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Mrs. Dunwoody : The Minister cannot intervene on me.

Mrs. Heal : My hon. Friend's comments echo the concerns that already exist. Ministers regularly say that the opted-out units are independent, so the Minister cannot then argue that they are part and parcel of the structure. The health service is being fragmented.

Mrs. Bottomley : The hon. Lady has failed to understand that the ring-fenced money held by the regions is for the trusts or directly managed units. Therefore, if such a cynical interpretation of the motivation of those committed professionals who are carrying forward the first wave of trusts were to apply, it would be irrelevant because the resources are ring fenced by the region and the trusts would be at no disadvantage. That cynical interpretation of the commitment of all those dedicated professionals who are carrying forward the first wave of trusts is so bitterly resented by the health service, which is why the Labour party has lost all credibility with the health professionals.

Mrs. Heal : Despite what the Minister has said, we are not embarrassed by our policy on health--far from it. We are saying that, under the legislation for the trusts, there is no obligation for them to train, despite what the hon. Lady has said.

Mr. O'Brien : May I substantiate my hon. Friend's point? I referred to the example of St. James's college in Leeds, which is a trust-funded college. It now discriminates against trained nurses taking the Project 2000 scheme. My hon. Friend has evidence. A person who is prepared to be named--I shall give the information if

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called to do so--has told me about the discrimination on training in a trust hospital in Leeds. The evidence is there and my hon. Friend is right to bring the matter to the attention of the House.

Mrs. Heal : I thank my hon. Friend for that helpful intervention.

Mr. Keith Mans (Wyre) : Where is the evidence?

Mrs. Heal : My hon. Friend the Member for Normanton (Mr. O'Brien) has already said that the information is there.

We are concerned about nurse education, which is why we believe that it will be crippling for the NHS and for the nation's health if, in years to come, we have poorly trained nurses who leave the profession because they are denied the opportunity of advancement and the capacity adequately to treat patients. Training does not make cash as extra-contractual referrals do, but it is an investment in Britain's health. The problem is that the Government will let opted-out units opt out of training and education. That will not happen under a Labour Government because units will not opt out. We welcome the Bill and support it in principle. The desire to modernise the UKCC and the national boards, and to condition them for the 1990s is uncontentious and is supported by the Opposition, by the professional organisations and by the health unions. The Bill is a commitment to nursing and to the esteem in which the professions are held throughout the country. We are concerned about some issues and we may wish to raise them again later in the Bill's progress to safeguard the position of all nurses throughout the 1990s. 5.51 pm

Mr. Roger Sims (Chislehurst) : I warmly welcome my hon. Friend the Minister's announcement about Project 2000 and its funding. I vividly recall speaking at a meeting of nurses when Project 2000 was first announced. Although nurses were delighted by the Government's saying that they intended to implement the proposals, there was understandably some doubt about whether resources would be made available for that. The Government have lived up to their word all the way along, and this afternoon my hon. Friend has said that the Government are backing Project 2000 with increasing amounts. I venture to speak on the Bill, first, because I have a general interest in health and, secondly, because I am a lay member of the General Medical Council, a self-regulating professional body which has much in common with the United Kingdom Central Council as it will be and as it has been.

It may be something of a cliche to say that some features of our country are the envy of the world, and it may not always be true. However, it is undoubtedly true in respect of both hospital and community nursing. It is commonplace to hear anyone who has been looked after by nurses expressing the highest praise for their diligence and sympathetic care, whether in hospital or in the home. I personally endorse that sentiment, having spent time--happily only a day--during the recess in hospital as a patient.

Our nurses are very much in demand in the United States, in Commonwealth countries and in the middle east, and they do wonderful work in parts of the third world.

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The reason is simple. They have a high standard of education and of professional performance, which is what the Bill is all about. The Bill simplifies and improves the systems of nursing education and of disciplinary procedures for the purpose of imposing and maintaining the highest possible professional standards. I wish to comment on two matters. First, the UKCC will continue to deal with professional misconduct, unlike the General Medical Council whose brief is to deal with serious professional misconduct. The definition of those two terms is a matter for discussion, to be decided by the respective councils and, if necessary, the courts.

