§ Motion made, and Question proposed, That this House do now adjourn.—[Joan Ryan.]6.56 pm
§ Tony Baldry (Banbury) (Con)
Paediatrics is often in the media. No doubt the Minister's officials expected me to want to talk about the cases of Sally Clark, Trupti Patel and Angela Cannings, but I do not. To avoid confusion about the matters that I want to raise in the debate, I have given the Minister notice of what I intend to say. I want to raise the less familiar cases of three-year old Ian Luckett, a Bloxham boy who tragically died at Oxford's Radcliffe infirmary, and of the late Dr. Ian Watkins.
I shall begin with the tragic case of Ian Luckett. He is the reason why, a number of years ago, the Horton general hospital recruited paediatricians of the calibre of Dr. Bob Bell, who retired recently after many years of outstanding service to the community.
Ian Luckett died in 1974, after accidentally receiving a drug overdose. His father, Donald Luckett, told of how his son said, "Daddy, I want to sleep. My eyes won't stay open." That was just before he was discharged from the Houghton general hospital. The next day, Ian's father was unable to wake him: sadly, he never regained consciousness, and he died three days later at the Radcliffe infirmary.
There followed three inquiries into the tragic death of Ian Luckett. Two were private, internal inquires held by the then Oxford area health authority and the then district hospital management committee. After considerable lobbying by the boy's family and my predecessor as Member of Parliament for Banbury, Sir Neil Marten, a full public inquiry was held. It is that public inquiry, held some 30 years ago, that is relevant to the pressures facing paediatric services at the Horton hospital today.
The public inquiry was ordered by the then Secretary of State for Health and Social Security, Barbara Castle. Opening the inquiry, the chairman said:The reason there has been this third enquiry is because it is recognised by the Department … that there should be the fullest enquiry to ensure such a thing does not happen again.I repeat that the aim was to ensure that "such a thing" did not happen again.
The evidence that the Luckett inquiry heard reinforced the need for an enhanced paediatric department, and for more trained paediatric staff at the Horton general hospital. Dr. Douglas Pickering, the consultant paediatrician at the Radcliffe infirmary, was reported by theBanbury Guardian of 6 June 1974 to have explained to the inquiry that hewould like to see doctors at the Horton rotate at the Radcliffe for paediatric experience".Local people want that rotation to be available today.
When I read the evidence to the Luckett inquiry, some 30 years after it was held, I was struck by how strong was the message that the Horton general hospital needed experienced paediatricians and comprehensive paediatric care, not least because of the distance to other hospitals in Oxford.
What did the inquiry find? The Luckett report began by observing that 418nursing and medical staff are devoted, but severely stretched",and I suggest that the same is true today, particularly among paediatricians. It recommended thatjunior medical staff might be rotated",and that recommendation is equally relevant today. It stressed thatonly severely ill children, fit to travel, should be admitted directly to Oxford hospitals.In other words, as many children as possible should be treated in Banbury.
It being Seven o'clock, the motion for the Adjournment lapsed, without Question put.
Motion made and Question proposed, That this House do now adjourn—[Mr. Jim Murphy.]
§ Tony Baldry
My predecessor, Sir Neil Marten, rightly concluded that the Luckett inquiryhighlights a number of matters that must be put right immediately. Nothing like this must be ever allowed to happen again".There is now a danger that it may happen again.
Shortly afterwards, a number of paediatric consultants, including Dr. Bob Bell, were appointed at Horton general hospital, and no sick children had to travel to Oxford hospitals. In future, sick children will almost certainly have to travel to Oxford hospitals by night, when, by definition, it will be an emergency, if 24 hours a day, seven days a week paediatric care is withdrawn from the Horton.
