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Monday, 21 May, 2001, 16:47 GMT 17:47 UK
John Denham quizzed

To watch coverage of the forum, select the link below:

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Health is a key issue in this election. The health minister John Denham answered your questions about the health service.

He took questions on a range of topics including waiting lists, pay for ancillary workers in the service, treatments standards across the country, and pay and conditions for nurses..

John Denham, the junior health minister answered your questions in a live forum.

A transcript of the forum appears below.

News Online Host

Hello, and welcome to election 2001 Online Forum. Today the issue is health and with me is the Health Minister, John Denham. Simple question first, John in Derbyshire asks, where on earth are the doctors and nurses? Where are those extra beds? Where are they?

John Denham

Well the doctors and nurses are right across the NHS, over 16,000 extra nurses, nearly 7,000 extra doctors and this winter for the first time for many, many years there's actually an increase in the number of general and acute beds in hospitals and that shows that the money is going in, and the investment is going in and we're getting extra staff. But of course it's not yet enough and that's why it's so important that we don't go back to Tory cuts after this election, that we can continue the investment and that will bring thousands more nurses on top of those we've already got and thousands more doctors, too.

News Online Host

David Thompson talks about doctors. He's from Leighton Buzzard, he's e-mailed us. He says you claim that you will increase the number of doctors in the UK, how is this possible given that the number of registrar places in the field of paediatrics has fallen by 130 in the last year and a half?

John Denham

Well, over all the number of registrar posts is increasing and that's why the total number of doctors is increasing. Now there will always be variations from one speciality to another. In the case of paediatrics it is because there is a relatively large pool of trained doctors or doctors in training that the training numbers haven't been increasing but if you look in other areas, key areas for cancer like hysto-pathology, for example, there are very sharp increases in the number of registrars, so overall the number of doctors in training for the more skilled jobs, the consultant jobs, is increasing and that's what will enable us to deliver the numbers.

News Online Host

I mean, one of the problems you've got is training new doctors, isn't it?

John Denham

Well, of course, you have to put the investment in and it hasn't been done in the past and we've already set out our plans for 2,000 extra medical school places. That is the right thing to do. Of course it will be seven years before the first of those doctors becomes available to the NHS. That is frustrating but there's no alternative and at least this government is investing in a huge expansion of medical education that should have been done years ago. If it had been done years ago we would have a lot more doctors, but we will at least ensure they are there for the future.

News Online Host

But you're saying you'll benefit from doctors now, surely if it's seven years ago then you'll benefiting from Conservative policies.

John Denham

Well, part of the, obviously doctors entering training seven years ago, entered training as under-graduates under a Conservative government. The number of registrar posts, that is those who've been through their basic training and who are now training to become consultants, has been expanded by this government.

News Online Host

Just moving on, Derek Ramsay from London wants to talk about the 15,000 new nurses. He says, I'm a staff working in a London intensive care unit. I'd like to know exactly where the 15,000 new nurses in the NHS are hiding, as my colleagues and I have not seen them. How exactly are the figures made up and what are you counting as a new nurse in the NHS? Does that include auxiliaries?

John Denham

No. The new registered nurses are counted by a census that's carried out every year by the NHS. That is actually published trust by trust, and health authority by health authority. So actually I can't give you the hospital by hospital now. But that is published later so people can see how many nurses, how many of the nurse numbers have increased by in each hospital. So it's the absolute increase in the number of nurses, it's taking account of everybody who's retired, everybody who's left the profession. It's an absolute increase. And if anybody wants to know about their own hospital and what's happened to nursing numbers or doctors numbers over the last few years, that's public available information and that's where this increase figure comes from.

News Online Host

How often to you get asked that question then, where are the nurses?

John Denham

Well what people often say, you see, what people often say is look, we're still under a lot of pressure. That's really I think what lies behind the question. And of course that is absolutely true because the pressures on the NHS are also increasing. That's why we're not satisfied with what we have done so far. That's why we need more new, additional nurses over and above those we've already recruited.

