough time. Those junior doctors cannot even be sure that their pathway to freedom is clear. The problems of manpower planning and the restrictions on consultants' posts means that many junior doctors face a bleak future in their chosen specialties. As my right hon. Friend the Member for Maidstone and The Weald said, hundreds of fully qualified obstetricians will be thrown on the scrap heap in the next few years because they have been trained for a specialty for which no consultant vacancies exist, even though the need for such consultants clearly does.

If junior doctors succeed in achieving a consultant's post, what lies in store for them? More problems, I am afraid, Mr. Deputy Speaker. Partly as a result of the improvement in junior doctors' hours under the previous Government, consultants now bear an ever greater workload. The Government have added the whole clinical governance agenda and its duty of quality to that load while simultaneously casting aspersions on the commitment of consultants to the NHS. The consultants are outraged. The chairman of the consultants committee said of industrial action: Twelve months ago, I would have been surprised to find 80 per cent. of my colleagues supporting. I've noticed an attitude change in the last few months. … The profession are saying we've struggled to hold this service together for so long for little recognition. It can't go on. The chairman of the junior doctors committee added: Doctors, both seniors and juniors, are fed up with being taken for granted by the Department of Health".

The BMA chairman says: We can't go on like this.… We have junior doctors becoming burnt out and disillusioned with medicine. Consultants are seeking to retire ever earlier as they find the burdens of on-call working unsustainable into their 60s. A crisis is looming. Junior doctors cannot see their career path before them as a result of inadequate planning and insufficient consultant posts. Consultants can no longer work at the intensity at which they are being asked to work, and the Government sit on their hands and do nothing. We have argued and the professions have argued that the Health Bill currently in Committee should include provisions for some form of manpower co-ordination so that these issues are addressed and doctors across the hospital service, both junior and senior, can see a way out of the current mess.

The BMA says in its briefing for the debate that the reality is lengthening hours of work for many doctors and/or increased intensity of work for others. This in turn contributes to a progressive decline in morale and motivation which itself militates against the productivity gains necessary to meet demand for medical services. In short, there is a vicious circle. But our health service does not run on doctors alone. Nurses and the professions allied to medicine make up the majority of the qualified staff.

In opposition, the Labour party courted the nurses without shame. I do not have time to recount the history of how Labour has dumped the nurses since they came into office, but I repeat what the Royal College of Nursing said after the famous pay settlement for the nurses earlier this year. It was good news for nurses starting out in their careers—one nurse in 15. The RCN said of the award for the other 14 out of 15: It will not solve the chronic staff shortage.

In opposition, Labour cynically exploited the concerns of the health professions. It raised the stakes. In office, the Labour Government have shamelessly abandoned them and they must now reap the harvest of frustrated expectations, low morale, faltering recruitment and a haemorrhaging of experienced staff from the service.

The Government will be judged by NHS staff, not on what they say, still less on what they said, but on the gap between the vision of the health service that they carefully painted in Opposition and the reality that they are now delivering. The Government cannot look backwards for ever. They are in charge now and they must address the looming crisis in NHS staffing. They must face the responsibility that they bear for first raising and then dashing expectations throughout the NHS, the consequent rock-bottom state of morale and the recruitment and retention problems that flow from it.

9.50 pm

The Minister of State, Department of Health (Mr. John Denham)

First, I congratulate the hon. Member for Runnymede and Weybridge (Mr. Hammond) on being given the responsibility of replying to the debate. I had heard that we might hear from the Trappist hon. Member for Rutland and Melton (Mr. Duncan), who is clearly still maintaining his vow of silence, which he has enjoyed for some time.

There have been some interesting contributions to the debate. Among other things, the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) asked about staff shortages. He will know that my right hon. Friend the Secretary of State told the Select Committee that we would be carrying out an authoritative survey of staff shortages, and that is now under way. We will be reporting in due course.

My hon. Friend the Member for Feltham and Heston (Mr. Keen) spoke about the human cost under the previous Government of disregarding the commitment of people who work hard to provide our national health service. The hon. Member for Broxbourne (Mrs. Roe), in a speech which I think even she would recognise as faintly absurd, conjured an extraordinary picture of the Government's primary care reforms. Among many other things that I would like to put out, it is important to stress that there is no threat to independent contractor status from our proposals.

My hon. Friend the Member for Rother Valley (Mr. Barron) set things straight on the Government record on nurses' pay and reminded us of the damage done by the previous Government with the introduction of the internal market, the two-tier system that that imposed on patients and the effect of short-term contracts on staff.

The hon. Member for Altrincham and Sale, West (Mr. Brady) spoke of local issues but underlined that he was talking about resources in the NHS. He, as did other Opposition Members, failed to explain how complaints about resources can be matched with their condemnation of our investment in the NHS as reckless and irresponsible. One wonders how they would be doing without it.

My hon. Friend the Member for Dartford (Dr. Stoate) spoke of the need to train more doctors and rightly stressed that we are increasing the number of training places for doctors. He also spoke rightly and far more accurately than others of the strength of support throughout the country for our primary care reforms and the commitment to working through those in place. I would not normally do this—

Mr. Amess

Will the Minister give way?

Mr. Denham

No, I will not.

The hon. Member for Isle of Wight (Dr. Brand), in an intervention, made a point about access centres. I take the opportunity of stressing that we want to see these centres develop with the support of primary care groups. We recognise the importance of the issue that the hon. Gentleman raised.

