§ 2. Mr. Bill Rammell (Harlow)
If he will make a statement on progress in meeting targets for the recruitment of nurses under the NHS plan. 
§ 10. Mr. Mike Hancock (Portsmouth, South)
What plans he has to improve the retention of nursing staff. 
§ The Secretary of State for Health (Mr. Alan Milburn)
I am being as quick as I can.
In the first year following publication of the NHS plan, the number of nurses employed in the NHS increased by 6,310; the number of qualified GPs and consultants increased by 1,230. By 2005, we expect 20,000 more nurses and 10,000 more doctors to be working in the NHS.
§ Mr. Rammell
I thank the Secretary of State for his response. Does he agree that having 20,000 extra nurses under the NHS plan is critical to the future health and well-being of the NHS and is in stark contrast to the previous Government's cuts in the nurse training programme? Does he also agree that high nursing costs are one of the biggest deterrents affecting nurse recruitment in the south of England? While the additional £1,000 a year cost-of-living allowance in parts of the south-east is welcome, it is inexplicable that it has not extended as far as Essex. I strongly urge my right hon. Friend to get his officials to look at that issue again.
§ Mr. Milburn
I am being barracked from the right and the left. As for Essex, my hon. Friend the Member for Harlow (Mr. Rammell) will be aware that we introduced cost-of-living allowances this year for the first time. By definition, there is an element of rough justice about that; I appreciate that, and accept that there is a pressing case for other areas to be included. We are keeping the issue under active review and want to be able to extend the cost-of-living increases both to parts of the country where the labour market pressures are greatest and to professional groups, apart from nurses and midwives, where recruitment is difficult.
697 In the more medium term, we need a better formula for distributing NHS resources so that we can take account of the fact that labour markets in the south-east, for example, are different from those in my part of the world. By and large, there are areas of full employment in the south-east. I hope that we will eventually have full employment in the north-east too. As for the number of training places and commissions, my hon. Friend is right; we still have nurse shortages today precisely because the number of training places were cut in the mid-1990s by about 20 per cent.
§ Mr. Hancock
Will the Secretary of State consider giving those returning to nursing greater help in meeting their retraining costs? Will he also consider a method of speeding up the re-registration of those who have returned to nursing, and will he comment on the fact that fewer than 50 per cent. of nurses working in the health service would be prepared to recommend nursing as a career with long-term prospects?
§ Mr. Milburn
Since April 1999, more than 9,000 nurses who had left the national health service have returned to it. They have been attracted back to the NHS because we have made it more worth while for them to come back. We have increased their pay, the staging of pay that used to occur regularly is no longer occurring, and we are giving them, I hope, decent and fair pay rises. We want that to be extended in the future and, as the hon. Gentleman knows, we are renegotiating the way in which pay is decided in the NHS, to make sure that it is fairer and more transparent for all members of staff, but particularly for nurses.
On nursing as an attractive career, it is important that those working in the nursing profession, those leading the nursing profession and all Members of the House continue to advocate the case for nursing. Nursing in the NHS continues to be a good career, as is evidenced by the fact that the number of applications for nurse degree courses over the past three years has risen by 86 per cent.
§ Mr. David Hinchliffe (Wakefield)
My right hon. Friend will be aware of the evidence that shows that the private health care sector recruits its staff almost entirely from the national health service. In respect of the concordats with the private sector at local level, what steps are the Government taking to ensure that the increased use of the private sector does not have a detrimental effect on the local NHS?
§ Mr. Milburn
That is an important issue. One part of our health care system cannot benefit at the expense of another. We are making increased use of spare private sector capacity—for example, in private hospitals—so that we are able to expand the care available to NHS patients. That means that we can get more NHS patients treated more quickly. It is a matter of record that many of the private sector providers—the BUPAs of the world—employ their own nursing staff. There are issues that we will need to keep under review concerning the contribution to costs that those private sector providers make.
