To ask the Secretary of State for Health what efforts his Department is making to recruit nurses to the NHS. 
To ask the Secretary of State for Health what recent representations he has received regarding the supply of nursing students. 
My Department continues to promote a range of initiatives designed to attract suitable, high-calibre recruits to the nursing profession.
The Secretary of State must recognise that there is a severe shortage of nurses. Does he recall that, in 1983, 37,000 nurses qualified? His Department predicts that in 1997–98, only 9,000 nurses are likely to qualify. Is that not a disgrace, given the pressure that it puts on nurses in the national health service? Why did he not take notice of the Royal College of Nursing's recommendation two years ago when it warned him of the shortage?
First, what I take notice of on the question whether there is a shortage of nurses is the independent review body, which examined the matter and published its report earlier this year, together with the finding that there was not a generalised shortage of nursing staff in the NHS, although there are localised shortages of nurses with particular skills. The figures that the hon. Gentleman quoted are wrong. It is not true that 35,000, or even 37,000, nurses qualified each year in the 1980s. The figure for nurses going into basic training in the 1980s oscillated around 15,000 a year—a figure to which we are returning in the commissions that we are planning for this year.
Does the Minister acknowledge that the drop in nursing student numbers, combined with increased demand, has caused nursing shortages? Is there any evidence that the 14 per cent. increase in commissioning of training places will be sufficient to meet future demand for nurses?
I hoped that the Labour party would welcome last year's 8 per cent. increase in the number of nurses going into basic training. This year, there is a further 14 per cent. increase in the number of basic training commissions. That takes us back, as I told the hon. Member for Wansbeck (Mr. Thompson), to roughly the same level of new commissions for basic nurse training as existed in the 1980s. Since then, there has been a dramatic improvement in nurse training because of the introduction of Project 2000, which has led to a reduction in the number of training nurses who drop out of training because they find it unsatisfactory.
Is my right hon. Friend satisfied that NHS hospitals can provide not only refresher courses but sufficiently flexible terms and conditions for nurses to encourage the return to the NHS of qualified nurses who may have left to start families and who are now able and willing to give more time to nursing?
My hon. Friend is on to a very important point. If we are to ensure that we have the skilled people we need to deliver modern health care, we must of course have a proper level of training, but we must also ensure that NHS trusts are good employers. My hon. Friend suggests some important ways in which we can ensure that we have a well-motivated, fully trained work force. The moves that the Government are making on more locally determined terms for nurses' employment are an important enabling step down the road that he rightly points out.
Does my right hon. Friend welcome the number of nurses who are now working in GP practices that are going in for primary care—a move that takes the strain off hospitals?
Yes, I can certainly join my hon. Friend in welcoming the huge growth in primary care nursing over the past 10 years. The number of practice nurses working in primary care 10 years ago was just under 2,000, but it is now 9,000. That is a fourfold increase in the nursing profession's commitment to primary care, which—as my hon. Friend rightly points out—is an important part of the health service.
Whatever the recruitment figures may have been last year, does the Secretary of State admit that, this year, there has been a triple blow to the morale of nurses in the health service? First, there was an independent recommendation on nurses' pay, to which the Government responded by giving nurses a pay rise below the rate of inflation. Secondly, huge amounts of time and money have been taken out of the health service by negotiating settlements on a local level. Out of 500 trusts, fewer than 200 have yet made offers. Thirdly, last week, although the Government recommended restraint to the House, they recommended that hon. Members vote a pay rise for themselves that is greater than the rise that they recommended for nurses. Nurses' morale is going down daily. What will the Secretary of State do to recover it—or is he absolutely oblivious to the problem?
The hon. Gentleman is wrong on every one of the points that he made. The Nurses and Midwives Pay Review Body made a specific recommendation, which the Government accepted in full and are implementing. It is not true to say that the Government have introduced a nurses' pay settlement that is below the rate of inflation. The Government have accepted the recommendation of the independent review body that there should be locally determined pay for nurses, with a 2 per cent. floor to ensure that every nurse gets a basic minimum increase.
Does my right hon. Friend recall the days of that nurse of all nurses, the matron? Will he advocate the return of the matron to hospitals when it is possible and appropriate?
My hon. Friend is right to point out the importance of professional leadership in the nursing profession, and the matron is one element that, in some trusts, has been found to be a means of achieving it. The most direct answer to the questions of my hon. Friend and of the hon. Member for Southwark and Bermondsey (Mr. Hughes) is to remind them and the House that, since 1979, nurses' pay has risen by more than 70 per cent. in real terms. That reflects both the commitment to nursing that my hon. Friend seeks and the commitment to proper pay for which the hon. Member for Southwark and Bermondsey argues.
Will the Secretary of State now accept that a real crisis is facing nursing in Britain? Will he explain to the House why nurses' morale has slumped, why nurse recruitment has collapsed and why the Government are still spending more new money on bureaucracy than they are on nurses? Will he also tell the House why uncertainty in the workplace is driving more NHS nurses away from providing valuable services? Today, will he announce that he will launch a national recruitment campaign to tackle the problem? Will he initiate talks with the Royal College of Nursing and nursing unions about the immediate crisis? Will he stop squandering the most precious asset of the NHS—its human resources? Nurses deserve better from the Government, and surely they should be getting some action from the Secretary of State.
The hon. Gentleman has to square his rhetoric with reality. He talks about declining recruitment in nursing. In 1994–95, the figure for recruitment into nurse training was 11,400 commissions; this year, there are 14,300 commissions. I defy the hon. Gentleman to square an increase from 11,400 to 14,300 with his rhetoric about declining recruitment. His rhetoric is nonsense, and the hon. Gentleman knows it.