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Baroness Park of Monmouth: My Lords, I wish to support the amendment of the noble Baroness, for two practical reasons: first, it can do no harm and nothing but good for the good nurses; secondly, I think it might ensure that anyone who is dismissed or disappears from a previous job for having fallen ill will not escape, as so many people do, because they have been given a reference which does not say how bad they are. For all kinds of reasons--for example, being sued in the courts--people often prefer to give very anodyne, if not misleading, references. If there was an official agency to whom they had to give such a reference, they would think more carefully. Incidentally, they would feel much safer.

For both those reasons, among the other much more important ones, I hope that the House will look upon this amendment with favour.

Lord Renton: My Lords, the noble Baroness, Lady Masham, the noble Lord, Lord Rix, and the noble Baroness, Lady Park, have put forward such strong reasons in favour of the amendment moved by the noble Baroness that it would, in my opinion, be most unwise and unfortunate if the Government were on this occasion, as on the previous occasion regarding the amendment of the noble Lord, Lord Rix, to say that they would like to hold another inquiry and then have a regulation to deal with the matter. That would be most unsuitable and unfortunate. Therefore, on this occasion I hope that the Government will accept the amendment.

Earl Howe: My Lords, I rise to speak to Amendment No. 138 standing in my name, which I had intended as a vehicle for raising exactly the same issues as those raised by the noble Baroness, Lady Masham. I do not

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believe that there is much disagreement in the profession that the Nurses Agencies Act is out of date and merits abolition. The extent to which the Act provides protection is, in practice, extremely limited, but if it is patient protection that we are looking for, as we clearly must, then, as has been said very succinctly already, the Employment Agencies Act, which effectively takes the place of the Nurses Agencies Act under Clause 91, has even less to recommend it. Even with the special requirements proposed for care agencies in the latest draft regulations, the Employment Agencies Act is, in my view, wholly inadequate to ensure the standards of public safety that we should now be insisting upon, and which the Bill seeks to promote.

First, under the Employment Agencies Act, there is no register of agencies, so there is no knowledge of which businesses exist to provide a service. Secondly, as the noble Baroness emphasised, inspection and enforcement under the Act occurs only when the DTI receives complaints. When the health and well-being of sick and vulnerable people are at stake I do question whether a reactive as opposed to a proactive enforcement system is appropriate.

Thirdly, the Employment Agencies Act regulations contain no requirement at all for a nurse to supervise recruitment and placement, which means that agencies can operate with an inadequate understanding of health issues and with no professional accountability in any meaningful sense. There are no rules on fit persons. The answer, I respectfully suggest, is for the national care standards commission to have delegated powers to register and inspect nurses agencies and for the repeal of the Nurses Agencies Act not to occur until adequate replacement measures are in force.

Perhaps I may just emphasise to the Minister that the issues that I and other noble Lords have just highlighted are far from being theoretical; they are very real. There are some nurses agencies that are not operated as well or as scrupulously as they should be. From a practical standpoint, the additional regulatory role that I have suggested for the commission should not involve it in a great deal of additional work because, as I think the noble Baroness said, most nurses agencies are also domiciliary care agencies in any case. Therefore, it would be a cost-effective and efficient way of doing the job.

The point I would stress to the Minister is that it is not enough to argue, as he did earlier, that proper registration and inspection of nurses agencies are unnecessary because nurses are professional people. Nor do I believe that codes of practice can take the place of an inspection regime that is automatic. It really is not appropriate to treat agencies that deal with people's health in the same way as one treats agencies that supply secretaries. The implications for the user are of a wholly different order.

It is interesting that the Government have tabled amendments which seek to regulate doctors agencies under the national care standards commission. I have no inherent objection to those amendments, but it does seem inconsistent for the commission to regulate

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doctors agencies and not nurses agencies. There are very few doctors agencies compared to the number that place nurses. Furthermore, a small number of doctors, I am advised, are placed through agencies, compared to the huge volume of nurses placed each year.

I look forward to hearing what the Minister has to say, and hope that he can provide some reassurance in relation to the very real concerns that have been expressed from all sides of the House.