The hon. Member for Southend, West (Mr. Amess) shouts at me, as he did every Tuesday and Thursday over the past three weeks during consideration of the Health Bill in Committee. He talked about shortages of consultant radiologists. I would point out that it takes 15 years to train such a consultant. That brings me to a rather central point—

Mr. Amess

Will the Minister give way?

Mr. Denham

No. There is very limited time.

Mr. Deputy Speaker (Mr. Michael J. Martin)

Order. The Minister is not going to give way.

Mr. Denham

I wish to mention all the speakers in the debate, as is courteous. However, I need, too, to answer some of the points that have been made.

If the Opposition's charge in their motion had been that we had not yet solved all the problems that we inherited from the Conservative Government, we would have had to say, "Yes, that is true."

The Opposition's problem tonight is that they have tried to make the case that everything was fine until the last general election, and since then it has gone badly wrong. That claim has no credibility in the House, in the country or, most importantly, among the NHS staff whom we are discussing. There is no more important group of people for the House to discuss.

Although I do not agree with the Opposition motion, I am happy that we are debating the topic. Those million people who change lives and save lives every day in every part of our country are of tremendous importance. There is not a single hon. Member whose family and constituents do not have reason to be grateful to them.

Mr. Brady

rose—

Mr. Amess

Will the Minister give way?

Mr. Denham

It is important that those who work in our national health service should be fairly rewarded, that their careers should develop, and that the NHS should make the best use of their skills and commitment.

Let me deal with the Opposition motion. First, on junior doctors' hours, the motion is wrong. The Opposition know that it is wrong, and they know that no amount of repeating something that is wrong will make it right.

Miss Widdecombe

Will the Minister give way?

Mr. Denham

We have no intention of increasing the hours of work of a single junior doctor in the United Kingdom. We are committed to implementing the new deal.

Miss Widdecombe

Will the Minister give way?

Mr. Denham

We want to cut the hours of the 15 per cent. of junior doctors working more than an average of 56 hours per week. [HON. MEMBERS: "Give way."] We are working to make sure that the conditions, the catering and the accommodation when they are on call are improved. We want to make sensible, practical progress to implement the working time directive—the very directive that the Conservatives opposed absolutely in principle. Like other countries, we need to be able to make it work without causing patients to suffer.

Miss Widdecombe

rose—

Mr. Denham

The Opposition complain about nurses' pay. It is quite true that some did not receive the increase in their April pay packets. I regret that, although the notification to employers was the earliest for several years. We shall have to look into the matter and take into account in future years that an offer that was made on 10 February was not accepted until mid-March, and further work was still necessary.

The increase will paid. I am not surprised that that was the worst that the Opposition could find to say in their motion about our treatment of nurses—nurses who this year have had the biggest real-terms increase for 10 years, paid nationally, in full, and not staged.

Miss Widdecombe

Will the Minister give way?

Mr. Denham

There will be extra action to recognise the need to retain and recruit new nurses. All nurses will get at least 4.7 per cent. more; 70,000 nurses will get 8.2 per cent. more; two thirds of nurses will earn more than £20,000 this year. More than £50 million is to be invested to improve the training and recruitment of nurses.

More than 50,000 people responded to the advertising campaign by telephone, and more than 650 qualified nurses are already back at work on the wards in our hospitals. Not only the nurses have benefited—the professions allied to medicine have had the biggest real-terms increase in 10 years.

Miss Widdecombe

Will the Minister give way?

Mr. Denham

We have made it clear to the consultants that as we discuss with them changes to the consultants' contract, we can consider the need to invest in changes that bring benefit to the NHS. All that is real progress, but it is not enough. For years under the previous Government, the NHS—

Sir Peter Emery (East Devon)

On a point of order, Mr. Deputy Speaker. I beg to move, That the Question be now put—we do not want to listen to that.

Mr. Deputy Speaker

Order. I call the Minister.

Mr. Denham

For years under the previous Government, the NHS was run as though people did not matter. The previous Government botched pay reform, so we have a mess of myriad jobs and grades over local and national contracts. They did not take effective action to protect staff from violence, racism or avoidable accidents at work.

9.59 pm

Mr. James Arbuthnot (North-East Hampshire)

rose in his place and claimed to move, That the Question be now put.

Question, That the Question be now put, put and agreed to.

Question put accordingly, That the original words stand part of the Question:—

The House divided: Ayes 167, Noes 339.

