| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
Lord Mackay of Ardbrecknish: My Lords, we now know that the noble Lord does not listen to, or believe in, anything that the OECD says. That is interesting. I shall note the next time he quotes the OECD on his side of the argument. As I have stated with regard to the statistics, they all look reasonable. Inflation is low, and is falling, and we are keeping it under control. My right honourable friend the Chancellor put up interest rates just recently to prevent any overheating. We do not believe there is overheating. We are confident that our economic policies under this Government will continue their successful course for many years to come.
Police (Insurance of Voluntary Assistants) Bill [H.L.]
3.35 p.m.
Lord Brabazon of Tara: My Lords, I beg to introduce a Bill to provide for the insurance by police authorities and the Receiver for the Metropolitan Police District of persons providing voluntary assistance for police purposes. I beg to move that the Bill be now read a first time.
Moved, That the Bill be now read a first time.-- (Lord Brabazon of Tara.)
On Question, Bill read a first time, and to be printed.
Charter Trustees Bill [H.L.]
Lord Sandys: My Lords, I beg to introduce a Bill to provide for the creation in England of parishes in cities and towns where charter trustees have been constituted. I beg to move that this Bill be now read a first time.
Moved, That the Bill be now read a first time.--(Lord Sandys.)
On Question, Bill read a first time, and to be printed.
Home Energy Rating Surveys Bill [H.L.]
National Health Service (Primary Care) Bill [H.L.]
3.37 p.m.
Baroness McFarlane of Llandaff moved Amendment No. 1:
The noble Baroness said: My Lords, in moving Amendment No. 1, I wish to speak also to Amendments Nos. 3, 8 and 19 which are related. The purpose of these amendments, as stated at Committee stage, is to allow nurses to propose pilot schemes in their own right, to ensure that health authorities must prepare proposals put forward by nurses, and to allow nurses providing nursing services under pilot schemes to become health service bodies.
The key reasons for bringing these amendments again are that nurses are often best placed to provide certain primary healthcare services for patients and to bring pilot schemes in respect of them. Justice demands that nurses should receive equitable treatment with doctors. Failure to make the change could undermine the success of the legislation.
I do not wish to be tedious or to weary the House in bringing back a group of amendments considered in detail in Committee and, by leave, withdrawn. However, the amendments attracted a considerable amount of support from all parts of the Chamber. I was surprised that the Minister was unable to accept the arguments. Following her very full and generous reply, I indicated that I wished to consider carefully what she had said, to study the White Paper Delivering the Future which had been published that day, and to have the opportunity to return to the issue at another stage.
The interest shown by the Minister in nursing, and in particular in community nursing, over the years has been considerable. The review, Neighbourhood Nursing, for which she chaired the committee, made her a redoubtable champion of community nurses. It must be a cause for particular personal gratification that 10 years on from what the profession calls the Cumberlege Report, and five years after the Nurse Prescribing Act, the roll-out of nurse prescribing was announced in the White Paper Delivering the Future. Nurses everywhere applaud that and the tenacity of the Baroness in keeping the issue on the political agenda.
I am all the more regretful, therefore, to return to these amendments and to the reply given by the Minister at Committee stage. One concern expressed was that nurse-led pilots should not replace general medical services with personal medical services; and that nurses should not provide services in the place of general practitioner services. Nurses would agree with that and with the importance of it. They appreciate their role and do not wish to encroach on medical roles.
However, there are a number of areas of healthcare which are not covered by general practitioners where nurses are best placed to provide services. Examples include services for homeless people or for those not registered with general practitioners, family planning services, midwifery services, health promotion and public health services. A community based programme was devised by the nurses in one deprived area to help families on low incomes eat a healthy diet. In another area, nurse-led community action saw the introduction of traffic calming schemes resulting in a reduction in child mortality and morbidity from road traffic actions on an estate. In inner London an initiative was established to deliver healthcare to the homeless population by nurse practitioners assessing needs and delivering care in hostels and treating conditions such as asthma, chronic lung infection, leg ulcers and foot conditions.