News Online Host

Julie from Uckfield in East Sussex, has e-mailed us, she talks about exactly what you were just talking about, pressure. She says that she works as a community nurse and she finds that the level of stress in the team is at a record high. The amount of paperwork has increased over the past few years, taking time away from the patients. There's so much change in her team, a lot to do with merging with another trust, and so on, what are you going to do about giving them the time to be with patients 100 per cent?

John Denham

I think it is very important that we go systematically through the NHS and identify areas where unnecessary paperwork has been built up for whatever reason. We've just done that as a big exercise for GPS. I'm not saying taking it away from nurses, but I'm just saying that the most recent thing we've done is we sat down with GPs, we said let's go through the paperwork that you do and actually we've been able to strip out millions upon millions of hours of work by GPs on paperwork. And I want to make sure that we can do that in other areas of the NHS as well.

News Online Host

How are you going to sort of square this relationship between the private sector? Because Tony Earhardt from Manchester has e-mailed us and she says as a financial management trainee in the NHS, she would like to know how far the Labour Party if re-elected intends to use the private sector in delivering health care?

John Denham

People should be in no doubt about two things. One is we are absolutely committed to the idea that NHS treatment is free at the point of need. What we have done this last winter is to use the private sector where we are in a situation where the NHS have money but not the capacity to carry out the operations and rather than have people wait unnecessarily on the waiting lists those operations were paid for in the private sector. They were still NHS operations, the patients didn't have to pay, and that co-operation will continue. But nobody should be in any doubt, the NHS is going to be the predominant provider of NHS health care. We've got the biggest hospital building programme in the history of the NHS underway. Those are NHS hospitals that are being built.

News Online Host

Under the NHS plan you said that we should have this stand-off between the private and the public sector in the NHS.

John Denham

Within the NHS we had a plan and last winter we had a concord act with the private sector which governed the way the NHS could use private sector capacity when the NHS didn't have the capacity. With the consultants what we want to do is actually to have a contract that rewards consultants better and more fairly to their commitment to the NHS than the NHS contract does at the moment. Now as part of that we said that we want to negotiate perhaps seven years just after people become a consultant in which they would work exclusively for the NHS. Coupled to that are higher rewards for commitment to the NHS. Now that's a contract which we've currently got to negotiate with the BMA over the months to come. But we really want to do is to say to a young doctor, if you commit yourself to the NHS for your career there will be rewards to you for doing that.

News Online Host

Well, one of the things you've committed to doing by the end of 2005 is reducing the maximum waiting list time. What are you doing now? Because Andrew Sneddon from Tamworth in Staffordshire says, I had a bypass operation after waiting three years from my first appointment. Is it not time that we had one standard of care in the UK and that care should meet people's basic needs?

John Denham

Well there are a number of things that we are doing and it's quite true that there are parts of the NHS where waiting lists are too long. Firstly we are cutting the waiting times in key areas, for example, in cancer treatment. We have said by 2005 that no one will wait more than three months for an out-patient appointment. And six months for an in-patient appointment. And between now and then we will be delivering on those targets. Now we'll do it in two ways. One is that we will put money into the service for the doctors, and the nurses, and the operating theatres, and the equipment, where we need to do it. And secondly we will re-organise the way that services are managed. Because sometimes we can cut waiting times dramatically by better management of the service. And in key areas, like coronary heart disease we have set out national standards just as your e-mailer has asked for. National standards as you say. This is the quality of heart care you should get from your GP in the community, this is the quality of heart care that you should get in a hospital. So we are setting national standards in key areas of clinical practice.

News Online Host

But Scott from Salisbury says his out-patient appointment has been deferred twice since January and there's no guarantee that the current appointment will be honoured. And Karen says that why should she wait nine months for an operation when she can get one on the private health care system tomorrow?