The situation for paediatrics is grim even at the John Radcliffe hospital. My recent correspondence with the chairman and chief executive of the Oxford Radcliffe hospitals and the president of the Royal College of Paediatrics and Child Health has produced the same point time and again: there is a national shortage of paediatricians—simple as that. A parliamentary answer to my question about the matter states that just 15 new paediatricians are being trained over the coming year in England and Wales, although it goes on to say—using words very carefully—thatan extra 155 National Training Numbers have been proposed for paediatrics through other initiatives."—[Official Report, 4 March 2004; Vol. 418, c. 1117W.]It is part of the impenetrable jargon of the NHS that training is referred to as national training numbers.
Why are so few paediatricians—just 15—being trained? The Minister should not underestimate the impact that downgrading local paediatric services will have on the people of north Oxfordshire and south Northamptonshire. The public inquiry of 1974 resulted in 24 hours a day, seven days a week paediatric services for north Oxfordshire and south Northamptonshire, which has been the situation for 30 years. Local people have become used to the high calibre of consultants such as Dr. Bob Bell and Dr. Harvey Marcovitch, who is now at the Royal College of Paediatrics and Child Health.
When Dr. Bob Bell retired in July last year, he expressed in public his concerns over the future of the children's ward at the Horton general hospital. There is now just one of the necessary five middle grade doctors in paediatric posts at Horton general hospital. Why have five advertisements led to no appointment? It 419 seems that the number of trained doctors in the country is simply insufficient, and not enough of them are being trained.
Only Ministers can give us the complete answer, but surely part of the explanation is illustrated by the tragic death of Dr. Sid Watkins. The 44-year-old Dr. Watkins committed suicide last year and was a consultant paediatrician who had worked more than 100 hours in that week. The British Medical Association does not believe that his working week was unusual and calculates that almost 80 per cent. of consultants work more than 50 hours every week.The Independent, the only broadsheet to cover Dr. Watkins's death, quoted Harvey Marcovitch, by now working at the Royal College of Paediatrics and Child Health, who commented:there isn't anyone around anymore among the juniors who really knows what's going on with individual children day by day. They each see snippets and the consultants are left as the people responsible for keeping an eye on the whole of the child's hospital admission.The answer must surely be to recruit more paediatricians, but NHS trusts cannot do so.The Independent did not mention the national shortage of paediatricians—it knew there was a shortage, but it did not know the numbers.
I know that the Royal College of Paediatrics and Child Health has conducted a survey and given the results to Ministers. I asked a parliamentary question about those results and—again, rather selectively—the answer was that Ministers were "considering" them. It would be interesting to know exactly what the Royal College of Paediatrics and Child Health said.
The parliamentary answer that I received on 4 March states:In 2004–05, a further 15 locally funded NTNs will be allocated."—[Official Report, 4 March 2004; Vol. 418, c. 1117W.]It seems bizarre: fifteen for the whole of England and Wales; fifteen, when the president of the Royal College of Paediatrics and Child Health is telling Ministers that there is a serious shortage of trained paediatricians because of the European working time directive; fifteen, when two weeks ago I met the chairman and chief executive of the Oxford Radcliffe hospitals to be told that they are unable to recruit paediatricians; and fifteen next year actually means that 85 fewer paediatricians are being trained than last year when there is a severe shortage up and down the country.
Not only is there clearly a shortage of paediatricians but the working time directive is exacerbating existing difficulties. The Royal College of Paediatrics and Child Health, the British Medical Association, and the NHS Confederation in evidence to the Select Committee on Health have all made clear their concerns over the time left to implement the working time directive, which has hit paediatrics particularly hard. It has hit smaller general hospitals hardest, and I understand that Ministers have made funds available for rural areas such as Cornwall and Lincolnshire. I am under the impression that almost £46 million has been made 420 available to implement the working time directive over the next three years. The Minister will be aware that I have asked his Department whether any additional funding might be made available to help the Horton general hospital. The Minister of State responded on 6 January:Turning specifically to the Horton, the recently announced strategic review explicitly sees a continuing and important role for the Horton in providing a range of hospital services. A paediatric task force is meeting to develop proposals for quality sustainable paediatric services at the Horton in response to difficulties in recruiting junior doctors.Recruiting junior doctors is still difficult, and that must be elated to the working time directive. Indeed, almost everywhere else in England and Wales is experiencing problems with it, especially in relation to paediatrics, because it involves 24-hour service. I reiterate that I hope that Ministers will consider the Radcliffe hospitals NHS trust as part of his Department's £46 million budget to recruit junior doctors and registrars who will have to meet the working time directive, whether existing or new.
