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Lord Jenkin of Roding: My Lords, will the noble Lord give way for a moment? The facts do not support what he says. When I became Secretary of State, the proportion of the national product to the health service was 4.7 per cent. By the end of the 1980s it was 6 per cent.

Baroness Ramsay of Cartvale: My Lords, really, this is not a debate--it is a debate but it is timed and therefore one does not interrupt.

Lord Davies of Coity: My Lords, my judgment of the circumstances is obviously different from that of the noble Lord. But the British people have recorded their view about the situation.

Another aspect of mismanagement of which I am conscious because of my father's work in a mental hospital, and which I observed with horror as it accelerated, was the rundown and closure of mental hospitals and the release of mental patients into the community. That process is now, thank goodness, not being continued. But what of the damaging consequences that the closure policy produced? Many of the released patients have committed murder. Ten times as many have committed suicide. And countless numbers are still living rough.

If we are to do better to fulfil Aneurin Bevan's dream in the next century we must face the fact that our record still leaves a lot to be desired. We must show greater compassion towards those less fortunate than ourselves. We must do more than make nice statements to show our appreciation and thanks to those who dedicate themselves to the care of the sick, the injured, the old and the terminally ill. We often hear it said, "Nurses can no longer be expected to be Florence Nightingales". I do not accept that. I believe that nurses are proud to be Florence Nightingales. But they object to having to be Oliver Twists and forced to ask for more. They also object to being forced to be Scrooge's Bob Cratchit--expected to be more concerned with accounting than with caring.

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There is no doubt that noble Lords on the Benches opposite have a great deal to answer for as regards the 1980s. There is no doubt that on 1st May 1997 the British people made plain their displeasure at the way the country was being led further and further away from being a compassionate and caring society and more and more towards a calculating one. We now have a Labour Government. And I say this to the Government. Just to applaud the architect Aneurin Bevan and just to draw attention to the past achievements of the National Health Service at this 50th anniversary will not be good enough. The Labour Government must act and not just state intentions. They must act on behalf of those who now need, and who will need, the National Health Service. And they must act on behalf of those who are in the front line, who have dedicated their lives to caring for others, for without them the National Health Service can never succeed. The signs are good. The reality will be better. Action to produce an infinitely improved National Health Service will be the only worthy monument to celebrate the 50th anniversary.

6.18 p.m.

Baroness Emerton: My Lords, I wish to add my thanks to the noble Lord, Lord Hunt, for his introduction to the debate and his excellent speech. I add my congratulations to the noble Baroness, Lady Knight of Collingtree, on her maiden speech and the expressions of understanding of the care and concern that patients appreciate.

I have to declare an interest. I am chairman of a healthcare trust. I am pleased to say that I have had the privilege of spending 45 years in the NHS as a nurse. I believe that today's NHS is still the envy of the world. As we look to other countries, so they look at the many areas where we have succeeded and still succeed in the aim to promote health and prevent disease and to provide a cure and care. It is a service which faces infinite demands within finite resources.

We have heard today of many changes which have taken place in the NHS over the 50 years due to medical science, technological developments and developments in public health, with improvements in the environment and diet, and prevention through the introduction of immunisation, vaccination and screening programmes.

Many speakers have indulged in a little reminiscence. I beg to reminisce for just two minutes. When I was nursing in 1953 I faced ward after ward of patients suffering from tuberculosis. That disease was practically eradicated, but, sadly, we are seeing its return, particularly among the homeless.

I wish to take up the remarks of the noble Baroness, Lady Pitkeathley, on whooping cough. I worked on a ward where there were 28 babies with severe whooping cough. Anything more terrifying I have yet to witness. Today we are very fortunate that the immunisation programme has almost eradicated whooping cough.

In relation to cataract treatment, I remember as a nurse having to place sandbags on either side of the patient's face, and having to feed patients, who had to lie flat for three weeks. Today, patients are in and out in a day, with a miraculous cure. So we have seen many,

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many improvements. I could go on reminiscing; however, I believe that reminiscent therapy is for the demented and I am not, I hope, demented.