John Denham

Well, lets look at the fundamental problem here. The NHS suffered from under-investment for years. The hospitals were out of date, there were too few staff. Investment that we've been making on the back of a successful economy is turning that round. But none of us are saying that the NHS is yet offering the short waiting times that we want it to offer right across the board. Some people do wait too long. What we must do is keep the new investment going into the NHS, not go back to Tory cuts, and that will deliver the shorting waiting times. Now that is going to take time. There's no easy way out of this. It's going to be step by step progress, year after year, but we will deliver on the shorter waiting times across the board that patients want to see.

News Online Host

Now presumably in 1997 you had the luxury of saying, well the Tories were in power, of course waiting lists are long. Why are we still in the 21st century saying that they are too long?

John Denham

Well, the NHS has lacked capacity. Take the problem of nursing numbers. We've done well to increase nursing numbers. But we don't yet have the supply of nurses that we want. So when we were elected in 1997, we set about reversing the cuts in nurse training places that the previous government had instituted. The number of nurse training places has gone up from 15,000 to 21,000. It will go up more. This September is the first month in which nurses who've been trained under a Labour government in those new places become available for the NHS. It takes time for the investment to produce the staff and the new facilities that we need. And that is why it is still fair for us to hark back to what happened to the NHS under the Tories. We hope people will recognise the progress we have made but recognise that there are a number of years of high investment still that need to be made to deliver the NHS we all want to see.

News Online Host

The Royal College of Nursing, not a militant lot, I would argue, over in Harrogate today condemning the practice of employing nurses from overseas. We're still at crisis point aren't we?

John Denham

Well we need to employ nurses from overseas, we need to make sure that is properly done, we need to make sure as we are doing that the NHS is not recruiting from countries like South Africa or Zimbabwe which have a nurse shortage. But there are countries, countries in Europe, like Spain, where nurses have come over in the last few months, or the Philippines, where they have a surplus of nurses and the government is happy for them to work overseas, where we can bring those nurses into the NHS. And until we get the full benefit of the investment that Labour has made in nurse training, we will need to have overseas nurses coming into the NHS.

News Online Host

What about the relationship with the private sector, just going back to that issue. Surely there must be some sort of relationship with the private sector to help lower paid workers in the NHS.

John Denham

Well, pathology lab staff got a much higher pay increase than most other people in the NHS this year because we recognise the pressures they are under. Ultimately, we are working with the unions at the moment to have a much better pay structure throughout the NHS, one where people don't get trapped in the way they can do at the moment at the top of grades, and so on. So we've recognised the problem of pathology. We addressed that this year, but there's more to be done in reforming the pay system. Overall I would make the point that with nurses, for example, the previous government was always in the habit of denying them the pay increase they were rewarded by the review body for six or nine months. We have for the last three years made the nurses' pay award in full and paid it from day one.

News Online Host

One of the main themes of all of these e-mails that have come in, you've had a lot of policies but you haven't delivered.

John Denham

Well we have delivered. We've delivered on more doctors, we've delivered on more nurses, we've delivered our promise to cut 100,000 from the number of people on waiting lists. The waiting times for out-patient appointments are coming down and have been consistently coming down for months now. So we have delivered but we're not yet there. The NHS isn't yet in the state we want it to be. But it's going in the right direction. But it depends on us maintaining the investment that we have started and that only a Labour government will continue after the election. The Tories with their 20 billion of spending cuts have made it quite clear they're not going to be able to sustain investment in public services. So if people want progress to continue I hope they will support us at the election.

News Online Host

OK, simple question again. Peggy Webb from Whitley Bay asks in the light of the TB outbreaks why, is there going to be an inquiry into the decision to stop vaccinations? Why stop?

John Denham

Well there wasn't such a decision to stop vaccinations. As you know we had problems with the supplier of the vaccine to the NHS, so for a period of I think two years we had to prioritise certain areas and certain groups of children. Those suppliers are now coming back on-stream and the vaccination programme is starting up again. So the root cause of the problem was actually with the suppliers of the vaccine. And that was a problem that was beyond our direct control.

News Online Host

OK, so you can't do anything about that today. You'll say tomorrow?

John Denham

Well, no that programme is now coming back on-stream.

News Online Host

John Denham, Health Minister, thank you very much.

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