There is a further problem. The Oxford Radcliffe trust is under the misapprehension that the Horton general hospital is no longer accredited to train registrar Paediatricians. That is a serious concern. It is also seriously surprising because the president of the Royal College of Paediatricians tells me that the Horton is accredited; that there is no problem; and that, moreover, he would welcome more paediatricians working at the Horton general hospital.
Why does the trust say that it cannot train paediatricians at the Horton? There can be no doubt that that assumption was formed on the basis of poor advice given to the trust by others in the NHS. By way of example, a regional adviser in the NHS wrote on 9 January 2004:with … junior doctors hours being reduced progressively, it has been felt that the middle-grade posts currently available at the Horton Hospital are not of sufficiently high intensity for Specialist Registrar Training. My apologies to the Horton Hospital but, at prevent, we do not feel it is appropriate to allocate Specialist Registrar training there.Such advice leaves the Horton general hospital in an invidious position. Without registrars, it is impossible to continue to have a 24-hour, seven-day paediatric department at the Horton general hospital with a children's ward with in-patient beds. The best that will be offered in future is a 9 to 6 service, five days a week, with any children requiring admission or more complex treatment being directed to Oxford.
On 1 March the chief executive of the Oxford Radcliffe hospitals NHS trust wrote to me. He said thatthe workload is not considered to be enough to provide appropriate experience to meet training requirement".That is what the trust believes. However, the Minister should know that the advice being given by NHS officials to the trust is completely the opposite of the paediatric service seen as suitable by the Royal College to operate at the Horton.
As Dr. Harvey Marcovitch explained by letter to me on 19 January:the Royal College has not made any recent pronouncement re: Banbury …. they will not be raised again formally until the next inspection, whenever that will be.421 The President of the Royal College, Professor Alan Craft, told me in a letter on 21 January that there is simply no reason why paediatric registrars cannot continue to work at the Horton general hospital if the trust so chooses, although staff shortagesare enormous pressures on all hospitals at the moment because of the forthcoming Working Time Directive".Furthermore, as the chief executive of the Royal College said in an email to me yesterday,the decision on the level of services is one that must be taken by the Trust in the light of demand and resources available.He echoed the finding of the Luckett inquiry that services should be provided as closely as possible to children in Banbury. It is as simple as that.
I understand that the Horton general hospital had its status accredited at the last inspection. That status has not changed and will not change until another inspection, whenever that may be. I had that point confirmed by the chief executive of the Royal College of Paediatricians yesterday. He said:Training approval for paediatric Registrar posts at Horton General Hospital has never been sought by the relevant trust. There is, in principle, no reason why the Oxford Radcliffe Trust should not submit a training programme to the College that includes some time at the Horton. We must stress however that the current plan to reduce the level of paediatric services in Banbury is not a direct or indirect result of any ruling on the part of the College.That utterly contradicts the advice that officials at the Department gave to the trust. Why have NHS officials given such inaccurate advice to the trust?
The chief executive of the Oxford Radcliffe hospitals NHS trust raises further concerns over the Horton general hospital not being accredited by the Royal College to take registrars. But the Oxford Radcliffe hospitals NHS trust has never asked the Royal College for such accreditation. It has not been told that it cannot train registrars, because no one has ever asked the question. There is no reason why registrars employed by the Oxford Radcliffe hospitals NHS trust should not undertake work in rotation in Oxford and Banbury at the Horton general hospital. Yet the trust tells me that it cannot even recruit paediatric doctors for the John Radcliffe. let alone for a smaller general hospital. Why? I hope that the Minister can give us an answer.