The NHS is a highly labour-intensive organisation. Sixty per cent. of the budget is spent on staff, and each member of staff plays a very valuable part in both direct and indirect care. They face rising demands and rising stress levels. More worrying is the fact that there is an increase in the verbal and physical abuse of staff. A recent report stated that nursing was a more dangerous profession than being a member of the police. Within the trust of which I am chairman there are 18 security staff and 46 closed circuit television cameras in order to protect and help the staff. Hospitals are no longer a haven of peace. We are faced with verbal and physical abuse. The staff deserve a big thank-you on this occasion of the celebration of 50 years of the NHS.

We look forward to the next 50 years, and we face many challenges. Initiatives set out in the New NHS White Paper point the way forward and it is to be hoped that we shall see a rise in the quality of care. The Green Paper to be published shortly will, I am sure, produce new thinking on improving public health, the emphasis being on a "health" service and not a "sick" service.

Within the overall challenges there has been increasing development in medical science and technology and the treatment of disease. We also heard during the debate of the rise in public awareness of disease and diagnosis and the rise in public expectation. The demographic trend, given the rising numbers of elderly, will also mean considerable pressure for the NHS in the future. In addition, there are rising cost pressures.

I want to concentrate on one or two of the challenges with which we are faced. The first is recruitment and retention of staff. Achieving the right number of right people, in the right place, at the right time, with the right qualification, is very difficult in a competitive market. The recent Campbell Report recommends an increase of 1,000 in the number of medical students. The current level of wastage in nursing is 21 per cent. The training programme for pharmacists has been increased from three to four years. In the year 2,000 there will be very few qualified pharmacists emerging from the training programme. All require education programmes to produce skilled, competent and knowledgeable staff.

The Government are to be congratulated on the current national recruitment campaign for nurses, midwives and health visitors--which needs to be backed up by local initiatives. During the past week, staff from my trust campaigned in a local supermarket and were successful in attracting new entrants, some of whom were wishing to return to nursing. The strong impression was that they wanted the opportunity to talk to nurses and find out what the career opportunities really are in the profession. By backing up the national campaign with local initiatives I believe we can be successful.

The delivery of high-quality care is dependent on high-quality education programmes. Again, much has been achieved in 50 years in the advance of medicine, nursing and professions supplementary to medicine in

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both pre- and post-qualification education. Moving nursing into further education is an achievement that has taken over 40 years.

Importantly, within the past 18 years the nurses, midwives and advisory health visitors, who deliver 80 per cent. of patient care, have taken a lead in developing a system of professional self-regulation that has produced a standard of practice and education which is the envy of the world. Indeed, the United Kingdom can be proud that it has influenced the development of regulation in other countries, and still continues to do so. Many key figures in nursing, such as the late Dame Catherine Hall, have been instrumental in shaping the UK-wide regulatory system which ensures that the public receive the highest standard of patient care.

Emerging from the Government's new NHS White Paper is an emphasis on enhancing the role of nurses, especially identified in commissioning healthcare as members of the boards of primary care groups. I ask the Minister to ensure that education and development programmes are available to those nurses to enable them to fulfil that role. Will the Government also ensure that development programmes are available for health visitors and school nurses to enable them to contribute fully to the new public health agenda?

The NHS is a complex organisation, meeting the needs of the population often at the most vulnerable time in their life. Fifty years on, the healthcare system can deliver the most highly technical and skilled care; but that must not be at the exclusion of meeting the most basic needs that go to make the patient or client comfortable, the ability to retain his or her dignity and the provision of support for relatives at a time of stress and anxiety.

The NHS plays a vital part in our society today. I know that it will continue to do so given the support of the Government, the dedication of staff and the trust and confidence of the public.

6.28 p.m.

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