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House of Commons
Friday 31 January 1992
The House met at half-past Nine o'clock
PRAYERS
[Mr. Speaker-- in the Chair ]
PETITION
Mifegyne
9.34 am
Mr. Harry Greenway (Ealing, North) : I wish to present a petition, which reads as follows :
To the Honourable the Commons of Great Britain, Northern Ireland in Parliament assembled. The humble petition of the Ealing Chapter of Full Gospel Business Men's Fellowship International.
The petition is in the name of John K. Winget, of 25 Conway crescent, Perivale, Greenford, Middlesex, and others. It
Showeth
That we the undersigned wish to note with regret that the Abortion Pill Mifegyne (known as "RU486") has been granted a product licence. We believe that drugs and medicines should be used only to save life. We deplore the fact that this drug causes the death of unborn human beings, and we express our grave concern that it will damage women physically and psychologically.
I support and associate myself strongly with the petitioners. The petition ends :
Wherefore your petitioners pray that your honourable House, which is committed to upholding respect for human life and protection of the weak and vulnerable, will do everything possible to prevent the distribution and use of Mifegyne (known as RU486) and any other drugs which, like it, are produced with the deliberate intention of destroying innocent human life. And your Petitioners, as in duty bound will ever pray, etc.
To lie upon the Table.
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Orders of the Day
Medicinal Products : Prescription by Nurses etc. Bill
Order for Second Reading read.
9.36 am
Mr. Roger Sims (Chislehurst) : I beg to move, That the Bill be now read a Second time.
I imagine that I am not the first hon. Member to be faced with a dilemma on learning, with a mixture of pleasure and trepidation, that he has won a high place in the ballot for private Members' Bills. Should one propose a controversial measure that is likely to attract publicity but will have little chance of ultimate success ; or should one introduce a modest Bill with some value, unlikely to make front-page headlines but with a reasonable prospect of reaching the statute book? It was obvious to me that, given that little of the parliamentary Session remained, I should choose the latter course, and I had little difficulty in deciding to introduce a Bill to allow a nurse prescribing.
We are all familiar with the respective roles of doctors and nurses. Doctors diagnose complaints and propose treatment, usually involving drugs. They may see the patient from time to time thereafter, but the responsibility for supervision of the patient and the administration of treatment lies with the nurse, who will see the patient far more frequently. That applies particularly when the patient is being treated at home--in the community--rather than in hospital.
Clearly, in some circumstances, when a nurse sees the need for drugs and dressings to be applied, it would be an advantage for her--or possibly him- -to be able to issue a prescription without having to trouble the doctor, who will certainly have full confidence in the nurse. The case is particularly strong when the patient needs perfectly straightforward medication or dressings which can be bought over the counter but to which the patient will be entitled free of charge if he has a prescription.
It is not difficult to imagine the frustration that is experienced by a district nurse who makes a regular visit to a patient and finds that that patient needs further supplies of a medicinal product or dressings. The nurse will have to return to the surgery, interrupt the doctor to get a prescription signed, and then go back to the patient to hand over the prescription.
The concept of nurse prescribing is not new. In 1986, the then DHSS commissioned a review chaired by Mrs. Julia Cumberlege on community nursing. Its report was entitled "Neighbourhood Nursing--a Focus for Care". I apologise to the House for the length of the quotation that I am about to give, but it is very much at the core of the issue that we are discussing. Under the heading "Power to Prescribe", the report said :
"We found district nurses waste time in requesting prescriptions from general practitioners for such things as dressings, ointments and medical sprays--those for leg ulcers, for example. In addition, many nurses have become very skilled in managing pain relief programmes for terminally ill patients. We believe therefore that community nurses who work with terminally ill patients should be permitted to use their professional judgment on matters such as the timing and dosage of drugs prescribed for pain relief. We recommend that the DHSS should agree a limited list of items and simple
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agents which may be prescribed by nurses as part of a nursing care programme, and issue guidelines to enable nurses to control drug dosage in well-defined circumstances. Detailed medical protocols should be drawn up with general practitioners which encourage community nurses within strictly agreed limits to vary the timing and dosage and use of alternative pain relief agents for patients who have been diagnosed by general practitioners as terminally ill and in pain. This may require nurses carrying on their own small supply of drugs, as midwives do now."Its views were supported by a 1987 report of the Social Services Select Committee. Based on the evidence that it received, it recommended that
"the Government introduce legislation to permit nurses with appropriate training limited powers to prescribe and in defined circumstances to modify dosage."