Division No. 186]	[10.2 pm
AYES
Ainsworth, Peter ((E Surrey)	Gorman, Mrs Teresa
Amess, David	Gray, James
Ancram, Rt Hon Michael	Green, Damian
Arbuthnot, Rt Hon James	Greenway, John
Ashdown, Rt Hon Paddy	Grieve, Dominic
Atkinson, Peter (Hexham)	Gummer, Rt Hon John
Baker, Norman	Hamilton, Rt Hon Sir Archie
Ballard, Jackie	Hammond, Philip
Beith, Rt Hon A J	Harris, Dr Evan
Bercow, John	Harvey, Nick
Beresford, Sir Paul	Hawkins, Nick
Body, Sir Richard	Heald, Oliver
Boswell, Tim	Heath, David (Somerton & Frome)
Bottomley, Peter (Worthing W)	Heathcoat—Amory, Rt Hon David
Bottomley, Rt Hon Mrs Virginia	Hogg, Rt Hon Douglas
Brady, Graham	Horam, John
Brand, Dr Peter	Howarth, Gerald (Aldershot)
Brazier, Julian	Hughes, Simon (Southwark N)
Breed, Colin	Hunter, Andrew
Brooke, Rt Hon Peter	Jack, Rt Hon Michael
Browning, Mrs Angela	Jackson, Robert (Wantage)
Burns, Simon	Jenkin, Bernard
Campbell, Rt Hon Menzies	Jones, Nigel (Cheltenham)
(NE Fife)	Keetch, Paul
Cash, William	Key, Robert
Chapman, Sir Sydney	King, Rt Hon Tom (Bridgwater)
(Chipping Barnet)	Kirkbride, Miss Julie
Chidgey, David	Laing, Mrs Eleanor
Chope, Christopher	Lait, Mrs Jacqui
Clappison, James	Lansley, Andrew
Clark, Rt Hon Alan (Kensington)	Leigh, Edward
Clark, Dr Michael (Rayleigh)	Letwin, Oliver
Clifton—Brown, Geoffrey	Lewis, Dr Julian (New Forest E)
Collins, Tim	Lidington, David
Colvin, Michael	Lilley, Rt Hon Peter
Cormack, Sir Patrick	Livsey, Richard
Cotter, Brian	Lloyd, Rt Hon Sir Peter (Fareham)
Cran, James	Llwyd, Elfyn
Davies, Quentin (Grantham)	MacGregor, Rt Hon John
Davis, Rt Hon David (Haltemprice	McIntosh, Miss Anne
& Howden)	Mackay, Rt Hon Andrew
Day, Stephen	Maclean, Rt Hon David
Dorrell, Rt Hon Stephen	McLoughlin, Patrick
Duncan, Alan	Malins, Humfrey
Duncan Smith, Iain	Maples, John
Emery, Rt Hon Sir Peter	Mates, Michael
Evans, Nigel	Maude, Rt Hon Francis
Faber, David	Mawhinney, Rt Hon Sir Brian
Fabricant, Michael	May, Mrs Theresa
Fallon, Michael	Michie, Mrs Ray (Argyll & Bute)
Fearn, Ronnie	Moss, Malcolm
Flight, Howard	Nicholls, Patrick
Forth, Rt Hon Eric	Norman, Archie
Foster, Don (Bath)	Oaten, Mark
Fox, Dr Liam	Öpik, Lembit
Gale, Roger	Ottaway, Richard
Garnier, Edward	Page, Richard
Gibb, Nick	Paice, James
Gill, Christopher	Paterson, Owen
Gillan, Mrs Cheryl	Pickles, Eric

Prior, David	Taylor, Sir Teddy
Redwood, Rt Hon John	Tonge, Dr Jenny
Rendel, David	Townend, John
Robathan, Andrew	Tredinnick, David
Robertson, Laurence (Tewk'b'ry)	Trend, Michael
Roe, Mrs Marion (Broxbourne)	Tyler, Paul
Rowe, Andrew (Faversham)	Tyrie, Andrew
Ruffley, David	Viggers, Peter
Russell, Bob (Colchester)	Walter, Robert
St Aubyn, Nick	Wardle, Charles
Sanders, Adrian	Waterson, Nigel
Sayeed, Jonathan	Webb, Steve
Shepherd, Richard	Wells, Bowen
Simpson, Keith (Mid-Norfolk)	Whitney, Sir Raymond
Smith, Sir Robert (W Ab'd'ns)	Whittingdale, John
Smyth, Rev Martin (Belfast S)	Widdecombe, Rt Hon Miss Ann
Soames, Nicholas	Wilkinson, John
Spicer, Sir Michael	Willetts, David
Spring, Richard	Willis, Phil
Stanley, Rt Hon Sir John	Wilshire, David
Stunell, Andrew	Woodward, Shaun
Swayne, Desmond	Yeo, Tim
Syms, Robert	Young, Rt Hon Sir George
Tapsell, Sir Peter
Taylor, Ian (Esher & Walton)	Tellers for the Ayes:
Taylor, Rt Hon John D (Strangford)	Mrs. Caroline Spelman and
Taylor, John M (Solihull)	Sir David Madel.
NOES
Abbott, Ms Diane	Cann, Jamie
Adams, Mrs Irene (Paisley N)	Casale, Roger
Ainger, Nick	Caton, Martin
Alexander, Douglas	Cawsay, Ian
Allen, Graham	Chapman, Ben (Wirral S)
Armstrong, Rt Hon Ms Hilary	Chaytor, David
Ashton, Joe	Clapham, Michael
Atherton, Ms Candy	Clark, Rt Hon Dr David (S Shields)
Atkins, Charlotte	Clarke, Charles (Norwich S)
Banks, Tony	Clarke, Eric (Midlothian)
Barnes, Harry	Clarke, Rt Hon Tom (Coatbridge)
Barron, Kevin	Clarke, Tony (Northampton S)
Battle, John	Clelland, David
Bayley, Hugh	Clwyd, Ann
Beard, Nigel	Coaker, Vernon
Beckett, Rt Hon Mrs Margaret	Coffey, Ms Ann
Begg, Miss Anne	Coleman, Iain
Bell, Stuart (Middlesbrough)	Colman, Tony
Benn, Rt Hon Tony	Connarty, Michael
Bennett, Andrew F	Cook, Frank (Stockton N)
Benton, Joe	Corbett, Robin
Bermingham, Gerald	Corbyn, Jeremy
Berry, Roger	Corston, Ms Jean
Best, Harold	Cousins, Jim
Betts, Clive	Cox, Tom
Blackman, Liz	Cranston, Ross
Blears, Ms Hazel	Cryer, Mrs Ann (Keighley)
Blizzard, Bob	Cryer, John (Hornchurch)
Blunkett, Rt Hon David	Cummings, John
Boateng, Paul	Cunningham, Rt Hon Dr Jack
Borrow, David	(Copeland)
Bradley, Keith (Withington)	Cunningham, Jim (Cov'try S)
Bradley, Peter (The Wrekin)	Curtis—Thomas, Mrs Claire
Brinton, Mrs Helen	Darling, Rt Hon Alistair
Brown, Rt Hon Nick (Newcastle E)	Davey, Valerie (Bristol W)
Brown, Russell (Dumfries)	Davidson, Ian
Browne, Desmond	Daives, Rt Hon Denzil (Llanelli)
Buck, Ms Karen	Davies, Geraint (Croydon C)
Burden, Richard	Dawson, Hilton
Burgon, Colin	Dean, Mrs Janet
Butler, Mrs Christine	Denham, John
Byers, Rt Hon Stephen	Dobson, Rt Hon Frank
Caborn, Rt Hon Richard	Donohoe, Briah H
Campbell, Alan (Tynemouth)	Dowd, Jim
Campbell, Mrs Anne (C'bridge)	Drew, David
Campbell, Ronnie (Blyth V)	Drown, Ms Julia
Campbell—Savours, Dale	Dunwoody, Mrs Gwyneth