Hitherto, the only power that the UKCC had in such cases was erasure from the register. As the Minister has explained, the Bill adds the possibility of suspension and, since the discussion in another place, the sanction of a caution. That is entirely admirable, because there are bound to be cases in which suspension and a caution will be more appropriate than complete erasure.

There is another dimension. As one of the two lay screeners on the General Medical Council, I see letters of complaint about doctors on which the council is unable to act. The reply to the complainants explaining why the council is unable to act has to be approved not only by a medical member of the council, but by one of the two lay screeners. I see a number of complaints that do not come near serious professional misconduct. Under the present powers, the GMC is unable to deal with them, yet the complaint, sometimes about one incident and sometimes about a series of incidents, may demonstrate that the doctor's behaviour is below the standard that patients are entitled to expect. At present, the GMC cannot deal with such a case. The GMC is addressing the problem under its performance review and my hon. Friend the Minister will be aware that various proposals are under discussion and are likely to appear before the House in due course. I cannot see that the Bill addresses a similar issue with regard to nurses, I am not talking about a specific offence of commission or omission, but about a nurse whose performance is simply not up to scratch. If that is the case, neither erasure nor suspension would serve any purpose, and a caution would help only if it were accompanied by more positive measures. What is needed is a mechanism for reviewing the nurse's performance, and for proposing and supervising some means of improvement.

One other clear difference between doctors and nurses is the fact that a doctor, once qualified and registered, is free to practise at any time regardless of whether he or she has been in regular practice and has kept up to date with medical developments. An example well known to the House is the right hon. Member for Plymouth, Devonport (Dr. Owen) who, as I understand it, could put up his plate as a general practitioner tomorrow morning despite the fact that he may not have seen a patient and certainly has not practised for 20 or 25 years. I hasten to add that he has made it clear that he has no intention of doing so. As an officer of the Hong Kong group, I might be tempted to consider other ways in which the right hon. Gentleman's talents might be directed--although you, Mr. Deputy Speaker, might feel that that was a little outside the scope of the Bill. It is, rather worrying that what I have described could happen. Let us suppose that a nurse who is trained, qualified and practising leaves the profession to raise a family and returns to it after an interval of some years. As

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I understand it, in the nursing profession there is a clear requirement that, on re-registering, a nurse must satisfy the UKCC every three years that she has kept her skills and knowledge up to date. That appears to me to be admirable, and it is an example from which the GMC could perhaps learn.

Mrs. Dunwoody : I have great sympathy with the hon. Gentleman's point and if, in future, he seeks to amend the Bill to suggest some form of retraining, I shall be happy to support his amendment. Having said that, there is a mild barrier in the case of doctors. In practice, if not in law, anyone seeking to go back into general practice who had not undertaken the necessary training period would find it virtually impossible to get another job. I agree absolutely that, in theory, anyone could return to general practice, but in practice he or she might find very real barriers.

Mr. Sims : The hon. Lady is quite right, and I remind her that I used the words "in theory", although I think that there would be nothing to prevent a doctor from starting up in private practice. Clearly, it would be difficult to get a job within the health service, but we know that there are plenty of doctors in private practice. I should like also to comment on the lack of lay involvement proposed for the UKCC. The UKCC is to be composed of 60 members in all, 45 of whom will be elected and 15 of whom will be appointed by the Secretary of State. But clause 1 gives the Secretary of State pretty clear guidance on the sort of appointments that he should make, and it looks likely that all 60 will be members of the nursing profession of one sort or another. That compares with a GMC of 100- plus members, of whom a dozen are lay members.

I fully understand the anxiety that all branches of the profession should be represented on the council and that there should be the right sort of geographical spread. My own involvement makes it difficult for me to be entirely objective about this, but I suggest that there should be some form of non-professional representation on the UKCC. One reason for that is that I think that lay involvement is right in principle. After all, nurses do not operate in a vacuum : they deal with patients all the time. Every one of us has been, or is likely to be, a patient. It is surely right that patients, as users of nurses' services, should at least have a voice on the council. Secondly, I suggest that lay people have something to contribute to the UKCC's deliberations and work and, although I say it myself, I think that the professional members of the GMC would endorse the view that lay members have a useful contribution to make.