In the same year, the Government's primary care White Paper said that representatives of the professions would be consulted. Paragraph 7.13 said :
"The Government also sees merit in giving nurses more freedom to prescribe a limited range of items (such as dressings, ointments or medical sprays) and to exercise their professional judgment in relation to the timing and dosage of drugs prescribed by doctors for pain relief. To some extent this development is already taking place. The Government will consult the Professional Standing Advisory Committees about the professional and ethical issues of prescribing by nurses with a view to producing appropriate guidance."
The Government then set up the advisory group on nurse prescribing under Dr. June Crown. Its terms of reference were to make recommendations on the circumstances in which nurses might prescribe, the categories of items to be covered and methods of prescribing them, the circumstances in which nurses might vary the timing and doses of drugs prescribed by doctors, the implications for nurse training and the resource implications.
The advisory's group's report was published on 20 December 1989. It comprises a detailed analysis of what might be involved in the proposal. I quote simply from some of its core recommendations, one of which was that
"suitably qualified nurses working in the community should be able, in clearly defined circumstances, to prescribe from a limited list of items and to adjust the timing and dosage of medicines within a set protocol."
It suggested that
"Nurses with a district nurse or health visitor qualification (including those employed as paediatric community nurses, practice nurses or private nurses ) having had the additional necessary training : should be empowered to prescribe items necessary for the care of patients with those conditions for which the nurse takes independent clinical responsibility ; should be able to supply certain categories of patients with items within a group protocol and adjust the timing and dosage of medicines within a patient- specific protocol."
My hon. Friend the Minister indicated general acceptance of the report's recommendations and that work and consultation on it would proceed.
Almost a year ago to the day, my hon. Friend the Member for Kensington (Mr. Fishburn) introduced his Nurse Prescribing Bill under the ten-minute rule. Shortly afterwards, the Minister announced that a cost-benefit analysis was being commissioned. That did not happen until April, when Touche Ross was asked to assess the cost and benefits of nurse prescribing. No doubt my hon. Friend's Bill was talked out because that analysis had only just been put in hand. It seemed to me that this was an admirable measure for the Government to introduce, particularly in a short
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parliamentary Session. I suggested that course to my right hon. Friend the Secretary of State and was encouraged by his comments at the Royal College of Nursing congress in May and at the Conservative party conference at Blackpool in October, when he expressed his general support for the concept.I was rather surprised, therefore, that such a measure was not included in the Queen's Speech. I know that the Royal College of Nursing and other professional bodies were disappointed by that omission. When I drew third place in the ballot for private Members' Bills, my choice of Bill seemed obvious.
Fortunately, my success coincided with the publication of the Touche Ross report--a formidable document which gives a most detailed analysis of the costs and benefits. I do not think that I would endear myself to the House if I went into them. There are obvious difficulties in making precise assessments of costs and savings when one is faced with a range of variables such as to what extent giving nurses the right to prescribe will lead to more prescriptions. It is difficult to translate savings in time and greater convenience into cash terms. Perhaps I could quote from part of the conclusions at paragraph 5.4 :
"We conclude that the nominal value of time saved and the gross costs of nurse prescribing are relatively close before allowance is made for benefits not evaluated in this study, namely"--
these seem very important benefits--
"faster treatment, at times, for patients, benefits from additional items prescribed and increased job satisfaction for nurses." The publication of the Touche Ross report appeared to remove the only remaining ground on which the Government might prefer to defer action. Once I had persuaded the Department of Health that I was anxious to proceed with the Bill, it offered complete co-operation. I should like to take this opportunity to offer my thanks to my hon. Friend the Minister for Health and her officials for their help in introducing the Bill, to the Royal College of Nursing for its persistent and effective campaigning, briefing and help in publicising the Bill, and to my hon. Friend the Member for Kensington for blazing the parliamentary trail. I am happy that he is a sponsor of the Bill, and I hope that he will speak later in the debate. The Bill is brief and simply amends existing legislation. Clause 1 brings nurses, midwives and health visitors into the category of "appropriate practitioners" for prescribing purposes and gives the Minister the power to specify, by regulation, categories of nurses who may prescribe and the qualifications and training that they would need. Clause 2 makes it legal for dispensers to dispense prescriptions written by such authorised nurses. Clauses 3 and 4 merely make similar provision for Scotland and Northern Ireland. I emphasise the fact that if the Bill becomes law there is no question of nurses in general immediately being able to prescribe. The Minister would have the power, which she does not have at present, to make regulations to turn the principle of nurse prescribing into practice. Of course, the cynic might think that that means that once the Bill has been passed nothing more needs to be done. I assure the House that that is not so.