In a letter of 29 January, the president of the Royal College told me:I am not too sure what the problem is at the Radcliffe hospital in terms of attracting registrars. Paediatrics is still very popular, and for regular registrars … there is no shortage.The Horton needs trained paediatricians. How many are needed? Five. How many are being trained this year? Only 15. Fifteen have been allocated for England and Wales, although we are told that some more have been proposed through other initiatives. Demand in larger cities and towns means that it would be difficult for one small general hospital in Oxfordshire to take a third of all the new paediatricians for the whole of England and Wales.
However, NHS advisers are not even giving the trust the opportunity to take on paediatricians and accrediting them to the trust but rotating them to its hospitals, including Horton—something recommended by a public inquiry set up by the then Secretary of State 422 about 30 years ago. That opportunity has unfairly been removed from the table for no good reason. The Minister must look into what his officials are saying to one another as there is evidently a serious communication problem. If he does not do so and his officials continue to base their work on somewhat false foundations, it will seriously impede the inquiry of the taskforce into which model of paediatric services would work best for Horton hospital. It is unacceptable for NHS officials to tell NHS trusts that they are not allowed paediatricians because they do not have the relevant status when in fact they do.
Not only is that manifestly unfair, but it will also put Horton general hospital at a severe disadvantage in respect of the findings of the paediatric taskforce, which will report shortly. The Minister will be aware that the taskforce is considering two ways forward for the Horton and paediatric services across Oxfordshire. The first is known as an ambulatory service, whereby I understand that Horton general hospital would provide a paediatric service from 9 am until 6 pm for five days a week. There would no longer be any paediatric beds at the Horton; patients would he seen, assessed and either treated there or sent to the John Radcliffe for more specialist treatment. In effect, there would no longer be 24-hour paediatric cover—no cover at nights and no cover at weekends.
There would inevitably be a detrimental impact on obstetrics at the Horton general hospital. At present, there is a special care baby unit and it is not clear whether it would be able to continue. There would most certainly be knock-on consequences for the accident and emergency department. It is unclear whether the A and E department would be happy to continue to give general 24-hour, seven-day-a-week cover if there were no longer any paediatric services at the Horton in the evenings, at night and at weekends. It is thus clear that the John Radcliffe would have to take on further cases from Banbury at a time when there is an acknowledged problem across Oxfordshire in recruiting trained paediatricians.
There is an alternative: more registrars. Paediatric registrars undertake a five-year training; the last three years are fairly specialist but the first two years are reasonably general. When the Horton general hospital merged with the John Radcliffe to form the Oxford Radcliffe hospitals NHS trust my understanding was that appointment would always be made to the trust, not to an individual hospital, so I see no reason why registrars based at the John Radcliffe should not also give cover and work at Horton general hospital.
However, the chief executive of the NHS trust has been advised to say that that is not possible becauseregistrars are appointed to training posts that have been allocated to a trust by the Regional Training Advisory committeeand it—cannot include any Horton based activity because the paediatric work available at the Horton is not considered by the committee to provide adequate training".That was in a letter to me as recently as 3 March. Again, I can say only that such activity could be included. The Royal College says that it could, so why does the regional training advisory committee believe that the Horton cannot take registrars? One can assume that it is 423 only because NHS officials from the Minister's Department say that it cannot. Instead, Horton general hospital is left trying to fill vacancies for trained paediatrics when there are simply not enough trained paediatricians available.
The taskforce's terms of reference are ill balanced before it has even reported. It is receiving bad advice from the Minster's Department and has started off on false foundations. Clearly, the Minister needs to sort out the communication problems over the employment of registrars. There are two immediate problems that he must address. The first is that his Department's officials are telling the NHS trust that its registrars cannot work at Horton general hospital. But they could; the royal college says that the hospital is accredited. The Luckett report made that recommendation more than 30 years ago.
The second problem is that the Government have invested in too few new paediatricians for the whole of England and Wales. Neither Horton general hospital nor the John Radcliffe can fill their paediatric vacancies, so if paediatric services are not being provided at the Horton and they cannot be found at the John Radcliffe, where on earth in Oxfordshire will they be provided?