Thirdly, it would be good public relations for the council not to be seen as an entirely closed body. I am sorry to keep referring to the GMC, Mr. Deputy Speaker, but it is a comparable body of which I have some knowledge. There is a tendency for people to refer to the GMC as the doctors looking after their own, but having worked for the GMC, my own impression is that doctors quite often wish to be harder on their own than lay members might be. Be that as it may, the implied criticism is at least modified by the fact that people know that a lay element exists within the GMC. Whether we like it or not, public image is important nowadays, and I wonder

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whether it would not be in the interests of the UKCC to consider the benefit of lay involvement, especially where matters of professional misconduct are being dealt with.

I apologise for detaining the House with those thoughts. I hasten to add that my comments have been in a constructive spirit. The Bill seems to me to be entirely admirable. I hope that it will command the full support of the House and will receive Royal Assent before other events intervene.

6.4 pm

Mr. Tom Pendry (Stalybridge and Hyde) : First, I congratulate my hon. Friend the Member for Mid-Staffordshire (Mrs. Heal) on her debut ; indeed, I thought it rather churlish of the Minister not to recognise that her opposite number was speaking from the Opposition Front Bench for the first time. I look forward to my hon. Friend making her debut as a Minister, and I am sure that that occasion will come in the not too distant future. When I was campaigning for my hon. Friend, I told the electors of Mid-Staffordshire that they would be sending a star to the House ; my hon. Friend has certainly lived up to that already.

If ever evidence was needed that we are in a general election year, the Bill before us provides it. Why else would the Government at last be listening to the views of professionals and trade union representatives who work in the national health service, who for years have been giving the Government the benefit of their experience and knowledge of working in the health service, day in and day out, only to find their advice falling on deaf ears?

Like my hon. Friend the Member for Halifax (Mrs. Mahon), I am sponsored by the National Union of Public Employees. We are well aware of the problems faced by those who have given their lives to working in the health service. My hon. Friend and I have raised their concerns in this place on many occasions. It is regrettable that it has taken the Government until now--as they approach the day of reckoning at the ballot box--to show some belated willingness to take those people's knowledge on board.

For all that, the Bill is welcome and it is to be hoped that the Government's apparent Saul-like conversion to the concept of listening to our NHS professionals will extend beyond the immediate measures proposed in the Bill. Certainly, I know that my constituents--workers, users and passionate supporters of the health service--are looking to the Government to match their own commitment to the NHS.

One important reason why it is to be hoped that the Government's attitude, as demonstrated today, will remain is that the nurses' pay awards are soon to be announced. My colleagues in the NUPE group of Members and I hope that, this year, the Government will listen to staff representatives as well as their own pay review body. I am well aware that our nursing staff are anxious that, rather than the pay award being staged, leaving the health authorities to make up shortfalls of up to £44 million, it should be implemented in full on the due date and fully funded.

The enormous value of the jobs that our nursing staff do should be recognised not only through the words that Ministers utter in this House but through actions to back those words. If the Minister wants to give concrete evidence of the Government's commitment to the national health service, she will announce today, in reply to the

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debate, that the Government will indeed fully fund that award and not seek to stage it. My hon. Friends and I look forward to hearing her make that announcement.

The general thrust of the measures in the Bill has commanded widespread support, as evidenced in the co-operation extended by my noble Friends in the other place to get the measures on to the statute book as quickly as possible. The Minister will be aware, however--from the contributions made in the other place by my noble friend Lord Carter among others--that there are still reservations on some issues that many of those working in the national health service would wish to have raised and taken on board by her and her boss, the Secretary of State.

My hon. Friend the Member for Mid-Staffordshire mentioned some of those reservations. I should like to back her up on a couple of issues so that we may be sure that, together, we have caught the Minister's ear and that the hon. Lady can pass on our concerns to her boss.

For example, the health service unions have expressed concern about the proposed changes to the constitution of the UKCC, to increase the council's maximum membership from 45 to 60, with the specification that two thirds be elected by the professions and the remainder appointed by the Secretary of State. Under that move, although the council would increase its membership, the opportunity to be a representative elected by the profession will be radically reduced. The Minister must recognise that.

