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Lord Renton: My Lords, before the Minister, sits down, perhaps I may be allowed to mention that, when it comes to the interpretation of the Bill, the undertaking to put something, if necessary, into regulations is nothing like as useful as including the definition in Clause 4, which the noble Lord, Lord Rix, wishes to do. From that rather important point of view, I hope that the Government will accept the amendment after all.

Lord Rix: My Lords, I was waiting for a response from the Minister to the noble Lord, Lord Renton. I, too, have some queries. In regard to the review the Minister has promised--which we obviously welcome--how long will that take? If the review takes place within a year, will its findings be known perhaps three years later? Will there be a time limit on that? And, following on from the point made by the noble Lord, Lord Renton, I should be very grateful to know whether it is possible to place that firm commitment either in regulations now or on the face of the Bill.

The Minister said that day centre staff will be monitored in their activities. I presume that means their activities outside the building.

Baroness Barker: My Lords, on the assumption that the Minister has not sat down--

Lord Burlison: My Lords, it is out of order for the noble Baroness to speak now.

Lord Hunts of Kings Heath: My Lords, I listened with great interest to the noble Lord, Lord Renton. In relation to the term "day centre", my amendment ensures that the general social care council will regulate establishments that provide nursing or personal care on a non-residential basis, wholly or mainly for persons who are or have been ill, are disabled or infirm, or who are or have been dependent on alcohol or drugs. I hope that is helpful to the House.

So far as concerns the question of when the review will take place and how long afterwards would any necessary action be taken, I am not in a position to respond to the noble Lord, Lord Rix, on that matter. But the fact that we have set a date for the review to be undertaken one year after the establishment of the commission is a sign of our commitment to wanting that to happen. We share the views of noble Lords about the importance of this matter.

Lord Rix: My Lords, in view of the Minister's gesture of goodwill towards the review and the suggestion--if not the promise--that the findings of the review will be promulgated not too long after the one year is up, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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Baroness Masham of Ilton moved Amendment No. 8A:

    Page 3, line 41, at end insert--

("( ) "Nursing and care staff agency" means any employment bureau supplying nurses in any part of the Register of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting.").

The noble Baroness said: My Lords, in moving Amendment No. 8A and in speaking to Amendments Nos. 10A and 138, I declare an interest as I have to use various nursing agencies to get help for my husband, who has a selection of serious medical conditions. There are not enough nurses available for people needing nursing care in their own homes, in nursing homes and in our hospitals. Because of this it is easy for people who may put patients at risk to get employment. Agencies can be very stretched when such a shortage exists.

A nurse who has been dismissed from a hospital trust for misconduct may be taken on by an agency which may not bother to check the references. Because of being a qualified nurse, such a person might be put in charge of the drugs cupboard and given the keys. By the law of averages, there will be agency nurses who will have serious problems of personality or addiction. Nothing can ever be foolproof. But the registration of nurses' agencies could help to provide safer, better standards for vulnerable patients.

Nurses' agencies supply qualified nurses to many thousands of elderly or disabled people at home, as well as to our National Health Service hospitals, nursing homes and so on. This amendment would give powers for the regulation of nurses' agencies to the national care standards commission which will already be responsible for personal domiciliary care services and for private and voluntary healthcare under this Bill. It will do that by creating a definition of a "nurses' agency" parallel to the definitions of domiciliary agencies and other services to be regulated.

The Care Standards Bill, as currently drafted, repeals the Nurses Agencies Act (NAA) and extends to nurses the Employment Agencies Act (EAA) which would then be the only regulation of the sector. Those proposals are inadequate and betray the policy intention behind the Care Standards Bill to assure minimum standards of care and public protection.

Damage to health for vulnerable people at home or in hospital cannot be set right by reactive enforcement. Not all types of temporary worker present these risks. The difference is that nobody dies from accountancy. This amendment is related to the amendment of the noble Earl, Lord Howe, to Clause 91. I believe that active regulation of nurses' agencies is essential. The existing regulation for nurses' agencies is not ideal, but if this amendment to Clause 4 is not passed, I shall support the amendment of the noble Earl, Lord Howe, to remove Clause 91 and retain the Nurses Agencies Act 1957. However, if this amendment is accepted, Clause 91 could stay.

A key purpose of the national care standards commission is to reassure members of the public that care services are of requisite standard; for example,

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people will be advised to purchase personal care only through a registered domiciliary agency. It is illogical to deny this safeguard and reassurance to people seeking higher dependency care at home. Many people already think that nursing agencies are fully registered. All other major types of care service will be subject to actively enforced minimum standards. The proposed new regime will leave nurses' agencies as the only exception. That would mean a missed opportunity which could have dangerous consequences. Services should be required to register with an appropriate authority so that operators can be traced, controlled and excluded where practice falls below standard.

The Employment Agencies Act operates no register. Services should be routinely inspected so that standards are assured in advance of failure or scandal. The Employment Agencies Act is enforced only in response to complaints to the Department of Trade and Industry. Services should be run only by "fit persons" judged against clear criteria of qualifications and conduct.

As regards nurses' agencies, the recruitment and placement of registered nurses should always be carried out under the supervision of a registered nurse who is professionally accountable for his or her own actions. For people buying home nursing, professional assessment and care planning are essential. Daily judgements must be made based on clinical knowledge. That will include infection control, access to drugs, and medical confidentiality.

Nurses are also entitled to professional support from the agencies supplying them. For the national care standards commission to inspect nurses' agencies would be a low-cost measure because most of the businesses concerned also supply domiciliary care. Therefore, inspections can be carried out at the same time.

This amendment is supported by Age Concern, the British Federation of Care Home Proprietors, Care Forum Wales, the Hampshire Care Association, Help the Aged, the Independent Healthcare Association, Mencap, the National Care Homes Association, the UK Central Council for Nursing, Midwifery and Health Visiting, and the United Kingdom Home Care Association. Nurses are not all angels--many are--but all people needing their care are vulnerable and in need of protection before and not after disaster happens. I hope that that will be avoided. I hope that your Lordships, and especially the Minister, will accept this necessary amendment. I beg to move.

3.45 p.m.

Lord Rix: My Lords, I support my noble friend's amendments. If they are accepted, I believe that there will no longer be any necessity to move Amendment No. 138 to Clause 91 in the name of the noble Earl, Lord Howe.

I have no strong views on the legislation under which the supply of agency nurses should be regulated. I wish the Government well in their endeavours to reduce hospital dependency on agency nurses. However, I seek an assurance that regulation will be

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specific to nursing and at least in line with the regulations for the provision of personal carers by domiciliary agencies.

Given that objective, there seems to be a great deal of sense in placing nurse agency activity under the care standards commission alongside domiciliary care agency activities, not least when it may well be, as the noble Baroness has already said, the same agency carrying out the same functions.

The Employment Agencies Act could then bite in an appropriate way and not on the rather dangerous assumption that one commercial activity is much like another. I could just about put up with an agency gardener doing undesirable things to my rose bushes, but I could not put up with an agency nurse doing undesirable things to a member of my family. We should not wave goodbye to the Nurses Agencies Act without an assurance of specific and effective regulation under the care standards commission being there in its place.

I am aware of professional nursing sensitivities at a time when nurses are becoming more like doctors and domiciliary work carers more like nurses. I trust that my noble friend's amendments will tread gently on all sensitivities, protect patients, and commend themselves to the Minister.

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