Eagle, Angela (Wallasey)	Kemp, Fraser
Eagle, Maria (L'pool Garston)	Kennedy, Jane (Wavertree)
Edwards, Huw	Khabra, Piara S
Ellman, Mrs Louise	Kidney, David
Ennis, Jeff	Kilfoyle, Peter
Field, Rt Hon Frank	King, Andy (Rugby & Kenilworth)
Fisher, Mark	King, Ms Oona (Bethnal Green)
Fitzpatrick, Jim	Kingham, Ms Tess
Flynn, Paul	Kumar, Dr Stephen
Foster, Michael Jabez (Hastings)	Ladyman, Dr Stephen
Foster, Michael J (Worcester)	Lawrence, Ms Jackie
Foulkes, George	Leslie, Christopher
Fyfe, Maria	Levitt, Tom
Gapes, Mike	Lewis, Terry (Worsley)
Gardiner, Barry	Liddell, Rt Hon Mrs Helen
George, Bruce (Walsall S)	Linton, Martin
Gerrard, Neil	Livingstone, Ken
Gibson, Dr Ian	Lloyd, Tony (Manchester C)
Gilroy, Mrs Linda	Lock, David
Godman, Dr Norman A	Love, Andrew
Godsiff, Roger	McAvoy, Thomas
Gordon, Mrs Eileen	McCabe, Steve
Griffiths, Jane (Reading E)	MaCafferty, Ms Chris
Griffiths, Win (Bridgend)	McCartney, Rt Hon Ian
Grocott, Bruce	(Makerfield)
Grogan, John	Macdonald, Calum
Gunnell, John	McDonnell, John
Hain, Peter	McGuire, Mrs Anne
Hall, Mike (Weaver Vale)	McIsaac, Shona
Hall, Patrick (Bedford)	McKenna, Mrs Rosemary
Hamilton, Fabian (Leeds NE)	Mackinlay, Thomas
Harman, Rt Hon Ms Harriet	McNulty, Tony
Heal, Mrs Sylvia	MacShane, Denis
Healey, John	Mactaggart, Fiona
Henderson, Ivan (Harwich)	McWalter, Tony
Hepburn, Stephen	McWilliam, John
Heppell, John	Mahon, Mrs Alice
Hewitt, Ms Patricia	Mallaber, Judy
Hill, Keith	Mandelson, Rt Hon Peter
Hinchliffe, David	Marsden, Gordon (Blackpool S)
Hoey, Kate	Marsden, Paul (Shrewsbury)
Hood, Jimmy	Marshall, David (Shettleston)
Hoon, Geoffrey	Marshall, Jim (Leicester S)
Hope, Phil	Martlew, Eric
Hopkins, Kelvin	Meacher, Rt Hon Michael
Howarth, George (Knowsley N)	Meale, Alan
Howells, Dr Kim	Merron, Gillian
Hoyle, Lindsay	Michie, Bill (Shef'ld Heeley)
Hughes, Ms Beverley (Stretford)	Milburn Rt Hon Alan
Hughes, Kevin (Doncaster N)	Miller, Andrew
Humble, Mrs Joan	Moffatt, Laura
Hurst, Alan	Moonie, Dr Lewis
Hutton, John	Moran, Ms Margaret
Iddon, Dr Brian	Morgan, Ms Julie (Cardiff N)
Illsley, Eric	Morgan, Rhodri (Cardiff W)
Ingram, Rt Hon Adam	Morley, Elliot
Jackson, Ms Glenda (Hampstead)	Morris, Ms Estelle, (B'ham Yardley)
Jackson, Helen (Hillsborough)	Mountford, Kali
Jamieson, David	Mullin, Chris
Jenkins, Brian	Murphy, Denis (Wansbeck)
Johnson, Alan (Hull W & Hessle)	Murphy, Jim (Eastwood)
Johnson, Miss Melanie	Murphy, Rt Hon Paul (Torfaen)
(Welwyn Hatfield)	Naysmith, Dr Doug
Jones, Barry (Alyn & Deeside)	Norris, Dan
Jones, Mrs Fiona (Newark)	O'Brien, Bill (Normanton)
Jones, Ms Jenny	O'Brien, Mike (N Warks)
(Wolverh'ton SW)	O'Hara, Eddie
Jones, Jon Owen (Cardiff C)	Olner, Bill
Jones, Dr Lynne (Selly Oak)	O'Neill, Martin
Jones, Martyn (Clwyd S)	Organ, Mrs Diana
Jowell, Rt Hon Ms Tessa	Osborne, Ms Sandra
Kaufman, Rt Hon Gerald	Palmer, Dr Nick
Keeble, Ms Sally	Pearson, Ian
Keen, Alan (Feltham & Heston)	Pendry, Tom
Keen, Ann (Brentford & Isleworth)	Perham, Ms Linda
Kelly, Ms Ruth	Pickthall, Colin