Currently, 102 members are elected to serve the national boards rather than the council. It is entirely proper that there should be direct elections to the UKCC, but the Minister knows that the proposed number of elected representatives on the council would deplete representation by more than half. The Minister will also know that the health service unions think that this balance needs to be changed. She should give a commitment to take their views on board. The Minister should assure midwives and health visitors that their voice will continue to be heard. I am told by some of them that if that does not happen they will feel isolated, unsupported and unable to influence policy. I am sure that the Minister will wish to allay those fears when she replies to the debate. That matter is especially important in view of the transfer of responsibilities for financing nursing, midwifery and health visitor education and training to the regional health authorities. That will mean that the RHAs will be responsible for determining the allocation of funds based on their own priorities and the regional interpretation of education and training needs.

The unions feel that this will create a gulf between policy developed by the UKCC and the implementation of that policy by the regions. The Minister has given some reassurance, which I accept, that she will do everything in her power to see that education and training in the NHS are extended and promoted. However, that does not go far enough, and I hope that, during the passage of the Bill, we shall have a more positive statement from the Minister.

In the context of Project 2000, my hon. Friends were right to impress upon the Minister the problems that are emerging in nursing education and causing a great deal of concern. My hon. Friend the Member for Normanton (Mr. O'Brien) was right about that. I have been informed by the nursing unions that enrolled nurses are afraid to come forward for the training schemes intended by the reforms, because there is no guarantee of a job to which

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they could return. My hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody) also made that point. Many have lost motivation and have become demoralised by the fierce and unrealistic competition for the tiny number of places available. The Minister must surely agree that that is scandalous and should tell us the action that she intends to take. She has gone some way by speaking about extra funding, but nurses want more positive assurances.

The Minister must answer the questions that have been asked in the debate. Although in the main the Bill is not contentious, we shall attempt to improve it. The Government are at least listening to what is happening in some parts of the health service, but they have a long way to go to ensure that the people who staff our NHS feel that they have the commitment that they need from the Government. 6.13 pm

Mr. Charles Kennedy (Ross, Cromarty and Skye) : I shall be exceedingly brief, because other hon. Members want to speak in this short debate. We must be making history because, since 1979, I cannot recall a Department of Health Bill having all-party support. That is an astonishing development, but, of course, we are on the eve of a general election. As the hon. Member for Stalybridge and Hyde (Mr. Pendry) said, it suggests that, as the Government are about to face reality, they are trying to do something in the health service that might command broader support.

I should like to underscore points that have already been made and to stress some anxiety about the Bill. One of the worries is about the proposal to transfer responsibility for education and so on down to local level, with consequent pressure on budgets. Such strain could lead to erosion of the importance of education and related matters. In her response, the Minister should dwell on that, because I am sure that she remembers only too well the passage of the National Health Service and Community Care Bill, the consequences of which may yet help to consign the Government to oblivion in the election.

The Minister will remember the lengthy arguments about community care, as will the hon. Member for Ynys Mo n (Mr. Jones), about the ring fencing of community care. The hon. Member may well speak about that in the debate. The Minister and other members of the Government trotted out arguments about why it was not acceptable to have such ring fencing. The most remarkable argument of all from this centralising Government was that it would undermine local democracy. If it was not acceptable to ring-fence community care at that time, how can the Government stand equivalent arguments on their head and rightly accept ring fencing in the context of nurse education? Perhaps the Minister could say more about the issue mentioned by the hon. Member for Mid-Staffordshire (Mrs. Heal) and discussed in another place--the stipulation that the function of the board in relation to midwifery is included in the legislation. However, a guarantee of the involvement of professional midwives in terms of direct representation is not mentioned in the Bill. Would it not be sensible to redress that? Judging by the Minister's opening speech or by pledges given by her colleague in another place, I do not think that the Government intend to exclude midwives in this way, and

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it would be sensible to include a provision in the Bill. The Bill commands all-party support, and I do not anticipate a Division. 6.16 pm

Mrs. Gwyneth Dunwoody (Crewe and Nantwich) : I shall be brief. As a vice-president of the Health Visitors Association, I shall deal especially with the worries of members of that association and those of midwives. A good midwife is worth 10 doctors, a theory that I proved somewhat practically many years ago. Their special skills should not only be retained but fully understood, and I am sorry to say that I see no clear evidence in the Bill that those people will be fully consulted and their needs taken into account. It is pointless to produce glossy patients charters stating that people will have freedom of choice and consultation about the facilities they receive when they do not have access to midwives who are able to transmit their worries upwards and downwards within the profession. It should be realised that midwives and health visitors are not only constantly learning new techniques and developing their skills, but that they frequently have to change their responses to meet developments in medicine and social care. That puts tremendous stress on the profession and requires a flexible, skilled and trained response from the practitioners in midwifery and health visiting. I hope that such matters will be addressed by the Bill.

