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Baroness Gardner of Parkes: My Lords, I thank the Minister for that reply. I do not know whether he is aware that I asked the noble Baroness, Lady Ashton, this question as a supplementary on 19 April. The question was originally tabled by the late Lady Brigstocke, who is sadly missed. The noble Baroness, Lady Ashton, replied that she would ensure that her noble friend had the opportunity to respond directly on the question of nurses; but I have heard nothing. That is why I tabled the Question.

Does the Minister agree that many people will never reach the number of A-levels required? He did not make clear in his reply whether they are still required. We are all delighted that nursing has reached the point where there are graduate nurses and nurse practitioners, and we want to see as many of those as possible. However, there are still many caring young people who would enter the nursing profession if there was something more of what the noble Baroness, Lady Ashton, described as a "modern apprenticeship" system.

Lord Warner: My Lords, one of the reasons for these changes is that the circumstances have changed. Certainly, the age profile of applicants has risen significantly; the average age of entrants to nursing and midwifery training is 28. The noble Baroness is right that we want to ensure that a wider range of people, particularly those with life skills, returning to nursing after other career changes can enter the profession; which is why more flexibility is being introduced. Of course, one of the other reasons for the changes is the increased protection for members of the public, as the character of the trainee nurse is assessed on application.

Lord Selsdon: My Lords, will the Minister remind the House what the total nursing population is of the
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United Kingdom? How short of nurses might we be? How many nurses in the system are non-British nationals?

Lord Warner: My Lords, I can bore the House again now. The Government have increasingly improved the number of nurses available; there have been 67,000 plus nurses since the Government came to office. I am grateful to the noble Lord for giving me the opportunity to remind the House of those figures. We have an increasing number of applicants for nursing, the acceptances for both pre-registration diploma training and pre-registration degree courses have been increasing, and there are more healthcare applicants entering training for qualification. There is a surge in all those areas, and the number of entering and returning nurses has gone up substantially.

Lord Swinfen: My Lords—

The Earl of Listowel: My Lords, are the Government recruiting sufficient midwives? Are the Government sufficiently successful at retaining midwives in their posts to provide a good quality service?

Lord Warner: My Lords, the Government continue to attract people into midwifery training, along with nursing training, in reasonable numbers. As I reminded the House before, the birth rate has been falling, so the number of babies born each year is reduced.

Lord Swinfen: My Lords, would the Minister be kind enough to answer my noble friend's question about the proportion of overseas nationals who are nursing in this country?

Lord Warner: My Lords, the Question is about entry to training, not about the number of nurses.

Lord Alderdice: My Lords, does the Minister accept that there are two unfortunate side effects of the perfectly natural and appropriate drives to increase the level of education of nurses and graduate nurses? First, there is a higher and higher expectation of those who achieve graduate status that they will move along a career path that moves them up and frequently, sadly, out of direct contact with patients and into management. Secondly, there is a sense that those who wanted to care for patients through the whole of their career are less valued because of the high premium being put on the higher standards of education. There is a genuine dilemma here, which requires to be addressed.

Lord Warner: My Lords, the Nursing and Midwifery Council has been trying to take account of the fact that a wide range of people are coming forward to enter nursing. It is worth bearing in mind the changing profile of the students. As I said earlier, the average age has gone up. In 2003, the average age for entering the programmes was 28 years, which is a lot further up the age scale than in the days when the great majority of those entering
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nurse training were 18 and 19 year-olds. We have an increasing number of mature applicants changing career without formal educational qualifications, but with extensive life skills. That meets some of the noble Lord's concerns. Alongside that, there are increasing numbers of students entering with A-levels, so there is a mixed picture around the profile of people entering nurse training.

Baroness Emerton: My Lords, would the Minister be prepared to consider a review of the correlation of theory to practice, in terms of having more supervision for students coming from universities and colleges into the clinical areas? Nursing is a combination of arts and science, and it is about delivering holistic care; basic care; caring for the nutrition and the comfort of the patient; and for hygiene; as well as the advanced technical procedures that must be carried out. It seems that there is a gap between the universities and colleges and the clinical areas, where clinical areas are so busy that they are unable to give supervision. A review would be extremely helpful for the profession.

Lord Warner: My Lords, that is a matter for the profession and for the Nursing and Midwifery Council to consider. The Government always take seriously the points made by the noble Baroness. I remind her that the Department of Health is working with its partners to produce the partnership quality assurance framework, so that we can be sure that the nurse training arrangements, among other professional training arrangements, meet proper quality assurance requirements.


The Earl of Sandwich asked Her Majesty's Government:

The Minister of State, Foreign and Commonwealth Office (Baroness Symons of Vernham Dean): My Lords, the United Kingdom remains committed to supporting Nepal and trying to resolve the conflict through work to improve Nepalese counter-insurgence capability, developing human rights, building political capacity, and providing humanitarian assistance. The United Kingdom has run conflict prevention programmes of £10 million over the past two financial years. DfID is running a bilateral programme of £6 million in 2003–04, which is expected to increase in 2004–05 and 2005–06 to £35 million and £47 million respectively.

The Earl of Sandwich: My Lords, it is encouraging to hear from the noble Baroness how much DfID is doing in conflict prevention and poverty reduction. Maoism, or the version of Maoism that exists in Nepal, thrives on unrepresentative government and a degree of political confusion. Is our embassy doing enough, alongside DfID, the Indian Government and
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the European Union, to encourage all political parties, including Congress, to enter the process, and to urge those parties to reduce tension in the country and give the Nepali people a sense of confidence in democratic government?

Baroness Symons of Vernham Dean: My Lords, I believe that our embassy is properly engaged in this process. We are encouraged by the formation of a multi-party government in Nepal under Prime Minister Deuba. We are looking forward to supporting the Nepalese in their progress towards a negotiated peace settlement. The noble Lord is right to point out that the Nepali Congress Party's decision to remain outside government is unfortunate, but it is not in itself an obstacle to peace negotiations or to peace. We hope that the new government will maintain those links to the Congress Party as the negotiation strategy continues to develop. I remind the noble Earl that in addition to our ambassador, Sir Jeffrey James is the UK Special Representative for Nepal, and he visits the country three times a year.

Lord Avebury: My Lords, regarding the development plan announced in May, of which the noble Baroness has given details today, does she not agree that some donor programmes, particularly in the west of the country, have had to be suspended because of the conflict? Will the Government, in their spending programme, give priority to all measures for bringing the conflict to an end? Is any of the £80 million specifically earmarked for the facilitation or promotion of dialogue between the government and armed rebels?

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