Perhaps I may conclude with two specific questions. Can the Minister confirm that one effect of the repeal of the Nurses Agencies Act 1957 will be to classify as agencies nursing banks run by NHS trusts? If so, does he think this desirable, bearing in mind that the nurses employed by the bank system are NHS employees? Secondly, can he confirm that the change will result in additional costs for NHS trusts, which will no longer be able to claim back an element of VAT from the agencies which supply them?

Lord Rea: My Lords, having listened to the noble Baroness and other noble Lords who have spoken to this amendment, I feel this is a necessary and important amendment. I was particularly impressed with the long list of extremely reputable national agencies that she read out which support the amendment, including the UKCC. I did not hear the Royal College of Nursing mentioned among that group. I should be interested to know why. My noble friend may not be able to accept the amendment as it stands, but I feel that he will be sympathetic to its spirit, and I should be grateful to hear how the Government intend to deal with this important issue.

Lord Jenkin of Roding: My Lords, I, too, support the amendment. I totally support the arguments advanced by my noble friend Lord Howe from the Opposition Front Bench. I would add only one other point. Looking around the House I think I am the only noble Lord who has held the position both of Secretary of State for Health and Social Services and Secretary of State for Industry. What struck me, as I moved from one department to the other, was how totally different they are: different in tradition; different in culture; different in attitude; and with a very considerable difference in experience and skills.

I shall not weary the House now with some of my experiences. However, in dealing with the pharmaceutical industry when I was at the Department of Industry, it was perfectly clear that it knew nothing about the pharmaceutical industry because it was sponsored in fact by the Department of Health. I find bizarre this proposal that nurses agencies should be handed to the tender care of the DTI. There is nobody in that department who can deal with them. I say that on the basis of past experience. They may have recruited all kinds of experts in nurses agencies in the past few years, but somehow I doubt it. It is such a totally different field from anything that the Department of Trade and Industry will have dealt with hitherto. Presumably, that department will be the one that will need to

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make the regulations and to supervise the administration of the sections of the Act. I find that incredible.

It may well be--and I have no particular expertise in the field--that, as my noble friend has said from the Front Bench, the Nurses Agencies Act 1957 is now substantially in need of modernisation. It needs to be brought up to date to deal with the profession and its activities and with agency activities as they are today and will be over the next few years.

I cannot believe it is right to put these matters under the control of the same department as controls the supply of secretaries, accountants, consultants and so on to industry and commerce. I say to the Minister that he cannot accept that position. The amendment may or may not be right--there are further stages of the Bill--but what the Government propose is not the right answer. The amendment at least raises the issue and would be one way forward. I hope that the Minister will be able to give us some comfort on this issue because I honestly do not believe that the Government's present proposals are viable.

4 p.m.

Baroness Emerton: My Lords, I rise to support the amendment of the noble Baroness, Lady Masham, and to agree with other noble Lords who have supported the amendment. The Royal College of Nursing supports the amendment. It has 1,000 managers represented on its care agencies forum. They would like the Minister to take account of these proposals. It is recognised that the Nurses Agencies Act 1957 is not very thorough. However, the RCN would be concerned if responsibility transferred to the DTI. The Royal College of Nursing, and certainly I as a nurse, would wish the Minister to take account of what has been said and accept the amendment.

Lord Swinfen: My Lords, I can think of no good reason, except possibly its drafting, why the Government should refuse to accept the amendment. Nurses have a wide range of skills. As my noble friend Lord Howe said, it is essential that they should be properly recruited to a nursing agency by someone who understands nurses and is qualified as a nurse. When sending a nurse to a private house it is essential that that nurse has the skills and experience necessary to deal with the patient that she or he is going to look after.

Nurse training today is not as general in scope as it used to be. Very often, nurses are trained in one specific field rather than as general nurses, as they were in the past. It would be disastrous to send a nurse who had been trained to look after geriatrics to look after a very young person or a child in their own home, as might happen. That would be chaotic. I strongly support the amendment.

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