I would be happier about the Bill if it were not so clear that the trusts will face great difficulties not only in the immediate future but in the continuing future in relation to nurses who seek further training courses, almost of any kind. In the first wave of trusts, the word "nursing" seems to have almost disappeared from the job descriptions. There are hardly any senior nursing posts listed in the trusts. That bodes ill for proper representation at every level of the professional structure.

The Minister is so reasonable and balanced that, whenever she appears, I know instinctively that the Government must be trying to put over something shady. They would not need such an apparently reasonable member of the House of Commons if their doings were above board. Therefore, the Bill must be looked at carefully. Although we may say, in a slightly dismissive way, that it is a straightforward, non-contentious Bill, it concerns the level of health care, not only for mothers for many generations to come, but for sick people at many levels of the health service, both within and without the hospital service.

In the past seven months, I have unfortunately had a rather close association with the health service as a patient, as the grandmother of a patient and as the daughter of a patient, and with a large number of London teaching hospitals. It is about time that the House of Commons realised that there is no point in bringing forward structures in which we talk about a high level of nursing care if, when it comes to the point, there is nobody on the wards capable of carrying out that level of nursing.

We should be concerned that a nurse can appear at the beginning of a shift, say, "My name is Susan, and I am looking after you," and then never be seen again because,

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like many others who are brought in in large numbers, she is an agency nurse, knows no one on the ward and is unable to have any relationship with the patients.

Like several of my hon. Friends, although I have a word of commendation for the Bill, I feel that we should be asking for more undertakings. It is nonsense to say that the money for education will be ring-fenced. In my area, the regional health authority is the most placid political lapdog of all the RHAs. It does exactly what its masters want, showing a level of dogma that, were it representing the Labour party, would warrant six-inch banner headlines in The Sun. Therefore, an undertaking that the RHAs will ring-fence money for training is not worth the paper that it is written on. Apart from that, I am sure that this is an excellent Bill.

6.22 pm

Mr. Ieuan Wyn Jones (Ynys Mo n) : It is pleasant to turn to a considered and measured debate on a Bill that commands general support, after the hype that we heard in the statement by the Secretary of State for Wales about local government finance. It is nice to have an atmosphere in which we can debate constructively the future of some of our great professions, particularly nursing. I had better declare a family interest, in that my mother was a qualified nurse and for many years was a district nurse in north Wales, and my wife is also a qualified nurse and midwife and has recently returned to the profession after a career break. I know something about the practical problems of nurses and how devoted they are to their professions and patients. I remember in particular during some pretty wicked winter months the problems that my mother and some of her district nurse colleagues had in reaching their patients through snow and drifts.

It is right that we should look, from time to time, at the way in which nurses are educated and trained, and at how they conduct themselves. Therefore, this small Bill is to be welcomed, in as far as it goes. However, one or two points need to be underlined. One, as hon. Members on both sides have said, is that we must recognise the challenges that face nurses, and particularly health visitors, in the current climate in the NHS.

A number of health visitors are worried about the direction in which their branch of the profession is moving, in the light of the new responsibilities that general practitioner practices are taking on, which mean that their clinics are taking over work that health visitors used to do.

If those changes mean that health visitors are taking on more responsibility for such things as health promotion, they are welcome. There is an extensive need for health promotion, especially given the recent report published in the county of Gwynedd, which showed a great increase in the number of girls who take up smoking at the ages of 12, 13 and 14. The work done by health visitors in health promotion, especially in this sector, is valuable. If that work can be extended, we should welcome such a move.

The new powers on disciplining of nurses who transgress are to be welcomed. To have just one power, that of erasure, is to take a sledgehammer to crack a nut. Many cases could be dealt with either by a caution or suspension. The disciplinary bodies would have more flexibility in dealing with problems if they did not have to go to the full extent of erasure. The morale of nurses would be improved if they knew that, for minor transgressions, they would not face the ultimate penalty.