The answer lies in increasing the number of registrars accredited to the Oxford Radcliffe hospitals NHS trust; furthermore, the Minister's Department must stop telling the NHS trust that registrars cannot rotate between the Horton and the John Radcliffe; and, in any event, more funding must be found so that more paediatricians can be trained than the absurdly low number that the Department is funding.
The chairman and chief executive of the NHS trust and my hon. Friend the Member for Daventry ( Mr. Boswell) and I will shortly meet the president of the Royal College, so I should welcome a response from the Minister on those two crucial issues. The crisis in paediatric services at Horton general hospital needs to be set against the background of other services at the hospital. If the taskforce makes a recommendation on paediatric services that is based both on inaccurate information from the Minister's Department and on inadequate funding for paediatric numbers, the loss of 24-hour, seven-day-a-week paediatric services could undermine the A and E department at the Horton.I am not confident that sufficient time has been taken to assess the likely domino effect caused by the downgrading of paediatric services. It remains, however, a real possibility, to which every GP who responded to my letter on the future of services at Horton general hospital referred. It leaves the real possibility of Ministers overseeing a situation whereby 30 years later the lessons of the Luckett tragedy are ignored.
Ministers must surely understand that local people hear that billions of pounds are being pumped into the NHS, and are somewhat confused by that when they realise that their local general hospital's children's ward is under threat. People in north Oxfordshire and south Northamptonshire want the comprehensive paediatric services that they have enjoyed for the past 30 years to continue. That is a 24-hour, seven-day a week paediatric service at Horton general hospital.
§ 7.15 pm.
§ Mr. Tim Boswell (Daventry) (Con)
I am grateful both to the Minister and to my hon. Friend the Member for Banbury (Tony Baldry), my constituency neighbour, for allowing me a few minutes of their time. I congratulate my hon. Friend on securing this important debate.
Although the debate is badged as being about paediatric services, and he has spoken on that matter with considerable expertise and great effect, there are major implications for the viability of Horton general hospital in Banbury. This is a significant interest for about 25,000 of my constituents in south-west Northamptonshire, including the town of Brackley. In turn, that amounts to about 20 per cent. of the total caseload at the Horton hospital. Incidentally, Miss Horton was from my constituency.
I have lived just inside my constituency boundary for more than 35 years, and during the whole of that time Horton hospital has been, for all practical purposes, my hospital. All three of my children were born there, and on one occasion I had every reason to be extremely grateful for the hospital's paediatric services in coping with an emergency, the response to which was led by Dr. Bob Bell, that involved a member of my family.
I recognise the real dilemma for health Ministers in balancing the changing requirements of modern practice standards against the need to offer convenient local services, including a rapid response to emergency situations, and doing so with limited trained manpower and other resources. However, I emphasise the difficulty that is posed by any withdrawal, in whole or in part, of paediatric services at the Horton, not only for the town of Banbury and its population, but for the scattered rural settlements around it in a number of counties and constituencies.
Some villages in my constituency are about 10 miles from Banbury and 25 miles from both Oxford and any other alternative service in Northampton, for example. I know also of the intensity of local feeling at the perceived danger of progressively withdrawing services that lead on from paediatrics to other services, with the ultimate fear that the entire hospital might become unviable. I associate myself with the concerns expressed by my hon. Friend and endorse his call for some constructive thinking in order to find a practical solution to this problem.
§ The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman)
I am grateful to the hon. Member for Banbury (Tony Baldry) for raising a subject on which he has been campaigning for some time, and I congratulate him on securing this debate. I am grateful that he gave me some notice of the issues that he was to raise. I also congratulate the hon. Member for Daventry (Mr. Boswell) on putting the case on behalf of his constituents.