Pike, Peter L	Steinberg, Gerry
Plaskitt, James	Stevenson, George
Pollard, Kerry	Stewart, David (Inverness E)
Pond, Chris	Stewart, Ian (Eccles)
Pope, Greg	Stinchcombe, Paul
Pound, Stephen	Stoate, Dr Howard
Powell, Sir Raymond	Stott, Roger
Prentice, Ms Bridget (Lewisham E)	Strang, Rt Hon Dr Gavin
Prentice, Gordon (Pendle)	Straw, Rt Hon Jack
Prescott, Rt Hon John	Stringer, Graham
Primarolo, Dawn	Stuart, Ms Gisels
Prosser, Gwyn	Sutcliffe, Gerry
Quin, Rt Hon Ms Joyce	Taylor, Rt Hon Mrs Ann
Quinn, Lawrie	(Dewsbury)
Radice, Giles	Taylor, Ms Dari (Stockton S)
Rammell, Bill	Taylor, David (NW Leics)
Rapson, Syd	Temple—Morris, Peter
Raynsford, Nick	Thomas, Gareth (Clwyd W)
Reed, Andrew (Loughborough)	Thomas, Gareth R (Harrow W)
Reid, Rt Hon Dr John (Hamilton N)	Timms, Stephen
Robinson, Geoffrey (Cov'try NW)	Tipping, Paddy
Roche, Mrs Barbara	Todd, Mark
Rooker, Jeff	Touhig, Don
Ross, Ernie (Dundee W)	Trickett, Jon
Rowlands, Ted	Turner, Dr Desmond (Kemptown)
Roy, Frank	Turner, Dr George (NW Norfolk)
Ruane, Chris	Twigg, Derek (Halton)
Ruddock, Joan	Twigg, Stephen (Enfield)
Russell, Ms Christine (Chester)	Vaz, Keith
Salter, Martin	Walley, Ms Joan
Sarwar, Mohammad	Ward, Ms Claire
Savidge, Malcolm	Wareing, Robert N
Sedgemore, Brian	Watts, David
Shaw, Jonathan	Whitehead, Dr Alan
Sheerman, Barry	Wicks, Malcolm
Sheldon, Rt Hon Robert	William, Rt Hon Alan
Simpson, Alan (Nottingham S)	(Swansea W)
Singh, Marsha	Williams, Alan W (E Carmarthen)
Skinner, Dennis	Williams, Mrs Betty (Conwy)
Smith, Rt Hon Andrew (Oxford E)	Wilson, Brian
Smith, Angela (Basildon)	Winnick, David
Smith, Rt Hon Chris (Islington S)	Winterton, Ms Rosie (Doncaster C)
Smith, Miss Geraldine	Wise, Audrey
(Morecambe & Lunesdale)	Wood, Mike
Smith, Jacqui (Redditch)	Worthington, Tony
Smith, John (Glamorgan)	Wright, Anthony D (Gt Yarmouth)
Smith, Llew (Blaenau Gwent)	Wright, Dr Tony (Cannock)
Soley, Clive	Wyatt, Derek
Southworth, Ms Helen
Spellar, John	Tellers for the Noes:
Squire, Ms Rachel	Mr. Robert Ainsworth and
Starkey, Dr Phyllis	Mr. David Hanson.

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments):—

The House divided: Ayes 338, Noes 163.

Division No. 187]	[10.16 pm
AYES
Abbott, Ms Diane	Battle, John
Adams, Mrs Irene (Paisley N)	Bayley, Hugh
Ainger, Nick	Beard, Nigel
Alexander, Douglas	Beckett, Rt Hon Mrs Margaret
Allen, Graham	Begg, Miss Anne
Armstrong, Rt Hon Ms Hilary	Bell, Stuart (Middlesbrough)
Ashton, Joe	Benn, Rt Hon Tony
Atherton, Ms Candy	Bennett, Andrew F
Atkins, Charlotte	Benton, Joe
Banks, Tony	Bermingham, Gerald
Barnes, Harry	Berry, Roger
Barron, Kevin	Best, Harold

