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1.43 pm

Mr. Nick Harvey (North Devon): I apologise because I, too, have a long-standing commitment that will prevent me from being present for the winding-up speeches.

I welcome the opportunity that the debate gives us to address the condition of the national health service as the winter pressures begin to mount, and to address the success or otherwise of the Government's policies to meet those pressures, some of which will require legislation in the coming Session.

The biggest problem facing the NHS continues to be its overall lack of capacity. I make no apology for starting by saying that, had the Government started, straight after their election in May 1997, to make the necessary investment to address capacity shortages, the health service would be considerably better placed now, as we go into this winter, than it is. The Secretary of State said that he could not argue that the NHS was completely fixed. That was realistic, even if something of an understatement.

Dr. Stoate: The hon. Gentleman mentions a lack of capacity and the Government's apparent failure to address it. As he was a Member of the House at the time, he will recall that one of the Government's first acts was to pass

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legislation to permit private finance initiative hospitals, one of the first of which was in my constituency. Next, the Government increased nurse trainee places, returning them to where they were before they took office. They have also increased the number of doctors in training by 1,000 a year and a further 1,000 a year as of next year. Surely that is addressing capacity at its root. The hon. Gentleman must agree that these issues will take many years to resolve because training nurses and doctors and building hospitals take a long time. Therefore, we could not possibly expect the Government to have put all those matters right in this three-year period.

Mr. Harvey: If a serious number of nurse trainees had been recruited by the Government in the autumn of 1997, their three-year training would by now be complete and there would be more nurses in the health service this winter than there are. As for the PFI, Mr. Will Hutton observed in The Observer last Sunday that capital investment by Government as a proportion of gross domestic product was lower today than when the Conservatives left office. If there is one single reason for that, it has been the failure of the PFI programme, particularly in the health service. It has caused delays and meant that hospitals that have been built have a smaller bed capacity than the ones that they replace. The Government's PFI policy, far from increasing capacity, has had precisely the opposite effect and is contributing to the present capacity difficulties.

More generally, the hon. Gentleman's point about the long-term policy of putting trainees into places is absolutely right. That is why we have to consider the short-term and long-term predicaments of the NHS. It is only right to say that many of the difficulties that the NHS is experiencing now are the result of cuts in trainee places for doctors, nurses and other health professionals that were made a decade or so ago.

In July, the Government published a national plan that set out a policy of recruiting considerably more trainees into all these professions in future. I applaud that. They could have gone further, but what they have committed themselves to is welcome. Naturally, it will take a considerable time to have an impact on NHS capacity. In the short term, all that the Government can do realistically is try to recruit back into the NHS the many qualified nurses who have left the profession and to recruit doctors from abroad.

The position, particularly regarding nurses, may get considerably worse before it gets conspicuously better. I make that point with reference to the age profile in the nursing profession, but also in some other key professions in the health service. The fact that there will be so much retirement in the next few years means that the health service will have to recruit even more trainees to come in at the bottom, fill the gaps and maintain the capacity. Medical professionals who are supportive of the overall aims of the NHS plan have been pointing that out consistently. There needs to be a strong emphasis on the recruitment and retention of staff for as long as conceivably possible.

Dr. Brand: Is it not true that not only does the NHS have a problem retaining staff, but it has enormous

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problems retaining recruits? Young and mature women training to be nurses cannot afford to complete their courses.

Mr. Harvey: My hon. Friend makes a good point. Conditions for trainee nurses are difficult. They are neither fish nor fowl. They do not get the advantages that trainees in many other professions get and, although they are treated as students, they do not get many of the practical advantages or the support that students on entirely academic courses get. Theirs is the worst of all possible worlds. Addressing the financial and support package for nurse trainees should be a high priority if, as my hon. Friend says, all those who start are to qualify and take up paid posts in the health service.

The hon. Member for Woodspring (Dr. Fox), who opened the debate for the Conservative party, made several points in his characteristically bullish fashion. However, a British Medical Association poll, which was published today, will not have given the Government enormous comfort. It shows that the number of people fairly or very dissatisfied with the NHS has risen from 17 to 28 per cent. The Government will be relieved to know that more people blamed the Conservatives than Labour, but not that many more--only 9 per cent. more when unprompted and 3 per cent. more when prompted with options.

As the hon. Gentleman said, this is the fourth winter that the Government have been in office, dealing with winter pressures in the NHS. As time passes, it becomes increasingly difficult to convince the public that all the problems predate 1 May 1997, although I do not suggest that they all started after that date. With all those capacity problems, the Government are right to consider creating better working relationships between the different professions and giving nurse practitioners and perhaps pharmacists powers to prescribe.

Many hon. Members will welcome the fact that more and better screening procedures are available for a variety of conditions, but of course they all need to be processed by laboratory staff, who already have many other duties in the NHS. I make a particular plea for laboratory staff. Their training is every bit as rigorous as that of others in the health service--in many cases, they have attained higher academic qualifications--but they are absolutely the poor relation in terms of their financial package. I worry that there will not be enough people in the NHS to carry out the tests that open opportunities for many new treatments for a variety of conditions. Pay is a real issue for those people. The NHS has many pay and staffing problems, but laboratory staff have a particularly strong grievance in their own right.