Discussions have been taking place for some time about the formulary covering the range of drugs which nurses would be allowed to prescribe, although that is likely to be relatively small because the majority of items that nurses will want and need to prescribe are those which can be purchased over the counter, and various forms of
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dressings. Discussions are also in hand about the training and the qualifications needed, and work is being done to set up the appropriate training courses.The report to which I referred suggested that people with district nurse and health visitor qualifications should be authorised to prescribe. If that happens, it will apply to about 28,000 district nurses and health visitors who are serving the community. Their ability to prescribe will clearly save time, avoid troubling doctors, save patients' and carers' time and will generally be more convenient. The measure will be especially beneficial to the elderly, to the disabled being cared for at home, to diabetics and to the terminally ill. The Bill has been welcomed on an individual and an organisational basis by nurses, by general practitioners and by patient organisations.
As I have said, it is merely an enabling measure. Once it reaches the statute book it would be up to the Secretary of State--not to me--to take further steps because he will have the regulation-making powers. I need hardly say that I shall be keeping an eagle eye on my hon. Friend the Minister, although I suspect that by then it may be her successor, as she is destined for higher things. However, I shall be pressing the occupant of that office for action if it proves necessary to do so.
I know that nurses in particular are anxious to see the intentions of the Bill translated into action. I hope that the Minister will be able to tell us more about the preparatory work in hand and give some idea of the timetable that she envisages for the Bill's implementation, when the regulations are likely to be laid, when training will start and when the first batch of authorised nurses will be able to exercise their right to prescribe.
I understand that the likelihood is that initially only nurses with district nurse and health visitor qualifications are likely to be involved. I should mention the fact that I have received representations from practice nurses suggesting that they should also be included. If they have the qualifications to which I referred they would in any event be included in, as it were, the first batch of qualifiers, but perhaps the Minister will confirm that some thought could be given in due course to extending the authorisation to practice nurses. I want to make it clear--and perhaps the Minister will confirm this--that there is no question of extending prescribing rights to hospital nurses in general. That is clearly not necessary, because doctors are invariably on site.
Of course, there will be costs involved in the implementation of the Bill and perhaps the Minister will say how she envisages that they will be met. I presume that her Department will meet the training costs, but as to the costs incurred in the prescribing operation, where nurses are attached to a fund-holding practice I imagine that those costs will be charged against the practice's budget, and I hope that that will be taken into account when the budgets are fixed. Otherwise it would seem appropriate that the costs should be met either by the health authority or--more likely--by the local family health service authority.
This is a simple Bill which will benefit many of our fellow citizens. It will ease the burden on hard-pressed general practitioners, will facilitate the work of the unsung heroines of our communities--the district nurses and health visitors--and will improve the treatment of their patients, among whom any of us might find himself numbered in the fullness of time.
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I mentioned the fact that the Bill started with the report of a body chaired by Mrs. Julia Cumberlege. The House will be aware that she is now Baroness Cumberlege, and I am happy that she is standing by, ready to sponsor the Bill should it find its way--as I hope that it will--to another place. Therefore, I hope that the Bill will receive the House's support and that its progress will be facilitated so that it may pass into my noble Friend's hands in another place and reach the statute book before it is overtaken by events.9.56 am
Ms. Harriet Harman (Peckham) : I congratulate the hon. Member for Chislehurst (Mr. Sims) on choosing this subject for his private Member's Bill. He said that he had faced a dilemma about whether to choose a Bill that would make the headlines or one that would be passed. I am sure that the 7 million or so patients who will benefit from nurses being able to prescribe will be grateful that he has chosen a Bill which will certainly be passed and will certainly--once it has reached the statute book and is implemented--have practical benefits for that many patients.