§ Mrs. Marion Roe (Broxbourne)
Is the Secretary of State aware that many nurses are becoming increasingly unhappy about their conditions of work, particularly the fact that they are unable to give the time and attention to 698 patients that they would wish? How many nurses fail their training course, and how many nurses do not go into the nursing profession, having completed the training course?
§ Mr. Milburn
The attrition rate, to which the hon. Lady is referring, is 10 to 11 per cent. of the number who apply for a nurse training course leading to a diploma or a degree, but the rate is falling. It is important that in the selection process we make sure that the candidates selected are appropriate for the job. The number of nurse training places, which was cut under the Administration whom the hon. Lady supported, is rising rapidly. That is welcome, but perhaps even more importantly, as I noted earlier, the number of people who want to go into nursing and who are applying for a nurse degree or a diploma course, is rising rapidly. I hope that that is a good sign of progress. It is one of many signs of progress that people will see in the NHS, and it is worth bearing in mind that there are currently 17,000 more nurses working in the NHS than when the Government took office.
§ Fiona Mactaggart (Slough)
I am pleased to hear what my right hon. Friend says about nurse training, but does he agree that in constituencies such as mine in the south-east of England, where there is a high level of employment, we need to be rather more imaginative about enabling people to get into the nursing profession—for example, by enabling those who have been hospital auxiliaries to do nurse training? What plans does he have to make nurse training more flexible and available to people who are currently employed in the health service?
§ Mr. Milburn
As my hon. Friend is aware, we have already taken steps in that regard. It is one of the absurdities of the way in which we have traditionally employed people in the NHS that staff are employed in ghettos, or in silos—nurses here, doctors there, health visitors over there, health care assistants over here. We are trying to develop the concept of a skills escalator, so that people can develop skills through their career and jump off into different careers as they develop professionally. We have certainly made it easier for health care assistants to become nurses. We needed to make it easier for nurses to develop their careers, too.
There is no simple answer to the problem of nurse shortages. An expansion in the number of nurse training places is obviously key to that and fair pay is important, but another crucial element is the so-called quality of life issue, which includes ensuring that nurses have flexible working conditions that suit them so that they can better balance their family and working lives, and that more child care is made available, not just in hospitals but in primary and community services too. There is real progress to report on all those aspects of improving the attraction of nursing as a career. Provided that we continue to invest in the NHS and, as my hon. Friend advocates, to make the reforms, we can look forward to an even bigger expansion in the number of nurses working in the NHS during the next few years than we have seen in the past few years.
§ Mr. Burns
Will the Secretary of State clear up a discrepancy on the targets? The NHS plan claims that there will be 20,000 more nurses by 2004, but in Labour's manifesto the year was 2005. On which target is the Government's policy based, what is the baseline for the 699 target, are the nurse figures based on targets for whole-time equivalents, and how can they be achieved when the Department of Health figures show that there are 9,400 nurse vacancies in Britain, 2,960 of which are in London alone?
§ Mr. Milburn
The hon. Gentleman might have said that the number of nurse vacancies is falling, not rising, that the number of nurse training places is rising, not falling, and that the number of nurses is rising, not falling. With regard to the relationship of the NHS plan to the manifesto, the hon. Gentleman might have noticed that the general election came after the NHS plan was published. The NHS plan was based on a baseline of 1999 figures up to 2004. The manifesto, on which we fought the election, was based on a baseline of 2000 up to 2005. [Interruption.] There is no particular revelation there. I know that the hon. Member for West Chelmsford (Mr. Burns) is from Essex, but even for a man from Essex he is getting terribly excited. [Interruption.] I am assured that men from Essex do get excited. [Interruption.] I have brought my hon. Friend the Member for Thurrock (Andrew Mackinlay) back into the Chamber. I always think that it is nice to make people happy, which is a rare occurrence in my job.
We can be confident of making good progress towards the targets precisely because of the changes that we have introduced. Nurses would not be working under the sort of pressure that they are working under today if the hon. Gentleman, among others, had done the right thing when he was a Minister in the Department of Health, and increased the number of training places rather than cutting them.