Some 25 or 30 years ago, bed occupancy rates in the NHS were about 70 or 75 per cent., but they can now be as high as 97 per cent. That lack of spare capacity--a problem that exists all year round--provides the background to the difficulties experienced in winter. It is not unique or unprecedented for scheduled elective surgery to be cancelled when pressures mount in the winter. That has been going on for at least the past decade or so. No one should pretend that the phenomenon is entirely new, but it has become increasingly apparent as bed occupancy rates have increased from 75 to 97 per cent.

I shall refer again to the PFI. There is absolutely nothing wrong in principle with the private sector shouldering some of the investment burden and, indeed,

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helping to take some of the risks. There is no reason in principle why the PFI should not be used to build new hospitals. However, it has not been shown--the information simply has not been put into the public domain--that using the PFI to build new hospitals represents better value for the taxpayer. The new hospitals being built are popular locally, but many clinicians resent the suggestion that decisions to build smaller hospitals with fewer beds are being taken on the basis of clinical judgment. It is perfectly clear that such decisions are far more to do with the commercial judgments being made about the investment.

Our other major misgiving is with the 30-year deal into which the PFI ties the NHS. Clearly, the NHS changes very fast in today's world, and 30 years is simply too long a period in which to make financial commitments to particular capital plant. Such plant may need to be configured once or twice, or even more often, during that time. It made sense, when the nation could lay its hands on so little capital and when previous Conservative Chancellors were presiding over a public sector borrowing requirement that rose to almost £50 billion at one stage, to look elsewhere for sources of capital investment. However, it makes altogether rather less sense when the Chancellor has the embarrassment of a huge surplus but does not know what to do with it.

One of the key matters that the legislation in this Session will address is another factor that contributes to the pressures in the winter, namely, nursing and residential care. I once again put on record that the Liberal Democrats deeply regret the fact that, although the Government set up a royal commission to examine the real difficulties that exist in that sector, they rejected what to our mind was the commission's key recommendation. We welcome the fact that the state will meet the expense of providing nursing care, but the decision not to follow the whole logic of the commission's report through to its ultimate conclusion, and the decision about paying for personal care, will exacerbate the problems in the nursing and residential sectors, to which the hon. Member for Woodspring referred.

I listened with interest to the hon. Gentleman and to the leader of the Conservative party. They suggested that the collapse in capacity in the nursing and residential home sector during the past year relates to the forthcoming regulations that will govern the physical and practical arrangements for running those homes. I share some of their concerns about those regulations, but they are mistaken to suggest that the regulations have much to do with the contraction that has occurred so far. Some owners of homes or the foundations behind them have wanted to get out of the market for quite a while, and it has been suggested that they are using the pending regulations as an excuse for doing so. We have seen little detail of the regulations, the impact of which will depend not on what they say but entirely on how pragmatic and sensible the Government are when they implement them.

Let us consider the number of places in nursing homes and what has happened in the past year or so. One can take the figure that the Secretary of State acknowledged, which I believe was 7,000 during the year to last April, or the figure of 15,000 during the year to October. I believe that the Conservatives even referred to 25,000 during the past two years. Whatever the figures, the fact remains that there has been a very significant contraction

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of this vital sector. That will add to the problems in winter, for all the reasons that we have rehearsed. If those places are not available, there will be bed blocking.

I welcome the fact that there are now more care packages in the community, but I am sceptical about the suggestion that the figure involved with those packages can possibly be greater than the number of lost beds in nursing and residential care homes. I do not see how that squares with the difficulties on the ground--social services departments are struggling with completely inadequate budgets and are cutting, and further cutting, the amount of support and care packages that they can buy or provide. That will create more winter pressures than there would otherwise have been.

I urge the Government to review yet again the funding formula that they use for social services authorities and health authorities, and to consider the weighting that they give to the number of elderly people that those authorities have in their population. The case of my own social services authority, Devon county council, is relevant. Before it was decided to move funding from the Department of Social Security to local authority budgets, Devon had about 16.5 per cent. of the national spend on long-term residential care for the elderly because we had 16.5 per cent. of the clients and patients. Under the system involving social services budgets, we have about 4 per cent. of the national spend, but we still have about 16.5 per cent. of patients and clients.

The funding formula does not give accurate or sensible weighting to the number of elderly people who live in a given area. About a year ago, my authority calculated that 500 residents would have to die before it would have the funding to put further clients into residential care. No one can run a budget on that basis. The authority has to raid other social services and county council budgets, such as those for education and highways, to make up for the deficiencies. Social services and health authority budgets need more funding in areas with many elderly people.

Had the Government accepted the royal commission's recommendation that free personal care should be delivered by the state, they would have made a huge contribution to relieving winter pressures in hospitals. We need to revisit that issue. I hope that it will be reflected in legislation and that the Government will invest in personal care.

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