Betts, Clive	Field, Rt Hon Frank
Blackman, Liz	Fisher, Mark
Blears, Ms Hazel	Fitzpatrick, Jim
Blizzard, Bob	Flynn, Paul
Blunkett, Rt Hon David	Foster, Michael Jabez (Hastings)
Boateng, Paul	Foster, Michael J(Worcester)
Borrow, David	Foulkes, George
Bradley, Keith (Withington)	Fyfe, Maria
Bradley, Peter (The Wrekin)	Gapes, Mike
Brinton, Mrs Helen	Gardiner, Barry
Brown, Rt Hon Nick (Newcastle E)	George, Bruce (Walsall S)
Brown, Russell (Dumfries)	Gerrard, Neil
Browne, Desmond	Gibson, Dr Ian
Buck, Ms Karen	Gilroy, Mrs Linda
Burden, Richard	Godman, Dr Norman A
Burgon, Colin	Godsiff, Roger
Butler, Mrs Christine	Gordon, Mrs Eileen
Byers, Rt Hon Stephen	Griffiths, Jane (Reading E)
Caborn, Rt Hon Richard	Griffiths, Win (Bridgend)
Campbell, Alan (Tynemouth)	Grocott, Bruce
Campbell, Mrs Anne (C'bridge)	Grogan, John
Campbell, Rt Hon Menzies	Gunnell, John
(NE Fife)	Hain, Peter
Campbell, Ronnie (Blyth V)	Hall, Mike (Weaver Vale)
Cann, Jamie	Hall, Partick (Bedford)
Casale, Roger	Hamilton, Fabian (Leeds NE)
Caton, Martin	Harman, Rt Hon Ms Harriet
Cawsey, Ian	Heal, Mrs Sylvia
Chapman, Ben (Wirral S)	Healey, John
Chaytor, David	Henderson, Ivan (Harwich)
Clapham, Michael	Hepburn, Stephen
Clark, Rt Hon Dr David (S Shields)	Heppell, John
Clarke, Charles (Norwich S)	Hewitt, Ms Patricia
Clarke, Eric (Midlothian)	Hill, Keith
Clarke, Rt Hon Tom (Coatbridge)	Hinchliffe, David
Clarke, Tony (Northampton S)	Hoey, Kate
Clelland, David	Hood, Jimmy
Clwyd, Ann	Hoon, Geoffrey
Coaker, Vernon	Hope, Phil
Coffey, Ms Ann	Hopkins, Kelvin
Coleman, Iain	Howarth, George (Knowsley N)
Colman, Tony	Howells, Dr Kim
Connarty, Michael	Hoyle, Lindsay
Cook, Frank (Stockton N)	Hughes, Ms Beverley (Stretford)
Corbett, Robin	Hughes, Kevin (Doncaster N)
Corbyn, Jeremy	Humble, Mrs Joan
Corston, Ms Jean	Hurst, Alan
Cousins, Jim	Hutton, John
Cox, Tom	Iddon, Dr Brian
Cranston, Ross	Illsley, Eric
Cryer, Mrs Ann (Keighley)	Ingram, Rt Hon Adam
Cryer, John (Hornchurch)	Jackson, Ms Glenda (Hampstead)
Cummings, John	Jackson, Helen (Hillsborough)
Cunningham, Rt Hon Dr Jack	Jamieson, David
(Copeland)	Jenkins, Brian
Cunningham, Jim (Cov'try S)	Johnson, Alan (Hull W & Hessle)
Curtis—Thomas, Mrs Claire	Johnson, Miss Melanie
Darling, Rt Hon Alistair	(Welwyn Hatfield)
Davey, Valerie (Bristol W)	Jones, Barry (Alyn & Deeside)
Davidson, Ian	Jones, Mrs Fiona (Newark)
Davies, Rt Hon Denzil (Llanelli)	Jones, Ms Jenny
Davies, Geraint (Croydon C)	(Wolverh'ton SW)
Dawson, Hilton	Jones, Jon Owen (Cardiff C)
Dean, Mrs Janet	Jones, Dr Lynne (Selly Oak)
Denham, John	Jones, Martyn (Clwyd S)
Dobson, Rt Hon Frank	Jowell, Rt Hon Ms Tessa
Donohoe, Brian H	Kaufman, Rt Hon Gerald
Dowd, Jim	Keeble, Ms Sally
Drew, David	Keen, Alan (Feltham & Heston)
Drown, Ms Julia	Keen, Ann (Brentford & Isleworth)
Dunwoody, Mrs Gwyneth	Kelly, Ms Ruth
Eagle, Angela (Wallasey)	Kemp, Fraser
Eagle, Maria (L'pool Garston)	Kennedy, Jane (Wavertree)
Edwards, Huw	Khabra, Piara S
Ellman, Mrs Louise	Kidney, David
Ennis, Jeff	Kilfoyle, Peter