The Bill will also help district nurses and health visitors. They do not want to waste their time going backwards and forwards to the general practitioner's surgery. The hon. Gentleman rightly said that it is a waste of the doctor's time for him to turn his attention to something that has already been decided by someone else and merely to rubberstamp it. Such a situation also undermines the role of district nurses and health visitors if they have to go through that procedure when they know that they should be able to take the responsibility. The Bill has the confidence of GPs and will suit patients. The hon. Member for Chislehurst can be certain that the Bill has the Opposition's support. It is important but not controversial. Everyone agrees that it makes sense and that it is a long-overdue reform. I do not want to concentrate on procedural matters, but, as the hon. Gentleman said, it is curious that the Bill has not been introduced by the Government, especially as the Nurses, Midwives and Health Visitors Bill has just completed its Committee stage. It would have made sense for the Government to include this measure in that Bill so that it could be dealt with at the same time. Having publicly committed themselves to extending legislation to protect residents in small private residential care homes, the Government left it to a Back-Bench Member to bring in a Bill, and they have done the same thing again. Having said that this is not the procedure by which such a measure should reach the statute book, I welcome the Bill because it will result in a long-overdue reform.
I wish to raise three issues that are part of the backdrop to the Bill. The first is training, which the hon. Gentleman mentioned. The second is retaining those district nurses and health visitors who, as a result of the Bill, will be better trained, more skilled and more useful. We need to keep them within the national health service work force and to make better use of their additional skills. The third is the question of nurse prescribing in community care.
I am simply flagging those issues ; I do not want to go into them in great detail. The Bill has the support of the Government and both sides of the House. It is uncontroversial. I should be sorry if the debate on the Bill
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were to be unnecessarily prolonged and so prevented the House from debating the Civil Rights (Disabled Persons) Bill that hon. Members are waiting to discuss.The issue of training was partly dealt with in the Nurses, Midwives and Health Visitors Bill. The training of nurses to prescribe will be vital if the service is to be as widely available as we want it to be and if it is genuinely to benefit patients. However, there are problems with post-basic education. Training for nurse prescribing is likely to be at post-basic level. Although there is usually an incentive to safeguard funding for pre- registration education to maintain the supply of nurses coming into the NHS, the incentives for post-basic education are less secure.
The Royal College of Nursing has expressed its particular concern that trust employers might offer a poor deal to nurses who want to undertake training courses. The RCN suggests that nurses in trusts who want to undertake post-basic training are being required to transfer to fixed-term training contracts, with no guarantee of employment on completion of training. We do not want any disincentives in the system that would prevent people doing post-basic training and becoming nurse prescribers. Can the Minister assure us that training for nurse prescribing will be provided and that it will be accessible to those nurses who need it?
I wish briefly to deal with two other issues, but we shall explore them further in Committee. We need to retain trained staff. Prescribing will be carried out by specially trained and experienced nurses, yet trained nurses are leaving the NHS at the rate of 80,000 a year--a quarter of all nurses. That is bad enough for nurses with the basic qualification, but it will be an absolute waste of training and experience if we do not retain within the NHS those who are qualified to be nurse prescribers.
So far, the Government have made a large number of verbal commitments to creating the terms and conditions of employment that would enable women to stay in the work force and not give up when they have families. However, at district health authority and hospital level there have not been the practical measures needed to achieve that. That is why the figures for nurses leaving the NHS remain so bad.
It all comes down to practical implementation of flexible working hours and job sharing, so that women working in the nursing profession do not have to follow male patterns of employment, where eventually they find that combining family responsibility with work is simply too difficult, and they leave. That point applies to nurses at the basic level, but it is even more important when they become a more valuable resource after their post-basic education has given them the ability to prescribe.
Community care is also an issue. Nurse prescribing should be an important component of care for those who have long-term continuing needs, but are living in the community. I want community care to be properly implemented and funded, with nurses prescribing as a part of their work in the care of people living at home.
Nurse prescribing will happen, and I hope that it does so promptly. I hope that the Minister gives the assurances about timing asked for by the hon. Member for Chislehurst. The Bill will work better if it is implemented properly, if there is access to training for all who want it,
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if there are flexible patterns of employment to enable nurses to stay in the work force following post-basic training and if community care--where they will be doing their work--is implemented and fully funded. I hope that the Minister will also assure us on those points.Once again, I congratulate the hon. Member for Chislehurst on choosing this subject for his Bill. He will not hit the headlines, but he will receive the gratitude of patients and nurses. We welcome the Bill.
10.5 am
Sir David Price (Eastleigh) : Like the hon. Member for Peckham (Ms. Harman), I congratulate my hon. Friend the Member for Chislehurst (Mr. Sims) on his good fortune in winning a high place in the ballot. I am delighted that he has chosen to introduce a Bill on nurse prescribing and I am honoured to be associated with it as one of its sponsors.
