1. Andrew Selous (South-West Bedfordshire) (Con): What estimate she has made of the cost to the NHS of the failure to return equipment loaned to patients in the last year for which figures are available. 
The Minister of State, Department of Health (Jane Kennedy): As I am sure all hon. Members would want me to do, speaking as Minister with responsibility for the health service in London, may I first pay my own tribute and express my deepest gratitude, which I know we all share, to the health and emergency services for their response last week?
Now to perhaps more prosaic, but none the less important mattersthe Department has not estimated those costs. It is for the local national health service and social care bodies to determine how best to provide equipment to meet the needs of individuals. Some equipment can be reused, subject to its condition and to any need to decontaminate it.
Andrew Selous: I am sure that the Minister will agree that public money is precious money, and I hope therefore that she will follow up the concerns of one of my constituents, a retired civil servant, who has brought to my attention the fact that many patients are loaned equipment on a short-term basis, such as chair and bed raisers, stools, helping hands and so on; that there is no follow-up for the return of that equipmentthat is purely left to the conscience of the patient; and that the providers of that equipment are making money out of the NHS by the continual loan of such equipment. Will the Minister undertake to look into that to ensure that there is no waste of precious NHS resources across the country?
I am grateful to the hon. Gentleman for raising this issue. He may be aware that in 2000 an initiative called integrating community equipment services was undertaken, through which we have placed greater emphasis on refurbishing and recycling equipment and, as he suggests, tracking the equipment
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that is loaned. He suggests that that is not working in his location. I would be grateful if he wrote to me specifically about that matter so that I can look into it in the detail that he is obviously requesting.
David Taylor (North-West Leicestershire) (Lab/Co-op): I endorse the remarks of the hon. Member for South-West Bedfordshire (Andrew Selous). There is certainly a problem in the east midlands, not unrelated to the fact that there appear to be no computer systems to track items that are not hugely costly individually, but are very valuable to people on the waiting lists for them. Will the Minister please investigate whether there is some way in which either a regional system or some other means could be developed to track, in particular, wheelchairs and equipment of that kind, which can lie gathering dust while other people could use them?
Jane Kennedy: I understand that the majority of services now pay particular attention to encouraging the return of such equipment and that those services have improved their decontamination, repair and maintenance systems. My hon. Friend will be pleased to hear that improved tracking systems are both enabling services to trace equipment and facilitating its return. However, given the concerns that have been raised today, I will undertake to look into this matter in some depth.
The Minister of State, Department of Health (Ms Rosie Winterton): Compliance with the code of practice is monitored by NHS Employers, an organisation that works closely with strategic health authorities and trusts to ensure that the NHS abides by the code.
Mr. Lilley: Can the Minister confirm that, none the less, this country imported some 15,000 nurses, largely from developing countries, in the last year for which we have figures, while exporting 8,000 nurses that we trained, largely to developed countries? Are we not at risk of being accused of hypocrisy if we spend a lot of time saying that we should give more aid to Africa, which should help its health service and train its nurses to cure the sicknesses and diseases that we deplore, when it is actually subsidising our health service by sending nurses to this country who, despite the measures that the Minister referred to, end up employed in the NHS?
We are the only developed country that has an ethical international recruitment policy. There are about 150 countries from which we do not actively recruit, including all the sub-Saharan African countries. I am sure that the hon. Gentleman will agree that it is difficult for us to stop people applying for jobs in this country and to prevent them from coming here. All sorts of human rights issues would be raised if we were to do that. However, we are clear that the NHS
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does not actively recruit in developing countries that say they have problems, and we have recently extended that to cover the independent health care sector as well.
Paul Clark (Gillingham) (Lab): I welcome the Minister's response as there is a need for a strong recruitment code in the NHS in respect of developing countries. Does she agree that there is a need for the NHS to share its expertise with such countries and those that are developing their own services? To that end, will she welcome the work of the Kent and Medway strategic health authority, which is currently hosting 10 Iraqi psychiatrists with the aim of enhancing their skills and knowledge, so that they can return to Iraq to develop their own home-grown mental health services?
Ms Winterton: My hon. Friend is absolutely right on two points. First, many people who come to this country to work in the NHS return to their own countries, taking with them new skills and expertise. Indeed, many Governments encourage workers from their countries to do that. Secondly, the NHS has many contacts with international organisations and other countries to help to train people and improve their expertise. I have met the 10 Iraqi psychiatrists to whom my hon. Friend referred, so I congratulate his trust on facilitating that programme by working with the Department of Health. The programme was greatly dependent on the commitment of Dr. Sadik, who initiated it. It will make a real difference to the development of services in Iraq and I know how much the psychiatrists appreciate the work that is being done.
Dr. Evan Harris (Oxford, West and Abingdon) (LD): I hope that the Minister will accept that I recognise the difficulties that she faces in controlling the flow, given what she said. Has she considered the British Medical Association's argument that there could be some form of restitution to countries? We know how many nurses are coming in from these countries, albeit not through active recruitment by the NHS, so could we not propose a scheme through which NHS workers could be funded on NHS salaries to volunteerI think that they would be willing to do soto go out in equal numbers to compensate those countries and provide their skills?
Ms Winterton: An active programme of work is under way to do just that. The hon. Gentleman is absolutely right that it is important for us to help developing countries to develop their health care systems in exactly that way. Much of the work is carried out through the Department for International Development, which recently put about £580 million into assisting the development of health care systems. DFID has worked jointly with the Department of Health and volunteers from the NHS. Some 40 per cent. of NHS trusts now have international links to allow volunteers to go to other countries and join in with Government-funded programmes, which are proving to be extremely successful.
Mr. John Baron (Billericay)
(Con): Although we recognise that this is a difficult area and that some progress has been made, there is no shortage of evidence to suggest that much more still needs to be done. For example, more than 10,000 work permits were granted
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last year to health workers from more than 80 countries on the Department of Health's proscribed list. No wonder the BMA has called on the Government to end the rape of the world's poorest countries. Given that the NHS is only commended to use recruitment agencies that comply with its code of practice, will the Government take a further step forward and give their policy real teeth by banning the NHS from using recruitment agencies that have not signed up to the code of practice?
Ms Winterton: We doabsolutely. Let me explain. Virtually everyone in the independent provider sector recently signed up to the code of practice. It is clear that if NHS employers find out that a trust has employed someone who has been recruited through an agency that has actively recruited in a developing country on the list of banned countries for recruitment, the agency will be removed from the trust's list. That extremely important development has taken place recently.
Returning to the question of work permits, I should say that the policy was changed recently so that work permits could not be extended from the time of training. For example, if people have work permits for the period during which they are training as doctors, they are expected to return to their home countries and reapply for a permit if they wish to work full time for the NHS. The changed work permit policy thus reflects some concerns expressed about people moving from training straight into full-time employment in the NHS. As I have explained, we continue to keep the policy under review, but the many recent changes have led to a 28 per cent. fall in the number of nurses recruited from South Africa, for example.
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