King, Andy (Rugby & Kenilworth)	Pound, Stephen
King, Ms Oona (Bethnal Green)	Powell, Sir Raymond
Kingham, Ms Tess	Prentice, Ms Bridget (Lewisham E)
Kumar, Dr Ashok	Prentice, Gordon (Pendle)
Ladyman, Dr Stephen	Prescott, Rt Hon John
Lawrence, Ms Jackie	Primarolo, Dawn
Leslie, Christopher	Prosser, Gwyn
Levitt, Tom	Quin, Rt Hon Ms Joyce
Lewis, Terry (Worsley)	Quin, Lawrie
Liddell, Rt Hon Mrs Helen	Radice, Giles
Linton, Martin	Rammell, Bill
Livingstone, Ken	Rapson, Syd
Lloyd, Tony (Manchester C)	Raynsford, Nick
Lock, David	Reed, Andrew (Loughborough)
Love, Andrew	Reid, Rt Hon Dr John (Hamilton N
McAvoy, Thomas	Robinson, Geoffrey (Cov'try NW)
McCabe, Steve	Roche, Mrs Barbara
McCafferty, Ms Chris	Rooker, Jeff
McCartney, Rt Hon Ian	Ross, Ernie (Dundee W)
(Makerfield)	Rowlands, Ted
Macdonald, Calum	Roy, Frank
McDonnell, John	Ruane, Chris
McGuire, Mrs Anne	Ruddock, Joan
McIsaac, Shona	Russell, Ms Christine (Chester)
McKenna, Mrs Rosemary	Salter, Martin
Mackinlay, Andrew	Sarwar, Mohammad
McNulty, Tony	Savidge, Malcolm
MacShane, Denis	Sedgemore, Brian
Mactaggart, Fiona	Shaw, Jonarthan
McWalter, Tony	Sheerman, Bary
McWilliam, John	Sheldon, Rt Hon Robert
Mahon, Mrs Alice	Simpson, Alan Nottingham S)
Mallaber, Judy	Singh, Marsha
Mandelson, Rt Hon Peter	Skinner, Dennis
Marsden, Gordon (Blackpool S)	Smith, Rt Hon Andrew (Oxford E)
Marsden, Paul (Shrewsbury)	Smith, Angela (Basildon)
Marshall, David (Shettleston)	Smith, Rt Hon Chris (Islington S)
Marshall, Jim (Leicester S)	Smith, Miss Geraldine
Martlew, Eric	(Morecambe & Lunesdale)
Meacher, Rt Hon Michael	Smith, Jacqui (Redditch)
Meale, Alan	Smith, John Glamorgan)
Merron, Gillian	Smith, Llew (Blaenau Gwent)
Michie, Bill (Shef'ld Heeley)	Soley, Clive
Milburn, Rt Hon Alan	Southworth, Ms Helen
Miller, Andrew	Spellar, John
Moffatt, Laura	Squire, Ms Rachel
Moonie, Dr Lewis	Starkey, Dr Phyllis
Moran, Ms Margaret	Steinberg, Gerry
Morgan, Ms Julie (Cardiff N)	Stvenson, George
Morgan, Rhodri (Cardiff W)	Stewart, David (Inverness E)
Morley, Elliot	Stewart, Ian (Eccles)
Morris, Ms Estelle (B'ham Yardley)	Stinchcombe, Paul
Mountford, Kali	Stoate, Dr Howard
Mullin, Chris	Stott, Roger
Murphy, Denis (Wansbeck)	Strang, Rt Hon Dr Gavin
Murphy, Jim (Eastwood)	Straw, Rt Hon Jack
Murphy, Rt Hon Paul (Torfaen)	Stringer, Graham
Naysmith, Dr Doug	Stuart, Ms Gisela
Norris, Dan	Sutcliffe, Gerry
O'Brien, Bill (Normanton)	Taylor, Rt Hon Mrs Ann
O'Brien, Mike (N Warks)	(Dewsbury)
O'Hara, Eddie	Taylor, Ms Dari (Stockton S)
Olner, Bill	Taylor, David, (NW Leics)
O'Neill, Martin	Temple—Morris, Peter
Organ, Mrs Diana	Thomas, Gareth (Clwyd W)
Osborne, Ms Sandra	Thomas, Gareth R (Harrow W)
Palmer, Dr Nick	Timms, Stephen
Pearson, Ian	Tipping, Paddy
Pendry, Tom	Todd, Mark
Perham, Ms Linda	Touhig, Don
Pickthall, Colin	Trickett, Jon
Pike, Peter L	Turner, Dr Desmond (Kemptown)
Plaskitt, James	Turner, Dr George (NW Norfolk)
Pollard, Kerry	Twigg, Derek (Halton)
Pond, Chris	Twigg, Stephen (Enfield)
Pope, Greg	Vaz, Keith