As my hon. Friend said, the Bill deals primarily with the delivery of health care in the community. As presently envisaged, it has little relevance to medical practice in hospitals. However, I wish to put down a marker that, as the provisions of the Bill succeed in care in the community --for health visitors and community nurses--I hope that the possibility of its being extended to certain aspects of hospital work will be considered. Both I and my hon. Friend have received representations from the Southampton eye hospital, suggesting that there might be a case for extending the provisions of the Bill to ophthalmic casualty.
I shall not develop that point today, because it is not immediately relevant ; I am simply putting down a marker that, as the Bill's provisions succeed in the community, we should not exclude an extension into other areas. As the Bill is drafted, such an extension would be possible at a subsequent stage through the Minister of the day introducing the necessary order.
My hon. Friend quoted from the Cumberlege report in support of his proposition that there should be a limited extension of prescribing from doctors to nurses. The report of my hon. and noble Friend Lady Cumberlege has clearly impressed my hon. Friend. It equally impressed those who served on the old Select Committee on Social Services. Paragraph 61 of the Select Committee report succinctly encapsulates all the arguments for the immediate move proposed by my hon. Friend. It states :
"The CNR team, and many witnesses believe that nurses should have freedom to prescribe a limited range of items, such as dressings, ointment and medical sprays".
I pause here to point out that items such as dressings are available on prescription. Hon. Members can buy them over the counter in a chemist's shop. It continues :
"and that they should be able to use their professional judgment on matters such as the timing and dosage of drugs prescribed by doctors for pain relief."
Pain relief is greatly important to many people. Our experience of people in that condition is that they are not in a steady state so, rightly, the prescription must be altered almost day by day according to the pain of the patient. It continues :
"Both suggestions have merit ; to some extent they reflect developments which are already happening, for example in the care of the terminally ill where many nurses have special expertise. It is obviously wasteful nonsense for a district nurse needing a new dressing for a patient to have to return to the surgery, tell the doctor what is needed, possibly even draft the
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prescription for him, get the prescription dispensed by a pharmacist and then make a second visit to the patient to apply the dressing."Those last few words describe the present position. I am sure that all would agree that it is nonsense and that there must be a simpler way. My hon. Friend's Bill would provide that simpler way. Our report continued :
"We recommend that the Government introduce legislation to permit nurses with appropriate training limited powers to prescribe and in defined circumstances to modify dosage."
I hope that my hon. Friend the Minister will forgive me if I say that the Treasury, as always, seems to have made rather heavy weather of this matter. What are the extra costs of nurse prescribing? The truth is that nobody knows--and in so far as there will be an extra cost, that cost shows an unfulfilled need.
That is the story of the resource implications of care in the community. One factor after another shows unfulfilled needs. As we become more successful in delivering health care in the community, we discover things that we should have been doing in the past but have not done. Now that those things are identified, we do them and--surprise, surprise--it costs more. I ask the Treasury to be relaxed about that.
Mr. James Arbuthnot (Wanstead and Woodford) : Does my hon. Friend agree that in practice, costs may be reduced? Nurse prescribing will save the waste of time that he has described when district nurses have to go backwards and forwards to doctors, and will allow them to give their time to more beneficial activities, rather than wasting petrol on such journeys.
Sir David Price : My hon. Friend has made an excellent point, succinctly put, which has not yet been fully recognised by the Treasury.
The Touche Ross report had to be completed in a considerable hurry, for reasons that we understand. Let us not attach too much weight to it, because the overall response rate from the 18 district health authorities surveyed was 15 per cent. of district nurses and 23 per cent. of health visitors. That sort of return is even lower than those used by political pollsters.
All that we know is that nurse prescribing will cost a bit more in medication. The extra costs will be those for the extra prescriptions generated ; we cannot say more than that. It is not possible to put a figure on the costs. However, I am delighted that the Government are giving my hon. Friend a money resolution--that is all very proper--but I beg the House not to be too concerned about what the figure is. Let us recognise that there is a figure and settle for that.
I warn the House--I am afraid that I have been an awful bore in continually pointing this out--that, as we extend the concept of health care out into the community, we shall find more and more unsatisfied demands that have not previously been recognised. I hope that in so far as we are achieving a consensus on care in the community, there is a general recognition that it will cost more and use more resources.