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A number of us have rightly underlined the need to look closely at the Government's proposals for the devolution of training responsibilities to regional health authorities and health authorities in Wales. We understand that the Government have accepted ring fencing, but when I looked closely at the arguments advanced in another place, I noticed that we were not told how long ring fencing would apply.

I hope that the Minister will tell us whether it is to be for one year only or for a number of years. This is important for one basic reason--if regional health authorities and district health authorities are to have proper provision for training, it must be planned over a number of years. An assurance on that would be helpful.

I make a final plea. In some cases--this is not necessarily personal experience--I have seen that nurses find it difficult to go back into the profession that they left many years ago to raise a family. Often, they re- enter the health service at grades lower than those to which they should be entitled. It would be useful if the Government were to say that nurses, after a career break, should be welcomed back into the profession, given proper training and guaranteed a proper job at a proper rate of pay and proper grading.

I welcome the Bill, and hope that it will have a speedy passage through the House.

6.27 pm

Mrs. Maria Fyfe (Glasgow, Maryhill) : I congratulate my hon. Friend the Member for Mid-Staffordshire (Mrs. Heal), whose contribution I enjoyed. I thoroughly agreed with the points that she made, and in particular with that about full representation of the various regions--a point not made by the Minister. I want to take that up, because it is a question not only of the regions within England, but of the nations within the United Kingdom. Although this is a United Kingdom Bill, it does not explain how it will be ensured that there will be proper representation among the appointments that the Secretary of State makes, to take account of nurses, midwives and health visitors living and working in Scotland. There may be an answer, but we have not yet had it from the Minister.

If health boards in Scotland are answerable to the Scottish Office, I want the Minister to answer this question about funding for training and education for health boards in Scotland. Is it proposed that there will be a difference, and if so, what will it be? In the discussions that I have had, midwives and health visitors in Scotland have told me of their concern about the changes in the practices that they are expected to undertake. The role of health visitors is being changed substantially in ways they are unhappy about. For a long time, midwives have been concerned about their role being undervalued and diminished by the high-tech treatment given by hospitals. It is essential that training and education give people occupying these positions the respect that they deserve and maintain the status of the profession, rather than diminishing it. The women who occupy most of the jobs in the profession feel that the latter is a more likely result.

When I intervened earlier, the Minister confirmed that there was nothing in the Bill about the section 32 arrangements of the Whitley council. If the Government do not introduce changes to the appeal procedures in the Bill, it is surely important to know when they are planning

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to do so. It is only weeks before we shall have a general election. I suspect that they hope to introduce changes at a later stage by means of a manoeuvre. If that is not their hope, I want an assurance from the Minister to that effect this evening.

It is pointless to complete a rigorous, expensive and highly specialised form of training if the health visitor or midwife finds that there is no job at the end of it. That has happened recently in Scotland's central belt. Health visitors were told, "I am sorry, but there is no work for you." Surely hon. Members on both sides can agree that the training of health visitors and midwives can be planned so that time is not wasted. In most instances, these people cannot apply for jobs in places throughout the United Kingdom. It must be recognised that they have family responsibilities in their own area.

6.31 pm

Mr. William O'Brien (Normanton) : I was content with the Minister's reply when I intervened earlier, especially with the parts relating to the principle and practice applied to those applying to be enrolled for the Project 2000 scheme. The Minister said that, if I would provide details of the constituent to whom I referred, she would take the matter up, and I shall do so.

I have been provoked to contribute to the debate by the position adopted by trust hospitals. The hon. Member for Wyre (Mr. Mans) asked for evidence, and I will supply it.

St. James's hospital in Leeds is a trust hospital with a nursing college attached to it. One of my constituents--Linda Bichard, who lives in Outwood --wrote to the Prime Minister on 7 January setting out details of her concerns. It is surprising that a letter received by the Prime Minister's office has not yet been passed to the Minister for Health. My constituent telephoned the director of nursing services at St. James's to inquire about enrolment for Project 2000. She is a qualified nurse with 14 years experience, a background which qualified her for a place within the scheme.

Mrs. Virginia Bottomley : If the hon. Gentleman's constituent is a qualified nurse, how could she be applying for a Project 2000 course ? The course would prepare her to become a qualified nurse.