The hon. Member for Banbury began his speech with the sad story of Ian Luckett. It was a tragedy that resulted from people being insufficiently experienced and working under pressure. The hon. Gentleman used the story to demonstrate why decisions were taken to establish children's health services in his local area and to support his view of how services should be shaped in 425 the future. Let me put that awful story back to him. Surely what it shows also is that clinical safety has to be a prime consideration when we design hospital services. Surely it shows also that when we configure services, we must take a strategic view that takes account of changing clinical practice, changing populations and changing circumstances.
The hon. Member for Daventry acknowledged that issue. The tragedy relayed by the hon. Member for Banbury happened in 1974, but the world has changed in the 30 years since. Technology, for example, has changed dramatically. When the tragedy happened, the personal computer had not even been invented, and many clinical tests and drugs that we employ today had not been dreamed of. Those changes alone required us to look critically at local service design. In 1974, junior doctors worked long and unsafe hours to accumulate the experience that they needed. Now we are driving down the hours that they work that so they can work more safely, but we still have to maintain the level of training that they receive. That means that we must change the way we work and look critically at the way in which hospital services are delivered. As for the working time directive, which imposes a tight time scale on those changes, we were not even in the European Union when that case was heard, never mind signed up to the type of change that we must plan for today.
I acknowledge the serious concerns expressed by the hon. Member for Banbury, and he is right to expert a certain level of service on behalf of his constituents. However, all I ask is that he keeps in mind the way the world changes, does not expect Banbury and Oxfordshire to be immune to those changes, and that he remains open minded about the way in which paediatric and other health services can best be delivered in his constituency, should change be proposed in the future. The Horton hospital, however, provides a substantial part of hospital care for patients in Oxfordshire. It copes with approximately 30,000 accident and emergency attendances a year out of the county total of 100,000. On average, 7,000 of those attendances are paediatric, and it delivers approximately 1,600 babies a year. Given that level of activity, the hospital's importance to the county is self-evident. I note, too, the comments of the hon. Member for Daventry about its importance to his constituents.
There has also been significant investment in Horton hospital over the past few years. The number of beds has risen from 200 in 1998 to 250 today, including 14 paediatric beds. The position of the primary care trusts—their view is shared by the Oxford Radcliffe hospitals NHS trust—is that the Horton is, and will remain, vital to the delivery of emergency and elective care in the county. The PCTs want locally based hospital care to continue and expand where appropriate, provided that the quality and safety of care are guaranteed. The NHS will continue to work to ensure that that happens and that necessary investment is made in the Horton. The chief executive of the Oxford Radcliffe hospitals NHS trust, in the letter of 3 March cited by the hon. Member for Banbury, explicitly states thatpaediatricians wish to see as much provided in Banbury as possible".He also believes that the development of the children's hospital in Oxford is not a major influence. 426 The hon. Member for Banbury was right to express concern about the impact of the working time directive, although I detected slight signs of his trying to have it both ways. He cited the tragic case of Dr. Watkins, who died after a 100-hour week, implying that that was why the recruitment of paediatricians was proving difficult. In another part of his speech, he held up the working time directive as a barrier to the implementation of safe paediatric services. The aim of the working time directive and Government policies is to hammer down doctors' working hours to ensure that in future doctors do not work 100 hours a week and that recruitment is made easier. We do not underestimate the impact of the working time directive, but it presents the NHS with a marvellous opportunity to change outdated working practices that do doctors and patients no favours. By introducing innovative ways of working that take away routine tasks from doctors in training and, at the same time, reduce the hours that they work, we shall enhance doctors' working lives and improve the quality of service to patients.
We must have effective systems in place to share emerging good practice and learn from others. A number of national pilot sites are currently testing new ways of providing services so that we can learn lessons from their experience. Every NHS trust has been asked to prepare an action plan detailing how they will ensure that junior doctors comply with the law on working time, and every strategic health authority has been asked to work with trusts to agree their action plans and ensure that they are realistic and deliverable. The North Oxford Paediatric Task Force is assessing the best way forward for the local health community, with special emphasis on paediatrics. Oxford Radcliffe hospitals NHS trust is also conducting a broader strategic review, and the two PCTs—North East Oxfordshire and Cherwell Vale—are looking at the future shape of hospital, intermediate and mental health services in north Oxfordshire.