I shall say nothing more about the financial side. The Touche Ross report had one or two nice things to say about the advantages of nurse prescribing. Under the heading, "Other Benefits"--uncosted--it said :
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"The further benefits from Nurse Prescribing are the benefits to patients of faster access to some prescription items and the benefits they will derive from additional items prescribed for them by District Nurses and Health Visitors."That sentence encapsulates one of the obvious advantages that will accrue from the Bill.
I am sure that both sides of the House will welcome my hon. Friend's Bill. In modern jargon, it is a patient-friendly Bill, and as such, it will appeal to both sides of the House.
10.13 am
Mr. David Bellotti (Eastbourne) : I congratulate the hon. Member for Chislehurst (Mr. Sims) on deciding to promote the Bill. It is important, because, as the hon. Member said, there have been earlier opportunities for such legislation--the Government could have chosen to include a measure in their order of business, and a private Member once introduced a Bill, but unfortunately did not have enough time to secure its progress. I believe that the Bill will make headline news, because millions of people will benefit from it and they will see the advantages to them. So, although the hon. Member for Chislehurst feels that he may not achieve headlines in the newspapers, I feel that he will.
The hon. Gentleman has the opportunity of warning us all not to speak for too long, because another important measure, concerning the civil rights of disabled people, is to come before the House today. I hope that we shall be able to ensure that both these important measures make progress.
In principle, the Liberal Democrats support the Bill because it puts patients first ; it brings their needs and concerns to the fore. It is so important that the person nearest to the patient should have the right to prescribe that I am sure the measure will receive all-party support.
We are told that there are 28,000 qualified district nurses and health visitors. With so many people who may eventually receive the training to prescribe, we can imagine the advantages that patients will derive from that training and delivery.
Such a measure has taken a long time to appear. I wonder why. The Government have had opportunities, but have not taken them. Nevertheless, the Bill will form an important part of the full delivery of their policy of care in the community. We shall not see real care in the community without nurses being able to prescribe drugs at the point at which they are needed.
We have an aging population and a growing number of residential care homes in the private, voluntary and statutory sectors. It is important that the health visitors and nurses who go to those homes can meet the needs that they find there. If we support care in the community we must realise that nurse prescribing is part of that and will help to make it work. That is why I was especially pleased to hear that the Government are prepared to allocate the necessary funds. If they did not, the costs would fall elsewhere--or the job would not be done.
Elderly people and chronically sick people in residential and nursing homes will not be the only ones to benefit. People in the community will benefit, too. I know from my work with homeless families that such people invariably need help late at night, in the early hours of the morning or at weekends, when it is especially difficult to find a general practitioner who will respond quickly to a call to
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see someone who has arrived on the doorstep --in my case that means the doorstep of the YMCAs for which I worked.Mr. Michael Stern (Bristol, North-West) : I accept what the hon. Gentleman says about the homeless, but does he agree that we should not be in danger of slighting the work of many general practitioners in inner cities where there are many transient homeless people? To give those GPs credit, working with family health authorities they have developed specialisations in dealing with the needs of transient people.
Mr. Bellotti : I agree that some of the work of GPs is outstanding in such areas, but they are greatly overburdened and have considerable calls on their time. Those of us who have worked with homeless families have found that many hours can pass between the telephone call and the arrival of a general practitioner. In recent years that situation has grown worse. Many of our GPs now have technology in their surgeries whereby calls are transferred to other doctors in the area. One tends not to know the GP who turns up, whereas one always knows the local health visitors and community nurses. I accept the hon. Gentleman's point, but he should also consider what I have said.
Terminally ill patients would also benefit. Not long ago I had the opportunity to visit St. Wilfrids hospice in Eastbourne, where wonderful work is done. That is true of hospices in every constituency. The hospice movement is wonderful, caring for people in their last weeks, days and hours. In those circumstances prescribing can relieve an enormous amount of pain, but it needs to be done very quickly. The Bill will help enormously there, and the people in Eastbourne certainly support that aspect of it.
In rural areas, the time taken by the GP to travel or the time taken by a family friend to go to the surgery to obtain a prescription can be considerable. Through the Bill, we seek to achieve the relief of pain for patients at the earliest opportunity. The Bill will be especially appreciated in rural areas.
I warmly commend the Bill and I congratulate the hon. Member for Chislehurst on introducing it. It has all-party support, so I hope that hon. Members will have the opportunity of saying a few words on it and of making progress on the Civil Rights (Disabled Persons) Bill. I commend the Bill to the House.
10.20 am
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