Mr. O'Brien : The young lady wishes to further her career within the nursing profession. She wishes to take advantage of the opportunities offered by Project 2000. If a person is dedicated to nursing and there are further qualifications that he or she can obtain, no restrictions should be placed on the person who wishes to obtain them.

As I have said, my constituent telephoned the director of nursing services at St. James's hospital in Leeds. She was told that her qualifications made her eligible for a position on the Project 2000 course. She was further advised that the decision of the nursing college to refuse to take her and others like her was an executive one. In the Cambridge area, however, a person with the same qualifications could be allowed to enrol. Therefore, there is discrimination. My constituents are losing out because trust hospitals are denying people such as Linda Bichard an opportunity which is being given to people in other areas by the national health service.

When my constituent wrote to the Prime Minister she set out her qualifications and explained that she was

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engaged in part-time studies to obtain further qualifications so that she would be qualified to participate in the Project 2000 course. She explained that she was astonished when she was told by the director of nursing services at Leeds that, although she was qualified to embark on the course, her application was being refused. As I have said, she was told that it was an executive decision. As Linda Bichard wrote, although many people drop out of the course, there are many others who are dedicated to the NHS and to the nursing profession, but are being told that there is no opportunity for them to further their aims within the nursing profession. Like my constituent, I find that astonishing. People wish to gain further qualifications and to help the nursing profession, but because of dogma--in this instance, and executive decision--they are being denied the opportunity to do so.

My constituent was told that she should contact the clearing house in Bristol to ascertain where the decision was taken and where enrolled nurses would be accepted for a Project 2000 course. On 7 January she wrote also to the officer in charge of the clearing house in Bristol. She explained her position and set out her

qualifications. She told the officer that she had applied for Project 2000 training at Leeds college of nursing and that the local policy decision was not to accept enrolled nurses as candidates, regardless of their academic qualifications. She told the people in Bristol that she had discussed the matter with several organisations and that they had advised her to contact the clearing office to obtain a ruling. She wrote :

"I understand that this is not a nationally agreed decision and hope that you could furnish me with information on which colleges are accepting E/N applicants and perhaps how many are at present on Project 2000 courses."

Surely the Minister should investigate the case that I have outlined. The right hon. Lady intervened to tell the House that, if my constituent is qualified, she does not need to apply for the course, and that view has been supported by other Conservative Members, but that is not the position in the regions. My concerns are increased because Ministers and Conservative Members do not know what is happening throughout the country. We are being told about the results of Project 2000 which emanate from the Government's policy when Ministers are not aware of what is taking place in the regions. As I have said, the Prime Minister has been notified of the position in which Linda Bichard finds herself. There is evidence that there are anomalies when applications are made for Project 2000 courses. Among the applicants are people who are dedicated to the nursing profession, people who are qualified and are taking on further part-time studies in their own time to gain more qualifications so that they can be accepted within Project 2000, but who in certain areas are being denied that opportunity.

If constituents of Conservative Members are being accepted on the course while my constituents are being denied similar access, I want to know why. I ask the Minister to deal with that matter when she replies. I am very concerned about it, and I hope that she will be able to give me some satisfaction.

6.40 pm

Mr. Frank Haynes (Ashfield) : I was very pleased with the speech of my hon. Friend the Member for Mid-Staffordshire (Mrs. Heal). This is the first occasion on

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which she has spoken from the Front Bench in an important debate. It may be a short debate, but it is certainly important.

Having listened to the Minister, I have become aware of something else. I want her to listen closely. It seems that, because we are coming up to a general election, the Government have thought again about the word "democracy". Clause 1 refers to elections to the United Kingdom Central Council for Nursing, Midwifery and Health Visiting. The Minister may smile, but I remind her that the Department of Health--especially when the right hon. and learned Member for Rushcliffe (Mr. Clarke) was Secretary of State- -has ignored the professional organisations and the trade unions within the health service.