Implementing the working time directive locally is the responsibility of trusts, but there are things the Department of Health, the medical profession and others can do to support them, which is why we have set up a national working time directive expert group with the Academy of Medical Royal Colleges, the joint consultants committee of the British Medical Association, the Royal College of Nursing and other key stakeholders.
We have also set up a national delivery board of NHS managers to ensure that strategic health authorities and trusts deliver working time directive compliance on the ground. They will spearhead trust efforts and ensure that help is directed to trusts that need it most. Currently the Oxford Radcliffe hospitals trust is 70 per cent. compliant with the WTD and there is a trust-wide assessment going on to get compliance to 100 per cent.
The hon. Gentleman is, however, right to highlight the particular problems of paediatrics and obstetrics with respect to the working time directive. Those are two acute specialties that do not easily lend themselves to cross-cover, owing to the particular skills and competencies attached to them. We recognise that they require particular and different solutions to those required for general acute services, and that is why we are working closely with the Royal College of Paediatrics and Child Health and the Royal College of Obstetrics and Gynaecology to deliver those solutions. 427 The RCPCH has already produced some models in its document "Old Problems, New Solutions". They examine the provision of emergency assessment services without the use of in-patient beds, and increased care in the community with particular emphasis on community paediatric teams that prevent admission and enable earlier discharge. The RCPCH also considered staff being used in new and different ways—for example, the growing and effective use of nurse practitioners in paediatrics and neonatal care. Redesign is another of the key tools to help achieve a reduction in the hours worked by doctors in training, and has the potential to provide new ways of delivering services that avoid the need for reconfiguration.
At various points in his speech the hon. Gentleman referred to staff numbers with respect to children's health services. More staff, working differently summarises the Government's approach to growing the NHS work force. That means making the most of the whole team, not just doctors. There has been a 17 per cent. increase in paediatric nurses between 1997 and 2002, and a 19 per cent. jump in the number of allied health professionals, most of whom work with children. We have also increased training places. In the same five-year period, training places for children's nursing have increased by 55 per cent. and for allied health professionals by 73 per cent.
In paediatrics, that means nearly 600 more consultants are working in the NHS today than were working there in 1997, and there are 253 more specialist registrars, the consultants of the future. NHS trusts are willing to fund extra specialist registrar training places in paediatrics, and between 2003–04 and 2004–05 trusts have the opportunity to fund up to 115 additional posts. Implementation of this initiative is progressing steadily. Central funding has been provided for 10 additional 428 specialist registrar posts in paediatric cardiology. We have also announced that additional national training numbers will be made available, subject to obtaining the appropriate educational approval, where trust action planning has calculated that they are needed for WTD compliance. To date, we have received some 200 bids for paediatric posts from trusts. The Oxford Radcliffe hospitals trust has bid for five of those places.
On communications, I hear what the hon. Gentleman said about mixed messages. The decision about where training can take place is not a local NHS decision. Only the Royal College of Paediatrics and Child Health and the post-graduate deanery operating through regional specialist training committees can decide where such training can take place. I will, however, make sure that officials study his comments carefully and that they are passed to the local strategic health authority so that if any mixed messages have been given, they can be sorted out and appropriate advice taken before any decisions about service changes are made.
The developments that I have described are not just a numbers exercise. We are increasing staff. More importantly, outcomes are improving. The increased investment made by the Government has meant better care for patients, and that is as true in Banbury and Oxfordshire as everywhere else. The working time directive and paediatric recruitment are a serious challenge, but it is one that we do not underestimate and it is being met. I hope the hon. Gentleman will be at least partly reassured by what I have said, and by my undertaking to ensure that we reflect on his comments and that local service designers do likewise. If the hon. Gentlemen should wish to have further discussions with me at a later date as these matters progress, I should be happy to meet them.
Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes past Seven o'clock.