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Lord Clement-Jones: My Lords, I do not wish to add to the debate. The noble Baroness, Lady Masham, and the noble Earl, Lord Howe, have put the points extremely well. I thank the Minister for responding to the weight of opinion on the matter, which was extremely strong; and, in doing so, demonstrating the good sense and flexibility which has been characteristic throughout the Bill.

Lord Rix: My Lords, I hesitate to appear as an extra in the final scene, having had star billing when the amendment was moved previously. However, I stress that I would have supported the amendment and wish that my name were attached to Amendments Nos. 1 and 3 tabled by my noble friend Lady Masham of Ilton. I recognise the important point raised by the noble Baroness, Lady O'Cathain, from the Opposition Benches. The inclusion of care staff may be an important adjunct to the clause.

Having said that, I, like other noble Lords, welcome the Government's acceptance of Amendment No. 2. I am most grateful for the alacrity with which it has been done.

Baroness Emerton: My Lords, as a nurse, I add my thanks to the Minister for accepting the amendment. I urge also that consideration be given to the issue of carers. Carers are becoming involved increasingly in closer contact with intimate care of patients, sometimes in an unsupervised way.

Baroness Gardner of Parkes: My Lords, I disagree with many of the points made, although I agree with a number of others.

It is excellent to hear that the Minister will accept Amendment No. 2, but I do not believe that that amendment is good enough. The points raised by the noble Baroness, Lady Masham, are sound. There needs to be provision for care assistants also. The nursing world is in chaos at present because of the desperate shortage of nurses. As time goes by we shall have to find some answer to that. The answer may well be more care assistants.

The fact that the Minister will accept Amendment No. 2--it covers only qualified nurses--indicates the great power of the Royal College of Nursing. I have

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nothing against that. It is a marvellous organisation which does a great deal of good. But the Minister overlooks the comments of 24 well-known, reputable, caring organisations, providing only for qualified nurses. The noble Lord divides nurses and those who do not have the full qualifications. As I have said previously in your Lordships' House, many people cannot become qualified nurses because the entry standards are too high. The only alternative for those people is to become care assistants. It would be wrong if those people were farmed out to the Department of Trade and Industry. That is not the right department. They need to be considered as responsible and caring for their patients as fully qualified nurses. Complete devotion to patients is a genuine dedication. One cannot simply say, "Because I have a few more letters after my name I am more capable of looking after you". One is more trained and more skilled but not necessarily more caring.

I have added my name to the amendment. If the Minister does not accept the addition of caring people, I press the noble Baroness, Lady Masham of Ilton, to seek the opinion of the House. I feel very strongly on the issue. To accept Amendment No. 2 but to leave out all carers is not good enough.

The Lord Bishop of Wakefield: My Lords, I shall not detain the House by repeating the helpful remarks made in the past few moments. Your Lordships will know that the Churches in many guises have a great deal to do with the pastoral welfare of those individuals about whom we speak. The points made in support of Amendment No. 1, as opposed to Amendment No. 2, would gain the support of my colleagues on these Benches, and represent the views of many people from many churches who have a great concern in this area.

3.15 p.m.

Lord Hunt of Kings Heath: My Lords, I thought that I was going well!

First, I thank noble Lords for their kind words. One of the characteristics of the debate is that due to the lateness of the hour we were unable to discuss the issue in Committee. Therefore it was only a week ago on Report that we first paid attention to these matters. For that reason, when I come to talk about care workers I assure noble Lords that we shall pay close attention to the remarks of the noble Baroness, Lady Masham, and others.

I agreed last week to reflect on the matter. In doing so, I emphasise to noble Lords that all along the Government have been committed to an effective system of regulation for nurses agencies. I acknowledge, as have other noble Lords, that there is almost universal agreement that the current regulatory system for nurse agencies is inadequate. The Nurses Agencies Act is widely agreed to be out of date and in need of reform. There has been a great deal of inconsistency in the way the Act has been policed (if that is the word) up and down the country. There is evidence that some local authorities have failed to carry out their duties effectively.

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We took that into account in first proposing that nurse agencies should be brought within the remit of the Employment Agencies Act. I listened with great interest to the suggestion that the Department of Trade and Industry is perhaps not as caring a government department as perhaps is the Department for Health. The fact is that the Employment Agencies Act provides a much tougher framework of protection for agency nurses and those for whom they care. For example, the Act's regulations require agencies to obtain sufficient information from workers and hirers for the purposes of selecting a suitable worker. Those checks will be further strengthened by the revised regulations currently out to consultation.

However, we want the system to be effective and to protect vulnerable people. I have concluded that a system that encompasses registration and routine inspection for nurses agencies will help to achieve those aims. The Government accept, therefore, that the national care standards commission should regulate nurses agencies.

Not surprisingly--I have learned that all Opposition amendments are always technically deficient--there is a slight deficiency in Amendment No. 2 which the Government intend to accept. In accepting the amendment, it would be our intention to propose in another place a slight redrafting to cover that technical amendment.

I should like to take this opportunity to say a few words about how the system will work. We shall be developing the necessary standards under which the commission will regulate nurses agencies. These standards will be developed in consultation with the agencies themselves and other key stakeholders. However, I wish to be clear about two areas. First, I fully expect qualified nurses to be involved in the commission's inspection work, which will be particularly apposite in inspecting nurses agencies. Secondly, I would expect the standards applied by the commission to encompass a requirement for a qualified nurse to be in charge of the placement of nurses. I hope that that meets a specific problem which noble Lords raised.

Our commitment to repeal the Nurses Agencies Act remains, and nurses agencies will also come within the remit of the Employment Agencies Act. This will ensure that nurses agencies will be on the same footing as domiciliary care agencies. Agencies which provide both care workers and nurses will be subject to broadly the same regulatory requirements across the whole of their business.

Essentially the commission will provide an additional tier of regulation. But we accept that this additional level of regulation by the commission is necessary. Although that means regulation by two systems, agencies will need to register under only one: the national care standards commission.

Of course, it will be a matter of concern to ensure that the impact of two separate regulatory systems does not create an unjustifiably heavy burden on the agencies themselves. Indeed, that has been the theme of some of the contributions made by noble Lords

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during the passage of the Bill. We shall look carefully at the scope for dovetailing the inspection role of the commission and the employment agencies standards inspectorate to ensure that the two organisations work together closely.

So far as concerns care workers, many care workers in the community will fall to be covered by the provisions in the Bill for the regulation of domiciliary care agencies. Of course, we would expect healthcare assistants (to use the correct terminology) within hospitals to be properly supervised and managed. The provision in the Bill allows for the commission to ensure that effective management and employment procedures are in place. However, I have taken note of the comments concerning a nursing agency which perhaps also hires care assistants to work in private sector hospitals. Rather than give a hard reply this afternoon, I say to noble Lords that it is a matter to which we shall give further consideration.

Baroness Gardner of Parkes: My Lords, before the noble Lord sits down, perhaps I may ask for some clarification. I did not understand the point that he made regarding whether or not care staff will come under the same regulatory system. It seemed to me that at one stage in his speech he indicated that they would. However, as he continued and said that he would look at the matter again, I believed that he said that they would not. Then he made the point about two different groups and two different regulatory authorities. Again, I find that very unsatisfactory. Perhaps he will clarify the point.

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