Walley, Ms Joan	Winterton, Ms Rosie (Doncaster C)
Ward, Ms Claire	Wise, Audrey
Wareing, Robert N	Wood, Mike
Watts, David	Worthington, Tony
Whitehead, Dr Alan	Wright, Anthony D (Gt Yarmouth)
Wicks, Malcolm	Wright, Dr Tony (Cannock)
Williams, Rt Hon Alan	Wyatt, Derek
(Swansea W)
Williams, Alan W (E Carmarthen)	Tellers for the Ayes:
Williams, Mrs Betty (Conwy)	Mr. David Hanson and
Winnick, David	Mr. Robert Ainsworth.
NOES
Ainsworth, Peter (E Surrey)	Hamilton, Rt Hon Sir Archie
Amess, David	Hammond, Philp
Ancram, Rt Hon Michael	Harris, Dr Evan
Arbuthnot, Rt Hon James	Harvey, Nick
Atkinson, Peter (Hexham)	Hawkins, Nick
Baker, Norman	Heald, Oliver
Ballard, Jackie	Heath, David (Somerton & Frome)
Beith, Rt Hon A J	Heathcoat—Amory, Rt Hon David
Bercow, John	Hogg, Rt Hon Douglas
Beresford, Sir Paul	Horam, John
Body, Sir Richard	Howarth, Gerald (Aldershot)
Boswell, Tim	Hughes, simon (Southwark N)
Bottomley, Peter (Worthing W)	Hunter, Andrew
Bottomley, Rt Hon Mrs Virginia	Jack, Rt Hon Michael
Brady, Graham	Jackson, Robert (Wantage)
Brand, Dr Peter	Jenkin, Bernard
Brazier, Julian	Jones, Nigel (Cheltenham)
Brooke, Rt Hon Peter	Keetch, Paul
Browning, Mrs Angela	Key, Robert
Burns, Simon	King, Rt Hon Tom (Bridgwater)
Campbell, Rt Hon Menzies	Kirkbridge, Miss Julie
(NE Fife)	Laing, Mrs Eleanor
Cash, William	Lait, Mrs Jacqui
Chapman, Sir Sydney	Lansley, Andrew
(Chipping Barnet)	Leigh, Edward
Chidgey, David	Letwin, Oliver
Chope, Christopher	Lewis, Dr Julian (New Forest E)
Clappison, James	Lidington, David
Clark, Rt Hon Alan (Kensington)	Lilley, Rt Hon Peter
Clark, Dr Michael (Rayleigh)	Livsey, Richard
Clifton—Brown, Geoffrey	Lloyd, Rt Hon Sir Peter (Fareham)
Collins, Tim	Llwyd, Elfyn
Colvin, Michael	MacGregor, Rt Hon John
Cormack, Sir Patrick	McIntosh, Miss Anne
Cran, James	MacKay, Rt Hon Andrew
Davies, Quentin (Grantham)	Maclean, Rt Hon David
Davis, Rt Hon David (Haltemprice	McLoughlin, Patrick
& Howden)	Malins, Humfrey
Day, Stephen	Maples, John
Dorrell, Rt Hon Stephen	Mates, Michael
Duncan, Alan	Maude, Rt Hon Francis
Duncan Smith, Iain	Mawhinney, Rt Hon Sir Brian
Emery, Rt Hon Sir Peter	May, Mrs Theresa
Evans, Nigel	Michie, Mrs Ray (Argyll & Bute)
Faber, David	Moss, Malcolm
Fabricant, Michael	Nicholls, Patrick
Fallon, Michael	Norman, Archie
Fearn, Ronnie	Oaten, Mark
Flight, Howard	Öpik, Lembit
Forth, Rt Hon Eric	Ottaway, Richard
Foster, Don (Bath)	Page, Richard
Fox, Dr Liam	Paice, James
Gale, Roger	Paterson, Owen
Garnier, Edward	Pickles, Eric
Gibb, Nick	Prior, David
Gill, Christopher	Redwood, Rt Hon John
Gillan, Mrs Cheryl	Rendel, David
Gorman, Mrs Teresa	Robathan, Andrew
Gray, James	Robertson, Laurence (Tewk'b'ry)
Green, Damian	Roe, Mrs Marion (Broxbourne)
Greenway, John	Rowe, Andrew (Faversham)
Grieve, Dominic	Ruffley, David
Gummer, Rt Hon John	Russell, Bob (Colchester)

St Aubyn, Nick	Tyler, Paul
Sanders, Adrian	Tyrie, Andrew
Sayeed, Jonathan	Viggers, Peter
Shepherd, Richard	Walter, Robert
Simpson, Keith (Mid-Norfolk)	Wardle, Charles
Smith, Sir Robert (W Ab'd'ns)	Waterson, Nigel
Smyth, Rev Martin (Belfast S)	Webb, Steve
Soames, Nicholas	Wells, Bowen
Spicer, Sir Michael	Whitney, Sir Raymond
Spring, Richard	Whittingdale, John
Stanley, Rt Hon Sir John	Widdecombe, Rt Hon Miss Ann
Stunell, Andrew	Wilkinson, John
Swayne, Desmond	Willetts, David
Syms, Robert	Willis, Phil
Tapsell, Sir Peter	Wilshire, David
Taylor, Ian (Esher & Walton)	Woodward, Shaun
Taylor, John M (Solihull)	Yeo, Tim
Taylor, Sir Teddy	Young, Rt Hon Sir George
Tonge, Dr Jenny
Townend, John	Tellers for the Noes:
Tredinnick, David	Mrs. Caroline Spelman and
Trend, Michael	Sir David Madel.

Question accordingly agreed to.

MR. DEPUTY SPEAKER forthwith declared the main Question, as amended, to be agreed to.

Resolved, That this House recognises and applauds the massive contribution the staff make to providing the fairest and most efficient healthcare system in the world; regrets the shambles in the NHS that the Government inherited which was demoralising to staff and damaging to patients; welcomes the action the new Government has taken to make things better for staff and patients alike, including £21 billion extra for the NHS over the next three years, record capital investment in new buildings, equipment and facilities to enable the staff to provide top-quality care, the biggest real-terms pay rise for nurses for 10 years paid nationally in full, proposals for radical pay reform to give fairer rewards to staff who extend their roles, widen their skills and work in teams to care for patients, negotiations on a new consultants' contract to ensure rewards go to those who contribute most to the NHS, ambitious targets to improve the quality of the working lives of NHS staff, including tough action to crack down on violence and racism at work, the promotion of family-friendly employment policies and investment in training and continuing professional development; welcomes the Government's commitment to reducing junior doctors' hours in line with the draft European Working Time Directive vehemently opposed by the Conservative Party and carefully planned so as not to damage improvements in patient care; and accepts no lectures about conditions of service for NHS personnel from a Party that did more in Government to demoralise the staff than any other in living memory and which spends most of its time in Opposition running down the achievements of the NHS staff and saying the Health Service can no longer cope.