One could continue with many examples. I was impressed with the words of the general secretary of the Royal College of Nursing as she addressed the Conservative Medical Society on Monday this week. She said:
The nurse's role in health education is well recognised and research shows the benefits of nursing inputs in reducing costs and saving waiting time for patients. I believe that because of all those factors it is right and proper that nurses should be able to instigate their own pilot schemes.
Principles of justice and equity are involved. In Committee, at col. 1413 of the Official Report of 17th December 1996, the noble Baroness, Lady Cumberlege, said:
At col. 1414, the noble Baroness said that the health authority receiving a proposal from a group of nurses would,
If the crucial issue is that the health authority needs to satisfy itself that the pilot covers particular areas of care, then that should apply to any proposal regardless of its source. The question of equity is at stake. There is no question that nurses wish to usurp the role of doctors. They wish to work collaboratively and in a relationship of equality. However, without the changes embodied in the amendments the role that nurses could and should be playing in primary care--with the importance of the added expertise that their roles now have--will be limited because the widest range of innovative schemes will not be put forward.
It is argued that as the Bill stands, there is nothing that a nurse, midwife or health visitor could not put forward through a doctor or a trust. But there is a considerable difference between initiating a pilot scheme at first hand, directly, and having to do so at one remove. Of course, all pilots must be scrutinised with the needs of patients foremost. But to suggest that the paperwork would become intolerable is to suggest that nurses would be irresponsible in submitting schemes and that their schemes were less important than doctors' or dentists' schemes.
I have worked most of my life in a different setting, in a university. It would be unthinkable in that setting that any one discipline would be treated differently from another in putting forward research proposals or innovative schemes of any kind. It is hurtful to nurses to think that they would be treated differently.
As the Bill stands, it inhibits nurses, midwives and health visitors from being able to play a full part in submitting pilot schemes. In tabling these amendments again, I seek some reassurance that, at least at a later stage of the Bill, these important amendments relating to nurses will receive consideration. I beg to move.
Page 1, line 14, at end insert ("or
(c) services are provided which are not personal medical services or personal dental services but which may be provided under Part I of the National Health Service Act 1977 or (as the case may be) Part I of the National Health Service (Scotland) Act 1978.").
"When the Government launched Delivering the Future, press reports talked of the birth of 'supernurse'. The white paper maps out the crucial role that nurses will play in the delivery of a primary health-led NHS but for most community nurses the supernurse of the newspaper reports already exists. For years community nurses--district nurses, community midwives and health visitors--have delivered the largest component of primary healthcare. But the roles that nurses have always taken on in the community, are now also part of general practice. The explosion in the number of practice nurses in the UK"--
from, I believe, 1,500 in 1977 to 18,000 now--
"has meant that nurse-led asthma and diabetes clinics, nurse-run outreach projects for the homeless people and well woman clinics run by nurses are commonplace in many GP practices".
"I am very clear that nothing should stand in the way of nurses, midwives and health visitors playing a full part in using the flexibility provided in this legislation to develop not only their professional skills but to use opportunities".
But she argued that nurses could exploit those opportunities only through partnerships with general practitioners or through taking a more significant role in a trust.
"have to be convinced that a pilot scheme which replaces general medical services with personal medical services would satisfactorily cover those areas of care which explicitly have to be provided by doctors".
However, no such requirement is made should a doctor propose a pilot scheme. The onus is simply on the health authority to consider any scheme submitted by a trust, doctor or dentist. Thus, if a nurse in partnership proposed to provide a 24-hour emergency mental health service for a locality and to employ a medical practitioner to undertake specific medical activities where necessary or appropriate, the scheme would not receive automatic consideration by the health authority. Yet if a doctor were to submit the proposal the health authority would be obliged to consider it even though the same services would be provided and the same questions would arise as to the nature of the areas of work covered.
Next Section
Back to Table of Contents
Lords Hansard Home Page