The former Secretary of State appointed people to the various health authorities, but he was not interested in any representation from the community. The Minister looks surprised. She should go to the regions and discover for herself what is happening there. Indeed, my hon. Friend the Member for Normanton (Mr. O'Brien) recommended that she should do just that. Certainly, in my region I have protested loudly about the fact that representatives from the community have been denied places on district and regional health authorities. Instead, the Government have appointed bosses from industry. We need local representation--councillors, for example. They were elected to such positions until the Government got their hands around the throats of the bodies and destroyed democracy. Now the Government are attempting to introduce a little democracy into appointments to the UKCC.

My hon. Friend the Member for Mid-Staffordshire got under the Minister's skin when she talked about the fiddling in opted-out trusts. It was a sore point for the Minister when my hon. Friend questioned whether the trusts would spend money on nurses' training. I attended a meeting of my local community health council last week. The House was not sitting, so I had the time to go and listen to some of the comments from those who represent the community on that council. Who was there to give a report? It was none other than the community physician, who talked about his annual report and the issue of community services.

The Government seem to be going down the wrong road in the provision of training for nurses, midwives and others who work in the community. I was a little concerned to discover that the report showed that the Government were not providing the necessary support for community services. They are ducking their responsibilities and giving them to local authorities, which have to provide that support.

I do not think that the Bill will work in the way the Minister suggests. I want the general election to take place very soon, because when the Labour party is in government it will implement this properly, although I shall not be coming back after the next election, as hon. Members know.

There are some good provisions in the Bill and we shall not vote against it today. The Minister is looking at her watch, but she will have enough time to say what she wants to say in response to the debate. I wish to make it clear that I do not accept that what the Minister said would happen will, in fact, happen. I do not accept that the opted-out trusts will spend money on nurses' training. I have said my piece and shown how I feel about the matter. I hope that the Minister will respond in the right

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way and provide some guarantees or assurances, but I wonder whether she will do so. I think that she has been put up for the job this afternoon by that wally--hon. Members know who I mean--the Secretary of State for Health. Nevertheless, I hope that what she has said will come to fruition.

6.46 pm

Mrs. Heal : With the leave of the House, Madam Deputy Speaker. I have enjoyed participating in the debate on what was thought to be an uncontroversial and uncontentious Bill. My hon. Friends have managed to inject some controversy into the debate. I am sure that, when members of the nursing, health visiting and midwifery professions read the report of the debate, they will note that the majority of contributions have come from the Labour Benches and that, with the exception of the Minister, there was only one contribution from the Conservative Benches. That is not an insignificant fact.

6.47 pm

Mrs. Virginia Bottomley : With the leave of the House, Madam Deputy Speaker. Like other hon. Members, I congratulate the hon. Member for Mid- Staffordshire (Mrs. Heal) on her inaugural Front-Bench speech. We have become used to her contributions during Question Time, but this is the first time that she has led for the Opposition in a major debate.

This has been an important debate, and I am pleased that it has been marked by a spirit of consensus. The matter is important for the nursing, health visitor and midwifery professions. I felt a tinge of sadness when I realised that this might be one of the last debates in which I participated when the hon. Member for Ashfield (Mr. Haynes) spoke. I felt a sense of nostalgia when he spoke.

I wish urgently to deal with a number of matters. First, on the point raised by the hon. Member for Normanton (Mr. O'Brien), I visited St. James's hospital shortly before Christmas and I was impressed by the progress that has been made by the trust. Its new day unit for children is a remarkable initiative and is of a standard that any hospital in the world would find hard to beat. There have also been many other initiatives, such as the new £15 million redevelopment of renal medicine, general surgery and intensive care facilities, which began in August.

There is some confusion about the case to which the hon. Gentleman referred, and I shall certainly study it. It may be that his constituent is an enrolled nurse wanting to take a conversion course, in which case Project 2000 would not be suitable. These are complex matters, but I give the hon. Gentleman the assurance that I shall personally consider that case.

I am concerned by the comments about the match between enrolled nurses wishing to take further courses and the availability of such courses. There were about six conversion courses for enrolled nurses in 1985 ; now, there are 225. It is a condition of Project 2000 places that arrangements should be made for enrolled nurses. However, I recognise points made by Opposition Members about the position of enrolled nurses.

The hon. Member for Mid-Staffordshire referred to the role of enrolled nurses on the UKCC and we shall certainly consider that further. She referred to the various minority groups, each of which has a valuable part to play in nursing care. Once we look beyond nurses, midwives and

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